Effect of an mHealth Wheelchair Skills Training Program for Older Adults: A Feasibility Randomized Controlled Trial

ObjectiveTo evaluate the effect of an mHealth wheelchair skills training program on clinical outcomes among older adult manual wheelchair users.Design2×2 factorial randomized controlled trial.SettingCommunity setting in 2 Canadian cities.ParticipantsConvenience sample of manual wheelchair users 50 years and older living in the community who were able to self-propel with both hands and communicate in English. Participants (N=18) were randomized into either a mHealth treatment (n=10) or tablet gaming control (n=8) group.InterventionsAll participants received 2 in-person sessions with their trainer and engaged in a 4-week monitored home training program with a computer tablet. The Enhancing Participation In the Community by improving Wheelchair Skills program provided wheelchair skills training; the control program included 9 dexterity and cognitive training games.Main Outcome MeasuresThe primary outcome was wheelchair skill capacity. Secondary outcomes included safety, self-efficacy, activity participation, mobility, divided-attention, and health-related quality of life.ResultsData collection was blinded to group allocation. Capacity improved by 2 skills but with no statistically significant between-group difference. The mHealth training program had a significant effect on participation (P=.03) and self-efficacy (P=.06) with large effect sizes (η_p²=0.22-0.29). Mobility, safety with skill performance, and divided attention measures demonstrated medium effect size changes, but only safety with skill performance was statistically significant. The program was more beneficial for participants with <1 year of wheelchair experience.ConclusionEnhancing Participation In the Community by improving Wheelchair Skills participants demonstrated good program adherence and clinical benefits were evident in community participation and wheelchair self-efficacy. Wheelchair safety and mobility were positively affected, while skill capacity showed a small, nonsignificant improvement. Future study should investigate benefit retention over time.     

The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial

ObjectiveTo evaluate the proof of concept of an innovative model of physical therapy Rehabilitation Enhancing Aging through Connected Health (REACH) and evaluated its feasibility and effect on physical function and health care utilization.DesignQuasi-experimental 12-month clinical trial.SettingTwo outpatient rehabilitation centers.ParticipantsCommunity-dwelling older primary care patients with a treatment arm undergoing the intervention (n=75; mean age=77±5.9y; 54% women) and propensity matched controls derived from a longitudinal cohort study (n=430; mean age=71±7.0y; 68% women) using identical recruitment criteria (N=505).InterventionCombined outpatient and home PT augmented with a commercially available app and computer tablet.MeasurementsPrimary outcomes included a feasibility questionnaire, exercise adherence, self-reported function, and the Short Physical Performance Battery (SPPB). Secondary outcomes included the rates of emergency department (ED) visits and hospitalizations.ResultsAmong REACH participants, we observed a 9% dropout rate. After accounting for dropouts, with propensity matching, n=68 treatments and n=100 controls were analyzed. Over the 12-month study duration, 85% of participants adhered to the exercise program an average of 2 times a week and evaluated the treatment experience favorably. In comparison to controls, after 1 year of treatment and within multivariable regression models, REACH participants did not manifest a significant difference in patient reported function (group x time effect 1.67 units, P=.10) but did manifest significant differences in SPPB (group x time effect 0.69 units, P=.03) and gait speed (group x time effect .08m/s, P=.02). In comparison to controls, after 1 year, the rate of ED visits (group x time treatment rate=0.27, P<.004) were significantly reduced, but a significant reduction in hospitalizations was not observed.ConclusionThe REACH intervention is feasible and has proof of concept in preventing functional decline and favorably affecting health care utilization. Evaluation on a larger scale is warranted.     

Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial

ObjectiveTo analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program.DesignRandomized controlled trial.SettingNeurology Unit of San Cecilio Hospital and 2 private and specialized health care centers.ParticipantsCommunity dwelling participants (N=38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03±8.98mo) and secondary ULA.InterventionsParticipants were randomly assigned to an 8-week combined ULA functional rehabilitation group (n=19) 3 days per week for 30 minutes or to a traditional health care education protocol group (n=19) once a month for 8 weeks. Both interventions were conducted at home.Main Outcome MeasuresSociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk).ResultsThere were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05).ConclusionA functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.     

