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Acceptability and deliverability of an auditory rhythmical cueing (ARC) training programme for use at home and outdoors to improve gait and physical activity post-stroke. 听觉节奏提示(ARC)训练方案的可接受性和可交付性,用于家庭和户外,以改善中风后的步态和身体活动。
Q2 Medicine Pub Date : 2022-01-04 DOI: 10.1186/s40945-021-00126-x
Patricia McCue, Lisa Shaw, Silvia Del Din, Heather Hunter, Sue Lord, Christopher I M Price, Helen Rodgers, Lynn Rochester, Sarah A Moore

Background: Although laboratory studies demonstrate that training programmes using auditory rhythmical cueing (ARC) may improve gait post-stroke, few studies have evaluated this intervention in the home and outdoors where deployment may be more appropriate. This manuscript reports stakeholder refinement of an ARC gait and balance training programme for use at home and outdoors, and a study which assessed acceptability and deliverability of this programme.

Methods: Programme design and content were refined during stakeholder workshops involving physiotherapists and stroke survivors. A two-group acceptability and deliverability study was then undertaken. Twelve patients post-stroke with a gait related mobility impairment received either the ARC gait and balance training programme or the gait and balance training programme without ARC. Programme provider written notes, participant exercise and fall diaries, adverse event monitoring and feedback questionnaires captured data about deliverability, safety and acceptability of the programmes.

Results: The training programme consisted of 18 sessions (six supervised, 12 self-managed) of exercises and ARC delivered by a low-cost commercially available metronome. All 12 participants completed the six supervised sessions and 10/12 completed the 12 self-managed sessions. Provider and participant session written records and feedback questionnaires confirmed programme deliverability and acceptability.

Conclusion: An ARC gait and balance training programme refined by key stakeholders was feasible to deliver and acceptable to participants and providers.

Trial registration: ISCTRN 12/03/2018.

背景:尽管实验室研究表明,使用听觉节奏线索(ARC)的训练方案可以改善中风后的步态,但很少有研究评估这种干预在家庭和户外的应用可能更合适。本手稿报告了利益相关者对家庭和户外使用的ARC步态和平衡训练计划的改进,以及评估该计划的可接受性和可交付性的研究。方法:在涉及物理治疗师和中风幸存者的利益相关者研讨会上,改进方案设计和内容。然后进行了两组可接受性和可交付性研究。12例卒中后伴有步态相关活动障碍的患者接受ARC步态和平衡训练方案或不进行ARC的步态和平衡训练方案。方案提供者书面说明、参与者锻炼和跌倒日记、不良事件监测和反馈问卷收集了关于方案的可交付性、安全性和可接受性的数据。结果:训练计划包括18次(6次监督,12次自我管理)的练习和ARC,由一个低成本的市售节拍器提供。所有12名参与者都完成了6个监督环节,10/12完成了12个自我管理环节。提供者和参与者会议的书面记录和反馈问卷确认了方案的可交付性和可接受性。结论:由关键利益相关者改进的ARC步态和平衡训练方案是可行的,并且为参与者和提供者所接受。试验注册:2018年3月12日。
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引用次数: 1
Prevalence and associated factors of COVID-19 across Italian regions: a secondary analysis from a national survey on physiotherapists. 意大利各地区COVID-19的患病率及相关因素:一项针对物理治疗师的全国调查的二次分析。
Q2 Medicine Pub Date : 2021-12-17 DOI: 10.1186/s40945-021-00125-y
Simone Gambazza, Silvia Bargeri, Isabella Campanini, Roberto Meroni, Andrea Turolla, Greta Castellini, Silvia Gianola

Background: Coronavirus disease 2019 (COVID-19) broke out in China in December 2019 and now is a pandemic all around the world. In Italy, Northern regions were hit the hardest during the first wave. We aim to explore the prevalence and the exposure characteristics of physiotherapists (PTs) working in different Italian regions during the first wave of COVID-19.

Methods: Between April and May 2020 a structured anonymous online survey was distributed to all PTs registered in the National Professional Registry to collect prevalence data of a confirmed diagnosis of COVID-19 (i.e., nasopharyngeal swab and/or serological test). A bottom-up agglomerative nesting hierarchical clustering method was applied to identify groups of regions based on response rate. Multivariable logistic regression was used to explore personal and work-related factors associated with a confirmed diagnosis of COVID-19.

