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1.
Hong Kong Physiother J ; 43(2): 117-127, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37583923

RESUMEN

Background: A clinical quality improvement programme named Accelerated Stroke Ambulation Programme (ASAP) was piloted in Physiotherapy Department of Tai Po Hospital from 1st October 2019 to 30th September 2020 and executed as a standard practice afterwards. The goal of ASAP was to facilitate early maximal walking ability of stroke patients in early rehabilitation phase. ASAP featured (1) proactive outcome monitoring and standardised process compliance monitoring by a patient database - Stroke Registry; (2) standardised mobility prediction by Reference Modified Rivermead Mobility Index (MRMI) Gain and (3) standardised intervention database - Stroke Treatment Library. Objective: To investigate the effectiveness of ASAP in an inpatient rehabilitation setting for stroke patients in terms of functional outcomes. Methods: The design was a retrospective comparative study to analyse the difference in functional outcomes of Pre-ASAP Group (1st October 2018 - 30th September 2019) and Post-ASAP Group (1st October 2020-30th September 2021). The primary outcome measures were MRMI, Berg's Balance Scale (BBS), Modified Barthel Index (MBI), MRMI Gain, BBS Gain, MBI Gain, MRMI Efficiency, BBS Efficiency and MBI Efficiency. Results: There 348 subjects in Pre-ASAP Group and 281 subjects in Post-ASAP Group. Both groups had highly significant within-group improvement in MRMI, BBS and MBI (p<0.001). The MRMI Gain of Pre-ASAP Group and Post-ASAP Group was 6.32 and 7.42, respectively; and the difference was significant (p<0.05). The BBS Gain of Pre-ASAP Group and Post-ASAP Group was 8.17 and 9.70, respectively; and the difference was in margin of significance (p=0.069). The MBI Gain of Pre-ASAP Group and Post-ASAP Group was 10.69 and 11.96, respectively; but the difference was non-significant (p=0.280). The MRMI Efficiency, BBS Efficiency and MBI Efficiency of Post-ASAP Group were higher than Pre-ASAP Group but the difference was non-significant. The results of this study reflected that stroke rehabilitation programme with proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database was practical in real clinical practice with better functional outcomes than traditional physiotherapy practice which were dominated by personal preference and experience of therapists. Conclusion: Proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database may enhance the effectiveness in terms of functional outcomes of stroke rehabilitation programme.

2.
Hong Kong Physiother J ; 40(1): 63-73, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32489241

RESUMEN

OBJECTIVE: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. METHODS: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. RESULTS: A total of 56 participants were allocated to the experimental group ( n = 27 ) and control group ( n = 29 ) . There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. CONCLUSION: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

3.
Hong Kong Physiother J ; 38(2): 141-147, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30930586

RESUMEN

BACKGROUND: Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score. OBJECTIVE: The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation. METHODS: This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed. RESULTS: Subjects with admission categories of MFAC 2 and 3 had a highly significant ( p < 0 . 001 ) MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant ( P < 0 . 001 ) MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant ( p < 0 . 001 ) MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant ( p < 0 . 001 ) MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant ( p < 0 . 001 ) LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC > 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC > 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC ( r = 0 . 84 , P < 0 . 0001 and r = 0 . 78 , P < 0 . 0001 , respectively), discharge MRMI ( r = 0 . 82 , P < 0 . 0001 and r = 0 . 78 , P < 0 . 0001 , respectively) and discharge MBI ( r = 0 . 78 , P < 0 . 0001 and r = 0 . 94 , P < 0 . 0001 , respectively). CONCLUSION: This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.