Improvement of hand hygiene adherence among staff in long-term care facilities for elderly in Japan

IntroductionHand hygiene is crucial for infection control in long-term care facilities for elderly (LTCFEs), because it can be easily implemented in the low-resource settings of LTCFEs. This study investigated the actual status of hand hygiene adherence in LTCFEs, identified the factors inhibiting its appropriate implementation, and evaluated the effectiveness of a hand hygiene promotion program.MethodsIn this before-and-after study, participants were staff members (n = 142) at two LTCFEs in Gunma Prefecture, Japan. We modified the World Health Organization's “five moments for hand hygiene” and assessed participants' hand hygiene adherence rates in four situations: (1) Before touching around a resident's mucous membrane area; (2) Before medical practice or clean/aseptic procedures; (3) After body fluid exposure/risk or after touching around a resident's mucous membrane area; and (4) After touching a resident's contaminated environments. The study was divided into four phases. In Phase 1, participants self-assessed their hand hygiene adherence using a questionnaire. In Phase 2, we objectively assessed participants' pre-intervention adherence rates. In Phase 3, an intervention comprising various hand hygiene promotion measures, such as education and hands-on training on hand hygiene practices and timings, was implemented. In Phase 4, participants' post-intervention adherence rates were objectively measured.ResultsAlthough most participants reported high hand hygiene adherence rate in the self-assessment (93.1%), the pre-intervention evaluation revealed otherwise (16.8%). Participants’ post-intervention adherence rates increased for all four situations (77.3%).ConclusionThe intervention program helped increase participants’ hand hygiene adherence rates, indicating its effectiveness. Similar interventions in other LTCFEs may also improve adherence rates.     

Polyhexamethylene biguanide discs versus unmedicated dressings for prevention of central venous catheter–associated infection in the intensive care unit: A pilot randomised controlled trial to assess protocol safety and feasibility

BackgroundCentral venous catheters are prone to infectious complications, affecting morbidity, mortality and healthcare costs. Polyhexamethylene biguanide-impregnated discs at the catheter insertion site may prevent local and bloodstream infection; however, efficacy has not been established in a critical care setting.ObjectiveThe objective of this study was to pilot test polyhexamethylene biguanide–impregnated discs compared to standard unmedicated dressings for central venous catheter infection prevention in critically ill patients.MethodsThis was a single-centre pilot randomised controlled trial. Adults admitted to intensive care requiring a central venous catheter for >72 h were eligible. Patients with a current bloodstream infection, concurrent central venous catheter, chlorhexidine or polyhexamethylene biguanide allergy, or sensitive skin were excluded. Patients were randomised to receive standard central venous catheter dressings with/without polyhexamethylene biguanide discs.Outcome measuresThe primary outcome was feasibility, defined by patient eligibility, recruitment, retention, protocol adherence, missing data, and staff satisfaction. Secondary outcomes included: central line–associated infection; primary bloodstream infection; local infection; skin complications; device/dressing dwell time; serious adverse events, and cost-effectiveness.ResultsOf 309 patients screened, 80 participants were recruited with 98% (n = 78) receiving an internal jugular catheter which dwelled for a median of 5 days (interquartile range = 4.0, 6.0). Feasibility criteria were predominantly met (recruitment 88%; retention 100%; protocol fidelity 91%); however, eligibility criteria were not met (32%; most commonly owing to short predicted catheter dwell). Staff acceptability criteria were met, with 83% of staff scoring dressing application and removal ≥7 on a numerical rating scale. There were no central line–associated bloodstream infections and no local infections. Insertion site itch occurred in 4% (control [n = 0], intervention [n = 3]) of participants, while 32% (24/76) reported pain, and 46% (35/76) tenderness.ConclusionsPolyhexamethylene biguanide discs appear safe for central venous catheter infection prevention. Feasibility of a large efficacy trial was established with some modifications to screening processes. Large, adequately powered randomised controlled trials are needed to test the infection prevention hypotheses.     

