scholarly journals Why we need an internationally shared rehabilitation definition for clinical research purposes

2021 ◽  
pp. 026921552110432
Author(s):  
Stefano Negrini ◽  
William Mark Magnus Levack ◽  
Thorsten Meyer ◽  
Carlotte Kiekens

Purpose: Responding to a recent editorial arguing against defining rehabilitation, we discuss the reasons for developing a classification of rehabilitation for research purposes, its philosophical background and some of the possible risks. Why define: Science requires the definition and classification of phenomena to allow replication of experiments and studies, and to allow interpretation and use of the findings. As understanding increases, the definitions can be refined. Defining rehabilitation does run the risk of excluding some interventions or practices that are either considered rehabilitation (perhaps wrongly) or are rehabilitation interventions; when identified, these errors in definition can be remedied. Defining rehabilitation for research purposes should not inhibit but could (possibly) orient research. Risk of not: Without a definition, rehabilitation will remain in a permanent limbo. Experts will (apparently) know what it is, while others are left guessing or failing to comprehend or recognise it. This uncertainty may reassure some people, because all possible interventions are included; we argue that it downgrades the understanding of our field because interventions that are not rehabilitation are, nonetheless, called rehabilitation. In an era of international collaboration, and of undertaking systematic reviews with metanalysis, we need a shared definition. Conclusion: Terminology is often controversial, but definition enables progress in understanding such that terms themselves can evolve over time.

1997 ◽  
Vol 38 (5) ◽  
pp. 855-862 ◽  
Author(s):  
P. Hochbergs ◽  
G. Eckervall ◽  
H. Wingstrand ◽  
N. Egund ◽  
K. Jonsson

Purpose: By means of MR imaging, to determine signal abnormalities in the femoral epiphysis; to determine their location, extent and restitution over time; and to correlate these findings to the Catterall radiological classification. Material and Methods: A total of 247 MR images in 86 patients (101 hips) with Legg-CalvC-Perthes disease were examined. The MR images were taken in the coronal plane, and the images through the center of the femoral head were used for this study. Results: T1-weighted images proved as good as T2-weighted images for the MR evaluation of the extent of the necrosis. In almost every case, the central-cranial part of the epiphysis showed a low initial signal. In Catterall group I, the medial part was never involved. In Catterall III and IV, almost the entire epiphysis showed signal changes. In the period 3–6 years after diagnosis, we still found signal changes in the epiphysis in some hips but there was no correlation with the Catterall classification. After 6 years, the epiphysis showed normal signal intensity in MR imaging. In T1-weighted images, Gd-enhancement occurred in the peripheral regions in the early stages of the disease. The central part of the epiphysis became more enhanced over time and peaked in the period 1–3 years after diagnosis. Conclusion: MR is a valuable modality for monitoring changes in the femoral epiphysis. We propose a new classification of the extent and pattern of epiphyseal bone-marrow abnormalities based on the 4 zones most commonly observed in MR imaging.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abhinav J Appukutty ◽  
Lesli E Skolarus ◽  
Mellanie V Springer ◽  
William J Meurer ◽  
James F Burke

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.


1997 ◽  
Vol 8 (S3) ◽  
pp. 273-279 ◽  
Author(s):  
Eric D. Caine

Establishing a medical diagnosis serves two utilitarian purposes: providing information necessary to initiate treatment and communicating information regarding prognosis. A nosology or diagnostic nomenclature (i.e., a classification of diagnoses) provides further utility by establishing a foundation for clinical research. In his book, Wulff outlined four types of diagnoses: (1) symptomatic or pseudoanatomic diagnoses (e.g., chronic headache, persistent diarrhea, or irritable bowel); (2) syndromes; (3) anatomic diagnoses; and (4) causal diagnoses. By definition, syndromes have no means of being validated by measures external to the constructs themselves. Often, specific syndromes reflect diverse origins, and conversely, specific etiologies may cause multiple syndromes (e.g., syphilis, human immunodeficiency virus, and diabetes).


2021 ◽  
Vol 12 ◽  
Author(s):  
Fatma Refat ◽  
Jakob Wertz ◽  
Pauline Hinrichs ◽  
Uwe Klose ◽  
Hesham Samy ◽  
...  