4.
Hong Kong Physiother J ; 36: 10-16, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30931034

RESUMEN

OBJECTIVE: This study aimed to evaluate the effectiveness of robotic-assisted gait training (RAGT) in improving functional outcomes among stroke patients. DESIGN: This was a retrospective matched control study. SETTING: This study was conducted in an extended inpatient rehabilitation centre. PATIENTS AND INTERVENTION: There were 14 patients with subacute stroke (4-31 days after stroke) in the RAGT group. Apart from traditional physiotherapy, the RAGT group received RAGT. The number of sessions for RAGT ranged from five to 33, and the frequency was three to five sessions per week, with each session lasting for 15-30 minutes. In the control group, there were 27 subacute stroke patients who were matched with the RAGT group in terms of age, days since stroke, premorbid ambulatory level, functional outcomes at admission, length of training, and number of physiotherapy sessions received. The control group received traditional physiotherapy but not RAGT. OUTCOME MEASURES: Modified Functional Ambulation Category (MFAC), Modified Rivermead Mobility Index (MRMI), Berg's Balance Scale (BBS), and Modified Barthel Index (MBI) to measure ambulation, mobility, balance, and activities of daily living, respectively. RESULTS: Both RAGT and control groups had significant within-group improvement in MFAC, MRMI, BBS, and MBI. However, the RAGT group had higher gain in MFAC, MRMI, BBS, and MBI than the control group. In addition, there were significant between-group differences in MFAC, MRMI, and BBS gains (p = 0.026, p = 0.010, and p = 0.042, respectively). There was no significant between-group difference (p = 0.597) in MBI gain (p = 0.597). CONCLUSION: The results suggested that RAGT can provide stroke patients extra benefits in terms of ambulation, mobility, and balance. However, in the aspect of basic activities of daily living, the effect of RAGT on stroke patients is similar to that of traditional physiotherapy.

5.
Ann Plast Surg ; 74(2): 176-81, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23797023

RESUMEN

BACKGROUND: When the Michigan Hand Questionnaire (MHQ) was originally developed, an exploratory factor analysis (EFA) was used to reduce the originally large number of generated items to the 63 items currently present on the questionnaire. Confirmation of the implied factor model of the existing MHQ has never been performed. The objective of this study was to confirm the factor model used to create the existing MHQ, and to possibly shorten the existing MHQ using factor analysis. METHODS: Patients attending the Plastic Surgery Clinic at the QEII Health Sciences Centre with a hand complaint were asked to complete the MHQ. Confirmatory factor analysis was performed to explore the implied factor structure of the original EFA and to examine the interplay between the MHQ subscales. Further item-reduction was performed using clinically guided decisions as well as factor analysis-guided statistics. RESULTS: Initial confirmatory factor analysis showed that original EFA model does not optimally explain the relationships between items in the existing MHQ and their corresponding factors. Our abbreviated model of the MHQ consists of 23 items, and performed more favorably in all goodness-of-fit parameters than the original 63-item questionnaire. CONCLUSIONS: The factor model of the existing MHQ does not fully take advantage of the relationship between items in the MHQ and the proposed factors. This study proposes a shortened version of the MHQ that more accurately reflects hand health as well as a factor-based interpretation of the subscales that takes interdependent relationships into account.


Asunto(s)
Evaluación de la Discapacidad , Traumatismos de la Mano/diagnóstico , Indicadores de Salud , Modelos Teóricos , Encuestas y Cuestionarios , Adulto , Análisis Factorial , Femenino , Traumatismos de la Mano/fisiopatología , Traumatismos de la Mano/psicología , Humanos , Masculino , Persona de Mediana Edad , Psicometría
6.
BMC Cancer ; 14: 53, 2014 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-24484999

