The latest medical research on Rehabilitation Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about rehabilitation medicine gathered by our medical AI research bot.

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Clinical practice guidelines for the management of brain tumours: A rehabilitation perspective.

Journal of rehabilitation medicine

To critically appraise published clinical practice guidelines (CPGs) for brain tumours, and to synthesize evidence-based recommendations from a rehabilitation perspective.

A comprehensive literature search included: health science databases, CPG clearinghouse/developer websites, and grey literature up to March 2018. All brain tumour CPGs that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Three authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) Instrument. Recommendations from included CPGs were categorized from a rehabilitation perspective.

Of the 11 CPGs identified, only 2, developed by the National Institute for Health and Clinical Excellence (NICE) and the Australian Cancer Network (ACN), included rehabilitation components for the management of brain tumours. Both CPGs were of moderate quality. The recommendations reported were generic, and only the ACN guidelines provided detailed recommendations for rehabilitation interventions. Both guidelines recommend a comprehensive multi-disciplinary care approach. Detailed comparison, however, was not possible due to inconsistent recommendations, making it difficult to summarize rehabilitative care.

Despite rehabilitation being an integral component of the management of brain tumours, only a limited number of CPGs have incorporated recommendations for specific rehabilitation interventions. In order to improve clinical outcomes in this population future CPGs should incorporate rehabilitation interventions.

Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: A randomized controlled trial.

Journal of rehabilitation medicine

Rehabilitation of patients following coronary artery bypass grafting (CABG) has been widely studied; however, research into early rehabilitation after CABG is sparse. The aim of this trial was to assess the impact of early rehabilitation, compared with usual care in patients following CABG.

Patients treated with CABG were randomized 1:1 to 4 weeks of comprehensive early rehabilitation or usual care. The primary outcome was the Six Minute Walk Test (6MWT). Secondary outcomes were mental health and physical activity (Medical Outcome Study Short Form; SF-12); anxiety and depression (Hospital Anxiety and Depression Scale; HADS); physical and emotional scores; sleep (Pittsburgh Sleep Quality Index; PSQI); pain (Örebro Musculoskeletal Screening Questionnaire; ÖMSQ) and muscle endurance (Sit-To-Stand test).

Sixteen patients dropped out. No significant differences between groups in the primary outcome (6MWT) were found after 4 weeks (p = 0.27). For secondary outcomes the odds ratio of HADS-D ≥ 8 decreased in favour of the experimental intervention (p = 0.04). There was non-adherence to parts of the intervention. Per-protocol analysis showed differences between groups for the 6MWT (p = 0.02) and the Sit-To-Stand test (p = 0.046).

In general, the intervention had no effect on the 6MWT, or secondary outcomes, except for depressive symptoms. However, in adherent participants, the intervention had a positive effect for the primary and several secondary outcomes.

Inter- and intra-rater variability of testing velocity when assessing lower limb spasticity.

Journal of rehabilitation medicine

To establish the variability of fast testing velocity and joint range of motion and position when assessing lower-limb spasticity in individuals following neurological injury.

The Modified Tardieu scale (MTS) was completed on the quadriceps, hamstrings (2 positions), gastrocnemius and soleus for each participant's more affected lower limb by 3 assessors. Mean absolute differences (MADs) were used to calculate variability as a measure of reliability.

Variability of peak testing velocity was greater at the ankle joint compared with the knee joint. The greatest MAD for V3 (fast) inter-rater testing velocity was 119°/s in the soleus, representing 29.4% of the mean variable value, and least for the quadriceps (64.3°/s; 18.5%). Inter-rater variability was higher than intra-rater variability for all testing parameters. The MAD for joint end angle ranged from 2.6° to 10.7° and joint start angle from 1.2° to 14.4°.

There was a large degree of inter- and intra-rater variability in V3 testing velocity when using the MTS to assess lower limb spasticity. The inter-rater variability was approximately double the intra-rater variability.

Manually assisted body-weight supported locomotor training does not re-establish walking in non-walking subjects with chronic incomplete spinal cord injury: A randomized clinical trial.

Journal of rehabilitation medicine

To assess the effects of manually assisted body-weight supported locomotor training in subjects with chronic incomplete spinal cord injury.

Random allocation to 60 days of body-weight supported locomotor training, or usual care, which might include over-ground walking. Walking function, lower extremity muscle strength and balance were blindly evaluated pre-/post-intervention.

A small, non-significant improvement in walking function was observed (0.1 m/s (95% confidence interval (95% CI) -0.2, 0.4)), but subjects without baseline gait function, did not re-establish walking. The effect on lower extremity muscle strength was 2.7 points (95% CI -1.4, 6.8). No difference was observed in balance measures.

Subjects with chronic incomplete spinal cord injury without baseline walking function were unable to re-establish gait with manually assisted body-weight supported locomotor training. A modest, non-significant, improvement was found in strength and walking speed. However, due to study recruitment problems, an effect size that was smaller than anticipated, and large functional heterogeneity among study subjects, the effect of late-onset body-weight supported locomotor training is not clear. Future studies should include larger numbers of subjects with less functional loss and greater functional homogeneity. Intensive training should probably start earlier post-injury.

