Effect of photobiomodulation therapy on the morphology, intracellular calcium concentration, free radical generation, apoptosis and necrosis of human mesenchymal stem cells-an in vitro study.

The aim of the study was to investigate the impact of multiwave locked system (MLS M1) emitting synchronized laser radiation at 2 wavelength simultaneous (λ = 808 nm, λ = 905 nm) on the mesenchymal stem cells (MSCs). Human MSCs were exposed to MLS M1 system laser radiation with the power density 195-318 mW/cm2 and doses of energy 3-20 J, in continuous wave emission (CW) or pulsed emission (PE). After irradiation exposure in doses of energy 3 J, 10 J (CW, ƒ = 1000 Hz), and 20 J (ƒ = 2000 Hz), increased proliferation of MSCs was observed. Significant reduction of Fluo-4 Direct™ Ca2+ indicator fluorescence over controls after CW and PE with 3 J, 10 J, and 20 J was noticed. A decrease in fluorescence intensity after the application of radiation with a frequency of 2000 Hz in doses of 3 J, 10 J, and 20 J was observed. In contrary, an increase in DCF fluorescence intensity after irradiation with laser radiation of 3 J, 10 J, and 20 J (CW, ƒ = 1000 Hz and ƒ = 2000 Hz) was also shown. Laser irradiation at a dose of 20 J, emitted at 1000 Hz and 2000 Hz, and 3 J emitted at a frequency of 2000 Hz caused a statistically significant loss of MSC viability. The applied photobiomodulation therapy induced a strong pro-apoptotic effect dependent on the laser irradiation exposure time, while the application of a sufficiently high-energy dose and frequency with a sufficiently long exposure time significantly increased intracellular calcium ion concentration and free radical production by MSCs.

Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico-Thoracic Regions of the Spine.

Background: Cervical spine disorders (CSDs) are a common cause of neck pain. Proper diagnosis is of great importance in planning the management of a patient with neck pain. Hence, the aim of this study is to provide an overview of the clinical pattern of early-stage functional disorders affecting the cervical and cervico-thoracic regions of the spine, considering the age and sex of the subjects. Methods: Two hundred adult volunteers were included in the study. Manual examination of segments C0/C1-Th3/Th4 was performed according to the methodology of the Katenborn-Evjenth manual therapy concept and the spine curvatures were assessed (cervical lordosis and thoracic kyphosis). Results: The most common restricted movement was lateral flexion to the left, and the least disturbed movement were observed in the sagittal plane (flexion and extension). The most affected segment was C7/Th1 (71.5% participants had problems in this segment), and the least affected segment was Th3/Th4 (69.5% participants had no mobility disorders in this segment). The number of disturbed segments did not differ between men and women (p > 0.05), but increased with age (r = 0.14, p = 0.04). Conclusions: Cervical mobility in adult population is frequently restricted. The number of affected segments increased with age and was not sex-dependent.

Assessment of the Functioning Profile of Patients with Lung Cancer Undergoing Lobectomy in Relation to the ICF Rehabilitation Core Set.

Lung cancer often presents with pain and breathlessness, frequently necessitating surgical procedures, such as lung lobectomy. A pivotal component of postoperative care is rehabilitation, aimed not only at improving the clinical condition but also at influencing the patient's functional profile. In a study conducted at the Clinic of Thoracic Surgery and Respiratory Rehabilitation in the Regional Multispecialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, the effectiveness of rehabilitation intervention was assessed in 50 patients (n = 27 M, n = 23 F) postlobectomy due to early stage nonsmall cell lung cancer (NSCLC). The International Classification of Functioning, Disability, and Health-ICF Rehabilitation Core Set was used to evaluate the functional profile, the modified Laitinen scale for pain assessment, and the modified Borg scale for breathlessness evaluation. Additionally, lung-expansion time was monitored. The significance level of the statistical tests in this analysis was set at α = 0.05. The study employed an analysis of the normality of the distributions of the numerical variables, reporting of variable distributions, estimation of differences between groups, estimation of differences within groups, estimation of the independence of categorical variables, and regression analysis. The research confirmed that rehabilitation partially improves the functional profile of patients and reduces the sensation of breathlessness postsurgery. The study highlighted the need for future research with a larger number of participants and an extended observation period to gain a deeper understanding of the impact of rehabilitation on patients after lung lobectomy procedures.