RESUMEN

BACKGROUND: Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by swelling, redness, pigmentation, fibrosis, and ulceration, pain, warmth, burning, and itching of the skin. The aim of this systematic review was to assess the effects of interventions which aim to prevent or manage RISR in people with cancer. METHODS: We searched the following databases up to November 2012: Cochrane Skin Group Specialised Register, CENTRAL (2012, Issue 11), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), CINAHL (from 1981) and LILACS (from 1982). Randomized controlled trials evaluating interventions for preventing or managing RISR in cancer patients were included. The primary outcomes were development of RISR, and levels of RISR and symptom severity. Secondary outcomes were time taken to develop erythema or dry desquamation; quality of life; time taken to heal, a number of skin reaction and symptom severity measures; cost, participant satisfaction; ease of use and adverse effects. Where appropriate, we pooled results of randomized controlled trials using mean differences (MD) or odd ratios (OR) with 95% confidence intervals (CI). RESULTS: Forty-seven studies were included in this review. These evaluated six types of interventions (oral systemic medications; skin care practices; steroidal topical therapies; non-steroidal topical therapies; dressings and other). Findings from two meta-analyses demonstrated significant benefits of oral Wobe-Mugos E for preventing RISR (OR 0.13 (95% CI 0.05 to 0.38)) and limiting the maximal level of RISR (MD -0.92 (95% CI -1.36 to -0.48)). Another meta-analysis reported that wearing deodorant does not influence the development of RISR (OR 0.80 (95% CI 0.47 to 1.37)). CONCLUSIONS: Despite the high number of trials in this area, there is limited good, comparative research that provides definitive results suggesting the effectiveness of any single intervention for reducing RISR. More research is required to demonstrate the usefulness of a wide range of products that are being used for reducing RISR. Future efforts for reducing RISR severity should focus on promising interventions, such as Wobe-Mugos E and oral zinc.


Asunto(s)
Neoplasias/radioterapia , Radiodermatitis/prevención & control , Radiodermatitis/terapia , Piel/efectos de la radiación , Humanos , Oportunidad Relativa , Radiodermatitis/diagnóstico , Radiodermatitis/etiología , Radioterapia/efectos adversos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Piel/patología , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas
7.
Ann Plast Surg ; 73(4): 385-9, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23728243

RESUMEN

BACKGROUND: The Michigan Hand Outcomes Questionnaire (MHQ) remains one of very few to be based on validated and systematic methods in its creation. However, test-retest reliability and internal validity have not been appropriately investigated in any other English-speaking population outside the original development sample. The objective of this study is to examine the reliability and internal validity of the MHQ in a Canadian population. METHODS: All patients with a clinical hand problem but no hand immobilization who attended our Plastic Surgery Clinic were invited to participate in this study. Patients were asked to complete the MHQ, and then contacted to arrange for completion of the MHQ a second time. Internal validity was estimated using Cronbach alpha. Reliability was estimated using the method of Bland and Altman, and intraclass correlation coefficients. Correlation analysis between score differences and time between tests was performed. RESULTS: Full versions of the MHQ were completed by 116 participants on their initial visit, while only 77 participants completed a second MHQ. Cronbach alpha ranged from 0.84 to 0.95 for the MHQ subscales. Intraclass-correlation coefficients ranged from 0.71 to 0.84 for the subscales. The magnitude of the limits of agreement for the subscales ranged from 13.8 to 26.2. The difference in scores between the first and second tests was not related to the time between tests. CONCLUSION: The high values of Cronbach alpha indicate high internal validity, but that there may be redundancy between items in the MHQ, which could be eliminated without losing information. Reliability of the MHQ is considered moderate. The limits of agreement are considered wide, indicating potential issues with respect to interpretation of a change in score between 2 administrations of the MHQ.


Asunto(s)
Evaluación de la Discapacidad , Traumatismos de la Mano , Enfermedades Musculoesqueléticas , Evaluación del Resultado de la Atención al Paciente , Satisfacción del Paciente , Encuestas y Cuestionarios , Adulto , Femenino , Mano/fisiopatología , Traumatismos de la Mano/fisiopatología , Traumatismos de la Mano/psicología , Humanos , Masculino , Michigan , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/fisiopatología , Enfermedades Musculoesqueléticas/psicología , Nueva Escocia , Psicometría , Reproducibilidad de los Resultados
8.
Clin Rehabil ; 24(3): 202-10, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20156983

