Showing papers in "Journal of Rehabilitation Medicine in 2020"
TL;DR: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors, and Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
Abstract: Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.
Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.
Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.
Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.
Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.
Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
377 citations
TL;DR: Action must be taken now to prepare for the aftershocks of the Covid-19 pandemic, and the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences of the experience.
Abstract: Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.
220 citations
145 citations
TL;DR: Use of specialized virtual reality and gaming virtual reality can be advantageous for treatment of the upper extremity, but not for hand dexterity and gait, and there was a significant difference in effects on balance between specializedvirtual reality and conventional treatment.
Abstract: Objectives To analyse the effectiveness of virtual reality-based interventions within several fields of rehabilitation, and to investigate whether the outcomes of virtual reality-based interventions, in terms of upper or lower limb function, gait and balance, differ with respect to the virtual reality system used. Methods A search of PubMed database resulted in an initial total of 481 records. Of these, 27 articles were included in the study. A final total of 20 articles, with neurological, orthoapedic, geriatric or paediatric patients, published between 2012 and 2019, were included in the study. Two independent reviewers selected potentially relevant articles based on the inclusion criteria for full-text reading. They extracted data, and evaluated the methodological quality of each study. Results Seventeen studies were included in the meta¬ -analysis. Eight studies analysed upper limb function, with no significant evidence that specialized VR is superior to conventional treatment. Regarding FuglMeyer scale results, the effect of specialized virtual reality therapy was found to be significantly better than conventional treatment. No significant differences between specialized VR and conventional treatment were observed in effects on hand dexterity and gait. There was a significant difference in effects on balance in favour of specialized virtual reality as compared to conventional treatment. Gaming virtual reality was significantly better than conventional treatment for upper limb function, but not for hand dexterity, gait and balance. Conclusion Use of specialized virtual reality and gaming virtual reality can be advantageous for treatment of the upper extremity, but not for hand dexterity and gait in all pathologies considered. Specialized virtual reality can improve balance in neurological patients.
48 citations
TL;DR: In this paper, the authors discuss missing (Commentary) and missing (commentary) sentences. But they ignore missing sentences. And missing sentences are not missing. But missing.
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46 citations
TL;DR: It is recommended that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.
Abstract: Objective COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. Methods A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. Results The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. Conclusion The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.
46 citations
TL;DR: From the perspective of health system, the Global Rehabilitation Alliance urges decision makers to ensure that rehabilitation services will be available for all patients with COVID-19 in the acute, post-acute and long-term phase and it must be ensured that all other persons with rehabilitation need have access to rehabilitation services.
Abstract: COVID-19 has become a pandemic with strong influence on health systems. In many cases it leads to a disruption of rehabilitation service provision. On the other hand, rehabilitation must be an integral part of COVID-19 management. Rehabilitation for COVID-19 should start from acute and early post-acute care and needs to be continued in the post-acute and long-term rehabilitation phase. Of course, it should follow specific safety protocol. Additionally, rehabilitation must be kept available for all other people who are in need. From the perspective of health system, the Global Rehabilitation Alliance urges decision makers to ensure that rehabilitation services will be available for all patients with COVID-19 in the acute, post-acute and long-term phase. Additionally, it must be ensured that all other persons with rehabilitation need have access to rehabilitation services. Rehabilitation services must be equipped with personal protection equipment and follow strict hygiene measures. In particular, rehabilitation must be accessible for vulnerable populations. For that reason, rehabilitation must be kept a health priority during the COVID-19 pandemic and given adequate financial resources. Last but not least, scientific studies should be performed to clarify the impact of the pandemic on rehabilitation services as well as on the needs for rehabilitation of COVID-19 patients.
40 citations
TL;DR: Effective and safe remote rehabilitation was performed in 41.9% of COVID-19 patients in this study, which resulted in improved rehabilitation in CO VID-19 zones.
