RESUMO
OBJECTIVES: To compare 12-month spinal fusion surgery rates in the setting of low back pain among digital musculoskeletal (MSK) program participants versus a comparison cohort who only received usual care. STUDY DESIGN: Retrospective cohort study with propensity score matched comparison cohort using commercial medical claims data representing over 100 million commercially insured lives. METHODS: All study subjects experienced low back pain between January 2020 and December 2021. Digital MSK participants enrolled in the digital MSK low back program between January 2020 and December 2021. Non-participants had low back pain related physical therapy (PT) between January 2020 and December 2021. Digital MSK participants were matched to non-participants with similar demographics, comorbidities and baseline MSK-related medical care use. Spinal fusion surgery rates at 12 months post participation were compared. RESULTS: Compared to non-participants, digital MSK participants had lower rates of spinal fusion surgery in the post-period (0.7% versus 1.6%; p < 0.001). Additionally, in the augmented inverse probability weighting (AIPW) model, digital MSK participants were found to have decreased odds of undergoing spinal fusion surgery (adjusted odds ratio: 0.64, 95% CI: 0.51-0.81). CONCLUSIONS: This study provides evidence that participation in a digital MSK program is associated with a lower rate of spinal fusion surgery.
Assuntos
Dor Lombar , Fusão Vertebral , Humanos , Fusão Vertebral/estatística & dados numéricos , Fusão Vertebral/tendências , Fusão Vertebral/efeitos adversos , Masculino , Feminino , Dor Lombar/cirurgia , Dor Lombar/epidemiologia , Dor Lombar/diagnóstico , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Pontuação de Propensão , Resultado do Tratamento , Modalidades de Fisioterapia/estatística & dados numéricos , Modalidades de Fisioterapia/tendênciasRESUMO
PURPOSE: To determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture. METHODS: A cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders. RESULTS: Of 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5-13) and 20 (IQR 8-38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2-3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2-3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02). CONCLUSION: Hip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.
Assuntos
Fraturas do Quadril , Tempo de Internação , Alta do Paciente , Modalidades de Fisioterapia , Humanos , Feminino , Masculino , Fraturas do Quadril/cirurgia , Fraturas do Quadril/reabilitação , Idoso , Idoso de 80 Anos ou mais , Alta do Paciente/tendências , Modalidades de Fisioterapia/tendências , Estudos de Coortes , Tempo de Internação/tendências , Tempo de Internação/estatística & dados numéricos , Austrália/epidemiologia , Pessoa de Meia-Idade , Nova Zelândia/epidemiologiaRESUMO
BACKGROUND: Vestibular rehabilitation (VR) is a commonly employed treatment method for disorders of dizziness and imbalance. Access to a clinic for rehabilitation appointments can be challenging for a person experiencing dizziness. Telehealth may offer a comparable alternative to clinic-based VR for some patients. OBJECTIVE: The objective of this study was to determine the efficacy of telehealth-based VR compared to traditional clinic-based VR, as measured with the Dizziness Handicapped Inventory (DHI) in a retrospective sample of patients with vestibular conditions. METHODS: This is a retrospective, multi-institutional review from May 2020 to January 2021. Three study groups were analyzed: a telehealth group, a hybrid group, and a clinic based control group. Treatment efficacy was measured using the DHI. A repeated measures ANCOVA was performed to compare changes between the groups and across timepoints. RESULTS: The repeated measures ANCOVA was not significant for the interaction of groups (control, telehealth, and hybrid) by time (pre and post) (pâ>â0.05). However, there was a significant main effect for time (pre and post) (pâ<â0.05). Specifically, all groups improved DHI scores from pre to post treatment with mean differences of control: 31.85 points, telehealth: 18.75 points, and hybrid: 21.45 points. CONCLUSION: Findings showed that in-clinic, telehealth, and hybrid groups demonstrated a decrease in DHI scores, indicating self-reported improvements in the impact of dizziness on daily life. Continued research is recommended to explore the efficacy of using telehealth in assessing and treating vestibular conditions.
