Journal of rehabilitation medicine. Clinical communications最新文献

Objective: To follow up patients with post-COVID-19 condition (PCC) 6 months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave.

Methods: A prospective pilot study conducted in a clinical setting of patients (n = 22) with PCC referred from primary healthcare to a specialist clinic for a 2 day-multidisciplinary team assessment followed by a subsequent rehabilitation plan. Data were collected through questionnaires filled in prior to the team assessment and 6 months later.

Results: Fifteen of the initial 22 patients participated in the follow-up. No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful. This differed between the genders, where all the women 100% (n = 8) perceived it as being helpful, compared with 40% (n = 2) of the men (p = 0.012).

Conclusions: Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing. However, since the participants themselves perceived the intervention as being helpful, the team assessment seems to be of some value. Further studies with larger populations would be of interest.

Objective: Firstly, the study explores the association between timely initiation of rehabilitation and 90-day and 365-day all-cause acute readmission and secondly, 90-day and 365-day all-cause mortality in a cohort of Odense Municipality residents.

Methods: The registry-based observational cohort study investigates acute contacts at Odense University Hospital from 2015 to 2020. Descriptive statistics, Cox regression and cumulative incidence rates were used for analysis.

Subjects: The study utilizes initiated rehabilitation referrals within 60 days from Odense Municipality residents.

Results: In total, 7,377 rehabilitation plans were initiated, including 5051 (68.5%) within the legal timeframe. Overall, timely initiation of rehabilitation within the legal timeframe was associated with a significantly reduced risk of 90-day all-cause acute readmission (Adjusted HR 0.82, 95% CI 0.74-0.90).In the adjusted analysis, timely initiation was also significantly associated with reduced risk in 365-day all-cause acute readmission (HR 0.90, 95% CI 0.83-0.97). Each week of delay in initiation of rehabilitation was associated with an increased risk of readmission (HR 1.05, 95% CI 1.02-1.07). Further, timely initiation of rehabilitation was associated with a significant reduction in the risk of 365-day all-cause mortality (HR 0.74, 95% CI 0.61-0.89).

Conclusion: Timely initiation of rehabilitation within the legal timeframe of 7 or 14 days was associated with significantly reduced risk of 90-day and 365-day all-cause acute readmission. Timely initiation of rehabilitation was also associated with significant reduction in the risk of 365-day all-cause mortality.

Objective: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function.

Design: Single-case study.

Patient: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days.

Methods: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection.

Results: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections.

Conclusion: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.

This case presents a 35-year-old male with spinal predominant neurofibromatosis-1 who developed an incomplete spinal cord injury (C3 Asia C) which did not improve despite urgent decompressive surgery for multiple cervical neurofibromas. This report outlines a novel indication for intrathecal baclofen. The patient suffered from lower limb weakness with severe spasticity and required assistance of at least two for all activities. The aim of rehabilitation was to improve overall tone while focusing on independence, mobility and quality of life. After a successful trial of intrathecal baclofen, he underwent implantation of an intrathecal baclofen pump. The dose was gradually increased while he received a progressive programme of stretching and functional rehabilitation therapy. After 6 weeks, his MAS had improved to 1-2/4 and he had progressed to independent transfers, independence for most activities of daily living and was able to discharge to his family home with minimal support.

Objective: To assess pain outcomes, stress levels and body awareness among patients with chronic pain and explore potential associations between these variables.

Design: An explorative study.

Methods: Patients with chronic pain in primary and specialist care were assessed regarding pain intensity using the Numerical Rating Scale (NRS; 0-10 point scale) and stress levels using the Stress and Crisis Inventory (SCI-93; 0-140). To assess body awareness, multidimensional assessment of interoceptive awareness (MAIA; 0-5), a widely used self-report measure of interoceptive bodily awareness was used.

Results: Participants (n = 42) reported an average NRS of 4.4, elevated stress levels and low body awareness. Stress levels were moderately correlated with pain intensity (r = 0.53; p < 0.001; 95% confidence interval [CI] 0.25-0.72) and number of pain sites (r = 0.58; p < 0.001; 95% CI 0.32-0.76). The regression analysis showed that pain outcomes predicted stress level scores and explained almost 50% of variance (R ² = 0.47, p < 0.001). Moreover, shorter pain duration predicted a higher body awareness (p = 0.04).

