Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

Objective

To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization.

Treatment Effect in Earlier Trials of Patients With Chronic Medical Conditions: A Meta-Epidemiologic Study

Objective

To determine whether the early trials in chronic medical conditions demonstrate an effect size that is larger than that in subsequent trials.

Chronic Pain Patients—Effects on Mental Health and Pain After a 57-Week Multidisciplinary Rehabilitation Program

Chronic musculoskeletal pain is a common health complaint in Norway and constitutes the largest proportion in terms of those who suffer long-term sickness and are in receipt of disability pensions. The aim of this study was to examine the relation between changes in pain and mental health among men and women with chronic musculoskeletal pain after a rehabilitation program. A total of 201 subjects (132 women and 63 men) with chronic pain (>6 months) and without any manifest organic diseases were referred to the 57-week multidisciplinary rehabilitation program. Measurements of pain (visual analog scale) and mental health (Hospital Anxiety and Depression Scale [HADS]), as well as sociodemographic data, were obtained before and after the rehabilitation period. At baseline, men showed higher HADS scores than women. Both women and men reported significant improvements in pain and mental health. The subjects scored higher on HADS both before and after the rehabilitation compared with a population-based study in the region. Older men and men with low education levels showed less improvement in HADS scores. In women, a significant association was found between change in pain and both change in anxiety and change in depression. The results support the hypothesis that there may be a strong association between change in chronic pain and psychologic factors, but there were gender differences.     

Effect of Functional Status on Survival in Patients With Stroke: Is Independent Ambulation a Key Determinant?

Chiu H-T, Wang Y-H, Jeng J-S, Chen B-B, Pan S-L. Effect of functional status on survival in patients with stroke: is independent ambulation a key determinant?ObjectiveTo investigate the effect of functional status, measured using the Modified Rankin Scale (MRS), at 3 months after stroke on survival in patients with stroke.DesignCohort study.SettingReferral medical center.ParticipantsPatients with stroke (N=1032).InterventionsNot applicable.Main Outcome MeasureSurvival after stroke.ResultsThe Kaplan-Meier survival curves stratified by the 3-month MRS score showed 2 clear groups of patients with 3-month MRS scores of 0 to 3 (able to walk without assistance) and 4 or 5 (unable to walk without assistance). Accordingly, we grouped the patients into a high function (HF) group (3-month MRS≦3) and a low function (LF) group (3-month MRS≧4). Multiple Cox regression analysis showed that the LF group had significantly poorer survival (adjusted hazard ratio=4.69; 95% confidence interval [CI], 2.89–7.60; P<.001) than the HF group. Other significant risk factors of higher mortality were older age, history of diabetes mellitus, and heart disease.ConclusionsThis study showed a significant influence of the 3-month MRS score on stroke survival. Moreover, independent ambulation may be a major determinant of a favorable survival prognosis. This finding suggests a potential role of rehabilitation in promoting stroke survival by maximizing ambulation function.     

Effect of Ankle-foot Orthosis on Lower Limb Muscle Activities and Static Balance of Stroke Patients Authors’ Names

[Purpose] This study examined the effects of an ankle-foot orthosis worn during balance training on lower limb muscle activity and static balance of chronic stroke patients. [Subjects] The subjects were twenty-five inpatients receiving physical therapy for chronic stroke. [Methods] The chronic stroke patients were divided into two groups: thirteen patients were assigned to the ankle-foot orthosis group, while the remaining twelve patients wore only their shoes. Each group performed balance training for 20 minutes, twice per day, 5 days per week, for 6 weeks. The lower limb muscle activities of the paralyzed side tibialis anterior, medial gastrocnemius, and the stability index were measured before and after the 6-week intervention. [Results] Comparison of the groups indicated a significant difference in the muscle activity of the paralyzed side tibialis anterior and the stability index of the eyes-open standing position. After the intervention, the ankle-foot orthosis group evidenced a significant difference in the muscle activities of the paralyzed side tibialis anterior and paralyzed side medial gastrocnemius as well as the stability index of the eyes-open standing position, eyes-closed standing position, eyes-open standing position on a sponge, and eyes-closed standing position on a sponge. The group that only wore their shoes showed significant differences in the stability indexes of eyes-open standing and eyes-open standing on a sponge. [Conclusion] Using the ankle-foot orthosis was effective during the initial training of lower limb muscle activities and the static balance training of chronic stroke patients. However, it was not effective for a variety of dynamic situations.Key words: Ankle-foot orthosis, Lower limb muscle activity, Static balance     

Examination of Factors Related to the Effect of Improving Gait Speed With Functional Electrical Stimulation Intervention for Stroke Patients

Background

Functional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and nonresponders have not been clarified.

