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Patient and Caregiver Perspectives on an eHealth Tool: A Qualitative Investigation of Preferred Formats, Features and Characteristics of a Presurgical eHealth Education Module. 患者和护理人员对电子健康工具的看法:手术前电子健康教育模块首选格式、功能和特点的定性调查。
IF 2.3 Q1 REHABILITATION Pub Date : 2021-04-21 eCollection Date: 2021-01-01 DOI: 10.1177/11795727211010501
Holly Reid, Somayyeh Mohammadi, Wendy Watson, Julie M Robillard, Morag Crocker, Marie D Westby, William C Miller

Introduction: Total hip and total knee replacement (THR and TKR) are suggested for reducing joint pain resulting from hip and knee osteoarthritis (OA), especially when other interventions have not resulted in desired outcomes. Providing prehabilitation education can improve patients' psychological and physical well-being before and after surgery. The use of electronic health (eHealth) tools can be considered an effective method to increase patients' access to prehabilitation, particularly for those facing barriers to attending diagnosis-specific in-person education sessions. However, limited attention is paid to both caregiver and patient perspectives regarding the delivery formats, features, and characteristics of eHealth tools.

Method: Patients with hip (n = 46) and knee OA (n = 14) and their family caregivers (n = 16) participated in in-person focus groups or phone interviews. Participants were shown a mock-up of an eHealth module, and asked to share their preferences regarding the formats, features, and characteristics of the eHealth prehabilitation tool. Data was transcribed verbatim and coded using primary thematic and secondary content analyses.

Result: Analyses revealed 3 main themes: 1. "easier to understand" emphasizes patients' preferences on delivery formats and features; 2. "what does that mean?" highlights requests for clear and simple information; and 3. "Preparation, right?" shows patients' perspectives on the best time to have access to the eHealth tool.

Discussion: Participants' preferences for prehabilitation tools included offering eHealth tools in multiple mediums of delivery (eg, written materials, pictures, videos). Participants preferred simplified information that emphasized the key points and rationale for the knowledge. There were differences in preferred timeline for having access to prehabilitation education, such as some participants wanting to receive prehabilitation well in advance, while others stated just before surgery was adequate. Our findings provide novel and actionable information about patient and caregiver perspectives on features and characteristics of prehabilitation education for patients with hip and knee OA.

导言:全髋关节和全膝关节置换术(THR 和 TKR)被建议用于减轻髋关节和膝关节骨性关节炎(OA)引起的关节疼痛,尤其是在其他干预措施未能达到预期效果的情况下。提供术前康复教育可以改善患者术前和术后的心理和生理健康状况。使用电子健康(eHealth)工具可被视为增加患者接受康复前教育机会的有效方法,特别是对于那些在参加特定诊断的面对面教育课程时面临障碍的患者。然而,人们对护理人员和患者对电子健康工具的交付形式、功能和特点的看法关注有限:方法:髋关节(46 人)和膝关节 OA 患者(14 人)及其家庭护理者(16 人)参加了现场焦点小组或电话访谈。向参与者展示了电子健康模块的模型,并要求他们分享自己对电子健康康复工具的格式、功能和特点的偏好。数据被逐字转录,并通过主要主题分析和次要内容分析进行编码:结果:分析揭示了三大主题:1. "更容易理解 "强调了患者对提供格式和功能的偏好;2."准备工作,对吗?"显示了患者对使用电子健康工具最佳时间的看法:讨论:参与者对康复前工具的偏好包括以多种媒介(如书面材料、图片、视频)提供电子健康工具。参与者更喜欢强调知识要点和原理的简化信息。在获得康复前教育的首选时间上存在差异,例如一些参与者希望提前很长时间接受康复前教育,而另一些参与者则表示在手术前接受康复前教育就足够了。我们的研究结果提供了关于患者和护理人员对髋关节和膝关节 OA 患者康复前教育的特点和特征的看法的新颖且可操作的信息。
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引用次数: 0
Tools and Techniques Used With Robotic Devices to Quantify Upper-Limb Function in Typically Developing Children: A Systematic Review. 与机器人设备一起用于量化典型发育儿童上肢功能的工具和技术:系统综述。
Pub Date : 2020-12-14 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720979013
Stephan Cd Dobri, Hana M Ready, Theresa Claire Davies

Background: Robotic devices have been used to quantify function, identify impairment, and rehabilitate motor function extensively in adults, but less-so in younger populations. The ability to perform motor actions improves as children grow. It is important to quantify this rate of change of the neurotypical population before attempting to identify impairment and target rehabilitation techniques.

