European journal of physical and rehabilitation medicine最新文献

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.

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.

Background: Femoroacetabular impingement syndrome (FAIS) significantly affects the physical function and quality of life of the young and middle-aged population. Pelvic tilt and trunk muscle endurance are physical features poorly studied in FAIS.

Aim: This study aimed to compare the anterior pelvic tilt and anterior, lateral, and posterior trunk muscles endurance between people with FAIS and healthy individuals, within FAIS sub types and between the symptomatic and asymptomatic hip in people with FAIS.

Design: Cross-sectional study.

Settings: Participants were recruited and screened for potential eligibility at the Rehabilitation, Sports Medicine, and Physiotherapy Unit between April 2021 and February 2022.

Population: Sixty-nine patients with FAIS and 69 controls.

Methods: A study adhering to STROBE guidelines recruited 138 participants (69 FAIS, 69 controls). The degree of pelvic tilt was measured by the palpation meter (PALM) tool. To assess trunk musculature endurance, isometric trunk tests described by McGill were performed (extension resistance test, flexion resistance test, and side plank test). Cases were classified based on FAIS subtypes. Differences between groups and subgroups were performed using t-tests and ANCOVA, respectively.

Results: Significant differences in anterior pelvic tilt were observed between the control and FAIS groups (P<0.001, d=0.72). Participants with FAIS exhibited greater pelvic tilt (MD=1.57, 95% CI=0.83 to 2.3). Trunk muscle endurance showed statistically significant differences (P<0.001, d=0.72) for posterior muscles. In comparisons between symptomatic and asymptomatic hips, significant differences were found in pelvic tilt (P<0.001, d=0.26) and lateral trunk muscle endurance (P<0.001, d=0.43). FAIS subtypes demonstrated significant differences in lateral trunk muscle endurance (P=0.002, ηp2=0.209).

Conclusions: This study found that patients with FAIS present large anterior pelvic tilt and lower posterior trunk muscle endurance. Although anterior pelvic tilt was comparable for all FAIS subtypes, Pincer-type with or without labral tear exhibited lower lateral trunk muscle endurance compared with Cam-type with or without labral tear. In addition, the symptomatic hip of FAIS patients showed lower lateral trunk muscle endurance compared to the asymptomatic hip.

Clinical rehabilitation impact: Incorporating rehabilitation strategies that address pelvic tilt and trunk muscle strengthening in individuals with FAIS might be considered as a potential means to improve these physical impairments, pending careful evaluation of their effectiveness.

Randomized controlled trials (RCTs) are considered the gold standard of evidence guiding intervention selection in rehabilitation. However, conduct of sufficiently powered RCTs in rehabilitation can be expensive, pose ethical and attrition concerns when participants are assigned to ineffective treatment as usual conditions, and are infeasible with low-incidence populations. Single-case experimental designs (SCEDs), including N-of-1 RCTs are causal inference studies for small numbers of participants and not necessarily one participant as the name implies. These designs are increasingly used to evaluate the effectiveness of rehabilitation interventions in diverse clinical settings and employ design features including but not limited to randomization and each participant serving as their own control. These and other internal validity enhancements can increase the confidence in study results coming from these designs. This manuscript discusses the expanded application of SCEDs in rehabilitation contexts to answer everyday clinical rehabilitation research questions with emphasis on strategies to use: 1) to maximize internal validity of this family of designs; 2) improve utility, effectiveness, and acceptability of these designs for rehabilitation end-users (clinicians, policymakers, and participants); 3) build evidence bases in areas of rehabilitation where RCTs are uncommonly used. Primary considerations for situating SCEDs within the continuum of experimental designs include increasing internal validity within designs, improving transparency in conduct and reporting of these studies, and increasing access to advanced research methods training for rehabilitation professionals.

Background: Children with ataxic cerebral palsy have unsteady movements and poor balance. Many therapeutic interventions are used to improve their upper and lower functioning.

Aim: To assess the effectiveness of virtual reality (VR) on balance impairment in ataxic cerebral palsy children.

Design: RCT.

Population: Sixty-four children with ataxic cerebral palsy.

Methods: Children were randomly assigned into two equal groups with 32 patients in each group. The control group received a specially developed physical therapy program and the VR group received VR training on a Wii balance board in addition to the control group's program. For three successive months the intervention program was implemented three times a week for both groups. Stability indices (overall, anteroposterior, and mediolateral) were measured using the Biodex balance system and Pediatric Balance Scale (PBS) at baseline and after three months of intervention for both groups.

Results: At the beginning of the intervention, there were no statistically significant differences between the two groups (P>0.05). However, following three months of the intervention, there was a statistically significant decline in the stability index scores., as well as a statistically significant improvement in the score of the PBS in both groups with a notable advancement in favor of the VR group (P≤0.05).

Conclusions: Adding VR training on a Wii balance board to a designed physical therapy program has a significant impact on improving balance deficits in ataxic cerebral palsy children.

Clinical rehabilitation impact: VR has a therapeutic effect on improving balance that may result in better and more efficient rehabilitation program of children with ataxic cerebral palsy.