Abstract: Objective To describe the effectiveness and risk management of remote rehabilitation for coronavirus disease (COVID-19) patients. Design Single-centre, retrospective, observational study. Patients COVID-19 patients undergoing rehabilitation (24 April to 24 May 2020). Methods All COVID-19 inpatients undergoing rehabilitation in the general ward were assessed. Data were collected on age, sex, physical ability, rehabilitation modality (remote/direct), need for intubation or extracorporeal membrane oxygenation, degree of pneumonia, oxygen therapy from the start of rehabilitation, D-dimer and C-reactive protein levels, and rehabilitation-related complications. Activities of daily living were measured using the Barthel Index. Results Out of a total of 43 patients, 14 were initially provided with remote rehabilitation and 29 with direct rehabilitation. Four patients were switched from direct to remote rehabilitation during the study, thus at the end of the study there were 18 in the remote rehabilitation group and 25 in the direct rehabilitation group. Patients in remote rehabilitation were significantly younger than those in direct rehabilitation. Of 12 patients who required intubation, 3 were given remote rehabilitation. One extracorporeal membrane oxygenation survivor underwent direct rehabilitation. All patients on remote rehabilitation were discharged home or to a hotel. Twelve out of 29 patients were transferred to a rehabilitation hospital due to delayed recovery of activities of daily living. No serious adverse events occurred. Conclusion Effective and safe remote rehabilitation was performed in 41.9% of COVID-19 patients in this study, which resulted in improved rehabilitation in COVID-19 zones.
31 citations
TL;DR: Overall, studies on exercise for low back pain have increased in number in the last 4 decades, and Burst key words showed that the stability, balance, and gait of individuals with low backPain have become the frontier of research.
Abstract: Objective To make a bibliometric analysis of global trends in research into exercise interventions for low back pain between 1980 and 2018. Methods Systematic literature, published from 1980 to 2018, was obtained from the Web of Science Core Collection database. CiteSpace software was used to analyse the relationship between publications and country, institution, journals, authors, references, and key words. Results A total of 1,140 publications were included in the analysis. Over the period studied there was an increase in the number of publications. A total of 276 academic journals focused on the categories Rehabilitation, Orthopedics, and Sports Science. The USA and the University of Sydney were the most productive country and institution, respectively. Spine, which is the main journal for research into exercise for managing low back pain, had the most publications. Burst key words showed that the stability, balance, and gait of individuals with low back pain have become the research development trend and focus in this field of research. Conclusion Overall, studies on exercise for low back pain have increased in number in the last 4 decades. This historical overview of research into exercise interventions for low back pain will be a useful basis for further research into potential collaborators, focus issues, and development trend.
27 citations
TL;DR: This updated version of ICSO-R provides a prerequisite for rehabilitation service organization assessment and implementation projects, reporting of contextual influences in clinical trials and many other aspects.
Abstract: Objective To develop a revised version of the International Classification of Service Organization in Rehabilitation (ICSO-R). Design Qualitative study. Subjects Not applicable Methods: The revision was based on testing the first version of the ICSO-R; 2 discussion rounds invited by the ICSO-R working group of the Standardized Rehabilitation Reporting Subcommittee of the World Health Organization Liaison committee of the International Society of Physical and Rehabilitation Medicine, and a call for corrections from a group of international experts. Results The resulting ICSO-R 2.0 version is composed of 2 dimensions (formerly 3); the Provider dimension and the Service delivery dimension. The categories of the Funding dimension from the first version of ICSO-R were incorporated into each of the other dimensions. The Provider dimension now consists of 9 categories and the Service delivery dimension consists of 14 categories. Subcategories have been added to 7 categories: governance/leadership, funding of provider, target groups, location of service delivery, setting, rehabilitation team, and funding of service delivery. Conclusion This updated version of ICSO-R provides a prerequisite for rehabilitation service organization assessment and implementation projects, reporting of contextual influences in clinical trials and many other aspects. In addition, ICSO-R 2.0 can be used for several purposes, e.g. to analyse and compare the provision of rehabilitation services in health systems and to support the quality management of rehabilitation services. However, the development of value sets for each (sub)category and further validation studies are still needed.
26 citations
TL;DR: This study shows that COVID-19 rehabilitation units must be organized following specific clinical and organizational needs, and was shown to be twice as expensive as the 2 other units studied.
