Preliminary effect and feasibility of physiotherapy with strength training and protein-rich nutritional supplement in combination with anabolic steroids in cross-continuum rehabilitation of patients with hip fracture: protocol for a blinded randomized controlled pilot trial (HIP-SAP1 trial).

BACKGROUND: A 2014 Cochrane review evaluating the effect of anabolic steroids after hip fracture concluded that the quality of the studies was insufficient to draw conclusions on the effects and recommended further high-quality trials in the field. Therefore, the aim of this pilot trial is to determine the preliminary effect and feasibility of a 12-week multimodal intervention consisting of physiotherapy (with strength training), protein-rich nutritional supplement and anabolic steroid on knee-extension muscle strength and function 14 weeks after hip fracture surgery. METHODS: We plan to conduct a randomized, placebo-controlled pilot trial with 48 patients operated for acute hip fracture. The patients are randomized (1:1) to either (1) physiotherapy with protein-rich nutritional supplement plus anabolic steroid or (2) physiotherapy with protein-rich nutritional supplement plus placebo. Outcome assessments will be carried out blinded at baseline (3-10 days after surgery) and at 14 weeks after entering the trial. Primary outcome is the change from baseline to follow-up in maximal isometric knee-extension muscle strength in the fractured limb. Secondary outcomes are physical performance test, patient-reported outcomes, and measures of body composition. DISCUSSION: If the trial is found feasible and the results show an indication of anabolic steroid being a relevant addition to further enhance the recovery of muscle strength and function in an enhanced recovery after surgery program, this trial will constitute the basis of a larger confirmatory trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03545347. Preregistered on 4 June 2018.

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study.

Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population. INTRODUCTION: Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. METHODS: We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. RESULTS: We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, ß = 2.614, p = 0.49; Q3, ß = 9.723, p < 0.01; Q4, ß = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]). CONCLUSIONS: In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

The use of animal-assisted therapy in combination with physical therapy in an inpatient rehabilitation facility: A case report.

BACKGROUND: Animal-assisted therapy (AAT) is a growing form of intervention in the field of rehabilitation often with the goals of decreasing pain, anxiety, and depression. There is a lack of literature on the use of AAT in inpatient rehabilitation facilities (IRF). PURPOSE: This intrinsic case report describes the use of AAT in combination with physical therapy (PT) in the treatment of a middle-aged female status-post spinal surgery. MATERIALS AND METHODS: This patient was treated with standard of care physical and occupational therapy in an IRF with the addition of AAT within 32% of the therapy sessions. AAT sessions focused on sitting and standing tolerance, standing balance, endurance, ambulation, stair negotiation and kitchen mobility. Clinical measures included the 6 Minute Walk Test (6MWT), the Functional Independence Measure (FIM) total score and the FIM motor subscale score. CLINICAL FINDINGS: From admission to discharge from the IRF, change was noted in the areas of sitting tolerance, total FIM score, the motor subscale score of the FIM, and on 6MWT distance. Due to other therapies simultaneously occurring, no conclusions on AAT as a treatment can be made. AAT did provide more opportunities for this patient to engage in therapeutic activities. CONCLUSION: AAT was used during PT, in attempt to facilitate participation and distract from pain in order to work on therapeutic activities and achieve the patient's functional goals. This case report can be used as a model for other IRF therapy programs interested in AAT, can provide information about a therapeutic modality and hopefully will inspire future rigorously designed research studies.

[The application of general magnetic therapy for the rehabilitation of the patients following the surgical treatment of herniated intervertebral discs]. / Obshchaia magnitoterapiia v reabilitatsii patsientov posle operativnogo lecheniia gryzh mezhpozvonkovykh diskov.

