Clinical Rehabilitation

To justify and describe an integrated rehabilitation programme for patients with chronic low back pain prior to evaluation in a randomized controlled trial.

The Template for Intervention Description and Replication (TIDieR) checklist was used as a structural framework for the description of the integrated rehabilitation programme. As a part of the description, the Medical Research Council guidance, ‘Developing and evaluating complex interventions’, was used as a framework to justify the integrated rehabilitation programme.

The integrated rehabilitation programme adopts a participatory biopsychosocial approach integrating inpatient activities supported by a multidisciplinary team and learning located within the patient’s own environment. The integrated rehabilitation programme comprises 3 weeks of inpatient stay and 11 weeks of home-based activities. The inpatient part of the programme consists of 38 clinical activities, some of them delivered more than once. The 38 clinical activities were described in an activity sheet developed for this purpose, combining five items from the TIDieR.

An integrated rehabilitation programme for patients with chronic low back pain has been justified and described. The intervention description is currently being used for successful structuring and standardization of the content and delivery of the integrated rehabilitation programme in a randomized controlled trial.

ClinicalTrials.gov: NCT02884466.

Approximately 20% of the children and adolescents after mild traumatic brain injury will not fully recover. They suffer long-term postconcussive symptoms and may experience limitations in activities and participation. Research suggests that early psychoeducational interventions may prevent long-term postconcussive symptoms. The Brains Ahead! intervention was developed to prevent long-term symptoms and, furthermore, to establish a more successful return to activities and participation after mild traumatic brain injury in children and adolescents. The intervention is currently being evaluated in a multicenter randomized controlled trial.

Providing individualized information and personal advice in addition to standardized information about the injury and possible consequences early after the injury may enable patients and caregivers to recognize and anticipate on relevant symptoms at an early stage and to prevent problems in activities and participation.

The Brains Ahead! intervention is a psychoeducational intervention for children and adolescents who sustained a mild traumatic brain injury and for their caregivers. The patients will receive a partially standardized and partially individualized psychoeducational session and a telephone follow-up within the first two to eight weeks after the injury.

To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis.

A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance (P < 0.05).

Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength.

Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.

To compare the effect of Kinesio taping on ankle functional performance with that of other taping methods (non-elastic taping) in healthy individuals and patients with ankle sprain.

A search was performed in electronic databases (MEDLINE, Embase, Cochrane Library, and China National Knowledge Infrastructure) for studies published up to 31 March 2018 using the following keywords: ankle, Kinesio taping, KT, and tape. Studies on ankle functional performance were selected, and data on Star Excursion Balance Test results, vertical jump height, and range of motion were extracted. Meta-analyses (where appropriate and possible) using either fixed or random effects model, standardized mean differences, and tests of heterogeneity were performed.

Ten studies fulfilled the inclusion criteria. The Star Excursion Balance Test results indicated that Kinesio taping was superior to other taping methods (placebo taping or tension-free taping). The mean difference was 3.2 (95% confidence interval (CI): 0.84–5.59, I² = 5%, P = 0.008). In studies in which vertical jump height was measured, a negative effect was observed for other taping methods (athletic taping or placebo taping), but not for Kinesio taping (mean difference = 1.06, 95% CI: 0.19–0.93, I² = 15%, P = 0.02). Both Kinesio taping and common taping had no significant effect on range of motion, with no differences between these methods (I² = 0%, P = 0.80).

Kinesio taping is superior to other taping methods (athletic taping) in ankle functional performance improvement.

Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failure with reduced ejection fraction (HFrEF).

We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, SciELO and CINAHL from the earliest date available to May 2018. Primary studies on HIIMT against low-intensity IMT or sham-IMT that evaluated exercise capacity and inspiratory muscle strength were included. Two independent reviewers evaluated the eligibility of studies retrieved from the databases. Disagreements were resolved by discussion or by a third reviewer. Weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence interval (CI) were estimated by random effect models.

Five studies met the eligibility criteria (138 patients). HIIMT improved VO₂peak (WMD 2.65 mL kg⁻¹ min⁻¹; 95% CI: 2.2 to 3.1 mL kg⁻¹ min⁻¹), walking tests (SMD 1.71; 95% CI: 0.83 to 2.59) and maximal inspiratory pressure (WMD 16.63 cmH₂O; 95% CI: 10.34 to 22.91 cmH₂O). The estimate for potential risks of adverse events was not performed because of the low prevalence of reports in primary studies.

