Pub Date : 2025-02-01Epub Date: 2025-01-27DOI: 10.23736/S1973-9087.25.08889-6
Alessandro Giustini, Giorgio Ferriero, Mauro Zampolini
{"title":"Primary care and outpatient rehabilitation: complementary approaches for comprehensive healthcare.","authors":"Alessandro Giustini, Giorgio Ferriero, Mauro Zampolini","doi":"10.23736/S1973-9087.25.08889-6","DOIUrl":"10.23736/S1973-9087.25.08889-6","url":null,"abstract":"","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-27DOI: 10.23736/S1973-9087.24.08637-4
Montserrat Alonso-Sardón, Helena Iglesias-DE-Sena, Antonio J Chamorro, José Ángel Santos-Sánchez, Alberto Benito-Rodríguez, José A Mirón-Canelo
Background: Neck and back pain pathologies are currently the main cause of absenteeism from work in Spain and in the European Union, and represent a high socio-labor, economic and health cost for the Health Systems.
Aim: To assess the effectiveness of a Back School Program of a Spanish mutual insurance company (risk factors, pain and disability scales) in women workers with low back or neck pain.
Design: We combined a descriptive study of first-session data collected in the total sample and a prospective multicenter intervention study in those participants who completed the second and third check-up at 6 and 9 months.
Setting: Women workers with low back or neck pain, from different sectors and occupations, who participated in a Back School Program of Ibermutua, a Spanish mutual insurance company, during the period from April 1st, 2009, to March 28th, 2019.
Population: Overall, 1452 women workers participated in the first session, 150 in the second session (6-month review) and 133 in the third session (9-month review).
Methods: Different questionnaires and scales were used for data collection, Visual Analog Scale, Neck Disability Index, Oswestry Disability Index, Concept Check Questionnaire and Back School Program Effectiveness Questionnaires.
Results: A total of 1095 (75.4%) had low back pain and 742 (51.1%) had neck pain (497 of them had pain in both locations); 42.8% (622) related the pain to their work activity. One in four women workers (390, 26.9%) performed a high-risk work activity (handling, weight transport, mechanical vibrations), 27.4% were prolonged standing and 22.8% were prolonged sitting. The workers participated in the Back School Program for two purposes: therapeutic (1150 women, 79.2%) and preventive (302 women, 20.8%).
Conclusions: The Back School is an effective intervention to manage pain and reduce disability in women workers.
Clinical rehabilitation impact: This study provided evidence that the Back School Program can be suitable for preventing and improving low back and neck pain and functional disability among women workers. The success of the Back Schools depends on women workers becoming aware of the importance of preventive measures aimed at strengthening the back muscles and collaborating actively, thus significantly reducing the incidence of low back and cervical pain in the workplace.
{"title":"Impact of low back and neck pain on the Spanish women-workers' health: effectiveness of a Back School.","authors":"Montserrat Alonso-Sardón, Helena Iglesias-DE-Sena, Antonio J Chamorro, José Ángel Santos-Sánchez, Alberto Benito-Rodríguez, José A Mirón-Canelo","doi":"10.23736/S1973-9087.24.08637-4","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08637-4","url":null,"abstract":"<p><strong>Background: </strong>Neck and back pain pathologies are currently the main cause of absenteeism from work in Spain and in the European Union, and represent a high socio-labor, economic and health cost for the Health Systems.</p><p><strong>Aim: </strong>To assess the effectiveness of a Back School Program of a Spanish mutual insurance company (risk factors, pain and disability scales) in women workers with low back or neck pain.</p><p><strong>Design: </strong>We combined a descriptive study of first-session data collected in the total sample and a prospective multicenter intervention study in those participants who completed the second and third check-up at 6 and 9 months.</p><p><strong>Setting: </strong>Women workers with low back or neck pain, from different sectors and occupations, who participated in a Back School Program of Ibermutua, a Spanish mutual insurance company, during the period from April 1<sup>st</sup>, 2009, to March 28<sup>th</sup>, 2019.</p><p><strong>Population: </strong>Overall, 1452 women workers participated in the first session, 150 in the second session (6-month review) and 133 in the third session (9-month review).</p><p><strong>Methods: </strong>Different questionnaires and scales were used for data collection, Visual Analog Scale, Neck Disability Index, Oswestry Disability Index, Concept Check Questionnaire and Back School Program Effectiveness Questionnaires.