Journal of rehabilitation medicine. Clinical communications最新文献

Background: Heterotopic ossification is a common complication after joint replacement surgery, such as hip or knee arthroplasty. In the intensive care unit, it is most commonly associated with traumatic brain injury or spinal cord injury. To prevent recurrence, surgical resection of heterotopic ossification is recommended once the ectopic bone has fully matured, which is estimated to occur after at least 12 months.

Case presentation: This case describes a young woman with no relevant previous medical history who developed severe bilateral heterotopic ossification on the anteromedial sides of her knees after an intensive care unit stay. Passive flexion of both knees was limited to 50°. X-ray was a simple diagnostic tool. Predisposing factors were extended immobilization, prolonged systematic inflammatory condition and mechanical ventilation. Due to the failure of initial conservative therapy, the heterotopic ossification was resected early, 4 months after onset of first symptoms. Following an intensive rehabilitation program, a normal, pain-free gait and full range of motion of both knees were achieved 9 months after surgery.

Conclusion: This case report demonstrates that early resection of heterotopic ossification can result in a good clinical and functional outcome.

Objective: To assess the effect of radial extracorporeal shockwave therapy on the reduction of local hypertonia in patients with cerebral palsy.

Design: Explorative pre-post intervention study.

Subjects/patients: Forty-five patients with cerebral palsy.

Methods: All patients received 3 sessions of radial extracorporeal shockwave therapy with a time interval of 1 week for each session. The outcomes were V1 and V3 of the Tardieu scale, the Timed Up and Go test, and the 10-metre walk test. The measurements were collected at baseline, immediately after the last session of shockwaves, at 12 and 24 weeks after baseline.

Results: The statistical analysis used was a mixed linear model of repeated measures. The degrees on the Tardieu scale increased significantly in all the treated muscles. The results of the Timed Up and Go test and the 10 m walk test confirmed a significant functional effect after the shockwave therapy (p < 0.001).

Conclusion: Functional improvement in patients treated with extracorporeal shockwave therapy has been observed to last up to 24 weeks.

Objective: In response to the high prevalence and morbidity associated with long COVID (LC), outpatient rehabilitation programmes were created across jurisdictions. We aimed to characterize baseline symptoms and impairments of patients attending outpatient LC rehabilitation.

Design: This study was a retrospective quality-improvement analysis.

Subjects/patients: Patients attending outpatient LC rehabilitation at the Oxfordshire Post-Covid Service.

Methods: Data included age/sex and 6 questionnaires performed at baseline: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Dyspnoea-12 (D12), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment-7 (GAD-7), Visual Analogue Scale (VAS) of self-rated health, and the Work And Social Adjustment Scale (WSAS). All scores were dichotomized (indicating presence/absence of clinically significant pathology). Potential differences between age (2 tests.

Results: A total of 422 patients were included (mean/standard deviation [SD] age = 47.1/13.2;132/31.3% male). A total of 76% had significant fatigue (FACIT-F), 69% had breathlessness (D12), 55% had depression (PHQ-9), 34% had anxiety (GAD-7), 41% self-reported poor health (VAS), and 57% had work/social life dysfunction (WSAS). D12 scores differed between age groups (older > younger, χ² = 3.19/p = 0.048), with no differences observed on other scales.

Conclusion: In this preliminary study, a high proportion of LC outpatients had significant impairments across domains. The findings of this study reaffirm the need for high-quality, multidisciplinary LC rehabilitation, and may be used to help build a standardized set of outcome measures moving forward.

Objective: Immune-mediated necrotizing myopathy associated with anti-signal recognition particle antibodies is a rare and debilitating condition characterized by significant muscle weakness and resultant disability. Although there are existing recommendations for physical therapy and exercise for patients with myositis in current literature, effective rehabilitation guidelines for such patients have not been fully established.

Case report: A 42-year-old woman presented with subacute onset proximal upper and lower limb weakness and dysphagia. She was diagnosed with anti-SRP immune-mediated necrotizing myopathy and was promptly initiated on aggressive immunosuppressive therapy. Despite this, she had significant impairment in function, including the inability to ambulate.

Intervention and outcome: The patient underwent an intensive structured inpatient rehabilitation programme consisting of strength and endurance exercises combined with functional exercises and robot-assisted gait training. This resulted in major improvements in objective outcomes including Functional Independence Measure, Modified Barthel Index, 10-metre-walk test and 6-minute-walk test scores. The programme was well tolerated by the patient with no adverse events.

Conclusion: This case details the crucial role of a structured rehabilitation programme in the holistic management of a patient with anti-SRP immune-mediated necrotizing myopathy. It also highlights the use of robotics in gait training, resulting in successful functional outcomes for the patient.

Objective: This longitudinal pilot study aimed to evaluate the feasibility, safety and potential benefits of Platelet-Rich Plasma injections into the lumbar intervertebral discs in patients with low back pain and degenerative intervertebral monodiscopathy, assessing potential efficacy on disability.

Design: Longitudinal pilot study.

Methods: Six participants with chronic low back pain and lumbar degenerative intervertebral disc (monodiscopathy) disease underwent 1 Platelet-Rich Plasma injection, with a 1-year follow-up. Platelet-Rich Plasma injections were administered into the lumbar intervertebral disc, and outcomes were measured using the Roland Morris Disability Questionnaire, numeric rating scale for pain, Tampa scale for kinesiophobia and lumbar flexion range. Magnetic resonance imaging analysis assessed disc changes.

Results: No adverse events were reported. At the end of the 1-year follow-up, half of the patients showed significant improvements in disability scores at 1 year, while 3 of the 6 patients had no change. Magnetic resonance imaging revealed no significant disc changes.

Conclusion: Platelet-Rich Plasma injections show promise for some patients with low back pain and degenerative intervertebral discopathy patients. However, caution is warranted due to study limitations, including small sample size and lack of a control group. Further research is needed to define Platelet-Rich Plasma therapy protocols.

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.