The A-test: assessment of functional recovery during early rehabilitation of patients in an orthopedic ward--content, criterion and construct validity.

BACKGROUND/AIM: The A-test was designed for assessment of functional recovery during early rehabilitation of patients in an orthopedic ward. This performance-based test consists of 10 items for assessing basic activities by a six level ordinal scale (0-5). Total scores can range from 0 to 50, i.e. from inability to perform any activity despite the help of therapists to complete independence and safety in performing all activities. The aim of this study was to examine the A-test validity. METHODS: This prospective study was conducted in an orthopedic ward and included 120 patients [60 patients with hip osteoarthritis that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF)] during early inpatient rehabilitation (1st-5th day). Validity was examined through 3 aspects: content validity--floor and ceiling effect, range, skewness; criterion validity--concurrent validity [correlation with the University of Iowa Level of Assistance Scale (ILAS) for patients with hip osteoarthritis, and with the Cumulated Ambulation Score (CAS) for patients with HF, Spearman rank correlation] and predictive validity [the New Mobility Score (NMS) 4 weeks after surgery, Mann-Whitney U test]; construct validity--4 hypotheses: 1) on the fifth day of rehabilitation in patients underwent arthroplasty due to hip osteoarthritis, the A-test results will strongly correlate with those of ILAS, while the correlation with the Harris hip score will be less strong; 2) in patients with HF, the A-test results will be significantly better in those with allowed weight bearing as compared to patients whom weight bearing is not allowed while walking; 3) results of the A-test will be significantly better in patients with hip osetoarthritis than in those with HF; 4) the A-test results will be significantly better in patients younger than 65 years than in those aged 65 years and older. RESULTS: The obtained results were: low floor (1%) and ceiling (2%) effect, range 0-50, skewness 0.57, strong correlation with ILAS for the patients with hip osteoarthritis (r = -0.97, p = 0.000) and with CAS for the patients with hip fracture (r = 0.91, p = 0.000). The patients with the A-test score 35 and more on the fifth day of rehabilitation (n = 46, Md = 4) had significantly higher NMS rank 4 weeks after surgery than the patients with the A-test score less than 35 (n = 59, Md = 2), (U = 379, z = -6.47, p = 0.000, r = 0.63). All 4 hypotheses were confirmed. CONCLUSION: The A-test is simple and valid instrument for everyday evaluation of pace and degree of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.

The A-test--reliability of functional recovery assessment during early rehabilitation of patients in an orthopedic ward.

BACKGROUND/AIM: There are few tests for evaluation of functional abilities of patients surgically treated for hip fractures or osteoarthritis during early rehabilition period. The aim of this study was to investigate reliability (interobserver reproducibility and internal consistency) of the A-test, an original test for functional recovery evaluation during early rehabilitation of patients in an orthopedic ward. METHODS: The investigation included 105 patients (55 patients with hip osteoarthritis that underwent arthroplasty and 50 surgically treated patients with hip fracture). It was conducted in an orthopedic ward during early inpatient rehabilitation (from 1st to 5th day). For their functional recovery evaluation during early rehabilitation we used the A-test, a performance-based test with 10 items for assessing basic activities by six level ordinal scale (0-5). For internal consistency of the test the Cronbach coefficient alpha was calculated for the A-test results collected during early rehabilitation for all patients (105 patients x 5 days = 525 measures) and separately for the results of patients with hip osteoarthritis (275 measures) and hip fracture (250 measures). Values of this coefficient > 0.7 imply good internal consistency of the test. Interobserver reproducibility was estimated as follows: two physiotherapists together conducted physical therapy with the patients, and then, separately, rated the performance of each activity from the test (78 measures). The agreement between their estimations was expressed by the linear weighted kappa coefficient (for very good agreement values of kappa coefficeent have to be in the range 0.81-1). RESULTS: The Cronbach coefficient alpha was 0.98 (the results of all the patients and the results of the patients with hip osteoarthritis) and 0.97 (the results of the patients with hip fracture). The values of kappa coefficient were in the range 0.81-0.92 for all items. CONCLUSION: The A-test is a reliable instrument for everyday evaluation of functional recovery during early rehabilitation of patients surgically treated in an orthopedic ward.