The Effect of a PNF Technique Program after Mastectomy on Lymphedema Patients’ Depression and Anxiety

[Purpose] This study was conducted to examine the effects of exercises applied with PNF techniques performed for 30 minutes per session, three times per week, after receipt of radiation therapy following mastectomy on depression and anxiety in patients diagnosed with lymphedema and to prepare basic data for creation of self-directed exercise programs for lymphedema patients that will enable them to perform exercises within the range of no pain. [Methods] The subjects of this study were 45 patients selected from among those diagnosed with breast cancer who showed lymphedema after anti-cancer therapy following mastectomy. [Results] The Beck depression score changed significantly during the five assessment periods however, there was no significant difference between the treatment groups. Post hoc analyses revealed that there was significant improvement in the Beck depression score from 4 weeks in all three groups. The interaction between group and time was also statistically significant. [Conclusion] In conclusion, PNF techniques helped to improve the depression and anxiety rates. Four weeks after the start of therapy, PNF techniques Depression and anxiety to create a greater degree of decline was on display.Key words: Lymphedema, Depression, Anxiety     

Effectiveness of Mulligan’s Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018

ObjectivesThe purpose of this study was to provide an updated systematic review and meta-analysis regarding the effectiveness of mobilization with movement (MWM) techniques on range of motion (ROM).MethodsAn electronic search strategy of the Physiotherapy Evidence Database, PubMed, Cochrane Library, Embase, Google Scholar, and CINAHL was performed between August 2008 and January 2018. Two independent reviewers selected the studies. Only randomized controlled trials were included. The methodology was independently assessed by 2 reviewers using the Physiotherapy Evidence Database scale. The Z indicator was considered for the assessment of statistical significance of ROM change, whereas for each meta-analysis referring to a specific joint pathology, the total mean difference (95% confidence interval) was compared against minimum detectable change values from relevant studies conducted in similar populations to assess clinical significance.ResultsIncluded were 18 studies with 753 participants in 10 separate meta-analyses for ROM. All studies were classified as high quality or medium quality. Peripheral joint MWM seems to produce better therapeutic results in comparison to sham, passive, other active, or no therapeutic approach, regarding improvement of joint ROM in specific peripheral joint pathologies, consistently in all movement directions for shoulder adhesive capsulitis (mean improvement 12.30^o-26.09^o, P < .02) and hip pain (mean improvement 4.50^o-14.80^o, P < .0001).ConclusionMobilization with movement produced a statistically and clinically significant ROM increase consistently in all movement directions for shoulder adhesive capsulitis and hip pain. However, for shoulder impingement, shoulder pain/dysfunction, hamstring tightness, knee osteoarthritis, and chronic ankle instability pathologies, a therapeutic benefit regarding ROM could not be clearly established. Owing to the small number of individual studies included within the separate groups of pathologies examined in our systematic review, methodologically rigorous studies with longer follow-up periods are warranted to better inform the evidence base on the effects of MWM on ROM.     

New-Onset Diabetes and Preexisting Diabetes Are Associated With Comparable Reduction in Long-Term Survival After Liver Transplant: A Machine Learning Approach

Objective

To identify key predictors and survival outcomes of new-onset diabetes after transplant (NODAT) in liver transplant (LT) recipients by using the Scientific Registry of Transplant Recipients.

Launch Delay of New Drugs in China and Effect on Patients’ Health

PurposeAlthough the launch delay of new drugs in China has been a deep concern during the past few years, research on this topic is scarce. The effect of recent regulatory efforts, such as initiating fast review channels to improve access to medical innovations, remains unclear. In this work, we measure the launch delay in China and study whether the fast channels contribute to shorter delays. We also offer an examination of the effect of launch delay on patients’ health.MethodsWe examined the launch delays of 40 new drugs engaged in the 3 national price negotiations in China. Launch delay was defined as the differences between the approval dates of the United States or the European Union and that of China and was measured according to approved indications of every specific drug. Thirty-four health impact models comparing the new drugs and their corresponding comparator therapies were populated with open data from published studies to assess the loss of health attributable to launch delay. The time horizon for each model was the specified delay time.FindingsA total of 40 new drugs with 54 approvals were studied. The median delay was 44.40 months (range, 7.30–196.24 months). For the 20 approvals granted with the fast channels, the median delay was 38.14 months, which was shorter than the 68.25 months of those 34 approvals on the track of standard procedure (P = 0.0276). Moreover, among the 34 health models for 27 new drugs, the largest loss of health was 5.76 life-years and 4.14 quality-adjusted life-years per potential patient, whereas the least loss was 0.006 life-years per head and 0.0035 quality-adjusted life-years per head, respectively.ImplicationsAccess to new drugs is delayed significantly in China, which may undermine patient benefit by causing loss of life-years and quality of life. The fast review procedures in China have appeared to mitigate the launch delay.     

The Effects of an 8-Week Stabilization Exercise Program on Lumbar Multifidus Muscle Thickness and Activation as Measured With Ultrasound Imaging in Patients With Low Back Pain: An Exploratory Study

Background

Lumbar stabilization exercise programs (LSEP) produce positive effects on clinical outcomes, but the underlying mechanisms remain relatively unexplored. Psychological and neuromuscular mechanisms can be involved, such as a better activation of the lumbar multifidus, which represents one possibility.

The Effects of Mindfulness Meditation-Based Complex Exercise Program on Motor and Nonmotor Symptoms and Quality of Life in Patients with Parkinson's Disease

Purpose

The present study was to examine the effect of a meditation-based exercise program on the motor and non-motor symptoms of Parkinson’s disease (PD).