Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy

Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii?), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP).

Method: Participants (n?=?102) were matched in pairs then randomized to: intervention (Mitii? for 20 weeks; n?=?51; 26 males; mean age?=?11 years 8 months (SD?=?2 years 4 months); Full Scale IQ?=?84.65 (SD?=?15.19); 28 left UCP; GMFCS-E&;R (I?=?20, II?=?31) or waitlist control (n?=?50; 25 males; mean age?=?11 years 10 months (SD?=?2 years 5 months); Full Scale IQ?=?80.75 (SD?=?19.81); 20 left UCP; GMFCS-E&;R (I?=?25, II?=?25). Mitii? targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21).

Results: There were no significant between group differences in attentional control (DSB; p?=?0.20;CI=??0.40,1.87); cognitive flexibility (Inhibition, p?=?0.34; CI=??0.73,2.11; number/letter sequencing, p?=?0.17; CI=??0.55,2.94); problem solving (Tower; p?=?0.28; CI=??0.61,2.09), information processing (Symbol; p?=?0.08; CI=??0.16, 2.75; Coding; p?=?0.07; CI=??0.12,2.52) or EF performance (p?=?0.13; CI=??10.04,1.38).

Conclusion:In a large RCT, Mitii^TM did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP.

• Implications for rehabilitation

• A large RCT of the multi-modal web based training; Move It to Improve It (Mitii^TM) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP).

• Mitii^TM training completed by an intervention group was highly variable with few children reaching the target dosage of 60?h. Technical issues including server and internet connectively problems lead to disengagement with the program.

• Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, Mitii^TM needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF.

     

Whole-body vibration strengthening compared to traditional strengthening during physical therapy in individuals with total knee arthroplasty

ABSTRACT

This study investigated the use of whole-body vibration (WBV) as an alternative strengthening regimen in the rehabilitation of individuals with total knee arthroplasty (TKA) compared with traditional progressive resistance exercise (TPRE). Individuals post TKA (WBV n = 8; TPRE n = 8) received physical therapy with WBV or with TPRE for 4 weeks. Primary dependent variables were knee extensor strength, quadriceps muscle activation, mobility, pain, and range of motion (ROM). There was a significant increase in knee extensor strength and improvements in mobility, as measured by maximal volitional isometric contraction and the Timed Up and Go Test (TUG), respectively, for both groups (p < 0.01). The WBV knee extensor strength improved 84.3% while TPRE increased 77.3%. TUG scores improved 31% in the WBV group and 32% for the TPRE group. There were no significant differences between groups for strength or muscle activation (Hotelling's T² = 0.42, p = 0.80) or for mobility (F = 0.54; p = 0.66). No adverse side effects were reported in either group. In individuals with TKA, both WBV and TPRE showed improved strength and function. Influence of WBV on muscle activation remains unclear, as muscle activation levels were near normal for both groups.     

Significance of perioperative goal-directed hemodynamic approach in preventing postoperative complications in patients after cardiac surgery: a meta-analysis and systematic review

Purpose: Goal-directed hemodynamic therapy (GDT) is used to prevent hypoperfusion resulting from surgery. The objective of this study was to analyze the efficacy and importance of perioperative GDT.

Methods: PUBMED, MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June 2016 using the search terms: cardiac output, cardiac surgical procedures, hemodynamics, goal-directed therapy, and intraoperative. Randomized-controlled trials with pre-emptive hemodynamic intervention for cardiac surgical population versus standard hemodynamic therapy were included.

Results: Nine studies were included with a total of 1148 patients. The overall analysis revealed no significant difference in the all-cause mortality (pooled peto OR =0.58, 95%CI =0.27–1.525, p?=?0.164), duration of mechanical ventilation (pooled difference in mean=??1.48, 95%CI=??3.24 to 0.28, p?=?0.099), or length of intensive care unit (ICU) stay (pooled difference in mean=??9.10, 95%CI=??20.14 to 1.93, p?=?0.106) between patients in the GDT and control groups. Patients in the GDP group were associated with shorter hospital stay than those in the control group (pooled difference in mean=??1.52, 95%CI=??2.31 to ?0.73, p?Conclusion: GDT reduces the length of hospital stay compared with the standard of care. Further studies are necessary to continually assess the benefit of GDT following major surgery.