Results: A total of 15,566 PTs completed the survey (response rate 43.3%). The majority of respondents (57.7%) were from Northern regions. Considering all respondents, the number of confirmed COVID-19 cases in Northern and Central Italy, was higher compared to those in Southern Italy (6.9% vs. 1.8%, P < 0.001); focusing the analysis on respondents who underwent nasopharyngeal swab and/or serological test led to similar findings (14.1% vs. 6.4%, P < 0.001). Working in Northern and Central regions was associated with a higher risk of confirmed diagnosis of COVID-19 compared to Southern regions (OR 3.4, 95%CI 2.6 to 4.3). PTs working in Northern and Central regions were more likely to be reallocated to a different unit and changing job tasks, compared to their colleagues working in the Southern regions (10.5% vs 3.7%, P < 0.001).

Conclusions: Work-related risk factors were differently distributed between Italian regions at the time of first pandemic wave, and PTs working in the Northern and Central regions were more at risk of a confirmed diagnosis of COVID-19, especially when working in hospitals. Preventive and organizational measures should be applied to harmonize physiotherapy services in the national context. REGISTRATION: https://osf.io/x7cha.

背景:2019年12月,新型冠状病毒病(COVID-19)在中国爆发,目前已成为全球大流行。在意大利,北部地区在第一波中受灾最严重。我们的目的是探讨在第一波COVID-19期间在意大利不同地区工作的物理治疗师(PTs)的患病率和暴露特征。方法:在2020年4月至5月期间,向在国家专业登记处注册的所有PTs分发结构化匿名在线调查,以收集确诊为COVID-19的患病率数据(即鼻咽拭子和/或血清学检测)。采用自底向上的聚集嵌套分层聚类方法,根据响应率进行区域分组识别。采用多变量logistic回归来探讨与COVID-19确诊相关的个人和工作因素。结果:共15566名患者完成调查,有效率43.3%。大多数受访者(57.7%)来自北方地区。考虑到所有受访者,意大利北部和中部确诊的COVID-19病例数高于意大利南部(6.9%对1.8%)。结论:在第一波大流行时,意大利地区之间与工作相关的风险因素分布不同,在北部和中部地区工作的PTs确诊COVID-19的风险更高,特别是在医院工作时。预防和组织措施应适用于协调全国范围内的物理治疗服务。注册:https://osf.io/x7cha。
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引用次数: 4
Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis. 多发性硬化症患者平衡能力锻炼计划的发展:利用Rasch分析的概念研究的发展。
Q2 Medicine Pub Date : 2021-12-15 DOI: 10.1186/s40945-021-00120-3
Karl Martin Sattelmayer, Odile Chevalley, Jan Kool, Evelyne Wiskerke, Lina Nilsson Denkinger, Katia Giacomino, Emmanuelle Opsommer, Roger Hilfiker

Background: People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual's abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme.

Methods: A "construct map" approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses.

Results: Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait "balance exercises in PwMS" comprised three subdimensions ("stable BOS", "sway" and "step and walk"). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS.

Conclusion: A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.