HIIMT seems to be a useful strategy for improving exercise capacity and inspiratory muscle strength in HFrEF patients.

To investigate the effect of an acute weekend physiotherapy service compared to no physiotherapy service on short-term outcomes following lower limb joint replacement.

Pre-post intervention (quasi-experimental) study nested within two stepped-wedge cluster randomized controlled trials.

Public tertiary hospital in Melbourne, Australia.

Consecutive patients undergoing hip and knee replacement.

This study analysed a subgroup of one cluster of the parent trials where acute weekend physiotherapy services were sequentially discontinued in random order from one cluster at a time. Intervention (at the ward level) included six months of existing acute weekend physiotherapy services (Phase 1; n = 130) followed by six months when these services were discontinued (Phase 2; n = 146).

Acute hospital length of stay and other short-term patient and hospital measures.

Availability of weekend physiotherapy was associated with increased odds of discharge directly home (odds ratio (95% confidence interval): 3.151 (1.039–9.555), P = 0.043) and improved mobility (coefficient: 4.301 (1.500–7.101), P = 0.003). However, hospitalization was perceived as less helpful (coefficient: –1.743 (−2.417 to −1.069), P = 0.013) and acute length of stay was longer, only in multivariable analyses (coefficient: 1.003 (0.105–1.890), P = 0.020) than when weekend physiotherapy services were unavailable. Similar results were observed when examining data according to receipt of weekend physiotherapy services rather than the intervention phase to which each patient was allocated.

The weekend physiotherapy service appears to have had beneficial impacts on discharge destination and patient mobility that may outweigh the unfavourable impacts on acute length of stay and patient-perceived helpfulness of hospitalization.

To investigate the effect of setting expectations verbally on the effectiveness of kinesiotape application in patients with a rotator cuff tear.

Randomized controlled, double-blind study.

Department of Physiotherapy and Rehabilitation.

Eighty-nine patients with rotator cuff tear.

Patients were randomized according to the verbal input given to patients about the effectiveness of kinesiotaping; Group 1 (there is no evidence that kinesiotaping is effective), Group 2 (there is limited evidence that kinesiotaping is effective), and Group 3 (there is evidence that kinesiotaping has an excellent effect).

Resting pain, activity pain, and night pain were assessed by visual analog scale. Range of motion was assessed by a universal goniometer. Function was evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form before and 24 hours after kinesiotape application. Only resting pain and activity pain were assessed after 30 minutes.

There were no statistically significant differences (ANOVA) between any groups at the three assessment points. The intragroup assessment showed that in Group 2, only resting pain after 30 minutes improved (3.2 ± 2.9 to 2.6 ± 2.8; P = 0.02). An improvement in resting pain both after 30 minutes and after 24 hours was found in the third group (4.1 ± 2.4 to 2.3 ± 2.3, P = 0.001; 4.1 ± 2.4 to 2.2 ± 2.3, P = 0.001, respectively). Activity pain and night pain were improved in all groups after 24 hours.

Setting positive expectations verbally about kinesiotaping might be effective in reducing pain in patients with rotator cuff tear.

To determine long-term effects of a highly challenging training program in people with Parkinson’s disease, as well as describe how initially observed improvements of the program deteriorated over time.

Long-term follow-up of previously reported outcomes at 10 weeks of a randomized controlled trial.

University hospital setting.

One-hundred elderly with mild-to-moderate (Hoehn and Yahr 2–3) Parkinson’s disease.

Participants in the training group (n = 51) received 10 weeks (three times/week) of balance and gait exercises, incorporating dual-tasks, while the control group (n = 49) received care as usual.

Balance control (Mini-Balance Evaluation System Test (Mini-BESTest)) and gait velocity. Mixed-design analyses of variance were used to determine potential training effects at 6- and 12-month follow-up, and piecewise regression models predicted the rate of deterioration.