Abstract: OBJECTIVE: The COVID-19 pandemic has caused significant motor, cognitive, psychological, neurological and cardiological disabilities in many infected patients. Functional rehabilitation of infectious COVID-19 patients has been implemented in the acute care wards and in appropriate, ad hoc, multidisciplinary COVID-19 rehabilitation units. However, because COVID-19 rehabilitation units are a clinical novelty, clinical and organizational benchmarks are not yet available. The aim of this study is to describe the organizational needs and operational costs of such a unit, by comparing its activity, organization, and costs with 2 other functional rehabilitation units, in San Raffaele Hospital, Milan, Italy. METHODS: The 2-month activity of the COVID-19 Rehabilitation Unit at San Raffaele Hospital, Milan, Italy, which was created in response to the emergency need for rehabilitation of COVID-19 patients, was compared with the previous year's activity of the Cardiac Rehabilitation and Motor Rehabilitation Units of the same institute. RESULTS: The COVID-19 Rehabilitation Unit had the same number of care beds as the other units, but required twice the amount of staff and instrumental equipment, leading to a deficit in costs. DISCUSSION: The COVID-19 Rehabilitation Unit was twice as expensive as the 2 other units studied. World health systems are organizing to respond to the pandemic by expanding capacity in acute intensive care and sub-intensive care units. This study shows that COVID-19 rehabilitation units must be organized and equiped according to the clinical and rehabilitative needs of patients, following specific measures to prevent the spread of infection amongs patients and workers.
TL;DR: Despite a significantly greater improvement in hand and arm function in favour of motion-controlled commercial video games, the results should be interpreted with caution with regards to high risk of bias and the low strength of evidence.
Abstract: Objective: To examine the effect of motion-controlled commercial video games compared with traditional occupational and physiotherapy methods for hand and arm function in persons of all ages with cerebral palsy.
Data sources: A systematic literature search was conducted in Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, OTseeker and PEDro for randomized controlled trials involving persons with cerebral palsy using motion-controlled commercial video games as a training method for hand and arm function, compared with traditional therapy.
Study selection and data extraction: Screening, data-extraction, risk of bias and quality assessment was carried out independently by 2 of the authors. The risk of bias of each study was assessed using the Cochrane Collaborations Risk of Bias Tool. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Data synthesis: Eight randomized controlled trials, with a total of 262 participants, were included. A random effects meta-analysis showed a statistically significant difference between the groups in favour of motion-controlled commercial video games. The quality of the evidence was, however, rated as very low.
Conclusion: Despite a significantly greater improvement in hand and arm function in favour of motion-controlled commercial video games, the results of this review should be interpreted with caution with regards to high risk of bias and the low strength of evidence. There is a need for high-powered studies on the effectiveness of training with motion-controlled commercial video games for persons with cerebral palsy, especially in adults.
TL;DR: Tai chi is an effective physical exercise in treating essential hypertension compared with control interventions and further randomized controlled trials are needed into the use of tai chi for the treatment and prevention of essential hypertension and other related chronic diseases.
Abstract: Background Physical exercise is an important part of hypertension management. The impact of different training styles and durations of tai chi on essential hypertension has not been evaluated to date. Objective To analyse the influence of tai chi on blood pressure and related risk factors in patients with essential hypertension. Methods A systematic review to assess the existing literature on the impact of tai chi in patients with essential hypertension. Randomized controlled trials were identified in Chinese and English databases to study the impact of tai chi on essential hypertension. Two reviewers selected studies independently of each other. Qualified trials were selected and their methodological quality critically evaluated. Results Thirteen trials were included in the analysis. Following tai chi there was a significant difference between intervention and control groups with regard to change in systolic blood pressure (SBP) (weighted mean difference = -6.58, 95% confidence interval (95% CI) (-8.14, -5.02), p = 0.005) and diastolic blood pressure (DBP) (standardized mean difference = -0.57, 95% CI (-0.77, -0.37), p 12 weeks in all studies. However, other styles of tai chi did not significantly reduce systolic or diastolic blood pressure after a duration ≤ 12 weeks. Conclusion Tai chi is an effective physical exercise in treating essential hypertension compared with control interventions. Different training durations and styles have different effects. Further randomized controlled trials are needed into the use of tai chi for the treatment and prevention of essential hypertension and other related chronic diseases.
TL;DR: The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient-reported outcomes, also includes standardized descriptions of the reporting clinical units.
