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

2021 ◽  
pp. 026921552110432
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.

Work and pain ◽  
2019 ◽  
pp. 19-32
Elaine Wainwright

Pain can be thought about at individual, social, and global levels and discursively defined in different ontological and epistemological ways. There is presently no absolute agreement about how to define it. However, there are movements to bridge the sufferer–observer, subjective–objective gap, and to think about pain from a functional perspective as opposed to conceptualizing it simply as an experience. Key conceptualizations of pain focus on its embodied nature and its extant function in protecting the organism from threat. Many epidemiological studies and systematic reviews define pain via International Association for the Study of Pain and International Classification of Diseases criteria, and show the extent of the global pain burden. Pain has many negative consequences across the life span, including a distinct impact on people’s working lives. How pain is conceptualized has important implications for clinical, research, and policy agendas. The embodied view of pain as an action against uncertainty means that if we are to reduce pain intrusion and interference (including whilst we work, or more broadly occupy ourselves) we must attend more deeply to how people manage threats to identity and coherence. We need clearer agendas to seek better pain-relieving resolutions than we achieve today.

2014 ◽  
Vol 34 (5) ◽  
pp. 737-742 ◽  
Emily S Sena ◽  
Gillian L Currie ◽  
Sarah K McCann ◽  
Malcolm R Macleod ◽  
David W Howells

The use of systematic review and meta-analysis of preclinical studies has become more common, including those of studies describing the modeling of cerebrovascular diseases. Empirical evidence suggests that too many preclinical experiments lack methodological rigor, and this leads to inflated treatment effects. The aim of this review is to describe the concepts of systematic review and meta-analysis and consider how these tools may be used to provide empirical evidence to spur the field to improve the rigor of the conduct and reporting of preclinical research akin to their use in improving the conduct and reporting of randomized controlled trials in clinical research. As with other research domains, systematic reviews are subject to bias. Therefore, we have also suggested guidance for their conduct, reporting, and critical appraisal.

2015 ◽  
Vol 113 (7) ◽  
pp. 1170-1177 ◽  
Jessica L. Unick ◽  
Kevin C. O'Leary ◽  
Leah Dorfman ◽  
J. Graham Thomas ◽  
Kelley Strohacker ◽  

It is often assumed that some individuals reliably increase energy intake (EI) post-exercise (‘compensators’) and some do not (‘non-compensators’), leading researchers to examine the characteristics that distinguish these two groups. However, it is unclear whether EI post-exercise is stable over time. The present study examined whether compensatory eating responses to a single exercise bout are consistent within individuals across three pairs of trials. Physically inactive, overweight/obese women (n28, BMI 30·3 (sd2·9) kg/m2) participated in three pairs of testing sessions, with each pair consisting of an exercise (30 min of moderate-intensity walking) and resting testing day. EI was measured using a buffet meal 1 h post-exercise/rest. For each pair, the difference in EI (EIdiff= EIex− EIrest) was calculated, where EIexis the EI of the exercise session and EIrestis the EI of the resting session, and women were classified as a ‘compensator’ (EIex>EIrest) or ‘non-compensator’ (EIex≤ EIrest). The average EI on exercise days (3328·0 (sd1686·2) kJ) was similar to those on resting days (3269·4 (sd1582·4) kJ) (P= 0·67). Although EI was reliable within individuals across the three resting days (intraclass correlation coefficient (ICC) 0·75, 95 % CI 0·60, 0·87;P< 0·001) and three exercise days (ICC 0·83, 95 % CI 0·70, 0·91;P< 0·001), the ICC for EIdiffacross the three pairs of trials was low (ICC 0·20, 95 % CI − 0·02, 0·45;P= 0·04), suggesting that compensatory eating post-exercise is not a stable construct. Moreover, the classification of ‘compensators’/‘non-compensators’ was not reliable (κ =− 0·048;P= 0·66). The results were unaltered when ‘relative’ EI was used, which considers the energy expenditure of the exercise/resting sessions. Acute compensatory EI following an exercise bout is not reliable in overweight women. Seeking to understand what distinguishes ‘compensators’ from ‘non-compensators’ based on a single eating episode post-exercise is not justified.

Michael G. Klein ◽  
Carolynn J. Cheng ◽  
Evonne Lii ◽  
Keying Mao ◽  
Hamza Mesbahi ◽  

ABSTRACT Objective: Health system preparedness for coronavirus disease (COVID-19) includes projecting the number and timing of cases requiring various types of treatment. Several tools were developed to assist in this planning process. This review highlights models that project both caseload and hospital capacity requirements over time. Methods: We systematically reviewed the medical and engineering literature according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We completed searches using PubMed, EMBASE, ISI Web of Science, Google Scholar, and the Google search engine. Results: The search strategy identified 690 articles. For a detailed review, we selected 6 models that met our predefined criteria. Half of the models did not include age-stratified parameters, and only 1 included the option to represent a second wave. Hospital patient flow was simplified in all models; however, some considered more complex patient pathways. One model included fatality ratios with length of stay (LOS) adjustments for survivors versus those who die, and accommodated different LOS for critical care patients with or without a ventilator. Conclusion: The results of our study provide information to physicians, hospital administrators, emergency response personnel, and governmental agencies on available models for preparing scenario-based plans for responding to the COVID-19 or similar type of outbreak.

