Clinical Rehabilitation

To investigate the effects of backward gait training on balance, gross motor function, and gait parameters in children with cerebral palsy.

PubMed, Cochrane Library, Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched up to May 2018.

Randomized controlled trials were included if they involved any form of backward gait training for children with cerebral palsy. Two authors independently screened articles, extracted data and assessed the methodological quality using PEDro scale, with any confliction resolved by the third author. Modified Sackett Scale was used to determine the level of evidence for each outcome.

Out of 1492 papers screened, 7 studies with 172 participants met the inclusion criteria. The duration of treatment ranged from 15 to 25 minutes, three times a week and for 6–12 weeks. The quality of studies ranged from good (two studies) to fair (four studies) and poor (one study), with a mean PEDro score of 4.7 out of 10. All included studies showed positive effects in the measured outcomes. The results showed level 1b evidence for balance when compared to no intervention, and for gross motor function, step length and walking speed when compared to same dose of forward gait training. The clinical heterogeneity of studies makes meta-analysis inappropriate.

In children with cerebral palsy, there is moderate evidence that backward gait training improves balance, gross motor function, step length and walking velocity. More high-quality studies are needed.

The rehabilitation after a total hip replacement varies in degree of supervision; however, it remains unknown whether supervised programmes are more effective than non-supervised.

This study compared the effectiveness of supervised exercise compared to non-supervised home-based exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function.

A systematic review and meta-analysis of randomized controlled trials investigating the effect of supervised exercise compared to non-supervised home-based exercise. An electronic search was performed in Medline, Embase and CINAHL on 14 March 2018. The methodological quality was assessed using the Cochrane Risk of Bias tool.

Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (standardized mean difference (SMD) −0.22 (95% confidence interval (CI) −0.46 to 0.02)), hip-related pain (SMD −0.03 (95% CI −0.27 to 0.21)), health-related quality of life (mean difference (MD) −3.08 (95% CI −6.29 to 0.14)) and performance-based function (SMD −0.26 (95% CI −0.68 to 0.17)) at end of treatment and in patient-reported function (MD −1.31 (95% CI −3.79 to 1.16)) at the 6- to 12-month follow-up.

The literature search was systematic, but limited to three databases. The overall quality of evidence was downgraded to moderate due to lack of blinding in included studies.

Supervised exercise was not significantly effective compared to non-supervised home-based exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement.

PROSPERO registration number: CRD42017055604.

To investigate the long-term effects of adding virtual reality–based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction.

Follow-up otoneurological examination in two randomized groups following a previous one-month trial.

Tertiary rehabilitation center.

A total of 47 patients with unilateral vestibular hypofunction, one group (n = 24) undergoing conventional vestibular rehabilitation and the other one (n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month.

One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure.

Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores.

Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation–only group (P < 0.001). Accordingly, some classical posturography scores such as surface with eyes open and length with eyes closed and low-frequency power spectra were significantly different between groups, with the virtual reality group showing improvement (P < 0.001). Self-report measures were significantly better in both groups compared to pretreatment, with significant improvement in the mixed-method group as compared to conventional rehabilitation alone: Dizziness Handicap Inventory mean total score was 24.34 (2.8) versus 35.73 (5.88) with a P-value <0.001.

Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.

To test whether rhythmic auditory stimulation (RAS) training reduces the number of falls in Parkinson’s disease patients with a history of frequent falls.

Randomized withdrawal study design.

A total of 60 participants (aged 62–82 years) diagnosed with idiopathic Parkinson’s disease (Hoehn and Yahr stages III or IV) with at least two falls in the past 12 months.

Participants were randomly allocated to two groups and completed 30 minutes of daily home-based gait training with metronome click–embedded music. The experimental group completed 24 weeks of RAS training, whereas the control group discontinued RAS training between weeks 8 and 16.

Changes in clinical and kinematic parameters were assessed at baseline, weeks 8, 16, and 24.