• Key Messages

• The results of this analysis revealed no significant difference between cardiac surgery patients receiving goal-directed hemodynamic therapy (GDT) or conventional fluid therapy in terms of the all-cause mortality, duration of mechanical intervention, and length of ICU-stay.

• The length of hospital stay was significantly reduced in patients treated with GDT compare to conventional fluid therapy.

• GDT may have limited benefit in reducing mortality; however, the association to shorter length of hospital stay may suggest that better hemodynamic balance can facilitate postoperative recovery.

     

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

Purpose: The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

Method: Six hundred and five hip-fractured patients admitted during 2010–2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

Results: Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05–1.58; p?=?0.017); (OR 2.15, 95%CI, 1.28–3.59; p?=?0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11–1.77; p?=?0.005); (OR 2.47, 95%CI, 1.15–5.30; p?=?0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18–4.33; p?=?0.014); (OR 2.87, 95%CI, 1.16–7.09; p?=?0.022), respectively].

Conclusions: Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome.

• Implications for Rehabilitation

• Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains.

• Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions.

• Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test.

• Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

     

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study

Purpose: To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers.

Methods: Seventy-two patients (60–87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63–82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy.

Results: The symptomatic extremity in patients was significantly (p?t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8–17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p?Conclusions: Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis.

• Implications for Rehabilitation

• Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present.

• Between-leg differences in leg extensor power (force?×?velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry.

• Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity.

• Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.

     

Exercise in knee osteoarthritis: do treatment outcomes relate to bone marrow lesions? A randomized trial

Purpose: Exercise is effective for reducing knee osteoarthritis (OA) pain but effect sizes vary widely. Moreover, not all knee OA patients perceive beneficial effects. Tailoring specific exercises to subgroups of knee OA patients may increase effectivity. Bone marrow lesions (BMLs) have been suggested as a criterion to define such subgroups.

This study aimed to investigate whether BMLs’ presence/absence is related to treatment outcomes in a group of knee OA patients who exercised for 18 weeks.

Methods: Subjects with symptomatic knee OA started a strength or walking exercise program. BMLs’ presence at baseline was assessed. Pain was assessed before and after the intervention with the intermittent and constant osteoarthritis pain (ICOAP) questionnaire. Also the global perceived effect (GPE) on the patient’s complaints was rated.

Results: Thirty-five patients (strength (N?=?17) and walking (N?=?18)) were analyzed for BMLs. BMLs were present in 25 (71%) knees. Five (14%) patients dropped out and 19 (54%) improved (GPE ≥5). All dropouts had BMLs, but no difference was seen between dropouts and retainers (p?>?0.05). Pain scores did not differ between intervention groups (p?>?0.05) or between patients with BMLs and without BMLs (p?>?0.05).

Conclusions: Pain scores and GPE was not different between knee OA patients with and without baseline BMLs in this sample.

• Implications for Rehabilitation

• Both walking and strengthening exercises are effective means of improving pain in patients with knee osteoarthritis.

• In a relatively small sample, this study shows that the presence or absence of subchondral bone marrow lesions, as seen on magnetic resonance images, is not related to treatment outcomes.

     

“Strong and steady”: a community-based strength and balance exercise group for children with cerebral palsy

Abstract

Purpose: This study investigated the effect of an eight-week community-based strength and balance exercise group for children with cerebral palsy (CP). Method: Ten children with CP participated in the study (8–15 years; six male; GMFCS I?=?6, II?=?4; five diplegia; five hemiplegia). Muscle strength was assessed using dynamometry and functional strength tests (seated throw, distance jump, vertical jump). Balance was assessed using the Bruninks–Oseretsky Test of Motor Proficiency, the Movement Assessment Battery for Children (MABC), lateral and forward reach tests and the Timed-up and Go. Results: Muscle strength improved in dominant side elbow flexors, hip abductors, ankle dorsiflexors and ankle plantarflexors (p?=?0.018–0.042). Functional strength improved in seated throw (t?=?2.7; p?=?0.024), distance jump (t?= ?2.8; p?=?0.025) and lateral step-up (p?<?0.05). Balance improved on the MABC (t?=?2.4; p?=?0.040), lateral (p?<?0.05) and forward reach (p?<?0.05). Conclusion: This feasibility study translated research into sustainable practice, showing that a community-based, low dose, group exercise program can improve the balance and strength of children with CP within current funding capacity.

