scholarly journals Symptom reduction and improved function in chronic CRPS type 1 after 12-week integrated, interdisciplinary therapy

2019 ◽  
Vol 19 (2) ◽  
pp. 257-270 ◽  
Author(s):  
Minna Elomaa ◽  
Jaakko Hotta ◽  
Amanda C de C Williams ◽  
Nina Forss ◽  
Anni Äyräpää ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Upper Limb ◽  
Psychological Factors ◽  
Psychological Intervention ◽  
Rehabilitation Program ◽  
Secondary Outcomes ◽  
Video Experiment ◽  
And Function ◽  
Weekly Group

Abstract Background and aims Complex Regional Pain Syndrome (CRPS) often recovers spontaneously within the first year, but when it becomes chronic, available rehabilitative therapies (pharmacological management, physiotherapy, and psychological intervention) have limited effectiveness. This study examined the effect of a 12-week intensive outpatient rehabilitation on pain relief and function in chronic CRPS patients. Rehabilitation program included memantine and morphine treatment (added to patient’s prior pain medication) and concurrent psychological and physiotherapeutic intervention. Primary outcome measure was a change in CRPS symptom count and secondary outcomes were motor performance, psychological factors, pain intensity, and quality of life. Methods Ten patients with chronic upper limb CRPS I (median 2.9 years, range 8 months to 12 years) were recruited to the study and were assessed before and after the intervention. Hand motor function of the patients was evaluated by an independent physiotherapist. There were standardized questionnaires for depression, pain anxiety, pain acceptance, quality of life, and CRPS symptom count. In addition, psychological factors were evaluated by a semi-structured interview. Severity of experienced pain was rated at movement and at rest. In addition, a video experiment of a hand action observation was conducted pre- and post-intervention to study possible change in neuronal maladaptation. Intervention consisted of pharmacological, psychological and physiotherapeutic treatment. First, 10 mg daily morphine was started and increased gradually to 30 mg daily, if tolerated. After 30 mg/day or tolerated dose of morphine was achieved, 5 mg daily memantine was started and increased gradually to 40 mg, if tolerated. Psychological intervention consisted of weekly group sessions, using cognitive and behavioral methods (relaxation, behavioral activation, and exposure) and acceptance and commitment therapy (ACT) and daily home practice. Physiotherapeutic intervention consisted of graded motor imagery and physiotherapy exercises with weekly group sessions and/or individual guidance by the physiotherapist, and individual exercise of the affected upper limb. Results Multimodal intensive intervention resulted in significant decrease in CRPS symptom count. The effect was strongest in motor and trophic symptoms (19% decrease after intervention) and in sensory symptoms (18% decrease). Additionally, improvement was seen in some, but not all, secondary outcomes (movement pain, motor symptoms, change in perceptions during video experiment of hand actions, and summary index with motor functioning, pain, and psychological factors). There were no dropouts. Conclusions Intensive 12-week multimodal intervention reduced some CRPS symptoms but was not sufficient to alter patients’ rest pain, distress, or quality of life. Implications These results support the efficacy of an interdisciplinary rehabilitation program for pain and function in chronic CRPS patients. After intervention, some CRPS symptoms reduced and function improved, but distress and quality of life were unchanged. This may be due to the relatively short duration of this program; to delayed effects; to particular cognitive problems of CPRS patients; and/or to low distress levels at baseline that make statistically significant reduction less likely.

scholarly journals Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Monticone ◽  
Igor Portoghese ◽  
Daniele Cazzaniga ◽  
Valentina Liquori ◽  
Giuseppe Marongiu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Group Differences ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
One Year ◽  
Task Oriented

Abstract Background General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. Methods By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients’ specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05). Results Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. Conclusions A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months. Trial registration On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552.

scholarly journals Effects of the combination of metformin and exercise on glycated hemoglobin, functional capacity, lipid profile, quality of life, and body weight

2019 ◽  
Vol 47 (3) ◽  
pp. 1131-1145 ◽  
Author(s):  
Sherif Eltonsy ◽  
Monique Dufour Doiron ◽  
Patrice Simard ◽  
Caroline Jose ◽  
Martin Sénéchal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lipid Profile ◽  
Functional Capacity ◽  
Glycated Hemoglobin ◽  
Rehabilitation Program ◽  
Directed Acyclic Graphs ◽  
Secondary Outcomes ◽  
6 Minute Walk Test ◽  
The Impact

