Health-related quality-of-life during rehabilitation in patients with critical illness neuropathy/myopathy after severe coronavirus disease 2019.

Our aim was to evaluate health-related quality-of-life (HRQoL) of the patients with critical illness neuropathy and/or myopathy after severe COVID-19 during their rehabilitation. The prospective cohort study included 157 patients (median age 64 years) admitted to rehabilitation. HRQoL was assessed the using European Quality 5-Dimensions questionnaire [EQ-5D index , range 0(or exceptionally less) to 1, and Visual Analogue Scale (VAS), range 0-100], which was completed by the patients at admission and discharge. Additionally, they were assessed with the de Morton Mobility Index (DEMMI), the 6-Minute Walk Test (6MWT), and the Functional Independence Measure (FIM). Median EQ-5D index was 0.32 and median EQ VAS was 48 at admission, and median EQ-5D index was 0.61 and median EQ VAS 80 at discharge. Some or extreme problems were reported by 154 (98%) patients regarding the mobility dimension, 151 (96%) regarding usual activities, 136 (87%) regarding self-care, 84 (54%) regarding pain or discomfort dimension, and 52 patients (34%) regarding anxiety or depression at admission. At discharge, some or extreme problems were still reported by 96 patients (61%) regarding mobility, 95 (61%) regarding usual activities, 70 patients (45%) regarding pain or discomfort, 46 (29%) regarding self-care, and 19 patients (12%) regarding anxiety or depression. At the same time, the patients exhibited significant improvements in the DEMMI (median increased from 41 to 67 points), 6MWT (from 60 to 293 m) and motor FIM (from 56 to 84 points). The improvement of the self-reported HRQoL was, thus, paralleled by the improvements in clinician-assessed mobility, walking endurance and functional independence.

Therapeutic electric stimulation does not affect immune status in healthy individuals - a preliminary report.

BACKGROUND: Neuromuscular electric stimulation is widely used for muscle strengthening in clinical practice and for preventative purposes. However, there are few reports on the effects of electric stimulation on the immune response of the organism, and even those mainly describe the changes observed immediately after the electrotherapeutic procedures. The objective of our study was to examine the possible immunological consequences of moderate low-frequency transcutaneous neuromuscular electric stimulation for quadriceps muscle strengthening in healthy individuals. METHODS: The study included 10 healthy volunteers (5 males, 5 females, mean age 37.5 years). At the beginning and after a two-week electric stimulation program, muscle strength was measured and peripheral blood was collected to analyse white blood cells by flow cytometry for the expression of cell surface antigens (CD3, CD19, CD4, CD8, CD4/8, DR/3, NK, Th reg, CD25 + CD3+, CD25 + CD4+, CD25 + CD8+, CD69 + CD3+, CD69 + CD4+, CD69 + CD8+) and phagocytosis/oxidative killing function. RESULTS: Muscle strength slightly increased after the program on the dominant and the nondominant side. No statistically or clinically significant difference was found in any of the measured blood and immune cells parameters as well as phagocytosis and oxidative burst function of neutrophil granulocytes and monocytes one day after the program. CONCLUSIONS: The program of transcutaneous low-frequency electric stimulation slightly strengthened the quadriceps femoris muscle while producing no changes in measured immunological parameters. Hence, therapeutic low-frequency electric stimulation appears not to be affecting the immune response of healthy persons.

Rehabilitation of COVID-19 patients with respiratory failure and critical illness disease in Slovenia: an observational study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often causes pneumonia and respiratory failure that may lead to postintensive care syndrome, including critical illness neuropathy (CIN) and critical illness myopathy (CIM). The data on the rehabilitation outcomes of post-novel coronavirus disease (COVID) patients with CIN and CIM following respiratory failure and mechanical ventilation are still limited. To address this, we enrolled in our prospective observational study a sample of 50 consecutive COVID-19 patients admitted to our facility between 2 November 2020 and 3 May 2021 with electrophysiologically confirmed or clinically suspected diagnosis of CIN/CIM. The functional abilities were assessed at admission and discharge with the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure, 10-metre walk test, 6-min walk test and the de Morton Mobility Index. The gain in motor FIM and the length of stay were used as an index of rehabilitation efficiency. Nutritional status was also assessed using anthropometric measurements and bioelectrical Impedance analysis. Psychologic evaluation was performed at admission only. At admission, functional limitations and severe malnutrition were present in all patients with psychologic problems in about one third. At discharge (42 ± 16 days later), clinically important and statistically significant improvements were found in all outcome measures, which was also noted by the patients. The gain in motor FIM was larger with the longer length of stay up to 2 months and plateaued thereafter. We conclude that post-COVID-19 patients who develop CIN/CIM following respiratory failure can improve functional and nutritional status during inpatient rehabilitation.

The associations between nutritional and functional status during recovery from Guillain-Barré syndrome: a retrospective study.

