Journal of rehabilitation medicine. Clinical communications最新文献

Objective: To compare the functional outcomes of patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis.

Design: A retrospective cohort study.

Patients: Patients with lower limb amputation who were admitted to a convalescent rehabilitation ward between January 2018 and December 2021.

Methods: The primary outcome was the effectiveness of the Functional Independence Measure (FIM) during hospitalisation in the ward. Secondary outcomes included the total and subtotal (motor/cognitive) FIM scores at discharge, gain in the total and subtotal (motor/cognitive) FIM scores, K-level at discharge, length of hospital stay in the ward, rehabilitation time, and discharge destination. Outcomes were compared between the non-haemodialysis and haemodialysis groups.

Results: A total of 28 patients (mean [standard deviation] age, 67.0 [11.9] years; men, 20) were enrolled in this study. Among them, 11 patients underwent haemodialysis. The FIM effectiveness was significantly higher in the non-haemodialysis group than in the haemodialysis group (median [interquartile range], 0.78 [0.72 - 0.81] vs 0.65 [0.28 - 0.75], p = 0.038). The amount of rehabilitation and all secondary outcomes were not significantly different between the groups (p > 0.05).

Conclusion: Patients with lower limb amputation who were receiving haemodialysis had poorer FIM effectiveness than those not receiving haemodialysis.

Objective: To evaluate the effects of exercise training on upper extremity physical function and physiological fitness outcomes in persons with multiple sclerosis (PwMS).

Methods: A search of 3 electronic databases (EMBASE, CINAHL, and ovidMEDLINE) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The included studies were randomized control trials that reported at least one outcome measure related to upper extremity function, contained a component of exercise training, and included PwMS.

Results: Of the 1381 articles retrieved from the electronic databases, 8 articles met the specific inclusion criteria. All the included articles incorporated strength training exercises into the rehabilitation intervention. Reported outcomes included the 9 Hole Peg Test (9HPT), Action Research Arm Test (ARAT), and Fugl-Meyer Assessment, with 3, 3, and 0 reporting significant improvements, respectively. Only grip strength was included as a physiological fitness outcome, with 2 articles reporting significant improvements.

Conclusion: The results of this review suggest that strength training may elicit improvements in functional and physiological upper extremity outcomes for PwMS. Several limitations of the current review must be noted, including a limited number of studies and the combination of strength training with other rehabilitative modalities.

Objective: Morel-Lavallée lesion is a well-known entity after a high-energy, shearing trauma. Another form of lesion in the subcutaneous tissue is fat necrosis, presenting as a palpable mass. The most common presentation of fat necrosis is oil cysts, which occur mainly in the breast. However, in the lower extremities fat necrosis appears as nodular cystic fat necrosis. We report here a case of a patient with multiple injuries after a low-velocity trauma, who developed fat necrosis.

Results: Six months after the traumatic event the patient reported multiple subcutaneous lumps on the right knee. On ultrasonography, the probable diagnosis of post-traumatic fat necrosis with consequent development of nodular cystic fat necrosis was seen. The diagnosis was confirmed based on magnetic resonance imaging (MRI).

Discussion: Fat necrosis should be included in the differential diagnosis in cases of tissue injuries after a trauma. Fat necrosis can present months or years after the initial injury. It is a benign entity and is the result of an organized haemorrhage, swelling and oedema that progresses with fibrosis. There is no absolute need for surgical treatment.

Objective: Spinal and bulbar muscular atrophy is characterized by slow-progressive muscle weakness, decreased functional performance and falls. Research into the use of exercise in spinal and bulbar muscular atrophy has shown equivocal to negative results, although authors suggest that patients with spinal and bulbar muscular atrophy may benefit from both increased exercise intensity and shorter bout duration. The aim of this case report is to explore the safety of a moderate intensity strength training programme coupled with dynamic balance and function-specific training in a patient with spinal and bulbar muscular atrophy.

Case report: A 56-year-old man with spinal and bulbar muscular atrophy presented with multiple falls and declining performance in physical, vocational, and recreational activities. Examination revealed several musculoskeletal impairments that were sub-clinical to mild compared with an SBMA natural history cohort.

Intervention and outcome: A 15-week moderate intensity exercise programme combining weight-lifting and functional exercises was performed under clinical supervision. Exercise volume, frequency and intensity were adjusted based on patient-reported outcomes and muscle damage blood markers. Performance-based and self-reported functional improvements occurred that exceeded the minimal clinically important difference. The intervention was well tolerated and the patient nearly doubled his baseline 10-repetition maximums for weight-lifting exercises.

Conclusion: Exercise therapy combining weight-lifting and upright functional training led to meaningful performance improvements in this case of a patient with spinal and bulbar muscular atrophy and relatively low disease burden.