• Implications for Rehabilitation

• It has been known that strength and balance training in the clinical research setting with specialized equipment is effective for children with CP, but this study demonstrates the translation of research into clinical practice in a low-cost, low-dose group program.

• Significant gains in both muscle strength and balance can be achieved in an eight-week community-based gym group using simple equipment.

     

Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners

Objective: The study objective was to measure the rates of inclusion of populations at risk of advanced melanoma in a pilot targeted screening project involving general practitioners.

Design: This cross-sectional database study compared the inclusion rates of patients who signed inclusion in a targeted screening project with those of patients who did not, during a period in which both groups of patients consulted investigators.

Setting: Data were extracted from the national healthcare insurance records in western France from 11 April to 30 October 2011.

Patients: Patients, older than 18, considered for the data extraction had consulted one of the 78 participating GPs during the study period, and were affiliated with the national healthcare insurance.

Main outcome measures: Inclusion in the screening was the main outcome measure. Patients at risk of advanced melanoma were characterized by male gender, age over 50, low income, rural residence, farmer, and presence of chronic disease.

Results: A total of 57,279 patients consulted GPs during the inclusion period and 2711 (4.73%) were included in the targeted screening. Populations at risk of advanced melanoma were less included: men (OR?=?0.67; 95%CI [0.61–0.73]; p?p?p?p?p?Conclusion: This study demonstrated inequalities in the inclusion of patients in a melanoma screening. Patients at risk of advanced cancer were screened less often. Further studies should focus on GPs ability to identify and screen these patients.

• KEY POINTS

• Advanced melanoma is more frequently diagnosed in men, older patients and socioeconomically disadvantaged populations, which leads to survival inequalities.

• ??Despite the involvement of general practitioners, the implementation of targeted melanoma screening did not avoid inclusion inequalities.

• ??Men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening.

• ??The display of a conventional or an alarmist poster in the waiting room did not statistically reduce these inclusion inequalities.

     

Preoperative factors related to the ambulatory status at 1 year after total knee arthroplasty

Purpose: The purpose of this study is to investigate whether preoperative factors can predict the ambulatory status at 1?year after primary total knee arthroplasty (TKA).

Methods: The subjects were 115 patients who had undergone TKA. Isometric lower limb muscle strength was measured and the Timed Up and Go (TUG) test and the 2011 knee society scoring were conducted preoperatively. Then, the patients were divided into two groups after surgery: a cane-assisted walking group (n?=?42) and independent walking group (n?=?73). Unpaired t-test, chi-square test, Mann–Whitney U-test, logistic regression analysis and the receiver-operating characteristic curve analysis were used in this study.

Results: A multiple logistic regression analysis selected age, TUG test and functional activities as significant variables estimating the use of a cane after surgery. Receiver-operating characteristic curve analyses revealed that the cut-off score for TUG test was 10.8?s (sensitivity?=?69%, specificity?=?67%, area under curve?=?0.81) and the cut-off score for functional activities was 39 points (sensitivity?=?83%, specificity?=?63%, area under curve?=?0.83) in predicting the ambulatory status.

Conclusions: Preoperative TUG test with a cut-off score of 10.8?s and functional activities with a cut-off score of 39 points are reliable assessment tools for predicting the use of walking aid following TKA.

• Implications for Rehabilitation

• An accurate prediction of the ambulatory status after total knee arthroplasty can aid patients in understanding their own goals of the activities of daily living.

• Preoperative timed up and go test of <10.8?s and a preoperative functional activities functional activities score in the 2011 knee society scoring >39 points are useful for predicting the ambulatory status after total knee arthroplasty.

     

Balance and walking performance are improved after resistance and aerobic training in persons with chronic stroke

Purpose: To investigate the effect of different types of physical training on balance performance and whether improved balance correlates with improved walking performance.

Methods: Forty eight participants with chronic stroke were randomly assigned to aerobic training on cycle ergometer (AT-group), resistance training of the lower extremities (RT-group), or sham training of upper extremities (ST-group). Participants exercised 3 d/week for 12 weeks. Balance (Berg Balance Scale), peak oxygen uptake rate, isometric knee extensor strength, maximal gait speed, and 6?minute walk test were measured at baseline and after 12 weeks.