Effects of Robotic Exoskeleton-Aided Gait Training in the Strength,Body Balance,and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study

ObjectiveTo assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up.DesignSingle-group longitudinal preliminary study.SettingIndividuals with multiple sclerosis (MS) at a hospital neurology ward.ParticipantsParticipants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5.InterventionsExoskeleton-assisted walk training.Main Outcome MeasuresPrimary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3).ResultsAt the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant.ConclusionsIndividuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.     

Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model

BackgroundObesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation.ObjectiveThe BariBoard? purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this.MethodsThis was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard? in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders.ResultsOf 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20–1.90, p = 0.40).ConclusionThis pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ? did not improve efficacy of chest compressions.     

Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke.DesignRandomized controlled trial.SettingRehabilitation sciences research center.ParticipantsPatients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13).InterventionsParticipants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk).Main Outcome MeasuresCortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity.ResultsThe experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups.ConclusionsA combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.     

Effectiveness of Botulinum Toxin Treatment for Upper Limb Spasticity Poststroke Over Different ICF Domains: A Systematic Review and Meta-Analysis

ObjectiveTo provide a comprehensive overview of reported effects and scientific robustness of botulinum toxin (BoNT) treatment regarding the main clinical goals related to poststroke upper limb spasticity, using the International Classification of Functioning, Disability and Health.Data SourcesEmbase, PubMed, Wiley/Cochrane Library, and Ebsco/CINAHL were searched from inception up to May 16, 2018.Study SelectionWe included randomized controlled trials comparing upper limb BoNT injections with a control intervention in patients with a history of stroke. A total of 1212 unique records were screened by 2 independent reviewers. Forty trials were identified, including 2718 patients with history of stroke.Data ExtractionOutcome data were pooled according to assessment timing (ie, 4-8wk and 12wk after injection), and categorized into 6 main clinical goals (ie, spasticity-related pain, involuntary movements, passive joint motion, care ability, arm and hand use, and standing and walking performance). Sensitivity analyses were performed for the influence of study and intervention characteristics, involvement of pharmaceutical industry, and publication bias.Data SynthesisRobust evidence is shown for the effectiveness of BoNT in reducing resistance to passive movement, as measured with the (Modified) Ashworth Score, and improving self-care ability for the affected hand and arm after intervention (P<.005) and at follow-up (P<.005). In addition, robust evidence is shown for the absence of effect on arm-hand capacity at follow-up. BoNT was found to significantly reduce involuntary movements, spasticity-related pain, and caregiver burden, and improve passive range of motion, while no evidence was found for arm and hand use after intervention.ConclusionsIn view of the robustness of current evidence, no further trials are needed to investigate BoNT for its favorable effects on resistance to passive movement of the spastic wrist and fingers, and on self-care. No trials are needed to further confirm the lack of effects of BoNT on arm-hand capacity, whereas additional trials are needed to establish the suggested favorable effects of BoNT on other body functions, which may result in clinically meaningful outcomes at activity and participation levels.     

Acute and Long-Term Effects of Mechanotherapy on the Outcome After an Achilles Repair: A Prospective Cohort Study With Historical Controls

