Clinical Rehabilitation最新文献

Objective: To develop consensus statements from a Delphi panel about physiotherapy of the trunk related to sitting function for people with subacute stroke, with the express aim of facilitating treatment choices by novice physiotherapists.

Design: A four-round e-Delphi study using free-text responses and 5-point Likert scales for agreement.

Participants: Twenty-six panel members with expertise in clinical and/or research in neurological rehabilitation.

Main measures: Round 1 consisted of 5 free-text questions. Subsequent rounds ascertained agreement and consensus on statements formulated from Round 1 responses. Consensus was defined a priori as ≥70% agreement. Round 3 presented an additional two clinical observation queries related to the statements for comment.

Results: Twenty participants completed all four rounds. Nineteen of 26 participants (73%) thought physiotherapy of the trunk was important through all stages of recovery after stroke. Different interpretations about what constitutes physiotherapy of the trunk following stroke were identified. Fourteen statements of agreement regarding physiotherapy of the trunk were formulated. The majority of statements involved different activities in sitting such as control of movement over the base of support and reaching with the unaffected arm. In addition to the statements of agreement clinical observations for implementation of the statements were developed.

Conclusions: In the absence of detail in clinical guidelines and a wide range of interventions in systematic reviews, this study provides clear and specific options for novice physiotherapists of treatment of the trunk related to functional task practice in sitting and as preparation for sit to stand.

Objective: To explore patient and healthcare professional perspectives on post-lower limb reconstruction support. Design: A qualitative study. Setting: One-to-one semi-structured interviews undertaken via video conferencing software or over the telephone. Participants: Thirty-two patients (who had undergone reconstructive surgery due to trauma, malunion, non-union, infection or congenital issues treated by internal or external fixation) and 22 orthopaedic healthcare professionals (surgeons, nurses and physiotherapists) were interviewed between November 2020 and June 2021. Results: Thematic analysis was undertaken on data surrounding clinical support. Four themes were generated: being involved and feeling informed, physiotherapy as a motivator for recovery, the importance of timely access to physiotherapy, and mental health support. Patients valued being involved in decisions about their care and feeling informed. Supportive nurses played a key role, with patients appreciating clear communication and empathy. Trust in the clinical team eased anxiety, whilst a lack of information caused stress and dissatisfaction. Post-surgery, information on recovery, access to physiotherapy, and hospital contacts were crucial. Physiotherapy was vital for regaining mobility, providing motivation, and promoting confidence. Access to mental health support was limited, though patients appreciated emotional support from physiotherapists and hospital staff. Conclusion: By providing comprehensive support, healthcare professionals can optimise patient satisfaction with care, enhance psychological well-being, and facilitate the successful rehabilitation and reintegration of patients back into their daily lives.

Objective: We aimed to develop and standardise a practical systematic screening tool for visual perception impairments after a stroke to replace current subjective methods.

Design: A mixed methods study including a cross-sectional study and a case series.

Setting: In the community and on stroke rehabilitation units.

Participants: Older volunteers without a neurological history contributed to normative data. Patients with ocular conditions or a stroke took part in our case series.

Instrument: The Oxford Visual Perception Screen.

Main measures: For each task of the Oxford Visual Perception Screen, we determined 5^th centile cut-off scores. We further explored effects of age, visual acuity and gender on visual perception through generalised linear models.

Results: Oxford Visual Perception Screen is a 15-min paper-and-pen assessment comprising 10 tasks including picture naming, star counting and reading. Normative data of 107 participants demonstrated persistent high performance with most cut-offs near ceiling. Apart from the Figure Copy (Z = 6.57, p < 0.001) and Global Shape Perception task (Z = 3.32, p < 0.001) we found no evidence for an effect of visual acuity on OxVPS. An effect of age was only observed in the Face Recognition (Z = 3.61, p < 0.001) and Reading task (Z = -3.50, p < 0.001). No effects of gender were observed. A series of eight cases illustrates the interpretation of OxVPS.

