RESUMEN
OBJECTIVES: Functional surgery (FS) is often used to correct congenital or acquired deformities in neurological patients. Along with functional results, short- and medium-term patient satisfaction should always be considered a key goal of surgery and rehabilitation. The aim of this study is to assess the short to medium-term satisfaction of patients who underwent FS and its correlation with perceived improvements. METHODS: Invitation to an anonymous online survey was sent via e-mail to all neurological adult patients or caregivers of children who underwent lower or upper limb FS over the 2018-2020 period. The survey investigated patients' satisfaction with the surgery and the variation in pain, ADLs, level of independence, body image, self-esteem, social interaction skills, participation in social events, leisure activities and sports, and use of orthoses or walking aids. Descriptive data analysis was performed. Correlations were assessed using Kendall's tau. RESULTS: 122 out of 324 adults and 53 out of 163 children's caregivers filled out the questionnaire, with a response rate approaching 40%. Eighty-three percent of adult respondents and 87% of the children's caregivers were satisfied or very satisfied in the short and medium terms and reported their expectations had been met. Satisfaction was significantly correlated (p < 0.01) with improvements in functional abilities, social participation, self-esteem, and pain reduction. Half of the adults and 40% of children stopped using their orthoses or replaced them with lighter ones. Dissatisfaction and worsened conditions were reported by <10% of the respondents. CONCLUSION: According to patients and caregivers, FS was satisfactory in the short and medium terms, following improvements in all the ICF domains for most patients.
In this study, we studied the satisfaction of patients with neurological diseases and their caregivers about two years after having undergone surgery to correct lower and/or upper limb deformities. We mailed a specifically designed survey to adult patients and caregivers of children who had surgery at our hospital. The questionnaire asked about how satisfied they were with the surgery and if they felt any improvements in different domains: meeting previous expectations, pain level, daily activities, being autonomous, body image, self-esteem, social interaction, participation in social events, leisure activities, and the use of orthoses or walking aids. About 40% of the patients we contacted filled out the questionnaire. Most of them said they were happy with the results obtained and felt their pre-surgical expectations had been met. Satisfaction was associated with improvements in functional abilities, social participation, self-esteem, and lessening of pain. Many patients also stopped using orthoses or switched to lighter ones. Only a few people said they were not happy or felt worse after the surgery. These findings highlight the positive impact of surgery on patient well-being and motor abilities.
RESUMEN
Introduction: In post-stroke patients with equinovarus foot deformity (EVFD), soft tissue rearrangements may contribute to muscle overactivity when a muscle is stretched or tension is applied. Therefore, we investigated the effects of surgically restoring the triceps surae (TS) length and lengthening ability on TS spasticity. Methods: This retrospective study included chronic post-stroke patients who underwent neuro-orthopedic surgery inclusive of TS lengthening. TS spasticity was measured using the Modified Tardieu Scale (MTS) before and 1 month after surgery, both with the knee extended (KE) and flexed (KF). MTS variations were analyzed using the Wilcoxon test. The time from stroke onset was compared between patients with and without post-surgical spasticity using the t-test. Statistical significance was set at 5%. Results: A total of 120 patients with EVFD, aged 57 (12) years, ranging from 1 to 36 years from stroke, were included in the study. The median MTS_KE score significantly decreased from 3 (range 0-4) to 2 (0-4) (p < 0.001) after surgery. The MTS score decreased by ≥1 point in more than half of the sample. Notably, 19 and 32 patients were completely relieved from spasticity (MTS = 0) in the KE and KF conditions, respectively. Post-surgical spasticity did not depend on the time since stroke onset (p = 0.560). Discussion: TS lengthening led to a short-term reduction of spasticity in 41% and 63% of chronic post-stroke patients in the gastro-soleus complex and soleus, respectively, with complete relief observed in 21% and 30% of the sample. Surgical lengthening can be considered an effective treatment that not only restores joint range of motion but also may reduce spasticity, even in chronic patients.