Objective To evaluate the impact of the combination of metformin and exercise on changes in glycated hemoglobin (HbA1c), functional capacity, the lipid profile, quality of life, and weight. Methods Data from a 12-week cardiovascular rehabilitation program (2014–2016) were retrospectively evaluated. Metformin exposure was determined through recorded prescriptions, and average minutes of exercise per week were computed from exercise logs. The primary outcomes were changes in HbA1c and functional capacity (6-minute walk test [6MWT]) over 12 weeks. The secondary outcomes were changes in the lipid profile, quality of life, and weight. Directed acyclic graphs were used to identify potential confounders, accounted for with multiple linear regression. Results The cohort comprised 403 patients (85 metformin users, 318 non-users). The average amount of exercise was 102.7±48.7 minutes/week among metformin users and 107.7±58.1 minutes/week among non-users. Although changes in HbA1c were similar for both groups, the coefficient for the metformin–exercise interaction indicated significantly greater improvements in the 6MWT among metformin users. There were no between-group differences in any secondary outcomes. Conclusions The combination of metformin and exercise led to greater gains in functional capacity than exercise alone. This combination did not appear to influence the effects of either treatment on other outcomes.

Effects of the @ctivehip tele-rehabilitation program on the quality of life, psychological factors and fitness level of patients with hip fracture: Controlled trial (Preprint)

2021 ◽  
Author(s):  
Marta Mora-Traverso ◽  
Rafael Prieto-Moreno ◽  
Pablo Molina-Garcia ◽  
Zeus Salas-Fariña ◽  
Lydia Martín-Martín ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hip Fracture ◽  
Effect Size ◽  
Psychological Factors ◽  
Rehabilitation Program ◽  
Medium Effect ◽  
Anxiety And Depression ◽  
Control Group ◽  
Fitness Level

BACKGROUND Hip fracture has a severe impact on patients’ quality of life, psychological factors and fitness level. Tele-rehabilitation has emerged in the last years as a promising alternative to conduct the rehabilitation process at home. However, there is no studies testing the effects of tele-rehabilitation interventions for patients with hip fracture on quality of life nor psychological factors, whereas the evidence on fitness level is scarce. OBJECTIVE To test the effects of the @ctivehip tele-rehabilitation program on the quality of life, psychological factors and fitness level of patients who had suffered a hip fracture. METHODS It is a non-randomized clinical trial including patients with 65 five years old onwards with a hip fracture as well as their family caregivers. The intervention group received a home-based multidisciplinary tele-rehabilitation intervention called @ctivehip lasting 12 weeks and the control group received the traditional care and rehabilitation provided by the Andalusian Public Health Care System. The outcomes measured were the patients’ quality of life through the EuroQol Quality of Life Questionnaire (EQ-5D), physiological factors (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS), and the fitness level, assessed with the International Fitness Scale (IFIS). Per-protocol (64 participants) and intention-to-treat (71 participants) analyses were performed, being the first one the main analysis. RESULTS The quality of life of the tele-rehabilitation group increased, while the control group scored worst at 3-month follow-up (medium effect size: 0.66 SDs; p = 0.006). The tele-rehabilitation group demonstrated a greater decrease than the control group in the total HADS score (medium effect size: -0.50 SDs; p = 0.015). Lastly, the tele-rehabilitation group recovered a fitness level close to the pre-hip fracture in comparison with the control group (small effect size: 0.49 SDs; p = 0.022). CONCLUSIONS The @ctivehip tele-rehabilitation program seem to be a promising treatment to improve the quality of life and psychological factors (i.e., anxiety and depression) of older adults after a hip fracture, as well as to recover their previous fitness level. CLINICALTRIAL ClinicalTrials.gov (Identifier: NCT02968589).

Regeneration of market squares in historic town centres: ideas, discussions, controversies

2018 ◽  
Vol 60 (1) ◽  
pp. 67-79
Author(s):  
Natalia Bursiewicz
Keyword(s):  
Quality Of Life ◽  
Form And Function ◽  
Points Of View ◽  
And Function ◽  
Historic Cities ◽  
Lower Silesia

Abstract In Poland, the last 15 years have been marked by various, numerous regeneration projects of historic cities that were supposed to improve the citizens quality of life and their security, as well as to create an attractive tourist offer. Those programs were often focused on the renewal, reshape and modernization of public squares. Such changes never go unnoticed. On contrary, these are frequently associated with criticism, debate and disagreements. The research has been focused on the analysis of regeneration projects from selected Market Squares in historic cities and town centres in Lower Silesia. The main aim was to exhibit the medieval origin of those squares and recently introduced contemporary layout. Moreover it was to present diverse opinions regarding square’s form and function, that can be crucial in understanding the architects, planners and citizens’ points of view and their ‘feelings’ towards the space.