AIM: The objective of the present work was to rehabilitate more efficiently the patients who had undergone the surgical treatment for herniated discs in the lumbosacral spine by applying general magnetic therapy during the combined treatment. MATERIAL AND METHODS: A total of 73 patients underwent the medical examination and treatment. The patients matched for age and sex presenting with similar clinical symptoms were divided into two groups. All of them received initial therapy that included medication, therapeutic physical exercises, and aquatic therapy. The patients in the main study group were given, in addition, general magnetic therapy. All the patients had their lower back examined before and after the treatment; moreover, they were asked to report their pain intensity based on the visual-analogue scale. The patients had their spinal and lower extremity temperature measured by means of thermal scanning with the use of remote infrared thermography and the non-invasive thermal imaging to check temperature fluctuations. To evaluate the psycho-emotional condition of the patients and to obtain their quality of life characteristics, they were asked to fill up the WAM (wellbeing, activity, mood) questionnaire; moreover, the disability Index was determined using the Oswestry questionnaire (version 2.1.), and the State-Trait Anxiety Inventory (STAI) was employed. RESULTS: 75.7% of the patients in the main group had the positive treatment results in the form of improvement of the affected movement skills, sensory processing abilities, and reflex functions as compared with the 58,3% success rate among the patients in the control groupd. Based on the data of non-invasive infrared thermal imaging, the patients of the main group had significantly lower post-treatment topical hyperthermia in the region of the surgical intervention in comparison with the controls which suggested the reduction of the severity of the inflammatory process and the manifestations of the muscular-tonic syndrome. Their temperature dropped by 1,46±0,07 °Ð¡ in contrast to the patients of the control group whose temperature decreased only by 0,91±0,04 °Ð¡ (р<0.05). These observations gave evidence that the inflammation had been alleviated and the muscle tension relieved. The adopted recovery program promoted, in addition, a temperature drop at the area of the skin innervated by the affected root. It has been found that not only the pain subsided and the compromised motor skills and sensory processing abilities improved but also the quality of life tended to ameliorate resulting in the occupational rehabilitation of the patients following the surgical treatment of herniated intervertebral discs. CONCLUSION: It has been found that the addition of general magnetic therapy to the combined treatment of the patients who had undergone the surgical treatment of herniated intervertebral discs favourably affects the clinical symptoms of the disease, intensifies regeneration, as well as improves blood circulation in the area affected by surgery, improves the psychoemotional state and the quality of life of the patients in such conditions thus making therapy considerably more efficient by preventing the complications and significantly shortening the duration of the treatment. .

Guided Imagery for Pain Management in Postoperative Orthopedic Patients: An Integrative Literature Review.

BACKGROUND: Pain following orthopedic surgery can be intense due to the nature of the surgical procedure. Pain is a multilevel phenomenon that includes physiological and psychosocial components. Interventions that address body, mind, and spirit are needed to provide holistic management of pain. Guided imagery is a mind-body intervention that can address all aspects of the patient's pain experience. PURPOSE: This integrative review, informed by Watson's theory of human caring, identifies evidence that either supports or refutes the use of guided imagery as a supplement to pharmaceutical pain management for postoperative orthopedic patients. METHOD: An integrative literature search was conducted. Twenty-two studies were identified as potentially relevant to this study. Nine of the articles met all inclusion criteria and were included in this study. RESULTS AND CONCLUSIONS: Based on the evidence reviewed, it is recommended that guided imagery be used as an adjunct for pain management in patients undergoing orthopedic surgery. However, additional research in this area is needed. Future research: Two topics for further research were identified. The first is a need to identify an optimal frequency of use of guided imagery. The second is to identify how to ensure patients are using the intervention as recommended.

Current Practices in Lumbar Surgery Perioperative Rehabilitation: A Scoping Review.

OBJECTIVE: The objective of this review was to identify current practices and relevant patient-reported and objective outcome measures with regard to rehabilitation protocols directed at the lumbar spine in perioperative procedure settings in order to inform clinical practice and future research. METHODS: A literature search was performed in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Central Register of Controlled Trials, PEDro (Physiotherapy Evidence Database), and PubMed using terms relevant to surgical interventions, rehabilitation, and the lumbar spine. RESULTS: Twenty-nine studies met the inclusion criteria, and 28 investigated postoperative forms of rehabilitation. Patient-reported outcomes typically used were pain and disability, although a wide range of objective measures based on physical capacities were often reported. Rehabilitation programs, for the most part, included some form of strengthening exercises alone or in combination with stabilization exercises, aerobic conditioning, stretching, or education. Despite most studies reporting statistically significant results between intervention groups, considering clinically significant improvement within intervention groups yielded a different portrait. CONCLUSIONS: A wide range of objective and subjective outcomes is used to document changes after active rehabilitation. Program components include both active and assisted interventions combined with various means of education and discussion. Multimodal rehabilitation protocols after lumbar surgery may be used to improve patient-reported and objective outcome measures such as pain, disability, and physical function. Further research should be conducted on the effects of preoperative rehabilitation programs.

