European journal of physical and rehabilitation medicine最新文献

Introduction: Latest epidemiological metrics put a global prevalence of 20.6 million people suffering from spinal cord injury (SCI), leading to a burden of functional disability, deterioration in quality of life and reduced life expectancy. A thorough statement of diagnostic methods and treatment protocols for swallowing disorders after SCI stands as a major priority to streamline patient care and cost-sharing. Here we have provided a systematic overview of the evidence on diagnostic and rehabilitation protocols of dysphagia in the SCI population.

Evidence acquisition: The literature was searched in six electronic databases up to April 30^th, 2024. Screening the 521 retrieved articles for inclusion criteria resulted in the selection of 43 studies that reported assessment tools and rehabilitation protocols for dysphagia in patients with SCI. Two researchers extracted the data in parallel, and inter-rater reliability (IRR) was used to estimate inter-coder agreement and then κ statistic to measure accuracy and precision. Based on PRISMA concepts and quality assessment steps, a k coefficient of at least 0.9 was obtained in all data extraction steps. All reports were assessed for risk of bias using the NIH Quality Assessment Toolkit. The study protocol was registered on PROSPERO (CRD42023449137).

Evidence synthesis: Dysphagia assessment methods were collected and grouped into four different macro categories (clinical assessment, rating scale, self-reported questionnaire, and instrumental assessment). It was found that the Bedside Swallow Evaluation (BSE) for the clinical assessment category (50%), the Bazaz score (32.5%) for the rating scale category, the Eating Assessment Tool-10 (EAT-10) (44.4%) for the self-reported questionnaire category, and the Videofluoroscopic Study of Swallowing (VFSS) (48.9%) for the instrumental assessment category were the most representative tools. The rehabilitation protocols described included either an early oral feeding exclusion or a consistency-modified oral intake, postural adaptations, oxygen therapy with a high-flow nasal cannula combined with indirect/direct therapy, specific exercises, and neuromuscular electrical stimulation.

Conclusions: Methods of diagnosis and rehabilitation protocols for dysphagia in SCI patients appear inconsistent. Further rigorous studies are needed to achieve better clinical handling in SCI settings while lowering the load of patient morbidity and related healthcare costs.

The need for medical rehabilitation is growing rapidly, including functional assessment and rehabilitation management of outpatients. The wide diversity of the out of the hospital PRM programs leads to define the basic principles and the role of the PRM specialist in the field. The aim of this article is to outline the core professional principles of the PRM for outpatient care, according to the Physical and Rehabilitation Medicine Section of the European Union of Medical Specialists. A Working Group (WG) on "Physical and Rehabilitation Medicine for Outpatients" was formed in March 2023. The final version was unanimously approved at the General Assembly on September 13^th, 2024. The principal aspects of PRM management of outpatients, according to the UEMS PRM Section, are reported. It is essential that PRM programs for outpatients are planned, developed, and implemented according to the professional principles of Physical and Rehabilitation Medicine in appropriate settings. They must be conducted by a multiprofessional team led by a PRM physician. These efforts aim to maximize functional outcomes and enhance the quality of life for individuals at risk of disability and chronic conditions.

Background: The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.

Aim: The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.

Design: A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.

Setting: Outpatient rehabilitation clinic and home-based rehabilitation program.

Population: Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).

Methods: Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.

Results: Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).

Conclusions: The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.

Clinical rehabilitation impact: Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.

Background: The defective spoken output of persons with aphasia has anomia as a main clinical manifestation. Improving anomia is therefore a main goal of any language treatment.

Aim: This study assessed the effectiveness of a novel, 2-week, rehabilitation protocol (PHOLEXSEM), focused on PHonological, SEmantic, and LExical deficits, aiming at improving lexical retrieval, and, generally, spoken output.

Design: A prospective, randomized controlled trial.

Setting: In-patient and out-patient population of the Neurorehabilitation Unit of the Istituto Auxologico Italiano IRCCS, Milan, Italy.

Population: The sample comprised 44 adults with aphasia due to left brain damage; 22 of them were assigned to the experimental (PHOLEXSEM) group, whereas 22 were assigned to the control group that received the Promoting Aphasics Communicative Effectiveness (PACE) protocol.

Methods: All participants were treated 30-min daily for two weeks. The PHOLEXSEM training included 3 sets of exercises: 1) non-word, word, and phrase repetition; 2) semantic feature analysis by naming; 3) phonemic, semantic, and verb recall. Treatment effects were evaluated with tasks and items different from those used for training, to assess generalization effects.

Results: After the PHOLEXSEM treatment, repetition, naming, lexical retrieval and sentence comprehension improved more than in the control - PACE - group, with gains generalizing to non-trained items. These improvements were independent of aphasia chronicity and only marginally influenced by demographic factors.

Conclusions: The 2-week PHOLEXSEM training, by targeting spoken output, ameliorates different aspects of aphasia, ranging from speech production (i.e., phonology and lexical retrieval) to comprehension.

Clinical rehabilitation impact: The PHOLEXSEM training is a useful and easy-to-administer intervention to improve post-stroke language deficits in adults of different ages, levels of education, duration, type, and severity of aphasia.

Background: Magnetic stimulation has a potential therapeutic effect on patients with chronic nonspecific low back pain (CNLBP). However, the efficacy and underlying brain mechanisms of closed-loop magnetic stimulation for CNLBP remain unclear.

Aim: This study aims to investigate the analgesic efficacy and brain activation of repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS) in patients with CNLBP.

