The role of acute rehabilitation in COVID-19 patients.

BACKGROUND: In the published literature there is scarce data on the importance of acute rehabilitation in patients suffering from COVID-19 disease. AIM: Evaluation of the feasibility of respiratory and neuromuscular rehabilitation treatment in stable acute COVID-19 inpatients. DESIGN: The study was designed as an observational prospective investigation of two cohorts respectively identified as Mild/Moderate and Stable Severe COVID-19 disease. All patients received a rehabilitation treatment consisting of breathing exercises, range of motion exercises and strengthening exercises, with the main difference in intensity and progression of treatment, depending on individual capacity of patient. SETTING: Inpatients with diagnosed mild to moderate, or stable severe COVID-19 infection were included in the study. POPULATION: Acute COVID-19 inpatients. METHODS: Patients were divided into two groups depending on the severity of disease: "mild to moderate group" (MMG) and "stable severe group" (SSG). Functional outcomes included the Barthel Index (BI), Six Minute Walk Test (6MWT), Borg Scale for dyspnea, "Time Up and Go" Test (TUG), "Sit To Stand" test (STS), "One Leg Stance Test" (OLST) and Beck Depression Inventory (BDI) were evaluated at baseline and after rehabilitative treatment, on discharge. RESULTS: We included 147 acute COVID-19 inpatients (75 male and 72 female), mean aged 63.90±13.76 years. There were noticeable statistically significant improvements in all observed measurements in both groups. Comparison between groups showed significant difference in MMG compared to SSG in all functional outcomes: TUG (P<0.001), STS (P<0.001), OLST (P<0.001), BDI (P=0.008), BI (P<0.001), and Borg scale for dyspnea (P<0.001). Despite the significant improvements of BI in SSG, the obtained values showed that the patients were still not functionally independent. CONCLUSIONS: Acute respiratory and neuromuscular rehabilitation program is a feasibile, but also effective and safe method for improving functional status in patients with COVID-19 infection. CLINICAL REHABILITATION IMPACT: Results of the present study implicate that a supervised early rehabilitation program, implemented in the treatment of patients with COVID-19 disease in the acute phasis a feasible way for significant improvement of patient's functional outcomes. Early rehabilitation should be included into clinical protocols for the treatment of patients with COVID-19.

Reliability, Validity and Temporal Stability of the Serbian Version of the Boston Carpal Tunnel Questionnaire.

Background and Objectives: The aim of this study was to validate the Serbian version of the Boston Carpal Tunnel Questionnaire (BCTQ) and to evaluate temporal stability for the purpose of its implementation in the evaluation of Serbian patients with carpal tunnel syndrome (CTS). Materials and Methods: For the validation of the Serbian version of the BCTQ (BCTQSR), we tested 69 individuals with diagnosed CTS that were referred for a conservative treatment at the Institute for Rehabilitation. Neurophysiological tests were used for the electrophysiological grading (EG) of CTS severity in the study sample. The final version of the BCTQSR was given to the tested participants from the study on two occasions: test and retest, with a five-day period between the two measurements. Results: The mean value for the symptom severity subscale (SSS) of the BCTQSR was 3.01 ± 0.94; for the functional status subscale (FSS) of the BCTQSR it was 2.85 ± 1.00. Cronbach's α for the SSS was 0.91 and 0.93 for the FSS. The intraclass correlation coefficients (ICCs) concerning the test−retest were significant (p < 0.001) and were 0.949 for the SSS and 0.959 for the FSS. Those with a higher EG grade had higher values of the SSS and FSS but without a statistical significance (p = 0.103 and p = 0.053, respectively). The intercorrelation of the BCTQSR subscales (SSS and FSS) on the test was significant (p < 0.001) with a correlation coefficient equal to 0.777. Conclusion: The Serbian version of the BCTQ (BCTQSR) was successfully culturally adopted. The BCTQSR was a valid and reliable instrument for the measurement of symptom severity and functional status in adults with CTS. Therefore, it can be used in clinical practice for patients with CTS.

Effects of 12-Week Exercise Program on Enzyme Activity of Serum Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Female Patients with Postmenopausal Osteoporosis: A Randomized Control Study.