RESUMEN

OBJECTIVE: To investigate the immediate effect of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with spinal cord injury. DESIGN: Randomized controlled trial. SETTING: Extended rehabilitation centre. SUBJECTS AND INTERVENTION: Eighteen subjects with spinal cord injury and symptoms of spasticity over lower limbs were randomly assigned to receive either 60 minutes of active TENS (0.25 ms, 100 Hz, 15 mA) or 60 minutes of placebo non-electrically stimulated TENS over the common peroneal nerve. OUTCOME MEASURES: Composite Spasticity Score was used to assess the spasticity level of ankle plantar flexors immediately before and after TENS application. Composite Spasticity Score consisted of Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus. Between-group statistical differences of reduction of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Mann-Whitney test. Within-group statistical differences of Composite Spasticity Score, Achilles tendon jerks, resistance to full-range passive ankle dorsiflexion and ankle clonus were calculated using the Wilcoxon signed ranks test. RESULTS: Significant reductions were shown in Composite Spasticity Score by 29.5% (p = 0.017), resistance to full-range passive ankle dorsiflexion by 31.0% (p = 0.024) and ankle clonus by 29.6% (p = 0.023) in the TENS group but these reductions were not found in the placebo TENS group. The between-group differences of both Composite Spasticity Score and resistance to full-range passive ankle dorsiflexion were significant (p = 0.027 and p = 0.024, respectively). CONCLUSION: This study showed that a single session of TENS could immediately reduce spasticity.


Asunto(s)
Espasticidad Muscular/terapia , Traumatismos de la Médula Espinal/rehabilitación , Estimulación Eléctrica Transcutánea del Nervio , Adulto , Anciano , Anciano de 80 o más Años , Tobillo/inervación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/etiología , Traumatismos de la Médula Espinal/complicaciones , Resultado del Tratamiento , Adulto Joven
11.
Hand (N Y) ; 14(2): 193-196, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-28975818

RESUMEN

BACKGROUND: The principle of relative motion has allowed patients to regain a higher degree of hand function, while protecting extensor tendon repairs. The purpose of this study was to determine whether the principle of relative motion could be a viable method to protect a flexor tendon repair. METHODS: Four fresh-frozen cadaver arms were each mounted on a testing apparatus (wrist in 30° of extension, metacarpophalangeal [MCP] joints blocked to 70°-80°). A minimum of 11 N was used to cyclically load the flexor digitorum profundus and extensor digitorum communis tendons to maximum allowable flexion and extension for 25 cycles. Measurements of elongation of the tendons were obtained through the use of differential variable reluctance transducers. Testing was performed in both intact and repaired (single 6-0 nylon suture) middle finger tendons (zone 3) with and without a relative motion flexion splint (RMFS), which placed the affected finger in 15° to 25° of relative flexion at the MCP joint. RESULTS: In all 4 hands, elongation was restricted to less than 1.3 mm in repaired tendon in the RMFS compared with elongation >2 mm in the nonsplinted condition. Average elongation was 0.86 mm (SD = 0.45). Visual examination of the tendons demonstrated no gapping with the use of the RMFS in any of the hands. All repairs had suture breakage and repair rupture without the RMFS. CONCLUSIONS: This study demonstrates that the RMFS decreases elongation and eliminates tendon-repair gapping after flexion/extension cycling in a cadaver model. It provides proof of concept that the RMFS may be a viable protective mechanism for flexor tendon repairs in zone 3.


Asunto(s)
Traumatismos de los Dedos , Laceraciones , Férulas (Fijadores) , Traumatismos de los Tendones , Tendones/fisiología , Cadáver , Traumatismos de los Dedos/rehabilitación , Traumatismos de los Dedos/cirugía , Humanos , Laceraciones/rehabilitación , Laceraciones/cirugía , Cuidados Posoperatorios , Traumatismos de los Tendones/rehabilitación , Traumatismos de los Tendones/cirugía , Tendones/cirugía
13.
Plast Reconstr Surg ; 140(3): 593-598, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28841622

