Movement Sonification Techniques to Improve Balance in Parkinson's Disease: A Pilot Randomized Controlled Trial.

BACKGROUND: Movement sonification has been recently introduced into the field of neuromotor rehabilitation alongside Neurologic Music Therapy and music-based interventions. This study introduces the use of musical auditory cues encompassing the melodic-harmonic aspect of music. METHODS: Nineteen patients with Parkinson's disease were randomly assigned to the experimental (n = 10) and control (n = 9) groups and underwent thrice-weekly sessions of the same gait training program, with or without sonification. Functional and motor parameters, as well as fatigue, quality of life, and the impact of intervention on patients' well-being, were assessed at baseline (PRE), the end of treatment (POST), and at follow-up (FU). Between-group differences were assessed for each outcome measure using linear mixed-effects models. The outcome measure was entered as the dependent variable, group and time as fixed effects, and time by group as the interaction effect. RESULTS: Mini BESTest and Dynamic Gait Index scores significantly improved in the experimental group (p = 0.01 and p = 0.03, respectively) from PRE to FU, demonstrating a significant impact of the sonification treatment on balance. No other significant differences were observed in the outcome measures. CONCLUSIONS: Larger sample sizes are needed to confirm the effectiveness of sonification approaches in Parkinson's disease, as well as in other neurological disorders.

Role of rehabilitation in the elderly after an acute event: insights from a real-life prospective study in the subacute care setting.

BACKGROUND: Any acute event, either primary or secondary to a chronic disease, is generally followed by some degree of physical impairment. Subacute care (SAC) represents one of the inpatient intermediate care settings aimed at completing recovery and restoring functional capacity. Debate exists on the role of the rehabilitation treatment in the SAC setting. AIM: The aim of this study was to compare the outcomes of patients managed in two different SAC Units where A) patients undergo an individualized rehabilitation program on top of optimal medical therapy (OMT) B) patients receive OMT only. DESIGN: Real-life prospective study. SETTING: SAC units. POPULATION: Seventy-five chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) patients transferred after an acute hospitalization. METHODS: Upon SAC admission, the following scales were obtained: cumulative illness rating scale comorbidity and severity (CIRSC and CIRSS), mini mental state examination (MMSE), Performance-Oriented Mobility Assessment (POMA), Barthel Index (BI), the 10-meter walking test (10MWT). Pre-admission BI was also collected based on history. Upon SAC discharge, BI, POMA, and 10MWT were repeated. RESULTS: Patients (44 in Group A, 31 in Group B) were similar with regard to age, gender, MMSE, clinical complexity, pre-admission BI, admission 10MWT, POMA, and bedrest conditions. Admission BI was lower in Group A. In both groups BI was lower when compared to the respective pre-admission score. Upon discharge, Group A patients were characterized by a higher BI and POMA compared to Group B. Indeed, BI and POMA improved at discharge only in Group A patients. Only this latter group reached the pre-morbid BI. Upon discharge the number of bedrest patients decreased only in Group A. The percentage of patients discharged home was also much higher in Group A, while a greater number of Group B patients were transferred to a rehabilitation ward or were enrolled in an integrated home care assistance program. CONCLUSIONS: In a real-life prospective experience, a better outcome is demonstrated in elderly CHF and COPD patients undergoing a rehabilitative approach during their in-hospital SAC stay. CLINICAL REHABILITATION IMPACT: An individualized rehabilitation program should integrate medical treatment of CHF and BPCO patients in the SAC setting. This approach demonstrates a better cost-effectiveness management of these patients.

Measurement properties of translated versions of the Scoliosis Research Society-22 Patient Questionnaire, SRS-22: a systematic review.