Patient perspectives on virtual reality-based rehabilitation after knee surgery: Importance of level of difficulty.

This article explored the perspectives of 25 patients regarding virtual reality (VR)-based rehabilitation following knee surgery and identified the important factors that allowed patients to immerse themselves in rehabilitation. Qualitative analysis of data collected via open-ended questionnaire and quantitative analysis of data from physical assessments and surveys were conducted. In the open-ended questionnaire, the majority of participants mentioned level of difficulty as the most common reason for selecting both the most and the least immersive exercise programs. Quantitative analysis showed that participants experienced a high level of flow (3.9 +/- 0.3 out of 5.0) and a high rate of expectation of therapeutic effect (96%) and intention of exercise adherence (96%). Further, participants with more severe pain or physical dysfunction tended to have more positive experiences (e.g., Difficulty-Skill Balance, Clear Goals, and Transformation of Time), leading to high levels of flow during VR-based rehabilitation. In conclusion, VR-based games are potentially acceptable as a motivational rehabilitation tool for patients following knee surgery. However, to best meet patients' needs, it might be useful to equip a VR program with varied levels of difficulty, taking into account the severity of the individual's knee injury. Additionally, severe pain or physical dysfunction might act as an indication rather than a contraindication for VR-based rehabilitation.

[Exploration of Problem Patterns in Orthopedic Medical Rehabilitation on Behalf of the German Pension Insurance to Improve Access Management and Treatment Adequacy]. / Exploration von Problemlagen in der orthopädischen Rehabilitation der gesetzlichen Rentenversicherung zur Optimierung der Zuweisungs- und Behandlungsadäquanz.

OBJECTIVE: To explore problem patterns of patients with musculoskeletal disorders assigned to and treated with a conventional (CR), behavioural-medical (BMR) or work-related (WR) rehabilitation concept. METHODS: We conducted interviews with 8 patients per concept, focus groups with 2 rehabilitation teams and 1 focus group with socio-medical assessors. For the interviews patients with chronic back pain were included, receiving inpatient rehabilitation. Data was examined by qualitative content analysis. RESULTS: We identified 7 problem patterns (one typical for patients in CR, 3 typical for specified subgroups in BMR resp. WR), differing in psychological co-morbidity, limitations of work-related activities and participation, psychosocial stress and pain. On the basis of detailed characterizations of these patterns, we developed recommendations for access and treatment management. CONCLUSION: The study specifies and demarcates different problem patterns in orthopedic rehabilitation and, therefore helps to further improve access management and treatment adequacy. Future studies should verify the generated findings on representative samples.

Outline of medical rehabilitation history in Poland and worldwide.

The study is an outline of the historical development of rehabilitation as a new medical discipline in Poland and worldwide. Rehabilitation has developed dynamically in the interwar period. In the US, it was pioneered by Howard Rusk, while in Poland, rehabilitation was introduced by Wiktor Dega. Medical rehabilitation is an interdisciplinary approach and is an integral and irremovable element of treatment at all treatment stages. Of note is the contribution of Wiktor Dega, who has developed and presented the Polish concept of rehabilitation, considered by the World Health Organization (WHO) as worth of being followed. Wiktor Dega believed that rehabilitation should be started possibly early--as soon as in the active disease stage and should provide and maintain good functional results after surgical treatment. The article discusses the contribution of pioneer specialists in rehabilitation in two first rehabilitation centers in Poland, established after World War II in Poznan and Konstancin near Warsaw.

The effects of therapeutic instrumental music performance on endurance level, self-perceived fatigue level, and self-perceived exertion of inpatients in physical rehabilitation.