</p><p><strong>Results: </strong>A total of 1095 (75.4%) had low back pain and 742 (51.1%) had neck pain (497 of them had pain in both locations); 42.8% (622) related the pain to their work activity. One in four women workers (390, 26.9%) performed a high-risk work activity (handling, weight transport, mechanical vibrations), 27.4% were prolonged standing and 22.8% were prolonged sitting. The workers participated in the Back School Program for two purposes: therapeutic (1150 women, 79.2%) and preventive (302 women, 20.8%).</p><p><strong>Conclusions: </strong>The Back School is an effective intervention to manage pain and reduce disability in women workers.</p><p><strong>Clinical rehabilitation impact: </strong>This study provided evidence that the Back School Program can be suitable for preventing and improving low back and neck pain and functional disability among women workers. The success of the Back Schools depends on women workers becoming aware of the importance of preventive measures aimed at strengthening the back muscles and collaborating actively, thus significantly reducing the incidence of low back and cervical pain in the workplace.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-27DOI: 10.23736/S1973-9087.24.08833-6
Stefano Negrini, Carlotte Kiekens, Matteo J Del Furia, Silvia Minozzi, Rebecca Ryan, Chiara Arienti, Anne Parkhill, Pierre Côte, Francesca Gimigliano, Carla Sabariego, Paolo Capodaglio, Simon Decary, Wouter DE Groote, Walter R Frontera, Qhayiya Mudau, Melissa Atkinson-Graham, Noora Bakaa, Irene Battel, Olivier K Butzbach, Claudio Cordani, Eshetu H Engeda, Theodore Konstantinidis, Giovanni Iolascon, Sara Liguori, Silvano Mior, Antimo Moretti, Marco Paoletta, Dima Touhami, Jessica Wong, Antony Duttine
Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. The protocol describes why HPSR is currently needed in rehabilitation, provides detailed information on the four EPOC pillars in interaction with rehabilitation and reports the Cochrane methods that will be followed to produce the overviews. 1. Del Furia MJ, Minozzi S, Arienti C, Battel I, Capodaglio P, Côté P, Décary S, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Mudau Q, Ryan R, Sabariego C, Negrini S. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. 2. Gimigliano F, Arienti C, Butzback OK, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Iolascon G, Kiekens C, Liguori S, Minozzi S, Mudau Q, Negrini S, Paoletta M, Ryan R, Sabariego C, Moretti A. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. 3. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C, Capodaglio P, Décary S, De Groote W, Del Furia MJ, Duttine A, Frontera WR, Kiekens C, Minozzi S, Gimigliano F, Mudau Q, Negrini S, Ryan R, Sabariego C, Côté P. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. 4. Touhami D, Ryan R, Engeda EH, Arienti C, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Minozzi S, Mudau Q, Negrini S, Sabariego C. Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews. The protocol is largely common to all four overviews. The individual parts of each overview can be identified by the sub-titles delivery arrangements, financial arrangements, governance arrangements, and implementation strategies for overviews 1 to 4.
{"title":"Evidence synthesis of health policy and systems research in rehabilitation: a protocol for Cochrane overviews of systematic reviews on delivery, governance, financial arrangements, and implementation strategies.","authors":"Stefano Negrini, Carlotte Kiekens, Matteo J Del Furia, Silvia Minozzi, Rebecca Ryan, Chiara Arienti, Anne Parkhill, Pierre Côte, Francesca Gimigliano, Carla Sabariego, Paolo Capodaglio, Simon Decary, Wouter DE Groote, Walter R Frontera, Qhayiya Mudau, Melissa Atkinson-Graham, Noora Bakaa, Irene Battel, Olivier K Butzbach, Claudio Cordani, Eshetu H Engeda, Theodore Konstantinidis, Giovanni Iolascon, Sara Liguori, Silvano Mior, Antimo Moretti, Marco Paoletta, Dima Touhami, Jessica Wong, Antony Duttine","doi":"10.23736/S1973-9087.24.08833-6","DOIUrl":"10.23736/S1973-9087.24.08833-6","url":null,"abstract":"<p><p>Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Program are collaborating to produce four Cochrane overviews of systematic reviews that synthesize the current evidence from health policy and systems research (HPSR) in rehabilitation. They will focus on the four pillars of HPSR identified by the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. The protocol describes why HPSR is currently needed in rehabilitation, provides detailed information on the four EPOC pillars in interaction with rehabilitation and reports the Cochrane methods that will be followed to produce the overviews. 1. Del Furia MJ, Minozzi S, Arienti C, Battel I, Capodaglio P, Côté P, Décary S, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Mudau Q, Ryan R, Sabariego C, Negrini S. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. 2. Gimigliano F, Arienti C, Butzback OK, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Iolascon G, Kiekens C, Liguori S, Minozzi S, Mudau Q, Negrini S, Paoletta M, Ryan R, Sabariego C, Moretti A. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. 3. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C, Capodaglio P, Décary S, De Groote W, Del Furia MJ, Duttine A, Frontera WR, Kiekens C, Minozzi S, Gimigliano F, Mudau Q, Negrini S, Ryan R, Sabariego C, Côté P. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. 4. Touhami D, Ryan R, Engeda EH, Arienti C, Capodaglio P, Côté P, Décary S, Del Furia MJ, De Groote W, Duttine A, Frontera WR, Gimigliano F, Kiekens C, Minozzi S, Mudau Q, Negrini S, Sabariego C. Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews. The protocol is largely common to all four overviews. The individual parts of each overview can be identified by the sub-titles delivery arrangements, financial arrangements, governance arrangements, and implementation strategies for overviews 1 to 4.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-23DOI: 10.23736/S1973-9087.24.08472-7
Charlotte Johnson, Ann Hallemans, Pieter Meyns, Silke Velghe, Nina Jacobs, Evi Verbecque, Katrijn Klingels
Background: Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.
Aim: To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).
Design: Cross-sectional case-control study.
Setting: Different outpatient settings and the community.
Population: Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).
Methods: We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).
Results: Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η2=0.25-0.66 [P<0.001], total: η2=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).
Conclusions: There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.
Clinical rehabilitation impact: The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.
{"title":"A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy, and typical development.","authors":"Charlotte Johnson, Ann Hallemans, Pieter Meyns, Silke Velghe, Nina Jacobs, Evi Verbecque, Katrijn Klingels","doi":"10.23736/S1973-9087.24.08472-7","DOIUrl":"10.23736/S1973-9087.24.08472-7","url":null,"abstract":"<p><strong>Background: </strong>Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.</p><p><strong>Aim: </strong>To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).</p><p><strong>Design: </strong>Cross-sectional case-control study.</p><p><strong>Setting: </strong>Different outpatient settings and the community.</p><p><strong>Population: </strong>Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).</p><p><strong>Methods: </strong>We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).</p><p><strong>Results: </strong>Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η<sup>2</sup>=0.25-0.66 [P<0.001], total: η<sup>2</sup>=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).</p><p><strong>Conclusions: </strong>There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.</p><p><strong>Clinical rehabilitation impact: </strong>The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"956-969"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-01DOI: 10.23736/S1973-9087.24.08458-2
Richard Albers, Stella Lemke, David Fauser, Sebastian Knapp, Gert Krischak, Matthias Bethge
Background: International studies identified comparable or better effects for telerehabilitation compared with face-to-face rehabilitation or no rehabilitation in people with back pain. In German rehabilitation centers, a standardized back school for patients with back pain is provided usually face-to-face as part of a multimodal rehabilitation program.
Aim: To examine the non-inferiority of a three-week, digitally assisted, multimodal rehabilitation that applies a digital version of a standardized back school (intervention group [IG]) against the same rehabilitation program applying the back school face-to-face (control group [CG]).
Design: Our study was a non-blinded multicenter randomized controlled trial. Recruitment was conducted from 2022 to 2023. We analyzed outcomes at the end of rehabilitation and 3 months later.
Setting: Implementation of the study and enrollment of participants was conducted in 8 German outpatient rehabilitation centers.
Population: Rehabilitants aged 18-65 years with back pain were included.
Methods: 284 patients with back pain were randomized into the IG or CG using computer-generated block randomization. We excluded 14 patients as they withdrew their consent and requested removal of their data. We finally included 270 patients (IG: N.=127, CG: N.=143). The primary outcome was self-reported pain self-efficacy (10-60 points). Secondary outcomes were, amongst others, current health status and pain.