背景:多发性硬化症(PwMS)患者经常从疾病的早期阶段就有平衡受损。平衡困难可以分为几类;尽管到目前为止,这些都缺乏科学依据。PwMS中的平衡受损可以通过特定的和具有挑战性的练习来解决。这样的练习应该提供一个最佳的挑战点;然而,平衡练习的难度通常是未知的,这使得很难针对个人的能力进行练习。本研究的目的是:为PwMS制定一项与平衡问题类别相关的锻炼计划;确定每一类练习的难度顺序;评估演习计划的内容和结构有效性。方法:采用“构造图”方法设计和制定PwMS锻炼计划。确定了潜在的相关平衡练习,然后建立了一个框架,包括四个维度的平衡练习(随后减少到三个维度)。13名物理治疗师对锻炼计划的相关性、可理解性和综合性进行了评估,他们还将19项关键锻炼与平衡类别联系起来。共有65名PwMS进行了19项平衡练习,对其难度进行了评分,并对每个练习的相关性和可理解性进行了评论。使用Rasch模型来评估练习的相对难度。为了评估数据与Rasch模型的拟合,我们使用了评定量表模型,这是一个用于多同构项目反应的单维潜在特质模型。结果:经物理治疗师和PwMS评估,运动方案的内容效度良好。Rasch分析显示,潜在特质“平衡练习”包括三个维度(“稳定的BOS”、“摇摆”和“迈步和行走”)。19种平衡练习显示出与各自维度的适当契合。平衡练习的难度足以涵盖PwMS的能力范围。结论:为PwMS制定了一个平衡锻炼计划,包括三个方面的平衡锻炼。每个练习的难度估计已经建立,可以用于有针对性的平衡训练。该方案的内容和结构有效性是充分的。
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引用次数: 2
Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. 一项多中心、随机对照试验的方案:外科医生指导的家庭治疗与门诊康复的物理治疗师反向全肩关节置换术:SHORT试验。
Q2 Medicine Pub Date : 2021-12-10 DOI: 10.1186/s40945-021-00121-2
June S Kennedy, Emily K Reinke, Lisa G M Friedman, Chad Cook, Brian Forsythe, Robert Gillespie, Armodios Hatzidakis, Andrew Jawa, Peter Johnston, Sameer Nagda, Gregory Nicholson, Benjamin Sears, Brent Wiesel, Grant E Garrigues, Christopher Hagen, Insup Hong, Marcella Roach, Natasha Jones, Kuhan Mahendraraj, Evan Michaelson, Jackie Bader, Libby Mauter, Sunita Mengers, Nellie Renko, John Strony, Paul Hart, Elle Steele, Amanda Naylor, Jaina Gaudette, Katherine Sprengel

Background: Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups.

Methods: This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over.

Discussion: RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy.

Trial registration: This study is registered as NCT03719859 at ClincialTrials.gov .

背景:反向全肩关节置换术(RTSA)已成为一种成功的手术,适应症扩大。结果可能受术后康复的影响;然而,关于RTSA后最佳康复策略的研究还很缺乏。本研究的主要目的是比较两组RTSA后患者报告和临床结果:一组康复由正式的门诊物理治疗师(PT组)指导,而家庭治疗组,患者在术后预约时由外科医生指导他们的康复练习(HT组)。次要目的包括比较两组之间的并发症、护理费用和生活质量。方法:这项随机对照试验在美国的7个地点开始。由临床研究助理在术前和术后2周、6周和12周、6个月、1年和2年随访时收集200名受试者的数据。评估了以下变量:美国肩关节外科医生(ase),使用数字疼痛量表的疼痛程度,单一评估数字评估(SANE)评分,以及用于分析主要目标的肩部主动和被动活动范围。卡方检验和t检验将用于测量两组基线特征的差异。用于测量差异的重复测量线性混合效应模型将用于与asas和SANE相关的结果和评分,以及运动范围测量。次要目的将分析比较并发症、成本和生活质量评估得分,使用从PROMIS 29 v. 2获得的数据、在标准护理术后就诊时进行的问卷调查和电子健康记录。受试者将被允许在PT组和HT组之间进行交叉,分析将包括包括交叉患者在内的治疗意向,以及将交叉患者移除的第二组,截断到他们交叉的时间。讨论:RTSA的实施频率越来越高,最佳的康复策略尚不清楚。这项研究将有助于明确正式物理治疗的作用,特别是考虑到结果、成本和并发症。此外,本研究将评估拟议的康复策略。试验注册:本研究在ClincialTrials.gov注册为NCT03719859。
{"title":"Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial.","authors":"June S Kennedy,&nbsp;Emily K Reinke,&nbsp;Lisa G M Friedman,&nbsp;Chad Cook,&nbsp;Brian Forsythe,&nbsp;Robert Gillespie,&nbsp;Armodios Hatzidakis,&nbsp;Andrew Jawa,&nbsp;Peter Johnston,&nbsp;Sameer Nagda,&nbsp;Gregory Nicholson,&nbsp;Benjamin Sears,&nbsp;Brent Wiesel,&nbsp;Grant E Garrigues,&nbsp;Christopher Hagen,&nbsp;Insup Hong,&nbsp;Marcella Roach,&nbsp;Natasha Jones,&nbsp;Kuhan Mahendraraj,&nbsp;Evan Michaelson,&nbsp;Jackie Bader,&nbsp;Libby Mauter,&nbsp;Sunita Mengers,&nbsp;Nellie Renko,&nbsp;John Strony,&nbsp;Paul Hart,&nbsp;Elle Steele,&nbsp;Amanda Naylor,&nbsp;Jaina Gaudette,&nbsp;Katherine Sprengel","doi":"10.1186/s40945-021-00121-2","DOIUrl":"https://doi.org/10.1186/s40945-021-00121-2","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups.</p><p><strong>Methods: </strong>This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over.</p><p><strong>Discussion: </strong>RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy.</p><p><strong>Trial registration: </strong>This study is registered as NCT03719859 at ClincialTrials.gov .</p>","PeriodicalId":72290,"journal":{"name":"Archives of physiotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39709738","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: 5
Cervical musculoskeletal impairments in migraine. 偏头痛的颈椎肌肉骨骼损伤。
Q2 Medicine Pub Date : 2021-12-08 DOI: 10.1186/s40945-021-00123-0
Zhiqi Liang, Lucy Thomas, Gwendolen Jull, Julia Treleaven