Objectives: For a population of typically developing children, this systematic review identifies and analyzes tools and techniques used with robotic devices to quantify upper-limb motor function. Since most of the papers also used robotic devices to compare function of neurotypical to pathological populations, a secondary objective was introduced to relate clinical outcome measures to identified robotic tools and techniques.

Methods: Five databases were searched between February 2019 and August 2020, and 226 articles were found, 19 of which are included in the review.

Results: Robotic devices, tasks, outcome measures, and clinical assessments were not consistent among studies from different settings but were consistent within laboratory groups. Fifteen of the 19 articles evaluated both typically developing and pathological populations.

Conclusion: To optimize universally comparable outcomes in future work, it is recommended that a standard set of tasks and measures is used to assess upper-limb motor function. Standardized tasks and measures will facilitate effective rehabilitation.

背景:机器人设备已广泛用于成人的功能量化、识别损伤和运动功能康复,但在年轻人群中应用较少。随着孩子的成长,运动能力也会提高。在试图确定损伤和目标康复技术之前,量化神经典型人群的这种变化率是很重要的。目的:对于典型发育的儿童群体,本系统综述确定并分析了机器人设备用于量化上肢运动功能的工具和技术。由于大多数论文也使用机器人设备来比较神经正常人群和病理人群的功能,因此引入了第二个目标,将临床结果测量与确定的机器人工具和技术联系起来。方法:检索2019年2月- 2020年8月5个数据库,共检索到226篇文献,其中19篇纳入综述。结果:机器人设备、任务、结果测量和临床评估在不同环境的研究中不一致,但在实验室组中是一致的。19篇文章中有15篇评估了典型发育人群和病态人群。结论:为了在未来的工作中优化普遍可比较的结果,建议使用一套标准的任务和测量方法来评估上肢运动功能。标准化的任务和措施有利于有效的康复。
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引用次数: 6
Implementation of Dynamic Lycra® Orthoses for Arm Rehabilitation in the Context of a Randomised Controlled Feasibility Trial in Stroke: A Qualitative study Using Normalisation Process Theory. 在卒中随机对照可行性试验的背景下实施动态Lycra®矫形器进行手臂康复:一项使用归一化过程理论的定性研究。
Pub Date : 2020-08-31 DOI: 10.1177/1179572720950210
Joke Delvaux, Alexandra John, Lucy Wedderburn, Jacqui Morris

Objective: To explore how non-research funded rehabilitation practitioners implemented dynamic Lycra® orthoses for arm recovery after stroke into rehabilitation practice, as part of a feasibility randomised controlled trial.

Design: Qualitative interview study.

Setting: Two in-patient stroke units and associated rehabilitation units.

Subjects: Fifteen purposefully selected stroke rehabilitation practitioners involved in delivery of dynamic Lycra® orthoses as part of a feasibility randomised controlled trial.

Methods: Semi-structured interviews conducted at the end of the trial. Interviews examined their experiences of orthosis implementation. Normalisation Process Theory structured the interview guide and informed data analysis. NVivo software supported data analysis.

Results: Practitioners intuitively made sense of the intervention in the face of uncertainty about its precise mechanisms of action (Normalisation Process Theory construct: coherence) and espoused commitment to the research, despite uncertainty about orthosis effectiveness (cognitive participation). They did however adapt the intervention based on perceived therapeutic need, their own skillsets and stroke survivor preference (collective action). They were uncertain about benefits (reflexive monitoring). Across the 4 theoretical constructs, ambivalence about the intervention was detected.

Conclusions: Ambivalence interfered with implementation - but only to an extent. 'Good-enough' coherence, cognitive participation, collective action and reflexive monitoring were sufficient to initiate normalisation - as long as implementation did not undermine the relationship between practitioner and stroke survivor. Ambivalence stemmed from practitioners' uncertainty about the intervention theory and mechanisms of action. Making intervention mechanisms of action more explicit to practitioners may influence how they implement and adapt a research intervention, and may determine whether those processes undermine or enhance outcomes.