Results: Our primary adjusted intention-to-treat analysis demonstrated that hybrid digitally assisted rehabilitation was non-inferior to face-to-face rehabilitation at the end of rehabilitation (b=-0.55; 95% CI=-2.75 to ∞) and at the 3-month follow-up (b=0.24; 95% CI=-2.86 to ∞). These results were in line with a non-adjusted intention-to-treat analysis, an adjusted complete case analysis, and an adjusted per-protocol analysis. Secondary outcomes were tested for superiority. Our primary adjusted intention-to-treat analysis found no significant group differences in the secondary outcomes.
Conclusions: This study provides evidence that hybrid digitally assisted rehabilitation in patients with back pain is a sound alternative to face-to-face rehabilitation in an outpatient rehabilitation setting.
Clinical rehabilitation impact: Hybrid digitally assisted rehabilitation can improve flexibility and access to rehabilitation. Further studies should examine which components and which time frame of rehabilitation can be digitized without any loss of effectiveness.
{"title":"Non-inferiority of hybrid outpatient telerehabilitation for patients with back pain: 3-month follow-up of a randomized controlled trial.","authors":"Richard Albers, Stella Lemke, David Fauser, Sebastian Knapp, Gert Krischak, Matthias Bethge","doi":"10.23736/S1973-9087.24.08458-2","DOIUrl":"10.23736/S1973-9087.24.08458-2","url":null,"abstract":"<p><strong>Background: </strong>International studies identified comparable or better effects for telerehabilitation compared with face-to-face rehabilitation or no rehabilitation in people with back pain. In German rehabilitation centers, a standardized back school for patients with back pain is provided usually face-to-face as part of a multimodal rehabilitation program.</p><p><strong>Aim: </strong>To examine the non-inferiority of a three-week, digitally assisted, multimodal rehabilitation that applies a digital version of a standardized back school (intervention group [IG]) against the same rehabilitation program applying the back school face-to-face (control group [CG]).</p><p><strong>Design: </strong>Our study was a non-blinded multicenter randomized controlled trial. Recruitment was conducted from 2022 to 2023. We analyzed outcomes at the end of rehabilitation and 3 months later.</p><p><strong>Setting: </strong>Implementation of the study and enrollment of participants was conducted in 8 German outpatient rehabilitation centers.</p><p><strong>Population: </strong>Rehabilitants aged 18-65 years with back pain were included.</p><p><strong>Methods: </strong>284 patients with back pain were randomized into the IG or CG using computer-generated block randomization. We excluded 14 patients as they withdrew their consent and requested removal of their data. We finally included 270 patients (IG: N.=127, CG: N.=143). The primary outcome was self-reported pain self-efficacy (10-60 points). Secondary outcomes were, amongst others, current health status and pain.</p><p><strong>Results: </strong>Our primary adjusted intention-to-treat analysis demonstrated that hybrid digitally assisted rehabilitation was non-inferior to face-to-face rehabilitation at the end of rehabilitation (b=-0.55; 95% CI=-2.75 to ∞) and at the 3-month follow-up (b=0.24; 95% CI=-2.86 to ∞). These results were in line with a non-adjusted intention-to-treat analysis, an adjusted complete case analysis, and an adjusted per-protocol analysis. Secondary outcomes were tested for superiority. Our primary adjusted intention-to-treat analysis found no significant group differences in the secondary outcomes.</p><p><strong>Conclusions: </strong>This study provides evidence that hybrid digitally assisted rehabilitation in patients with back pain is a sound alternative to face-to-face rehabilitation in an outpatient rehabilitation setting.</p><p><strong>Clinical rehabilitation impact: </strong>Hybrid digitally assisted rehabilitation can improve flexibility and access to rehabilitation. Further studies should examine which components and which time frame of rehabilitation can be digitized without any loss of effectiveness.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"1009-1018"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT.
Evidence acquisition: Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach.
Evidence synthesis: Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I2=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I2=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I2=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I2=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I2=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I2=0%). Certainty of evidence ranged from low to very low.
Conclusions: UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.