RESUMEN
Introduction: Patients with Charcot-Marie-Tooth disease (CMT) often suffer from walking-related pain (WRP), muscle weakness, foot deformities, and reduced ankle dorsiflexion (DF), which affects their ability to walk and daily activities. Functional surgery (FS) can restore foot deviations, affecting the loading ability during gait. We assessed the short-term effects of FS in patients with CMT on WRP, foot and ankle structure, and function, along with patients' perceived improvement. Methods: This is a prospective cohort study on CMT patients who had undergone FS and rehabilitation. We analyzed the changes after 1 month, focusing on WRP, DF, the center of pressure progression (COPP) during walking, and measures of walking ability. The non-parametric Wilcoxon test was used. Results: Ten patients were included. One month after FS, WRP reduced from 5.5 (IQR = 3.5) to 2 (IQR = 3.5), p = 0.063, with an effect size of 0.615. The highest decrease was found in patients with very high pre-surgical pain levels. DF almost reached 10° for both active and passive movements (p < 0.05), and COPP improved from 44 to 60% (p = 0.009) of foot length. Gait speed, lower limb functioning, and balance did not change. More than half of the sample felt improved or much improved after FS. Conclusion: FS can be effective in reducing WRP and restoring foot posture in CMT patients in the short-term, which allows them to wear shoes, and leads to a perceived improvement and satisfaction. Lack of improvement in functional skills may be due to muscle weakness typical of CMT. Studies with longer follow-ups may confirm these hypotheses.
RESUMEN
Background: Muscle overactivity is one of the positive signs of upper motor neuron lesions. In these patients, the loss of muscle length and extensibility resulting from soft tissue rearrangement has been suggested as a contributing cause of muscle overactivity in response to stretching. Objective: To assess the effects of surgical lengthening of the quadriceps femoris (QF) muscle-tendon unit by aponeurectomy on muscle spasticity. Methods: This is a case-control study on chronic stroke patients with hemiparesis that have undergone lower limb functional surgery over a 8-year period. CASEs underwent corrective surgery for both the foot and knee deviations, inclusive of a QF aponeurectomy. Controls (CTRLs) underwent corrective surgery for foot deviations only. QF spasticity was assessed with the Modified Tardieu Scale (MTS) before and 1 month after surgery. The Wilcoxon test was used to assess MTS variations over time and the Mann-Whitney test was used to verify the presence of group differences at the 1 month mark. Results: Ninety-three patients were included: 57 cases (30F, 1-34 years from lesion) and 36 controls (12F, 1-35 years from lesion). Before surgery, both CASEs and CTRLs had similar MTS scores (median MTS = 3) and functional characteristics. One month after surgery, QF spasticity was significantly lower in the CASEs compared to CTRLs (p = 0.033) due to a significant reduction of the median MTS score from 3 to 0 in the CASE group (p < 0.001) and no variations in the CTRL group (p = 0.468). About half of the cases attained clinically significant MTS reductions and complete symptom relief even many years from the stroke. Conclusions: Functional surgery inclusive of QF aponeurectomy can be effective in reducing or suppressing spasticity in chronic stroke patients. This is possibly a result of the reduction in neuromuscular spindle activation due to a decrease in muscle shortening, passive tension, and stiffness.
