Purpose: To examine the effectiveness of different modified Constraint-Inuced Therapy (mCIMT) protocol intensities on upper extremity motor function in adults with hemiplegia.
Methods: A search was conducted in PubMed, Scopus, EBSCO, and Cochrane Library for articles published between April 2010 and December 2021. Only randomized controlled trials (RCTs) were included. Studies were excluded if they used a sample of less than five, mCIMT in combination with other therapy, and/or if they were not written in English. Methodologic quality was assessed using the Cochrane collaboration risk of bias tool-2.
Results: Thirty-six RCTs with a total of 721 participants were included. Most researchers followed a moderate to low protocol intensity in terms of total treatment time and moderate to high intensity with regard to restriction time. Almost all of the upper limb motor function measures showed statistically significant improvements (p < .05) after mCIMT, irrespective of the protocol's intensity, but there was lack of high-quality studies. Statistically significant improvements did not always translate to clinical importance.
Conclusions: Low-intensity CIMT protocols may result in comparable improvements to more intensive ones but caution has to be taken when drawing conclusions due to high risk of bias studies.
Purpose: An ethnographic and phenomenological mapping of the experiences of healthcare professionals with the functional independence measure (FIM) in stroke rehabilitation.
Methods: This is a cross-sectoral qualitative study with triangulation of data from two focus group interviews, 15 individual interviews, and 11 participant observations of FIM assessments performed by six different healthcare professions in interprofessional teams. FIM assessments were performed at hospital and in a community rehabilitation centre as interprofessional meetings with a local facilitator certified in FIM.
Results: Three overarching themes, learning space, improved interprofessional collaboration, and transferability, emerged from the data. The use of FIM within the provided structures established an environment that allowed the various healthcare professionals (HCP) to learn with, about, and from each other. This is perceived as promoting interprofessional collaboration and enhancing patient-specific knowledge within the interprofessional team. The established patient-specific knowledge is specific to the individual team and is difficult to transfer intraorganisationally and across sectors.
Conclusion: FIM was a catalyst for improved interprofessional knowledge transfer and interprofessional collaboration within the individual teams, but intraorganisational and cross-sectoral dissemination of patient-specific knowledge was limited.
Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.
Background: Living with a lower limb amputation influences multiple facets of life due to altered function. Individuals achieve a varied level of function post amputation, depending on several variables like age, level of function prior to amputation, and available personal and environmental resources. Releasing the potential to live life to the fullest despite a disability is important to the individual.
Objectives: The primary objective of this study is to identify barriers and facilitators for function which lower limb amputees experience in their lives several years after amputation, from the amputee's perspective. This knowledge can contribute to further development of the clinical pathway for lower limb amputees in a Norwegian rehabilitation hospital.
Methods: The study has a descriptive and exploratory qualitative design with a phenomenological hermeneutical approach. Semistructured, individual interviews were conducted for data collection. Thematic analysis inspired by Braun and Clarke was used for data analysis. The sample consisted of eight transfemoral amputees (70 ± 6.9 (58-77 years)) living in the southern part of Norway. Average time since amputation was 11 years.
Results: The results have been categorised into two main themes with subthemes: (1) facilitators: personal resources, a well-fitted prosthesis, rehabilitation, social network, balance in activity/rest, and accessibility and (2) barriers: walking distance, poorly fitted prosthesis, pain, comorbidities, climate/terrain/falling, reduced local competence on amputation, and pandemic.
Conclusion: Lower limb amputees experience barriers in their everyday life, but they also develop strategies to cope with their disability. Clinical implications can include increased nutritional guidance, structural psychological mapping and follow-up, structured follow-ups over a significant period of time, and extended use of digital consultation.
Methods: A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors' rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach.
Results: We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run.
Conclusion: The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors' and carers' long-term needs.
Background: The Functional Rating Index (FRI) is a self-report scale widely used to determine the level of disability in low back pain (LBP) populations.
Objectives: This study was aimed at conducting the cross-cultural adaptation of the FRI-Arabic version (FRI-Ar) and testing the clinometric properties of FRI-Ar.
Methods: The cross-cultural adaptation process was used to develop the FRI-Ar. This study included acute and subacute LBP patients. Each patient was asked to complete the questionnaires at three time points: baseline, 24-hour follow-up, and two-week follow-up. The questionnaires used were FRI-Ar, Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), Numerical Pain Rating Scale (NPRS), Global Perceived Effect Scale (GPE), and Patient-Specific Functional Scale (PSFS). Statistical analysis was carried out to measure the instrument's reliability, validity, and responsiveness.