Both groups improved significantly at week 8. At week 16—after the control group had discontinued training—significant differences between groups emerged including a rise in the fall index for the control group (M = 10, SD = 6). Resumption of training reduced the number of falls so that group differences were no longer significant at week 24 (M_experimental = 3, SD = 2.6; M_control = 5, SD = 4.4; P > 0.05). Bilateral ankle dorsiflexion was significantly correlated with changes in gait, fear of falling, and the fall index, indicating ankle flexion as a potential kinematic mechanism RAS addresses to reduce falls.

RAS training significantly reduced the number of falls in Parkinson’s disease and modified key gait parameters, such as velocity and stride length.

To collect data to estimate the sample size of a definitive randomized controlled trial to evaluate the effects of Melodic Intonation Therapy in post-stroke nonfluent aphasia.

A randomized, crossover, interventional pilot trial.

Departments of Neurology and Rehabilitation from a university general hospital.

Stroke survivors with post-stroke nonfluent aphasia.

Patients randomized to group 1 had treatment with Melodic Intonation Therapy first (12 sessions over six weeks) followed by no treatment; the patients in group 2 started active treatment between three and six months after their inclusion in the study, serving as waiting list controls for the first phase.

The Communicative Activity Log (CAL) questionnaire and the Boston Diagnostic Aphasia Examination (BDAE) were evaluated at baseline, and at six and 12 weeks.

Twenty patients were included. Four of the patients allocated to group 2 crossed over to group 1, receiving the treatment at first. Intention-to-treat analysis: after adjustment for baseline scores, the mean difference in the CAL evaluation from baseline in the treated group was 8.5 points (95% confidence interval (CI), 0.11–17.0; P = .043), with no significant change in any of the BDAE sections. Per-protocol analysis showed similar results with a clear treatment effect (P = .043) on the CAL.

Melodic Intonation Therapy might have a positive effect on the communication skills of stroke survivors with nonfluent aphasia as measured by the CAL questionnaire. A full-scale trial with at least 27 patients per group is necessary to confirm these results.

This study evaluated the possible effect of the combined intervention of physical exercise and cognitive training on cognitive function in stroke survivals with vascular cognitive impairment.

A single-blind (investigator-blinded but not subject-blinded) randomized controlled trial.

Medical Rehabilitation Center of Shanghai General Hospital, China.

A total of 225 patients (mean age 64.59 years, SD = 4.27) who exhibited vascular cognitive impairment were included in this study.

Patients were randomly allocated into one of the four groups: (1) physical exercise (n = 56; 50-minute session), (2) cognitive training (n = 57; 60-minute session), (3) combined intervention of physical exercise and cognitive training (n = 55; 50-minute session + 60-minute session), or (4) control groups (n = 57; 45-minute session). All participants received training for 36 sessions, three days per week, for 12 weeks.

Measures were recorded at baseline, after the intervention and at a six-month follow-up. Primary measurements included the Trail Making Part B, Stroop, forward digit span, and mental rotation tests.

A total of 179 participants (79.56% response rate) completed the study. Cognitive performances on all four tasks in the combined training group improved significantly after the intervention (P < 0.01). Changes in cognitive performance were greater in the combined intervention group than those in the physical exercise group (e.g. forward digit span, 13.61% vs. 2.18%, P = 0.003), the cognitive training group (e.g. mental rotation, 17.36% vs. 0.87%, P = 0.002), and the control group (e.g. Stroop, −4.11% vs. −0.72%, P = 0.026).

The combined intervention produced greater benefits on cognitive function compared to either training alone in stroke survivors with vascular cognitive impairment.

This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.

Randomized controlled trial.

Geriatric department, participants’ residential care facilities, and ordinary housing.

Individuals aged ⩾70 years with acute hip fracture (n = 205) were included.

Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.

Complications, readmissions, and days spent in hospital were registered from patients’ digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits.

No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively.

Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation.

To investigate the effects of group-based vestibular rehabilitation in patients with traumatic brain injury.