PURPOSE: The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) has been translated into various languages and tested in patients with scoliosis. However, the translations and their psychometric properties have never been systematically reviewed. This study aimed to evaluate the psychometric properties and to provide the current level of evidence of all the available translations of the SRS-22 using the "COnsensus-based Standards for the selection of health status Measurement INstruments" (COSMIN). METHODS: A systematic review was performed. The PubMed, Medline, EMbase, and CINAHL databases were searched for articles concerning the translations of the SRS-22 and/or evaluating any of their measurement properties. Two reviewers independently assessed the methodological quality and the psychometric estimates of the selected studies by using the 4-point rating scale COSMIN checklist and a validated quality assessment criteria, respectively. The level of evidence of each psychometric property per language was determined combining COSMIN outcomes and psychometric results. RESULTS: The search strategy led to 24 articles evaluating the SRS-22 in 17 different languages. The methodological quality of the properties was mostly poor to fair, and there was a lack of information regarding them. The overall assessment was positive in 42.5 % of cases. The level of evidence resulted in a limited positive evidence in 11 languages. CONCLUSIONS: The Chinese (traditional), Dutch, Italian, Norwegian, and Spanish translations are advisable; the Greek, Japanese, Korean, Persian, Thai, and Turkish translations showed encouraging results but should be used with caution; the Brazilian, Chinese (simplified), Polish, and Swedish translations showed contradictory or scarce results, and no suggestions can be formulated; the French Canadian and German translations did not provide methodologically sound information. Further attention should be given to cross-cultural and structural validity, hypothesis testing, and responsiveness.

Responsiveness and minimal important changes for the Knee Injury and Osteoarthritis Outcome Score in subjects undergoing rehabilitation after total knee arthroplasty.

OBJECTIVE: The aim of this study was to evaluate the responsiveness and minimal important changes for the Knee Injury and Osteoarthritis Outcome Score (KOOS) in subjects undergoing rehabilitation after total knee arthroplasty. DESIGN: At the beginning and end of a rehabilitation program, 148 patients completed the KOOS. A global perception of change scale was also completed at the end of the program and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was assessed on the KOOS subscales and calculated by distribution methods (effect size; standardized response mean). The minimal important changes of the KOOS subscales were assessed using anchor-based methods (receiver operating characteristic curves) to compute the best cutoff levels between the improved and stable subjects. RESULTS: The effect sizes ranged from 0.83 to 1.35, and the standardized response means ranged from 0.76 to 1.22. The receiver operating characteristic analyses revealed an area under the curve of 0.89, 0.88, 0.94, 0.93, and 0.85 for the Pain, Symptoms, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales, respectively, showing discriminative capacities; the minimal important changes were 16.7 for Pain (sensitivity: 83%; specificity: 82%), 10.7 for Symptoms (80%; 80%), 18.4 for Activities of Daily Living (82%; 82%), 12.5 for Sport/Recreation (96%; 78%), and 15.6 for Quality of Life (88%; 67%). CONCLUSIONS: The KOOS was sensitive in detecting clinical changes. The authors recommend taking the minimal important changes provided into account when assessing patient improvement or planning studies in this clinical context.

Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial.

OBJECTIVE: To compare the improvement in disability, kinesiophobia, pain, and quality of life obtained by means of home-based functional exercises aimed at managing kinesiophobia with that obtained by giving subjects undergoing total knee arthroplasty (TKA) advice to stay active after discharge from a rehabilitation unit. DESIGN: Randomized controlled trial with 6-months' follow-up. SETTING: Patients' homes. PARTICIPANTS: Patients (N=110; 40 men; mean age, 67y) at the end of a 15-day period of in-hospital rehabilitation after undergoing primary TKA. INTERVENTIONS: In the experimental group, before returning home, the patients were asked to continue the functional exercises learned during hospitalization in twice-weekly 60-minute sessions for 6 months, and were given a book containing theoretical information about the management of kinesiophobia. In the control group, the patients were advised to stay active and gradually recover their usual activities. MAIN OUTCOME MEASURES: Repeated-measures analysis of covariance with baseline values as the covariates (P<.05) was used to assess the effect of treatment on disability, fear-avoidance beliefs, pain intensity, and quality of life. RESULTS: The analysis revealed a significant time by group interaction in all the variables in favor of the experimental group. Post hoc analysis showed that the effect of the group was statistically significant at the end of home training and follow-up. The treatment effect was clinically tangible in terms of disability and quality of life, and persisted for 6 months after the intervention ended. CONCLUSIONS: A home-based program based on functional exercises and the management of kinesiophobia was useful in changing the course of disability, fear-avoidance beliefs, pain, and the quality of life in patients with TKA.