Effects of action observation treatment in recovery after total knee replacement: a prospective clinical trial.

OBJECTIVE: We hypothesized that self-administered action observation treatment can increase the effectiveness of inpatient rehabilitation of patients after a primary total knee replacement. DESIGN: A pilot randomized controlled trial. SETTING: Thirty-one inpatients, admitted to our Physical and Rehabilitation Medicine Department. SUBJECTS: After a primary total knee replacement were randomly assigned to either an experimental ( n=14) or control ( n=17) group. INTERVENTION: All subjects received conventional physiotherapy and were required to perform additional self-administered exercises explained in a written informative brochure. Subjects in the experimental group were asked to watch a video showing a person exercising whilst the control group watched a nature video without exercises being shown. MAIN OUTCOMES MEASURE: Changes in Visual Analogue Scale, active and passive range of motion of knee, Barthel index, Short Form-36 Health Survey, Tinetti scale, Lequesne index measurements. RESULTS: At the end of the intervention period, the increase of the active range of motion over the active flexion and extension in the experimental group was higher than in the control group; the difference between groups was 15.6° (95%CI 5.3-24.8) and 3.4° (95%CI 1.1-5.6), for active flexion and active extension respectively; between-group effect sizes were large at post-treatment period (d>1.3). CONCLUSIONS: adding action observation training to conventional inpatient physiotherapy is associated with a greater degree of recovery in patients who have undergone a primary total knee replacement.

Effects of Action Observation Therapy in Patients Recovering From Total Hip Arthroplasty Arthroplasty: A Prospective Clinical Trial.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of action observation therapy (AOT) compared with written information in patients submitted to a physical therapy program after primary total hip arthroplasty (THA). METHODS: We conducted a prospective clinical trial. Twenty-four patients with THA, 62.5% female (aged 69.0 ± 8.5 years), received AOT in addition to conventional physical therapy (experimental group) or written information in addition to conventional physical therapy (exercise and information group) for 10 sessions. Outcomes used were visual analog scale, hip active and passive range of motion, Barthel Index, Short Form 36 (SF-36) Health Survey, Tinetti Scale, and Lequesne Index measurements. All measures were collected at baseline and at the end of the intervention. Repeated measures analysis of variance was used to examine the interventions effects within groups and between groups. RESULTS: No relevant baseline differences were observed between groups. Both treatments produced statistically significant improvements on visual analog scale, active and passive range of motion, Barthel Index, SF-36, Tinetti Scale, and Lequesne Index immediately after the intervention (all, P < .001). SF-36 (physical functioning subscale) revealed a statistically significant intergroups difference (P = .02) after treatment. CONCLUSIONS: Both treatments were effective at improving pain, functional status, quality of life, and gait features in patients with primary THA. In addition to conventional physical therapy, AOT improved perceived physical function more than written information. TRIAL REGISTRATION IDENTIFIER: NCT02861638.

Association between malnutrition and Barthel Index in a cohort of hospitalized older adults article information.

[Purpose] In this study, we sought to evaluate the relationship between the Barthel Index and the Mini Nutritional Assessment Short Form in a cohort of elderly patients hospitalized in the General Rehabilitation Center. [Subjects and Methods] Three hundred and forty-four patients underwent an extensive evaluation, which included the following tests: 1) a Mini Nutritional Assessment Short Form to evaluate nutritional status; and 2) a Barthel Index assessment to evaluate functional status. We categorized patients into three age groups (65-74 yrs, 75-84 yrs, and >85 yrs). Barthel Index cutoff scores were defined as ≥45 out of 100 for better functional status and <45 for worse functional status. [Results] Significant associations between age distribution and the scores obtained with the Barthel Index and Mini Nutritional Assessment Short Form were found; nutritional status measured with Mini Nutritional Assessment Short Form and functional status measured with the Barthel Index were positively related. [Conclusion] This study shows that the Mini Nutritional Assessment Short Form value was associated with the Barthel Index score, and that these scores varied with age.

