scholarly journals Personalised inpatient multidisciplinary rehabilitation elicits clinically relevant improvements in physical function in patients with multiple sclerosis – The Danish MS Hospitals Rehabilitation Study

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732198938
Author(s):  
Lars G Hvid ◽  
Tobias Gaemelke ◽  
Ulrik Dalgas ◽  
Mette K Slipsager ◽  
Peter V Rasmussen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Physical Function ◽  
Upper Extremity ◽  
Step Test ◽  
Multidisciplinary Rehabilitation ◽  
Extremity Function ◽  
Walking Capacity ◽  
Upper Extremity Function ◽  
Dynamic Gait Index

Purpose Evidence of the effects of inpatient multidisciplinary rehabilitation (MDR) on physical function in patients with multiple sclerosis (MS) is limited, particularly whether clinically relevant improvements can be achieved. The aim of this study, therefore, was to investigate the effects of personalised inpatient MDR on the physical function of MS patients. Methods Embedded in the Danish MS Hospitals Rehabilitation Study, a pragmatic study was performed in MS patients undergoing four weeks of inpatient MDR specifically targeting physical function. Outcomes were assessed at baseline (n = 142), at discharge (n = 137) and at six months follow-up (n = 126) using the six-minute walk test (6MWT), six-spot step test (SSST), five times sit to stand test (5STS), nine-hole peg test (NHPT), dynamic gait index (DGI) and 12-item MS walking scale (MSWS). Results From Baseline-to-Discharge, significant and clinically relevant improvements were found in all measures of walking capacity (6MWT, SSST, 5STS, DGI and MSWS; p < 0.05) along with significant (but not clinically relevant) improvements in upper extremity function (NHPT; p < 0.05). Whilst comparable improvements were observed within subgroups of MS phenotype (relapsing-remitting [RR] vs. secondary + primary progressive [SP + PP]), disease severity (moderate [EDSS2.5–5.5] vs. severe [EDSS6.0–7.5]) and age (young/middle-aged [Age24–59] vs. old [Age60–65]), an attenuated adaptation was nevertheless observed for 6MWT in the most affected and vulnerable subgroups (i.e. SP + PP, EDSS6.0–7.5 and Age60–65). The significant improvements in walking capacity and upper extremity function persisted at six months follow-up but did not exceed anymore the thresholds regarded as clinically relevant. Conclusion The results provide novel evidence that personalised inpatient MDR targeting physical function in MS patients elicits significant and clinically relevant improvements in physical function.

Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling Within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2939-2947 ◽  
Author(s):  
Alma R Hernández-Ortíz ◽  
Raquel Ponce-Luceño ◽  
Carlos Sáez-Sánchez ◽  
Olga García-Sánchez ◽  
César Fernández-de-las-Peñas ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Shoulder Pain ◽  
Repeated Measures ◽  
Muscle Tone ◽  
Trigger Point ◽  
Treatment Session ◽  
Dry Needling ◽  
Extremity Function ◽  
Upper Extremity Function

Abstract Objectives To investigate the effects of applying dry needling into a trigger point (TrP) or non-TrP area in people who have suffered a stroke and to investigate if the effects of dry needling are maintained at six-week follow-up. Methods A controlled, repeated-measures, crossover, double-blinded randomized trial was conducted. Nineteen patients with hemiparetic shoulder pain after a stroke event were randomly assigned to receive a single multimodal treatment session combined with TrP dry needling or non-TrP dry needling. The neuro-rehabilitation session included modulatory interventions targeting the central nervous system. Spasticity (Modified Ashworth Scale), shoulder pain intensity (numerical pain rate scale, 0–10), and upper extremity function (Motor Evaluation Scale for Upper Extremity in Stroke [MESUPES], Reaching Performance Scale [RPS]) were assessed before (baseline) and one, two, three, four, five, and six weeks after the treatment session by a blinded assessor. All participants received both sessions in a randomized order where they were followed up for six weeks before receiving the opposite treatment and then followed up for another six weeks. Results Changes in muscle tone (all P &gt; 0.266) and upper extremity function (MESUPES: F = 0.544, P  = 0.465; RPS close task: F = 0.820, P = 0.371; RPS far task: 0.830, P  = 0.368) were similar after both interventions at all follow-up periods. The decrease in shoulder pain was higher within the TrP dry needling group as compared with the non-TrP dry needling group, particularly at two and four weeks (P  = 0.01). Conclusions The effect of dry needling on muscle tone (spasticity) and upper extremity function is not related to its application in or outside of a TrP area. The effect of dry needling on shoulder pain was slightly superior when applied over a TrP in poststroke people. These effects were maintained six weeks after treatment.