目的:作为一项可行性随机对照试验的一部分,探讨非研究资助的康复从业者如何在康复实践中使用动态Lycra®矫形器进行中风后手臂恢复。设计:定性访谈研究。设置:两个中风住院病房和相关的康复病房。受试者:作为可行性随机对照试验的一部分,有目的地选择了15名参与提供动态Lycra®矫形器的中风康复从业者。方法:在试验结束时进行半结构化访谈。访谈调查了他们使用矫形器的经验。规范化过程理论构建了访谈指南和知情数据分析。NVivo软件支持数据分析。结果:尽管矫形器的有效性(认知参与)存在不确定性,但从业者在面对其确切作用机制的不确定性时直观地理解了干预(规范化过程理论结构:连贯性),并支持对研究的承诺。然而,他们确实根据感知的治疗需求、自己的技能和中风幸存者的偏好(集体行动)调整了干预措施。他们不确定收益(反射性监控)。在4个理论结构中,人们发现了对干预的矛盾心理。结论:歧义干扰了实施,但只是在一定程度上只要实施不破坏从业者和中风幸存者之间的关系,足够好的连贯性、认知参与、集体行动和反射性监测就足以启动正常化。歧义源于从业者对干预理论和行动机制的不确定性。使干预行动机制对从业者更加明确可能会影响他们如何实施和调整研究干预,并可能决定这些过程是否会破坏或增强结果。
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引用次数: 3
Systematic Review of Interventions Designed to Maintain or Increase Physical Activity Post-Cardiac Rehabilitation Phase II. 旨在维持或增加心脏康复后身体活动的干预措施的系统综述。
Pub Date : 2020-08-25 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720941833
Helen Graham, Kathy Prue-Owens, Jess Kirby, Mythreyi Ramesh

Background: Cardiovascular disease (CVD) continues to be the No. 1 cause of death in the United States and globally, and individuals with a history of a cardiac event are at increased risk for a repeat event. Physical inactivity creates health problems for individuals with chronic heart disease. Evidence shows that physical activity (PA), as a central component of cardiac rehabilitation phase II (CRII), decreases hospital readmission and mortality. Yet, individual adherence to PA tends to decline several months following CRII completion.

Objective: The purpose of this review was to evaluate current literature for interventions designed to assist individuals diagnosed with myocardial infarction (MI), coronary artery bypass graft (CABG), coronary artery disease (CAD), and percutaneous coronary intervention (PCI) to maintain or increase PA post-CRII.

Methods: A systematic search of 5 electronic databases including hand-searched articles between 2000 and 2019. Key Medical Subject Headings (MeSH) search terms included cardiac rehabilitation, intervention, exercise or PA, outcomes, compliance, adherence, or maintenance. Only interventions implemented following CRII program completion were included for review.

Results: Based on the inclusion criteria, the search yielded 19 randomized control trials retained for descriptive analysis. Interventions were categorized into 3 domains. The intervention designs varied widely in terms of duration of the intervention and the length of time to outcome measurement. Most interventions were short-term with only 2 studies offering a long-term intervention of greater than 1 year. Interventions using a theoretical approach most often included a cognitive-behavioral model.

Conclusions: Interventions offered shortly after completion of CRII may help cardiac patients maintain PA and reduce the risk of experiencing additional cardiac events; however, more quality research is needed. Additional research to examine PA maintenance in older adults (70 years and older) would be valuable based on the increase in average lifespan. Studies with larger and more diverse samples, and less variation in methods and outcomes would greatly increase the ability to conduct a high-quality meta-analysis.