Depressive Disorders, Cognitive and Physical Function of Older People in Early Dementia Detection.

BACKGROUND: Aging is associated with cognitive decline, leading to cognitive and physical impairments, which are risk factors for loss of independence and dementia development. Early diagnosis is beneficial for both, the patient and their family, to avoid long-term consequences. The aim of this study was to analyze the frequency of depressive disorders and their influence on cognitive and physical function of older people in early dementia detection. METHODS: There were 852 patients, aged at least 60 years, from the Central Teaching Hospital. The study was conducted between September 2022 and June 2023. The qualified participants were examined using four tools: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Timed Up and Go (TUG) and Schulman's Clock-Drawing Test. RESULTS: Over one-third had depressive disorders. A relationship with p < 0.05 was observed between GDS and IADL: r = -0.61. A relationship with p > 0.05 was observed between GDS and TUG: r = -024. A relationship with p < 0.05 was observed between GDS and CDT: r = 0.74. CONCLUSIONS: The first signs of depressive disorders in older people may be considered an indication for further diagnosis of dementia.

Development of simple descriptions of the ICF Generic-30 Set in different languages: laying the foundation for an ICF-based clinical tool for Europe.

BACKGROUND: Functioning is considered a third indicator of health and a key outcome in rehabilitation. A universal practical tool for collecting functioning information is essential. This tool would be ideally based on the International Classification of Functioning, Disability and Health. AIM: To report the results of the development of country/language-specific versions of an ICF-based clinical tool in six European countries. DESIGN: Consensus process. SETTING: Expert conferences. POPULATION: Multi-professional group of rehabilitation professionals in six European countries. METHODS: 1) Developed an initial proposal by translating the published English-language version of the simple descriptions into the targeted language; 2) conducted a multi-stage consensus conference to finalize the descriptions; 3) employed a three-stage multi-professional expert panel translation back to English. The consensus conference model was modified for geographically large countries. RESULTS: Croatian, Flemish/Dutch, Greek, Polish, and Turkish versions were produced. CONCLUSIONS: The creation of the country/language-specific simple descriptions is a significant part of the "system-wide implementation of the ICF" initiative that will pave the way for the implementation of the ICF in national health systems. CLINICAL REHABILITATION IMPACT: The practical ICF-based clinical tool with country/language specific versions for standardized reporting of functioning will serve as a means of integrating functioning information in national health systems and additionally for monitoring the effects of rehabilitation interventions.

Symmetry of the Neck Muscles' Activity in the Electromyography Signal during Basic Motion Patterns.

The activity of muscles during motion in one direction should be symmetrical when compared to the activity of the contralateral muscles during motion in the opposite direction, while symmetrical movements should result in symmetrical muscle activation. The literature lacks data on the symmetry of neck muscle activation. Therefore, this study aimed to analyse the activity of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles at rest and during basic motions of the neck and to determine the symmetry of the muscle activation. Surface electromyography (sEMG) was collected from UT and SCM bilaterally during rest, maximum voluntary contraction (MVC) and six functional movements from 18 participants. The muscle activity was related to the MVC, and the Symmetry Index was calculated. The muscle activity at rest was 23.74% and 27.88% higher on the left side than on the right side for the UT and SCM, respectively. The highest asymmetries during motion were for the SCM for the right arc movement (116%) and for the UT in the lower arc movement (55%). The lowest asymmetry was recorded for extension-flexion movement for both muscles. It was concluded that this movement can be useful for assessing the symmetry of neck muscles' activation. Further studies are required to verify the above-presented results, determine muscle activation patterns and compare healthy people to patients with neck pain.