RESUMEN
Introduction: Charcot-Marie-Tooth disease (CMT) is a slow and progressive peripheral motor sensory neuropathy frequently associated with the cavo-varus foot deformity. We conducted a scoping review on the clinical scales used to assess foot deviations in CMT patients and analyzed their metric properties. Evidence Acquisition: A first search was conducted to retrieve all scales used to assess foot characteristics in CMT patients from the Medline, Web of Science, Google Scholar, Cochrane, and PEDro databases. A second search was conducted to include all studies that evaluated the metric properties of such identified scales from the same databases. We followed the methodologic guidelines specific for scoping reviews and used the PICO framework to set the eligibility criteria. Two independent investigators screened all papers. Evidence Synthesis: The first search found 724 papers. Of these, 41 were included, using six different scales: "Foot Posture Index" (FPI), "Foot Function Index", "Maryland Foot Score", "American Orthopedic Foot & Ankle Society's Hindfoot Evaluation Scale", "Foot Health Status Questionnaire", Wicart-Seringe grade. The second search produced 259 papers. Of these, 49 regarding the metric properties of these scales were included. We presented and analyzed the properties of all identified scales in terms of developmental history, clinical characteristics (domains, items, scores), metric characteristics (uni-dimensionality, inter- and intra-rater reliability, concurrent validity, responsiveness), and operational characteristics (normative values, manual availability, learning time and assessors' characteristics). Conclusions: Our results suggested the adoption of the six-item version of the FPI scale (FPI-6) for foot assessment in the CMT population, with scoring provided by Rasch Analysis. This scale has demonstrated high applicability in different cohorts after a short training period for clinicians, along with good psychometric properties. FPI-6 can help health professionals to assess foot deformity in CMT patients over the years.
RESUMEN
In literature, indices of overall walking ability that are based on ground reaction forces have been proposed because of their ease of administration with patients. In this study, we analyzed the correlation between the indices of dynamic loading and propulsion ability of 40 chronic hemiparetic post-stroke patients with equinus foot deviation and a set of clinical assessments of ankle joint deviations and walking ability. Ankle passive and active range of motion (ROM) and triceps surae spasticity were considered, along with walking speed and three complementary scales of walking ability focusing respectively on the need for assistance on functional mobility, including balance and transfers, and the limitation in social participation. The correlation between the ground reaction force-based indices and both clinical and functional variables was carried out using the non-parametric Spearman correlation coefficient. Both indices were correlated to 8 of the 10 investigated variables, thus supporting their use. In particular, the dynamic propulsive ability was correlated with all functional scales (rho = 0.5, p < 0.01), and has the advantage of being a continuous variable. Among clinical assessments, limited ankle ROM affected walking ability the most, while spasticity did not. Since the acquisition of ground reaction forces does not require any patient prepping, the derived indices can be used during the rehabilitation period to quickly detect small improvements that, over time, might lead to the broad changes detectable by clinical scales, as well as to immediately highlight the lack of these improvements, thus suggesting adjustments to the ongoing rehabilitation approach.
RESUMEN
Dystonia is a disabling and disfiguring disorder that can often affect many aspects of patients' daily lives, and lower their self-esteem. To date, quality of life (QoL) has been assessed in dystonic patients using generic measures that do not address the specific problems of this diagnostic group. Recently, two disease-specific scales "The Cervical Dystonia Impact Profile (CDIP-58)" and the "Craniocervical Dystonia Questionnaire (CDQ-24)" were validated for measuring QoL in craniocervical dystonia patients. No disease-specific scales for QoL for dystonic patients are currently available in Italian. The aim of our study was to produce and validate the Italian version of the CDIP-58 and CDQ-24. We obtained the Italian version of CDQ-24 and CDIP-58 with a back-translation design. Both scales were applied to a population of 94 craniocervical dystonia patients along with the Short Form 36 health-survey questionnaire (SF-36), both before and 4 weeks after botulinum toxin therapy. A group of 65 controls matched for sex, age and comorbidity underwent the SF-36. Internal consistency was satisfactory for all subscales. Both the CDIP-58 and CDQ-24 showed moderate to high correlations with similar items of the SF-36. Sensitivity to change was confirmed by highly significant improvements in all CDQ-24 subscales and by moderate improvements in three out of eight CDIP-58 subscales and total score. This is the first Italian study on QoL in dystonia patients. We validated the Italian version of two disease-specific questionnaires to evaluate QoL in craniocervical dystonia patients. These scales could be useful for both clinical practice and clinical trials.