A single-blind randomized controlled trial.

University Hospital (recruitment and baseline assessments) and Metropolitan University (experimental intervention).

A total of 65 patients (45 women) with mild-to-moderate traumatic brain injury (mean age 39.4 ± 13.0 years) were randomly assigned to intervention (n = 33) or control group (n = 32).

Group-based vestibular rehabilitation for eight weeks. Participants were tested at baseline (3.5 ± 2.1 months after injury) and at two post-intervention follow-ups (2.7 ± 0.8 and 4.4 ± 1.0 months after baseline testing).

Primary outcome: Dizziness Handicap Inventory. Secondary outcome: High-Level Mobility Assessment Tool. Other outcomes: Vertigo Symptom Scale; Rivermead Post-concussion Symptoms Questionnaire; Hospital Anxiety and Depression Scale; and Balance Error Scoring System. Between-group differences were analyzed with a linear mixed-model analysis for repeated measurements.

At baseline, no group differences were revealed (personal factors, clinical characteristics and outcome measures). At the first follow-up, statistically significant mean differences in favor of the intervention were found in the primary (−8.7, 95% confidence interval (CI): −16.6 to −0.9) and secondary outcomes (3.7 points, 95% CI: 1.4–6.0). At the second follow-up, no significant between-group differences were found. No significant between-group differences in the other outcomes were found at the two follow-ups.

The intervention appeared to speed up recovery for patients with dizziness and balance problems after traumatic brain injury. However, the benefits had dissipated two months after the end of the intervention.

To investigate the efficacy of a four-week underwater treadmill exercise regimen compared to a home exercise regimen relative to pain relief and functional improvement in obese patients with knee osteoarthritis.

Single-blind randomized controlled trial.

Outpatient.

Eighty primary knee osteoarthritis with pain ⩾5/10 and body mass index ⩾25 kg/m².

Daily quadriceps exercise at home for 30 minutes (control group) or underwater treadmill exercise (study group) for 30 minutes/day, three times/week for four weeks.

Pain score, six-minute walking distance, quadriceps strength, and body weight were evaluated at baseline and after four weeks. Adverse events, global assessment, and satisfaction index were assessed at the end of study.

All outcomes in both groups were significantly improved at the end of the study, except for body weight. The mean difference (95% confidence interval (CI)) in outcomes between groups were −0.53 (−1.31, 0.26) for pain; 10.81 (−11.9, 33.53) meters for 6-minute walking distance; 0.67 (−0.10, 1.44) kilograms for quadriceps strength; and 0.01 (−0.66, 0.68) kilograms for body weight. No significant differences were observed between groups, for the per protocol analysis or the intention-to-treat analysis. Participants in the study group evaluated significantly better global improvement and higher patient satisfaction than those in control group (13 (39.4%) vs. 4 (10.8%); P = 0.014 and 23 (69.7%) vs. 16 (43.2%); P = 0.021, respectively).

Exercise using an underwater treadmill was found to be as efficacious as home exercise for relieving pain and improving function in obese people with mild to moderate knee osteoarthritis.

To evaluate construct validity and reproducibility of the Functional Gait Assessment (FGA) for measuring walking balance capacity in persons after stroke.

Cross-sectional study.

Inpatient and outpatient rehabilitation center.

Fifty-two persons post-stroke (median (25% and 75% percentiles)) time post-stroke 6 (5–10) weeks) with independent walking ability (mean gait speed 1.1 ± .4 m/s).

Subjects completed a standardized FGA twice within one to eight days by the same investigator. Validity was evaluated by testing hypotheses on the association with two timed walking tests, Berg Balance Scale, and the mobility domain of the Stroke Impact Scale using correlation coefficients (r), and with Functional Ambulation Categories using the Kruskal–Wallis test. Reproducibility of FGA scores was assessed with intraclass correlation coefficient and standard error of measurement.

