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Self-Management Interventions to Prevent the Secondary Condition of Pain in People with Disability Due to Mobility Limitations 自我管理干预措施,以防止继发性疼痛的残疾人由于行动限制
Pub Date : 2016-01-01 DOI: 10.4137/RPO.S12339
Katherine Froehlich-Grobe, S. Driver, Katherine D. Sanches
Introduction This focused review examines the use and effectiveness of self-management strategies in preventing or managing pain, which is among the most common secondary conditions faced by individuals with a mobility disability. Methods This focused review was part of a two-phase comprehensive scoping review. Phase I was a comprehensive scoping review of the literature targeting multiple outcomes of self-management interventions for those with mobility impairment, and Phase II was a focused review of the literature on self-management interventions that target pain as a primary or secondary outcome. Two authors searched CINAHL, PubMed, and PsyclNFO for papers published from January 1988 through August 2014 using specified search terms. Following the scoping review, the authors independently screened and selected the studies and reviewed the eligible studies, and the first author extracted data from the included studies. Results The scoping review yielded 40 studies that addressed pain self-management interventions for those living with mobility impairment. These 40 accumulated papers revealed a heterogeneous evidence base in terms of setting (clinic, community, and online), target populations, intervention duration (3 weeks to 24 months), and mode (health-care providers and lay leaders). Most of the reviewed studies reported that the self-management intervention led to significant reduction of pain over time, suggesting that self-management may be a promising approach for addressing pain experienced by people who live with mobility limitations. Discussion This review also reveals moderate-to-high bias across studies, and findings indicate that future research should enhance the methodological quality to provide stronger evidence about the effectiveness of self-management strategies for reducing pain among those with mobility impairments.
这篇重点综述探讨了自我管理策略在预防或管理疼痛方面的使用和有效性,疼痛是行动障碍患者面临的最常见的继发性疾病之一。方法本综述是两阶段综合范围综述的一部分。第一阶段是对针对行动障碍患者自我管理干预的多种结果的文献的全面范围审查,第二阶段是对以疼痛为主要或次要结果的自我管理干预的文献的重点审查。两位作者使用指定的搜索词检索了从1988年1月到2014年8月期间发表的论文,检索了CINAHL、PubMed和PsyclNFO。在范围审查之后,作者独立筛选和选择研究并审查符合条件的研究,第一作者从纳入的研究中提取数据。结果:范围审查产生了40项研究,涉及行动障碍患者的疼痛自我管理干预。这40篇累积的论文揭示了在环境(诊所、社区和在线)、目标人群、干预持续时间(3周到24个月)和模式(卫生保健提供者和非专业领导)方面的异质性证据基础。大多数回顾的研究报告说,自我管理干预导致疼痛随着时间的推移显著减少,这表明自我管理可能是解决行动不便的人所经历的疼痛的一种有前途的方法。本综述还揭示了研究的中高偏倚,研究结果表明,未来的研究应提高方法质量,为减少行动障碍患者疼痛的自我管理策略的有效性提供更有力的证据。
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引用次数: 2
Self-Management Interventions to Prevent Depression in People with Mobility Limitations 自我管理干预预防行动不便人群抑郁
Pub Date : 2016-01-01 DOI: 10.4137/RPO.S39720
S. Driver, Katherine Froehlich-Grobe, Katherine D. Sanches
Introduction This focused review reports on the impact of self-management interventions on depression in people with a mobility disability. Method There were two phases to the search including a comprehensive scoping review of the literature examining multiple secondary conditions impacted by self-management programs (Phase 1) and a focused review of the literature detailing the impact of self-management interventions on depression (Phase 2). CINAHL, PubMed, and PsyclNFO were searched for articles published between January 1988 through August 2014 and studies were screened by the first author based on specific inclusion and exclusion criteria. Results Twenty-five studies met criteria with results, demonstrating a mixed effect of self-management programs on depression. Sixteen studies included an intervention and control/comparison group, of which eight (50%) had a significant effect on depression. A further nine studies did not include a control/comparison group and five found significant changes in depression and four found no change. Eighteen out of 25 studies (72%) were rated as having moderate-to-high bias and nine different outcome measures were used across studies. Discussion Based on the mixed findings and varied approaches adopted for intervention and outcome assessment, future research should adopt a more rigorous methodological approach to examine self-management interventions on depression.
