scholarly journals Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

2020 ◽  
Vol 29 (3) ◽  
pp. 360-366 ◽  
Author(s):  
Nicholas Hattrup ◽  
Hannah Gray ◽  
Mark Krumholtz ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Interdisciplinary Approach ◽  
Rehabilitation Program ◽  
Psychological State ◽  
Sufficient Evidence ◽  
Symptom Duration ◽  
Clinical Question ◽  
Bottom Line ◽  
Duration Of Symptoms ◽  
Symptom Intensity

Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

The Effects of Aerobic Exercise on Postconcussion Symptoms in Patients With Persistent Symptoms: A Critically Appraised Topic

2020 ◽  
Vol 25 (1) ◽  
pp. 4-11
Author(s):  
Timothy A. Kulpa ◽  
Jamie Mansell ◽  
Anne Russ ◽  
Ryan Tierney
Keyword(s):  
Aerobic Exercise ◽  
Treatment Plan ◽  
Rehabilitation Program ◽  
Bottom Line ◽  
Persistent Symptoms ◽  
Improved Outcomes ◽  
Cognitive Rest ◽  
Potential Clinical Utility ◽  
Active Rehabilitation ◽  
Postconcussion Symptoms

Context: Patients who do not fully recover from a concussion in 7–14 days may require an impairment-based rehabilitation program. Recent evidence indicates improved outcomes with active rehabilitation compared to passive physical and cognitive rest. Clinical Question: In patients with persistent symptoms (greater than 4 weeks) following concussion, how does aerobic exercise affect postconcussion symptoms? Clinical Bottom Line: There is moderate and sufficient SORT Level B evidence to support the inclusion of subsymptom threshold (SST) exercise in the multimodal treatment plan for patients suffering from persistent symptoms after concussion. All five included studies reported moderate to very large effects ranging from d = 0.72 to d = 10.64 in reducing symptoms after the implementation of SST aerobic exercise. Additionally, two studies also identified moderate and very large effects (d = 0.77, d = 2.56) favoring aerobic exercise over stretching interventions. These results indicate that this treatment has potential clinical utility and is a viable option to reduce symptoms in patients with postconcussion syndrome and persistent symptoms following concussion.

Current Evidence in Anterior Cruciate Ligament Rehabilitation: Neuromuscular Electrical Stimulation Combined With a Strengthening Program: A Critically Appraised Topic

2017 ◽  
Vol 22 (6) ◽  
pp. 5-11
Author(s):  
Michael E. Lynch ◽  
Christine A. Lauber
Keyword(s):  
Anterior Cruciate Ligament ◽  
Electrical Stimulation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Strength ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Bottom Line ◽  
Anterior Cruciate

Clinical Question:Is it beneficial to add neuromuscular electrical stimulation (NMES) to a strengthening program after anterior cruciate ligament (ACL) reconstruction surgery?Clinical Bottom Line:There is sufficient evidence to support the inclusion of NMES in a rehabilitation strengthening program post ACL reconstruction. All three included studies reported significant quadriceps strength gains (p < .05) in favor of the group that completed both NMES and strengthening exercises compared with a strength-only group. Two studies initiated NMES within 4 days of surgery. One study found significant quadriceps strength increases when NMES was implemented 6 months after surgery.

Do Patients With Cervical Radiculopathy Benefit From the Addition of Cervical Traction to a Rehabilitation Program? A Critically Appraised Topic

2017 ◽  
Vol 22 (3) ◽  
pp. 18-25
Author(s):  
Nicole Vetroczky ◽  
Christine A. Lauber
Keyword(s):  
Multimodal Treatment ◽  
Treatment Approach ◽  
Cervical Radiculopathy ◽  
Rehabilitation Program ◽  
Clinical Question ◽  
Cervical Pain ◽  
Bottom Line ◽  
Multimodal Treatment Approach ◽  
Cervical Traction

Clinical Question:In patients with cervical radiculopathy and associated pain, is there a benefit to including intermittent, mechanical cervical traction to a multimodal treatment approach to reduce cervical pain and disability?Clinical Bottom Line:The majority of best evidence suggests favorable outcomes regarding decreasing cervical pain and disability with the inclusion of intermittent, mechanical cervical traction into a multimodal treatment approach.