RESUMEN

BACKGROUND: Composite grafts consisting of adipose tissue and skin have been reported in the literature but have been restricted to areas smaller than 4 to 5 cm. The senior author (D.T.W.C.) has developed a technique of adipose tissue-preserved full-thickness skin grafts for larger areas with success similar to that achieved with conventional full-thickness skin grafts. METHODS: All cases of the senior author involving a full-thickness skin graft were identified and reviewed to identify cases in which adipose tissue-preserved full-thickness skin grafts were used. Indication for skin grafting, anatomical location of recipient and donor sites, size of graft, total number of grafts received by each patient, and percentage take were extracted from patient charts. Graft take was measured between days 5 and 14. RESULTS: A total of 72 adipose tissue-preserved skin grafts on 47 patients were identified from 1994 to 2009, with a median follow-up of 8 years. The size of defect ranged from 0.7 to 210 cm, with a median area of 6 cm (interquartile range, 2.5 to 15 cm). Only six of 72 grafts were found to have less than 100 percent take. The lowest take percentage was 85 percent in a graft with an area of 2.6 cm. There were no graft failures. CONCLUSIONS: This study confirms the proof-of-concept that both larger and distant donor- site adipose tissue-preserved skin grafts are a viable alternative to conventional defatted full-thickness skin grafting. It appears that there is a low complication rate with respect to graft failure or incomplete graft take. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Tejido Adiposo/trasplante , Trasplante de Piel/métodos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/cirugía , Heridas y Lesiones/cirugía
14.
PeerJ ; 4: e2325, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27602291

RESUMEN

The modified Thomas test was developed to assess the presence of hip flexion contracture and to measure hip extensibility. Despite its widespread use, to the authors' knowledge, its criterion reference validity has not yet been investigated. The purpose of this study was to assess the criterion reference validity of the modified Thomas test for measuring peak hip extension angle and hip extension deficits, as defined by the hip not being able to extend to 0º, or neutral. Twenty-nine healthy college students (age = 22.00 ± 3.80 years; height = 1.71 ± 0.09 m; body mass = 70.00 ± 15.60 kg) were recruited for this study. Bland-Altman plots revealed poor validity for the modified Thomas test's ability to measure hip extension, which could not be explained by differences in hip flexion ability alone. The modified Thomas test displayed a sensitivity of 31.82% (95% CI [13.86-54.87]) and a specificity of 57.14% (95% CI [18.41-90.10]) for testing hip extension deficits. It appears, however, that by controlling pelvic tilt, much of this variance can be accounted for (r = 0.98). When pelvic tilt is not controlled, the modified Thomas test displays poor criterion reference validity and, as per previous studies, poor reliability. However, when pelvic tilt is controlled, the modified Thomas test appears to be a valid test for evaluating peak hip extension angle.

15.
PeerJ ; 3: e1281, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26421244

RESUMEN

Background. Foam rolling has been shown to acutely increase range of motion (ROM) during knee flexion and hip flexion with the experimenter applying an external force, yet no study to date has measured hip extensibility as a result of foam rolling with controlled knee flexion and hip extension moments. The purpose of this study was to investigate the acute effects of foam rolling on hip extension, knee flexion, and rectus femoris length during the modified Thomas test. Methods. Twenty-three healthy participants (male = 7; female = 16; age = 22 ± 3.3 years; height = 170 ± 9.18 cm; mass = 67.7 ± 14.9 kg) performed two, one-minute bouts of foam rolling applied to the anterior thigh. Hip extension and knee flexion were measured via motion capture before and after the foam rolling intervention, from which rectus femoris length was calculated. Results. Although the increase in hip extension (change = +1.86° (+0.11, +3.61); z(22) = 2.08; p = 0.0372; Pearson's r = 0.43 (0.02, 0.72)) was not due to chance alone, it cannot be said that the observed changes in knee flexion (change = -1.39° (-5.53, +2.75); t(22) = -0.70; p = 0.4933; Cohen's d = - 0.15 (-0.58, 0.29)) or rectus femoris length (change = -0.005 (-0.013, +0.003); t(22) = -1.30; p = 0.2070; Cohen's d = - 0.27 (-0.70, 0.16)) were not due to chance alone. Conclusions. Although a small change in hip extension was observed, no changes in knee flexion or rectus femoris length were observed. From these data, it appears unlikely that foam rolling applied to the anterior thigh will improve passive hip extension and knee flexion ROM, especially if performed in combination with a dynamic stretching protocol.