本研究综述了自我管理干预对行动障碍患者抑郁症的影响。方法搜索分为两个阶段,包括对研究自我管理项目影响的多种次要条件的文献的全面范围审查(第一阶段)和对详细介绍自我管理干预对抑郁症影响的文献的重点审查(第二阶段)。检索1988年1月至2014年8月期间发表的文章,并由第一作者根据特定的纳入和排除标准筛选研究。结果25项研究的结果符合标准,证明了自我管理项目对抑郁症的影响好坏参半。16项研究包括干预和控制/对照组,其中8项(50%)对抑郁症有显著影响。另外九项研究没有包括对照组/对照组,其中五项发现抑郁症有显著变化,四项没有发现变化。25项研究中有18项(72%)被评为中度至高度偏倚,研究中使用了9种不同的结果测量方法。基于混合的研究结果和不同的干预和结果评估方法,未来的研究应该采用更严格的方法来检验抑郁症的自我管理干预。
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引用次数: 1
A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation 临床实践改进方法在康复中的应用范围综述
Pub Date : 2016-01-01 DOI: 10.4137/RPO.S20360
M. Lamontagne, C. Gagnon, Anne-Sophie Allaire, L. Noreau
Context The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.
临床实践改进(CPI)方法是一种方法学和质量改进方法,已经出现并越来越受欢迎。然而,没有系统的描述其使用或其在康复环境中实践的决定因素。方法我们对CPI方法在康复环境中的应用进行了范围审查。结果共纳入文献103篇。我们发现了涉及6个不同人群的13项CPI举措的证据。共发现了335个决定因素的引用,其中68.7%与CPI本身有关。关于哪种类型的外部和内部环境、个人特征和实施过程可能促进或阻碍CPI的使用的信息很少。鉴于这种方法方法越来越受欢迎,CPI计划将从对其成功决定因素的不断了解中获益,并将其纳入未来的实施中。
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引用次数: 1
An Assessment of Rehabilitation Protocols following Anterior Cruciate Ligament Reconstruction: A Systematic Review 前交叉韧带重建后康复方案的评估:系统回顾
Pub Date : 2016-01-01 DOI: 10.4137/RPO.S40054
Daniel C. Indorato, Ronda Sturgil
The present study provided a systematic review with meta-analysis of randomized controlled trials involving the effectiveness of various rehabilitation methods that have been implemented for the treatment of anterior cruciate ligament reconstruction (ACLR). The review of the literature revealed the following as evidence for effective ACLR rehabilitation: early intervention strategy focused on restoring range of motion, muscle strength, and ligament stability with the utilization of closed kinetic chain exercises. The literature supports the use of dynamic intraligamentary stabilization, which should also be implemented in the rehabilitation protocol within the first three months after surgery. The research suggests that the patient should undergo at least 30-90 minutes of cryotherapy immediately following ACLR surgery. There is also some evidence regarding the effectiveness of neuromuscular rehabilitation training programs, but further investigations are needed. Future research should consider the timing of rehabilitation as well as supplemental rehabilitation exercises to continue to improve the quality of care delivered to patients following ACLR.
本研究对随机对照试验进行了系统回顾和荟萃分析,研究了用于治疗前交叉韧带重建(ACLR)的各种康复方法的有效性。文献综述显示,ACLR有效康复的证据如下:早期干预策略侧重于恢复运动范围、肌肉力量和韧带稳定性,利用闭合动力链练习。文献支持动态韧带内稳定的使用,也应在术后前三个月内的康复方案中实施。研究表明,ACLR手术后患者应立即接受至少30-90分钟的冷冻治疗。关于神经肌肉康复训练项目的有效性也有一些证据,但还需要进一步的研究。未来的研究应考虑康复的时机以及辅助康复练习,以继续提高ACLR后患者的护理质量。
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引用次数: 3
Experiences with Holistic Health Practices among Adults with Spinal Cord Injury 成人脊髓损伤的整体健康实践经验
Pub Date : 2015-01-01 DOI: 10.4137/RPO.S12363
F. Shroff
Purpose To explore experiences with holistic practices (HP) by people with spinal cord injury (SCI) in British Columbia, Canada, including the types of HP they access and the reasons they utilize these forms of treatment. Method This was a qualitative study of 53 adults with SCI. Participants were engaged in semistructured interviews in focus-group and one-to-one settings. Inductive thematic analysis was used to identify prominent themes. Results Eighty-seven percent of participants had accessed some form of HP. They reported a variety of reasons for accessing HP, such as symptom relief and the desire to avoid side effects of conventional therapy. Caregivers and healthcare providers had important roles in encouraging HP. The perceived benefits of HP included physical, emotional, and spiritual components. Barriers to access included logistics, time, and financial constraints. Participants frequently mentioned the use of marijuana as a form of relaxation and pain relief—this was a surprise finding because marijuana is generally not considered a form of HP. Conclusion Eighty-seven percent of the participants in our study were actively engaged in various efforts to improve their health, including the use of HP. Reasons for accessing HP were based on a desire to improve mental, emotional, and physical health as well as to provide hope. Participants chose HP to alleviate pain, boost the immune system, gain strength, improve physical appearance, enhance relaxation, improve mood, feel empowered, and more. Rehabilitation professionals may wish to inform themselves of the range of products and services incorporated in the HP spectrum, and of their potential benefits for SCI patients.