Conclusion: We present the Oxford Visual Perception Screen, a standardised visual perception screening tool alongside normative data and illustrative cases. The Oxford Visual Perception Screen can potentially change screening for visual perception impairments in clinical practice and is available at https://oxvps.webspace.durham.ac.uk/.

Objective: To investigate cost-effectiveness of pre-discharge home assessment visits for patients recovering after hip fracture.

Design: Cost-effectiveness analysis completed alongside a randomised controlled trial.

Setting: Hospital wards and the community.

Participants: Adults 50 years and over with hip fractures planning to return home.

Intervention: Participants were randomised to either usual-care hospital-based discharge planning or usual-care hospital-based discharge planning with a pre-discharge home assessment visit by an occupational therapist.

Main measures: Functional Independence Measure, EQ-5D-3L, and number of falls. Incremental cost-effectiveness ratios were calculated for changes at 30 days and 6 months.

Results: Seventy-seven patients participated. Compared to usual care, the home assessment group likely had fewer falls at 30 days (incidence rate ratio = 0.41, 95% confidence interval (CI) 0.15 to 1.11) and increased functional independence at 6 months (11.2 units, 95% CI 4.2 to 18.2) but no difference in quality of life (0.0 units, 95% CI -0.1 to 0.1). The mean cost to provide a home assessment visit was A$135.70. A mean cost saving of A$6182 (95% CI -$6414 to $18,777) favoured the home assessment group. The incremental cost-effectiveness ratio found a saving of A$71,337 (95% CI -$998,930 to $411,409) in achieving clinically important changes in functional independence for the home assessment group at 6 months and a saving of A$34,832 (95% CI -$331,344 to $213,900) per fall avoided in favour of the home assessment group at 30 days.

Conclusion: From a health service perspective, pre-discharge home assessments for patients after hip fracture are likely to be cost-effective in restoring functional independence and reducing falls.

Objective: Post-stroke aphasia (language impairment) has a devastating impact on quality of life and people with aphasia experience long-term unmet needs. A shared understanding of the experiences underpinning these unmet needs is required to identify priorities for improvement. Establishing priorities for meaningful service improvement requires involvement of service users and providers. Therefore, this research aimed to: (1) collaboratively identify priorities for aphasia service improvement according to people with aphasia, significant others, speech pathologists, and (2) co-design a plan for service development and improvement.

Design: Prioritisation phase of an experience-based co-design project. Online surveys were used to prioritise ideas (n = 773). Three multi-stakeholder consensus groups were held to shortlist top priorities. Design principles were applied during three consecutive co-design workshops, to develop a concept design targeting the top priority.

Participants, setting: People with aphasia (n = 41), significant others (n = 35) and speech pathologists (n = 75) across 26 health and hospital sites in remote, regional, and metropolitan Queensland, Australia.

Results: Consensus was established on seven priorities: (1) chart alert system for aphasia, (2) training for healthcare providers in ways to support communication, (3) care that is tailored to the individual, (4) consistent care, (5) equitable access to care, (6) intensive communication therapy options, and (7) mental health service options. A concept design (implementation strategy) was created for the top priority.

Conclusions: Multi-stakeholder consensus was gained on seven priorities. Development, implementation, and evaluation of the co-designed concept plan for the top priority may decrease miscommunication in hospital settings and enhance experiences of people with aphasia communicating with healthcare providers.

Objective: To determine the effect of sensorimotor training on stability, balance, mobility, quality of life, and muscle strength after lower extremity and trunk thermal burns.

Design: A prospective, randomised controlled trial.

Setting: Physiotherapy outpatient setting.

Participants: Sixty participants with lower extremity and trunk thermal burns, aged 20-50 years, were randomly allocated to either the Sensorimotor Training group or the Control group.

Intervention: The Sensorimotor Training group received both a sensorimotor training programme and a traditional physiotherapy programme, while the Control group received only the traditional physiotherapy programme. The intervention was applied three days per week for eight weeks.

Outcome measures: The anteroposterior stability index was the primary outcome, while secondary outcomes included the overall stability index, mediolateral stability index, Timed Up and Go Test, Berg Balance Scale, and the Short Form-36 questionnaire, all measured at baseline and after eight weeks.