Objective: Hip pain is common in patients of advanced age and has a very broad differential. Of the potential aetiologies, iliopsoas tendon ruptures are rare. Consequently, there is a paucity of literature on iliopsoas rupture in the older adult population, and its rarity can lead to a delay in its diagnosis. When iliopsoas ruptures do occur, they are typically secondary to trauma; however, they can occur spontaneously. Iliopsoas injuries can be disabling, but they respond well to conservative management. We report here a case of a 70-year-old woman who presented to an unaffiliated emergency department with left anterior hip pain 2 weeks after a fall from standing height.

Results: Initial X-ray and computed tomography were negative for fracture, and the patient was discharged with home health physical therapy. Her symptoms persisted. At a subsequent emergency department visit several weeks later, magnetic resonance imaging revealed a complete left iliopsoas tendon rupture with retraction. She was treated conservatively and made a complete recovery after physical therapy.

Discussion: This paper reviews the literature related to iliopsoas injuries, highlights the importance of iliopsoas tendon injuries among the differential for acute hip pain, and provides management recommendations for this rare, but probably underdiagnosed, injury. This treatable condition warrants further attention, as delay in diagnosis can prolong morbidity.

Objective: Osteoarthritis is one of the most common chronic conditions leading to disability among older people (age 60+ years). Knee osteoarthritis has a significant impact on daily functioning. Pain, stiffness, reduced strength, changes in posture, and reduced knee stability may result in reduced mobility. The aim of this study is to evaluate the short- and long-term effects of conservative therapeutic use of a semi-rigid knee brace for management of patients with knee osteoarthritis, using patient-reported outcomes.

Design: Patients with osteoarthritis using a semi-rigid knee brace were asked to complete a questionnaire about the effectiveness of the brace after wearing it for 3 weeks. The primary outcome measure was mobility, assessed using an ordinal scale with and without use of the knee brace. Secondary outcome measures were pain symptoms and overall daily functioning.

Results: A total of 381 patients completed the questionnaire. The results show considerably improved mobility while using a knee brace in different mobility groups. In the group of respondents who were limited to their home environment mobility decreased by 74% while using a knee brace. In the group of respondents who were able to walk to a nearby shop mobility increased by 50%, and the group experiencing no mobility restrictions increased from 3% without using a knee brace to 13% while using a knee brace. In addition, 54% of respondents reported a reduction in pain symptoms and 62% of respondents reported an improvement in overall daily functioning while using a knee brace.

Conclusion: The results of this large-scale patient-reported outcome measure (PROM) study show that the use of a semi-rigid knee brace appears to provide suitable joint support, offering pain relief and freedom of movement and should be considered a useful non-surgical treatment method for use in patients with knee osteoarthritis.

Clinical trial: This study does not include a clinical trial.

Background: Haemophilic arthropathy is often associated with a loss of range of motion. Total knee arthroplasty is an effective treatment option for patients with end-stage haemophilic arthropathy of the knee. However, even after arthroplasty, the range of motion sometimes remains insufficient.

Objective: To evaluate static progressive stretch as a treatment method for haemophilic patients with decreased range of motion after total knee arthroplasty.

Methods: Static progressive stretch was used to improve range of motion in patients with a postoperative extension lag of more than 10° and flexion of less than 80°. A total of 7 knees were treated for a mean of 21.7 weeks.

Results: Statistically significant increases in range of motion and in Knee Society Score were observed when comparing pre-treatment and post-treatment values.

Conclusions: Static progressive stretch using an orthotic device could be a successful adjuvant method for treating joint stiffness in patients with haemophilia after total knee arthroplasty.

Objective: Swallowing disorders are systematically present in patients with severe brain injury, disorders of consciousness, and subsequently poor quality of life. The study hypothesis was that taste and smell could improve swallowing function and quality of life in such patients, who are fed by gastrostomy tube.

Methods: Eight patients with unresponsive wakefulness syndrome were included in this study. All patients had been in a stable state for at least 2 years, and the delay between the neurological event and the study was always more than 2 years. Strong tastes and smells were selected using the Pfister olfactory classification. Taste and smell stimulations were performed every weekday, Monday to Friday, for 1 week (5 sessions) by a speech and language therapist. Evaluation of swallowing was performed before the first session and after the fifth session, and included the number of spontaneous swallows during 10 min, the presence of drooling, and spontaneous tongue and velum mobility.

Results: The number of spontaneous swallows at the initial evaluation was 6.8 ± 5.1 n/min. At the final evaluation there was a significant increase in the number of spontaneous swallows (9.1 ± 4.1 n/min, p < 0.01).

Conclusion: This clinical observation has shown that taste and smell stimulations are relevant in clinical practice to improve spontaneous swallowing.