Particularities of tinnitus in children and adolescents

ORL ro ◽  
2016 ◽  
Vol 4 (1) ◽  
pp. 40-42
Author(s):  
Alexandra Boloș ◽  
Sebastian Cozma ◽  
Andreea Silvana Szalontay
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
Children And Adolescents ◽  
Psychological Factors ◽  
Ambient Noise ◽  
Psychological Consequences ◽  
Therapeutic Approaches

Tinnitus is a common otologic symptom and probably the most troublesome. Tinnitus causes a number of physical and psychological consequences, that interfere with the quality of life of the patient. Many authors believe that the presence of tinnitus in children is a matter of lesser importance than in adults because it is met less frequently and would be a fleeting symptom, inoffensive for them (Graham, 1981). In addition, the prevalence of tinnitus during adolescence and even in young adults is increasing, possibly as a consequence of the increased ambient noise (Bulbul SF, Shargorodsky J). Various therapeutic approaches have generated different results, which led us to consider the role of psychological factors, hence the need to underline the particularities of this symptom in childhood.  

scholarly journals Carpal and cubital tunnel syndromes

2021 ◽  
pp. 175573802110182
Author(s):  
Richard Mayne ◽  
Neil Heron
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Upper Limb ◽  
Cubital Tunnel ◽  
Hand Dominance ◽  
Affected Person ◽  
Wrist Function ◽  
Tunnel Syndromes ◽  
Huge Variety

Tingling, pain and numbness in the hand can be a major cause of morbidity for many people. Adequate hand and wrist function are required for a huge variety of daily tasks, therefore disorders of the hand and wrist can have significant detrimental effects on the quality of life for affected individuals. With any upper limb issue, it is important to consider hand dominance, occupation and pastimes of the affected person. This article focuses on the optimal diagnosis and management of carpal and cubital tunnel syndromes from a primary care perspective.

scholarly journals The Motivation Journey: A Grounded Theory Study on Female Cancer Survivors’ Experience of a Psychological Intervention for Quality of Life

2021 ◽  
Vol 18 (3) ◽  
pp. 950
Author(s):  
Ilaria Durosini ◽  
Lucrezia Savioni ◽  
Stefano Triberti ◽  
Paolo Guiddi ◽  
Gabriella Pravettoni
Keyword(s):  
Quality Of Life ◽  
Grounded Theory ◽  
Cancer Survivors ◽  
Psychological Intervention ◽  
Psychological Interventions ◽  
Theory Approach ◽  
Axial Coding ◽  
Motivation To Participate ◽  
Female Cancer Survivors

Psychological interventions are proposed to cancer survivors to support their quality of life against the emotional trauma of cancer and the side effects of treatment. Psychological interventions often require patient engagement and commitment to activities that could be more or less demanding in terms of lifestyle change (e.g., psychotherapy, sports). Analyzing participant motivations (personal aims, expectations, needs) prior to participation is useful to predict their adherence to the intervention as well as final outcomes. Yet, participant motivations may evolve during the intervention because the intervention experience turns out to be meaningful and positively challenging. The present study aimed to obtain a preliminary understanding of the process of motivation change in female cancer survivors who participated in a sport-based intervention to promote quality of life by employing a grounded theory approach. Data analysis took place alongside data collection and according to the procedure of grounded theory (“open coding”, “axial coding”, and “selective coding”) in order to describe the process of motivation change during women’s participation in psychological intervention for quality of life. On 14 women interviewed, 13 reported changing their motivation to participate during the first months of involvement, mostly changing from individualistic to group-related motivations (i.e., from self-care to friendship with other participants and enriching group membership), and from physical to psychological growth (i.e., pursuing not only physical health but also self-fulfillment). The discussion explains the preliminary aspects of the motivation change process and highlights the importance to monitor motivation dynamics within psychological interventions.

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