Assuntos
Tontura , Modalidades de Fisioterapia , Telemedicina , Doenças Vestibulares , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Doenças Vestibulares/reabilitação , Doenças Vestibulares/terapia , Tontura/terapia , Tontura/reabilitação , Modalidades de Fisioterapia/tendências , Adulto , Idoso , Resultado do TratamentoAssuntos
Medo/psicologia , Dor Musculoesquelética/psicologia , Dor Musculoesquelética/reabilitação , Modalidades de Fisioterapia/tendências , Medicina Física e Reabilitação/tendências , Aprendizagem da Esquiva , Humanos , Movimento , Transtornos Fóbicos/etiologia , Transtornos Fóbicos/reabilitação , Modalidades de Fisioterapia/psicologiaRESUMO
BACKGROUND: The novel coronavirus SARS-CoV-2 has caused a global COVID-19 pandemic, leading to worldwide changes in public health measures. In addition to changes in the public sector (lockdowns, contact restrictions), hospitals modified care to minimize risk of infection and to mobilize resources for COVID-19 patients. Our study aimed to assess the impact of these measures on access to care and behaviour of patients with thoracic malignancies. METHODS: Thoracic oncology patients were surveyed in October 2020 using paper-based questionnaires to assess access to ambulatory care services and tumor-directed therapy during the COVID-19 pandemic. Additionally, behaviour regarding social distancing and wearing of face masks were assessed, as well as COVID-19 exposure, testing and vaccination. Results are presented as absolute and relative frequencies for categorical variables and means with standard deviation for numerical variables. We used t-test, and ANOVA to compare differences in metric variables and Chi2-test to compare proportions between groups. RESULTS: 93 of 245 (38%) patients surveyed completed the questionnaire. Respiration therapy and physical therapy were unavailable for 57% to 70% of patients during March/April. Appointments for tumor-directed therapy, tumor imaging, and follow-up care were postponed or cancelled for 18.9%, 13.6%, and 14.8% of patients, respectively. Patients reported their general health as mostly unaffected. The majority of patients surveyed did not report reducing their contacts with family. The majority reduced contact with friends. Most patients wore community masks, although a significant proportion reported respiratory difficulties during prolonged mask-wearing. 74 patients (80%) reported willingness to be vaccinated against SARS-CoV-2. CONCLUSIONS: This survey provides insights into the patient experience during the second wave of the COVID-19 pandemic in Munich, Germany. Most patients reported no negative changes to cancer treatments or general health; however, allied health services were greatly impacted. Patients reported gaps in social distancing, but were prepared to wear community masks. The willingness to get vaccinated against SARS-CoV-2 was high. This information is not only of high relevance to policy makers, but also to health care providers.
Assuntos
Assistência Ambulatorial/tendências , COVID-19/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Neoplasias Pulmonares/terapia , Oncologia/tendências , Padrões de Prática Médica/tendências , Idoso , Agendamento de Consultas , COVID-19/diagnóstico , COVID-19/transmissão , Vacinas contra COVID-19/uso terapêutico , Estudos Transversais , Feminino , Alemanha , Pesquisas sobre Atenção à Saúde , Nível de Saúde , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Máscaras/tendências , Pessoa de Meia-Idade , Modalidades de Fisioterapia/tendências , Terapia Respiratória/tendências , Comportamento Social , Fatores de Tempo , Tempo para o Tratamento/tendênciasRESUMO
OBJECTIVE: To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. METHODS: Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. RESULTS: A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. CONCLUSION: Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
Assuntos
Modalidades de Fisioterapia/tendências , Escleroderma Sistêmico/reabilitação , HumanosRESUMO
PURPOSE: The purpose of this study was to identify the important factors, facilitators, and barriers for telehealth effectiveness as described by pediatric physical therapists, transitioning from in-person to telehealth during the COVID-19 pandemic. METHODS: Pediatric physical therapists' responses to 3 open-ended questions and 1 multipart Likert Scale question from an anonymous survey were collected and analyzed using thematic analysis and descriptive statistics. RESULTS: Three overarching themes (Caregiver Engagement, Technology, and Resilience) were identified and accompanied by 3 subthemes (Personal Attributes, Equity, and COVID-Specific Considerations). Themes were supported by the Likert Scale question with Child/Caregiver Interaction, Internet Connection, and Family Factors identified as the most important factors related to telehealth effectiveness. CONCLUSIONS: High caregiver engagement and access to stable technology were most important for telehealth effectiveness. The telehealth service model met a need during the pandemic; however, emerging evidence suggests that it could be considered as an effective service delivery mode postpandemic.