The present study investigated the effects of a Neurologic Music Therapy (NMT) sensory-motor rehabilitation technique, Therapeutic Instrumental Music Performance (TIMP) as compared to Traditional Occupational Therapy (TOT), on endurance, self-perceived fatigue, and self-perceived exertion of 35 hospitalized patients in physical rehabilitation. The present study attempted to examine whether an active musical experience such as TIMP with musical cueing (i.e., rhythmic auditory cueing) during physical exercises influences one's perception of pain, fatigue, and exertion. All participants were diagnosed with a neurologic disorder or had recently undergone orthopedic surgery. Investigators measured the effects of TOT and TIMP during upper extremity exercise of the less affected or stronger upper extremity. Results showed no significant difference on endurance measures between the 2 treatment conditions (TIMP and TOT). Statistically significant differences were found between TIMP and TOT when measuring their effects on perceived exertion and perceived fatigue. TIMP resulted in significantly less perception of fatigue and exertion levels than TOT. TIMP can be used foran effective sensory-motor rehabilitation technique to decrease perceived exertion and fatigue level of inpatients in physical rehabilitation.

The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study.

BACKGROUND AND PURPOSE: Rotator cuff tears are frequently encountered in medical outpatient settings and often require surgical repair to achieve desirable functional outcomes. However, the optimal form of post-operative rehabilitation of rotator cuff repairs remains unidentified by the research literature. The aim of this study was to determine the feasibility of implementing and investigating the effect of a combined aquatic and land-based rehabilitation programme in the post-operative rehabilitation of rotator cuff tears. METHODS: A cohort of 18 subjects undergoing rotator cuff repair were examined over a treatment period of 12 weeks. Twelve subjects participated in a combined aquatic and land-based programme, while six subjects received a standard land-based protocol. Passive range of motion and the Western Ontario Rotator Cuff Index outcomes were measured pre-operatively and at three, six and 12 weeks, post-operatively. Subjective responses on patient's assurance and confidence in the value of the exercises (questionnaire using an 11-point Visual Analogue Scale (VAS)) were collected at 12 weeks for both groups. RESULTS: There was a significant improvement in both range of motion and Western Ontario Rotator Cuff scores in all subjects with treatment (p < 0.001). Furthermore, participation in aquatic therapy significantly improved passive flexion range of motion measures at three weeks (mean 46 degrees , 95% CI 17-75, p = 0.005) and six weeks (30 degrees , 95% CI 8-51, p = 0.01). There was no significant difference in the attendance rates (80% in both groups) or patients perceptions of the programmes (100% confidence and assurance in both groups). CONCLUSION: The implementation of a combined aquatic and land-based physiotherapy programme following surgical repair of the rotator cuff is feasible and presents a potential viable alternative to conventional land-based exercise with comparable outcomes.

[Postoperative physiotherapy in acute care--when, what and how much?]. / Postoperative Physiotherapie im Akutbereich--wann, welche und wieviel?

This article documents the role of early musculoskeletal rehabilitation in acute care after orthopaedic surgery involving the hip, knee or spine. It discusses the open questions of the type, time and intensity of physiotherapeutic intervention. The role of standardized quality management to define clinical pathways is discussed.

[Comparison of two electrical stimulation protocols on quadriceps muscle after anterior cruciate ligament surgery. Feasability study]. / Etude comparative de deux protocoles d'électrostimulation du quadriceps après chirurgie du ligament croisé antérieur. Etude de faisabilité.

OBJECTIVES: To evaluate the feasibility of a study comparing the effects of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery. MATERIAL: Seven sportsmen with a mean age of 26 yrs were randomly grouped in two: a 20 Hz stimulated group (4 patients) and a 80 Hz stimulated group (3 patients). After surgery all patients received electrical stimulation of the quadriceps femoris, five days a week, for 12 weeks, and had a standard program of voluntary contractions. The main outcome assessed before and three months after surgery were: quadriceps and hamstring peak torque at 90, 180 and 240 degrees /second, maximal isometric quadriceps at 75 degrees of flexion and muscle and subcutaneous fat volumes of the thigh using MRI. RESULTS: After 12 weeks of rehabilitation, the thigh muscle volume deficit of the operated limb was between 3 and 9% in the 20 Hz stimulated group and between 1 and 2% in the 80 Hz stimulated group. Quadriceps peak torque deficit was less than 30% except for two patients in the 20 Hz stimulated group. Maximal isometric quadriceps deficit of the operated limb was higher than 30% except for two patients in the 20 Hz stimulated group. CONCLUSION: The study showed that comparison of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery is possible if stimulation period is not more than four weeks.