Relationship between secondary health conditions and life satisfaction in persons with spinal cord injury: study across twenty-one countries.

PURPOSE: To determine the relationships between impact of secondary health conditions (SHCs), treatment of SHCs, and life satisfaction (LS) following spinal cord injury (SCI) across 21 countries. Hypotheses were as follows: (1) Persons with SCI and fewer SHCs report higher LS and (2) Persons who receive treatment for SHCs report higher LS than those who do not receive treatment. METHODS: Cross-sectional survey, including 10,499 persons with traumatic or non-traumatic SCI aged 18 years or older and living in the community. To assess SHCs, 14 items adapted from the SCI-Secondary Conditions Scale were used (range 1-5). SHCs index was calculated as the mean of all 14 items. LS was assessed using a selection of 5 items from the World Health Organization Quality of Life Assessment. LS index was calculated as the mean of these 5 items. RESULTS: South Korea, Germany, and Poland exhibited the highest (2.40-2.93) and Brazil, China, and Thailand the lowest (1.79-1.90) impact of SHCs. Indexes for LS and SHCs were inversely correlated (- 0.418; p < 0.001). Mixed Model Analysis showed that the fixed effect (key predictors of the study) of SHCs index (p < 0.001) and the positive interaction between SHCs index and treatment (p = 0.002) were significant determinants of LS. CONCLUSION: Persons with SCI across the world are more likely to perceive better LS if they experience fewer SHCs and receive treatment for SHCs, in comparison to those who do not. Prevention and treatment of SHCs following SCI should be a high priority in order to improve the lived experience and enhance LS.

Ergonomics of E-Learning Workstations and the Prevalence of Musculoskeletal Disorders-Study among University Students.

The prevalence of musculoskeletal disorders (MSD) has increased significantly in recent years. The COVID-19 pandemic has led to a fundamental change in the lifestyles, ways of learning and working patterns of the general population, which in turn, might lead to health consequences. The aim of this study was to evaluate the conditions of e-learning and the impact of the learning modality on the occurrence of musculoskeletal symptoms among university students in Poland. This cross-sectional study included 914 students who completed an anonymous questionnaire. The questions covered two time periods (before and during the COVID-19 pandemic) and were aimed at obtaining information about lifestyle (including physical activity using the modified International Physical Activity Questionnaire, 2007 (IPAQ), perceived stress and sleep patterns), the ergonomics of computer workstations (by Rapid Office Strain Assessment, 2012 (ROSA) method), the incidence and severity of musculoskeletal symptoms (by the Nordic Musculoskeletal Questionnaire, 2018 (NMQ)) and headaches. The main differences between the two periods were statistically significant according to the Wilcoxon test in terms of physical activity, computer use time, and severity of headaches. During the COVID-19 pandemic, there was a significant increase in MSD (68.2% vs. 74.6%) and their intensity (2.83 ± 2.36 vs. 3.50 ± 2.79 points) among the student population (p < 0.001). In the group of students with MSD, there was a high musculoskeletal load, due to the lack of ergonomic remote learning workstations. In future, a thorough study should be carried out, and there is an urgent need to raise students' awareness of arranging learning workstations according to ergonomic principles in order to prevent the occurrence of musculoskeletal problems.

Comparison of Life Satisfaction in Persons With Spinal Cord Injury Living in 22 Countries With Different Economic Status.