2020 ◽  
Vol 29 (01) ◽  
pp. 193-202
Anthony Solomonides

Objectives: Clinical Research Informatics (CRI) declares its scope in its name, but its content, both in terms of the clinical research it supports—and sometimes initiates—and the methods it has developed over time, reach much further than the name suggests. The goal of this review is to celebrate the extraordinary diversity of activity and of results, not as a prize-giving pageant, but in recognition of the field, the community that both serves and is sustained by it, and of its interdisciplinarity and its international dimension. Methods: Beyond personal awareness of a range of work commensurate with the author’s own research, it is clear that, even with a thorough literature search, a comprehensive review is impossible. Moreover, the field has grown and subdivided to an extent that makes it very hard for one individual to be familiar with every branch or with more than a few branches in any depth. A literature survey was conducted that focused on informatics-related terms in the general biomedical and healthcare literature, and specific concerns (“artificial intelligence”, “data models”, “analytics”, etc.) in the biomedical informatics (BMI) literature. In addition to a selection from the results from these searches, suggestive references within them were also considered. Results: The substantive sections of the paper—Artificial Intelligence, Machine Learning, and “Big Data” Analytics; Common Data Models, Data Quality, and Standards; Phenotyping and Cohort Discovery; Privacy: Deidentification, Distributed Computation, Blockchain; Causal Inference and Real-World Evidence—provide broad coverage of these active research areas, with, no doubt, a bias towards this reviewer’s interests and preferences, landing on a number of papers that stood out in one way or another, or, alternatively, exemplified a particular line of work. Conclusions: CRI is thriving, not only in the familiar major centers of research, but more widely, throughout the world. This is not to pretend that the distribution is uniform, but to highlight the potential for this domain to play a prominent role in supporting progress in medicine, healthcare, and wellbeing everywhere. We conclude with the observation that CRI and its practitioners would make apt stewards of the new medical knowledge that their methods will bring forward.

2019 ◽  
Vol 62 (9) ◽  
pp. 3265-3275
Heather L. Ramsdell-Hudock ◽  
Anne S. Warlaumont ◽  
Lindsey E. Foss ◽  
Candice Perry

Purpose To better enable communication among researchers, clinicians, and caregivers, we aimed to assess how untrained listeners classify early infant vocalization types in comparison to terms currently used by researchers and clinicians. Method Listeners were caregivers with no prior formal education in speech and language development. A 1st group of listeners reported on clinician/researcher-classified vowel, squeal, growl, raspberry, whisper, laugh, and cry vocalizations obtained from archived video/audio recordings of 10 infants from 4 through 12 months of age. A list of commonly used terms was generated based on listener responses and the standard research terminology. A 2nd group of listeners was presented with the same vocalizations and asked to select terms from the list that they thought best described the sounds. Results Classifications of the vocalizations by listeners largely overlapped with published categorical descriptors and yielded additional insight into alternate terms commonly used. The biggest discrepancies were found for the vowel category. Conclusion Prior research has shown that caregivers are accurate in identifying canonical babbling, a major prelinguistic vocalization milestone occurring at about 6–7 months of age. This indicates that caregivers are also well attuned to even earlier emerging vocalization types. This supports the value of continuing basic and clinical research on the vocal types infants produce in the 1st months of life and on their potential diagnostic utility, and may also help improve communication between speech-language pathologists and families.

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 355-362 ◽  
Marie Urban ◽  
Alban Fouasson-Chailloux ◽  
Isabelle Signolet ◽  
Christophe Colas Ribas ◽  
Mathieu Feuilloy ◽  

Abstract. Summary: Background: We aimed at estimating the agreement between the Medicap® (photo-optical) and Radiometer® (electro-chemical) sensors during exercise transcutaneous oxygen pressure (tcpO2) tests. Our hypothesis was that although absolute starting values (tcpO2rest: mean over 2 minutes) might be different, tcpO2-changes over time and the minimal value of the decrease from rest of oxygen pressure (DROPmin) results at exercise shall be concordant between the two systems. Patients and methods: Forty seven patients with arterial claudication (65 + / - 7 years) performed a treadmill test with 5 probes each of the electro-chemical and photo-optical devices simultaneously, one of each system on the chest, on each buttock and on each calf. Results: Seventeen Medicap® probes disconnected during the tests. tcpO2rest and DROPmin values were higher with Medicap® than with Radiometer®, by 13.7 + / - 17.1 mm Hg and 3.4 + / - 11.7 mm Hg, respectively. Despite the differences in absolute starting values, changes over time were similar between the two systems. The concordance between the two systems was approximately 70 % for classification of test results from DROPmin. Conclusions: Photo-optical sensors are promising alternatives to electro-chemical sensors for exercise oximetry, provided that miniaturisation and weight reduction of the new sensors are possible.

1997 ◽  
Vol 8 (S3) ◽  
pp. 273-279 ◽  
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).

1997 ◽  
Vol 38 (5) ◽  
pp. 855-862 ◽  
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.

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