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1.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651
Objective
To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.Design
Multicenter prospective cohort study.Setting
Institutions for physical therapy and rehabilitation.Participants
Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.Interventions
Not applicable.Main Outcome Measures
Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.Results
Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).Conclusions
PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. 相似文献2.
Ana Francisca Rozin Kleiner Aline Souza Pagnussat Camila Pinto Ritchele Redivo Marchese Ana Paula Salazar Manuela Galli 《Archives of physical medicine and rehabilitation》2018,99(12):2420-2429
Objective
To assess the effects of automated peripheral stimulation (AMPS) in reducing gait variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test).Design
Interventional, double-blinded, placebo-controlled, randomized trial.Setting
Clinical rehabilitation.Participants
Thirty subjects were randomized into 2 groups: AMPS (n=15) and AMPS sham (n=15).Interventions
Both groups received 2 treatment sessions a week for 4 consecutive weeks (totaling 8 treatment sessions). AMPS was applied by using a medical device (Gondola?) and consisted in mechanical pressure stimulations delivered by metallic actuators on 4 areas of the feet. Treatment parameters and device configuration were modified for AMPS sham group.Main Outcome Measures
Gait analyses were measured at baseline and after the first, fourth, and eighth treatment sessions.Results
Interactions among groups and sessions were found for both conditions while off anti-Parkinsonian medications. AMPS decreased gait variability in subjects with PD and FOG for both single and dual task conditions.Conclusions
AMPS is an effective add-on therapy for treating gait variability in patients with PD and FOG. 相似文献3.
Cheng-Ya Huang Yu-An Chen Ing-Shiou Hwang Ruey-Meei Wu 《Archives of physical medicine and rehabilitation》2018,99(8):1540-1546.e2
Objective
To examine the task prioritization effects on postural-suprapostural dual-task performance in patients with early-stage Parkinson disease (PD) without clinically observed postural symptoms.Design
Cross-sectional study. Participants performed a force-matching task while standing on a mobile platform, and were instructed to focus their attention on either the postural task (posture-first strategy) or the force-matching task (posture-second strategy).Setting
University research laboratory.Participants
Individuals (N=16) with early-stage PD who had no clinically observed postural symptoms.Interventions
Not applicable.Main Outcome Measures
Dual-task change (DTC; percent change between single-task and dual-task performance) of posture error, posture approximate entropy (ApEn), force error, and reaction time (RT). Positive DTC values indicate higher postural error, posture ApEn, force error, and force RT during dual-task conditions compared with single-task conditions.Results
Compared with the posture-first strategy, the posture-second strategy was associated with smaller DTC of posture error and force error, and greater DTC of posture ApEn. In contrast, greater DTC of force RT was observed under the posture-second strategy.Conclusions
Contrary to typical recommendations, our results suggest that the posture-second strategy may be an effective dual-task strategy in patients with early-stage PD who have no clinically observed postural symptoms in order to reduce the negative effect of dual tasking on performance and facilitate postural automaticity. 相似文献4.