OBJECTIVE: To analyze and compare life satisfaction (LS) in persons with spinal cord injury (SCI) living in 22 countries participating in the International Spinal Cord Injury (InSCI) community survey. The study tested the hypothesis that there are differences in LS across InSCI countries according to the countries' economic status specified as gross domestic product per capita purchased power parity (GDP-PPP). DESIGN: Cross-sectional survey. SETTING: Community setting (22 countries representing all 6 World Health Organization regions). PARTICIPANTS: Persons (N=12,108) with traumatic or nontraumatic SCI aged at least 18 years, living in the community and able to respond to one of the available language versions of the questionnaire. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: LS measured by 5 items selected from the World Health Organization Quality of Life Assessment-BREF: satisfaction with overall quality of life, health, daily activities, relationships, and living conditions. LS index was calculated as the mean of these 5 items. RESULTS: The highest level of LS was reported by persons with SCI living in the United States, Malaysia, and Switzerland (mean range, 3.76-3.80), and the lowest was reported by persons with SCI living in South Korea, Japan, and Morocco (mean range, 2.81-3.16). There was a significant cubic association between LS index and GDP-PPP. Regression tree analysis revealed the main variables differentiating LS index were GDP-PPP and monthly income, followed by time since injury and education. CONCLUSIONS: Life satisfaction reported by persons with SCI related mainly to their country economic situation expressed by GDP-PPP and monthly income. The results of this study underscore the need for policy dialogues to avoid inequalities and improve the life experience in persons with SCI.

Relationship Between Level of Economic Development, Age, and Etiology of Spinal Cord Injury: A Cross-Sectional Survey From 22 Countries.

OBJECTIVE: To examine relationships between age and spinal cord injury (SCI) and cause of SCI and how this depends on economic development. DESIGN: Cross-sectional survey. SETTING: Community, 22 countries representing all stages of economic development. PARTICIPANTS: A total of 12,591 adults with SCI (N=12,591). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interactions between age at injury and gross domestic product per capita based on purchasing power parity (GDP PPP) quartiles calculated with the application of logistic regression with the Maximum Likelihood estimator. Independence between SCI cause and age was assessed with the Wald test. RESULTS: In persons with traumatic SCI, younger age was associated with a higher likelihood of injury in motor vehicle collisions, whereas older individuals had a greater chance of SCI due to falls. Associations between increased likelihood of high-energy traumatic SCI and younger age, low-energy traumatic SCI with older age, nontraumatic SCI with older age in persons injured in adulthood, and a higher prevalence of incomplete SCI lesions in individuals injured at an older age were revealed. Higher GDP PPP influenced positively the likelihood of low-energy SCI in older individuals and was negatively associated with the chance of sustaining SCI in motor vehicle collisions and the likelihood of having nontraumatic SCI at an older age. CONCLUSIONS: SCI in older age is predominantly because of falls and nontraumatic injuries. Higher country income is associated with an increased proportion of SCI sustained later in life because of low-energy trauma involving cervical injury and a lower chance of being because of motor vehicle collisions. An increased prevalence of nontraumatic SCI in older individuals associated with lower country income may reflect a higher exposure to socially preventable conditions and lower access to or efficacy of health care. Future studies on etiology of SCI should make the distinction between low and high falls and overcome underrepresentation of older persons.

Evidence-based position paper on the professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy. The European PRM position (UEMS PRM section).

Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. The aim of this study was to improve physicians' professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. A systematic review of the literature including an 18-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. As the result of a Consensus Delphi procedure, 74 recommendations are presented together with the systematic literature review. The PRM physician's role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM program developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients' health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions. This evidence-based position paper is representing the official position of The European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cerebral palsy.

Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey.

OBJECTIVES: To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level. DESIGN: Cross-sectional community survey. PARTICIPANTS: Individuals (N=12,591) living with SCI in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Nottwil Environmental Factors Inventory-Short Form. RESULTS: Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality. CONCLUSIONS: Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.

Cervico-ocular reflex upregulation in dizzy patients with asymmetric neck pathology.

OBJECTIVES: The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness. MATERIAL AND METHODS: Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R-) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded. RESULTS: Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R- group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed. CONCLUSIONS: Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms. Int J Occup Med Environ Health. 2019;32(5):723-33.

Clinical replicability of rehabilitation interventions in randomized controlled trials reported in main journals is inadequate.

