scholarly journals Mindfulness in Patients with Upper-Extremity Conditions: A Summary of Existing Literature

2020 ◽  
Vol 12 (S 01) ◽  
pp. S1-S8
Author(s):  
Thomas J. M. Kootstra ◽  
Diederik P. J. Smeeing ◽  
Reinier B. Beks ◽  
Mark van Heijl ◽  
Marike Kokke ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Outcome Measures ◽  
Observational Studies ◽  
Minimal Clinically Important Difference ◽  
Weighted Average ◽  
Randomized Controlled ◽  
Clinically Important Difference ◽  
The Subject ◽  
Functional Outcome Measures

AbstractMindfulness implies entering a mental state of awareness which allows for the reframing of an experience, and functionality has shown to be influenced by mindset. The aim of this systematic review was to assess effects of mindfulness in patients with upper-extremity conditions. PubMed, Embase, Cochrane, and CINAHL databases were searched on June 19, 2019, for studies investigating mindfulness in patients with upper-extremity conditions. Two validated instruments for methodologic assessment were used to assess study quality. Studies that reported pain, psychological, or functional outcome measures were included. One randomized controlled trials and three observational studies were included, which together included 335 patients that completed final follow-up. The weighted average age was 52.4 years and 48% of the patients were male. Evaluation of the outcome measures used was immediately after the mindfulness intervention or assessment in all studies. Mindfulness appeared to be positively associated with less pain (though below the minimal clinically important difference), increased mood, and better function. Mindfulness is associated with increased mood and possibly better functionality in adults with a large range of upper-extremity conditions when measured or used as an intervention. Future researcher should expand the subject as only four studies were included in this review. This is a Level IV study.

837 Clinical Experience Using Functional Outcome Measures in the Outpatient Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S257-S257
Author(s):  
Melissa Boals ◽  
Lisa Curtis ◽  
Amalia Cochran ◽  
John Kevin Bailey ◽  
Rebecca Coffey
Keyword(s):  
Lower Extremity ◽  
Functional Outcome ◽  
Grip Strength ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Maximal Function ◽  
Burn Patients ◽  
Function Score ◽  
Functional Outcome Measures

Abstract Introduction For patients with severe burns, the emphasis has shifted from survival to maximizing functional outcomes. Outcome measures are tools that help establish a baseline status and monitor progression towards meaningful tasks such as activities of daily living (ADLs) and mobility (Staley et al. 1996). The goal of this retrospective study is to describe the use of functional outcome measures in burn patients in an outpatient setting using standardized measures. Methods A retrospective chart review of burn patients seen in the outpatient burn clinic between February 1, 2017 and May 31, 2019 was conducted. Only patients seen for burn injury, treated as outpatients, and with functional outcome measures recorded were included in the study. Pertinent demographic and clinical data were collected as well as outcome measures. All patients had grip strength dynamometry performed. Patients with upper extremity and lower extremity burns were administered the The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Lower Extremity Functional Scale (LEFS). Return to work data was also collected if the patient was employed at baseline. Results A total of 113 out patients were included in the analysis. Mean age was 43 years (20–88 years) with a mean TBSA of 6.1% (0.1 -67%). The mean number of OT and PT visits in the clinic were both 1.4. Initial grip strength measurements were obtained in 67 patients at a mean of post burn day (PBD) 33 and an average grip strength of 21.29 kg (right) and 26.8 kg (left). Follow up grip strength measurements were obtained in 45 patients on mean PBD 43 with right hand 49.98 kg and left hand of 51.28 kg. Initial QuickDASH was administered to 89 patients on PBD 47 with a mean percent disability of 48.72 (0–100). Second QuickDASH was given to 45 patients on PBD 68 with a mean percent disability score of 37.01 (0 – 95.45) - Initial LEFS was given to 77 patients mean PBD 61 with a mean % of maximal function score of 44%. Second LEFS was given to 40 patients mean PBD 71 with a mean % maximal function score of 58%. Mean return to work for the 46 patients who were employed was 53.6 days post burn. Conclusions Positive improvements were shown in grip strength and lower extremity function, but a decline in function was demonstrated for upper extremity function. This decline may be the result of a nearly 50% attrition rate on follow up QuickDASH measures due to discharge of highly functional individuals, meaning the remaining upper extremity burn patients had more severe injuries and dysfunction. Applicability of Research to Practice Ongoing research is needed to identify the best timing of outcome measures and how to best incorporate this information into burn treatment plans.