Background: Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain.

Main body: Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy.

Conclusions: Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.

背景:颈部疼痛在偏头痛患者中是常见和致残的。经常寻求颈椎肌肉骨骼干预,但目前没有证据支持这种干预对这一人群。改善对偏头痛中颈椎肌肉骨骼损伤的理解可以阐明颈部疼痛的机制,并指导临床医生和研究人员对偏头痛和颈部疼痛患者的管理。正文:偏头痛过敏是评估颈椎损伤的主要考虑因素,因为它会加重偏头痛并混淆结果。目前偏头痛中颈椎损伤的证据是有限的,因为忽视了颈部疼痛的不同潜在原因和过敏的可能影响。颈椎肌肉骨骼损伤的研究结果在研究内部和研究之间是混合的,表明偏头痛中存在不同形式的颈部疼痛。一些偏头痛患者有颈部疼痛,这是偏头痛症状的一部分,因此很少或没有颈椎肌肉骨骼损伤。另一些人的颈部疼痛来源于颈部,因此表现出类似于颈部疾病的颈部肌肉骨骼损伤模式。颈椎肌肉骨骼功能障碍的存在可能与偏头痛有关,也可能与偏头痛无关,但目前缺乏这方面的知识,这影响了管理决策。颈椎肌肉骨骼干预可能适用于已确定的颈椎功能障碍的偏头痛患者,但其他因素需要进一步澄清,包括确定i)患者特定结果,ii)共存的偏头痛相关颈部疼痛的影响,以及iii)偏头痛超敏反应对治疗效果的潜在调节作用。结论:物理治疗师应该通过熟练的评估来寻找颈椎损伤的组合,以确定个别患者是否存在颈椎肌肉骨骼功能障碍。颈椎功能障碍与偏头痛的相关性以及共存的偏头痛相关颈部疼痛的影响需要通过对疼痛行为的详细评估和进一步的研究来确定。未来的临床试验应明确预期的治疗结果,并在调查颈椎肌肉骨骼干预的疗效时选择患有颈椎肌肉骨骼功能障碍的个体。
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引用次数: 8
Choosing what works for whom: towards a better use of mechanistic knowledge in clinical practice. 选择什么对谁有效:在临床实践中更好地利用机械知识。
Q2 Medicine Pub Date : 2021-12-01 DOI: 10.1186/s40945-021-00122-1
Rafael K Alaiti, Bruno T Saragiotto, Leandro Fukusawa, Nayra D A Rabelo, Anamaria S de Oliveira

Background: Clinicians commonly try to use mechanism-based knowledge to make sense of the complexity and uncertainty of chronic pain treatments to create a rationale for their clinical decision-making. Although this seems intuitive, there are some problems with this approach.

Discussion: The widespread use of mechanism-based knowledge in clinical practice can be a source of confusion for clinicians, especially when complex interventions with different proposed mechanisms of action are equally effective. Although the available mechanistic evidence is still of very poor quality, in choosing from various treatment options for people with chronic pain, an approach that correctly incorporates mechanistic reasoning might aid clinical thinking and practice.

Conclusion: By explaining that not all evidence of mechanism is the same and by making a proposal to start using mechanism-based knowledge in clinical practice properly, we hope to help clinicians to incorporate mechanistic reasoning to prioritize and start choosing what may best work for whom.