William J. Beckworth John F. Holbrook Lisa G. Foster Laura A. Ward James R. Welle 《PM & R》2018,10(4):331-337
Background
The intervertebral disk is the largest avascular structure in the body. It relies on passive diffusion from arteries at the periphery of the disk for nutrition. Previous studies have suggested a correlation between vascular disease and lumbar degenerative disk disease (DDD), but the association with facet arthritis and stenosis has not been evaluated.Objective
To evaluate the degree of lumbar artery stenosis, aortic atherosclerosis on computed tomography angiography, and its relationship to lumbar DDD, facet arthritis, and spinal canal stenosis.Design
Retrospective case review.Setting
Academic tertiary care hospital.Participants
Not applicable.Methods
A total of 300 lumbar arteries (150 lumbar artery pairs of the first to fifth lumbar arteries) were evaluated on consecutive computed tomography angiography scans. Severity of vascular disease of lumbar arteries was documented as normal, mild, moderate, severe, or occluded. Aortic vascular disease was documented along the posterior wall where the lumbar arteries originate.Main Outcome Measurements
The relationship between vascular disease with DDD, facet arthritis, and spinal canal stenosis was examined and further evaluated controlling for age.Results
Lumbar artery and aortic atherosclerosis had a positive relationship with DDD, facet arthritis, and spinal stenosis that was statistically significant (P < .05) even after controlling for age. The correlation coefficient was greatest in the younger age group when looking at lumbar artery vascular disease with DDD (0.73, confidence interval 0.50-0.96, P < .0001) and aortic vascular disease with DDD (0.72, confidence interval 0.49-0.94, P < .0001). The correlation of vascular disease with facet arthritis and stenosis was not strong in the older age group.Conclusion
Atherosclerotic disease of the lumbar arteries and aorta correlated with lumbar DDD, facet arthritis, and spinal canal stenosis after we adjusted for age, although the correlation with facet arthritis and spinal canal stenosis was not as strong in the older age group.Level of Evidence
IV 相似文献5.
Kuan-yi Li Yu-pei Hsiao Rou-shayn Chen Ching-yi Wu 《Archives of physical medicine and rehabilitation》2018,99(7):1303-1310
Objective
To investigate the kinematic and myographic effects of weighted wrist cuffs on individuals with Parkinson disease (PD) during a reaching task.Design
Cross-sectional study.Setting
Biomechanics research laboratory.Participants
Individuals (N=39) with PD (n=19) and healthy age-matched control subjects (n=20).Interventions
Participants were instructed to reach and grasp a can at a distance of 80% of their arm length without a wrist cuff, while wearing separate 0.5- and 1.0-kg wrist cuffs, and subsequently without a wrist cuff.Main Outcome Measures
Movement time, kinematic, and electromyographic data were recorded during all reach and grasp movements. Four end point coordinate strategy variables, 3 joint recruitment variables, and 2 co-contraction indices were derived from the raw data for analysis.Results
Significant interaction effects were found in the trunk and index finger movement time as the weight of the cuff increased from 0.5 to 1.0kg. The group of individuals with PD showed decreased movement times in both instances, whereas the control group showed increased movement times as the weight of the wrist cuff increased from baseline to 0.5 and 1.0kg. No group difference was observed in the co-contraction index of the upper arm and forearm.Conclusions
Adoption of weighted wrist cuffs in the clinic should be cautiously undertaken because compensatory movements may be induced in the trunk of individuals with PD. 相似文献6.
Managing Antithrombotic Therapy in Patients With Both Atrial Fibrillation and Coronary Heart Disease
Purpose
Atrial fibrillation (AF) and coronary heart disease (CHD) commonly occur together. Previous consensus guidelines were published before the wide availability of novel oral anticoagulants (NOACs) and newer P2Y12 antiplatelet agents. We examine recent evidence to guide management in 3 categories of patients with AF and CHD: patients with stable CHD, nonstented patients with recent acute coronary syndrome, and patients with a coronary stent requiring dual-antiplatelet therapy.Methods
We conducted a literature search by evaluation of PubMed and other data sources including international meeting reports. We critically reviewed recent clinical trial and relevant registry evidence to update European and US consensus documents.Findings
Oral anticoagulation with warfarin or NOACs is required to prevent embolic stroke in AF, and antiplatelet therapy is insufficient for this purpose. Antiplatelet therapy using monotherapy with aspirin is the standard of care in stable CHD. Dual-antiplatelet therapy with aspirin and clopidogrel or a new P2Y12 inhibitor (dual-antiplatelet therapy) is needed to reduce coronary events after an acute coronary syndrome or after percutaneous coronary intervention. Combinations of these agents increase the risk of bleeding, and limited clinical trial evidence suggests that withdrawal of aspirin may reduce bleeding without increasing coronary events.Implications
Available clinical trials and registries provide remarkably little evidence to guide difficult clinical decision making in patients with combined AF and CHD. In patients on triple antithrombotic therapy with vitamin K antagonists, aspirin, and clopidogrel, a single clinical trial indicates that withdrawal of aspirin may reduce bleeding risk without increasing the risk of coronary thrombosis. It is unclear whether this evidence applies to combinations of NOACs and newer P2Y12 inhibitors. Clinical trials of combinations of the newer antithrombotic agents are urgently needed to guide clinical care. 相似文献7.