Effects of a short-term differently dosed aerobic exercise on maximum aerobic capacity in breast cancer survivors: a pilot study.

BACKGROUND/AIM: Regular physical activity and exercise improves quality of life and possibly reduces risk of disease relapse and prolongs survival in breast cancer survivors. The aim of this study was to evaluate the impact of a 3-week moderate intensity aerobic training, on aerobic capacity (VO2max) in breast cancer survivors. METHODS: A prospective, randomized clinical study included 18 female breast cancer survivors in stage I-IIIA, in which the primary treatment was accomplished at least 3 months before the study inclusion. In all the patients VO2max was estimated using the Astrand's protocol on a bicycle-ergometer (before and after 3 weeks of training), while subjective assessment of exertion during training were estimated by the Category-Ratio RPE Scale. Each workout lasted 21 minutes: 3 minutes for warm-up and cool-down each and 15 min of full training, 2 times a week. The workload in the group E1 was predefined at the level of 45% to 65% of individual VO2max, and in the group E2 it was based on subjective evaluation of exertion, at the level marked 4-6. Data on the subjective feeling of exertion were collected after each training course in both groups. RESULTS: We recorded a statistically significant improvement in VO2max in both groups (E1--11.86%; E2--17.72%), with no significant differences between the groups. The workload level, determined by the percent of VO2max, was different between the groups E1 and E2 (50.47 +/- 7.02% vs 55.58 +/- 9.58%), as well as subjective perception of exertion (in the groups E1 and E2, 11.6% and 41.6% of training, respectively, was graded in the mark 6). CONCLUSION: In our group of breast cancer survivors, a 3-week moderate intensity aerobic training significantly improved the level of VO2max.

Sexual rehabilitation after myocardial infarction and coronary bypass surgery: why do we not perform our job?

BACKGROUND/AIM: There is a perception that in patients with heart diseases in Serbia sexual rehabilitation does not exist. Why do we not perform our job? A kind of resistance to sexual rehabilitation is common for heart disease patients. Prejudices regarding patients' sexuality, fear and limited knowledge are not rare among the members of medical staff. The aim of this study was to assess knowledge on sexual rehabilitation, inner sense during conversation on sexual rehabilitation and quality of sexual life in patients with myocardial infarction (MI) and bypass surgery (BPS). Also, we wanted to assess an opinion of the medical staff members about that. METHODS: We performed a prospective nonrandomized clinical study, which involved 40 participants: ten patients, six partners and twenty four medical staff members. All participants were tested by the self-created questionnaires. The main issues of observation were: knowledge about sexual rehabilitation, quality of sexual life and inner sense during conversation on sexual rehabilitation. The data were analyzed by the Shapiro-Wilk test, Kolmogorov Smirnov test, Mann Whitney Exact test and Fishers Exact test. Statistical significance was set up to p < 0.05. RESULTS: There was a statistically significant difference among the participants regarding an attitude when sexual activity should be resumed after MI or BPS. The members of medical staff had a significantly different opinion about the most important team members responsible for sexual rehabilitation performance. There was a statistically significant difference (p = 0.01) in quality of patient's sexual life after MI or BPS (score: 14.2 +/- 5.5) in relation to conditions before them (score: 21.3 +/- 3.1). The members of medical staff had significantly (P = 0.05) worse inner sense (score: 3.8 +/- 0.7) during and after fulfilling the questionnaires than the patients (score: 4.6 +/- 0.5). CONCLUSION: Ignorance and prejudices are reasons why we do not perform our job.

Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) in patients with acute low back pain (LBP) with radiculopathy. BACKGROUND DATA: Acute LBP with radiculopathy is associated with pain and disability and the important pathogenic role of inflammation. LLLT has shown significant anti-inflammatory effects in many studies. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was performed on 546 patients. Group A (182 patients) was treated with nimesulide 200 mg/day and additionally with active LLLT; group B (182 patients) was treated only with nimesulide; and group C (182 patients) was treated with nimesulide and placebo LLLT. LLLT was applied behind the involved spine segment using a stationary skin-contact method. Patients were treated 5 times weekly, for a total of 15 treatments, with the following parameters: wavelength 904 nm; frequency 5000 Hz; 100-mW average diode power; power density of 20 mW/cm(2) and dose of 3 J/cm(2); treatment time 150 sec at whole doses of 12 J/cm(2). The outcomes were pain intensity measured with a visual analog scale (VAS); lumbar movement, with a modified Schober test; pain disability, with Oswestry disability score; and quality of life, with a 12-item short-form health survey questionnaire (SF-12). Subjects were evaluated before and after treatment. Statistical analyses were done with SPSS 11.5. RESULTS: Statistically significant differences were found in all outcomes measured (p < 0.001), but were larger in group A than in B (p < 0.0005) and C (p < 0.0005). The results in group C were better than in group B (p < 0.0005). CONCLUSIONS: The results of this study show better improvement in acute LBP treated with LLLT used as additional therapy.

[The effects of pulsed low frequency magnetic field in early rehabilitation of patients with cementless total hip arthroplasty].

INTRODUCTION: Early rehabilitation of patients with cementless total hip arthroplasty (cTHA) includes different physical modalities and pulsed low frequency magnetic field (PLFMF), which effects have not been explored yet. OBJECTIVE: To investigate the effects of PLFMF which was applied in different doses in early rehabilitation of patients with METHOD: Prospective, controlled, clinical study included 90 patients, divided in three groups with 30 patients each. First two groups were treated with high (group A) or low (group B) doses of PLFMF, in addition to kinesitherapy. Control group C was treated only with kinesitherapy. Study was completed in three weeks. RESULTS: Subjects of group A had significantly lower pain than group B (p < 0.01) and group C (p < 0.001) subjects in the first postoperative week. Pain in group B subjects was significantly lower than in group C in all three postoperative weeks (p < 0.01). In relation to other two groups, subjects of group A had higher hip Harris score values at the end of the third post-operative week (p < 0.05), and they were faster on 10-meter distance at the end of the first postoperative week (p < 0.01). CONCLUSION: PLFMF used in low and high doses for patients with cTHA had significant effects on pain abatement, especially at higher doses. Improvement of function was earlier and more manifested in the group treated with high doses of PLFMF.

Tratamento com estimulação elétrica funcional para facilitação da recuperação motora em paciente com acidente cerebrovascular subagudo / Functional electrical therapy for facilitation of motor recovery in a patient with subacute stroke

Objetivo: Determinar a eficácia de um protocolo de Tratamento com Estimulação Elétrica Funcional (FET) administrado a um paciente com acidente cerebrovascular subagudo. Descrição do Caso: Paciente destro, 67 anos, sexo masculino, que sofreu infarto nas regiões occipital esquerda e frontoparietal 6 meses antes de sua admissão neste estudo e que demonstrou grau elevado de motivação para recuperar plenamente a força do braço e o controle adequado dos dedos do membro superior afetado. Intervenção: Trinta minutos de FET, 5 vezes por semana durante 3 semanas (7 ½ horas no total) além da fisioterapia convencional. Principais Medidas de Avaliação de Resultados: A Escala Modificada de Ashworth (MAS), o teste de funcionalidade das extremidades dos membros superiores (UEFT), o Registro de Atividade Motora (MAL), O teste de 6 fases de Brunnstrom, a Medida de Independência Funcional (MIF). Resultados: O paciente apresentou melhora bastante significativa nas escalas quantitativas UEFT e MAL. Ele melhorou de forma específica na atividade de escrever ao obter melhor controle dos dedos e na capacidade de controlar objetos pesados. Também, observou-se o aumento da amplitude ativa de movimento (ROM) dos músculos proximais, embora a estimulação elétrica tenha sido aplicada apenas aos músculos distais. Houve uma melhora na qualidade geral da utilização do braço, conforme mensurado pela escala qualitativa MAL. Conclusões: A terapia com Estimulação Elétrica Funcional (FET) em pacientes com acidente cerebrovascular subagudo com alta motivação para tarefas específicas pode ser um método eficaz para a melhora do funcionamento e da utilização dos braços afetados.