背景:临床医生通常试图使用基于机制的知识来理解慢性疼痛治疗的复杂性和不确定性,从而为他们的临床决策提供依据。虽然这看起来很直观,但这种方法存在一些问题。讨论:基于机制的知识在临床实践中的广泛使用可能成为临床医生困惑的来源,特别是当具有不同提议的作用机制的复杂干预措施同样有效时。尽管现有的机制证据质量仍然很差,但在为慢性疼痛患者选择各种治疗方案时,正确结合机制推理的方法可能有助于临床思考和实践。结论:通过解释并非所有的机制证据都是相同的,并提出在临床实践中开始正确使用基于机制的知识的建议,我们希望帮助临床医生结合机制推理来优先考虑并开始选择对谁最有效的方法。
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引用次数: 1
Correlation between community balance and mobility scale (CB&M) with a battery of outcome measures to assess balance in Parkinson's disease - a cross-sectional study. 社区平衡和活动量表(CB&M)与评估帕金森病平衡的一系列结果措施之间的相关性-一项横断面研究
Q2 Medicine Pub Date : 2021-11-08 DOI: 10.1186/s40945-021-00117-y
Ziona Lionel Dsouza, Sydney Roshan Rebello, Cherishma Dsilva

Background: Evaluating balance in a functional context that integrates challenging tasks frequently performed in the community is essential to identify community-dwelling individuals who are at risk of falls in early Parkinson Disease (PD) than a simple balance measure. Community Balance and Mobility (CB&M) scale is one such measure that evaluates severe deficits in gait, balance, and mobility. The risk of falling and fear of fall is common among PD individuals and this affects the day to day functioning as well as the quality of life. Early identification of individuals who may be at risk to fall will lead to intervention strategies that can help to with balance issues. The aim of this study was to correlate between Community Balance and Mobility with a battery of outcome measures commonly used to assess balance in Parkinson's disease.

Methods: A cross sectional study design; with individuals referred to Outpatient physiotherapy department, diagnosed with idiopathic Parkinson's disease, independently mobile and on a stable drug regimen referred by the neurologist; were screened and recruited by convenience sampling. With written informed consent, demographic data gathered and scales such as Berg Balance scale, Community balance & mobility scale, Functional Reach test and Timed up and go test were administered with an ample amount of rest.

Results: The results obtained were documented and analysed using Karl Pearson's correlation coefficient. Significant correlation between CB&M and BBS (r = 0.795) was found, CB&M and TUG (r = - 0.755), CB&M and FRT (r = 0.772).

Conclusion: CB&M is a useful measure which integrates items that challenge balance in the community context. It has been used to assess high functioning community dwelling individuals and hence may be apt for individuals with early Parkinson's, since the tasks to be performed in CB&M are challenging and these simulate community level activities where the risk of falls is higher. It may well be a good tool to assess early Parkinson's; their level of balance, community level activity and without need for sophisticated & expensive equipment.

背景:与简单的平衡测量相比,在整合社区中经常执行的挑战性任务的功能环境中评估平衡对于识别早期帕金森病(PD)中有跌倒风险的社区居民至关重要。社区平衡和活动(CB&M)量表是评估步态、平衡和活动严重缺陷的一种测量方法。跌倒的风险和对跌倒的恐惧在PD患者中很常见,这影响了日常功能和生活质量。早期识别可能有跌倒风险的个体将导致有助于平衡问题的干预策略。本研究的目的是将社区平衡和活动能力与一系列通常用于评估帕金森病平衡的结果测量相关联。方法:采用横断面研究设计;被诊断为特发性帕金森氏病的个体转诊到门诊物理治疗部门,可独立移动,并由神经科医生转诊使用稳定的药物方案;通过方便抽样进行筛选和招募。在获得书面知情同意的情况下,收集了人口统计数据,并进行了Berg平衡量表、社区平衡和移动能力量表、功能延伸测试和定时起身测试等测试,同时进行了充足的休息。结果:用卡尔·皮尔森相关系数对所得结果进行了记录和分析。CB&M与BBS (r = 0.795)、CB&M与TUG (r = - 0.755)、CB&M与FRT (r = 0.772)呈显著相关。结论:CB&M是一种有效的测量方法,它整合了社区环境中挑战平衡的项目。它已被用于评估高功能社区居住个体,因此可能适用于早期帕金森患者,因为在CB&M中执行的任务具有挑战性,这些模拟了跌倒风险较高的社区水平活动。它可能是评估早期帕金森症的好工具;他们的平衡水平,社区水平的活动,不需要复杂和昂贵的设备。
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引用次数: 0
Shoulder pain prevalence by age and within occupational groups: a systematic review. 肩痛流行的年龄和职业群体:一个系统的回顾。
Q2 Medicine Pub Date : 2021-11-04 DOI: 10.1186/s40945-021-00119-w
Christopher J Hodgetts, Charlotte Leboeuf-Yde, Amber Beynon, Bruce F Walker