8.
Rachel A. Lindor Marysia S. Tweet Kiran A. Goyal Christine M. Lohse Rajiv Gulati Sharonne N. Hayes Annie T. Sadosty 《The Journal of emergency medicine》2017,52(3):286-291
Background
Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present.Objectives
We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers’ awareness and recognition of this condition.Patients and Methods
We performed a retrospective medical record review of all patients who presented to the ED of a single academic medical center from January 1, 2002 through October 31, 2015 and were subsequently diagnosed with SCAD by angiography. These patients were identified by International Classification of Diseases, Ninth Revision codes and a Boolean search of the diagnosis field of the medical record. Data regarding patients’ presentations and course were abstracted by two independent reviewers.Results
We identified 20 episodes of SCAD involving 19 patients, all of whom were female. The majority of patients had 0–1 conventional cardiovascular disease risk factors. Most patients had chest pain (85%), initial electrocardiograms without evidence of ischemia (85%), and elevated initial troponin (72%). The most common diagnosis in providers’ differential was acute coronary syndrome (ACS).Conclusion
Patients with SCAD present with similar symptoms compared to patients with ACS caused by atherosclerotic disease, but have different risk profiles. Providers should consider SCAD in patients presenting with symptoms concerning for ACS, especially in younger female patients without traditional cardiovascular disease risk factors, as their risk may be significantly underestimated with commonly used ACS risk-stratifiers. 相似文献9.
Cory L. Christiansen Matthew J. Miller Amanda M. Murray Ryan O. Stephenson Jennifer E. Stevens-Lapsley William R. Hiatt Margaret L. Schenkman 《Archives of physical medicine and rehabilitation》2018,99(11):2160-2167
Objective
To determine preliminary efficacy of a home-based behavior-change intervention designed to promote exercise, walking activity, and disease self-management.Design
A single-blind, randomized controlled pilot trial.Setting
One Veterans Administration and 2 regional medical centers.Participants
A total of 38 participants randomized to behavior-change intervention (n=19) or attention control (CTL; n=19) group.Interventions
Weekly 30-minute telephone sessions for 12 weeks with intervention group sessions focused on health behavior change and CTL group sessions focused on health status monitoring.Main Outcome Measures
Physical function, walking activity (steps/d averaged over 10d), and disability were measured at baseline, 12 weeks (intervention end), and 24 weeks after baseline with the Timed Up and Go (TUG) test as the primary outcome measure.Results
The TUG test was not changed from baseline in either group and was not different between groups after 12 or 24 weeks. Several exploratory outcomes were assessed, including daily step count, which increased 1135 steps per day in the intervention group compared to 144 steps per day in the CTL group after 12 weeks (P=.03). Only the intervention group had within-group increase in steps per day from baseline to 12 (P<.001) and 24 (P=.03) weeks and spent significantly less time in sedentary activity (4.8% decrease) than the CTL group (0.2% decrease) at 24 weeks (P=.04). There were no other between-group differences in physical function or disability change over time.Conclusion
The behavior-change intervention demonstrates promise for increasing walking activity for people with dysvascular transtibial amputation (TTA). The efficacy of implementing such intervention in the scope of conventional TTA rehabilitation should be further studied. 相似文献10.
Moriah J. Brier Rhonda M. Williams Aaron P. Turner Alison W. Henderson Ann Marie Roepke Daniel C. Norvell Helene Henson Joseph M. Czerniecki 《Archives of physical medicine and rehabilitation》2018,99(3):452-458
Objective
To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA).Design
Cross-sectional cohort study using self-report surveys.Setting
Department of Veterans Affairs, academic medical center, and level I trauma center.Participants
Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men).Interventions
Not applicable.Main Outcome Measures
The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction.Results
In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms.Conclusions
The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict. 相似文献11.