背景:心血管疾病(CVD)仍然是美国和全球第一大死亡原因,有心脏事件史的个体再次发生心血管事件的风险增加。缺乏运动给慢性心脏病患者带来健康问题。有证据表明,身体活动(PA)作为心脏康复二期(CRII)的核心组成部分,可以降低再入院率和死亡率。然而,在中区填海工程完成几个月后,个人对PA的依从性趋于下降。目的:本综述的目的是评估目前的文献,旨在帮助诊断为心肌梗死(MI)、冠状动脉旁路移植术(CABG)、冠状动脉疾病(CAD)和经皮冠状动脉介入治疗(PCI)的个体在crii后维持或增加PA。方法:系统检索2000 - 2019年5个电子数据库的人工检索文章。关键医学主题标题(MeSH)搜索词包括心脏康复、干预、运动或PA、结果、依从性、依从性或维持。只有在CRII项目完成后实施的干预措施才被纳入评估。结果:根据纳入标准,检索得到19个随机对照试验用于描述性分析。干预措施分为3个领域。干预设计在干预的持续时间和结果测量的时间长短方面差异很大。大多数干预是短期的,只有2项研究提供了超过1年的长期干预。使用理论方法的干预通常包括认知行为模型。结论:在完成CRII后不久提供的干预可能有助于心脏患者维持PA并降低经历其他心脏事件的风险;然而,还需要更多高质量的研究。基于平均寿命的增加,对老年人(70岁及以上)的PA维持进行额外的研究将是有价值的。样本量更大、更多样化、方法和结果差异更小的研究将大大提高进行高质量荟萃分析的能力。
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引用次数: 9
Cardiac Specialists' Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting. 心脏专家对低资源环境下心脏康复转诊和参与障碍的看法。
Pub Date : 2020-08-25 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720936648
Mahdieh Ghanbari-Firoozabadi, Masoud Mirzaei, Khadijeh Nasiriani, Mozhgan Hemati, Jamal Entezari, Mohammadreza Vafaeinasab, Sherry L Grace, Hasan Jafary, Seyed Mahmood Sadrbafghi

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively.

Aim: This study investigated cardiac specialists' perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral.

Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group.

Results: Four themes emerged: "physician factors," "center factors," "patient factors," and "cultural factors." Regarding "physician factors," most participants mentioned shortage of time. Regarding "center factors," most participants mentioned poor physician-patient-center coordination. In "patient factors," the subcategories that arose were socioeconomic challenges and clinical condition of the patients. "Cultural factors" related to lack of belief in behavioral/preventive medicine.

Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.

背景:在确保患者获得心脏康复(CR)方面,心脏病专家可以说是最有影响力的提供者。医生转诊障碍在高收入环境之外的调查很少,而且没有定性。目的:本研究调查了心脏病专家对低资源环境下患者CR参与的障碍和促进因素的看法,重点是转诊。方法:在定性研究中,采用常规的内容分析方法进行焦点小组研究。在伊朗亚兹德工作的14名合格心脏专家中,有13名参加了一个或两个焦点小组(分别为n = 9和n = 10)。将第一次焦点小组的记录逐字抄写成word文件,所有现场笔记和抄本内容的准确性经研究小组批准,然后进行归纳分析。经过类似的过程,第二个焦点小组达到饱和。结果:出现了四个主题:“医生因素”、“中心因素”、“患者因素”和“文化因素”。关于“医生因素”,大多数参与者提到时间短缺。关于“中心因素”,大多数参与者提到了较差的医患中心协调。在“患者因素”中,出现的子类别是社会经济挑战和患者的临床状况。“文化因素”与缺乏对行为/预防医学的信念有关。结论:在高资源环境中,CR转诊和参与的障碍是多层次的。然而,在这些环境中引入CR的时间相对较短,似乎引起了极大的缺乏认识。文化信仰可能会有所不同,在这种情况下,从CR项目到转诊提供者的沟通是一个特别的挑战。
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引用次数: 4
Experience of Information Provision at the Stroke Unit From the Perspective of Relatives to Stroke Survivors. 从亲属到中风幸存者的角度看中风单位信息提供的经验。
Pub Date : 2020-08-13 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720947086
Linda Kristensson, Ann Björkdahl

Introduction: Stroke not only affects the stroke survivor, it also significantly affects their families. Given the important supportive role that relatives of stroke survivor have, they should receive information that helps them plan and cope with the new situation. The objective of the study was to explore how relatives to stroke survivors perceived the information provided by the stroke unit.

Methods: This qualitative study was based on extensive semi-structured interviews with an inductive approach. A heterogeneous convenience sample of relatives to stroke survivor (n=14) was selected. Qualitative content analysis served to analyze the transcribed interview texts.

Results: The content analysis yielded four categories, each with 2-3 subcategories. The overall theme was "to be acknowledged or not": it encompassed the underlying meaning and the relationships between the categories. The four categories were as follows: shifting information needs; striving for information; lacking of continuity and structure; and taking part and being acknowledged.

Conclusions: The study highlighted that the relatives of stroke survivors have a strong need for information and showed that the relatives experienced that they did not always feel satisfactorily informed and supported by the healthcare professionals in the stroke unit. A challenge for the healthcare professionals was to be able to give the right information at the right time and in the appropriate way. The study also showed that when the relatives were acknowledged and invited to participate in the rehabilitation process, they were less anxious of the discharge.