Abstract: OBJECTIVE: To describe the organization, content and dosage of interdisciplinary pain rehabilitation, and the differences in degree of severity of problems of patients admitted to clinical units reporting to a Swedish national quality pain registry, grouped according to unit size and possible affiliation with a university hospital. METHODS: Reports from 31 out of 39 clinical units in Sweden, on inclusion processes, organization, content and dosage of interdisciplinary pain rehabilitation, and patient-reported data from a Swedish national quality pain registry at assessment for interdisciplinary pain rehabilitation were analysed. RESULTS: the number of patients treated annually at each unit ranged from 3 to 340. In 17 units, teams comprised 5 professionals. Dosage of interdisciplinary pain rehabilitation ranged from 20-180 h per patient in total. Patients at the university-hospital units scored the highest levels of symptoms and lowest levels of health-related quality of life. Units used similar sets of inclusion criteria, and several treatments, such as education, self-training and psychological interventions, were used by most units. CONCLUSION: When interpreting outcome data from registries, aspects other than rehabilitation outcomes must be considered. The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient-reported outcomes, also includes standardized descriptions of the reporting clinical units. (Less)
TL;DR: It is essential that prescribing life-long exercise is important for healthy aging including the preservation of muscle mass/strength, physical and cognitive functioning, and independent living.
Abstract: Objective Impairment of physical function is the main determinant of morbidity/mortality in sarcopenia and frailty. Physical function tests are performed by the movement around the joints, and skeletal muscles are the main generators of the forces required to perform these functional tasks. However, the central nervous system, which initiates and coordinates muscle movements, controls the magnitude and temporal parameters of muscle forces. Methods Non-systematic literature review was performed about the effects of aging on neuromotor control. Result The ability of a muscle to produce force by aging is deteriorated not only by muscle structural changes, but also by neuromotor control dysfunction. With aging, changes in muscle structure and loss of volumes in brain structures related with movement and cognition have been shown. Age-related cognitive impairment can have considerable negative effects on the force generating capacity of skeletal muscles. In this sense, the relationship has been found between handgrip strength, gait speed, and cognition. Conclusion Treatments targeting muscle mass only would be insufficient unless we address the impairment of neurocognitive functions. It is essential that prescribing life-long exercise is important for healthy aging including the preservation of muscle mass/strength, physical and cognitive functioning, and independent living.
TL;DR: Females living with stroke may demonstrate a greater response to exercise on selective attention and conflict resolution compared with males with stroke, suggesting that there may be sex-specific effects of exercise on cognitive function in individuals with stroke.
Abstract: Objective To determine whether there are differences in exercise-associated changes in cognitive func-tion between males and females living with stroke. Design Secondary analysis of data from a prospective assessor-blinded randomized controlled trial. Participants Fifty participants (50-80 years, > 1 year post-stroke, able to walk ≥ 5 m). Methods Participants were allocated into a 6-month aerobic exercise programme (14 males, 11 females) or balance and flexibility programme (15 males, 10 females). Working memory (Verbal Digit Span Backwards Test), selective attention and conflict resolution (Stroop Colour-Word Test), and set shifting/cognitive flexibility (Trail-Making Test B) were assessed before and after the programmes. Results There was a group × time interaction in females (effect size 0.28, p = 0.03), which was not observed in males (effect size 0.01, p = 0.62). Females demonstrated a Stroop Colour-Word Interference test change of -2.3 s, whereas males demonstrated a change of +5.5 s following aerobic exercise. There were no differences between exercise groups in either sex for any of the other outcomes (working memory and set-shifting/cognitive flexibility). Conclusion Females living with stroke may demonstrate a greater response to exercise on selective attention and conflict resolution compared with males with stroke. These findings suggest that there may be sex-specific effects of exercise on cognitive func-tion in individuals with stroke.
TL;DR: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation, and a positive treatment expectancy was of importance.
Abstract: Objective To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. Methods A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. Conclusion Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.
TL;DR: High-quality evidence for its routine use for the treatment of stroke survivors is lacking and beneficial effect of rTMS is suggested with: "moderate quality" evidence for dysphagia and hemineglect, "low to moderate quality"Evidence for motor function, daily activities, and "low quality"evidence for aphasia and post-stroke depression.