Subjects scored a median of 22 out of 30 points at the first FGA. Moderate to high significant correlations (r .61–.83) and significant differences in FGA median scores between the Functional Ambulation Categories were found. Eight hypotheses (80%) could be confirmed. Inter-rater, intra-rater, and test–retest reliability of the total scores were excellent. The standard error of measurement and minimal detectable change were 2 and 6 points, respectively. No relevant ceiling effect was observed.

The FGA demonstrated good measurement properties in persons after stroke and yielded no ceiling effect in contrast to other capacity measures. In clinical practice, a measurement error of 6 points should be taken into account in interpreting changes in walking balance.

To investigate the inter-rater and intra-rater reliability of the Brief Balance Evaluation System Test (Brief-BESTest) in people with chronic obstructive pulmonary disease and its correlation between the Brief-BESTest score and lung function, functional exercise capacity, functional lower limb strength, and fear of falling.

Prospective, single-group, observational study.

Outpatient pulmonary rehabilitation program.

People with chronic obstructive pulmonary disease who were attending a pulmonary rehabilitation program.

Participants performed three Brief-BESTests on two separate days, assessed by two independent physiotherapists. Participants also performed a lung function test, two 6-minute walk tests, the five sit-to-stand test and completed the Fall Efficacy Scale International questionnaire.

Thirty participants (mean (SD) age was 72 (7), forced expiratory volume in 1 second % predicted was 47 (16%), and baseline 6-minute walk distance was 427 (90) meters) completed the study. The interclass coefficients of the inter-rater and intra-rater reliability were 0.86 and 0.96, respectively. The Brief-BESTest score was moderately correlated with the 6-minute walk distance (r = 0.49, P < 0.01) and the five sit-to-stand test time (r =−0.54, P < 0.01). No adverse events were reported after the completion of 90 tests in this study.

The Brief-BESTest was shown to have good inter- and intra-rater reliability for measuring balance in people with chronic obstructive pulmonary disease. A moderate correlation was demonstrated between the Brief-BESTest balance score with functional exercise capacity and functional lower limb strength in this population.

This study aimed to evaluate the validity of the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale (ECPDS) to discriminate for cognitive impairment in schizophrenia.

This multicentre cross-sectional study used a validation design with receiver operating characteristic (ROC) curve analysis.

The study was undertaken in a French network of seven outward referral centres.

We recruited individuals with clinically stable schizophrenia diagnosed based on the Structured Clinical Interview for assessing Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; DSM-IV-R) criteria.

The index test for cognitive impairment was ECPDS (independent variable), a 13-item scale completed by a relative of the participant. The reference standard was a standardized test battery that evaluated seven cognitive domains. Cognitive impairment was the dependent variable and was defined as an average z-score more than 1 SD below the normative mean in two or more cognitive domains.

Overall, 97 patients were included (67 with schizophrenia, 28 with schizoaffective disorder, and 2 with schizophreniform disorder). The mean age was 30.2 (SD 7.7) years, and there were 75 men (77.3%). There were 59 (60.8%) patients with cognitive impairment on the neuropsychological battery, and the mean ECPDS score was 27.3 (SD 7.3). The ROC curve analysis showed that the optimal ECPDS cut-off was 29.5. The area under the curve was 0.77, with 76.3% specificity and 71.1% sensitivity to discriminate against cognitive impairment.

The ECPDS is a valid triage tool for detecting cognitive impairment in schizophrenia, before using an extensive neuropsychological battery, and holds promise for use in everyday clinical practice.

To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury.

Six-month prospective study.

A rehabilitation center and community hospitals.

Independent ambulatory individuals with spinal cord injury.

Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total.

A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity (n = 71, 79%) and walked with a walking device (n = 54, 60%) completed in the study. More than one-third of the subjects (n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P < 0.002, power = 1.000).

Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

To characterize how rehabilitation goals of older patients change over time and to explore professionals’ attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals.

Qualitative interview study.

Three geriatric rehabilitation centers.

Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited.

Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed.

During inpatient rehabilitation, participants’ main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge.

During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.