Background: Shoulder pain was previously shown to diminish in older populations and it was suggested that this could be explained by reduced usage with age. Our objectives were to investigate if estimates of shoulder pain continue to increase after the age of 50 in working populations and to compare these estimates in physically demanding occupations with sedentary occupations.

Methods: A systematic review of retrospective, cross-sectional, prospective, or longitudinal. studies reporting prevalence or incidence of non-specific shoulder pain in occupational groups stratified by age. Searches were conducted in PubMed, Scopus, and CINAHL from inception until January 2020. Study characteristics and prevalence estimates stratified by age were extracted. Two reviewers independently performed a critical analysis of the included studies to determine their validity and risk of bias.

Results: Twenty studies with a total of 40,487 participants and one study of a clinical data base were included and assigned a direction of the estimates for shoulder pain as either 'increasing', 'remaining stable' or 'decreasing' past the age of 50. Shoulder pain generally increased past 50, with 16 of the 21 included studies reporting higher estimates/odds ratios in older participants. In the more physically active occupations over 50, the estimates increased in 14 of the 18 samples compared to only two of the four involving sedentary occupations.

Conclusions: Shoulder pain prevalence remains common in workers beyond the age of 50. Prevalence continues to increase in physically demanding occupations. Clinicians should consider factors of occupation when managing shoulder pain.

Trial registration: PROSPERO (CRD42019137831).

背景:以前的研究表明,肩部疼痛在老年人中减少,这可能是由于随着年龄的增长,肩部疼痛的使用减少。我们的目的是调查50岁以后肩部疼痛的估计值是否在工作人群中继续增加,并比较体力要求高的职业和久坐不动的职业的估计值。方法:回顾性、横断面、前瞻性或纵向的系统综述。研究报告了按年龄分层的职业群体中非特异性肩痛的患病率或发病率。从成立到2020年1月,在PubMed、Scopus和CINAHL中进行了搜索。提取按年龄分层的研究特征和患病率估计。两名审稿人独立地对纳入的研究进行了批判性分析,以确定其有效性和偏倚风险。结果:纳入了20项研究,共40,487名参与者和一项临床数据库研究,并为50岁以上的肩部疼痛评估分配了“增加”,“保持稳定”或“减少”的方向。肩痛一般在50岁以上加重,21项纳入的研究中有16项报告老年参与者的估计/比值比较高。在50岁以上的体力活动较多的职业中,18个样本中有14个样本的估计值增加,而在4个涉及久坐职业的样本中,只有2个样本的估计值增加。结论:肩痛的患病率在50岁以上的工人中仍然很常见。在体力要求高的职业中患病率继续上升。临床医生在处理肩痛时应考虑职业因素。试验注册:PROSPERO (CRD42019137831)。
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引用次数: 19
Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study. 干针与假针对慢性肩痛患者冈下肌的神经生理学和心理物理学影响:随机可行性研究。
Q2 Medicine Pub Date : 2021-10-18 DOI: 10.1186/s40945-021-00118-x
Antoine Laramée, Guillaume Léonard, Mélanie Morin, Mélanie Roch, Nathaly Gaudreault

Background: Dry needling (DN) is increasingly used for treating myofascial trigger points (MTrPs) and has shown significant effects on pain and function. This study aimed to assess feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the effects of infraspinatus DN on corticospinal excitability and mechanical pain sensitivity.