目的探讨加拿大不列颠哥伦比亚省脊髓损伤(SCI)患者的整体实践(HP)经验,包括他们访问的HP类型以及他们使用这些治疗形式的原因。方法对53例成人脊髓损伤患者进行定性研究。参与者以焦点小组和一对一的方式进行半结构化访谈。归纳主题性分析用于识别突出的主题。结果87%的参与者接触过某种形式的HP。他们报告了使用HP的各种原因,如缓解症状和避免常规治疗副作用的愿望。护理人员和医疗保健提供者在鼓励使用HP方面发挥了重要作用。惠普带来的好处包括身体上、情感上和精神上。进入的障碍包括物流、时间和资金限制。参与者经常提到使用大麻作为一种放松和缓解疼痛的方式——这是一个令人惊讶的发现,因为大麻通常不被认为是一种形式的HP。在我们的研究中,87%的参与者积极参与各种努力来改善他们的健康,包括使用HP。访问惠普的原因是基于改善精神、情感和身体健康以及提供希望的愿望。参与者选择HP来减轻疼痛、增强免疫系统、增强力量、改善外貌、促进放松、改善情绪、感觉更有力量等等。康复专业人员可能希望了解HP频谱中包含的产品和服务的范围,以及它们对脊髓损伤患者的潜在益处。
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引用次数: 2
A Structural and Conceptual Modification of the International Classification of Function, Disability and Health (ICF) 国际功能、残疾和健康分类(ICF)的结构和概念修正
Pub Date : 2015-01-01 DOI: 10.4137/RPO.S13340
R. Jahiel
Current criticisms of the International Classification of Function, Disability and Health (ICF) are focused on its activity/participation component and on its conceptual basis. I propose structural and conceptual changes. (1) The components would be body structure, body function, intent, actual environment, and participation. (2) Intent would be linked to the concept of self-agency, and its codes would have two qualifiers associating it with capability and strength of willed activity. (3) All activity/participation codes of the original ICF would be moved to the modified ICF's participation component. This component is based on interaction between intent and environment, and it is linked to the concept of joint agency. (4) A new entity, scene setting, represents the sum total of all components' codes involved in a given act of participation. (5) Additional constructs are suggested to elucidate the relations between intent and environment that allow enactment of a given act of participation. The modified ICF is consistent with current concepts of disability and unambiguous in distinctions between body function, activity, and participation. There are no significant alterations in the original ICF codes.
目前对《国际功能、残疾和健康分类》的批评主要集中在其活动/参与部分及其概念基础上。我建议在结构和概念上进行改变。(1)构成要素为身体结构、身体功能、意图、实际环境和参与。(2)意图将与自我代理的概念联系起来,其代码将有两个限定词将其与意志活动的能力和强度联系起来。(3)原ICF的所有活动/参与代码将移至修改后的ICF的参与组件。该组件基于意图和环境之间的交互作用,并与联合代理的概念相关联。(4)一个新的实体,即场景设置,代表了在一个给定的参与行为中所涉及的所有成分代码的总和。(5)本文还提出了其他的构念来阐明意图和环境之间的关系,从而使特定的参与行为得以实施。修改后的ICF与当前的残疾概念一致,并且明确区分了身体功能、活动和参与。原始的ICF代码没有明显的变化。
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引用次数: 2
Force Plate Assessment of Quiet Standing Balance Control: Perspectives on Clinical Application within Stroke Rehabilitation 静立平衡控制的力板评估:在脑卒中康复中的临床应用
Pub Date : 2015-01-01 DOI: 10.4137/RPO.S20363
A. Mansfield, E. Inness
Assessment of balance control is essential to guide physical rehabilitation poststroke. However, current observational assessment tools available to physiotherapists provide limited information about underlying dyscontrol. This paper describes a force plate-based assessment of quiet standing balance control that we have implemented for individuals attending inpatient stroke rehabilitation. The assessment uses two force plates to measure location of ground reaction forces to maintain stability in quiet standing in five conditions (eyes open, eyes closed, standing symmetrically, and maximal loading on the less-affected and more-affected limbs). Measures of interest are variability of the centers of pressure under each foot and both feet combined, weight-bearing asymmetry, and correlation of center of pressure fluctuations between limbs. We present representative values for the above-mentioned measures and case examples to illustrate how the assessment can reveal patient-specific balance control problems and direct treatment. We identify limitations to our current assessment and recommendations for future research.