BACKGROUND: Osteoporosis is a disease characterized by decreased bone density and destruction of bone microarchitecture. Indicators for altered bone homeostasis are changes in the serum level of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). The purpose of the current study was to evaluate the effect of a 12-week exercise program on enzyme activity of serum MMP-9 and TIMP-1 in postmenopausal osteoporotic patients. Materials and methods. Participants were randomized in two groups: exercise (EG) (N = 37) and control (CG) (N = 37) and control (CG) (. RESULTS: Significant differences between pretreatment and posttreatment enzyme activities of serum MMP-9 (p=0.009), TIMP-1 (p=0.009), TIMP-1 (p=0.009), TIMP-1 (. CONCLUSION: Our results suggest that a 12-week exercise program has an influence on enzyme activity of serum MMP-9, revealing a possible role of MMPs in initiating training-specific adaptation. Although measurements of circulating MMP-9 and TIMP-1 allowed us to detect effects of exercise, as of today, they have no real role in the diagnosis of osteoporosis and/or follow-up of osteoporotic patient's response to treatment. MMP-9 might be used as an important prognostic marker for the evaluation of patient's response to exercise. Larger-randomized controlled studies need to be performed to expand this area of knowledge. This trial is registered with trial registration number: NCT03816449).

Validation of the Neck Disability Index in Serbian Patients With Cervical Radiculopathy.

OBJECTIVE: The purpose of this study was to translate the Neck Disability Index into the Serbian language (NDI-S) and to investigate the validity of this version for use in Serbian population. METHODS: Fifty patients with cervical radiculopathy were enrolled in the study and completed a multidimensional questionnaire, including NDI-S. Inclusion criteria were ages between 18 and 65 years, Serbian speaking, no cognitive or hearing impairment, sharp and radiating neck and upper extremity pain that has lasted less than 12 months, radiculopathy signs evaluated by electromyoneurography and disc herniation, or spondylotic changes of cervical spine visualized on magnetic resonance imaging. Exclusion criteria were malignancy, previous cervical spine discectomy, trauma of the cervical spine and myelopathy, polyneuropathy, fibromyalgia, and psychiatric disorders. Validity was determined by the correlation of the Neck Disability Index, with pain measured by visual analogue scale, characteristics related to pain, and mental status. Also, factor structure of NDI-S was explored through factor analysis. Reliability was assessed through internal consistency (Cronbach's α and item-total correlations). RESULTS: Correlation analysis between pain and NDI-S showed significant values (P < .01). The NDI-S correlated well with patients mental status (r = 0.421, P < .01). Cronbach's α of NDI-S was 0.85, denoting excellent internal consistency of the questionnaire. Item-total correlations were significant and ranged from 0.328 to 0.789. Factor analysis demonstrated a 2-factor structure with an explained variance of 55%. CONCLUSION: The NDI-S is a valid questionnaire to measure neck and arm pain related to disability in Serbian patients with cervical radiculopathy.

COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION

ABSTRACT Objective: To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program. Methods: This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire. Results: There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups. Conclusion: Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture. Level of Evidence II, Prognostic Studies .

Functional status measured by Levine questionnaire in surgically and conservatively treated patients with carpal tunnel syndrome regarding nerve conduction studies.

AIM: To evaluate and compare the functional status in surgically treated patients with Carpal tunnel syndrome (CTS) compared with those treated conservatively by Levine Questionnaire (LQ) in relation to electroneurographic findings. METHODS: The prospective study included 80 patients with diagnosed CTS. Patients were assessed clinically and electrophysiologically. The main outcome measures were sensory latency of median nerve (SL II), and terminal (distal) motor latency of median nerve (TML). For the assessment of functional status we performed Levine Questionnaire (LQ) scoring examination which was divided in two sections: symptoms severity scale (SSS) and functional status scale (FSS). Regarding treatment options patients were divided into 2 groups: group that underwent surgical procedure (Group A) and group that underwent only conservative treatment (Group B). Patients were assessed neurophysiologically twice: before treatment and 12 months after treatment. RESULTS: There is significant increase in LQ-FSS (p=0.021) and LQ-SSS (p=0.038) scores for increased TML and significant increase of LQ-SSS scores (p=0.027) for increased SL II for Group A, while in Group B, LQ-FSS (p=0.034) and LQ-SSS (p=0.018) were significantly increased in patients with increased SL II. After treatment there was significant increase in LQ-FSS (p=0.037) and LQ-SSS (p=0.041) scores for increased SL II for Group B, while in Group A after treatment, we have noticed non-significant differences both regarding TML and SL II values. CONCLUSION: We have demonstrated the benefits of surgical treatment and better functional improvement with symptoms reduction particularly in more severe cases of patients with CTS. KEY WORDS: Carpal tunnel syndrome, Conservative treatment.