Although tinnitus represents a major global burden, no causal therapy has yet been established. Ongoing controversies about the neuronal pathophysiology of tinnitus hamper efforts in developing advanced therapies. Hypothesizing that the unnoticed co-occurrence of hyperacusis and differences in the duration of tinnitus may possibly differentially influence the neural correlate of tinnitus, we analyzed 33 tinnitus patients without (T-group) and 20 tinnitus patients with hyperacusis (TH-group). We found crucial differences between the T-group and the TH-group in the increase of annoyance, complaints, tinnitus loudness, and central neural gain as a function of tinnitus duration. Hearing thresholds did not differ between T-group and TH-group. In the TH-group, the tinnitus complaints (total tinnitus score) were significantly greater from early on and the tinnitus intensity distinctly increased over time from ca. 12 to 17 dB when tinnitus persisted more than 5 years, while annoyance responses to normal sound remained nearly constant. In contrast, in the T-group tinnitus complaints remained constant, although the tinnitus intensity declined over time from ca. 27 down to 15 dB beyond 5 years of tinnitus persistence. This was explained through a gradually increased annoyance to normal sound over time, shown by a hyperacusis questionnaire. Parallel a shift from a mainly unilateral (only 17% bilateral) to a completely bilateral (100%) tinnitus percept occurred in the T-group, while bilateral tinnitus dominated in the TH-group from the start (75%). Over time in the T-group, ABR wave V amplitudes (and V/I ratios) remained reduced and delayed. By contrast, in the TH-group especially the ABR wave III and V (and III/I ratio) continued to be enhanced and shortened in response to high-level sound stimuli. Interestingly, in line with signs of an increased co-occurrence of hyperacusis in the T-group over time, ABR wave III also slightly increased in the T-group. The findings disclose an undiagnosed co-occurrence of hyperacusis in tinnitus patients as a main cause of distress and the cause of complaints about tinnitus over time. To achieve urgently needed and personalized therapies, possibly using the objective tools offered here, a systematic sub-classification of tinnitus and the co-occurrence of hyperacusis is recommended.


F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 221 ◽  
Author(s):  
Assem M. Khamis ◽  
Lara A. Kahale ◽  
Hector Pardo-Hernandez ◽  
Holger J. Schünemann ◽  
Elie A. Akl

Background: The living systematic review (LSR) is an emerging approach for improved evidence synthesis that uses continual updating to include relevant new evidence as soon as it is published. The objectives of this study are to: 1) assess the methods of conduct and reporting of living systematic reviews using a living study approach; and 2) describe the life cycle of living systematic reviews, i.e., describe the changes over time to their methods and findings. Methods: For objective 1, we will begin by conducting a cross-sectional survey and then update its findings every 6 months by including newly published LSRs. For objective 2, we will conduct a prospective longitudinal follow-up of the cohort of included LSRs. To identify LSRs, we will continually search the following electronic databases: Medline, EMBASE and the Cochrane library. We will also contact groups conducting LSRs to identify eligible studies that we might have missed. We will follow the standard systematic review methodology for study selection and data abstraction. For each LSR update, we will abstract information on the following: 1) general characteristics, 2) systematic review methodology, 3) living approach methodology, 4) results, and 5) editorial and publication processes. We will update the findings of both the surveys and the longitudinal follow-up of included LSRs every 6 months. In addition, we will identify articles addressing LSR methods to be included in an ‘LSR methods repository’. Conclusion: The proposed living methodological survey will allow us to monitor how the methods of conduct, and reporting as well as the findings of LSRs change over time. Ultimately this should help with ensuring the quality and transparency of LSRs.


Author(s):  
Sónia Leite ◽  
Diana Brás

Resumo As sociedades têm, ao longo dos tempos, desenvolvido práticas e conceitos diversos face ao que consideram como “o diferente”. A forma como as pessoas “diferentes” têm sido encaradas em diversos momentos históricos traduz, de alguma forma, fatores de ordem social, cultural, religiosa e económica, próprios das diversas épocas (Pereira, 1999). Na última década, foram introduzidas mudanças significativas no apoio a prestar aos alunos com Necessidades Educativas Especiais (NEE) pelas escolas do ensino regular. O Decreto-Lei no 3/2008, de 7 de Janeiro veio revogar o Decreto-Lei no 319/91, de 23 de Agosto, o qual determina os apoios especializados a prestar aos alunos com NEE. Este diploma gerou muita controvérsia por parte dos investigadores nacionais, por limitar o público-alvo de apoios especializados e defender um modelo de avaliação das NEE por referência à Classificação Internacional de funcionalidade, incapacidade e saúde (CIF). Uma década depois, o diploma que regulamenta a Educação Especial foi novamente revisto, tendo surgido o Decreto-Lei 54/2018. Através de um questionário com questões abertas e fechadas foi nosso intuito obter informação relativamente à perspetiva dos professores de ensino regular acerca da inclusão de alunos com NEE nas salas de ensino regular e às alterações previstas no novo Decreto-Lei que regulamenta a Educação Especial e os apoios a prestar a estes alunos.Palavras-chave: Educação Especial, Necessidades Educativas Especiais, Decreto-Lei Abstract Societies have, over time, developed diverse practices and concepts in relation to what they consider as "the different". The way in which "different" people have been viewed at various historical moments translates in some way into social, cultural, religious and economic factors characteristic of the various eras (Pereira, 1999). In the last decade, significant changes have been introduced in support for pupils with Special Educational Needs (SEN) in regular schools. Decree- Law no. 3/2008, of 7 January, revoked Decree-Law no. 319/91, of 23 August, which determines the specialized support to be provided to students with SEN. This diploma generated much controversy on the part of the national researchers, for limiting the target audience of specialized supports and to defend a model of evaluation of the SEN with reference to the International Classification of functionality, incapacity and health (CIF). A decade later, the diploma that regulates Special Education was again revised, and Decree-Law 54/2018 emerged. Through a questionnaire with open and closed questions, it was our intention to obtain information regarding the perspective of teachers of regular education about the inclusion of students with SEN in the regular teaching rooms and the changes provided for in the new Decree- Law that regulates Special Education and the support to these students.Keywords: Special Education, Special Educational Needs, Decree-Law