Moving forward in fall prevention: an intervention to improve balance among patients in a quasi-experimental study of hospitalized patients.

We investigated the effectiveness of three different rehabilitative programs: group exercise, individual core stability or balance training intervention with a stabilometric platform to improve balance ability in elderly hospitalized patients. We used a prospective quasi-experimental study design. Twenty-eight patients, 39.3% women [age (mean±SD) 72.4±6.5 years], known to have had at least a fall in the last 12 months, were consecutively assigned to one of the following three groups: group exercise intervention, individual core stability or balance training with a stabilometric platform (five sessions a week for 3 weeks in each group). Outcomes were collected at baseline and immediately following the intervention period. In each intervention group, patients showed improvement in balance and mobility, shown as an improvement in the three functional tests score (the Tinetti scale, the Berg Balance Scale, and the Time Up and Go test) (all, P<0.05), whereas, generally, the changes in the score of the test of the stabilometric platform (Postural Stability Test and Fall Risk Test) were not significant for all the interventions. No significant group-by-time interaction was detected for any of the intervention groups, which suggests that the groups improved in the same way. These findings indicate that participation in an exercise program can improve balance and functional mobility, which might contribute toward the reductions of the falls of elderly hospitalized patients and the subsequent fall-related costs. Functional scales might be more appropriate than an instrumental test (Postural Stability Test and Fall Risk Test of the Biodex Balance System) in detecting the functional improvement because of a rehabilitative intervention.

The diagnostic accuracy of five tests for diagnosing partial-thickness tears of the supraspinatus tendon: A cohort study.

STUDY DESIGN: A cohort study. INTRODUCTION: The causes of the pain can be difficult for clinicians to diagnose due to the complexity of the shoulder anatomy and the wide spectrum of shoulder conditions. PURPOSE OF THE STUDY: The aim of this study was to investigate the clinical usefulness of provocative diagnostic tests, in patients with partial-thickness tears of the supraspinatus (SST) tendon. METHODS: The partial-thickness tears SST tendon group consisted of 50 patients and 50 subjects with shoulder pain. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of five physical examination tests were calculated using a 2 × 2 table. RESULTS: All the tests exhibited clinical useful positive LR greater than 2 (all, >7.0). The Yocum, Jobe, and Hawkinse-Kennedy exhibited clinically useful negative LR of less than 0.5. CONCLUSIONS: The provocative tests examined were clinically useful in determining the presence or absence of pathology of the supraspinatus tendon. LEVEL OF EVIDENCE: 2b.

Botulinum toxin treatment for slipping rib syndrome: a case report.

BACKGROUND: Slipping rib syndrome (SRS) is a musculoskeletal cause of severe and recurrent thoracic or abdominal pain. The etiology of SRS is unknown, it seems to arise from costal hypermobility with a tendency of one of the ribs (usually from 8th to 10th but also 11th and 12th have been described) to slip under the superior adjacent rib. Its prevalence is underestimated because SRS is mainly a clinical diagnosis, frequently missed. The critical aspect of the diagnosis is knowledge of the condition itself, which, when lacking, often results in the patient being referred to many different specialists and exposed to unnecessary and costly investigations. The management of the condition includes conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block. However, where conservative therapy fails, surgical treatment, with excision of the rib, may be performed. METHODS: In this paper we describe the case of a patient with persistent and debilitating flank pain who, after many investigations, was diagnosed with SRS. RESULTS: The usual conservative treatment failed, after which we treated the patient with injections of incobotulinumtoxin A into muscles inserting on the inferior side of the rib cage (quadratus lumborum muscle, muscle transversus abdomini, abdominal external oblique muscle, and recto abdomini) achieving a complete relief from pain. CONCLUSIONS: To our knowledge botulinum toxin has never been proposed before for the treatment of SRS. We believe that it should be considered as a therapeutic option, especially where other medical treatments have failed or as an intermediate step before surgical intervention.