Suzanne R. O&#x;Brien Ning Zhang 《Archives of physical medicine and rehabilitation》2018,99(1):107-115
Objectives
To determine the association between therapy intensity and discharge outcomes for aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and to determine the association between therapy intensity and time to community discharge.Design
Retrospective observational design.Setting
SNFs.Participants
Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs.Interventions
The total minutes of physical therapy, occupational therapy, and speech therapy per day were divided into intensity groups: high (≥60min); medium-high (45–<60min); medium-low (30–<45min); and low (<30min).Main Outcome Measures
Four discharge outcomes—community, hospitalization, permanent placement, and death—were examined using a multivariate competing hazards model. For those associated with community discharge, a Poisson multivariate model was used to determine whether length of stay differed by intensity.Results
High intensity therapy was associated with more community discharges in comparison to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high, medium-low, and low intensity groups, respectively). More hospitalizations and deaths were found as therapy intensity decreased. Only high intensity therapy was associated with a 2-day shorter length of stay (incident rate ratio, .95).Conclusions
High intensity therapy was associated with desirable discharge outcomes and may shorten SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services, there may be desirable benefits to beneficiaries who receive high intensity therapy. 相似文献12.
Odessa Addison Steven J. Prior Rishi Kundi Monica C. Serra Leslie I. Katzel Andrew W. Gardner Alice S. Ryan 《Archives of physical medicine and rehabilitation》2018,99(4):623-628
Objectives
(1) To determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD); (2) to compare a subgroup of the group with age-, race-, sex-, and body mass index (BMI)–matched non-PAD control counterparts, and (3) to compare the functional status of those with PAD with and without sarcopenia.Design
Cohort study.Setting
Medical center.Participants
Sedentary community-dwelling men (N=108; age, >50y) with a confirmed diagnosis of PAD (44% blacks; BMI, 27.8±0.4kg/m2; ankle-brachial index, .62±.01).Interventions
Not applicable.Main Outcome Measures
Dual-energy x-ray absorptiometry scans were used to assess appendicular lean mass and determine the prevalence of sarcopenia by/height2. Treadmill tests were used to determine claudication onset time, peak walking time, and claudication recovery time. 6-Minute walk distance was also measured.Results
Sarcopenia prevalence in our PAD cohort was 25%. The PAD subgroup (n=42) matched with control counterparts in terms of race, sex, age, and BMI had higher prevalence rates than did their non-PAD counterparts (23.8% vs 2.4%; P<.05). Individuals with sarcopenia (n=28) had a shorter 6-minute walk distance (326±18.8m vs 380±9.7m; P<.05) and higher claudication recovery time (592±98s vs 395±29s; P<.05) than did individuals with PAD but without sarcopenia (n=80). There was no difference in claudication onset time or peak walking time between the PAD groups.Conclusions
Men with PAD demonstrate a high prevalence of sarcopenia. Those with sarcopenia and PAD demonstrate decreased mobility function. 相似文献13.
Daniel Dominguez Ferraz Karen Valadares Trippo Gabriel Pereira Duarte Mansueto Gomes Neto Kionna Oliveira Bernardes Santos Jamary Oliveira Filho 《Archives of physical medicine and rehabilitation》2018,99(5):826-833
Objectives
To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD).Design
A pilot randomized, controlled, single-blinded trial.Setting
A state reference health care center for elderly, a public reference outpatient clinic for the elderly.Participants
Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank.Intervention
The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20).Main Outcome Measures
The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale.Results
All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups.Conclusions
Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants. 相似文献14.