ObjectivesTo evaluate the effects of vibration on Achilles’ tendon microcirculation and characteristics following surgical repair of Achilles’ tendon rupture.DesignCohort study with historical controls.SettingA university institute.ParticipantsParticipants (N=32), including 19 (16 men, 3 women; median [range] age: 43.0 [25.0-57.0] years) and 13 (10 men, 3 women; 44.00 [29.0-60.0] years) in the vibration (application to the ball of the foot, 30Hz, 2mm amplitude, 4kg pressure, and self-administration) and control groups, respectively, who underwent unilateral Achilles’ tendon repairs were recruited.InterventionA 4-week vibration intervention in the vibration group.Main Outcome MeasurementsThe tendon microcirculation was measured after the first session of vibration. The participants were evaluated repeatedly with bilateral follow-up measurements of tendon stiffness, 3 functional outcome tests, and a questionnaire survey.ResultsAcute effects of the vibration were observed immediately after the 5-minute vibration (P≤.001). Lower total hemoglobin and oxygen saturation were respectively observed (P=.043) in the repaired legs 3 and 6 months postsurgery in the vibration group as compared with the control group. The vibration group also showed greater tendon stiffness, heel raising height and hopping distance 3 or 6 months postoperation in both the repaired and noninjured legs (all P<.05). The microcirculatory characteristics 2 months postoperation were correlated with the outcomes at 6 months postoperation.ConclusionsDifferences in microcirculatory characteristics and better rehabilitation outcomes were observed in the legs with an Achilles repair that underwent the early vibration intervention.     

Intradialytic Resistance Training Improves Functional Capacity and Lean Mass Gain in Individuals on Hemodialysis: A Randomized Pilot Trial

ObjectiveTo compare the effects of high vs moderate loads of intradialytic resistance training (RT) on body composition, sarcopenia prevalence, functional capacity, inflammatory markers, and quality of life (QoL) in individuals on hemodialysis.DesignA pilot randomized clinical trial.SettingTwo hemodialysis centers.ParticipantsIndividuals on hemodialysis (N=80; 51% men, aged 30-75y) in treatment for at least 3 months, adequately dialyzed (Kt/V≥1.2, where K is dialyzer clearance in mL/min, t is time, and V is volume of water) with vascular access via arteriovenous fistula.InterventionsThe 12 weeks of intradialytic RT was performed 3 times per week. The training groups were: high-load intradialytic group (HLG, 8-10 repetitions), moderate-load intradialytic group (MLG, 16-18 repetitions), and control group (CG, stretching exercise). The total training volume was equalized among training groups.Main Outcome MeasuresLean leg mass was assessed by a dual-energy x-ray absorptiometry; functional capacity was assessed by Short Physical Performance Battery and Timed Up and Go test; and QoL was assessed by Kidney Disease QoL Instrument, inflammatory markers, and sarcopenia.ResultsAfter the training period, the HLG increased lean leg mass compared with the CG. The HLG also displayed improvements in the pain and physical function domains. The skeletal muscle index and functional capacity increased in both RT protocols. The prevalence of sarcopenia was reduced 14.3% and 25% in the MLG and HLG, respectively, while there was an increase of 10% in the CG. No differences were observed in cytokines after intervention.ConclusionsHigh-load intradialytic RT was associated with gains in lean leg mass and QoL while functional capacity, appendicular muscle mass, and sarcopenia status were improved regardless of the RT load.     

Long-Term Specialized Physical Therapy in Cervical Dystonia: Outcomes of a Randomized Controlled Trial

ObjectiveTo evaluate the effectiveness of a specialized physical therapy (SPT) program on disability in cervical dystonia (CD) compared to regular physical therapy (RPT).DesignA single-blinded randomized controlled trial.SettingThis study was performed by a physical therapist in a primary health care setting. Measurements were performed at baseline, 6 and 12 months in the botulinum toxin (BoNT) outpatient clinic of the neurology department.ParticipantsPatients with primary CD and stable on BoNT treatment for 1 year (N=96).Main Outcome MeasuresThe primary outcome was disability assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcomes were pain, anxiety, depression, quality of life (QOL), and health related costs over 12 months.ResultsA total of 72 participants (30 men, 42 women) finished the study: 40 received SPT, 32 RPT. No significant between group differences were found after 12 months of treatment (P=.326). Over these 12 months both groups improved significantly (P<.001) on the TWSTRS disability scale compared to baseline (SPT 1.7 points, RPT 1.0 points). Short Form 36 (SF-36) General Health Perceptions (P=.046) and self-perceived improvement (P=.007) showed significantly larger improvements after 12 months in favor of SPT. Total health related costs after 12 months were $1373±556 for SPT compared to $1614±917 for RPT.ConclusionSPT revealed no significant differences compared to RPT after 12 months of treatment on the TWSTRS disability scale. Both groups showed similar improvements compared to baseline. Positive results in the SPT group were higher patient perceived effects and general health perception. Treatment costs were lower in the SPT group. With lower costs and similar effects, the SPT program seems to be the preferred program to treat CD.     