Effect of transcutaneous electrical nerve stimulation for the management of postoperative surgical pain after lower extremity amputation: a pilot study / Efeito da estimulação elétrica nervosa transcutânea (TENS) no tratamento de dor pós-cirúrgica após amputação de membro inferior: estudo piloto

A estimulação elétrica nervosa transcutânea (TENS) é uma modalidade não-médica e não-invasiva. Há muita controvérsia e atitudes contrárias em relação ao lugar que a TENS ocupa no tratamento da dor após amputação de membro inferior. Objetivo: Avaliar o papel da TENS no tratamento de dor cirúrgica pós-operatória após amputação de membro inferior. Material e métodos: Teste controlado randomizado, conduzido com 46 indivíduos submetidos à amputação de membro inferior, que foram aleatoriamente divididos em grupo controle e grupo tratado. O grupo controle recebeu cuidados-padrão no pós-operatório; o grupo tratado recebeu cuidados-padrão e aplicação de TENS. Quarenta indivíduos completaram efetivamente o estudo de acordo com o protocolo de estudo. A maior parte das amputações consistiu de amputação transtibial devido a complicações da diabete. Foram utilizados cinco dispositivos portáteis Ultima TENS XL-A1 com eletrodos auto-adesivos. Esta é a aplicação convencional da TENS, caracterizada pela aplicação de impulsos elétricos com a duração de 200 microssegundos, freqüência de 110 Hz e amplitude de 44 V. O tratamento foi administrado durante 10 dias, 2 horas por dia. A avaliação da eficácia da TENS foi feita utilizando-se a escala visual analógica (EVA) horizontal (0-100 mm). O teste t de Student foi usado na análise estatística. Resultados: A intensidade da dor estava significantemente diminuída em ambos os grupos no 10º dia em comparação ao 1º dia de pós-operatório. Não houve diferenças significantes entre o grupo controle (EVA = 4,18±1,48) e o grupo tratado (EVA= 3,59±1,44), de acordo com a intensidade média diária da dor (t = 1,25; df=38). A intensidade da dor no 10º dia de pós-operatório foi significantemente menor no grupo tratado (EVA = 1,65± 0,80 ) versus o grupo controle (EVA = 3,2± 1,15; t = 5; df = 38; p< 0,01 ). Conclusão: A TENS convencional (dose: 200 microssegundos, 110 Hz, 44 V), administrada 2 horas por dia, durante 10 dias, significantemente reduziu a dor cirúrgica pós-operatória em 20 indivíduos com amputação de membro inferior.

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, nonmedical modality. There are a lot of dilemmas and opposing attitudes regarding the use of TENS in pain management after lower limb amputations. Objective: To establish the role of TENS for the management of postoperative surgical pain after lower limb amputations. Material and methods: Randomized controlled trial, which included forty-six subjects who had undergone lower limb amputations, randomly divided into control and treatment group. The control group received standard postoperative care, whereas the treatment group received standard postoperative care plus TENS. Forty subjects successfully completed the study according to the study protocol. The majority of the individuals had undergone transtibial amputation due to complication of diabetes. Five Ultima TENS XL-A1 portable devices with four self-adhesive electrodes were used. This was the conventional TENS mode, characterized by the delivery of electrical impulses with a duration of 200 microseconds, frequency of 110 Hz, and amplitude of 44V. Treatment was carried out for 2 hours a day, during 10 days. The evaluation of TENS efficacy was performed using the horizontal VAS (0-100 mm). Student T test was used in the statistical analysis. Results: Pain intensity was significantly diminished in both groups at the tenth in comparison with the first postoperative day. There was no significant difference between the control (VAS = 4.18±1.48) and the treatment group (VAS= 3.59±1.44) according to the daily mean pain intensity (t = 1.25; df =38). Pain intensity on the tenth postoperative day was significantly lower in the treatment (VAS = 1.65± 0.80) when compared with the control group (VAS = 3.2± 1.15; t = 5; df = 38; p< 0.01). Conclusion: Conventional TENS (dose: 200 microseconds, 110 Hz, 44V), administered two hours a day during ten days, significantly reduced postoperative surgical pain in twenty subjects who had undergone lower limb amputations.