简介:超声引导灌洗(UGL)是一种经皮微创治疗肩袖钙化性肌腱病(RCCT)的方法。它是使用注射器将生理盐水和/或麻醉溶液直接注入钙化处,从而吸出碎裂的钙化物质。本系统综述旨在研究 UGL 是否能有效改善 RCCT 患者的疼痛、功能、生活质量、活动范围 (ROM),并促进钙化完全吸收:仅纳入了考虑到任何阶段和任何时间发病的 RCCT 患者接受 UGL 治疗的随机对照试验。对Embase、CENTRAL、CINHAL、PEDro和MEDLINE进行了检索,直至2024年5月。两位独立作者根据标题和摘要选择了随机对照试验,随后对全文进行了全面评估。使用 Cochrane risk of bias 2 (ROB2) 工具评估了偏倚风险(ROB),并通过 GRADE 方法评估了证据的确定性:共纳入七项研究(709 名受试者)。总体而言,三项研究被判定为低偏倚风险。汇总结果显示,UGL 和体外冲击波疗法(ESWT)在 12 周(SMD=-0.52,95% CI -1.57, 0.54,P=0.34,I2=93%)和 26 周(MD=-1.20,95% CI -2.66,0.27,P=0.11,I2=82%),而在52周时,出现了有利于UGL的显著差异(SMD=-0.52,95% CI -0.85,-0.19,P=0.002,I2=38%)。在功能方面,汇总结果显示 UGL 和 ESWT 在 6 周(MD=3.34,95% CI -11.45,18.12,P=0.66,I2=79%)和 52 周(SMD=0.10,95% CI -0.40,0.60,P=0.69,I2=30%)时差异不显著。考虑到 UGL 联合髋臼下皮质类固醇注射(SCI)与单独注射之间的钙化吸收率,汇总结果显示 UGL 的差异显著(2=0%)。证据的确定性从低到极低不等:UGL似乎是一种合理、安全的RCCT治疗方法,但与其他非/微创方法相比,UGL在控制疼痛、增强功能和提高钙化吸收率方面的效果值得怀疑。由于证据的确定性从低到极低不等,因此应谨慎解释这些结果。
{"title":"Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials.","authors":"Cristiano Sconza, Valentina Palloni, Domenico Lorusso, Federico Guido, Giacomo Farì, Lucrezia Tognolo, Ezio Lanza, Fabrizio Brindisino","doi":"10.23736/S1973-9087.24.08544-7","DOIUrl":"10.23736/S1973-9087.24.08544-7","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT.</p><p><strong>Evidence acquisition: </strong>Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach.</p><p><strong>Evidence synthesis: </strong>Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I<sup>2</sup>=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I<sup>2</sup>=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I<sup>2</sup>=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I<sup>2</sup>=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I<sup>2</sup>=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I<sup>2</sup>=0%). Certainty of evidence ranged from low to very low.</p><p><strong>Conclusions: </strong>UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"995-1008"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-18DOI: 10.23736/S1973-9087.24.08361-8
Sandra Schmitz, Thorsten Meyer-Feil
The randomized controlled trial (RCT) is the study design with the greatest potential to maximize internal validity when assessing the effectiveness of medical interventions, making it invaluable for evidence-based medicine. Yet, especially in the field of rehabilitation, it is not universally accepted as an unassailable gold standard due to serious problems of its implementation. This paper first examines three factors that limit the applicability of RCTs in rehabilitation practice. The first two factors stem from the nature of rehabilitative treatment itself: the complexity of rehabilitation interventions and the long-term and holistic nature of rehabilitation goals. The third factor relates to the differing functions of RCTs. Interventions vary in their complexity in increasing degree between component, measure, and program interventions. Lower complexity is associated with a greater likelihood of using high rigor efficacy studies. Methodological rigor further depends on the degree to which intervention conditions or contexts can be controlled for. This is particularly the case when examining body-related short-term outcomes. Whether it is reasonable to conduct an RCT also hinges on its function: to gain knowledge or to legitimate the utilization of an intervention in rehabilitation practice. The discussion highlights key challenges to RCT implementation and states questions that should help to identify an RCT as the most appropriate research design. Further empirical and theoretical research is indicated to clarify the distinction between levels of intervention, as this paper is based on theoretical considerations. Additionally, a concise explication of the different functions of an RCT and its meanings for their implementation is needed.