Design: This was a single-center, double-blind, randomized controlled trial.

Setting: Huashan Hospital.

Population: CNLBP.

Methods: Thirty patients with CNLBP were randomly allocated into the experimental group and control group, with fifteen patients in each group. Patients in both groups received CNLBP-related health education. On this basis, patients in the experimental group received a two-week rTMS combined with rPMS treatment, while the control group received rPMS treatment combined with sham-rTMS stimulation. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and Neurometer CPT sensory nerve quantitative detector were used to evaluate the participants before and after treatment. In addition, functional near-infrared imaging (fNIRS) was employed to ascertain participants' brain function.

Results: After treatment, both groups exhibited a significant decrease in VAS and ODI scores compared to their pre-treatment levels (all P<0.05). While there was no statistical significance between the two groups. Neurometer CPT revealed that the experimental group improved the pain threshold of C-fiber on the unaffected side (P=0.036). In addition, compared with the control group, the experimental group exhibited a notable increase in the activation of the somatosensory association cortex (SAC) region and an improvement in the functional connectivity of brain regions, including SAC and the primary motor cortex (PMC), after treatment.

Conclusions: Combining rTMS with rPMS can significantly relieve pain and remodel brain regions in individuals with CNLBP. This closed-loop rehabilitation model paradigm merits additional clinical investigation and implementation.

Clinical rehabilitation impact: Magnetic stimulation therapy based on closed-loop rehabilitation mode has a good prospect for clinical rehabilitation for patients with CNLBP.

Introduction: Low back pain (LBP) represents a frequent health issue in most of the countries; in recent years, there was a growing interest concerning the role of balance and postural stability in individuals with non-specific LBP (NS-LBP). The aim of this systematic review is to provide a synthesis of the evidence on the association between NS-LBP and an impaired dynamic balance.

Evidence acquisition: The reporting of this study followed the 2020 PRISMA statement. Analytical observational studies, investigating the dynamic balance performance via functional or motor-tasks tests in LBP in comparison to healthy people, were searched in PubMed, Embase and Scopus up to December 2023. Their characteristics were reported in a standardized form, and their methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies.

Evidence synthesis: A qualitative synthesis of the study findings and a discussion of the results are provided. 19 cross-sectional studies were included in this review, with an overall sample size of 894. A meta-analysis was not possible due to high levels of heterogeneity across the studies. None of the included studies were deemed to be of a good methodological quality. Overall, most studies reported differences between NS-LBP and healthy people in terms of dynamic balance, showing worst performances in NS-LBP, both at motor-task tests and at the posturography.

Conclusions: Impaired dynamic balance seems to be correlated to NS-LBP. However, due to the presence of methodological issues in the included studies, further confirmations are needed. Clinicians should take into consideration the importance of a balance assessment in NS-LBP, by implementing proper functional tests. High-quality observational research is recommended, to assess dynamic balance with standardized and uniform modalities, in relation to specific stages of the condition.

Background: Long-lasting symptoms (>12 weeks) following a COVID-19 infection are defined as the post-COVID-19 syndrome (PCS), often manifesting as fatigue and reduced exercise capacity. Thus, exercise has been suggested as a non-pharmacological therapy.

Aim: To investigate the effects of endurance vs. concurrent exercise on physical function, symptoms and quality of life in individuals with PCS, that did not need hospital admission during acute COVID-19.

Design: Parallel-group, single-center, randomized controlled trial.

Setting: This study was conducted at the University of Vienna.

Population: Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.

Methods: Participants were randomized to either 12 weeks of supervised endurance training (ED) or concurrent training (CT), or a non-exercising control group (C). As the primary outcome, VO2peak was assessed pre and post intervention. Secondary outcomes were handgrip and lower body strength, heart rate variability, symptoms, health-related quality of life (HRQoL) and concentration performance. The main effects for time and group as well as the time*group interaction were assessed via a 2x2 analysis of variance. Additionally, within-group pre-post testing was performed.

Results: Taking the study protocol into account, 42 subjects could be included in the analysis (N.=14 in each group). A significant time*group interaction favoring both exercise conditions was found for VO2peak (partial Eta²=0.267; ED: +3.9 mL/min/kg; CT: +3.2 mL/min/kg). The Fatigue Severity Score significantly decreased in ED (Hedges' g=0.63) and CT (Hedges' g=0.82) from pre to post, but not in C. Breathlessness and lower body strength improved most in CT. Significant within-group improvements in HRQoL and the number of PCS symptoms occurred in all groups.

Conclusions: Both exercise regimes led to increases in VO2peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.

Clinical rehabilitation impact: The results show that in this population both exercise regimes are feasible and safe and lead to improvements in various health domains.

Considering the growing role of ultrasound-guided procedures in musculoskeletal medicine, training as regards these interventions is pivotal. While hands-on training on cadavers can be considered optimal, it has several drawbacks, e.g., high cost, poor availability, and technical challenges regarding preservation. Apart from cadavers, different approaches to practicing needle guidance are taught in ultrasound workshops whereby phantoms from meat (e.g., chicken breast), cheese or gelatin are used. Likewise, this article aims to provide a detailed description as to how different gelatin-based phantoms can be prepared. In line with the EURO-MUSCULUS/USPRM (European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) protocols/background, the authors describe particular basic and advanced phantoms to be used for practicing different technical/manual skills pertaining to common ultrasound-guided procedures. The present manuscript can be considered a practical and ready-to-use "recipe book" for readers who are interested in the wide spectrum of interventional ultrasound.