OBJECTIVE: The objective of this study was to study if randomized controlled trials (RCTs) in rehabilitation (a field where complex interventions prevail) published in main journals include all the details needed to replicate the intervention in clinical practice (clinical replicability). STUDY DESIGN AND SETTING: Forty-seven rehabilitation clinicians of 5 professions from 7 teams (Belgium, Italy, Malaysia, Pakistan, Poland, Puerto Rico, the USA) reviewed 76 RCTs published by main rehabilitation journals exploring 14 domains chosen through consensus and piloting. RESULTS: The response rate was 99%. Inter-rater agreement was moderate/good. All clinicians considered unanimously 12 (16%) RCTs clinically replicable and none not replicable. At least one "absent" information was found by all participants in 60 RCTs (79%), and by a minimum of 85% in the remaining 16 (21%). Information considered to be less well described (8-19% "perfect" information) included two providers (skills, experience) and two delivery (cautions, relationships) items. The best described (50-79% "perfect") were the classic methodological items included in CONSORT (descending order: participants, materials, procedures, setting, and intervention). CONCLUSION: Clinical replicability must be considered in RCTs reporting, particularly for complex interventions. Classical methodological checklists such as CONSORT are not enough, and also Template for Intervention Description and Clinical replication do not cover all the requirements. This study supports the need for field-specific checklists.

Effect of Photobiomodulation Therapy on the Increase of Viability and Proliferation of Human Mesenchymal Stem Cells.

BACKGROUND AND OBJECTIVES: We have investigated how low intensity laser irradiation emitted by a multiwave-locked system (MLS M1) affects the viability and proliferation of human bone marrow mesenchymal stem cells (MSCs) depending on the parameters of the irradiation. STUDY DESIGN/MATERIALS AND METHODS: Cells isolated surgically from the femoral bone during surgery were identified by flow cytometry and cell differentiation assays. For irradiation, two wavelengths (808 and 905 nm) with the following parameters were used: power density 195, 230, and 318 mW/cm 2 , doses of energy 3, 10, and 20 J (energy density 0.93-6.27 J/cm 2 ), and in continuous (CW) or pulsed emission (PE) (frequencies 1,000 and 2,000 Hz). RESULTS: There were statistically significant increases of cell viability and proliferation after irradiation at 3 J (CW; 1,000 Hz), 10 J (1,000 Hz), and 20 J (2,000 Hz). CONCLUSIONS: Irradiation with the MLS M1 system can be used in vitro to modulate MSCs in preparation for therapeutic applications. This will assist in designing further studies to optimize the radiation parameters and elucidate the molecular mechanisms of action of the radiation. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Assessment of Disability and Factors Determining Disability among Inhabitants of South-Eastern Poland Aged 71-80 Years.

INTRODUCTION: The aim of the study was to assess the level of disability in a sample of older people in south-eastern Poland and to identify any potential relationship between their profile of functioning and a complex set of variables including activities, participation, and contextual factors. MATERIALS AND METHODS: The study included 800 people aged 71-80 years. The WHODAS 2.0 questionnaire was applied for the assessment of disability. RESULTS: A total of 43.88% of the interviewees showed a moderate level of disability, while 17.75% had severe or extremely high levels of disability. In addition, 7.75% of the interviewees had no functional limitations and 30.62% demonstrated a mild level of disability. The studied individuals reported the greatest difficulties with life activities such as cleaning, cooking, or shopping, followed by Limited Participation and then getting along. Age, number of chronic diseases, a low level of education, a low level of physical activity, poor living conditions, and lack of opportunities for daily help significantly contributed to higher levels of disability. CONCLUSIONS: Measures intended to reduce the level of disability in older adults should focus on improving medical care, health education, increasing physical activity, adapting housing to the needs of everyday functioning, and providing daily help.

The effect of MLS laser radiation on cell lipid membrane.