scholarly journals Long-Term Quality of Life after Free Flap Upper Extremity Reconstruction for Traumatic Injuries

2019 ◽  
Vol 36 (03) ◽  
pp. 213-222 ◽  
Author(s):  
Sara van Bekkum ◽  
Tim de Jong ◽  
Michiel Zuidam ◽  
Marc A. M. Mureau
Keyword(s):  
Upper Extremity ◽  
Free Flap ◽  
Extremity Function ◽  
Sf 36 ◽  
Patient Reported ◽  
Extremity Reconstruction ◽  
Upper Extremity Function

Abstract Background Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL. Methods In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ). Results A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 “physical component score” and “role limitations due to physical health” scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36. Conclusion Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.

Postoperative Analysis of Patients Who Received the Universal 2 Total Wrist Implant System

2012 ◽  
Vol 28 (4) ◽  
pp. 466-472 ◽  
Author(s):  
Matthew B.A. McCullough ◽  
Brian D. Adams ◽  
Nicole M. Grosland
Keyword(s):  
Upper Extremity ◽  
Patient Perception ◽  
Joint Stability ◽  
Perceived Disability ◽  
Extremity Function ◽  
Total Wrist Arthroplasty ◽  
Severe Arthritis ◽  
Upper Extremity Function ◽  
Implant System

Third-generation total wrist arthroplasty devices have provided joint stability, relief from pain and increased wrist motion for patients suffering from severe arthritis. While reports of clinical follow-up appointments describe improved wrist function, the improvement in overall upper extremity function and patient perception remains a question. Therefore, the purpose of this study was to assess the upper extremity function in patients that received the Universal 2 total implant system. Eight patients participated in the complete protocol, which included testing activities of daily living as well as surveys to assess patient perception. The findings of the current study suggest that although patients exhibit motion that exceeds the needed amount, many still have a perceived disability.

Assessment of Upper Extremity Function in Multiple Sclerosis: Review and Opinion

2014 ◽  
Vol 126 (5) ◽  
pp. 102-108 ◽  
Author(s):  
George H. Kraft ◽  
Dagmar Amtmann ◽  
Susan E. Bennett ◽  
Marcia Finlayson ◽  
Matthew H. Sutliff ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Extremity ◽  
Extremity Function ◽  
Upper Extremity Function

scholarly journals A smartphone sensor-based digital outcome assessment of multiple sclerosis

2021 ◽  
pp. 135245852110285
Author(s):  
Xavier Montalban ◽  
Jennifer Graves ◽  
Luciana Midaglia ◽  
Patricia Mulero ◽  
Laura Julian ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Extremity ◽  
Clinical Care ◽  
Intraclass Correlation ◽  
Rank Correlation ◽  
Static Balance ◽  
Balance Test ◽  
Passive Monitoring ◽  
Extremity Function ◽  
Upper Extremity Function

Background: Sensor-based monitoring tools fill a critical gap in multiple sclerosis (MS) research and clinical care. Objective: The aim of this study is to assess performance characteristics of the Floodlight Proof-of-Concept (PoC) app. Methods: In a 24-week study (clinicaltrials.gov: NCT02952911), smartphone-based active tests and passive monitoring assessed cognition (electronic Symbol Digit Modalities Test), upper extremity function (Pinching Test, Draw a Shape Test), and gait and balance (Static Balance Test, U-Turn Test, Walk Test, Passive Monitoring). Intraclass correlation coefficients (ICCs) and age- or sex-adjusted Spearman’s rank correlation determined test–retest reliability and correlations with clinical and magnetic resonance imaging (MRI) outcome measures, respectively. Results: Seventy-six people with MS (PwMS) and 25 healthy controls were enrolled. In PwMS, ICCs were moderate-to-good (ICC(2,1) = 0.61–0.85) across tests. Correlations with domain-specific standard clinical disability measures were significant for all tests in the cognitive ( r = 0.82, p < 0.001), upper extremity function (|r|= 0.40–0.64, all p < 0.001), and gait and balance domains ( r = −0.25 to −0.52, all p < 0.05; except for Static Balance Test: r = −0.20, p > 0.05). Most tests also correlated with Expanded Disability Status Scale, 29-item Multiple Sclerosis Impact Scale items or subscales, and/or normalized brain volume. Conclusion: The Floodlight PoC app captures reliable and clinically relevant measures of functional impairment in MS, supporting its potential use in clinical research and practice.

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