Method: This randomized feasibility study included adults with chronic non-traumatic shoulder pain and a infraspinatus MTrP. Participants were randomized to receive real DN or sham DN in the infraspinatus MTrP. Feasibility outcomes included data pertaining to recruitment, retention of participants, completeness and safety of assessment procedures. Neurophysiological and psychophysical outcomes included corticospinal excitability and mechanical pain sensitivity measured by active motor threshold (aMT) and pressure pain threshold (PPT), respectively. They were assessed at baseline, immediately after and 24 h post-intervention.

Results: Twenty-one participants were recruited over a 6-month period. Nineteen participants completed the treatment and follow-up assessment. Motor evoked potential responses were discernible in all but 1 participant. Only 1 minor adverse event related to transcranial magnetic stimulation (mild headache) affected the measurements. No DN adverse effects were recorded in both groups. An overall completeness rate of 81% was reached, with 70% completeness in the DN group and 91% in the sham group. Data analysis revealed that real DN increased corticospinal excitability (reduced aMT) 24 h post-intervention (Mdn = - 5.96% MSO, IQR = 5.17, p = 0.04) and that sham DN triggered similar responses immediately after the intervention (Mdn = - 1.93% MSO, IQR = 1.11, p = 0.03). Increased mechanical pain sensitivity (reduced PPT) was significant only in the sham group, both immediately (Mdn = - 0.44 kg/cm2, IQR = 0.49, p = 0.01) and 24 h post-intervention (Mdn = - 0.52 kg/cm2, IQR = 1.02, p = 0.02). Changes in corticospinal excitability was positively correlated with changes in mechanical pain sensitivity in the DN group, both immediately (r = 0.77, p = 0.02) and 24 h post-intervention (r = 0.75, p = 0.05).

Conclusion: The present study demonstrates the feasibility of quantifying the neurophysiological and psychophysical effects of DN, and provides recommendations and guidelines for future studies. Moreover, it provides preliminary evidence that DN may increase corticospinal excitability of the infraspinatus muscle in patients with chronic shoulder pain and that the relationship of neurophysiological and psychophysical effects is promising to better understand its mechanisms of action.

Trial registration: NCT04316793 ; retrospectively registered November 3, 2020.

背景:干针疗法(DN)越来越多地用于治疗肌筋膜触发点(MTrPs),并已显示出对疼痛和功能的显著效果。本研究旨在评估进行随机假对照试验的可行性,并收集冈下干针疗法对皮质脊髓兴奋性和机械痛敏感性影响的初步数据:这项随机可行性研究的参与者包括患有慢性非创伤性肩痛和冈下MTrP的成年人。参与者被随机分配到冈下MTrP接受真DN或假DN治疗。可行性结果包括与招募、保留参与者、评估程序的完整性和安全性有关的数据。神经生理学和心理物理学结果包括皮质脊髓兴奋性和机械痛敏感性,分别通过主动运动阈值(aMT)和压力痛阈值(PPT)测量。这些结果分别在基线、干预后立即和干预后 24 小时进行评估:招募了 21 名参与者,为期 6 个月。结果:在 6 个月的时间里,共招募了 21 名参与者,其中 19 人完成了治疗和后续评估。除 1 名参与者外,其他参与者均出现了运动诱发电位反应。只有一个与经颅磁刺激有关的轻微不良反应(轻微头痛)影响了测量结果。两组患者均未出现 DN 不良反应。总体完整率达到 81%,其中 DN 组为 70%,假体组为 91%。数据分析显示,真正的 DN 增加了干预后 24 小时的皮质脊髓兴奋性(降低了 aMT)(Mdn = - 5.96% MSO,IQR = 5.17,p = 0.04),而假 DN 在干预后立即引发了类似的反应(Mdn = - 1.93% MSO,IQR = 1.11,p = 0.03)。机械痛敏感性的增加(PPT 降低)仅在假干预组中有显著表现,包括干预后即刻(Mdn = - 0.44 kg/cm2,IQR = 0.49,p = 0.01)和干预后 24 小时(Mdn = - 0.52 kg/cm2,IQR = 1.02,p = 0.02)。在 DN 组中,皮质脊髓兴奋性的变化与机械痛敏感性的变化呈正相关,干预后即刻(r = 0.77,p = 0.02)和干预后 24 小时(r = 0.75,p = 0.05)均是如此:本研究证明了量化 DN 神经生理学和心理物理学效应的可行性,并为今后的研究提供了建议和指导。此外,该研究还提供了初步证据,证明 DN 可提高慢性肩痛患者冈下肌的皮质脊髓兴奋性,而且神经生理学效应和心理物理学效应之间的关系有望更好地了解其作用机制:NCT04316793 ; 2020年11月3日回顾性注册。
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引用次数: 0
Patients' health outcomes after an implementation intervention targeting the physiotherapists' clinical behaviour. 针对物理治疗师临床行为的实施干预后患者的健康结果。
Q2 Medicine Pub Date : 2021-10-09 DOI: 10.1186/s40945-021-00116-z
Johanna Fritz, Lena Almqvist, Anne Söderlund, Lars Wallin, Maria Sandborgh