中风不仅影响中风幸存者,也严重影响他们的家庭。鉴于中风幸存者的亲属具有重要的支持作用,他们应该获得有助于他们计划和应对新情况的信息。该研究的目的是探讨中风幸存者的亲属如何感知中风单位提供的信息。方法:本定性研究基于广泛的半结构化访谈,采用归纳方法。选取脑卒中幸存者亲属的异质性方便样本(n=14)。定性内容分析用于分析转录的访谈文本。结果:内容分析分为四类,每类有2-3个子类。总的主题是“承认或不承认”:它包含了潜在的意义和类别之间的关系。这四个类别是:不断变化的信息需求;争取信息;不连贯的:缺乏连续性和结构的;参与并得到认可。结论:该研究强调,中风幸存者的亲属有强烈的信息需求,并表明亲属经历,他们并不总是感到满意的通知和支持的医疗保健专业人员在卒中单位。医疗保健专业人员面临的挑战是能够在正确的时间以适当的方式提供正确的信息。该研究还表明,当亲属得到承认并被邀请参与康复过程时,他们对出院的焦虑程度较低。
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引用次数: 3
Development and Construct Validity of the Work Instability Scale for People With Common Mental Disorders in a Sample of Depressed and Anxious Workers: A Rasch Analysis. 抑郁和焦虑工人样本中常见精神障碍患者工作不稳定性量表的开发和结构效度:Rasch 分析。
IF 2.3 Q1 REHABILITATION Pub Date : 2020-07-14 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720936664
Louise Danielsson, Robin Fornazar, Kristina Holmgren, Åsa Lundgren Nilsson, Gunnel Hensing

Background: Sick leave due to common mental disorders, encompassing depression and anxiety disorders, is high. Capturing early signs of reduced function could aid adjustments of work tasks and environment and, thus, endorse a pro-active approach to occupational and health care interventions to prevent long-term sick-leave spells. However, few measurements exist to identify early signs of imbalance, and none that is illness-specific. The aim of this study was to develop a work instability scale for people with common mental disorders and to test the fundamental psychometric properties of the scale.

Methods: Participants were working adults 18-65 years old with depression or anxiety. The scale development started with qualitative interviews (n = 27) which informed the drafting of a dichotomous, self-report questionnaire. Cognitive debriefing (n = 12) was used to check face validity and modify the draft. Internal construct validity of the draft was tested using Rasch analysis (n = 128). The work ability index was used as a comparator measure.

Results: The initial 63-item draft showed poor fit to Rasch model expectations. Items displaying poor fit or local response dependency were stepwise removed, resulting in a unidimensional 34-item scale fitting the model expectations, and with no differential item functioning. Person-item threshold distribution showed that the scale is better suited to measure low to moderate work instability, than to measure high instability. Correlations between the newly developed scale and the work ability index showed a significant, moderately strong correlation.

Conclusions: In the initial target sample, the 34-item scale showed acceptable fundamental properties and internal construct validity. Further validation of the scale in a larger sample, including tests for external validity, is warranted.