scholarly journals Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis

2017 ◽  
Vol 27 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Jennifer C. Urquhart ◽  
Osama A. Alrehaili ◽  
Charles G. Fisher ◽  
Alyssa Fleming ◽  
Parham Rasoulinejad ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Weighted Average ◽  
Average Treatment Effect ◽  
Secondary Outcome ◽  
Thoracolumbar Burst Fractures ◽  
Treatment Comparison ◽  
Average Treatment ◽  
Burst Fractures ◽  
Time Weighted Average

OBJECTIVEA multicenter, prospective, randomized equivalence trial comparing a thoracolumbosacral orthosis (TLSO) to no orthosis (NO) in the treatment of acute AO Type A3 thoracolumbar burst fractures was recently conducted and demonstrated that the two treatments following an otherwise similar management protocol are equivalent at 3 months postinjury. The purpose of the present study was to determine whether there was a difference in long-term clinical and radiographic outcomes between the patients treated with and those treated without a TLSO. Here, the authors present the 5- to 10-year outcomes (mean follow-up 7.9 ± 1.1 years) of the patients at a single site from the original multicenter trial.METHODSBetween July 2002 and January 2009, a total of 96 subjects were enrolled in the primary trial and randomized to two groups: TLSO or NO. Subjects were enrolled if they had an AO Type A3 burst fracture between T-10 and L-3 within the previous 72 hours, kyphotic deformity < 35°, no neurological deficit, and an age of 16–60 years old. The present study represents a subset of those patients: 16 in the TLSO group and 20 in the NO group. The primary outcome measure was the Roland Morris Disability Questionnaire (RMDQ) score at the last 5- to 10-year follow-up. Secondary outcome measures included kyphosis, satisfaction, the Numeric Rating Scale for back pain, and the 12-Item Short-Form Health Survey (SF-12) Mental and Physical Component Summary (MCS and PCS) scores. In the original study, outcome measures were administered at admission and 2 and 6 weeks, 3 and 6 months, and 1 and 2 years after injury; in the present extended follow-up study, the outcome measures were administered 5–10 years postinjury. Treatment comparison between patients in the TLSO group and those in the NO group was performed at the latest available follow-up, and the time-weighted average treatment effect was determined using a mixed-effects model of longitudinal regression for repeated measures averaged over all time periods. Missing data were assumed to be missing at random and were replaced with a set of plausible values derived using a multiple imputation procedure.RESULTSThe RMDQ score at 5–10 years postinjury was 3.6 ± 0.9 (mean ± SE) for the TLSO group and 4.8 ± 1.5 for the NO group (p = 0.486, 95% CI −2.3 to 4.8). Average kyphosis was 18.3° ± 2.2° for the TLSO group and 18.6° ± 3.8° for the NO group (p = 0.934, 95% CI −7.8 to 8.5). No differences were found between the NO and TLSO groups with time-weighted average treatment effects for RMDQ 1.9 (95% CI −1.5 to 5.2), for PCS −2.5 (95% CI −7.9 to 3.0), for MCS −1.2 (95% CI −6.7 to 4.2) and for average pain 0.9 (95% CI −0.5 to 2.2).CONCLUSIONSCompared with patients treated with a TLSO, patients treated using early mobilization without orthosis maintain similar pain relief and improvement in function for 5–10 years.

scholarly journals Defining Minimal Clinically Important Difference After Open Hip Abductor Repair