Abstract WP170: Identifying the "New Norm" of Cardiac Rehabilitation after Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Elaine T Miller ◽  
Kari Dunning ◽  
Dustyn Whitesel ◽  
Amber Deinlein ◽  
Brett Kissela ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Aerobic Exercise ◽  
Interdisciplinary Approach ◽  
Cost Effective ◽  
Rehabilitation Program ◽  
Exercise Stress ◽  
Stroke Survivors ◽  
Cardiac Rehabilitation Program ◽  
The Creation

Background and Purpose: Physical inactivity after stroke stymies motor recovery, perpetuates further deconditioning, and contributes to a high long-term risk of cardiac events and recurrent stroke. This study used stakeholder input to develop a cardiac rehabilitation program specific to stroke. Methods: An exploratory qualitative study was performed consisting of separate focus groups of stroke survivors, caregivers, rehabilitation clinicians, nurse practitioners along with individual physician interviews. Two experienced researchers in qualitative research methodology independently identified themes, patterns, and issues prioritized by participants. Results: Four major themes emerged: safety, individualization of the cardiac rehabilitation program, return to function and living at highest potential, and need to maintain prolonged activity. Major components identified in developing the cardiac rehabilitation program included: Individualized stroke survivor education pertaining to fall prevention, safe aerobic exercise and learning how to live well after stroke (e.g., fitness, nutrition, chronic disease management, etc.); Exercise/stress testing prior to aerobic exercise; Determine when to begin cardiac rehabilitation post stroke (e.g., readiness, needs, resources, benefit, etc.), individualize approach and timing after holistic assessment; Education/training of cardiac rehabilitation professionals regarding best care practices for stroke survivors; Interdisciplinary approach to assure safety and continuum of care; Referral programs for IADLs, driving, sexual function, etc.; Motivational interviewing to overcome barriers with inclusion of peer mentoring/coaching; Discharge to cost effective community programs or a sustainable home program. Conclusions: Addressing safety concerns along with the creation of an individualized cardiac rehabilitation program that enables stroke survivors to achieve and maintain their highest level of function long-term are fundamental components. Partnering with the major stakeholders and incorporating a coordinated interdisciplinary approach are crucial to the creation of a feasible and cost effective cardiac rehabilitation program for stroke survivors.

The Effect of Cognitive Rest as Part of Postconcussion Management for Adolescent Athletes: A Critically Appraised Topic

2017 ◽  
Vol 26 (5) ◽  
pp. 437-446 ◽  
Author(s):  
Rachel S. Johnson ◽  
Mia K. Provenzano ◽  
Larynn M. Shumaker ◽  
Tamara C. Valovich McLeod ◽  
Cailee E. Welch Bacon
Keyword(s):  
Cognitive Activity ◽  
Management Plan ◽  
Symptom Duration ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Patient Centered ◽  
Bottom Line ◽  
School Work ◽  
Centered Care ◽  
Cognitive Rest

Clinical Scenario:It is hypothesized that cognitive activity following a concussion may potentially hinder patient recovery. While the recommendation of cognitive rest is often maintained and rationalized, a causal relationship between cognitive activity and symptom duration has yet to be established.Clinical Question:Does the implementation of cognitive rest as part of the postconcussion management plan reduce the number of days until the concussed adolescent patient is symptom free compared to a postconcussion management plan that does not incorporate cognitive rest?Summary of Key Findings:A thorough literature search returned 7 possible studies; 5 studies met the inclusion criteria and were included. Three studies indicated that increased cognitive activity is associated with longer recovery from a concussion, and, therefore, supported the use of cognitive rest. One study indicated that the recommendation for cognitive rest was not significantly associated with time to concussion symptom resolution. One study indicated that strict rest, defined as 5 days of no school, work, or physical activity; might prolong symptom duration.Clinical Bottom Line:There is moderate evidence to support the prescription of moderate cognitive rest for concussed patients. Clinicians who intend on implementing cognitive rest in their concussion protocols should be aware of inconsistencies and be open-minded to alternative treatment progressions while taking into consideration each individual patient and maintaining adequate patient-centered care principles.Strength of Recommendation:Grade B evidence exists that prescription of moderate cognitive rest for concussed patients may be beneficial as a supplement to physical rest as treatment for symptom reduction in adolescents.