Megan B. Shannon Madeleine Genereux Cynthia Brincat William Adams Linda Brubaker Elizabeth R. Mueller Colleen M. Fitzgerald 《PM & R》2018,10(6):601-606
Background
Pelvic floor physical therapy (PFPT) is a common and effective treatment for several pelvic floor disorders, but there is limited knowledge about adherence to the therapy or what factors influence attendance.Objective
To determine rates of PFPT attendance (initiation and completion) as well as correlates of PFPT attendance.Design
Retrospective cohort analysis.Setting
Urban outpatient clinics at a tertiary medical center treating women with pelvic floor disorders.Participants
Patients prescribed PFPT during the time period January 1, 2014, through January 1, 2015.Main Outcome Measurements
Number of PFPT visits recommended and attended; diagnoses associated with PFPT referral.Results
Two-thirds of participants (66%; 118/180) initiated PFPT but less than one-third (29%; 52/180) completed the full treatment course. On univariate analysis, age, body mass index, diagnosis requiring PFPT treatment, marital or employment status, insurance type, number of comorbidities, incontinence status on examination, and stage of prolapse did not differ between PFPT initiators and noninitiators. Those who self-identified as Hispanic were less likely to initiate PFPT when compared with non-Hispanic patients, although this only trended toward significance (odds ratio 0.40, 95% confidence interval 0.14-1.09; exact P = .078).Conclusions
Two-thirds (66%) of patients initiated PFPT but less than one-third (29%) completed the treatment course. There appears to be an opportunity to augment PFPT attendance, as well as explore racial disparities in attendance.Level of Evidence
II 相似文献15.
Michiel J. Vanfleteren Maud Koopman Martijn A. Spruit Herman-Jan Pennings Frank Smeenk Willem Pieters Jan J. van den Bergh Arent-Jan Michels Emiel F. Wouters Miriam T. Groenen Frits M. Franssen Lowie E. Vanfleteren 《Archives of physical medicine and rehabilitation》2018,99(11):2279-2286.e3
Objective
To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).Design
Retrospective cohort study.Setting
PR network.Participants
A cohort of 1981 patients with COPD (55% men; age: 66.8±9.3y; forced expiratory volume in the first second%: 50.7±19.5; residual volume [RV]%: 163.0±49.7).Intervention
An interdisciplinary PR program for patients with COPD consisting of 40 sessions.Main Outcome Measures
Participants were stratified into 5 quintiles according to baseline RV and were evaluated on the basis of pre- and post-PR 6-minute walk distance (6MWD), constant work rate test (CWRT), and Saint George’s Respiratory Questionnaire (SGRQ), among other clinical parameters.Results
With increasing RV quintile, patients were younger, more frequently women, had lower forced expiratory volume in the first second%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT, and worse SGRQ scores (P<.01). All RV strata improved after PR in all 3 outcomes (P<.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (P<.01) but similar Δ6MWD (P=.948) and ΔSGRQ (P=.086) after PR.Conclusions
LH in COPD is related to younger age, female sex, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH, however, influences walking and cycling response after PR differently. 相似文献16.
Roberto S. Miyasato Carla Silva-Batista Tiago Peçanha David A. Low Marco T. de Mello Maria E.P. Piemonte Carlos Ugrinowitsch Cláudia L.M. Forjaz Hélcio Kanegusuku 《PM & R》2018,10(11):1145-1152
Background
Patients with Parkinson disease (PD) present cardiovascular autonomic dysfunction that impairs blood pressure control. However, cardiovascular responses during resistance exercise are unknown in these patients.Objective
To investigate cardiovascular responses during resistance exercise performed with different muscle masses in patients with PD.Design
Prospective, repeated-measures.Setting
Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo.Participants
Thirteen patients with PD (4 women, 62.7 ± 1.3 years, stages 2-3 of the modified Hoehn and Yahr scale; “on” state of medication) and 13 paired control patients without PD (7 women, 66.2 ± 2.0 years).Interventions
Both groups performed, in a random order, bilateral and unilateral knee extension exercises (2 sets, 10-12 maximal repetition, 2-minute intervals).Main Outcome Measurements
Systolic blood pressure (SBP) and heart rate (HR) were assessed before (pre) and during the exercises.Results
Independent of set and exercise type, SBP and HR increases were significantly lower in PD than the control group (combined values: +45 ± 2 versus +73 ± 4 mm Hg and +18 ± 1 versus +31 ± 2 bpm, P = .003 and .007, respectively). Independently of group and set, the SBP increase was greater in the bilateral than the unilateral exercise (combined values: +63 ± 4 versus +54 ± 3 mm Hg, P = .002), whereas the HR increase was similar. In addition, independently of group and exercise type, the SBP increase was greater in the second than the first set (combined values: +56 ± 4 versus +61 ± 4 mm Hg, P = .04), whereas the HR increases were similar.Conclusions
Patients with PD present attenuated increases in SBP and HR during resistance exercise in comparison with healthy subjects. These results support that resistance exercise is safe and well tolerated for patients with PD from a cardiovascular point of view supporting its recommendation for this population.Level of Evidence
II 相似文献17.