背景:常见精神障碍(包括抑郁症和焦虑症)导致的病假率很高。捕捉功能减退的早期迹象有助于调整工作任务和环境,从而支持积极主动的职业和医疗干预方法,防止长期病假的发生。然而,目前很少有测量方法可以识别失衡的早期迹象,也没有针对特定疾病的测量方法。本研究的目的是为常见精神障碍患者制定工作不稳定性量表,并测试该量表的基本心理测量特性:研究对象为 18-65 岁患有抑郁症或焦虑症的在职成年人。量表的开发始于定性访谈(n = 27),访谈结果为二分法自我报告问卷的起草提供了依据。认知汇报(n = 12)用于检查表面效度和修改草案。采用 Rasch 分析法(n = 128)检验了草案的内部结构效度。结果:最初的 63 个项目草案与 Rasch 模型的预期契合度较低。我们逐步删除了拟合度较差或存在局部反应依赖性的项目,最终得到了符合模型预期的单维 34 个项目量表,并且没有出现项目功能差异。人-项阈值分布表明,该量表更适合测量中低度工作不稳定性,而不是测量高度不稳定性。新开发的量表与工作能力指数之间存在显著的中度相关性:在最初的目标样本中,34 个项目的量表显示出了可接受的基本属性和内部构造效度。有必要在更大的样本中对该量表进行进一步验证,包括外部效度测试。
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引用次数: 0
Association Between Pediatric Inpatient Rehabilitation Services and Children's Functional Outcomes: King Fahad Medical City Experience. 儿童住院康复服务与儿童功能预后之间的关系:法赫德国王医疗城的经验。
Pub Date : 2020-06-15 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720928394
Sanaa Mohammed Madi, Naif Ibrahim Alraddadi
Background: Disability may affect children’s performance of functional activities. This may translate to difficulties in returning to home and/or school. It has been documented that intensive rehabilitation programs for children with disabilities lead to an improvement in their functional abilities. Wee-FIM is a valid and reliable outcome measure that is used commonly with children undergoing rehabilitation. Objectives: To study changes in the functional status of children admitted to a specialized pediatric inpatient rehabilitation unit. Design: A retrospective cohort study. Setting: King Fahad Medical City—Rehabilitation Hospital, Riyadh, Saudi Arabia. Methods: Investigators reviewed records of children admitted to a pediatric rehabilitation unit between January 1, 2012, and December 31, 2017. The outcome measures used were rehabilitation length of stay (LOS), Wee-FIM gain, and Wee-FIM efficiency. Results: The total number of records included in this study was 361 records. Sixty percent of the children were boys. The mean age was 8.7 ± 3.8 years (range, 3-17 years). Children with cerebral palsy accounted for 45.2% of the children. The mean LOS was 43 days. Children with brain tumors had the shortest LOS compared with children with other diagnoses. Mean (SD) Wee-FIM efficiency was 0.58 (±0.6). Highest Wee-FIM efficiency was observed in children with brain tumors. Average Wee-FIM gain was 20 (±15). The highest functional gain was 27 in children with brain tumors while the lowest was 16 in children with cerebral palsy. Conclusions: Intensive inpatient rehabilitation program is associated with improvement in functional performance in children with a variety of impairments and disabilities.
背景:残疾可能影响儿童功能性活动的表现。这可能会导致返回家庭和/或学校的困难。有文献表明,对残疾儿童进行强化康复治疗可以改善他们的功能能力。Wee-FIM是一种有效和可靠的结果测量方法,通常用于接受康复治疗的儿童。目的:研究儿科康复专科住院儿童功能状态的变化。设计:回顾性队列研究。地点:沙特阿拉伯利雅得法赫德国王医疗城康复医院。方法:研究人员回顾了2012年1月1日至2017年12月31日期间入住儿科康复病房的儿童记录。使用的结果测量是康复停留时间(LOS)、Wee-FIM增益和Wee-FIM效率。结果:本研究共纳入病历361份。60%的孩子是男孩。平均年龄8.7±3.8岁(3 ~ 17岁)。脑瘫患儿占45.2%。平均生存期为43天。与其他诊断的儿童相比,脑肿瘤儿童的LOS最短。平均(SD) Wee-FIM效率为0.58(±0.6)。在儿童脑肿瘤患者中观察到最高的Wee-FIM效率。Wee-FIM平均增益为20(±15)。患有脑肿瘤的儿童的功能增益最高为27,而患有脑瘫的儿童的功能增益最低为16。结论:强化住院康复计划与各种损伤和残疾儿童功能表现的改善有关。
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引用次数: 1
A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis. 叙述性回顾:局部使用非甾体抗炎药布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。
Pub Date : 2020-06-11 eCollection Date: 2020-01-01 DOI: 10.1177/1179572720914945
Catrin Hawthorn

A narrative review: The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.

Objective: To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.

Background: With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).

Methods: Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.

Discussion: Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access ("over the counter"), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks.

Conclusion: Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.