Conclusion: In patients with chronic pain, high pain intensity and multiple painful sites seem to be associated with impaired stress regulation. The patients had low body awareness, which was negatively influenced by pain duration.

Objective: Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand.

Design: Case report.

Subjects: One individual that wished for a better quality of life after unsatisfying hand function following a replantation.

Methods: A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented.

Results: Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed.

Conclusions: The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation.

Clinical relevance: When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.

Objective: Making the diagnosis of sarcopenia is not always easy and this is especially true for those with cardiovascular disease. The purpose of this study is to investigate whether it is possible to diagnose sarcopenia by using ultrasound-guided measurements of anterior femoral muscle thickness.

Methods: We investigated the utility of ultrasound-guided measurements of anterior femoral muscle thickness in 1075 hospitalized patients with cardiovascular disease (675 men). As a comparison, sarcopenia was assessed by skeletal muscle mass index using bioelectrical impedance analysis and the Asia Working Group for Sarcopenia criteria.

Results: When the receiver operating characteristic curve using muscle thickness was examined, we found this could be used to make the diagnosis of sarcopenia (men: cutoff value 2.425 cm, area under the curve 0.796; women: cutoff value 1.995 cm, area under the curve 0.746). The prevalence of sarcopenia according to the criteria with skeletal muscle mass index was 34.2% in men and 51.8% in women, while its prevalence according to the cutoff value of muscle thickness was 29.2% in men and 36.7% in women.

Conclusion: Ultrasound-guided measurement of the anterior femoral muscle thickness is a simple and useful method to help make the diagnosis of sarcopenia in patients with cardiovascular disease.

Objective: To examine the effect of in-bed leg cycling exercise on patients with intensive care unit-acquired weakness (ICU-AW).

Design: Single-center retrospective study.

Subjects/patients: Patients admitted to the ICU between January 2019 and March 2023 were enrolled in the ergometer group, and those admitted to the ICU between August 2017 and December 2018 were enrolled in the control group.

Methods: The ergometer group performed in-bed leg cycling exercises 5 times per week for 20 min from the day of ICU-AW diagnosis. Furthermore, the ergometer group received 1 early mobilization session per day according to the early mobilization protocol, whereas the control group received 1 or 2 sessions per day. The number of patients with recovery from ICU-AW at ICU discharge and improvement in physical functions were compared.

Results: Significantly more patients in the ergometer group recovered from ICU-AW than in the control group (87.0% vs 60.6%, p = 0.039). Regarding physical function, the ergometer group showed significantly higher improvement efficiency in Medical Research Council sum score (1.0 [0.7-2.1] vs 0.1 [0.0-0.2], p < 0.001).

Conclusion: In-bed leg cycling exercise, in addition to the early mobilization protocol, reduced the number of patients with ICU-AW at ICU discharge.

Objective: People with a lower-limb amputation often have a sedentary lifestyle and increasing physical activity is important to optimize their health and quality of life. To achieve this the Amputee Parateam programme was developed. Amputee Parateam is a sports programme that addresses important physical, environmental, and social barriers for sports participation. This programme was evaluated in terms of various aspects of physical functioning and health.

Design: Repeated measures design.

Patients: Thirteen participants with a lower-limb amputation, with a median age of 51 (interquartile range (IQR) 40-63).

Methods: Measurements were performed at T0 (baseline), T1 (after 6 weeks) and T2 (follow-up after 12 months). Outcome measures were walking ability, functional mobility, daily activity, health-related quality of life, and adherence to sports at follow-up.

Results: Walking ability and functional ability significantly improved between T0 and T1. Adherence to sports at follow-up was high, with 11/13 participants still practicing sports weekly. There were no significant changes in daily activity or health-related quality of life.

Conclusions: The Amputee Parateam programme successfully improved walking ability and functional mobility and resulted in a high adherence to sports among the participants. However, these improvements in physical capacity did not lead to less sedentary behaviour in daily life.