2021 ◽  
Author(s):  
Andrew Chen ◽  
Ronen Stein ◽  
Robert N. Baldassano ◽  
Jing Huang

ABSTRACTBackgroundThe current classification of pediatric CD is mainly based on cross-sectional data. The objective of this study is to identify subgroups of pediatric CD through trajectory cluster analysis of disease activity using data from electronic health records.MethodsWe conducted a retrospective study of pediatric CD patients who had been treated with infliximab. The evolution of disease over time was described using trajectory analysis of longitudinal data of C-Reactive Protein (CRP). Patterns of disease evolution were extracted through functional principal components analysis and subgroups were identified based on those patterns using the Gaussian mixture model. We compared patient characteristics, a biomarker for disease activity, received treatments, and long-term surgical outcomes across subgroups.ResultsWe identified four subgroups of pediatric CD patients with differential relapse-and-remission risk profiles. They had significantly different disease phenotype (p < 0.001), CRP (p < 0.001) and calprotectin (p = 0.037) at diagnosis, with increasing percentage of inflammatory phenotype and declining CRP and fecal calprotectin levels from Subgroup 1 through 4. The risk of colorectal surgery within 10 years after diagnosis was significantly different between groups (p < 0.001). We did not find statistical significance in gender or age at diagnosis across subgroups, but the BMI z-score was slightly smaller in subgroup 1 (p =0.055).ConclusionsReadily available longitudinal data from electronic health records can be leveraged to provide a deeper characterization of pediatric Crohn disease. The identified subgroups captured novel forms of variation in pediatric Crohn disease that were not explained by baseline measurements and treatment information.SummaryThe current classification of pediatric Crohn disease mainly relies on cross-sectional data, e.g., the Paris classification. However, the phenotypic classification may evolve over time after diagnosis. Our study utilized longitudinal measures from the electronic health records and stratified pediatric Crohn disease patients with differential relapse-and-remission risk profiles based on patterns of disease evolution. We found trajectories of well-maintained low disease activity were associated with less severe disease at baseline, early initiation of infliximab treatment, and lower risk of surgery within 10 years of diagnosis, but the difference was not fully explained by phenotype at diagnosis.


2021 ◽  
Vol 30 (1) ◽  
pp. 93-110
Author(s):  
Tianyi Wang ◽  

Differential equations are widely used to model systems that change over time, some of which exhibit chaotic behaviors. This paper proposes two new methods to classify these behaviors that are utilized by a supervised machine learning algorithm. Dissipative chaotic systems, in contrast to conservative chaotic systems, seem to follow a certain visual pattern. Also, the machine learning program written in the Wolfram Language is utilized to classify chaotic behavior with an accuracy around 99.1±1.1%.


2021 ◽  
Author(s):  
Qinglan Ding ◽  
Daisy Massey ◽  
Chenxi Huang ◽  
Connor Grady ◽  
Yuan Lu ◽  
...  

BACKGROUND Harnessing health-related data posted on social media in real-time has the potential to offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. OBJECTIVE The aim of this study was to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the coronavirus disease 2019 (COVID-19) pandemic, and to determine how discussion of these symptoms and medical conditions on social media changed over time. METHODS We used natural language processing (NLP) algorithms to identify symptom and medical condition topics being discussed on social media between June 14 and December 13, 2020. The sample social media posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of the posts. We also assessed the frequency of different health-related discussions on social media over time during the study period, and compared the changes in the frequency of each symptom/medical condition discussion to the fluctuation of U.S. daily new COVID-19 cases during the study period. Additionally, we compared the trends of the 5 most commonly mentioned symptoms and medical conditions from June 14 to August 31 (when the U.S. passed 6 million COVID-19 cases) to the trends observed from September 1 to December 13, 2020. RESULTS Within a total of 9,807,813 posts (nearly 70% were sourced from the U.S.), we identified discussion of 120 symptom topics and 1,542 medical condition topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were: anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were: COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). The changes in the frequency of 2 medical conditions, COVID-19 and unspecified infectious disease, were similar to the fluctuation of daily new confirmed cases of COVID-19 in the U.S. CONCLUSIONS COVID-19 and symptoms of anxiety were the two most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population's mental health status and enhance public health surveillance for infectious disease.


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