16.
Sports Med ; 32(13): 851-65, 2002.
Artículo en Inglés | MEDLINE | ID: mdl-12392445

RESUMEN

Extracorporeal shockwave therapy (ESWT) has been in use for the treatment of tendinopathies since the early 1990s. The exact mechanism by which ESWT relieves tendon-associated pain is not known; however, there is an increasing body of literature that suggests that it can be an effective therapy for patients who have had repeated nonsurgical treatment failures. The highest strength of evidence is shown in randomised controlled trials, of which there are a small number. Reported results for tendinopathies of the shoulder, elbow and heel have shown consistent positive results in favour of ESWT over placebo ESWT in individuals who have failed conservative therapy. These studies provide strong evidence for ESWT as an effective therapy for the treatment of chronic treatment-resistant tendinopathies. There is still much debate over several issues surrounding ESWT that have not been adequately addressed by the literature: high- versus low-energy ESWT, shockwave dosage and number of sessions required for a therapeutic effect. Further research is needed to ascertain the most beneficial protocol for patient care.


Asunto(s)
Traumatismos en Atletas/terapia , Litotricia/métodos , Traumatismos de los Tendones/terapia , Ensayos Clínicos como Asunto , Humanos
17.
Am J Sports Med ; 32(7): 1660-7, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15494330

RESUMEN

BACKGROUND: Extracorporeal shock wave therapy is a relatively new therapy used in the treatment of chronic tendon-related pain. Few randomized controlled trials have been performed on it, and no studies have examined the effectiveness of extracorporeal shock wave therapy as a frontline therapy for tendon-related pain. HYPOTHESIS: Subjects treated with active extracorporeal shock wave therapy will have higher rates of treatment success than subjects treated with sham extracorporeal shock wave therapy. DESIGN: Double-blind randomized controlled trial. METHODS: Sixty subjects who had previously untreated lateral epicondylitis for less than 1 year and more than 3 weeks were included in this study. Subjects were randomly allocated to receive 1 session per week for 3 weeks of either sham or active extra-corporeal shock wave therapy. Subjects in the active therapy group received 2000 pulses (energy flux density, 0.03-0.17 mJ/mm(2)). All subjects were provided with a forearm-stretching program. After 8 weeks of therapy, subjects were classified as either treatment successes or treatment failures according to fulfillment of all 3 criteria: (1) at least a 50% reduction in the overall pain visual analog scale score, (2) a maximum allowable overall pain visual analog scale score of 4.0 cm, and (3) no use of pain medication for elbow pain for 2 weeks before the 8 week follow-up. Visual analog scale scores were also collected for pain at rest, during sleep, during activity, at its worst, and at its least, as well as for quality of life (using the EuroQoL questionnaire) and grip strength. RESULTS: Success rates in the sham and active therapy groups were 31% and 39%, respectively. No significant difference was detected between groups (chi(2)(1)= 0.3880, P = .533). Mean change in quality of life over 8 weeks was an increase of 1.3 and 3.3 for sham and active therapy groups, respectively, and mean change in grip strength over 8 weeks was an increase of 7.4 kg and 6.8 kg for sham and active therapy groups, respectively. CONCLUSIONS: Despite improvement in pain scores and pain-free maximum grip strength within groups, there does not appear to be a meaningful difference between treating lateral epicondylitis with extracorporeal shock wave therapy combined with forearm-stretching program and treating with forearm-stretching program alone, with respect to resolving pain within an 8-week period of commencing treatment.