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110077
Author(s):  
Tyler J. Uppstrom ◽  
Spencer W. Sullivan ◽  
Joost A. Burger ◽  
Anil S. Ranawat ◽  
Bryan T. Kelly ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Outcome Measures ◽  
Minimal Clinically Important Difference ◽  
Open Repair ◽  
Gluteus Medius ◽  
Patient Characteristics ◽  
Harris Hip Score ◽  
Younger Patients ◽  
Clinically Important Difference ◽  
Hip Abductor

Background: Open repair for gluteus medius and minimus tears is a common surgical treatment for patients with lateral hip pain associated with abductor tears; however, clinically meaningful outcomes have not been described after open surgical treatment. Purpose: To define the minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) in patients undergoing open gluteus medius or minimus repair, and to identify preoperative patient characteristics predictive of achieving MCID postoperatively. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected data from a consecutive series of patients undergoing open abductor repair between July 2010 and April 2019 was conducted. Perioperative patient data collected included patient characteristics and preoperative and postoperative modified Harris Hip Score (mHHS) and International Hip Outcome Tool (iHOT-33) score. Paired t tests were utilized to compare preoperative and postoperative PROMs and MCID was calculated for both PROMs. Multivariate logistical regression analysis was used to assess the association between preoperative variables and the likelihood for achieving MCID. Results: A total of 47 patients were included in the study. The majority of patients were female (78.7%), with an average age of 63 ± 10.7 years. The average follow-up for both the mHHS and the iHOT-33 surveys was 37.8 ± 27.9 months (range, 10-102 months). Patients demonstrated statistically significant improvements on the mHHS and iHOT-33 postoperatively ( P < .001 for both). The MCIDs of mHHS and iHOT-33 were calculated to be 9.9 and 14.3, respectively. Overall, 82.9% of patients achieved MCID for mHHS and 84.1% of patients achieved MCID for iHOT-33 postoperatively. Multivariate logistical analysis demonstrated younger patients were less likely to achieve MCID for both outcome measures. Four patients (8.5%) suffered postoperative complications after open repair. Conclusion: This study defined MCID for mHHS and iHOT-33 for patients undergoing open repair of hip abductor tears, with a large percentage of patients (>80%) achieving meaningful outcomes for both outcome measures. There was a low complication rate. Younger patients were less likely to achieve MCID compared with older patients.

Minimal clinically important difference of the 6-min walking test in patients with asthma

2021 ◽  
Vol 25 (3) ◽  
pp. 215-221
Author(s):  
E. Zampogna ◽  
N. Ambrosino ◽  
R. Centis ◽  
F. Cherubino ◽  
G. B. Migliori ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Operating Characteristic ◽  
Minimal Clinically Important Difference ◽  
Walking Ability ◽  
Walking Test ◽  
Receiver Operating Characteristic Curves ◽  
Clinically Important Difference ◽  
Copd Assessment Test ◽  
Before And After ◽  
Perceived Change

BACKGROUND: The 6‐min walking test (6MWT) is responsive to physiological changes and pulmonary rehabilitation (PR) in patients with asthma. The minimal clinically important difference (MCID) has not been established yet.OBJECTIVE: To determine the MCID of 6MWT in patients with asthma.METHODS: Using the perceived change in walking ability and the modified Medical Research Council (mMRC) score as anchors, receiver operating characteristic curves and quantile regression, we evaluated 6MWT before and after PR in these patients. The St George Respiratory Questionnaire (SGRQ), the COPD assessment test (CAT) and other outcome measures were also assessed.RESULTS: Of 142 patients with asthma, 37 were enrolled. After PR, 6MWT increased from 453.4 m ± 88.8 to 493.0 m ± 97.2 (P = 0.0001); other outcome measures also increased. There was a slight correlation between baseline 6MWT and SGRQ, CAT and mMRC. No significant correlations were found between post‐PR changes in 6MWT and in other outcome measures. Comparing different methods of assessment, the MCID ranged from 26 m to 27 m.CONCLUSION: The most conservative estimate of the MCID of 6MWT after PR was 26 m in patients with asthma. This estimate may be useful in clinical interpretation of data, particularly in response to intervention studies.

