Cost effectiveness of a telerehabilitation intervention vs home based care for adults with severe neurologic disability: A randomized clinical trial.

Context: Several options are available for the care of neurological conditions including care delivered in rehabilitation centres, at home or remotely. While economic studies are available comparing centres and homes, very little economic data relates to mobile teams comparing face-to-face and remote care. Objective: To conduct an economic study comparing face-to-face care at home and care delivered remotely (tele-rehabilitation). Method: A randomised clinical study with two groups; a control group receiving home care and an experimental group receiving tele-rehabilitation. The primary outcome measure was the ICER (Incremental Cost Effectiveness Ratio). Participants: Patients with severe neurological disabilities. Results: 80 patients were enrolled in the study; 77 were analysed to calculate the ICER, which was positive and located in the SW quadrant. A bootstrap with 1000 replications was positioned at 72.8% in the SW quadrant. Conclusion: Tele-rehabilitation is an acceptable alternative to the management of neurological patients at home. In the mildest cases, remote-rehabilitation may even be dominant. More extensive studies are needed to specify the indications.

Telerehabilitation during the COVID-19 pandemic, what are the determinants of satisfaction for chronic diseases? a retrospective study.

Background: During the Covid-19 health crisis, telerehabilitation provided a solution to ensure the continuity of care. Since then, it has been offered as an alternative to face-to-face rehabilitation in chronic conditions. Data measuring satisfaction are essential to adapt and increase the effectiveness of this type of programme. Aim and scope: This research focused on determining the most significant determinants of participant satisfaction in a telerehabilitation programme. Methods: We conducted a retrospective study by analysing the satisfaction questionnaire used from the start of the programme. Result: Two hundred and ten (210) participants completed the programme; 180 questionnaires were filled in and 175 analyzed of which 70 with chronic low back pain (CLBP), 59 for multiple sclerosis (MS) and 22 with parkinson's disease (PD). Satisfaction was high for all participants (scoring out of 10, mean = 8.22 sd = 1.53), but the determinants reported for the three main conditions involved in the programme differed. Main determinant was "benefice" for CLBP (p = 1.23e-05), "home exercises adapted" for MS (p = 0.000679) and "interest in staying at home" for PD (p = 1.84e-05). Conclusion: Depending on the context of the condition/disease, the drivers of satisfaction were not identical. Knowledge of these determinants will allow us to further improve the programme. However, some unresolved questions remain regarding the place of therapists, their role and the skills required for a successful telerehabilitation programme. Further studies are required to understand the impact.

Medication, rehabilitation and health care consumption in adults with cerebral palsy: a population based study.

OBJECTIVE: To evaluate medication, rehabilitation and healthcare consumption in adults with CP as a function of Gross Motor Function Classification System (GMFCS) level. DESIGN: Questionnaire-based cross-sectional study. SETTING: Brittany, a French county. SUBJECTS: Adults with cerebral palsy. INTERVENTIONS: Questionnaires relating to drugs, orthotic devices, mobility aids, rehabilitation and medical input were sent to 435 members of a unique regional French network dedicated to adults with cerebral palsy. The questionnaire was completed by the participant or a helper if necessary. RESULTS: Of the 282 responders, 7.8% had a GMFCS level of I, 14.2% II, 17.7% III, 29.1% IV and 31.2% V. Participants consumed a large amount of healthcare. Almost three-quarters took orally administered drugs, of which antispastic and antiepileptic drugs were among the most frequent. Nearly all patients had at least one type of rehabilitation, 87.2% had physiotherapy, 78% used at least one mobility aid and 69.5% used at least one orthotic device. The frequency of numerous inputs increased with GMFCS level. Specificities were found for each GMFCS level, e.g. participants with GMFCS level IV and V had a high level of medical input and a greater use of trunk-supporting devices, antireflux and laxative. Profiles could be established based on GMFCS levels. CONCLUSIONS: Adults with cerebral palsy use a large amount of drugs, mobility aids, orthotic devices, rehabilitation and medical input. Healthcare is targeted at cerebral palsy-related issues. GMFCS is a determinant of healthcare consumption and thus a useful tool for clinical practice to target care appropriately.

Effects of pregnancy and child birth on urinary symptoms and urodynamics in women with multiple sclerosis.