Background: A behavioural medicine approach in physiotherapy has shown positive effects on increased and sustained activities and participation, including reduced sick leave for patients with persistent musculoskeletal pain. The aim of this study was to explore the health outcomes of patients with persistent musculoskeletal pain treated by physiotherapists who had received active compared with passive support when implementing a behavioural medicine approach.

Methods: An explorative and comparative pre-/post-test trial was conducted. A total of 155 patients with musculoskeletal pain ≥4 weeks were consecutively recruited by physiotherapists in primary healthcare who had received active or passive support when implementing a behavioural medicine approach. Data concerning health outcomes for patients were collected using questionnaires before and after the physiotherapy treatment and at half-, one- and two-year follow-ups. Descriptive, non-parametric and parametric bi- and multivariate statistics were used.

Results: There were no differences over time between the patients treated by physiotherapists who had received active compared to passive implementation support regarding pain-related disability, pain intensity, self-rated health, self-efficacy in performing daily activities, catastrophic thinking related to pain, and fear of movement. Significant improvements over time were identified in both groups regarding all variables and the effect sizes were large. The percentage of patients on sick leave significantly decreased in the patient group treated by physiotherapists who had received active implementation support.

Conclusion: It is very important to include patient outcomes when evaluating the implementation of multicomponent interventions. It seems that the implementation method did not play a major role for the patients' outcomes in this study. Most of the patients' health outcomes improved regardless of whether they were treated by physiotherapists who had received active or passive support when implementing a behavioural medicine approach. This was likely because the active implementation support was not extensive enough to enable the physiotherapists to sustain the behavioural medicine approach.

Trial registration: The study protocol was retrospectively registered in ClinicalTrials.gov . ID NCT03118453 , March 20, 2017.

背景:物理治疗中的行为医学方法已经显示出对增加和持续的活动和参与的积极作用,包括减少患有持续性肌肉骨骼疼痛的患者的病假。本研究的目的是探讨在实施行为医学方法时,接受主动与被动支持的物理治疗师治疗的持续性肌肉骨骼疼痛患者的健康结果。方法:采用探索性、比较性的前后试验方法。共有155名肌肉骨骼疼痛≥4周的患者被初级卫生保健的物理治疗师连续招募,这些患者在实施行为医学方法时接受了主动或被动的支持。在物理治疗前后以及在半年、一年和两年的随访中,通过问卷调查收集有关患者健康结果的数据。采用描述性、非参数和参数双、多变量统计。结果:在疼痛相关残疾、疼痛强度、自评健康、日常活动的自我效能、与疼痛相关的灾难性思维和对运动的恐惧方面,接受主动实施支持与被动实施支持的物理治疗师治疗的患者之间没有随时间的差异。随着时间的推移,两组在所有变量方面都有了显著的改善,而且效应量很大。在接受积极实施支持的物理治疗师治疗的患者组中,请病假的患者比例显著下降。结论:在评估多组分干预措施的实施情况时,纳入患者的预后是非常重要的。在本研究中,实施方法似乎并没有对患者的预后起主要作用。大多数患者的健康状况得到改善,无论他们是否接受了物理治疗师的治疗,他们在实施行为医学方法时接受了主动或被动的支持。这可能是因为积极的实施支持不够广泛,不足以使物理治疗师维持行为医学方法。试验注册:研究方案在ClinicalTrials.gov上回顾性注册。ID NCT03118453, 2017年3月20日。
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引用次数: 1
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Archives of physiotherapy
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