scholarly journals Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial

2016 ◽  
Vol 96 (6) ◽  
pp. 787-796 ◽  
Author(s):  
David Høyrup Christiansen ◽  
Poul Frost ◽  
Deborah Falla ◽  
Jens Peder Haahr ◽  
Lars Henrik Frich ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Outcome Measures ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Exercise Group ◽  
Subacromial Impingement Syndrome ◽  
Decompression Surgery ◽  
Subacromial Decompression ◽  
Randomized Controlled

Background Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. Objective The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. Design A multicenter randomized controlled trial was conducted. Setting The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. Patients One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. Intervention A standardized exercise program consisting of physical therapist–supervised individual training sessions and home training was used. Outcome Measures The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. Results At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=−0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. Limitations The nature of the exercise intervention did not allow blinding of patients and care providers. Conclusion The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.

scholarly journals The added value of cognition-targeted exercise versus symptom-targeted exercise for multiple sclerosis fatigue: A randomized controlled pilot trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258752
Author(s):  
Azza Alketbi ◽  
Salah Basit ◽  
Nouran Hamza ◽  
Lori M. Walton ◽  
Ibrahim M. Moustafa
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
Recruitment Rate ◽  
Control Group ◽  
Entire Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Intervention Protocol

Background Fatigue is considered one of the most common symptoms of multiple sclerosis (MS) and lacks a current standardized treatment. Therefore, the aim of this study was to examine the feasibility and effectiveness of a cognition-targeted exercise versus symptom-targeted exercise for MS fatigue. Methods In this Pilot, parallel-group, randomized controlled trial, sixty participants with multiple sclerosis, were randomly assigned to either a Cognition-Targeted Exercise (CTE) (N = 30, mean age 41) or a Symptom-Targeted Exercise (STE) (N = 30, mean age 42). The participants in the experimental group received eight, 50-minute sessions of weekly Cognitive Behavior Therapy (CBT) in addition to a CTE Program; whereas, participants in the control group received eight, 50-minute sessions of weekly CBT in addition to the standardized physiotherapy program (STE Program). Feasibility was assessed through recruitment rate, participant retention, adherence and safety, in addition to clinical outcome measures, including: (1) Modified Fatigue Impact Scale (MFIS), (2) Work and Social Adjustment Scale (WSAS), (3) Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). All outcome measures were assessed at baseline (pretreatment), following completion of the eight visit intervention protocol, and at 3-months follow-up. Results The recruitment rate was 60% and 93% of participants completed the entire study. The recruited participants complied with 98% of the required visits. No adverse events were recorded. A Generalized Estimation Equation Model revealed a significant difference over time as an interaction term during the post and follow up visit for all clinical outcome measures (p < .001). Conclusion The addition of CTE to CBT exhibited positive and more lasting influence on MS fatigue outcomes compared to Symptom-Targeted Exercise (STE). Feasibility and efficacy data from this pilot study provide support for a full-scale RCT of CTE as an integral component of Multiple Sclerosis fatigue management.

scholarly journals The Effects of Therapeutic Exercise With and Without Mobilization in Participants With Chronic Ankle Instability: A Randomized Controlled Trial

2020 ◽  
pp. 1-8
Author(s):  
Cameron Bolton ◽  
Sheri Hale ◽  
Todd Telemeco
Keyword(s):  
Randomized Controlled Trial ◽  
Outcome Measures ◽  
Ankle Instability ◽  
Controlled Trial ◽  
Chronic Ankle Instability ◽  
Therapeutic Exercise ◽  
Convenience Sample ◽  
Randomized Controlled ◽  
Hop Test

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.

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