Clinical Rehabilitation
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Published By Sage Publications

1477-0873, 0269-2155
Updated Tuesday, 14 September 2021

2021 ◽  
pp. 026921552110326
Isabel Forner-Cordero ◽  
José Muñoz-Langa ◽  
Juan María DeMiguel-Jimeno ◽  
Pilar Rel-Monzó

Objective: To assess whether the treatment with intermittent pneumatic compression plus multilayer bandages is not inferior to classical trimodal therapy with manual lymphatic drainage in the decongestive lymphedema treatment. Study Design: Randomized, non-inferiority, controlled study to compare the efficacy of three physical therapies’ regimens in the Decongestive Lymphatic Therapy. Participants: 194 lymphedema patients, stage II–III with excess volume > 10% were stratified within upper and lower limb and then randomized to one of the three treatment groups. Baseline characteristics were comparable between the groups. Intervention: all patients were prescribed 20 sessions of the following regimens: Group A (control group): manual lymphatic drainage + Intermittent Pneumatic Compression + Bandages; Group B: pneumatic lymphatic drainage + Intermittent Pneumatic Compression + Bandages; and Group C: only Intermittent Pneumatic Compression + Bandages. End-point: Percentage reduction in excess volume (PREV). Results: All patients improved after treatment. Global mean of PREV was 63.9%, without significant differences between the groups. The lower confidence interval of the mean difference in PREV between group B and group A, and between group C and group A were below 15%, thus meeting the non-inferiority criterion. Most frequent adverse events were discomfort and lymphangitis, without differences between groups. A greater baseline edema, an upper-limb lymphedema and a history of dermatolymphangitis were independent predictive factors of worse response in the multivariate analysis. Conclusions: Decongestive lymphatic therapy performed only with intermittent pneumatic compression plus bandages is not inferior to the traditional trimodal therapy with manual lymphatic drainage. This approach did not increase adverse events.

2021 ◽  
pp. 026921552110432
Xinyi Xu ◽  
Denise Shuk Ting Cheung ◽  
Robert Smith ◽  
Agnes Yuen Kwan Lai ◽  
Chia-Chin Lin

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

2021 ◽  
pp. 026921552110380
Zohre Khosrokiani ◽  
Amir Letafatkar ◽  
Amy Gladin

Objective: We investigated whether adding lumbar motor control training with a pressure biofeedback unit improves outcomes of a conservative deep cervical flexor motor control program on neck pain, neck disability, deep cervical flexor endurance, and health status in middle-aged patients with chronic neck pain and forward head posture after eight weeks of interventions. Design: Randomized controlled trial. Setting: Outpatient setting. Subjects and interventions: A total of 113 males and females (mean age 39 ± 5 years) with chronic neck pain were randomized to three treatment groups, group 1 ( n = 38) combined deep cervical flexor motor-control training and lumbar motor control exercise, group 2 ( n = 37) deep cervical flexor motor control training alone, and group 3 ( n = 38) passive treatment and education. Main outcome measures: Pain, neck disability, deep cervical flexor muscular endurance, and health status. Results: There were significant improvements in the combination group compared with the deep cervical flexor motor-control group alone ( d = 2.03, 95% confidence interval (CI): −2.8 to −1.27, P = 0.021) for pain ( d = −0.99, 95% CI = −1.75 to −0.23, P = 0.023), disability ( d = 1.92, 95% CI = 0.86 to 2.98, P = 0.001), deep cervical flexor endurance, and ( d = −2.75, 95% CI = −8.81 to −1.68, P = 0.037) for health status favoring the combination group. There were significant between-group differences favoring both active groups versus the passive control in all out comes. Conclusion: The addition of Lumbar motor control training as a complementary treatment may enhance effectiveness of deep cervical flexor motor control training on neck pain, neck disability, and deep cervical flexor endurance in patients with chronic moderate neck pain and forward head posture.