Patients with Guillain-Barré syndrome (GBS) are at high risk for inadequate nutrition throughout their illness, yet the wider impact of malnutrition in this population remains unknown. Thus, the purpose of our study was to investigate the associations between nutritional status and functional status at admission to inpatient rehabilitation for GBS and to determine whether the admission phase angle, a biological marker of cellular health, is a prognostic indicator of functional improvement at the end of rehabilitation. The study included 27 participants recovering from GBS who screened positive for nutritional risk upon admission to rehabilitation. According to the Global Leadership Initiative on Malnutrition criteria, the majority of participants were classified as malnourished. A decreased phase angle was found in 93% (mean 3.7°, SD 1.3°). Lower phase angle was moderately associated with lower motor Functional Independence Measure (mFIM) at admission (r = 0.53, P = 0.005), suggesting that phase angle may be an indicator of functional status. By the end of rehabilitation, all participants improved functional independence and muscle strength, and the majority improved walking abilities. However, the correlation between admission phase angle and mFIM efficiency was not statistically significant (P = 0.3867). We conclude that malnutrition is significantly associated with low functional independence and muscle strength at admission. The inability of admission phase angle to predict functional improvement is probably due to the complex interactions between recovery from GBS and interventions provided during a comprehensive multidisciplinary rehabilitation for GBS, and also relatively small sample size.

Influence of foot orthoses on plantar pressures, foot pain and walking ability of rheumatoid arthritis patients--a randomised controlled study.

PURPOSE: To compare the effectiveness of functional foot orthoses and unshaped (flat) orthotic material on plantar pressure redistribution, forefoot pain reduction and walking ability in rheumatoid arthritis (RA) patients. METHODS: Forty patients with RA were randomised to receive unshaped material (UM) (n = 20) or functional foot orthoses (n = 20). Plantar pressure measurement was performed with an F-scan system. Foot pain was assessed by the pain subscale of the Foot Function Index. Walking ability was assessed by the 6-min walking test. Investigations were performed at baseline, 1 week after the patient received shoes with orthoses and 6 months later. RESULTS: Plantar pressures were significantly higher at painful than at non-painful foot areas. No differences in plantar pressure redistribution were found between the groups. Notable reduction of pain and improvement of activity (walking ability) was observed in both groups. Foot pain has moderate impact on the walking ability of RA patients. CONCLUSIONS: The study showed no clear advantage of functional foot orthoses over UM.

Feasibility of de Morton Mobility Index for adult patients of all ages at low and basic functioning level: a study using the Slovenian translation.

We investigated metric properties of the Slovenian translation of de Morton Mobility Index in patients with musculoskeletal impairments during rehabilitation. The study included 30 inpatients, aged 22-84 years, with musculoskeletal impairments with or without impairment of peripheral nerves. They were assessed repeatedly with de Morton Mobility Index, Functional Ambulation Classification, Ten-metre Walk Test, Six-minute Walk Test, Berg Balance Scale and the motor subscale of the Functional Independence Measure. Convergent validity of de Morton Mobility Index was confirmed by good to very good correlations with the other measurements. Known-groups validity was demonstrated by significant differences in de Morton Mobility Index scores between patients who were not able to walk and those who were able to walk with or without waking aid, at admission and after 4 weeks. Predictive validity of de Morton Mobility Index for functional independence after 4 weeks of rehabilitation was moderate. Minimal clinically important difference of de Morton Mobility Index was estimated to be five points. De Morton Mobility Index was responsive after 2 and 4 weeks of rehabilitation (Cohen's d 1.15 and 0.95, respectively). No floor or ceiling effects were identified. Internal validity of de Morton Mobility Index was confirmed by Rasch analysis. Hence, de Morton Mobility Index is a valid, unidimensional, and responsive measure of mobility for patients with musculoskeletal impairments at rehabilitation regardless of age. Its use is recommended for adult patients at low and basic functioning level.

Therapeutic electrical stimulation and immune status in healthy men.

In physical and rehabilitation medicine, there are few reports on the effects of therapeutic low-frequency electrical stimulation on the immune response of the organism, even though electrical stimulation is used widely in clinical practice and sports medicine. The aim of our study was to examine the possible immunological consequences of moderate transcutaneous neuromuscular electrical stimulation (NMES) for quadriceps muscle strengthening in healthy individuals. The study included twelve healthy male adult volunteers (mean age 42 years) without contraindications for electrical stimulation. At the beginning and immediately after a 20-min session of NMES of quadriceps muscles, peripheral blood was collected to analyse the biochemical blood components (creatinine, creatine kinase, estimated glomerular filtration rate, cortisol), differential white blood cell count and immunological parameters. The intensity of NMES was set at maximum tolerance, eliciting on average about one-sixth of the maximum voluntary isometric contraction of the same leg. No statistically significant differences in the average group level were found in any of the measured biochemical blood components, white blood cell count or immunological parameters after the NMES session. On an individual level, the changes in creatine kinase, estimated glomerular filtration rate, basophils and some immunological parameters correlated with changes in the cortisol level. We can conclude that moderate transcutaneous low-frequency electrical stimulation for quadriceps muscle strengthening used in our study did not induce essential changes in immune status in healthy men.