Assuntos
COVID-19/epidemiologia , Modalidades de Fisioterapia/tendências , Telemedicina/estatística & dados numéricos , Criança , Humanos , Pandemias , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
INTRODUCTION/AIM: This retrospective study aimed to quantify the changes in motor function in patients with Duchenne muscular dystrophy (DMD) due to the government-imposed travel restrictions associated with the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Twelve DMD patients were enrolled in this investigation (mean ± SD age: 9.8 ± 3.6 y). Their physical characteristics and motor function were evaluated approximately 3 mo before, immediately before, and approximately 3 mo after the travel restrictions were decreed. Statistical comparisons were performed of the changes in motor function before and after the travel restrictions. RESULTS: The change in range of motion (ROM) of ankle dorsiflexion was significantly decreased after the travel restrictions. Changes in body mass index and other motor function parameters were not significant. DISCUSSION: An apparent decrease in the amount of physical activity due to travel restrictions in response to COVID-19 negatively affected ankle dorsiflexion ROM but not other motor functions. A more sedentary lifestyle and lack of regular physical therapy services most likely contributed to this reduction. The use of remote rehabilitation tools with the involvement of physiotherapists may help mitigate such changes and prevent more severe physical decline.
Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Destreza Motora/fisiologia , Distrofia Muscular de Duchenne/terapia , Modalidades de Fisioterapia , Viagem , Adolescente , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/tendências , Feminino , Humanos , Masculino , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/fisiopatologia , Modalidades de Fisioterapia/tendências , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Viagem/tendênciasRESUMO
SYNOPSIS: In this Viewpoint, I argue that we may be at an inflection point in the course of the physical therapy profession. The current debate over "active" and "passive" therapies highlights once again how much physical therapy practices reflect shifting cultural and social attitudes. Calls for less passive management of musculoskeletal conditions and more self-management reflect the neoliberal desire for autonomous, entrepreneurial, endlessly resilient, and self-sufficient subjects who will shift the burden of health care from the state to the individual. Such shifts in practice have important implications for therapists and clients alike, and practitioners should give careful thought to what is going on at a deeper societal level when they contemplate profound changes in practice. J Orthop Sports Phys Ther 2021;51(7):318-321. Epub 15 May 2021. doi:10.2519/jospt.2021.10536.
Assuntos
Dor Musculoesquelética/terapia , Modalidades de Fisioterapia/tendências , Previsões , Humanos , AutogestãoRESUMO
As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.
Assuntos
Obesidade Infantil/terapia , Programas de Redução de Peso/métodos , Terapia Comportamental/métodos , Terapia Comportamental/organização & administração , Terapia Comportamental/tendências , Criança , Redes Comunitárias/organização & administração , Redes Comunitárias/tendências , Humanos , Terapia Nutricional/métodos , Terapia Nutricional/tendências , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Obesidade Infantil/epidemiologia , Obesidade Infantil/etiologia , Modalidades de Fisioterapia/organização & administração , Modalidades de Fisioterapia/tendências , Prevalência , Serviços de Saúde Escolar/organização & administração , Serviços de Saúde Escolar/tendências , Programas de Redução de Peso/organização & administração , Programas de Redução de Peso/tendênciasRESUMO
STUDY DESIGN: A systematic review and meta-analysis. OBJECTIVE: This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. SUMMARY OF BACKGROUND DATA: Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. METHODS: Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. RESULTS: Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. CONCLUSION: Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.
Assuntos
Terapia por Exercício/métodos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/reabilitação , Teste de Esforço/métodos , Teste de Esforço/tendências , Terapia por Exercício/tendências , Feminino , Humanos , Pessoa de Meia-Idade , Modalidades de Fisioterapia/tendências , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Traumatismos da Medula Espinal/psicologia , Estimulação Magnética Transcraniana/métodos , Estimulação Magnética Transcraniana/psicologia , Estimulação Magnética Transcraniana/tendências , Resultado do Tratamento , Caminhada/fisiologia , Adulto JovemRESUMO
In this systematic review, objectives were to investigate dropout rates, adverse events, and effects of exercise-based therapies on urogenital function and quality of life (QoL) in persons with spinal cord injury (SCI). Database searches were conducted on MEDLINE, EMBASE, and CINAHL for studies examining any form of exercise intervention on urogenital function and/or QoL in adults with SCI. Quality of publications was evaluated using the Joanna Briggs Institute critical evaluation tools. When possible, Hedges' g was calculated for overall effect sizes. Subgroup analyses were conducted on sex and injury severity. Ten studies (228 participants) were included in this review. Three studies examined pelvic floor muscle training, and seven studies examined locomotor training. Overall quality of evidence was low because of small sample sizes and non-randomized designs in most studies. Dropout rates ranged from 12% to 25%, and adverse events were reported only in some studies investigating locomotor training. For lower urinary tract (LUT) outcomes, urodynamic findings were mixed despite moderately positive changes in maximum bladder capacity (g = 0.50) and bladder compliance (g = 0.37). Fairly consistent, but small, improvements were observed in LUT symptoms, primarily bladder awareness and incontinence. LUT QoL improved in most cases. Fewer data were available for sexual outcomes, and only minor improvements were reported. Subgroup analyses, based on sex and severity of injury, were inconclusive. There is some indication for the potential benefit of exercise on urogenital outcomes in persons with SCI, but there is insufficient evidence given the number of studies and heterogeneity of outcome measures.
