Annals of Physical and Rehabilitation Medicine最新文献

Background: Intrathecal baclofen (ITB) therapy effectively reduces severe spasticity but is associated with complications that can be serious. The evolution of these complications over time and their predictive factors are not well known.

Objectives: The primary aim was to describe the incidence of ITB complications in adults with neurological disorders and disabling spasticity. The secondary aims were to describe the complications and the time-course of their incidence, to identify factors associated with complications, and to evaluate ITB effectiveness.

Method: We conducted a retrospective, single-centre, longitudinal observational study of data from people implanted with an ITB pump between 1995 and 2023. We calculated the incidence of complications overall and per category, and their evolution over the study period. Factors associated with complications were searched among demographic, clinical, device-related, and ITB dose characteristics. Effectiveness of ITB therapy was assessed using a goal-achievement scale.

Results: Data from 170 individuals were included (1577 years of ITB therapy); 198 complications were reported. Complication incidence was 0.13 events per pump-year and rate was 0.63 events per implantation. 49 % of complications were device related, 31 % procedure related and 20 % drug related. Surgical intervention was required for 63 % of complications. The main risk factors were walking capacity with odds ratio (OR) 3.12 (95 % CI 1.14 to 9.10, P = 0.030), and pre-Ascenda catheters with OR 3.36 (95 % CI 1.28 to 9.10, P = 0.014). Synchromed II pumps were associated with a higher risk of procedure-related complications: OR 3.41 (95 % CI 1.14 to 12.12, P = 0.039). Complication incidence decreased continuously during the study period, mainly because of a reduction in the number of device-related complications. Goals were partially achieved in 51 % of participants and achieved in 37 %.

Conclusions: The incidence of complications associated with ITB therapy was high, and complications were mostly serious (requiring hospitalisation and/or life threatening). We recommend thorough examination of the benefits and risks of ITB therapy for each individual and systematic screening for dysfunctions at follow-up visits.

Background: Osteoarthritis (OA) is a complex disease that causes pain, stiffness and swelling, limiting function and mobility, thus interfering with daily life and affecting personal, social, and psychological aspects of life.

Objective: To evidence the role of exercise on pain reduction and the effectiveness of one type of training over another in terms of pain, functional capacity, and inflammatory biomarkers in OA.

Methods: Studies retrieved from Web of Science, PubMed and Scopus databases were systematically reviewed. RCTs involving physical exercise interventions in participants with OA were included. The 3 main outcomes considered in the systematic review were pain, functional capacity and inflammatory biomarkers. The effects of different types of interventions (aerobic, resistance, combined, neuromuscular and others) were analysed for each outcome. Systematic review and meta-analysis were conducted following the PRISMA Statement.

Results: 21 studies were included in the systematic review and 11 in the meta-analysis. The meta-analysis was conducted on pain in training intervention subgroups, showing a larger effect size for neuromuscular training -2,26 (95 % CI -4,37 to -0,14). Functional capacity and inflammatory biomarkers were analysed only with a systematic review because it was not possible to estimate the efficacy of the different training protocols with a meta-analysis.

Conclusion: Neuromuscular training protocols seem to be the most effective in reducing pain in OA. Direct comparison of different training treatment options on functional capacity and inflammatory biomarkers for OA is not currently feasible in practice, due to the heterogeneity of the test and the small number of studies. High-quality physical exercise intervention studies are warranted to estimate their effectiveness more accurately on pain, functional capacity, and inflammatory status in OA.

Prospero registration number: CRD42023481061.

Background: Despite the lack of clinically validated strategies for treating spinal cord injury (SCI), combining therapeutic strategies with rehabilitation is believed to promote recovery of motor function; however, current research findings are inconsistent.

Objectives: To explore whether combination therapy involving therapy and rehabilitative training (CIRT) has a synergistic effect on motor function recovery in animal models of SCI.

Methods: We conducted a systematic review and meta-analysis of studies identified in a keyword search of 6 databases and extracted open-field motor scores from the Basso Mouse Scale (BMS) and the Basso, Beattie, and Bresnahan Locomotor Rating Scale (BBB) for meta-analysis using a weighted mean difference (WMD) and 95 % CI. We also performed qualitative synthesis and analysis of secondary outcome measures related to histological improvements and adverse effects.

Results: Eighty-seven preclinical studies were included. Combination treatment with treadmill training resulted in a significant improvement in motor function (1.40, 95 % CI 0.82 to 1.98, P < 0.01, I² = 49 %), especially when initiated 1-2 weeks post-injury (1.77, 95 % CI 1.10 to 2.45, P < 0.01, I² = 33 %) in rats. In mice, CIRT lasting <6 weeks may enhance recovery (0.95, 95 % CI 0.49 to 1.40, P < 0.01, I² = 33 %). Although there is a trend toward better outcomes in the chronic phase, insufficient sample sizes prevent definitive conclusions from being drawn. Combined therapy also enhances the reorganization of inhibitory synaptic structures and functions, without aggravating allodynia or spasticity.

Conclusions: This systematic review and meta-analysis suggest that CIRT can lead to superior motor function recovery compared to single-modality therapy (SMT) in animal models of SCI, with no significant adverse effects on allodynia or spasticity. However, the efficacy of CIRT depends on various factors, and further research is needed to establish optimal treatment strategies and understand the underlying mechanisms of recovery.

Background: Inspiratory and expiratory muscle training (RMT) has been shown to have beneficial effects in individuals with long-term post-COVID-19 symptoms.

Objective: To assess the effects of adding RMT to an aerobic exercise (AE) training program for health-related quality of life (HRQoL) and exercise tolerance in individuals with long-term post-COVID-19 symptoms, and to evaluate the effects on physical and lung function, and psychological status.

Methods: 64 individuals with long-term post-COVID-19 symptoms of fatigue and dyspnoea were randomly assigned to AE+RMT or AE+RMT_sham groups for an 8-wk intervention (AE: 50min/day, 2 times/wk; RMT: 40min/day, 3 times/wk). Primary outcomes were HRQoL (EuroQol-5D questionnaire) and exercise tolerance (cardiopulmonary exercise test). Secondary outcomes were physical function: respiratory muscle function (inspiratory/expiratory muscle strength and inspiratory muscle endurance), lower and upper limb strength (1-min Sit-to-Stand and handgrip force); lung function: spirometry testing and lung diffusing capacity; and psychological status (anxiety/depressive levels).

Results: Postintervention, there were no statistically significant improvements in HRQoL or exercise tolerance in the AE+RMT compared with the AE+RMT_sham group. In the AE+RMT group, large improvements in respiratory muscle function (d = 0.7 to 1.3) and low-moderate improvements in peak expiratory flow (d = 0.4) occurred compared with the AE+RMT_sham group. Lung function outcomes, lower and upper limb strength and psychological status did not increase more in the AE+RMT group than in the AE+RMT_sham group.

Conclusion: For individuals with long-term post-COVID-19 symptoms, combining RMT with an AE training program resulted in improvements in respiratory muscle strength, inspiratory muscle endurance and peak expiratory flow; however, the differences between groups were not statistically significant for HRQoL, exercise tolerance, psychological distress, and lung diffusing capacity.

Database registration: United States Clinical Trials Registry (NCT05597774).