Effects of isokinetic muscle strengthening on muscle strength, mobility, and gait in post-stroke patients: a systematic review and meta-analysis.

Clinical rehabilitation

To investigate whether isokinetic muscle strengthening improves muscle strength, mobility, and gait in post-stroke patients.

We searched for randomized controlled trials at PubMed/Medline, SciELO, PEDro, and Cochrane Central Register of Controlled Trials, from the earliest date available to June 2018. Randomized controlled trials that examined the effects of isokinetic muscle strengthening versus other rehabilitation interventions or control in post-stroke patients were included. Study quality was evaluated using the PEDro scale. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test.

In total, 13 studies (347 patients) focusing on the use of isokinetic in rehabilitation following stroke were included. All trials were of low-to-moderate quality. Isokinetic muscle strengthening improved muscle strength WMD 0.8 (95% CI: 0.2, 1.4; N = 96), mobility WMD -2.03 seconds (95% CI: -2.9, -1.1; N = 111) and gait speed WMD 0.9 m/s (95% CI: 0.05, 1.8; N = 87).

Isokinetic muscle strengthening seems to be a useful strategy for improving muscle strength, mobility, and gait in post-stroke patients.

The effect of early intervention of mirror visual feedback on pain, disability and motor function following hand reconstructive surgery: a randomized clinical trial.

Clinical rehabilitation

To determine the effect of mirror visual feedback (MVF) on disability, pain, and motor function on patients who underwent hand reconstructive surgery.

Randomized, single-blinded controlled trial.

Rehabilitation center.

A total of 40 patients who were randomly assigned into the intervention group ( n = 20) and control group ( n = 20) participated in this study.

The rehabilitation sessions took place twice a week for eight weeks. The control group received traditional rehabilitation for 75 minutes. While the intervention group performed MVF and traditional rehabilitation for 30 and 45 minutes, respectively.

Pain and disability of the hand were assessed with McGill pain questionnaire and Disability of Arm, Shoulder, and Hand (DASH) scores. The range of joint motion was evaluated by Goniometer, and the strength of grip and pinch was evaluated by Dynamometer and Pinch gauge and dexterity evaluated by Minnesota Manual Muscle test.

The results indicated that both traditional and MVF methods induced significant decreasing pain (Pain Rate Index: F = 68.48, P = 0.000; Number of Word Count: F = 70.96, P = 0.000), disability ( F = 50.08, P = 0.000) and increasing dexterity (placing test: F = 28.73, P = 0.000), and range of motion ( F = 33.16, P = 0.000). The results also showed that the positive effect of MVF on pain, disability, dexterity, and range of motion was significantly greater than that of controls ( P < 0.05), but there was no significant result in grip and lateral pinch strength between the intervention and control group ( P > 0.05).

MVF, in conjunction with traditional rehabilitation programs, may lead to greater improvements in pain, disability, placing dexterity, and range of motion. But it seems not to be effective on pinch and grip power and turning dexterity.

Effectiveness of rehabilitation after cervical disk surgery: a systematic review of controlled studies.

Clinical rehabilitation

To present a synopsis of evidence on the efficacy of rehabilitation after cervical disk surgery performed for neck pain and radiculopathy.

The databases of Medline, EMBASE, and Cochrane Central were searched for studies reporting effects of rehabilitation interventions in patients undergoing surgery due to cervical disk disease with pain and radicular syndrome, published before 31 August 2018.

Project was registered with PROSPERO database (number CRD42018085937). Randomized controlled trials that evaluated the efficacy of rehabilitation interventions versus other, sham, or no treatment were selected. The primary outcomes were disability and pain. Secondary outcomes were other measures assessing biological, psychological or social effect of rehabilitation. Two reviewers independently screened studies for eligibility, assessed risk of bias and extracted data. Evaluation of evidence was performed with the GRADE system.

Five papers were included in the review. The eligible studies were heterogeneous in intervention and outcome reporting. There are low- to very-low-quality evidence that some interventions (use of cervical collars after non-plated anterior cervical diskectomy an fusion, structured physiotherapy, and interactive patients' education) provide some benefit within functioning, pain, and selected psychological variables in patients undergoing cervical disk surgery. Controlled trials addressing comprehensive interdisciplinary rehabilitation, multidisciplinary pain management, occupational therapy, psychotherapy, social and vocational interventions were not identified.

There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness, harms, and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy.

A systematic review of measures of adherence to physical exercise recommendations in people with stroke.

Clinical rehabilitation

To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools.

Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures.

Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers.

In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), 'record of practice' ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified.

There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.

Is dry heat treatment (fluidotherapy) effective in improving hand function in patients with rheumatoid arthritis? A randomized controlled trial.

Clinical rehabilitation

To evaluate the efficacy of dry heat treatment (fluidotherapy) in improving hand function in patients with rheumatoid arthritis.

Prospective randomized controlled trial.

Departments of Physical Medicine and Rehabilitation and Rheumatology in a university hospital.

Patients with rheumatoid arthritis.

All patients were randomly divided into two groups. Group 1 underwent dry heat treatment (fluidotherapy) and Group 2 was a control group. Patients in both groups participated in a joint protection and exercise program.