The effectiveness of biomechanical taping and Kinesiotaping on shoulder pain,active range of motion and function of participants with Trapezius Myalgia: A randomized controlled trial

BackgroundTrapezius Myalgia (TM) is characterized by shoulder pain and dysfunction. Kinesio Taping is commonly used in symptom management of TM. Biomechanical Taping (BMT), a novel intervention, may provide equally effective management.ObjectivesThis paper reports on the effectiveness of Biomechanical Taping compared with Kinesio Taping in improving shoulder pain, active range of motion (AROM), and function.MethodsTwo groups of participants with TM were recruited through simple random sampling of participants from nine call centers and purposively-sampled participants from one fast-food chain and one community based rehabilitation center in Manila, Philippines. Participants were randomly allocated to either Kinesio Taping or biomechanical taping group in a double-blind clinical trial. Irrespective of the type of taping, participants performed gentle passive stretching of upper trapezius for six times each held for 30 s on Days 1, 3, and 5. On Days 2 and 4, participants performed gentle passive stretch of upper trapezius three times a day. Pre- and post-intervention measures were taken of Visual Analogue Scale for pain intensity, AROM for shoulder movement, and Disability of Arm, Shoulder, and Hand for function.ResultsOf 68 participants, 62 had shoulder symptoms secondary to TM. Similar significant within group improvements were found for Visual Analogue Scale scores, and Disability of Arm, Shoulder and Hand for biomechanical taping and Kinesio Taping interventions when comparing between group results (p < 0.05).ConclusionBiomechanical Taping appears to be as effective as Kinesio Taping in the short term in decreasing pain and improving function of individuals with TM. Both taping techniques did not restrict shoulder AROM of included participants.Mesh TermsAthletic Tape, Myalgia, Pain Measurements, Shoulder PainNon-Mesh TermsBiomechanical Taping Technique     

Outcomes Following Percutaneous Coronary Intervention in Renal Transplant Recipients: A Binational Collaborative Analysis

ObjectiveTo investigate the clinical and procedural characteristics in patients with a history of renal transplant (RT) and compare the outcomes with patients without RT in 2 national cohorts of patients undergoing percutaneous coronary intervention (PCI).Patients and MethodsData from the National Inpatient Sample (NIS) and British Cardiovascular Intervention Society (BCIS) were used to compare the clinical and procedural characteristics and outcomes of patients undergoing PCI who had RT with those who did not have RT. The primary outcome of interest was in-hospital mortality.ResultsOf the PCI procedures performed in 2004-2014 (NIS) and 2007-2014 (BCIS), 12,529 of 6,601,526 (0.2%) and 1521 of 512,356 (0.3%), respectively, were undertaken in patients with a history of RT. Patients with RT were younger and had a higher prevalence of congestive cardiac failure, hypertension, and diabetes but similar use of drug-eluting stents, intracoronary imaging, and pressure wire studies compared with patients who did not have RT. In the adjusted analysis, patients with RT had increased odds of in-hospital mortality (NIS: odds ratio [OR], 1.90; 95% CI, 1.41-2.57; BCIS: OR, 1.60; 95% CI, 1.05-2.46) compared with patients who did not have RT but no difference in vascular or bleeding events. Meta-analysis of the 2 data sets suggested an increase in in-hospital mortality (OR, 1.79; 95% CI, 1.40-2.29) but no difference in vascular (OR, 1.24; 95% CI, 0.77-2.00) or bleeding (OR, 1.21; 95% CI, 0.86-1.68) events.ConclusionThis large collaborative analysis of 2 national databases revealed that patients with RT undergoing PCI are younger, have more comorbidities, and have increased mortality risk compared with the general population undergoing PCI.     