INTRODUCTION: Authors of numerous publications have proved the therapeutic effect of laser irradiation on biological material, but the mechanisms at cellular and subcellular level are not yet well understood. OBJECTIVE: The aim of this study was to assess the effect of laser radiation emitted by the MLS M1 system (Multiwave Locked System) at two wavelengths (808 nm continuous and 905 nm pulsed) on the stability and fluidity of liposomes with a lipid composition similar to that of human erythrocyte membrane or made of phosphatidylocholine. MATERIAL AND METHODS: Liposomes were exposed to low-energy laser radiation at surface densities 195 mW/cm2 (frequency 1,000 Hz) and 230 mW/cm2 (frequency 2,000 Hz). Different doses of radiation energy in the range 0-15 J were applied. The surface energy density was within the range 0.46 - 4.9 J/cm 2. RESULTS: The fluidity and stability of liposomes subjected to such irradiation changed depending on the parameters of radiation used. CONCLUSIONS: Since MLS M1 laser radiation, depending on the parameters used, affects fluidity and stability of liposomes with the lipid content similar to erythrocyte membrane, it may also cause structural and functional changes in cell membranes.

Evidence based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for ageing people with disabilities. The European PRM position (UEMS PRM Section).

Ageing people with disabilities (APwDs) are faced with challenges of ageing which is straightforwardly related to disability that adds to the burden related to their early-onset disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for APwDs (as a distinct group from those who are disabled due to the ageing process) in order to promote their functioning properties and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with the 30 recommendations resulting from the Delphi procedure. The professional role of PRM physicians in relation to APwDs is extending, expanding and/or improving health-related rehabilitation services worldwide in various settings (getting beyond the rehabilitation facilities) emphasizing the concept of integrated care with collaboration across other sectors to meet the specific needs of APwDs. This evidence based position paper (EBPP) represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in APwDs.

European Organizations of Physical and Rehabilitation Medicine.

Physical and Rehabilitation Medicine (PRM) is a basic medical specialty officially recognized in Europe since 1962. This article briefly presents the significance, attainments and tasks recently undertaken by the leading structures responsible for international harmonization and management of the specialty within healthcare systems in Europe and for scientific development: the Section and Board of the European Union of Medical Specialists (UEMS-PRM), European Academy of Rehabilitation Medicine (AEMR) and European Society of PRM (ESPRM). The concept of rehabilitation according to the biopsychosocial model of functioning recently promoted by the World Health Organization (WHO) closely follows the assumptions of the Polish Model of Rehabilitation, formulated in the 1960's and approved by the WHO in 1970. Since its accession to the European Union in 2004, Poland has been gradually increasing active participation in the European structures of PRM.

Analysis of problems in the daily functioning of patients after hip arthroplasty.

BACKGROUND: Awareness of functional status of patients after arthroplasty helps therapists to select suitable topics of education that will enable the patients to continue rehabilitation on their own and improve the quality of life among hip joint prosthesis recipients. MATERIAL AND METHODS: The study involved a group of 60 patients (41 men and 19 women) after arthroplasty who were hospitalised in medical rehabilitation wards of Lodz hospitals. The average age of the patients was 65.0±11.2 years (65.4±11.5 years among women and 63.9±10.8 years among men). The functional status of the patients was assessed using the modified Rankin Scale (mRS) for self-evaluation of disability, Barthel Index (BI) to determine the degree of independence in performance of daily living activities and a survey prepared by the authors. RESULTS: The degree of disability of the study subjects may be assessed as moderate (mRS score: 2.8 overall, 2.6 for women and 3.1 for men). The distributions of disability scores indicate a clinically significant difference in the assessment of disability level between women and men. The functional status of patients with regard to performance of daily living activities was evaluated as moderately severe (BI: 77.7±18.2 overall, 76.8±17.2 for women, 79.5±16.6 for men). The women after hip arthroplasty assessed their ability to dress and undress as significantly poorer than the men did. CONCLUSIONS: 1. The patients assessed their functional status as moderate disability. 2. The study participants faced the most serious problems with bathing, walking up and down stairs, grooming, and dressing and undressing. 3. The women assessed their ability to dress and undress as significantly poorer than the men did. 4. Physiotherapists and nurses were indicated as the main sources of education.