Rehabilitation of Guillain-Barré syndrome patients: an observational study.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy resulting in severe impairments of many body structures and functions with consequent limitations of activities and participation. The aim of our study was to evaluate rehabilitation outcome in these patients. Forty-five (20 women, 25 men) with GBS patients who had completed primary comprehensive rehabilitation were included in the study. Medical Research Council Scale for Muscle Strength was used for assessment of lower-limb function. Patients' activities were assessed using the Functional Independence Measure and two walking tests (6 min and 10 m). The patients were also described using an adapted International Classification of Functioning, Disability and Health checklist. Assessment was performed at admission and at discharge. Clinically important and statistically significant improvements were found in all outcome measures. Strong and significant correlations were found between the outcome measures. International Classification of Functioning, Disability and Health coding also clearly reflected the progress. Improvement in patients' activities increased statistically significantly with time for up to 3 months of rehabilitation. The outcome was not related to the time interval from establishing the diagnosis to the start of rehabilitation. Hence, multidisciplinary care for GBS patients is effective, because clinically important and statistically significant improvements regarding body functions and activities are achieved during relatively short inpatient rehabilitation.

Influence of foot pain on walking ability of diabetic patients.

OBJECTIVE: To assess foot pain and its correlation with walking ability in diabetic patients. SUBJECTS: Two groups of type 2 diabetic patients (30 with symptomatic neuropathy and 30 without symptomatic neuropathy) and 30 healthy volunteers were studied. METHODS: Pain was assessed by the pain sub-scale of the Foot Function Index. Internal consistency for the pain sub-scale was tested. Walking ability was assessed by the 6-minute walking test. RESULTS: The pain was worse in diabetic patients, the pain sub-scale scores differed between the groups (p < 0.05). High internal consistency was found for the pain sub-scale of the Foot Function Index. Results of the 6-minute walking test differed among the 3 groups: healthy volunteers performed best, and diabetic patients with symptomatic neuropathy worst (p < 0.001). Foot pain correlated moderately with the result of walking test (r = -0.449, p < 0.001). CONCLUSION: The pain sub-scale of the Foot Function Index is suitable for the assessment of pain in diabetic patients. Patients with severe foot pain have more difficulties when walking long distances than patients with less severe or without any pain.

Rehabilitation of critical illness polyneuropathy and myopathy patients: an observational study.

Critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in intensive care units. The number of patients with CIPNM admitted to inpatient rehabilitation is increasing. The aim of this study was to comprehensively evaluate the outcome of their rehabilitation. Twenty-seven patients with CIPNM were included in the study. The diagnosis was established clinically and confirmed electrophysiologically. Manual muscle testing was used for the assessment of function. Activity was assessed using the functional independence measure and two walking tests. The patients were also assessed using an adapted International Classification of Functioning, Disability and Health (ICF) checklist. All assessments were performed at admission and discharge. Clinically important and statistically significant improvements were found in all observed measures. High and significant correlations were found between the measures, except between muscle strength and the results of walking tests. Improvement in body functions during rehabilitation decreased as the time from established diagnosis to the start of rehabilitation increased, but it was not related to rehabilitation duration. Improvements in terms of the ICF mainly corresponded to the gain in functional independence measure scores. Major improvement regarding body functions and activities/participation was achieved in patients with CIPNM with a relatively short rehabilitation. Rehabilitation of such patients should start as early as possible once the diagnosis has been established. Comprehensive assessment of such patients combining established scales, objective clinical tests, and the ICF is recommended.

Reliability of in-shoe plantar pressure measurements in rheumatoid arthritis patients.

Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar pressure measurement system in rheumatoid arthritis patients. Twelve rheumatoid arthritis patients were included in this study. Plantar pressures measurement was carried out in six consecutive walks and average peak pressure on seven spots analyzed for each walk. Intraclass correlation was estimated for each spot and for within-patient coefficient of variation between spots. For each spot, average within-patient coefficient of variation between walks was also calculated. Repeated measures of analysis of variance and Hotelling's T test, both with Holm correction, were used to test equality of mean measurement across patients between walks. The intraclass correlations, which were all statistically significant at P<0.0001, ranged from 0.897 to 0.999, with a mean of 0.97 for single measure and 0.99 for average measure estimates. Overall median of within-patient coefficient of variation between walks was 7%. None of the tests of equality of means showed significant differences between walks. On both feet, the highest variability of measurements was observed at midfoot, whereas all the other spots demonstrated excellent reliability. The measurement setup was found to be highly reliable and therefore suitable for clinical practice, as well as for research. If possible, taking an average of several measurements is recommended.