Clinical Rehabilitation最新文献

Objective: To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications.

Design: A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer.

Setting: Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023.

Subjects: Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription.

Interventions: All the patients included in the research were prescribed with their first pair of therapeutic footwear.

Main measures: Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day.

Results: The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5-8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities.

Conclusions: Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations.

Objectives: To examine the effects of acupuncture and therapeutic exercise alone and in combination on temporomandibular joint symptoms in tension-type headache and to evaluate the potential interaction of existing temporomandibular dysfunction on the success of headache treatment.

Design: Pre-planned secondary analysis of a randomized controlled, non-blinded trial.

Setting: Outpatient clinic of a German university hospital.

Subjects: Ninety-six Participants with frequent episodic or chronic tension-type headache were randomized to one of four treatment groups.

Interventions: Six weeks of acupuncture or therapeutic exercise either as monotherapies or in combination, or usual care. Follow-up at 3 and 6 months.

Main measures: Subjective temporomandibular dysfunction symptoms were measured using the Functional Questionnaire Masticatory Organ, and the influence of this sum score and objective initial dental examination on the efficacy of headache treatment interventions was analyzed.

Results: Temporomandibular dysfunction score improved in all intervention groups at 3-month follow-up (usual care: 0.05 [SD 1.435]; acupuncture: -5 [SD 1.436]; therapeutic exercise: -4 [SD 1.798]; combination: -3 [SD 1.504]; P = 0.03). After 6 months, only acupuncture (-6 [SD 1.736]) showed a significant improvement compared to the usual care group (P < 0.01). Subjective temporomandibular dysfunction symptoms had no overall influence on headache treatment.

Conclusions: Only acupuncture had long-lasting positive effects on the symptoms of temporomandibular dysfunction. Significant dental findings seem to inhibit the efficacy of acupuncture for tension-type headache.

Background: There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure.

Objective: To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity.

Need: A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs.

Building blocks: People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism.

The theory: Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management.

Implications: The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective.

Conclusion: The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.

Objective: Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation.

Design: Scoping review.

Data source: A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023.

Review methods: The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results.

Results: Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients.

Conclusion: Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness.

Objective: This study aimed to assess the effectiveness of virtual reality-based treadmill training on gait performance and tolerance in the elderly.

Design: Two-armed randomized controlled trial.

Setting: The Medical Rehabilitation Sciences Department, Umm Al Qura University, Saudi Arabia.

Participants: Sixty Saudi elderly of both sexes, aged 65-75 years, were included.

Interventions: Participants were divided into two groups. The control group received treadmill training without virtual reality, alongside a conventional exercise program. The experimental group received a training program that was similar to the control group's exercises but with C-Mill virtual reality treadmill training. The program lasted one hour, three times per week, over four consecutive weeks.

Main measures: The study assessed changes in outcome measures at baseline, Post-1 (after four weeks of training), and Post-2 (four weeks post-training). These measures encompassed the primary outcome, the 6-minute walk test (meter), as well as secondary outcomes such as stride length (meter), stride time (second), cadence (steps/minute), and velocity (meter/second). These parameters were evaluated using the GaitRite electronic gait analysis walkway.

Results: The experimental group showed better improvement in the mean values of the 6-minute walk test, stride length, stride time, cadence, and velocity compared to the control group at post-1 and post-2. The P-values were respectively at post-1 (0.019, 0.015, 0.041, 0.013, and 0.021) and (0.011, 0.025, 0.073, 0.061, and 0.017) at post-2 (all, P < .05).

Conclusions: C-Mill virtual reality treadmill training shows potential in improving gait parameters and walking tolerance in the elderly in Saudi Arabia.

Objective: To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched.

Design: Case-control study.

Setting: Higher education institution.

Participants: One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI.

Main measures: A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer.

Results: Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57 Hz (95% confidence interval -4.42,-0.72) and -79.74 N/m (-143.52,-15.97); -2.20 Hz (-3.82,-0.58) and -81.30 N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively].

Conclusions: Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.