{"title":"Randomized controlled trials as a source of evidence in rehabilitation: a critical analysis.","authors":"Sandra Schmitz, Thorsten Meyer-Feil","doi":"10.23736/S1973-9087.24.08361-8","DOIUrl":"10.23736/S1973-9087.24.08361-8","url":null,"abstract":"<p><p>The randomized controlled trial (RCT) is the study design with the greatest potential to maximize internal validity when assessing the effectiveness of medical interventions, making it invaluable for evidence-based medicine. Yet, especially in the field of rehabilitation, it is not universally accepted as an unassailable gold standard due to serious problems of its implementation. This paper first examines three factors that limit the applicability of RCTs in rehabilitation practice. The first two factors stem from the nature of rehabilitative treatment itself: the complexity of rehabilitation interventions and the long-term and holistic nature of rehabilitation goals. The third factor relates to the differing functions of RCTs. Interventions vary in their complexity in increasing degree between component, measure, and program interventions. Lower complexity is associated with a greater likelihood of using high rigor efficacy studies. Methodological rigor further depends on the degree to which intervention conditions or contexts can be controlled for. This is particularly the case when examining body-related short-term outcomes. Whether it is reasonable to conduct an RCT also hinges on its function: to gain knowledge or to legitimate the utilization of an intervention in rehabilitation practice. The discussion highlights key challenges to RCT implementation and states questions that should help to identify an RCT as the most appropriate research design. Further empirical and theoretical research is indicated to clarify the distinction between levels of intervention, as this paper is based on theoretical considerations. Additionally, a concise explication of the different functions of an RCT and its meanings for their implementation is needed.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"1078-1087"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-10DOI: 10.23736/S1973-9087.24.08483-1
Marta Pinto, Lia Jacobsohn, Fátima Florindo-Silva, Lara Costa E Silva
Introduction: Monosymptomatic nocturnal enuresis is the most common voiding disorder and is associated with a decrease in the well-being and quality of life. Physiotherapy intervention has emerged as a second line treatment, and the treatment strategies that have been most commonly used to treat children and adolescents with monosymptomatic nocturnal enuresis are electrostimulation, magnetotherapy, biofeedback, behavioral therapy and pelvic floor muscle training. Establishing the efficacy of these physiotherapy strategies in children and adolescents up to 16 years is the aim of this Systematic Review.
Evidence acquisition: Research was conducted from December 2022 to November 2023 in five databases: PubMed, Web of Science, Academic Search Complete, CINAHL Plus, and PEDro and two independent reviewers assessed titles and abstracts and judged each article for eligibility. Ten randomized-controlled trials written in English remained for analysis. PRISMA guidelines were followed, and the protocol was registered in PROSPERO database.
Evidence synthesis: Electrostimulation was the most studied therapeutic modality and the one that showed better results, with significant improvements on bladder volumes and wet nights frequency, especially when used in association with Behavioral Therapy, Biofeedback and Pelvic Floor Muscle Training. Magnetotherapy presented less evidence.
Conclusions: The obtained results demonstrated that physiotherapy treatment strategies may be of added value in clinical practice, as they were well tolerated, and provided a safe and effective contribution to second line treatment options for children and adolescents with refractory Monosymptomatic Nocturnal Enuresis to first line treatments.
{"title":"Physiotherapy intervention on monosymptomatic nocturnal enuresis: a systematic review.","authors":"Marta Pinto, Lia Jacobsohn, Fátima Florindo-Silva, Lara Costa E Silva","doi":"10.23736/S1973-9087.24.08483-1","DOIUrl":"10.23736/S1973-9087.24.08483-1","url":null,"abstract":"<p><strong>Introduction: </strong>Monosymptomatic nocturnal enuresis is the most common voiding disorder and is associated with a decrease in the well-being and quality of life. Physiotherapy intervention has emerged as a second line treatment, and the treatment strategies that have been most commonly used to treat children and adolescents with monosymptomatic nocturnal enuresis are electrostimulation, magnetotherapy, biofeedback, behavioral therapy and pelvic floor muscle training. Establishing the efficacy of these physiotherapy strategies in children and adolescents up to 16 years is the aim of this Systematic Review.</p><p><strong>Evidence acquisition: </strong>Research was conducted from December 2022 to November 2023 in five databases: PubMed, Web of Science, Academic Search Complete, CINAHL Plus, and PEDro and two independent reviewers assessed titles and abstracts and judged each article for eligibility. Ten randomized-controlled trials written in English remained for analysis. PRISMA guidelines were followed, and the protocol was registered in PROSPERO database.</p><p><strong>Evidence synthesis: </strong>Electrostimulation was the most studied therapeutic modality and the one that showed better results, with significant improvements on bladder volumes and wet nights frequency, especially when used in association with Behavioral Therapy, Biofeedback and Pelvic Floor Muscle Training. Magnetotherapy presented less evidence.</p><p><strong>Conclusions: </strong>The obtained results demonstrated that physiotherapy treatment strategies may be of added value in clinical practice, as they were well tolerated, and provided a safe and effective contribution to second line treatment options for children and adolescents with refractory Monosymptomatic Nocturnal Enuresis to first line treatments.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"1051-1059"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-23DOI: 10.23736/S1973-9087.24.08475-2
Wenxiu Wu, Jingjing Lin, Xuezhen Zhou, Suzhen Ye, Mengmeng Shao, Jiangying Yu, Chengye Zhou, Haiyan Li
Background: Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings.