Primary outcome measures were Health Assessment Questionnaire and Duruoz Hand Index. Secondary outcome measures were pain and stiffness, Grip Ability Test, Disease Activity Score-28, and grip strength. These assessments were performed at the hospital at baseline, week 3, and week 12.

A total of 93 participants were allocated to Group 1 ( n = 47) and Group 2 ( n = 46). The mean age of these groups was 54.19 ± 11.15 years and 53.00 ± 10.15 years, respectively ( P = 0.592). At baseline, there were no significant differences between the groups in any parameter except significantly poorer Health Assessment Questionnaire score in Group 1 ( P = 0.007). At week 3, there were no significant differences between the groups in any of the parameters ( P > 0.005). At week 12, Duruoz Hand Index scores were significantly better in Group 2 ( P = 0.039).

Dry heat treatment (fluidotherapy) was not effective in improving hand function in patients with rheumatoid arthritis. Moreover, no positive effect on any other clinical parameters was observed.

Neural Correlates of Hypokinetic Dysarthria and Mechanisms of Effective Voice Treatment in Parkinson Disease.

Neurorehabilitation and neural repair

Hypokinetic dysarthria is highly prevalent in idiopathic Parkinson disease (PD), and effectiveness of high-intensity voice treatment is well established. However, the neural correlates remain largely unknown.

We aimed to specify cerebral pathophysiology of hypokinetic dysarthria and treatment-induced changes using functional magnetic resonance imaging (fMRI).

We used fMRI to investigate healthy controls (HCs) and patients with idiopathic PD-associated dysarthria before and after treatment according to the Lee Silverman Voice Treatment LOUD (LSVT). During fMRI, participants covertly read sentences with normal (eg, conversation in a quiet room) or high (eg, shouting on a windy beach) intensity. In addition, we tested LSVT effects on intelligibility and different speech features (intensity, pitch, articulation).

LSVT effectively improved intelligibility, articulation, and pitch in patients. Covert high-intensity speech compared with covert normal-intensity speech led to increased activation of mainly secondary motor areas and bilateral superior and medial temporal regions. Prior to LSVT, patients showed less activity in several speech-associated areas compared with HCs. As a neural correlate of effective LSVT, increased right-sided superior temporal activity correlated with improved intelligibility.

This is the first brain imaging study using a covert speech paradigm in PD, which revealed cortical hypoactivation as correlate of hypokinetic dysarthria. Furthermore, cortical correlates of effective LSVT treatment colocalized with the neuronal network, showing increased activation during high- versus normal-intensity speech generation.

Prolonged slow expiration technique improves recovery from acute bronchiolitis in infants: FIBARRIX randomized controlled trial.

Clinical rehabilitation

To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay.

Randomized controlled trial.

Infants' unit of university hospital.

Infants with acute bronchiolitis ( N = 80).

Infants were randomized into respiratory treatment (RT) with prolonged slow expiration or treatment as usual (control) for one-week period.

The primary outcomes were Acute Bronchiolitis Severity Scale score and O2 saturation, recorded shortly after each intervention during the stay and at medical discharge, and the hospital stay.

The RT had a significantly lower Acute Bronchiolitis Severity Scale 10-minute after the first intervention (mean difference -1.7 points, 95% confidence interval (CI) -3.0 to -0.38), 2 hours after (-2.0 points, 95% CI -3.2 to -0.86) and the last day before medical discharge (-1.3 points, 95% CI -2.1 to 0.51). No changes were detected in O2 saturation. The survival analysis of time at medical discharge showed decrease in the average number of days to achieve an Acute Bronchiolitis Severity Scale of less than 2 points (RT: 2.6 days, 95% CI 2.1-3.1; Control: 4.4 days, 95% CI 3.6-5.1).

A prolonged slow expiration physiotherapy reduces Acute Bronchiolitis Severity Scale scores and does not change O2 saturation. Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.

Effects of mechanical inspiration and expiration exercise on velopharyngeal incompetence in subacute stroke patients.

Journal of rehabilitation medicine

To investigate the therapeutic effects of mechanical inspiration and expiration exercise using mechanical cough assist on velopharyngeal incompetence in patients with subacute stroke.

Subjects were randomly assigned to 2 groups. The study group received conventional dysphagia therapy and additional mechanical inspiration and expiration exercise. The control group received conventional dysphagia therapy only. Swallowing function was evaluated according to the American Speech-Language-Hearing association scale, functional dysphagia score, and the penetration aspiration scale, based on the videofluoroscopic swallowing study. Coughing function was measured using peak cough flow.

Eighteen patients in each group completed the protocol and were analysed. After treatment, the study group showed significant improvement in functional dysphagia score with regard to nasal penetration degree. Comparing the treatment effect between the 2 groups, nasal penetration degree and peak cough flow showed greater improvement in the study group.

Mechanical inspiration and expiration exercise had a therapeutic effect on velopharyngeal incompetence in subacute stroke patients with dysphagia. This therapy is easy to provide clinically and could be a useful therapeutic strategy for velo-pharyngeal incompetence with dysphagia in patients with stroke.