High Frequency and Intensity Rehabilitation in 641 Subacute Ischemic Stroke Patients

ObjectivesTo determine the effects of exergaming on quality of life (QoL), motor, and clinical symptoms in subacute stroke patients.DesignA pseudorandomized controlled trial, using a before-after test design.SettingUniversity hospital.ParticipantsSubacute, ischemic stroke outpatients (N=3857), 680 of whom were randomized and 641 completed the study.InterventionsWe determined the effects of 5 times a week twice daily (EX2; 50 sessions; n=286) and once daily (EX1; 25 sessions; n=272) exergaming and low-intensity standard care (control [CON]; 25 sessions; n=83) on clinical, mobility, blood pressure (BP), and QoL outcomes.Main Outcome MeasuresThe primary outcome was Modified Rankin Scale. Secondary outcomes were activities of daily living, 5 aspects of health-related QoL, Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), and static balance (center of pressure).ResultsDuring exercise, the peak heart rate was 134, 134, and 126 beats per minute in the EX2, EX1, and CON groups, respectively. mRS improved similarly in the EX2 (–1.8; effect size, d=–4.0) and EX1 (–1.4; d=–2.6) groups, but more than in the CON group (–0.7; d=–0.6). QoL, Barthel Index, BBS, 6MWT, and standing posturography improved more in the EX2 group and the same in the EX1 and CON groups. Systolic and diastolic resting BP decreased more in the EX2 and EX1 groups than in the CON group. The intervention effects did not differ between men (n=349) and women (n=292).ConclusionsTwice daily compared with once daily high-intensity exergaming or once daily lower intensity standard care produced superior effects on clinical and motor symptoms, BP, and QoL in male and female subacute ischemic stroke participants.     

Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes

ObjectiveTo evaluate the efficacy of continuous passive motion (CPM) after total knee arthroplasty (TKA) and whether the use of CPM is related to improved clinical and functional outcomes.Data SourcesA systematic MEDLINE search via Web of Science, Cochrane Library, and PubMed databases was conducted.Study SelectionEnglish-language articles published between January 2000 and May 2018 reporting the related clinical outcomes of CPM after TKA were included. A total of 3334 titles and abstracts were preliminarily reviewed, of which 16 studies were included according to the eligibility criteria.Data ExtractionTwo different reviewers were selected to perform the study extraction, independent of each other. If there were any disagreements regarding the final list of studies, the third reviewer reviewed the list as an arbitrator for completeness.Data SynthesisA total of 16 trials with 1224 patients were included. The pooled results revealed that use of CPM did not show a statistically significant improvement of postoperative knee range of motion (ROM) except for middle-term passive knee extension and long-term active knee flexion ROM. Also, CPM therapy did not show a significant positive effect on the functional outcomes. No significant reduction in length of stay (LOS) and incidence of adverse events (AEs) was identified.ConclusionAmong patients undergoing TKA, neither the ROM nor the functional outcomes could be improved by CPM therapy. Moreover, the risk of AEs and LOS could not be reduced by application of CPM. The current available evidence suggested that this intervention was insufficient to be used routinely in clinical practice.     

Content and Effectiveness of Interventions Focusing on Community Participation Poststroke: A Systematic Review