COMORBIDITY IMPACT ON SOCIAL FUNCTIONING AFTER HIP FRACTURE: THE ROLE OF REHABILITATION.

OBJECTIVE: To analyze the impact of rehabilitation treatment on social functioning in elderly patients after hip fracture during a rehabilitation program. METHODS: This study included 203 patients with hip fracture. Four groups were analyzed on rehabilitation: Group 1, at admission, Group 2, at discharge, Group 3, three months after discharge and Group 4, six months after discharge. The analyzed parameters included: musculoskeletal, neurological and cognitive impairments. Impairment severity was graded by cumulative index rating scale for geriatrics (CIRS-G). Evaluation of social functioning was completed by social functioning component (SFC) from quality of life (SF-36) questionnaire. RESULTS: There was a significant improvement in SF-36 SFC values for observed impairments from admission to six months after discharge for each severity degree (p<0.01), except for CIRS-G severity degree 4 for cognitive impairment, where significance was p<0.05. For the group of patients with musculoskeletal impairment, there was a significant difference between the values of SF-36 SFC concerning different severity degrees of CIRS-G only at six months after discharge (p<0.05). Patients with neurological or cognitive impairments have shown significant differences between the values of SF-36 SFC in regard to severity degrees of CIRS-G in all observational groups. CONCLUSION: Different degrees of observed impairments influence the degree of social functioning recovery in the elderly after hip fracture.Level of Evidence II, Prognostic Studies .

Electrodiagnostic evaluation of patients with carpal tunnel syndrome regarding the presence of subjective and physical findings.

The aim of our study was to evaluate the changes of median nerve conduction velocities by electrodiagnostic procedure in carpal tunnel syndrome (CTS) patients with and without present subjective and physical findings. We have evaluated 116 patients that were diagnosis with CTS. Subjective findings: weakness, numbness and night pain were analyzed. Further physical findings were evaluated: Tinels sign, muscles hypotrophy and weakness according to muscle manual test (MMT). Duration of complaints was evaluated as well. Electroneurographic findings included: estimation of median nerve motor terminal latency (mMTL), sensory velocity (mSV) and motor velocity (mMV). Significantly longer complaints were present in patients who experienced night pain (p=0.015) and those with muscles weakness on MMT (p=0.016). Statistically significant increase for mMTL values was noticed for patients with Tinels sign (p=0.045), present muscles hypotrophy (p=0.001) and weakness on MMT (p=0.001). There is significant decrease for mMV in group with present Tinels sign (p=0.048), muscle hypotrophy (p=0.003) and weakness on MMT (p=0.002), and for mSV in group with present muscle hypotrophy (p=0.008) and group with weakness on MMT (p=0.019). Multivariate logistic regressional analysis shown that only for hypotrophy, mMTL variable presents significant independent contributor (p=0.009). For the diagnosis confirmation and treatment planning along with elecroneurography it is necessary to evaluate patients with CTS clinically, since different clinical manifestations are correlating in different degree with electroneurographic findings.

Medial tibial stress syndrome: case report.

INTRODUCTION: Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. CASE REPORT: A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. CONCLUSION: The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome.

Scintigraphy evaluation of the types of functional constipation in children with bowel bladder dysfunction.

PURPOSE: To evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group). PATIENTS AND METHODS: One-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit. RESULTS: FFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections. CONCLUSIONS: FFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children..

Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome.

OBJECTIVE: This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for <1 year. METHODS: Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm(2)/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel's sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment. RESULTS: Significant reduction in pain, reduction in the percentage of patients with a positive Tinel's sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group). CONCLUSIONS: This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.