The latest medical research on Rehabilitation Medicine

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What attributes should a specialist in rehabilitation have? Seven suggested specialist Capabilities in Practice.

Clinical Rehabilitation

Many services and professionals refer to themselves as providing rehabilitation. There is no agreed method for determining whether someone has specific expertise in rehabilitation. This makes it difficult for patients and payers to know whether professionals who claim to provide rehabilitation are specifically expert in rehabilitation.

Doctors have a medical speciality of rehabilitation. The medical training curriculum gives attributes that differentiate a rehabilitation specialist from other doctors. Until recently, these attributes were competencies to undertake activities associated with specialization. Apart from nurses, who have at least one, unofficial, curriculum identifying specific competencies, other professions involved in rehabilitation do not have any way to show specialization in rehabilitation.

The U.K. General Medical Council accredits specialist medical training. It has moved from specifying multiple practical clinical competencies to specifying fewer high-level 'Capabilities in Practice'. Six are generic to all doctors, eight identify the trained doctor as having specialist rehabilitation skills. This article adopts this approach to put forward seven generic and seven specialist capabilities to identify any professional as having special expertise in rehabilitation. The seven specialist capabilities centre on the biopsychosocial model of illness and multidisciplinary teamwork. Four of them could be used to define a specialist rehabilitation team.

Seven capabilities identifying specialization in rehabilitation are put forward for discussion. They could form the basis of a formal recognition that any professional has additional expertise in rehabilitation. A validating authority would be needed to provide oversight and governance.

Association of subsequent falls with evidence of dual-task interference while walking in community-dwelling individuals after stroke.

Clinical Rehabilitation

The aim of this study was to examine the fall predictive value of single-task walking tests and extent of interference observed in dual-task walking tests in ambulatory individuals post stroke.

This is an observational study with prospective cohort.

The study was conducted at the university laboratory.

A total of 91 community-dwelling individuals with chronic stroke participated in the study.

Time required to complete a 10-m walk test with and without obstacle negotiation was measured in isolation and in conjunction with performance of a verbal fluency task (category naming). Fall incidence, circumstances, and related injuries were recorded by monthly telephone calls for 12 months.

A total of 91 individuals (mean (SD) age = 62.7 (8.3) years; mean (SD) post-stroke duration = 8.8 (5.3) years) participated in the study; 29 (32%) of them reported at least one fall during the follow-up period, with a total of 71 fall episodes. There was a significant difference in obstacle-crossing time under single-task (mean difference = 8.3 seconds) and dual-task (mean difference = 7.4 seconds) conditions, and also the degree of interference in mobility performance (increased dual-task obstacle-crossing time relative to the single-task obstacle-crossing time; mean difference = 3.3%) between the fallers and the non-fallers (P < 0.05). After adjusting for the effects of other relevant factors, a greater degree of interference in mobility performance remained significantly associated with a decreased risk of falling (adjusted odds ratio = 0.951, 95% CI = 0.907-0.997, P = 0.037).

The degree of mobility interference during dual-task obstacle-crossing was the most effective in predicting falls among all the single-task and dual-task walking measure parameters tested. This simple dual-task walking assessment has potential clinical utility in identifying people post stroke at high risk of future falls.

Targeted Rhythmic Auditory Cueing During Treadmill and Overground Gait for Individuals With Parkinson Disease: A Case Series.

Journal of Neurologic Physical Therapy

Rhythmic auditory cueing and treadmill walking can improve spatiotemporal gait parameters through entrainment of movement patterns. Careful selection of cue frequencies is necessary if treadmill walking is to be employed, because cadence and step length are differentially affected by walking on a treadmill and overground. The purpose of this study was to describe the treatment of gait impairments for individuals with Parkinson disease, using strategically selected rhythmic auditory cue frequencies on both a treadmill and overground.

All participants completed 6 weeks of gait training, in which each session employed rhythmic auditory cueing during treadmill-based gait training followed by overground gait training. We provided targeted rhythmic auditory cueing with a metronome set to 85% and 115% of their self-selected cadence for treadmill and overground training, respectively. We performed clinical tests of gait and balance prior to, midway, and following training, and at a 3-month follow-up.

All participants improved overground gait speed (participant 1: +0.27 m/s; participant 2: +0.20 m/s; and participant 3: +0.18 m/s) and stride length (15.7 ± 4.17 cm) with small changes to cadence. Likewise, there were only small changes in balance.

We hypothesize that the large improvements in gait speed are due to the concomitant increases in stride length. Further research is needed to test the effect of targeted rhythmic auditory cueing during treadmill and overground gait.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A309).

Reliability and Concurrent Validity of Life Space Assessment in Individuals With Vestibular Disorders.

Journal of Neurologic Physical Therapy

The Life Space Assessment (LSA) is a self-report measure that allows clinicians to determine how often someone moves around in his or her environment with or without assistance. Presently, there are no reliable and valid measures that capture all 3 aspects of mobility (ie, mobility frequency, distance, and assistance needed) for individuals with vestibular disorders. The purpose of this study was to describe life space and to determine the reliability and concurrent validity of the LSA as a tool to measure mobility and function in individuals with balance and vestibular disorders.