Abstract: OBJECTIVE: To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke population. METHODS: The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PubMed were searched for systematic reviews up to 15 January 2019. Three authors independently screened the reviews and assessed the methodological quality, using Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool. Quality of evidence for outcomes evaluated within the reviews was appraised with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) tool. RESULTS: Twelve reviews (n = 9,117 participants) evaluated the effectiveness of rTMS on motor and non-motor (aphasia, depression, dysphagia and cognition) functions. The rTMS protocols applied and outcomes measured were diverse amongst the selected reviews. The findings suggest beneficial effect of rTMS with: "moderate quality" evidence for dysphagia and hemineglect, "low to moderate quality" evidence for motor function (upper limb function, daily activities), and "low quality" evidence for aphasia and post-stroke depression. CONCLUSION: Despite widespread use of rTMS, high-quality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population.
TL;DR: It is indicated that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive.
Abstract: Objectives: To investigate the outcomes one year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A secon ...
TL;DR: BTX-A injection is not superior to radial extracorporeal shock wave therapy in the treatment of plantar flexor muscle spasticity in subjects with cerebral palsy.
Abstract: Objectives To investigate whether botulinum toxin type A (BTX-A) injection is more effective than radial extracorporeal shock wave therapy in reducing plantar flexor muscle spasticity in subjects with cerebral palsy. Methods A total of 68 subjects with cerebral palsy were randomly allocated to BTX-A injection (Group 1) or radial extracorporeal shock wave therapy (Group 2) (first experiment; E1). Outcome was evaluated using the Tardieu V1 and V3 stretches, at 3 weeks, 2 months (M2) and M3 after baseline. At M6 subjects in Group 1 received radial extracorporeal shock wave therapy and subjects in Group 2 received BTX-A injection (second experiment; E2); outcome was evaluated as in E1. Treatment success was defined as improvement in foot dorsiflexion ≥10° when performing the V3 stretch at M2 in both experiments. Results In both experiments mean V1 and V3 significantly improved over time. In E1 both treatments resulted in similar treatment success. In E2 fewer subjects treated with BTX-A injection reached the criteria of treatment success than did subjects treated with radial extracorporeal shock wave therapy, which was due to a carry-over effect from E1. No significant complications were observed. Conclusion BTX-A injection is not superior to radial extracorporeal shock wave therapy in the treatment of plantar flexor muscle spasticity in subjects with cerebral palsy.
TL;DR: A dedicated programme for this specific group of patients seems advantageous to warrant the best functional outcome and quality of life, and a multilevel approach for clinical, functional, nutritional and neuropsychological needs seems advantageous.
Abstract: Objective To evaluate the clinical characteristics and rehabilitation management of patients who undergo amputation for COVID-19-associated coagulopathy. Methods Clinical and laboratory data for 3 patients were analysed and their rehabilitative management discussed. Results The medical records of 3 patients who had undergone amputation due to acute lower extremity ischaemia and who were provided with rehabilitation in our COVID-19 unit were reviewed. Conclusion Coagulation changes related to SARS-CoV-2 may complicate recovery from this devastating disease. The rehabilitation management of amputated patients for COVID-19 acute lower extremity ischaemia is based on a multilevel approach for clinical, functional, nutritional and neuropsychological needs. Based on this limited experience, a dedicated programme for this specific group of patients seems advantageous to warrant the best functional outcome and quality of life.
TL;DR: A specific ultrasound set-up for measurement of quadriceps thickness is reliable and reproducible in an intensive care unit population.
Abstract: Objective Muscle atrophy is frequent in critically ill patients and is associated with increased mortality and long-lasting alteration in quality of life. Muscle ultrasound has not been clearly validated in intensive care unit patients. The aim of this study was to compare the level of agreement between ultrasound and computed tomography scan for the measurement of quadriceps muscle thickness. Design A prospective observational study. Patients Forty-two consecutive patients admitted to a neurological intensive care unit. Methods Quadriceps thickness was measured 15 cm above the upper edge of the patella. Iterative brain computed tomography scans were associated with a quadriceps-centred acquisition sequence. Concomitantly, an ultrasound of the quadriceps was performed. The position of the studied leg was standardized for ultrasound and computed tomography. Results A total of 73 measurements of ultrasound and computed tomography quadriceps thickness were compared. The correlation between both measures was 0.93 (95% confidence interval (95% CI) 0.84-1.02). Intra-rater reliability of ultrasound measurements and inter-rater reliability were excellent, with an ICC of 0.98 (95% CI 0.97-0.99) and 0.96 (95% CI 0.92-0.98), respectively. Conclusion A specific ultrasound set-up for measurement of quadriceps thickness is reliable and reproducible in an intensive care unit population.