Introduction: Fractures are common bone injuries, which have a great burden on global health. Fracture healing is a long-term process that may be influenced by a number of factors. The 10-15% of all bone fractures may be complicated by an impaired healing (i.e. delayed union or non-union). The application of weak electromagnetic fields has been proposed to have different effects on bones such as enhancing proliferation - orientation - migration of osteoblast-like cells and supporting osteogenic differentiation in bone marrow-derived mesenchymal stem cells. Despite the amount of evidence on cellular and histological effects, to date the application of pulsed electromagnetic fields has not achieved univocal consensus in daily practice. The purpose of this systematic review update is to research, select, analyze and summarize the most recent scientific evidence regarding the effects of pulsed electromagnetic fields in the treatment of acute bone fractures.

Evidence acquisition: A systematic review using the following MeSH terms (Magnetic Field Therapy; Electromagnetic Fields; Bone and Bones; Fractures, Bone; Fractures Healing) and strings {("Magnetic Field Therapy [mh]" OR "Electromagnetic Fields [mh]) OR "magnetotherapy" OR "pulsed electromagnetic field") and ("Fractures, bone [mh]" OR "Bone and Bones [mh]") and ("Fractures Healing [mh]")} was conducted on PubMed, Cochrane Library, Epistemonikos and Scopus electronic databases. Only full articles published in English between January 2014 and December 2022 were considered. Eligibility criteria were defined according to the Population, Intervention, Comparison, Outcomes, and Study (PICOS) design framework. Case reports, case series, uncontrolled studies and expert opinions were excluded. All articles were checked for quality and risk of bias.

Evidence synthesis: Three randomized controlled trials were included (197 patients in total). None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results about pain relief emerged. Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture.

Conclusions: This systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. Controversial evidence was found about the effects of pulsed electromagnetic fields on pain and functional recovery. Considering the scant and heterogenous literature published to date, which represents a limit for our conclusion, further studies with rigorous and high-quality methodology are needed.

Background: The effect of motor imagery applied to dysphagia patients with Wallenberg syndrome has not yet been reported.

Aim: This trial aimed to investigate the effect and mechanism of motor imagery based on action observation treatment in the rehabilitation of patients with dysphagia in Wallenberg syndrome.

Design: A randomized controlled trial.

Setting: The setting was in-patient.

Population: Thirty patients with dysphagia of Wallenberg syndrome.

Methods: The patients were divided into the experimental group and the control group. Both groups received conventional dysphagia treatment, and the experimental group underwent the addition of motor imagery based on action observation treatment to the control group once a day for 14 days. Overall swallowing function was assessed with specific scales before and after intervention. Meanwhile, the functional near infrared spectroscopy was used to detect changes in cerebral hemodynamics during the execution of volitional swallowing task and swallowing motor imagery.

Results: The standardized swallowing assessment score (P=0.030), Murray secretion scale score (P=0.044) and swallowing quality of life score (P=0.011) of the experimental group improved better than those of the control group. In addition, multiple brain regions of the cortical presented extensive activation (P<0.05) during the execution of swallowing motor imagery. Moreover, there were significant differences (P<0.05) in brain regions pre-motor and supplementary motor cortex, right primary motor cortex, and right primary somatosensory cortex of the experimental group before and after treatment.

Conclusions: The present study indicated that motor imagery based on action observation treatment could improve swallowing function for patients with dysphagia of Wallenberg syndrome as an add-on training. As a top-down rehabilitation training, the mechanism of this therapy may be related to the selective activation of mirror neuron system.

Clinical rehabilitation impact: Motor imagery based on action observation treatment can be implemented as part of the therapeutic for dysphagia of Wallenberg syndrome.

According to Cochrane Rehabilitation's recently published definition for research purposes, rehabilitation is inherently complex. Rehabilitation teams frequently implement multiple strategies concurrently, draw on input from a range of different health professionals, target multiple outcomes, and personalize therapeutic plans. The success of rehabilitation lies not only in the specific therapies employed, but also in how they are delivered, when they are delivered, and the capability and willingness of patients to engage in them. In 2021, the UK Medical Research Council (MRC) and the National Institute of Health Research (NIHR) released the second major update of its framework for developing and evaluating complex interventions. This framework has direct relevance to the development and implementation of evidence-based practice in the field of rehabilitation. While previous iterations of this framework positioned complex interventions as anything that involved multiple components, multiple people, multiple settings, multiple targets of effect, and behavior change, this latest framework expanded on this concept of complexity to also include the characteristics and influence of the context in which interventions occur. The revised MRC-NIHR framework presents complex intervention research as comprising the following four inter-related and overlapping phases: 1) development or identification of the intervention; 2) feasibility; 3) evaluation; and 4) implementation, with different methods and tools required to address each of these phases. This paper provides an overview of the MRC-NIHR framework and its application to rehabilitation, with examples from past research. Rehabilitation researchers are encouraged to learn about the MRC-NIHR framework and its application. Funders of rehabilitation research are also encouraged to place greater emphasis on supporting studies that involve the right design to address key uncertainties in rehabilitation clinical practice. This will require investment into a broader range of types of research than simply individual-level randomized controlled trials. Rehabilitation research can both learn from and contribute to future iterations of the MRC-NIHR framework as it is an excellent environment for exploring complexity in clinical practice.