ObjectiveTo investigate the content and effectiveness of interventions that address poststroke community participation.Data SourcesEMBASE, PsycINFO, PubMed, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched using 3 indexing terms and respective thesaurus: stroke, social participation, and clinical trials. Filters for English, publication dates (January 2001-May 2017), and publication types were used. The search also included checking references from relevant systematic reviews.Study SelectionStudies conducted with adults with stroke, evaluating interventions addressing community participation, having a comparison group, and reporting at least 1 of 3 outcomes (participation, depression, and health-related quality of life) were selected. Retrieved articles were screened by 2 reviewers. After substantial agreement was achieved using interrater reliability, reviewers screened articles independently. Eighteen of 1130 articles were included.Data ExtractionCharacteristics of participants, key elements of intervention, comparator, and results were independently extracted by 2 reviewers. Intervention content was categorized based on 9 categories from the International Classification of Functioning, Disability, and Health Activities and Participation domains. Risk of selection, performance, attrition, and reporting bias were evaluated.Data SynthesisTwo intervention categories were identified: leisure participation and community integration. Three leisure and 4 community integration interventions showed significant group differences favoring the intervention group in the target outcomes. The majority of interventions addressed the leisure, interpersonal relations, and community life categories of International Classification of Functioning, Disability, and Health with few focusing on political life, education, assisting others, and religion.ConclusionsA limited number of studies showed an effect on participation, depression, and health-related quality of life outcomes. There were gaps in intervention content indicating that current community participation interventions fall short in addressing full inclusion and citizenship of people with stroke. Future interventions should focus on civic- and societal-level participation and community activities beyond leisure.     

A Comparative Study of Treatment Interventions for Patellar Tendinopathy: A Randomized Controlled Trial

ObjectivesTo determine the additional effect of dry needling (DN) or percutaneous needle electrolysis (PNE) combined with eccentric exercise (EE) and determine which is the most effective for patients with patellar tendinopathy (PT).DesignBlinded, randomized controlled trial, with follow-up at 10 and 22 weeks.SettingsRecruitment was performed in sport clubs. Diagnosis and intervention were conducted at San Jorge University.ParticipantsPatients (N=48) with PT with pain for at least 3 months between the ages of 18 and 45 years.InterventionsThree interventions were carried out: DN and EE, PNE and EE, and EE with sham needle as the control group.Main Outcome MeasuresDisability was measured using the Victorian Institute of Sports Assessment Questionnaire, patellar tendon. Visual analog scale was used to measure pain over time, the Short Form-36 was used to measure quality of life, and ultrasound was used to measure structural abnormalities.ResultsA total of 48 participants (42 men, 6 women; average age, 32.46y; SD, 7.14y) were enrolled. The improvement in disability and pain in each group between baseline and post-treatment and baseline and follow-up was significant (P≤.05), without differences among groups.ConclusionDN or PNE combined with an EE program has not shown to be more effective than a program of only EE to improve disability and pain in patients with PT in the short (10wk) and medium (22wk) terms. Clinical improvements were not associated with structural changes in the tendon.     

Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center

ObjectiveTo estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel.MethodsThe Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board–approved protocol, only includes employees who have further authorized their records for use in research.ResultsA total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were “reactive” and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group.ConclusionThe seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.     

Effect of Exoskeletal-Assisted Walking on Soft Tissue Body Composition in Persons With Spinal Cord Injury

ObjectiveTo determine the effect of overground walking using a powered exoskeleton on soft tissue body composition in persons with spinal cord injury (SCI).DesignA prospective, single group observational pilot study.SettingMedical center.ParticipantsPersons (N=8) with chronic (>6mo) SCI between 18 and 65 years old who weighed less than 100 kg.InterventionsOverground ambulation training using a powered exoskeleton (ReWalk) for 40 sessions, with each session lasting up to 2 hours, with participants training 3 times per week.Main Outcome Measure(s)Dual-energy x-ray absorptiometry (DXA) was used to measure lean mass (LM) and fat mass (FM) from the whole body, arms, legs and trunk. DXA was also used to assess visceral adipose tissue (VAT). Walking performance was measured by 6-minute walk test.ResultsParticipants significantly lost total body FM (?1.8±1.2kg, P=.004) with the loss of adiposity distributed over several regional sites. Six of the 8 participants lost VAT, with the average loss in VAT trending toward significance (?0.141kg, P=.06). LM for the group was not significantly changed.ConclusionsSustained and weekly use of powered exoskeletons in persons with SCI has the potential to reduce FM with inferred improvements in health.