Seventy-six participants were included at final follow-up. No significant (P > .05) between-group differences remained at either 6 or 12 months following the intervention. The mean Mini-BESTest scores of the training and control group were 19.9 (SD 4.4) and 18.6 (SD 4.3), respectively, at the 12-month follow-up. Gait speed was 1.2 (SD 0.2) m/s in both groups at 12 months. The training group showed a larger deterioration rate per month in balance performance (0.21 point) and gait velocity (0.65 cm/s) than controls (P < .05).

These results suggest that training effects diminish within 6 months after balance training, implying that the program may need to be repeated regularly.

To empirically test the hypothesis that the 10 roles on the Revised Role Checklist are represented in the International Classification of Functioning, Disability and Health participation areas.

Cross-sectional survey.

Investigators from Japan, Norway, Sweden, Switzerland, the United Kingdom and the United States recruited a total of 295 adults from the general population. There were 103 (34.9%) male and 191 (64.7%) female participants with one participant not indicating gender. The age distribution of participants was from <25 (n = 68) to 75+ with a mode of 25–34 years.

The Revised Role Checklist Part 1 was used to assess perceived incumbency in 10 roles. In addition, subjects were asked to provide role examples.

Of the 7087 examples provided by participants, 6578 (92.8%) fit the original hypothesis that the roles in the Revised Role Checklist were covered in participation areas. Fit was determined when the role example was either named in the associated International Classification of Functioning, Disability and Health participation area or when the criteria of: “does this example conceivably fit in the respective area as ‘a person’s involvement in life situations’ fit relative to each role.” Slight modification of the scope of three roles of the original hypothesis resulted in a 97.6% match.

The roles in the Revised Role Checklist are well represented in the International Classification of Functioning, Disability and Health categories of participation.

To assess the psychometric properties and feasibility of the Finnish translation of the measure of processes of care for adults (MPOC-A) when used in an inpatient rehabilitation setting.

A feasibility study.

Inpatient rehabilitation settings.

A total of 858 people with severe neurological disabilities, musculoskeletal problems, and mental disorders were recruited to the study.

The MPOC-A questionnaire is a self-administered questionnaire consisting of 34 items in five-factorial domains. The construct validity of the translated questionnaire was evaluated using confirmatory factor analysis. To compare the fit of the model to the fit of the independent null-model Comparative Fit Index was used. Internal consistency for the total scale and subscales was calculated using Cronbach’s alpha reliability coefficient.

A total of 554 people, mean age 52 years (SD = 9), participated in the study. Most of the responders had musculoskeletal problems (n = 328, 57%). The respondents rated the client-centeredness in rehabilitation service as moderate (m = 5.40, SD = 0.81). The five-factor and the one-factor model fitted the data well according to all three indices. Internal consistency showed high reliability between the one-factor and five-factor models for all except one domain (0.49–0.93). The mean for Person Infit for the people with neurological disabilities was higher than for the other two groups (m = 1.77, SD = 1.32) indicating less predictable response patterns in this group.

The results confirm the appropriate psychometric properties of the Finnish version of the MPOC-A, especially for people with musculoskeletal problems and those with mental health disorders.

To estimate the number of people in a prolonged disorder of consciousness (PDOC) who may need a formal best interests decision-making process to consider starting and/or continuing life-sustaining treatment each year in the population of a developed country.

Identification of studies on people with a PDOC giving information about incidence, and/or prevalence, and/or cause, and/or location of long-term care. Sources included systematic reviews, a new search of MEDLINE (April 2018), and a personal collection of papers. Validating information was sought from existing data on services.

There are few epidemiologically sound studies, most having bias and/or missing information. The best estimate of incidence of PDOC due to acute onset disease is 2.6/100,000/year; the best estimate of prevalence is between 2.0 and 5.0/100,000. There is evidence that prevalence in the Netherlands is about 10% of that in other countries. The commonest documented causes are cerebral hypoxia, stroke, traumatic brain injury, and tumours. There is some evidence suggesting that dementia is a common cause, but PDOC due to progressive disorders has not been studied systematically. Most people receive long-term care in nursing homes, but a significant proportion (10%–15%) may be cared for at home.

Each year, about 5/100,000 people will enter a prolonged state of unconsciousness from acute onset and progressive brain damage; and at any one time, there may be 5/100,000 people in that state. However, the evidence is very limited in quality and quantity. The numbers may be greater.