一个叙述性的回顾:使用外用非甾体抗炎药(NSAID)布洛芬治疗膝骨关节炎。支持临床医生在骨关节炎一线治疗中的决策。目的:为了在临床层面上对膝关节骨关节炎的药理学治疗指南进行讨论,这篇叙述性综述着眼于与口服替代药物相比,局部使用非甾体抗炎药是一种临床有效、安全且具有成本效益的治疗方法。背景:随着65岁以上人群非甾体抗炎药处方的过度使用,越来越多的人呼吁加大非甾体抗炎药口服制剂的销售限制。我们认为,对于局部使用非甾体抗炎药对患者的益处(迄今为止联合处方委员会[JFC]没有记录不良反应的证据)和提供者(局部使用比国民健康服务[NHS]处方更便宜)仍然缺乏认识。方法:主要在线资源包括PubMed、Athens、Cochrane Library、Google Scholar、MEDLINE以及相关临床和试验指南,数据最终收集日期为2017年3月。我们也直接联系了制造商和许可证持有人进一步澄清。纳入随机、双盲对照研究、委托报告、国际指南、MEHA指南和许可证持有人数据。在可能的情况下,纳入的研究必须公平随机化,并坚持国家健康与临床卓越研究所(NICE)和其他指南所强调的关键治疗途径。讨论:目前的指南建议,寻求膝关节骨关节炎初始治疗的患者应考虑综合治疗方式,包括药物治疗,特别是使用非甾体抗炎药。在临床层面,这一建议所确定的一个反复出现的问题是口服非甾体抗炎药的不当使用,以及对易于获得(“非处方”)和过度使用相关风险的担忧,可能导致该队列患者的全身不良事件。多项研究调查了口服非甾体抗炎药的负面影响和使用的相关风险。我们无法找到表明局部使用非甾体抗炎药有任何不良系统事件的研究来源;然而,有比较口服非甾体抗炎药和外用非甾体抗炎药的高质量试验,在6周和12周时显示出相似的疗效水平。结论:局部使用非甾体抗炎药可以很好地缓解轻度至中度膝骨关节炎患者的疼痛。也有证据表明,局部应用是一种临床有效、安全、经济的治疗方法。
{"title":"A Narrative Review: The Use of the Topical NSAID Ibuprofen for the Treatment of Knee Osteoarthritis. Supporting Clinician Decision-Making in the First-Line Treatment of Osteoarthritis.","authors":"Catrin Hawthorn","doi":"10.1177/1179572720914945","DOIUrl":"https://doi.org/10.1177/1179572720914945","url":null,"abstract":"<p><strong>A narrative review: </strong>The use of the topical nonsteroidal anti-inflammatory drugs (NSAID) ibuprofen for the treatment of knee osteoarthritis. Supporting clinician decision-making in the first-line treatment of osteoarthritis.</p><p><strong>Objective: </strong>To open discussion at a clinical level on the guidelines for the pharmacological management of osteoarthritis of the knee, this narrative review looks into the use of topical NSAID being a clinically effective, safe, and cost-efficient treatment compared to an oral alternative.</p><p><strong>Background: </strong>With the over prescription of NSAIDs in the age of above 65 years, there has been a call for increased restrictions of the sale of oral preparations of NSAIDs. It is our view that there is still a lack of awareness in the benefit of topical NSAIDs to the patient (no evidence of adverse reactions recorded by the Joint Formulary Committee [JFC] to date) as well as provider (topical application is cheaper as a National Health Service [NHS] prescription).</p><p><strong>Methods: </strong>Key online resources included PubMed, Athens, Cochrane Library, Google Scholar, MEDLINE, and relevant clinical and commissioning guidelines with the final date of data collection in March 2017. We also contacted the manufacturer and license holder directly for further clarification. Randomized, double-blind control studies, commissioned reports, International Guidelines, MEHA Guidelines, and license holder data were included. Where possible studies included had to have fair randomization and adhere to key treatment pathways as highlighted by National Institute for Health and Clinical Excellence (NICE) and other guidelines.</p><p><strong>Discussion: </strong>Current guidelines advise that patients who seek initial treatment of osteoarthritis of the knee should consider a combination of treatment modalities, including pharmacological therapies, particularly the use of NSAIDs. At a clinical level, a reoccurring issue identified with this advice is the inappropriate use of oral NSAIDs, and the concern that the risks associated with ease of access (\"over the counter\"), and overuse, may result in systemic adverse events in this cohort of patients. Multiple studies have examined the negative effect of oral NSAIDs and the associated risks of use. We were unable to source studies that showed any adverse systemic events from the use of topical NSAIDs; however, there are good quality trials comparing oral to topical NSAIDs, showing similar levels of efficacy at 6 and 12 weeks.</p><p><strong>Conclusion: </strong>Topical NSAIDs provide good levels of pain relief in subjects with mild to moderate knee osteoarthritis. There is also evidence for the use of the topical application being a clinically effective, safe, and cost-efficient treatment.</p>","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572720914945","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39414720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Identifying the Most Common CrossFit Injuries in a Variety of Athletes. 确定各种运动员中最常见的混合训练损伤。
Pub Date : 2020-01-22 eCollection Date: 2020-01-01 DOI: 10.1177/1179572719897069
Kirill Alekseyev, Alex John, Andrew Malek, Malcolm Lakdawala, Nikhil Verma, Colton Southall, Argyrios Nikolaidis, Sudheer Akella, Samantha Erosa, Rayeed Islam, Efrain Perez-Bravo, Marc Ross