The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis

2016 ◽  
Vol 25 (4) ◽  
pp. 399-403
Author(s):  
Scott W. Cheatham ◽  
Morey J. Kolber ◽  
Kathryn Kumagai Shimamura
Keyword(s):  
Case Series ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Ice Hockey ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
High Quality Research ◽  
Osteitis Pubis ◽  
Rehabilitation Programs

Clinical Scenario:The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis.Focused Clinical Question:Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation?Summary of Key Findings:Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6–48 mo for all patients.Clinical Bottom Line:There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation.Strength of Recommendation:There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

Which Low Back Instability Tests Should Be Incorporated Into a Stabilization Classification Exam for Athletes?: A Critically Appraised Topic

2020 ◽  
Vol 25 (2) ◽  
pp. 57-61
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Moderate Level ◽  
Sufficient Evidence ◽  
Clinical Question ◽  
Low Back ◽  
Bottom Line ◽  
Prone Instability Test ◽  
Level 2

Clinical Question: Is there sufficient evidence to determine which low back instability tests should be incorporated into a stabilization classification exam for athletes? Clinical Bottom Line: There is moderate level 2 evidence to include, but not to use in isolation, the prone instability test along with other instability tests in a stabilization classification exam.

scholarly journals Subsymptomatic Aerobic Exercise for Patients With Postconcussion Syndrome: A Critically Appraised Topic

2019 ◽  
Vol 28 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Katrina G. Ritter ◽  
Matthew J. Hussey ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Perceived Exertion ◽  
Case Series ◽  
Rating Of Perceived Exertion ◽  
Symptom Improvement ◽  
Clinical Question ◽  
Postconcussion Syndrome ◽  
Exercise Protocol ◽  
Current Standard ◽  
Bottom Line

Clinical Scenario: Patients who experience prolonged concussion symptoms can be diagnosed with postconcussion syndrome (PCS) when those symptoms persist longer than 4 weeks. Aerobic exercise protocols have been shown to be effective in improving physical and mental aspects of health. Emerging research suggests that aerobic exercise may be useful as a treatment for PCS, where exercise allows patients to feel less isolated and more active during the recovery process. Clinical Question: Is aerobic exercise more beneficial in reducing symptoms than current standard care in patients with prolonged symptoms or PCS lasting longer than 4 weeks? Summary of Key Findings: After a thorough literature search, 4 studies relevant to the clinical question were selected. Of the 4 studies, 1 study was a randomized control trial and 3 studies were case series. All 4 studies investigated aerobic exercise protocol as treatment for PCS. Three studies demonstrated a greater rate of symptom improvement from baseline assessment to follow-up after a controlled subsymptomatic aerobic exercise program. One study showed a decrease in symptoms in the aerobic exercise group compared with the full-body stretching group. Clinical Bottom Line: There is moderate evidence to support subsymptomatic aerobic exercise as a treatment of PCS; therefore, it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms. A previously validated protocol, such as the Buffalo Concussion Treadmill test, Balke protocol, or rating of perceived exertion, as mentioned in this critically appraised topic, should be used to measure baseline values and treatment progression. Strength of Recommendation: Level C evidence exists that the aerobic exercise protocol is more effective than the current standard of care in treating PCS.

scholarly journals POS1120 PRESENCE OF TOPHI IS ASSOCIATED WITH A RAPID DECLINE IN THE RENAL FUNCTION IN PATIENTS WITH GOUT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 839.1-839
Author(s):  
Y. J. Oh ◽  
K. W. Moon
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Clinical Characteristics ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Involvement ◽  
Rapid Decline ◽  
Symptom Duration ◽  
Tophaceous Gout ◽  
Duration Of Symptoms ◽  
Increased Risk