One hundred twenty-eight participants (mean age of 55 ± 16.7 years) experiencing dizziness or imbalance who were seeking the care of an otoneurologist were recruited. Participants completed the LSA, Dizziness Handicap Inventory (DHI), and the 12-Item Short Form Health Survey (SF-12).

The mean LSA score of the sample was 75/120 ± 30. The LSA demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.91). The LSA was negatively correlated with the DHI total score (ρ = -0.326, P < 0.01), DHI physical subscore (ρ = -0.229, P = 0.02), DHI functional subscore (ρ = -0.406, P < 0.01), and DHI emotional subscore (ρ = -0.282, P < 0.01). The LSA was positively correlated with both the physical (ρ = 0.422, P < 0.01) and mental (ρ = 0.362, P < 0.01) composite scores of the SF-12.

Similar to the findings in community-dwelling older adults, the LSA demonstrated excellent test-retest and internal consistency in individuals with vestibular disorders. The LSA is a valid and reliable tool for measuring mobility and function in individuals with vestibular disorders.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A317).

Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis.

Journal of Rehabilitation Medicine

To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.

Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months, and beyond.

Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15-45%); and reduced exercise capacity ((mean 6-min walking distance 461 m, CI 450-473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31-47%), depression (33%, 95% CI 20-50%) and anxiety (30%, 95% CI 10-61) beyond 6 months were considerable. Low scores on Short-Form 36 were identified at 6 months and beyond.

Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.

Participation in and outcomes from a 12-month tailored exercise programme for people with multiple sclerosis (MSTEP©): a randomized trial.

Clinical Rehabilitation

To estimate, among people with multiple sclerosis, the extent to which a personally tailored exercise programme (MSTEP©) resulted in greater improvements in exercise capacity and related outcomes over 12 months in comparison with general exercise guidelines.

Two-group randomized trial.

Ambulatory and sedentary.

MSTEP©, a personally adapted exercise regimen done on most days including two days of high intensity exercise; guidelines recommending 30 minutes of moderate intensity aerobic and strength training two times per week.

Primary outcome was peak oxygen consumption (VO2peak) at 12 months; secondary outcomes were composite measures of physical function, fatigue, and health-related quality of life.

In total, 137 people were randomized, 66 were lost over 12 months leaving 71 with outcome data, 34 in MSTEP© group, and 37 in the Guideline group. Exercise enjoyment and confidence and exercise-induced fatigue predicted retention. There were no differences between groups on the proportion making a 10% increase in VO2peak (27.1% MSTEP© vs 29.6% Guidelines; OR: 0.83; 95% CI: 0.23-3.08) by the 12 month assessment. The effect on fatigue was larger in the MSTEP© group than the Guideline groups (OR: 1.59; 95% CI: 0.93-2.74), the effect on physical function was more modest (OR: 1.35; 95% CI: 0.80-2.25), and null for health-related quality of life outcomes.

The disappointing exercise retention suggests that people with multiple sclerosis may not consider exercise important to their brain health. Either type of exercise resulted in stable exercise capacity over 1 year in those sticking with the programme.

Diagnostic nerve block in prediction of outcome of botulinum toxin treatment for spastic equinovarus foot after stroke: A pilot retrospective observational study.

Journal of Rehabilitation Medicine

To evaluate the role of diagnostic nerve block in predicting the outcome of botulinum toxin type A treatment for spastic equinovarus foot due to chronic stroke.

Each patient was given diagnostic tibial nerve block (lidocaine 2% perineural injection) assessment followed by botulinum toxin type A inoculation into the same muscles as had been targeted by the nerve block. All patients were evaluated before diagnostic nerve block, after the nerve block, and 4 weeks after botulinum toxin injection. Outcomes were ankle dorsiflexion passive range of motion of the affected side, and calf muscle spasticity, measured with the modified Ashworth scale and the Tardieu Scale.

Significant improvements were measured after diagnostic nerve block and botulinum toxin injection compared with the baseline condition. Diagnostic nerve block led to significantly greater improvements in all outcomes than botulinum toxin injection.

This study confirmed diagnostic nerve block as a valuable screening tool in deciding whether to treat spastic equinovarus with botulinum toxin. However, the results support the evidence that diagnostic nerve block results in a greater reduction in muscle overactivity than does botulinum toxin type A in patients with spastic equinovarus due to stroke.

Effectiveness of radiotherapy to prevent recurrence of heterotopic ossification in patients with spinal cord injury and traumatic head injury: A retrospective case-controlled study.

Journal of Rehabilitation Medicine

To evaluate recurrence and early postoperative complications (sepsis) following surgical excision combined with radiotherapy for troublesome hip heterotopic ossification in patients with spinal cord injury and traumatic brain injury.

The primary end-point was recurrence of heterotopic ossification. Secondary end-points were postoperative complications and, more specifically, sepsis that required surgical revision.

There was no difference between the odds ratios (OR) for recurrence for each group (OR case group = 0.63, OR spinal cord injury subgroup = 0.45 and OR head injury subgroup = 1.04). The rate of sepsis requiring surgical revision was significantly higher in the case group (p < 0.05).