TL;DR: Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait, and the large variation in effectiveness may be due to differences in ankle stiffness.
Abstract: Objective: To describe the orthotic properties and evaluate the effects of ankle-foot orthoses for calf muscle weakness in persons with non-spastic neuromuscular disorders compared with shoes-only. Design: Cross-sectional study. Subjects: Thirty-four persons who used ankle-foot orthoses for non-spastic calf muscle weakness. Methods: The following orthotic properties were measured: ankle-foot orthosis type, mass, and ankle and footplate stiffness. For walking with shoes- only and with the ankle-foot orthoses, walking speed, energy cost and gait biomechanics were assessed. Results: Four types of ankle-foot orthosis were identified: shaft-reinforced orthopaedic shoes (n = 6), ventral ankle-foot orthoses (n = 10), dorsal leaf ankle-foot orthoses (n = 12) and dorsiflexion-stop ankle-foot orthoses (n = 6). These types differed significantly with regards to mass, ankle-and footplate stiffness. Compared with shoes-only, all anklefoot orthoses/orthopaedic shoes groups combined increased walking speed by 0.18 m/s (95% confidence interval (95% CI) 0.13-0.23), reduced energy cost by 0.70 J/kg/m (95% CI 0.48-0.94) and limited ankle dorsiflexion by -3.0° (95% CI 1.3-4.7). Higher ankle-foot orthoses ankle stiffness correlated with greater reductions in walking energy cost and maximal ankle dorsiflexion angle. Conclusion: Ankle-foot orthoses for persons with non-spastic calf muscle weakness vary greatly in properties and effects on gait. The large variation in effectiveness may be due to differences in ankle stiffness, although this requires further prospective evaluation.
TL;DR: Virtual reality therapy combined with conventional physiotherapy can contribute to functional improvement in the subacute and chronic phases after stroke.
Abstract: OBJECTIVE To analyse the effect of virtual reality (VR) ther-apy combined with conventional physiotherapy on balance, gait and motor functional disturbances, and to determine whether there is an influence on motor recovery in the subacute ( > 6 months) phases after stroke. METHODS A total of 59 stroke inpatients (mean age 60.3 years (standard deviation (SD) 14.8); 14.0 months (SD 25.7) post-stroke) were stratified into 2 groups: subacute (n = 31) and chronic (n = 28). Clinical scales (Fugl-Meyer lower extremity (FM LE); Functional Independence Measure (FIM); Berg Balance Scale (BBS); Functional Ambulation Category (FAC); modified Ashworth scale (MAS); 10-metre walk test (10MWT); and kinematic parameters during specific motor tasks in sitting and standing position (speed; time; jerk; spatial error; length) were applied before and after treatment. The VR treatment lasted for 15 sessions, 5 days/week, 1 h/day. RESULTS The subacute group underwent significant change in all variables, except MAS and length. The chronic group underwent significant improvement in clinical scales, except MAS and kinematics. Motor impairment improved in the severe ≤ 19 FM LE points, moderate 20-28 FM LE points, mild ≥ 29 FM LE points. Neither time since stroke onset nor affected hemisphere differed significantly between groups. The correlations were investigated between the clinical scales and the kinematic parameters of the whole sample. Moreover, FM LE, BBS, MAS, and speed showed high correlations (R2>> 0.70) with independent variables. CONCLUSION VR therapy combined with conventional physiotherapy can contribute to func-tional improvement in the subacute and chronic phases after stroke.
TL;DR: The 13-item TSK-NL Heart has good psychometric properties, and it is recommended to use this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation.