Results: Training specific effects were observed; the AT-group improved peak oxygen uptake rate by 15.5 (6.0–25.0)%, the RT-group improved non-paretic knee extensor strength by 35.1 (18.3–51.9)% and the ST-group improved non-paretic knee extensor strength by 8.9 (0.7–17.1)%. All groups improved balance (6.0 (95% CI: 3.2–8.8)%), maximal gait speed (10.2 (6.5–14.0)%), and 6?minute walk distance (12.4 (8.8–15.9)%) but balance improvements did not correlate with improvements in muscle strength, peak oxygen uptake rate, or walking.

Conclusions: Physical exercise improves balance and walking performance, but improved balance is not a prerequisite for functional improvements in chronic stroke.

• Implications for Rehabilitation

• Aerobic training and progressive resistance training show small significant improvements in balance and walking, indicating a possible clinical relevance of these training modalities.

• Improvements in balance may not be a prerequisite for improvements in walking distance when assistive devices are allowed during walking tests.

     

Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders

Abstract

Purpose: The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder.

Methods: A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder.

Results: Veterans with (vs. without) post-traumatic stress disorder (n?=?896) reported lower social participation (40.2 vs. 43.9, p?<?0.0001). Multivariate analyses showed that longer duration of injury (OR?=?0.98, 95% CI: 0.97–1.00, p?=?0.04) and white race (OR?=?0.62, 95% CI: 0.38–1.01, p?=?0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR?=?1.43, 95% CI: 1.25–1.64, p?<?0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR?=?0.94, 95% CI: 0.90–0.98, p?=?0.003).

Conclusions: Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation.

• Implications for Rehabilitation

• Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences.

• Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder.

• Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation.

• These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.

     

Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial

Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. Method: We recruited 113 patients suffering from chronic WAD grades I–III and several years’ duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. Results: From baseline to post-treatment, the BAT group increased their physical functioning (median 5, IQR?=?15) more than the ET group (median?=?0, IQR?=?15), p?=?0.032, effect size ?0.54. Three months after the end of treatment, the BAT group had less bodily pain (m?=?17.5, 95% CI 6.9–17.6) than the ET group (m =?4.9, 95% CI ?0.1 to 9.8), p?=?0.044, effect size ?0.4. The BAT group had also increased their social functioning (m?=?13.3, 95% CI 6.6–19.9) more than the ET group (m?=?3.5, 95% CI ?3 to 9.9), p?=?0.037, effect size ?0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD.

• Implications for Rehabilation

• Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work.

• Exercise therapy (ET) may alleviate symptoms of chronic WAD.

• Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs.

• In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.

     

Predictors of Symptom Duration and Bacteriuria in Uncomplicated Urinary Tract Infection

Abstract

Objective: To identify baseline predictors of symptom duration after empirical treatment for uncomplicated urinary tract infection (UTI) and significant bacteriuria in a cohort of women treated for UTI.

Design: Prospective single-centre cohort study.

Setting: Outpatient clinic in Norway.

Patients: From September 2010 to November 2011, 441 women aged 16–55 years with symptoms of uncomplicated UTI were included.

Results: Dipstick findings of leukocyte esterase 1?+?(incidence rate ratio (IRR) 1.93, 95% confidence interval (CI) 1.23–3.01, p?<?0.01) and microbe resistant to mecillinam treatment (IRR 1.41, 95% CI 1.07–1.89, p?=?0.02) predicted longer symptom duration. More pronounced symptoms did not predict longer symptom duration (IRR 1.18, 95% CI 0.94–1.46, p?=?0.15) or significant bacteriuria (odds ratio [OR] 1.16, 95% CI 0.72–1.88, p?=?0.54). Leukocyte esterase 2?+?(OR 2.51, 95% CI 0.92–6.83, p?=?0.07) or 3?+?(OR 2.40, 95% CI 0.88–6.05, p?=?0.09) and nitrite positive urine dipstick test (OR 3.22, 95% CI 1.58–7.01, p?=?<0.01) were associated with bacteriuria.

Conclusion: More pronounced symptoms did not correlate with significant bacteriuria or symptom duration after empirical treatment for acute cystitis. One might reconsider the current practice of treating uncomplicated UTI based on symptoms alone.