Asunto(s)
Litotricia , Codo de Tenista/terapia , Adulto , Método Doble Ciego , Femenino , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Dolor , Calidad de Vida , Resultado del Tratamiento
18.
Can J Plast Surg ; 21(1): 33-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24431934

RESUMEN

BACKGROUND: In a socialized medicine model, prioritization of referrals for specialist consultation is highly important in the distribution of heath care. For high-burden diseases, such as carpal tunnel syndrome (CTS), the factors that influence prioritization are not well understood. OBJECTIVE: To determine the factors that influence the prioritization of referrals for CTS consultation by plastic surgeons in Canada. METHODS: All members of the Canadian Society of Plastic Surgery with e-mail addresses were invited to participate in an online survey regarding the method by which they prioritize referrals for CTS. RESULTS: Forty per cent of invited members completed the survey (150 surgeons). Of these, 118 (79%) stated that they performed CTS surgery. The majority of respondents who performed CTS surgery prioritized their consultation list chronologically (77%). Factors that would alter the chronological order or prioritization included subsequent contact by the referring physician (24%); personal relationship with the patient (16%); and specific information in the referral letter (15%), which usually involved symptom severity or electromyography findings. Sixty-six per cent of plastic surgeons stated that there was no conscious decision on how they came to choose the method of prioritization they used for referrals regarding CTS. DISCUSSION: The majority of plastic surgeons in Canada prioritize referrals for consultation on CTS chronologically. A minority of respondents reported reassigning priority based on clinical severity. The rationale for the methods by which Canadian Society of Plastic Surgery members prioritize these referrals is poorly understood. Further study on developing evidence-based prioritization methods may be useful in assisting surgeons and their patients in outcome-based decisions.


HISTORIQUE: Dans un modèle de médecine sociale, la priorisation des aiguillages vers une consultation en spécialité revêt une grande importance dans la distribution des soins. Dans le cas des maladies au taux de morbidité élevé, telles que le syndrome du canal carpien (SCC), les facteurs qui influent sur la priorisation sont mal compris. OBJECTIF: Déterminer les facteurs qui influent sur la priorisation des aiguillages en vue d'une consultation relative à un SCC auprès des chirurgiens plasticiens du Canada. MÉTHODOLOGIE: Tous les membres de la Société canadienne des chirurgiens plasticiens qui ont fourni une adresse de courriel ont été invités à participer à un sondage virtuel sur la méthode qu'ils utilisent pour prioriser les aiguillages en vue d'un SCC. RÉSULTATS: Quarante pour cent des membres invités ont rempli le sondage (150 chirurgiens). De ce nombre, 118 (79 %) ont déclaré avoir exécuté des chirurgies du SCC. La majorité des répondants qui avaient exécuté de telles chirurgies priorisaient leur liste de consultation de manière chronologique (77 %). Les facteurs qui pouvaient modifier l'ordre chronologique ou la priorisation incluaient un contact subséquent par le médecin traitant (24 %), une relation personnelle avec le patient (16 %) et de l'information précise dans la lettre d'aiguillage (15 %), laquelle précisait généralement la gravité des symptômes ou les résultats de l'électromyographie. Quarante-deux pour cent des chirurgiens plasticiens ont déclaré qu'il n'y avait aucun processus de décision conscient dans le choix de leur méthode de priorisation. EXPOSÉ: La majorité des chirurgiens plasticiens du Canada priorise de manière chronologique les aiguillages en consultation à cause d'un SCC. Une minorité de répondants déclare réévaluer les priorités compte tenu de la gravité clinique. On comprend mal le motif de la méthode par laquelle les membres de la Société canadienne des chirurgiens plasticiens priorisent ces aiguillages. D'autres études sur l'élaboration de méthodes de priorisation fondées sur des données probantes pourraient être utiles pour aider les chirurgiens et leurs patients à prendre des décisions fondées sur les issues.

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