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European Journal of Physical and... Jun 2020The improvement of the upper limb disability, which is mainly caused by stroke, is still one of the rehabilitation treatment challenges. However, the effectiveness of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The improvement of the upper limb disability, which is mainly caused by stroke, is still one of the rehabilitation treatment challenges. However, the effectiveness of task-based mirror therapy (TBMT) on subacute stroke with moderate and severe upper limb impairment has not been deeply explored.
AIM
The purpose of this study was to investigate the effects of TBMT, in comparison to occupational therapy, in moderate and severe upper limb impairment by analyzing the motor function and activities of daily living in subacute stroke patients.
DESIGN
A randomized controlled trial.
SETTING
Rehabilitative inpatient unit.
POPULATION
Thirty patients with moderate and severe-subacute stroke recruited from the Second Affiliated Hospital of Chongqing Medical University have been randomly divided into two groups; the task-based mirror therapy group (N.=15) and the control group (N.=15).
METHODS
The first group received TBMT while the control group only underwent only occupational therapy without a mirror utilization. Taking into consideration that both groups received conventional therapy. The intervention time was equal for both groups consisting of 25 minutes per day for 25 days. Fugl-Meyer Assessment (FMA), Brunnstrom Assessment (BRS), Modified Barthel Index (MBI), and Modified Ashworth Scale (MAS) were used to assess the outcomes for this study.
RESULTS
After 25 sessions of treatment, the patients in both groups have shown-improvement in the activates of daily living, motor recovery, and motor function. No significant differences between the two groups were observed on BRS and MBI. However, interestingly, the results of the TBMT group were significantly better than the control group in FMA (P<0.05) and certain aspects of MAS (elbow flexion, wrist flexion, wrist extension, and fingers extension with P<0.05).
CONCLUSIONS
This study shows that the combination of conventional rehabilitation treatment and TBMT is an effective way to improve the functional recovery in the upper limb stroke patients.
CLINICAL REHABILITATION IMPACT
TBMT is a therapeutic technique that can be used in subacute stroke patients with moderate and severe upper limb impairment.
Topics: Adult; Disability Evaluation; Feedback, Sensory; Female; Humans; Male; Middle Aged; Occupational Therapy; Paresis; Psychomotor Performance; Recovery of Function; Single-Blind Method; Stroke Rehabilitation; Upper Extremity
PubMed: 32214062
DOI: 10.23736/S1973-9087.20.06070-0 -
The Journal of Head Trauma... 2019To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain...
OBJECTIVE
To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.
PARTICIPANTS
Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.
DESIGN
An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.
MAIN MEASURES
Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.
RESULTS
Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).
CONCLUSIONS
The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.
Topics: Brain Injuries, Traumatic; Clinical Decision-Making; Hemodynamics; Hospitalization; Humans; Intensive Care Units; Intracranial Pressure; Occupational Therapy; Patient Care Team; Physical Therapy Modalities; Speech Therapy; Surveys and Questionnaires; Time-to-Treatment
PubMed: 30829824
DOI: 10.1097/HTR.0000000000000477 -
CA: a Cancer Journal For Clinicians Mar 2021Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve...
Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
Topics: Cancer Survivors; Exercise Therapy; Humans; Medical Oncology; Neoplasms; Practice Guidelines as Topic; Quality of Life; Survivorship
PubMed: 33107982
DOI: 10.3322/caac.21639 -
Clinical Interventions in Aging 2019After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these... (Review)
Review
INTRODUCTION
After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE.
METHODS
A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized.
RESULTS
After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation.
DISCUSSION
This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups.
CONCLUSION
Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Female; Health Services for the Aged; Humans; Patient Care Team; Rehabilitation; Treatment Outcome
PubMed: 31496672
DOI: 10.2147/CIA.S207863 -
Australian Journal of General Practice Sep 2020General practitioners play a vital and increasing part in the perioperative care of patients undergoing total knee replacement (TKR). Rising obesity rates,...
BACKGROUND
General practitioners play a vital and increasing part in the perioperative care of patients undergoing total knee replacement (TKR). Rising obesity rates, sports-related injuries and an ageing population are likely to result in a sharp increase in TKR procedures within the next decade, combined with higher cost concerns. Rehabilitation practices that show economic efficiency and produce superior patient outcomes are a major focus of current research.
OBJECTIVE
The aim of this article is to provide an evidence-based summary of current rapid recovery protocols following TKR surgery.
DISCUSSION
Rapid recovery protocols have been shown to be effective at reducing length of stay, postoperative pain and complications without compromising patient safety. These rapid recovery protocols include same-day mobilisation; blood preservation protocols; self-directed pedalling-based rehabilitation; and individualised targeted discharge to self-directed, outpatient therapist-directed or inpatient therapist-directed rehabilitation. Low-cost self-directed rehabilitation should be considered usual care, with inpatient rehabilitation reserved for the minority of at-risk patients.
Topics: Arthroplasty, Replacement, Knee; Early Ambulation; Exercise Therapy; Humans; Length of Stay; Pain, Postoperative; Rehabilitation; Treatment Outcome
PubMed: 32864678
DOI: 10.31128/AJGP-03-20-5297 -
Respiratory Care Jun 2023Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of... (Review)
Review
Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of early mobilization as an important component of critical care rehabilitation. However, there have been some inconsistent results. Moreover, the lack of standardized mobilization protocols and the associated safety concerns are a barrier to the implementation of early mobilization in critically ill patients. Therefore, determining the appropriate modalities of implementation of early mobilization is a key imperative to leverage its potential in these patients. In this paper, we review the contemporary literature to summarize the strategies for early mobilization of critically ill patients, assess the implementation and validity based on the International Classification of Functioning, Disability and Health, as well as discuss the safety aspects of early mobilization.