• Key Points

• Treatment strategies for milder infectious diseases must consider ways of reducing antibiotic consumption to decelerate the increase in antibiotic resistance. Our findings suggest that more emphasis should be put on urine dipstick results and bacteriological findings in the clinical setting. One might reconsider the current practice of treating uncomplicated UTIs based on symptoms alone.

     

Efficacy of the whole-body vibration for pain,fatigue and quality of life in women with fibromyalgia: a systematic review

Purpose: To determine the quality of evidence on the use of whole-body vibration (WBV) in controlling pain, fatigue and quality of life in women with fibromyalgia.

Methods: The search involved MEDLINE/PubMed, LILACS, CINAHL, CENTRAL and PEDro, without temporal or language restriction. The terms “fibromyalgia” and “whole-body vibration” were used. Trials (randomized or quasi-randomized) that compared a group of women with fibromyalgia who received WBV to a control group with no intervention were included. The quality of evidence was assessed using the GRADE system. The quantitative evaluation by meta-analysis was also used, whenever possible.

Results: Three studies were included. Regarding the outcome pain, it has not been possible to assess the magnitude of effect of treatment. The result of the outcome fatigue showed no difference between the groups after the proposed intervention (Mean Difference: 0.01; 95% CI: ?0.11 to 0.09). The meta-analysis for the outcome quality of life showed a small difference between groups, favoring the WBV group (Standard Mean Difference: 0.4943; p?=?0.05; 95% CI: 0.0045 to 0.9841).

Conclusions: The results, based on very low quality of evidence, were inconclusive regarding pain, and showed no clinically important effects on the control of fatigue and improvement of quality of life.

• Implications for rehabilitation

• There is no evidence to support the use of whole-body vibration for pain treatment of women with fibromyalgia.

• The use of whole-body vibration in women with fibromyalgia showed no clinically important effects in the control of fatigue and improvement of quality of life.

     

The effect of unilateral training on contralateral limb strength in young,older, and patient populations: a meta-analysis of cross education

Background: Cross education is the contralateral strength gain following unilateral training of the ipsilateral limb. This phenomenon provides an ideal rehabilitation model for acute or chronic rehabilitation; however, previous cross education meta-analyses have been limited to a handful of studies.

Objectives: The present meta-analysis aimed to (1) be as inclusive as possible, (2) compare cross education in young able-bodied, older able-bodied, and patient populations, (3) compare cross education between training modalities, and (4) detail the impact of methodological controls on the quantification of cross education.

Methodology: A review of English literature identified studies that employed unilateral resistance training and reported contralateral strength results. Studies were separated to examine the effect of population, training modality, limb, sex, and familiarization on the magnitude of cross education. The percent strength gain and effect size were calculated for ipsilateral and contralateral limbs.

Results: A total of 96 studies fit the predetermined inclusion criteria and were included in the analysis. The included studies were further divided into 141 units employing separate unilateral training paradigms. These were separated into young, able-bodied (n?=?126), older, able-bodied (n?=?9), and neuromuscular patients (n?=?6). Cross education was an average of 18% (standardized mean difference (SMD)?=?0.71) in young, able-bodied participants, 17% (SMD?=?0.58) in healthy able-bodied participants, and 29% (SMD?=?0.76) in neuromuscular patients.

Conclusion: Cross education was present in young, older, and patient populations and similar between upper and lower limbs and between males and females. Electromyostimulation training was superior to voluntary training paradigms.     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

Effects of perioperative statins on patient outcomes after noncardiac surgery: a meta-analysis

Background: Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery. However, controversy remains regarding whether perioperative administration of hydroxymethylglutaryl-CoA reductase inhibitors (statins) has a beneficial effect on patient outcomes.

Objective: We performed a meta-analysis to validate the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

Methods: Electronic databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) were searched for randomized controlled trials (RCTs) published up to 10 November 2017. RCTs were eligible for inclusion if they compared perioperative statin treatment with control treatment in patients scheduled for noncardiac surgery and reported data pertaining to clinical outcomes.