Background:Gout is the most common inflammatory arthritis resulting from a chronic deposition of MSU crystals in the joints and other soft tissues. After the process of repeated tissue damage and repair due to gout, tophi could be formed around the affected joints. Intra-articular tophi may sometimes result in bone destruction, joint deformities, and dysfunction which can adversely affect the patient’s quality of life. Furthermore, early-onset tophaceous gout patients are more likely to develop renal dysfunction, however, few studies have investigated if the presence of tophi is related with the progression of renal dysfunction in gout patients.Objectives:We aimed to compare clinical characteristics of patients with and without tophi at the time of the diagnosis of gout and investigate the effect of tophi on the renal function in gout patients.Methods:Data of 257 patients who were first diagnosed with gout at the Kangwon National University Hospital from January 2012 to December 2018 were retrospectively studied. Patients were divided into 2 groups according to the presence of tophi at the diagnosis. We compared clinical characteristics and the progression of renal dysfunction between the two groups.Results:Of all patients, 66 (25.5%) initially presented with tophi. Patients with tophi were older, had a longer duration of symptoms, and had a higher prevalence of multiple joint involvement than those without tophi. The decline in the eGFR was more prominent in patients with tophi than in those without (-4.8±14.5 ml/min/1.73m2vs. -0.7±11.9 ml/min/1.73m2, respectively; P=0.039). In multivariate logistic regression analysis, a prolonged symptom duration (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.004–1.017; P=0.001) and multiple joint involvement (OR, 3.027; 95% CI, 1.831–5.004; P<0.001) were significantly associated with increased risk of formation of tophi. The presence of tophi was significantly associated with a rapid decline in the eGFR (β=-0.141; P=0.035).Conclusion:A prolonged symptom duration and multiple joint involvement were independent risk factors for tophi as the presenting symptom in gout patients. The presence of tophi was associated with a declining renal function. Therefore, an early diagnosis and active treatment are important in tophaceous gout.References:[1]Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol 2014;26:186-91.[2]Liu F, Du GL, Song N, Ma YT, Li XM, Gao XM, et al. Hyperuricemia and its association with adiposity and dyslipidemia in Northwest China: results from cardiovascular risk survey in Xinjiang (CRS 2008-2012). Lipids Health Dis 2020;19:58.[3]Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet 2016;388:2039-52.[4]Ruoff G, Edwards NL. Overview of Serum Uric Acid Treatment Targets in Gout: Why Less Than 6 mg/dL? Postgrad Med 2016;128:706-15.[5]Bieber A, Schlesinger N, Fawaz A, Mader R. Chronic tophaceous gout as the first manifestation of gout in two cases and a review of the literature. Semin Arthritis Rheum 2018;47:843-8.Disclosure of Interests:None declared.

scholarly journals 1501. Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 2 of multi-site trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S752-S753
Author(s):  
Stephanie A Richard ◽  
Timothy Burgess ◽  
Timothy Burgess ◽  
Limone Collins ◽  
Rhonda Colombo ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Clinic Visit ◽  
Vaccine Effectiveness ◽  
Symptom Duration ◽  
Blood Draw ◽  
Duration Of Symptoms ◽  
Nasal Swabs ◽  
Second Year ◽  
Military Facilities ◽  
Pragmatic Assessment

Abstract Background Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (egg-based, cell -based, and recombinant) to assess differences in immunogenicity and effectiveness. Methods Participants in the second year of PAIVED were enrolled from Oct 2019 through Jan 2020 at 9 military facilities. Participants received weekly inquiries about influenza-like-illnesses (ILI) experienced in the past week, and if the participant reported having a cough or sore throat and a) muscle/body aches or fatigue and/or b) being feverish or having chills, they were scheduled for a clinic visit. During this visit, a blood sample and a nasal swab were collected, as well as information about symptom duration and severity. A second (convalescent) visit was conducted approximately 4 weeks later, which involved collecting additional information about the duration of symptoms and illness burden, as well as a second blood draw. Due to the COVID-19 pandemic, acute and convalescent visits were disrupted at most sites in March and April due to COVID-19 precautions. Results PAIVED year 2 enrolled 5,892 participants who completed demographic forms (Table 1). Among those who reported any ILIs, most reported one ILI (1,345), while 264 reported two ILIs, and 42 reported three ILIs. Nasal swabs were processed from 273 ILIs at four sites (Fig 1), and 14 cases of influenza were identified thus far. The median duration of ILIs was ten days, with a median of three days of limited activity, and two days with fever. Nine individuals were hospitalized. Table 1. Demographic characteristics of individuals enrolled in PAIVED 2019/20 Figure 1. Lab results as of 5/15 (N=273 samples) Conclusion Over 25% of participants reported an ILI, and 5% of the nasal swabs that have been tested thus far have been positive for influenza. While most samples have not yet been analyzed, we have identified some breakthrough cases of influenza among vaccinated participants. Planned analyses include comparative vaccine effectiveness in order to inform future vaccine purchasing decisions. Disclaimer Disclosures All Authors: No reported disclosures

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