平衡控制的评估是指导脑卒中后身体康复的必要条件。然而,目前物理治疗师可用的观察性评估工具提供的关于潜在控制障碍的信息有限。本文描述了一种基于力板的静站立平衡控制评估,我们已经实施了个人参加住院中风康复。评估使用两个力板测量地面反作用力的位置,以在五种情况下(睁眼、闭眼、对称站立、受影响较小和受影响较大的四肢上的最大负荷)保持安静站立时的稳定性。感兴趣的测量是每只脚和双脚合起来的压力中心的可变性,负重的不对称性,以及四肢之间压力中心波动的相关性。我们提出了上述措施的代表性值和案例示例,以说明评估如何揭示患者特定的平衡控制问题和直接治疗。我们确定了当前评估的局限性,并对未来研究提出了建议。
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引用次数: 23
Percutaneous Fascia Release for Treating Chronic Recurrent Gluteal Myofascial Pain—A Pilot Study of a New Technique 经皮筋膜松解术治疗慢性复发性臀肌筋膜疼痛——一种新技术的初步研究
Pub Date : 2015-01-01 DOI: 10.4137/RPO.S30483
Hsin-Shui Chen, Ming-Ta Lin, C. Hong, Y. Hsieh, L. Chou
Objective To investigate the therapeutic effectiveness of percutaneous fascia release to treat chronic recurrent gluteal myofascial pain related to recurrent tendonitis or bursitis at the attachment sites. Methods Five patients (three males, two females; aged 48.6 ± 8.9 years) with myofascial trigger points in the gluteus medius muscle were treated. Outcome measures, including pain intensity, pressure pain threshold, and the relative strength of hip abduction, were assessed before, immediately after, and six months after the treatment. The data measured before and after treatment (different times) on visual analog scale, pressure pain threshold, and relative hip abduction strength were analyzed by Wilcoxon signed-rank test and paired t-test, respectively, for the comparisons between time points. Results Reduction in pain intensity and increase in the pressure pain threshold and the relative hip abduction strength were found in all five patients after treatment when compared with those of before treatment (P < 0.05). Moreover, all of these improvements existed for at least six months (P > 0.05). Conclusions Percutaneous fascia release of gluteal muscle insertion sites can be used to treat chronic gluteal pain related to subtrochanteric bursitis to avoid recurrence, if other treatment cannot control the recurrence, although this was demonstrated only on a small sample size without control and blind assessment in the pilot study.
目的探讨经皮筋膜松解术治疗附着部位复发性肌腱炎或滑囊炎引起的慢性复发性臀肌筋膜疼痛的疗效。方法5例患者(男3例,女2例;患者年龄48.6±8.9岁,肌筋膜触发点位于臀中肌。结果测量,包括疼痛强度、压痛阈值和髋关节外展的相对强度,在治疗前、治疗后和治疗后6个月进行评估。治疗前后(不同时间)视觉模拟量表、压痛阈值、髋关节相对外展强度数据分别采用Wilcoxon sign -rank检验和配对t检验进行时间点间比较。结果5例患者治疗后疼痛强度均较治疗前减轻,压痛阈值及髋关节相对外展力均升高,差异有统计学意义(P < 0.05)。这些改善至少持续6个月(P < 0.05)。结论经皮筋膜松解臀肌止点可用于治疗与转子下滑囊炎相关的慢性臀痛,如果其他治疗方法不能控制复发,可避免复发,尽管这只是在没有对照和盲评估的小样本量的初步研究中得到证实。
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引用次数: 1
Comparative Effects of Portable and Stationary Traction in the Management of Mechanical Neck Disorders 便携式和固定式牵引治疗机械性颈部疾病的效果比较
Pub Date : 2015-01-01 DOI: 10.4137/RPO.S24889
A. Bello, J. Crabbe, Emmanuel Bonney
Objective The purpose of this study was to compare the therapeutic effects of portable and stationary tractions on treatment outcomes in patients with mechanical neck disorders (MNDs). Methods Forty-one participants with MNDs were randomly assigned to either portable traction or stationary traction. Participants' pain level, activity limitation, disability, and neck range of motion were measured before and after 6 weeks of intervention. Inferential statistics for comparing the treatment outcome involved paired t-test and two-way analysis of variance at P < 0.05. Results The mean age of participants was 47.3 ± 10.5 years. After intervention, there were significant improvements in both groups. However, the portable traction group had significantly higher score on neck flexion than the stationary traction group at baseline (portable: 27.1 ± 6.0, stationary: 22.1 ± 6.8; P = 0.009) and after intervention (F-ratio = 15.0; P = 0.001). Conclusion Inclusion of both portable and stationary tractions to usual physiotherapy provided comparable treatment outcomes in patients with MNDs.
