Encuesta sobre la situación de investigación en rehabilitación en España. Resultados / Survey on the state of investigation in rehabilitation in Spain: Results

En la vocalía de investigación, formación e innovación de la sociedad Española de Medicina Física y Rehabilitación (SERMEF), quisimos aproximarnos a cuál es el estado de la investigación en nuestra especialidad en España. Para ello, se elaboró y distribuyó una encuesta online entre médicos rehabilitadores de España, que obtuvo 253 respuestas. De estos, el 65% afirmó que en su centro de trabajo sí se realiza actividad investigadora en rehabilitación; el número de proyectos activos en sus centros según declararon era de: ninguno en el 35,7%; uno en el 17,7%, 2 en el 23,3%, 3 en el 8,4% y 4 o más en el 14,9%. Entre las principales dificultades que se encuentran los encuestados el 89% destacan que no se dispone de personal contratado para investigación y el 95% que en sus centros no se destina parte de la jornada laboral para investigación. En cuanto a la actividad investigadora personal, el 56% atestiguan participar en investigación, siendo el rol más habitual el de investigador principal (58%). El 95% de los encuestados refiere que el principal obstáculo para desarrollar un proyecto de investigación es la presión asistencial y la falta de tiempo, y correspondientemente, una amplia mayoría (83%) alega que disponer de tiempo estipulado para investigar en su jornada laboral sería una motivación.(AU)

The research, training and innovation committee of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF) wanted to know the state of research in our speciality. To this end, an online survey was developed and distributed among rehabilitation doctors in Spain, which obtained 253 responses. Of these, 65% stated that research activity in rehabilitation does take place in their work centre; the number of active projects in their centres as stated by them was: none in 35.7%; one in 17.7%, two in 23.3%, three in 8.4% and four or more in 14.9%. Among the main difficulties encountered, 89% highlight that there is no staff hired for research and 95% that in their centres part of the working day is not allocated to research. In terms of personal research activity, 56% reported that they were involved in research, with the most common role being that of principal investigator (58%). Ninety-five percent of respondents report that the main obstacle to developing a research project is the pressure of care and lack of time, and correspondingly, a large majority (83%) claim that having stipulated time for research in their working day would be a motivation.(AU)

Pulmonary Rehabilitation in the Management of Chronic Obstructive Pulmonary Disease among Asian Indians- Current Status and Moving Forward.

Chronic Obstructive Pulmonary Disease (COPD) is a significant public health concern in India with high prevalence and associated disability, morbidity, mortality. The progression of COPD is not confined to the lungs but includes extrapulmonary involvement that reduces the functional capacity and quality of life. Pulmonary Rehabilitation (PR) is an evidence-based intervention, targeting multiple domains of pulmonary and extrapulmonary manifestations, and therefore, is recommended as an integral part of COPD management. The practical implementation of PR in India is poor. In this review, we have summarized the latest pieces of evidence in support of PR and highlight the challenges and potential solutions for PR implementation in India.

Treatise on the influence of theism, transhumanism, and posthumanism on nursing and rehabilitation healthcare practice.

Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article is to discuss theistic ontologies such as the Judeo-Christian, Shinto-Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare.

Evaluation of Patient Motivation and Satisfaction During Technology-Assisted Rehabilitation: An Experiential Review.

Objective: The aim of this experiential review is to explore the state of the art of the literature regarding the evaluation tools available for assessment of patient motivation and satisfaction during technology-assisted rehabilitation (robot rehabilitation, virtual reality rehabilitation, and serious games rehabilitation). Materials and Methods: A systematic search of the peer-reviewed literature published from January 1990 to August 2019 was conducted. The protocol for this review was registered in PROSPERO and carried out in accordance with the PRISMA recommendations. Results: The search of PubMed, PsycINFO, Scopus, and Web of Science databases identified a total of 333 records. After adjusting for duplicates and other inclusion criteria, 69 studies were selected for inclusion in the review. We found that authors used a wide range of dedicated questionnaires and, in about 50% of studies, a few validated tools to assess motivation and satisfaction during technology-assisted rehabilitation. The instruments most used were the Intrinsic Motivation Inventory (IMI), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), and the Usefulness, Satisfaction, and Ease of use (USE) scale. Motivation and satisfaction were generally portrayed as multidimensional concepts; overall, 29 domains were assessed by 9 different tools. Conclusion: The tools used in the current literature to assess patient motivation and satisfaction during technology-assisted rehabilitation are quite variegated, but we would recommend use of the IMI and USE questionnaires based on their widespread diffusion. However, the choice of domains explored and number of items calls for harmonization. Ideally, this should be a joint task for the whole scientific community.