Abstract: Objectives: To determine the psychometric properties of a questionnaire to assess fear of movement (kinesiophobia): the Tampa Scale for Kinesiophobia (TSK-NL Heart), and to investigate the prevalence of kinesiophobia in patients attending cardiac rehabilitation. Methods: A total of 152 patients were evaluated with the TSK-NL Heart during intake and 7 days later. Internal consistency, test-retest reliability and construct validity were assessed. For construct validity, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were used. The factor structure of the TSK-NL Heart was determined by a principal component analysis (PCA). Results: After removal of 4 items due to low internal consistency, the TSK-NL Heart showed substantial reliability (intraclass correlation coefficient; ICC: 0.80). A strong positive correlation was found between the TSK-NL Heart and the CAQ (rs: 0.61). Strong positive correlations were found between the TSK-NL Heart and de HADS (Anxiety) (rs: 0.60) and between the TSK-NL Heart and the CAQ (rs: 0.61). The PCA revealed a 3-factor structure as most suitable (fear of injury, avoidance of physical activity, perception of risk). High levels of kinesiophobia were found in 45.4% of patients. Conclusion: The 13-item TSK-NL Heart has good psychometric properties, and we recommend using this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation. Keywords: Tampa Scale for Kinesiophobia; cardiac rehabilitation; exercise; fear of movement; physical activity; cardiovascular disease
TL;DR: The results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.
Abstract: Objective To evaluate the role of diagnostic nerve block in predicting the outcome of subsequent botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke. Design Retrospective observational study. Patients Fifty chronic stroke patients with spastic equinovarus foot. Methods Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale. Results Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection. Conclusion This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.
TL;DR: This study verifies that lower limb proprioception is impaired in children with DCD and displays greater proprioceptive deficits at the ankle compared with the knee joint.
Abstract: Objective To determine the joint position sense of the lower extremities and its relationship with motor function in children with developmental coordination disorder (DCD) and typically developing (TD) children. Methods A total of 56 participants were recruited; 28 children with DCD (age 10.86±1.07 years; 13 females, 15 males) and 28 TD children (age 10.96±1.18 years; 12 females, 16 males). Knee and ankle joint position sense were assessed using a Biodex isokinetic dynamometer. Joint position acuity was measured by position error (PE) and position error variability (PEV). Motor function was examined using the 2nd edition of Movement Assessment Battery for children (MABC-2) and quantified via sub-scores from 3 MABC-2 domains. Results Both PE and PEV at knee and ankle joints were significantly greater in children with DCD compared with TD children. In addition, both PE and PEV were significantly greater at the ankle joints than the knee joints in children with DCD. For children with DCD only, joint position acuity in the lower extremities significantly and negatively correlated with MABC-2 balance sub-score. Conclusion This study verifies that lower limb proprioception is impaired in children with DCD. Also, children with DCD displayed greater proprioceptive deficits at the ankle compared with the knee joint. Children with DCD who had poorer joint position acuity, i.e. greater PE and PEV, in the lower extremities tended to perform less well in balance function.
TL;DR: The results indicate that attention training is promising early after acquired brain injury and that Attention Process Training boosts functional improvement.
Abstract: BACKGROUND Evaluation of outcome after intensive cognitive rehabilitation early after brain injury is complicated due to the ongoing biological recovery process. OBJECTIVE To evaluate the efficacy of Attention Process Training early after acquired brain injury through time-series measurement with statistical process control. DESIGN Randomized controlled trial. METHOD Patients with acquired brain injury (n = 59) within 4 months' post-injury in interdisciplinary rehabilitation received an additional 20 h of attention training with Attention Process Training or with activity-based attention training. The primary outcome variable was Paced Auditory Serial Attention Test (PASAT) evaluated using statistical process control. RESULTS Both groups improved (p < 0.001), although a higher number of patients improved with attention process training (χ2 (1, n = 59) = 5.93, p = 0.015) and the variability was significantly decreased. The Attention Process Training group maintained or improved performance at 6 months follow-up (χ2 (1, n = 51) = 6,847, p = 0.033). Attention Process Training required fewer intervention hours for improvement. Based on individual performance, 3 improvement trajectories were identified: stationary, steady, and rapid improvers. CONCLUSION The results indicate that attention training is promising early after acquired brain injury and that Attention Process Training boosts functional improvement. Notably, in the present group of relatively homogeneous patients, 3 different trajectories were identified for recovery after acquired brain injury regardless of intervention.