Assuntos
Terapia por Exercício/métodos , Qualidade de Vida , Traumatismos da Medula Espinal/terapia , Incontinência Urinária/terapia , Terapia por Exercício/tendências , Humanos , Modalidades de Fisioterapia/tendências , Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/psicologia , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/psicologiaRESUMO
In late 2019, a previously unknown coronavirus, SARS-CoV-2 (the coronavirus that causes COVID-19), was reported in Wuhan, China. Similar to the polio virus epidemic, the fear, uncertainty, and collective response associated with COVID-19 have disrupted daily life on a global scale. In this editorial, we argue that it is time for musculoskeletal physical therapists to grasp the opportunity provided by the COVID-19 pandemic to provide care that is (1) primarily active, (2) focused on self-efficacy and self-management, and (3) far less reliant on passive therapies. J Orthop Sports Phys Ther 2021;51(1):5-7. doi:10.2519/jospt.2021.0102.
Assuntos
COVID-19 , Doenças Musculoesqueléticas/terapia , Modalidades de Fisioterapia/tendências , COVID-19/epidemiologia , Previsões , Humanos , Pandemias , SARS-CoV-2 , AutogestãoRESUMO
BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2-10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3-5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large effect sizes. These gains were maintained or improved upon 3 months' post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions.
Assuntos
Terapia por Exercício/métodos , Destreza Motora/fisiologia , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/terapia , Terapia Ocupacional/métodos , Fonoterapia/métodos , Criança , Pré-Escolar , Terapia por Exercício/tendências , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/diagnóstico , Terapia Ocupacional/tendências , Modalidades de Fisioterapia/tendências , Projetos Piloto , Fonoterapia/tendências , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common form of nerve entrapment. Clinically, various signs and symptoms compare due to overexposure to mechanical vibrations transmitted to the wrist bones and cartilage, resulting in compression of the sensory and motor nerve fibers of the median nerve. Early symptoms include nocturnal paresthesia and electromyography reveals reduced sensory nerve conduction velocity. Aim of this study was to evaluate the efficacy of a dietary integrator composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins in patients with early (minimal) carpal tunnel syndrome. METHODS: 36 patients (28 female and 8 male) with early CTS characterized by sensory nerve demyelination and inflammation of the transverse carpal ligament. Patients were divided into two groups, group A (18 patients received physical therapy) and group B (18 patients received physical therapy and an oral integrator). Clinical (sleep quality questionnaire to measure severity of paresthesia) and neurophysiological assessment (Sensory Nerve Conduction Velocity) performed at baseline, and then at 30 and 60 days after treatment. RESULTS: Sleep quality and Sensory Nerve Conduction Velocity data analysis show improvement in both groups at 30 and 60 days, with statistical difference between them in both time of analysis. CONCLUSION: In the early CTS, with sensory fibers damage, use of dietary integrator, such as Micronil Dol®, composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins can be effective in quick recovery of median nerve sensory.
Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/terapia , Suplementos Nutricionais , Terapia por Exercício/métodos , Condução Nervosa/fisiologia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico , Estudos de Casos e Controles , Terapia por Exercício/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/tendências , Sono/fisiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine the utilization of physical therapy (PT) and predictors for its use in individuals with osteoarthritis (OA) while focusing on sociodemographic and disease-related factors. METHODS: For this cross-sectional study, 657,807 patients (age 30-79 years) diagnosed with hip, knee, or polyarticular OA were identified in claims data. In 2016, a questionnaire including information on disease status, demography, and socioeconomics was sent to a random sample of 8,995 patients stratified by sex, age, and type of diagnosis. Claims data from 2016 included the utilization and type of PT, as well as the prescribing medical specialist, and were linked to questionnaire data. Multivariable logistic regression was conducted to determine variables associated with the use of PT. RESULTS: In total, 3,564 (40%) patients completed the questionnaire and agreed to linking questionnaire and claims data (69% female, mean age 66.5 years). In 2016, 50% of the study population received PT at least once, and women received it more frequently than men (53% versus 43%). Most PT was prescribed by orthopedists (45%) and general practitioners (32%). Multivariable logistic regression showed that women, higher household income, having both hip and knee OA, lower functional status, higher disease activity, and individuals living in the eastern, southern, and western states of Germany were associated with an increased utilization of PT. CONCLUSION: Considering current guideline recommendations and that more than one-third of OA patients with high functional impairment and/or pain did not receive PT in the last 12 months, there is considerable potential for improvement. This is especially true for men and individuals with a low income.
Assuntos
Osteoartrite/terapia , Modalidades de Fisioterapia/tendências , Padrões de Prática Médica/tendências , Demandas Administrativas em Assistência à Saúde , Adulto , Idoso , Bases de Dados Factuais , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes/tendências , Pesquisas sobre Atenção à Saúde , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/epidemiologia , Osteoartrite/fisiopatologia , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de TempoRESUMO
Facial nerve paralysis (FNP) has a significant effect on a person's quality of life. In individuals with FNP undergoing facial rehabilitation, methods to analyze the loss of function are useful in diagnosis, treatment and follow up. To propose a protocol with kinematic analysis coupled with sEMG to evaluate the outcomes of FNP, quantifying the excursion degrees of the facial muscles and symmetry of voluntary movements. 10 patients (Group A) were followed by diagnosis until the end of the rehabilitation program. Kinematic analysis of 20 healthy adults (group B) was performed as a starting point to have a normality range and to test intra-subject and inter- intra rater reliability. An optoelectronic system and sEMG wireless electrodes were used. In Group A, a significant improvement in the movement of frontalis muscle (P = 0.0118) after 4-week treatment from the beginning (T0) 9.8 ± 4.5 mm to the end of rehabilitation (T1) 16.3 ± 5.8 mm and orbicularis oris (P = 0.0143) from T0 14.8 ± 5.5 mm to T1 20.3 ± 3.3 mm and, a reduction of % of maximum voluntary contractions (MVC) at T1 for frontalis and orbicularis compared to T0. This protocol provides meaningful data in a simple, reliable and objective way for the functional assessment of patients with PNF.
Assuntos
Fenômenos Biomecânicos/fisiologia , Eletromiografia/métodos , Músculos Faciais/fisiopatologia , Paralisia Facial/fisiopatologia , Movimento/fisiologia , Adulto , Nervo Facial/fisiopatologia , Paralisia Facial/diagnóstico , Paralisia Facial/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/tendências , Qualidade de Vida , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Quadriceps dysfunction is a common, chronic complication following anterior cruciate ligament reconstruction (ACLR) that contributes to aberrant gait biomechanics and poor joint health. Vibration enhances quadriceps function in individuals with ACLR, but the duration of these effects is unknown. This study evaluated the time course of the effects of whole body vibration (WBV) and local muscle vibration (LMV) on quadriceps function. Twenty-four volunteers with ACLR completed 3 testing sessions during which quadriceps isometric peak torque, rate of torque development, and EMG amplitude were assessed prior to and immediately, 10, 20, 30, 45, and 60 min following a WBV, LMV, or control intervention. WBV and LMV (30 Hz, 2g) were applied during six one-minute bouts. WBV increased peak torque 5-11% relative to baseline and control at all post-intervention time points. LMV increased peak torque 6% relative to baseline at 10 min post-intervention and 4-6% relative to control immediately, 10 min, and 20 min post-intervention. The interventions did not influence EMG amplitudes or rate of torque development. The sustained improvements in quadriceps following vibration, especially WBV, suggest that it could be applied at the beginning of rehabilitation sessions to "prime" the central nervous system, potentially improving the efficacy of ACLR rehabilitative exercise.