目的比较便携式牵引和固定式牵引对机械性颈部疾病(MNDs)患者治疗效果的影响。方法41例老年痴呆患者随机分为固定式牵引组和便携式牵引组。在干预前后6周测量参与者的疼痛程度、活动限制、残疾和颈部活动范围。比较治疗结果的推论统计采用配对t检验和P < 0.05的双向方差分析。结果患者平均年龄为47.3±10.5岁。干预后,两组患者均有显著改善。然而,在基线时,便携式牵引组的颈部屈曲评分明显高于固定式牵引组(便携式:27.1±6.0,固定式:22.1±6.8;P = 0.009)和干预后(f比= 15.0;P = 0.001)。结论将便携式和固定式牵引纳入常规物理治疗可为MNDs患者提供相当的治疗效果。
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引用次数: 1
Cooptation of Peer Support Staff: Quantitative Evidence 同伴支援人员的合作:量化证据
Pub Date : 2014-03-01 DOI: 10.4137/RPO.S12343
Anthony J. Alberta, Richard R. Ploski
Objective In 2007, the Centers for Medicare and Medicaid Services (CMS) sent a letter to state Medicaid directors outlining requirements for implementing peer-based recovery support services (P-BRSS) as a Medicaid-funded service. Since then, 30 states have implemented these services. Although the literature describing implementation of P-BRSS has identified the cooptation of peer support staff (PSS) as a barrier to the effective provision of P-BRSS, the evidence for it remains anecdotal. This study attempts to determine if the context of employment in either a treatment organization or peer organization affected cooptation. Methods We conducted a survey of PSS in the fall of 2013. In all, 92 of the 181 respondents were working as PSS at the time, 53 in treatment organizations. Chi-square analysis was used to determine if the context of employment had an effect on the cooptation of peer staff. Results Peer staff working in treatment organizations reported that they were supervised by treatment staff and participated in employment-related training to improve their skills at providing treatment services more frequently than their counterparts in peer organizations. Peer staff working in treatment organizations also participated in training and education to prepare for employment as treatment professionals more frequently than peer staff working in peer organizations. Conclusions and Implications for Practice Peer staff members working in treatment organizations are subject to processes of acculturation into professional cultures that peer staff working in peer organizations are not. Effective implementation of P-BRSS should include specific efforts to minimize the cooptation of peer staff.
2007年,医疗保险和医疗补助服务中心(CMS)致函各州医疗补助主任,概述了将基于同伴的康复支持服务(P-BRSS)作为医疗补助资助服务实施的要求。从那时起,已有30个州实施了这些服务。虽然描述P-BRSS实施的文献已经确定同伴支持人员(PSS)的合作是有效提供P-BRSS的障碍,但证据仍然是轶事。本研究试图确定在治疗组织或同伴组织工作的背景是否影响了合作。方法于2013年秋季对PSS患者进行调查。在181名被调查者中,92人当时是PSS, 53人在治疗机构工作。使用卡方分析来确定就业背景是否对同伴员工的合作有影响。结果在治疗机构工作的同伴人员报告说,他们受到治疗人员的监督,并参加与就业有关的培训,以提高他们提供治疗服务的技能。在治疗机构工作的同伴工作人员也比在同伴组织工作的同伴工作人员更频繁地参加培训和教育,为作为治疗专业人员就业做准备。在治疗机构工作的同伴工作人员要经历适应专业文化的过程,而在同伴组织工作的同伴工作人员则不会。有效执行P-BRSS应包括具体努力尽量减少同级工作人员的配合。
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引用次数: 13
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Rehabilitation Process and Outcome
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