Results: Significant differences were identified between groups after eight weeks, favouring the Sensorimotor Training group. Mean differences (95% CI) between groups were: -0.89 (-1.23, -0.54) for the anteroposterior stability index; 6.67 (4.48, 8.86) for the Berg Balance Scale; -1.7 (-2.82, -0.59) for the Timed Up and Go Test; 11.22 (7.03, 15.40) for knee extensor torque; and 7.98 (4.62, 11.35) for physical function.

Conclusion: Sensorimotor training, when added to a conventional physiotherapy programme, can significantly improve stability, balance, mobility, quality of life, and muscle strength compared to conventional physiotherapy alone in participants with lower extremity and trunk thermal burns.

Objective: To understand in people with stroke: (1) reasons for cardiopulmonary treadmill exercise test termination, (2) how frequently secondary criteria indicating a maximal test are met, and (3) how test termination is related to volume of oxygen consumption and participant characteristics.

Design: A secondary analysis from the Promoting Recovery Optimization of Walking Activity in Stroke (NCT02835313) clinical trial.

Setting: Four outpatient rehabilitation clinics.

Participants: People with chronic stroke able to walk without assistance of another person.

Intervention: Participants (n = 250) randomized in a larger clinical trial completed symptom limited graded exercise treadmill tests pre- (n = 247) and post-intervention (n = 185). Treadmill exercise tests were conducted at constant speed with incremental incline increases.

Main measures: The primary measure was reason for cardiopulmonary exercise test termination. Secondary measures included: oxygen consumption, ventilatory threshold, peak heart rate, respiratory exchange ratio, six-minute walk test, and fastest walking speed.

Results: There were six categories of test termination, electrocardiogram (11%), blood pressure/heart rate (13%), biomechanical (25%), self-selected (41%), equipment malfunction (8%), and other (2%). Only 1.9% of tests achieved the threshold to confirm a maximal aerobic effort. There were no differences in peak volume of oxygen consumption or participant characteristics between test termination categories.

Conclusions: Analyses indicate few with chronic stroke exhibit a maximal aerobic effort on a cardiopulmonary exercise test. If the cardiorespiratory system is not thoroughly taxed during treadmill exercise tests in people with chronic stroke, interpreting results as their cardiorespiratory fitness should be done cautiously.

Objective: The purpose of this study was to evaluate the effects of the threshold value of Fear-Avoidance Beliefs Subscales on quantified movement as a function of gender.

Design study: Retrospective cohort study.

Settings: Single center study.

Participants: One hundred forty patients (aged 38.4) with chronic low back pain and referred to functional restauration program.

Intervention: Patients participated in a five-week multidisciplinary Functional Restoration Program between 1 April 2013 and 1 April 2019, evaluated with clinical scales, psychosocial care and objective gait analysis. This study was a noninterventional retrospective study.

Main measures: Objective gait analysis with the Vicon Motion Systems (Ltd, Oxford, UK), Fear-Avoidance Belief Scale, Visual Analog Scale, the DALLAS Pain Questionnaire, and the Hospital Anxiety and Depression Scale.

Results: Data from 131 patients were studied. Patients with significant Fear-Avoidance Beliefs scores walked with significantly higher cadence. Patients with higher work subscale values presented significantly lower cadence, without effects on step length and self-selected speed. Women with significant fear-avoidance belief score walked with higher step length (0.58 m (0.05)) than men with significant fear-avoidance belief score (0.61 m (0.05). Correlations between Fear Avoidance Beliefs Questionnaire and spatiotemporal parameters were gender-dependent but nonsignificant or low.

Conclusions: The threshold values depicted in the literature on psychometric analysis reveal low but quantitative effect of fear-avoidance on spatiotemporal parameters. These threshold values can be used by clinicians to evaluate the significance of the clinical scale. Considering gait, cadence should help the clinician to assess the fear-avoidance, particularly for patients are not able to complete all clinical scale items.