Background: CrossFit is an increasingly popular, rapidly growing exercise regimen. Few studies have evaluated CrossFit-associated musculoskeletal injuries on a large scale. This study explores such injuries and associated risk factors in detail.

Objective: To identify the most common musculoskeletal injuries endured during CrossFit training among athletes at different levels of expertise.

Design: Survey-based retrospective cross-sectional study.

Setting: Distribution at CrossFit gyms in the United States and internationally. Also published on active online forums.

Participants: A total of 885 former and current CrossFit athletes.

Methods: Institutional review board-approved 33-question Web-based survey focused on CrossFit injuries and associated risk factors. Survey submissions were accepted for a period of 6 months.

Main outcome measurements: Specific injuries with associated workouts, risk factors that affected injury including (1) basic demographics, (2) regional differences in reported injuries, (3) training intensity, and (4) expertise level at time of injury.

Results: Of the 885 respondents, 295 (33.3%) were injured. The most common injuries involved the back (95/295, 32.2%) and shoulder (61/295, 20.7%). The most common exercises that caused injury were squats (65/295, 22.0%) and deadlifts (53/295, 18.0%). Advanced-level (64/295, 21.7%) athletes were more significantly injured than beginner-level (40/295, 13.6%) athletes. International participants were 2.2 times more likely than domestic US participants to suffer injury. Individuals with 3+ years of CrossFit experience were 3.3 times more likely to be injured than those with 2 or less years of experience. Participants who trained for 11+ h/week were significantly more likely to be injured than those who trained less than or equal to 10 h/week.

Conclusions: As CrossFit becomes more popular, it is important to monitor the safety of its practitioners. Further studies are needed to explore how to lower this injury prevalence of 33.3%. Areas to focus on include factors that have caused the regional (international vs US states) differences, level of expertise/experience differences (advanced level vs intermediate and beginner levels), and stretching routine modifications.

背景:混合健身是一种日益流行、发展迅速的锻炼方式。很少有研究大规模评估混合健身相关的肌肉骨骼损伤。本研究详细探讨了此类损伤及其相关危险因素。目的:确定不同专业水平的运动员在混合健身训练中最常见的肌肉骨骼损伤。设计:基于调查的回顾性横断面研究。环境:分布在美国和世界各地的综合健身馆。也发表在活跃的网上论坛。参与者:共有885名前和现任混合健身运动员。方法:由机构审查委员会批准的基于网络的33个问题调查,重点关注CrossFit损伤及其相关危险因素。接受调查意见书为期6个月。主要结果测量:与训练相关的特定损伤,影响损伤的危险因素包括(1)基本人口统计学,(2)报告损伤的地区差异,(3)训练强度,(4)受伤时的专业水平。结果:885名被调查者中,295人受伤,占33.3%。最常见的损伤包括背部(95/295,32.2%)和肩部(61/295,20.7%)。引起损伤最常见的运动是深蹲(65/295,22.0%)和硬举(53/295,18.0%)。高水平运动员(64/295,21.7%)损伤明显高于初级水平运动员(40/295,13.6%)。国际参与者受伤的可能性是美国国内参与者的2.2倍。有3年以上混合健身经验的人受伤的可能性是有2年或更少经验的人的3.3倍。与每周训练少于或等于10小时的参与者相比,每周训练11小时以上的参与者明显更容易受伤。结论:随着混合健身运动越来越流行,对其使用者的安全进行监测是非常重要的。如何降低33.3%的损伤发生率需要进一步的研究。需要关注的领域包括导致地区(国际vs美国各州)差异的因素,专业知识/经验水平差异(高级水平vs中级和初级水平),以及拉伸常规修改。
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引用次数: 17
期刊
Rehabilitation Process and Outcome
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