Aim: This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors.
Design: Prospective observational study.
Setting: Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University.
Population: Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited.
Methods: Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders.
Results: Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk.
Conclusions: Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients.
Clinical rehabilitation impact: This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.
{"title":"Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke.","authors":"Wenxiu Wu, Jingjing Lin, Xuezhen Zhou, Suzhen Ye, Mengmeng Shao, Jiangying Yu, Chengye Zhou, Haiyan Li","doi":"10.23736/S1973-9087.24.08475-2","DOIUrl":"10.23736/S1973-9087.24.08475-2","url":null,"abstract":"<p><strong>Background: </strong>Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings.</p><p><strong>Aim: </strong>This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors.</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Setting: </strong>Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University.</p><p><strong>Population: </strong>Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited.</p><p><strong>Methods: </strong>Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders.</p><p><strong>Results: </strong>Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk.</p><p><strong>Conclusions: </strong>Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients.</p><p><strong>Clinical rehabilitation impact: </strong>This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"929-937"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-10-24DOI: 10.23736/S1973-9087.24.08046-8
Carine Milcent
Background: Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.
Design: Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect "as if" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.
Setting: An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.
Population: Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.
Methods: We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.
Conclusions: The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.
Clinical rehabilitation impacts: The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.
背景:病人的社会经济地位对医院效率的影响,在控制临床部分特征方面可能有作用,但在康复中心却鲜有研究:设计:由于国家医疗保险制度,康复中心是免费的。为了回答患者的社会经济地位(SES)是否与效率和绩效相关,我们采用了反事实分析法,"假设 "患者的病例与任何医院的病例相同,从而得出患者的 SES 影响。我们将数据限制在公立急症监护病房的病人身上,因为这些病房是根据病人的情况来决定是否收治康复部门的病人,从而限制了混杂因素造成的偏差。此外,对六种病症的分析也得出了相同的结果:背景:法国康复中心的详尽行政数据库。为了确定患者的社会经济状况,我们使用了两个数据来源:患者进入康复护理中心时收集的信息和患者在急症护理中心住院期间收集的信息。这种双重信息可避免两次入院之间社会经济细节的丢失:所招募的患者均为2018年期间在法国因中风、慢性阻塞性肺病、心力衰竭或全髋关节置换术在急症监护室和康复中心入院的患者。主要是老年人群。由于报销制度的原因,患者的人口统计学、合并症和社会经济地位等信息都被编码。为了控制两组患者基线数据的差异,我们逐步增加了不同的控制因素(医院所有权、患者临床特征、康复护理特殊性、医务人员详细信息和患者社会经济地位):方法:我们结合选定的结果质量指标(身体评分改善、认知评分改善、死亡率、重返家庭)来评估康复中心的效率。结论:医疗机构的绩效与医疗服务的质量并不相关:结论:医疗机构的绩效不仅与病人的病例组合有关,还与收治病人的社会经济状况有关。临床康复的影响:数据显示,病人的社会经济状况影响康复护理的效率和绩效。在控制患者的社会经济地位方面,营利性康复医院似乎比公立康复医院更有效率。
{"title":"The effect of patients' socioeconomic status in rehabilitation centers on the efficiency and performance.","authors":"Carine Milcent","doi":"10.23736/S1973-9087.24.08046-8","DOIUrl":"10.23736/S1973-9087.24.08046-8","url":null,"abstract":"<p><strong>Background: </strong>Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.</p><p><strong>Design: </strong>Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect \"as if\" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.</p><p><strong>Setting: </strong>An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.</p><p><strong>Population: </strong>Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.</p><p><strong>Methods: </strong>We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.</p><p><strong>Conclusions: </strong>The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.</p><p><strong>Clinical rehabilitation impacts: </strong>The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"919-928"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}