Based on the results of this case-control study, we suggest that radiotherapy should not be combined with surgery in patients with troublesome hip heterotopic ossification undergoing excision. Radiotherapy does not appear to prevent recurrence and, moreover, it is associated with an increased risk of postoperative sepsis.

Preoperative physical factors that predict stair-climbing ability at one month after total knee arthroplasty.

Journal of Rehabilitation Medicine

To identify preoperative physical performance factors that predict stair-climbing ability at 1 month after total knee arthroplasty.

Eighty-four patients who underwent a primary unilateral total knee arthroplasty Methods: Before and 1 month post-operation, the patients completed physical performance tests, including a stair-climbing test, a 6-minute walk test, a Timed Up-and-Go test, tests of the isometric flexor and extensor strength of the operated and non-operated knees, and instrumental gait analysis. Disease-specific physical function was measured by the Western Ontario McMaster Universities Osteoarthritis Index.

Correlation analysis showed that postoperative stair-climbing test scores were significantly correlated with preoperative physical performance and function. Linear regression analysis showed that postoperative stair-ascent scores were correlated with preoperative Timed Up-and-Go test scores and peak torque of the extensor of the operated knee. Postoperative stair-descent scores were positively correlated with preoperative stair-descent scores and age.

The results show that preoperative balance ability and quadriceps strength in the operated knee could influence postoperative stair-climbing ability at 1 month after total knee arthroplasty. These findings will be useful for developing pre- and post-operative rehabilitation strategies for improving stair-climbing ability in the early stages after total knee arthroplasty.

Reliability and validity of the long-distance corridor walk among stroke survivors.

Journal of Rehabilitation Medicine

To identify the psychometric properties of the Long-Distance Corridor Walk (LDCW) among community-dwelling stroke survivors.

The LDCW was administered to the 25 stroke survivors on 2 separate days with a 7-day interval. Fugl-Meyer Assessment for the Lower Extremities (FMA-LE), measurement of lower limb muscle strength, Berg Balance Scale (BBS), limit of stability (LOS), Narrow-Corridor Walk Test (NCWT), Timed Up and Go (TUG) test, and the Community Integration Measure-Cantonese version (CIM) were performed on either day. The healthy older adults completed the LDCW once, and the results were recorded by a random rater.

The LDCW showed excellent inter-rater reliability and test-retest reliability, and significant correlations with FMA-LE, BBS, TUG, and NCWT. A cut-off score of 127.5 m for the 2-min walk and 426.69 s for the 400-m walk distinguished stroke survivors from healthy older adults. The MDC in the LDCW in the 2-min walk and 400-m walk were 18.69 m and 121.43 s, respectively.

The LDCW is a reliable clinical measurement tool for the assessment of advanced walking capacity in stroke survivors.

Need for comprehensive management of frailty at an individual level: European perspective from the advantage joint action on frailty.

Journal of Rehabilitation Medicine

ADVANTAGE Joint Action is a large collaborative project co-founded by the European Commission and its Member States to build a common understanding of frailty for Member States on which to base a common management approach for older people who are frail or at risk of developing frailty. One of the key objectives of the project is presented in this paper; how to manage frailty at the individual level.

A systematic review of the literature was conducted, including grey literature and good practices when possible.

The management of frailty should be directed towards comprehensive and holistic treatment in multiple and related fields. Prevention requires a multifaceted approach addressing factors that have resonance across the individual's life course. Comprehensive geriatric assessment to diagnose the condition and plan a personalized multidomain treatment increases better outcomes. Multicomponent exercise programmes, adequate protein and vitamin D intake, when insufficient, and reduction in polypharmacy and inadequate prescription, are the most effective strategies found in the literature to manage frailty effectively.

Frailty can be effectively prevented and managed with a multidomain intervention strategy based on comprehensive geriatric assessment.

Quality of life of adults with chronic spinal cord injury in mainland china: A cross-sectional study.

Journal of Rehabilitation Medicine

To evaluate the quality of life of patients with chronic spinal cord injury in mainland China.

The WHOQOL-BREF and WHOQOL-DIS module were used to assess quality of life. Anxiety/depression was measured using the Zung Self-Rating Anxiety/Depression Scale. Quality of life was compared with that of reference populations from China, Korea, etc. Multivariate linear regression was conducted to determine the factors that might be associated with quality of life.

The means of the 4 domains of the WHOQOL-BREF varied from 11.5 to 13.0. The mean of the 12-item WHOQOL-DIS module was 38.7. The quality of life of the participants as measured by the WHOQOL-BREF was 1.1-4.7 points lower than that of the global reference population, while quality of life as measured by the WHOQOL-DIS module was 1.2 points lower than that of the Korean data. Anxiety and depression were negative factors associated with quality of life (p < 0.05). Better community integration was a positive factor for physical quality of life and quality of life as measured by the WHOQOL-DIS module (p <0.01).

The quality of life of adults with chronic spinal cord injury in mainland China was lower compared with reference populations. Duration of spinal cord injury, sex, community integration, anxiety, and depression were related to quality of life.