OBJECTIVE: Our objective was to study the impact of pregnancy and delivery on vesicourethral disorders in patients with multiple sclerosis (MS). DESIGN AND SETTING: We performed a retrospective chart review of records of women diagnosed with MS who were referred to the clinic. PARTICIPANTS: A total of 102 women with MS (mean age of 44.7 +/- 11.4 years at the time of the study and mean age of 30.0 +/- 9.6 years at the onset of MS) participated in the study. The mean duration of disease was 15 +/- 10 years. The mean Expanded Disability Status Scale score was 5.4 +/- 1.8. MAIN OUTCOME MEASURES: For each patient, demographic data, disease characteristics, urological and obstetrical history and urodynamic data were collected. Urinary disorders were classified as irritative (urinary urgency and frequency) or as obstructive (hesitancy of micturition, reduced or interrupted urinary stream and sensation of incomplete bladder emptying). Urodynamic study consisted of cystometry with continuous recording of urethral sphincter electromyography in 77 (76%) cases. Intravesical and intraurethral pressures were recorded. Bladder dysfunctions were classified into neurogenic detrusor overactivity or detrusor underactivity. RESULTS: Pregnancies and deliveries did not influence symptoms. Moreover, the only statistical difference from a urodynamic point of view was a decrease in maximal urethral closure pressure. CONCLUSION: No interaction between pregnancy, delivery and urinary symptoms was found in this study. The effects of pregnancy and delivery seemed to be the same in women with MS and in healthy women, with a tendency towards a decrease in urethral pressure in women with MS.

Cervical spondylotic myelopathy in athetoid cerebral palsy patients: about five cases.

UNLABELLED: We herein report five cases of cerebral palsy athetosic patients with spondyloid cervical myelopathy. Four of them underwent decompressive surgery. The level of cervicarthrosis differs from a control population with a more frequent osteoarthritis on the lower cervical spine. The diagnosis of spondylotic cervical myelopathy is frequently overlooked because of the insidious progression of neurologic disorders and of the pre-existent neurological handicap. Depressive syndrome is often evoked in such a situation, and thus responsible for a delay of diagnosis. The presence of an hypersignal in T2 MRI sequences is still controversial. For some authors it is an indication for surgery, which is the treatment with the best functional results. CONCLUSION: Cervical spondylotic myelopathy must be evoked in patients with athetoid cerebral palsy who complain about a decrease of their functional ability.

Role for botulinum toxin in back pain treatment in adults with cerebral palsy: report of a case.

OBJECTIVE: To report a case illustrating the usefulness of botulinum toxin A in the treatment of spinal dystonia responsible for low back pain and postural disorders. METHODS: Critical appraisal of a case report. CASE REPORT: A young woman with cerebral palsy had lumbar paraspinal muscle dystonia responsible for pain and hyperlordosis unresponsive to oral medications for muscle spasm. Botulinum toxin A (Botox(R), 200 U) was injected into the paraspinal muscles at six sites, to good effect. DISCUSSION: The few reported cases consistently show a favorable effect of local botulinum toxin A injections in patients with painful paraspinal muscle dystonia related to neurological disease or chronic low back pain. CONCLUSION: Botulinum toxin A may be a useful treatment for incapacitating painful dystonia of the paraspinal muscles. This treatment improves posture in the sitting position and facilitates the fitting of orthotic devices. Furthermore, botulinum toxin A treatment may help to determine whether an intrathecal baclofen test is in order.

Atypical low back pain: stiff-person syndrome.

Stiff-person syndrome was diagnosed in a patient with chronic low back pain. The diagnosis of this rare neurological condition rests mainly on the clinical findings of axial and proximal limb rigidity, increased lumbar lordosis often accompanied with pain, and normal neurological findings apart from brisk deep tendon reflexes. Electromyography of the lumbar paraspinal muscles shows motor unit firing at rest with normal appearance of the motor unit potentials. Titers of antibody to glutamic acid decarboxylase are elevated. Diazepam is the treatment of reference. Physical therapy can substantially improve quality of life.

Prognostic factors in the recovery of the ability to walk after stroke.

We have studied the recovery of walking ability on being discharged from a department of physical medicine and rehabilitation in patients with hemiplegia after stroke, and the factors influencing this recovery. This prospective study was based on 93 patients. The patients, who were considered to be ambulatory, were able to move 10 metres on their own or with supervision when they were discharged. The potentially influential factors studied were: age, the aetiology and the side of hemiplegia, co-morbidity, the delay in starting rehabilitation, the neurological damage evaluated by the middle cerebral artery scale of Orgogozo, the initial functional damage evaluated by the functional score carried out within the scale of Functional Independence Measure (FIM), the existence of aphasia, of a depressive or hemineglect syndrome, presence of superficial or profound sensory disorders, incontinence at the start of rehabilitation and at one month after stroke, the existence of cognitive or psychiatric disorders. The non-parametric Mann-Whitney, the chi2, and the correlation test were used. The threshold of significance was .05. Based on 93 patients (47 women and 46 men, average age 64.8) 87.1% were walking at discharge, on average 3 months after stroke. The predictive factors or those linked to an absence of recovery were the presence of superficial sensory disorders, the initial neurological damage, the initial functional damage, the presence of a depressive syndrome, and urinary incontinence. We stress the significance of the sensorimotor and initial functional damage, and of incontinence in establishing a prognosis for recovery of walking ability, in order to decide the objectives and the rehabilitative treatment for each patient.