2021 ◽  
pp. 026921552110432
Gökçe Yağmur Güneş Gencer ◽  
Öznur Yilmaz

Objectives: To investigate the effect of trunk training on trunk control, arm, and pulmonary function in children with Duchenne muscular dystrophy. Design: A randomised controlled trial. Settings: Neuromuscular diseases clinic of university hospital. Subjects: Twenty-six children with Duchenne muscular dystrophy aged 5–16 were included in the study. Intervention: Participants were randomly allocated into two groups. The study group ( N = 13) exercised with the trunk-oriented exercise program and the conventional exercise program, whereas the control group ( N = 13) underwent the conventional exercise program for eight weeks. Main measures: The primary outcomes were trunk control was assessed using the Trunk Control Measurement Scale, the arm function was assessed using Performance of Upper Limb, and respiratory function using the pulmonary function test. Data collection was conducted at baseline, and eighth week. The differences in trunk control scores, arm function scores, and respiratory function values before and after the training were calculated for the intergroup comparison. Results: The mean age of the participants was 11.6 (2.6) in the study group and 10.6 (3.4) in the control group. The changes between trunk control score, arm function score (total and distal level score), and respiratory function value (Forced Vital Capacity, Forced Expiratory Volume in one second, and Peak Expiratory Flow Volume percentage values) were compared and significant differences were found after eight week periods in the study and control groups. Conclusions: Trunk-oriented exercise program in Duchenne muscular dystrophy might be effective for trunk control, arm, and respiratory function.

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.

2021 ◽  
pp. 026921552110387
Letticia Cristina Santos Cardozo Roque ◽  
Angélica da Silva Tenório ◽  
Lígia Tomaz de Aquino ◽  
Renata dos Santos Ferreira ◽  
Angela Luzia Branco Pinto Duarte ◽  

Objective: To investigate the effectiveness of Maitland’s joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. Design: Randomized controlled trial. Setting: Tertiary university hospital. Subjects: Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group ( n = 12) or control group ( n = 12). Interventions: The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. Main measures: The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). Results: Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group ( P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). Conclusion: Maitland’s joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.

2021 ◽  
pp. 026921552110409
Jessica Kersey ◽  
Lauren Terhorst ◽  
Allen W Heinemann ◽  
Joy Hammel ◽  
Carolyn Baum ◽  

Objective: This study examined the construct validity of the Enfranchisement scale of the Community Participation Indicators. Design: We conducted a secondary analysis of data collected in a cross-sectional study of rehabilitation outcomes. Subjects: The parent study included 604 community-dwelling adults with chronic traumatic brain injury, stroke, or spinal cord injury. The sample had a mean age of 64.1 years, was two-thirds male, and included a high proportion of racial minorities ( n = 250, 41.4%). Main measures: The Enfranchisement scale contains two subscales: the Control subscale and the Importance subscale. We examined correlations between each Enfranchisement subscale and measures of participation, environment, and impairments. The current analyses included cases with at least 80% of items completed on each subscale (Control subscale: n = 391; Importance subscale: n = 219). Missing values were imputed using multiple imputation. Results: The sample demonstrated high scores, indicating poor enfranchisement (Control subscale: M = 51.7; Importance subscale: M = 43.0). Both subscales were most strongly associated with measures of participation (Control subscale: r = 0.56; Importance subscale: r = 0.52), and least strongly associated with measures of cognition (Control subscale: r = 0.03; Importance subscale: r = 0.03). The Importance subscale was closely associated with depression ( r = 0.54), and systems, services, and policies ( r = 0.50). Both subscales were associated with social attitudes (Control subscale: r = 0.44; Importance subscale: r = 0.44) and social support (Control subscale: r = 0.49; Importance subscale: r = 0.41). Conclusions: We found evidence of convergent validity between the Enfranchisement scale and measures of participation, and discriminant validity between the Enfranchisement scale and measures of disability-related impairments. The analyses also revealed the importance of the environment to enfranchisement outcomes.

2021 ◽  
pp. 026921552110407
Braden Te Ao ◽  
Matire Harwood ◽  
Vivian Fu ◽  
Mark Weatherall ◽  
Kathryn McPherson ◽  

Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults ( n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving.

2021 ◽  
pp. 026921552110401
Javier Merino-Andrés ◽  
Agustín García de Mateos-López ◽  
Diane L Damiano ◽  
Alberto Sánchez-Sierra

Objective: This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation. Data sources: Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021. Review methods: Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration’s tool for assessing the risk of bias and PROSPERO’s registration number ID: CRD42020193535. Results: Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity. Conclusion: A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.

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