Results: The FRI was cross-culturally adapted to the Arabic language, and the adapted version was validated. Two hundred patients completed the questionnaires at the baseline; however, 120 patients completed the questionnaires at 24-hour and two-week follow-up. Cronbach's alpha, interclass correlation coefficient (ICC2,1), standard error of measurement (SEM), and minimal detectable change (MDC95%) for the FRI-Ar were observed as 0.85, 0.85, 1.17 (2.9%), and 3.24, respectively. The FRI-Ar showed a moderate positive correlation only with the RMDQ, ODI, and NPRS (p < 0.05). Also, it showed the responsiveness with a small effect size (ES = 0.29) and standardized response mean (SRM = 0.44).
Conclusion: The FRI-Ar was developed, and it showed good reliability and validity. However, it revealed the responsiveness with the small change. It can evaluate both pain and functional limitations in acute and subacute LBP patients. Before using it in the Arabic population with acute and subacute LBP, it is recommended to conduct further research to test internal and external responsiveness using an external criterion with a more extended follow-up period and suitable interventions.
Background: Type 2 diabetes mellitus (T2DM) has been reported to affect the vestibular system resulting in dizziness and vertigo complaints. This complication is known to disable the social participation. The Participation Scale Short Simplified (PSSS) has been developed to quantify the severity of social participation restrictions. The aim of this study was to translate and cross-culturally adapt the PSSS into Indonesian Bahasa (PSSS-Ina). The measurement properties of the translated version and the factors contributing to the severe participation restriction were determined.
Methods: The participants comprised 55 T2DM with vestibular dysfunction (VD) in the community center for diabetes mellitus in Central Java, Indonesia. The signs of VD were confirmed by head impulse test, Dix Hallpike Test, and supine roll test. The PSSS-Ina was administered twice with a four-week interval. The physical examination was also performed to identify the contributing factors.
Results: The test-retest reliability of the PSSS Indonesian Bahasa version (PSSS-Ina) between two measurement sessions was excellent (ICC of 0.93, p < 0.001, and 95% CI: 0.88-0.95). The correlation coefficient between two administrations was high (r = 0.88). Based on the demonstrated content validity, the values of the corrected item and total correlation were greater than 0.3. No floor and ceiling effects were observed. The good internal consistency was confirmed with Cronbach's alpha of 0.84. The factor analysis produced three factors of activity participation, social engagement, and work-related participation. The multiple logistic regression revealed that the balance performance of mCTSIB was the main factor contributing to the severe participation restriction reflected by the PSSS-Ina score.
Conclusion: The Indonesian version of the PSSS-Ina demonstrated excellent comprehensibility and reliability in individuals suffering T2DM with VD. This tool is therefore helpful in identifying the participation limitation in individuals with VD.
This study is aimed at comparing the design and configuration of the most commonly used manual wheelchair models through cardiorespiratory responses, perceived exertion, and mobility performance using two different manual wheelchairs, during mobility tasks. A within-group 2 × 3 × 2 controlled experiment was designed with three independent and four dependent variables. The independent variables included wheelchairs, with the levels active wheelchair with a rigid frame and passive wheelchair with foldable frame; conditions with the levels straight line, slalom, and agility; and speed with levels comfortable and fast. Dependent variables included oxygen uptake (VO2), distance travelled, speed, and perceived exertion. Results show that the active wheelchair yielded more beneficial characteristics although only the effect of wheelchair type on VO2 efficiency (oxygen uptake per meter travelled) was statistically significant with a large effect size (F(1, 14) = 118.298, p < 0.001, η 2 = 0.541). The better VO2 efficiency was achieved with the active wheelchair under all tested conditions. The effect of wheelchair type on Borg scores was also statistically significant, although with a small effect size (F(1, 14) = 10.340, p = 0.006, η 2 = 0.119); thus, active wheelchair use had lower Borg scores under all trials and was considered less exhausting than the passive wheelchair. In summary, use of the active wheelchair resulted in the users expending less energy per meter travelled and at the same time experiencing less fatigue. This may benefit overall wheelchair mobility and possibly reduce health complications.
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