Results: Twelve RCTs involving 4707 patients (2371 in the perioperative statin group and 2336 in the control group) were ultimately included in this meta-analysis. The incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation were all lower in patients treated with statins than in control group patients, as shown by the fixed-effects model (odds ratio (OR)?=?0.460, 95% confidence interval (CI)?=?0.324–0.653, p?=?0 for myocardial infarction; OR?=?0.617, 95% CI?=?0.476–0.801, p?=?0 for composite of death/myocardial infarction/stroke; OR?=?0.406, 95% CI?=?0.247–0.666, p?=?0 for new atrial fibrillation). No significant differences in the incidences of stroke or transient ischemic attack, all-cause mortality and cardiovascular mortality were observed between the statin and control arms.

Conclusions: This meta-analysis supports the hypothesis that perioperative statins effectively reduce the incidences of postoperative myocardial infarction, composite of death/myocardial infarction/stroke and new cases of atrial fibrillation in patients undergoing noncardiac surgery.

• Key Messages

• Cardiovascular complications are strongly correlated with a higher risk of mortality during follow-up after noncardiac surgery.

• We performed a meta-analysis to confirm the hypothesis that perioperative statins improve patient outcomes after noncardiac surgery.

     

Construct validity and inter-rater reliability of the Dutch activity measure for post-acute care “6-clicks” basic mobility form to assess the mobility of hospitalized patients

Abstract

To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post-Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p?=?0.011), less restrictive discharge locations (p?=?0.001), more independence in activities of daily living (p?=?0.001) and less physiotherapy visits (p?<?0.001). A correlation was found between the “6-clicks” and length of stay (r=??0.408, p?=?0.001), but not between the “6-clicks” and age (r=??0.180, p?=?0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828–0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch “6-clicks” shows a good construct validity and moderate-to-excellent inter-rater reliability when used to assess the mobility of hospitalized patients.

• Implications for Rehabilitation

• Even though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care.

• The Activity Measure for Post-Acute Care “6-clicks” Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population.

• This study shows that the Dutch version of the Activity Measure for Post-Acute Care “6-clicks” Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients.

     

Integrative group-based cognitive rehabilitation efficacy in multiple sclerosis: a randomized clinical trial

Purpose: This study aimed to determine the efficacy of the integrative group-based cognitive rehabilitation programme, REHACOP, on improving cognitive functions in multiple sclerosis (MS).

Methods: Fourty-two MS patients were randomized to the treatment programme REHACOP (n?=?21) or waiting list control condition (n?=?21). The REHACOP group received cognitive rehabilitation in group format for three months focused on attention, processing speed, learning and memory, language, executive functioning, and social cognition. Patients completed a neuropsychological assessment at baseline and follow-up, which included tests of attention, processing speed, working memory, verbal memory, verbal fluency, and executive functioning. Repeated measures multivariate analysis of covariance (MANCOVA) was used to determine the efficacy of the cognitive rehabilitation programme.

Results: Group?×?Time interactions revealed significant improvements in the REHACOP group as compared with the control group for processing speed (p?=?0.011, n_p²?=?0.16), working memory (p?=?0.014, n_p²?=?0.15), verbal memory (p?=?0.025, n_p²?=?0.13), and executive functioning (p?=?0.024, n_p²?=?0.13), showing medium–large effect sizes.

Conclusions: Patients receiving REHACOP showed improvements in several cognitive domains. This preliminary study thus provides evidence supporting the efficacy of this integrative group-based cognitive rehabilitation intervention in MS. Future research should confirm these findings, examine the impact of the treatment on everyday life functioning and explore the presence of brain changes associated with cognitive rehabilitation.

• Implications for rehabilitation

• This study provides initial evidence for integrative group-based cognitive rehabilitation efficacy in MS patients through the implementation of the REHACOP cognitive rehabilitation programme.

• Patients received cognitive rehabilitation for three months (3 one-hour-sessions per week) focused on training attention, learning and memory, language, executive functioning, and social cognition.

• Patients attending REHACOP sessions showed medium to large and statistically significant improvements in processing speed, working memory, verbal memory, and executive functioning.

     

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study

Background: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait.

Aim: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs.

Method: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters.

Results: Maximum hip joint extension was significantly increased (p?=?0.011), and hip abduction and adduction were both significantly reduced (p?=?0.011 and p?=?0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p?=?0.035) was demonstrated but there were no significant increases in either walking speed or cadence.

Conclusions: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs.

• Implications for Rehabilitation

• The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using.

• Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear.

• The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis.

• In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced.

• The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.