Topics: Humans; Early Ambulation; Critical Illness; Critical Care; Physical Therapy Modalities
PubMed: 37041029
DOI: 10.4187/respcare.10481 -
Foot and Ankle Clinics Sep 2019Most nonoperative treatments for insertional Achilles tendinopathy (IAT) have insufficient evidence to support treatment recommendations. Exercise has the highest level... (Review)
Review
Most nonoperative treatments for insertional Achilles tendinopathy (IAT) have insufficient evidence to support treatment recommendations. Exercise has the highest level of evidence supporting the ability of this treatment option to reduce IAT pain. The effects of exercise may be enhanced by a wide variety of other treatments, including soft tissue treatment, nutritional supplements, iontophoresis, education, stretching, and heel lifts. When exercise is unsuccessful, extracorporeal shock wave therapy seems to be the next best nonoperative treatment option to reduce IAT pain. After other nonoperative treatment options have been exhausted, injections may be considered, particularly to facilitate participation in an exercise program.
Topics: Achilles Tendon; Exercise Therapy; Extracorporeal Shockwave Therapy; Humans; Pain Measurement; Physical Therapy Modalities; Tendinopathy
PubMed: 31371000
DOI: 10.1016/j.fcl.2019.04.004 -
Journal of Musculoskeletal & Neuronal... Sep 2019This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements.
METHODS
This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization.
RESULTS
Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05).
CONCLUSIONS
Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.
Topics: Adult; Aged; Bursitis; Female; Humans; Male; Middle Aged; Muscle Stretching Exercises; Physical Therapy Modalities; Range of Motion, Articular; Scapula; Shoulder Joint; Single-Blind Method
PubMed: 31475938
DOI: No ID Found -
International Urogynecology Journal Nov 2019Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION AND HYPOTHESIS
Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a multidisciplinary approach may be required to treat it. Musculoskeletal factors play an important role; thus, rehabilitating the pelvic floor and modifying the tone of the pelvic floor muscles (PFMs) may be an effective way to treat this dysfunction. The aim of this randomized controlled clinical study was to evaluate the effects of pelvic floor rehabilitation techniques on dyspareunia.
METHODS
Of 84 women, assessed for eligibility, 64 women with dyspareunia were randomized into two groups: the experimental group (n = 32) received electrotherapy, manual therapy, and PFM exercises and the control group (n = 32) had no treatment while on the waiting list. Evaluations of PFM strength and endurance, sexual function, and pain were made directly before and after 3 months of treatment and at the 3-month follow-up.
RESULTS
Between-group changes showed significant improvement in the experimental group in comparison with control group. Mean difference in the PFM strength (according to the 0-5 Oxford scale) between groups was 2.01 and the mean difference of endurance was 6.26 s. Also, the mean difference in the Female Sexual Function Index score (the score ranges from 2 to 95) was 51.05, and the mean difference in the VAS score was 7.32. All of the changes were statistically significant (p < 0.05).
CONCLUSIONS
According to the results, pelvic floor rehabilitation is an important part of a multidisciplinary treatment approach to dyspareunia.
Topics: Adult; Dyspareunia; Electric Stimulation Therapy; Exercise Therapy; Female; Humans; Musculoskeletal Manipulations; Pelvic Floor
PubMed: 31286158
DOI: 10.1007/s00192-019-04019-3 -
Current Opinion in Neurology Dec 2019This review discusses recent advances in the rehabilitation of motor deficits after traumatic brain injury (TBI) and spinal cord injury (SCI) using neuromodulatory... (Review)
Review
PURPOSE OF REVIEW
This review discusses recent advances in the rehabilitation of motor deficits after traumatic brain injury (TBI) and spinal cord injury (SCI) using neuromodulatory techniques.
RECENT FINDINGS
Neurorehabilitation is currently the only treatment option for long-term improvement of motor functions that can be offered to patients with TBI or SCI. Major advances have been made in recent years in both preclinical and clinical rehabilitation. Activity-dependent plasticity of neuronal connections and circuits is considered key for successful recovery of motor functions, and great therapeutic potential is attributed to the combination of high-intensity training with electrical neuromodulation. First clinical case reports have demonstrated that repetitive training enabled or enhanced by electrical spinal cord stimulation can yield substantial improvements in motor function. Described achievements include regaining of overground walking capacity, independent standing and stepping, and improved pinch strength that recovered even years after injury.
SUMMARY
Promising treatment options have emerged from research in recent years using neurostimulation to enable or enhance intense training. However, characterizing long-term benefits and side-effects in clinical trials and identifying patient subsets who can benefit are crucial. Regaining lost motor function remains challenging.
Topics: Animals; Brain Injuries, Traumatic; Deep Brain Stimulation; Humans; Neurological Rehabilitation; Neuronal Plasticity; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Spinal Cord Stimulation; Transcranial Direct Current Stimulation
PubMed: 31567546
DOI: 10.1097/WCO.0000000000000750