Marie-Hélène Raymond Louise Demers Debbie Ehrmann Feldman 《Archives of physical medicine and rehabilitation》2018,99(1):35-42.e1
Objective
To compare the preferences of occupational therapists, elderly people, and adults with disabilities regarding prioritization criteria for occupational therapy waiting lists in home care.Design
Discrete choice experiment survey.Setting
Survey mailed to occupational therapists working in home care and community-dwelling elderly or disabled persons.Participants
A sample (N=714) of home-based occupational therapists (n=241), elderly persons from a bank of research participants (n=226), and adults with physical disabilities recruited through community organizations (n=247).Interventions
Not applicable.Main Outcome Measures
The dependent variable was whether the referral scenario was prioritized or not in each question. The results were analyzed through logistic regression using conditional logit models.Results
Prioritization preferences differed between groups (P<.001). Occupational therapists most strongly prioritized people who had a few falls (odds ratio vs no falls, 48.7), whereas elderly people and adults with disabilities most strongly prioritized people who were unable to enter and exit the home (odds ratio vs no difficulty entering and exiting the home, 30.8 for elderly people and 16.8 for persons with disabilities.)Conclusions
Our results highlight the gap between the priorities of home-based occupational therapists and their target clientele. Although further inquiry is needed to inform priority setting, the findings emphasize the importance of public or patient involvement in decisions on waiting list prioritization. 相似文献18.
Objective
To evaluate the efficacy of neurodynamic techniques used as the sole therapeutic component compared with sham therapy in the treatment of mild and moderate carpal tunnel syndromes (CTS).Design
Single-blinded, randomized placebo-controlled trial.Setting
Several medical clinics.Participants
Volunteer sample of patients (N=250) diagnosed with CTS (n=150).Interventions
Neurodynamic techniques were used in the neurodynamic techniques group, and sham therapy was used in the sham therapy group. In the neurodynamic techniques group, neurodynamic sequences were used, and sliding and tension techniques were also used. In the sham therapy group, no neurodynamic sequences were used, and therapeutic procedures were performed in an intermediate position. Therapy was conducted twice weekly for a total of 20 therapy sessions.Main Outcome Measures
Symptom severity (symptom severity scale) and functional status (functional status scale) of the Boston Carpal Tunnel Questionnaire.Results
A baseline assessment revealed no intergroup differences in all examined parameters (P>.05). After therapy, there was statistically significant intragroup improvement in nerve conduction study (sensory and motor conduction velocity and motor latency) only for the neurodynamic techniques group (P<.01). After therapy, intragroup statistically significant changes also occurred for the neurodynamic techniques group in pain assessment, 2-point discrimination sense, symptom severity scale, and functional status scale (in all cases P<.01). There were no group differences in assessment of grip and pinch strength (P>.05).Conclusions
The use of neurodynamic techniques has a better therapeutic effect than sham therapy in the treatment of mild and moderate forms of CTS. 相似文献19.
20.
Janet K. Freburger Dongmei Li Erin P. Fraher 《Archives of physical medicine and rehabilitation》2018,99(1):26-34.e5