Proprioceptive training on the recovery of total knee arthroplasty patients: A meta-analysis protocol of randomized controlled trial.

BACKGROUND: Total knee arthroplasty is a common surgery for end-stage of knee osteoarthritis. Proprioceptive training has become an important part in athletes training programmes in different sports. However, the effects of proprioceptive training on the recovery of total knee arthroplasty were unknown. This meta-analysis, with its comprehensive and rigorous methodology, will provide better insight into this problem. METHODS AND ANALYSIS: Electronic databases including PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) database, Wanfang Database and Chinese Biomedical Literature Database (CBM) were searched from its inception to October 21, 2020. We only included proprioceptive training vs placebo in patients after total knee arthroplasty and pooled results were summarized by STATA 12.0 software. Two researchers independently selected the study and assessed the quality of the included studies. The heterogeneity was measured by I2 tests (I2 < 50 indicates little heterogeneity, I2 ≥ 50 indicates high heterogeneity). Publication bias was ruled out by funnel plot and statistically assessed by Beggs test (P > .05 as no publication bias). RESULTS: Results will be published in relevant peer-reviewed journals. CONCLUSION: Our study aims to systematically present the clinical effects of proprioceptive training after total knee arthroplasty patients, which will be provide clinical guidance for total knee arthroplasty patients.

[Post-COVID-19 rehabilitation; a matter of customisation]. / Nazorg voor covid-19-patiënten.

In the early phase of the COVID-19 pandemic, knowledge about the natural course of recovery of COVID-19 is limited. We therefore describe - based on generic knowledge of post IC syndrome (PICS) and (pulmonary) rehabilitation - the possibilities to organize personalized rehabilitation programs in several care settings. To illustrate variety in need for rehabilitation, we described three cases of critical COVID-19 disease survivors after treatment in the intensive care unit. Some patients require immediate rehabilitation following hospitalization, but rehabilitation may also be initiated in the home environment. For the latter population monitoring of progress and recovery should be organized to assess whether a more intensified multidisciplinary rehabilitation program is needed. This may be initiated in one of the medical rehabilitation centers or in pulmonary rehabilitation centers. Post-COVID-19 rehabilitation, regardless of the specific form, should be patient-centered and multidisciplinary organized.

Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence.

This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.

Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field.

While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.

Reproducibility and reliability of performance indicators to evaluate the therapeutic effectiveness of biofeedback therapy after elbow surgery: An observational case series.

Electromyographic biofeedback (EMG-BF) therapy provides information on the state of contraction of the targeted muscles and relaxation of their antagonists, which can facilitate early active range of motion (RoM) after elbow surgery. Our aim in this study was to calculate the minimum detectable change (MDC) during EMG-BF therapy, initiated in the early postoperative period after elbow surgery.This study is an observational case series. EMG-BF of muscle contraction and relaxation was provided during active elbow flexion and extension exercises. Patients completed 3 sets of 10 trials each of flexion and extension over 4 weeks. The total range of flexion-extension motion and scores on the Japanese Society for Surgery of the Hand version of the disability of the arm, shoulder, and hand questionnaire and the Japanese version of the Patient-Rated Elbow Evaluation were obtained at baseline and weekly during the 4-week intervention period. A prediction formula was developed from the time-series data obtained during the intervention period, using the least-squares method. The estimated value was calculated by removing the slope from the prediction formula and adding the initial scores to residuals between the measured scores and predicted scores individually. Systematic error, MDC at the 95th percentile cutoff (MDC95), repeatability of the measures, and the change from the baseline to each time-point of intervention were assessed.The MDC95 was obtained for all 3 outcome measures and the range of values was as follows: RoM, 8.3° to 22.5°; Japanese version of the Patient-Rated Elbow Evaluation score, 17.6 to 30.6 points; and disability of the arm, shoulder, and hand questionnaire subscale: disability and symptoms score, 14.2 to 22.9 points.The efficacy of EMG-BF after elbow surgery was reflected in earlier initiation of elbow RoM after surgery and improvement in patient-reported upper limb function scores. The calculated MDC95 cut-offs could be used as reference values to assess the therapeutic effects of EMG-BF in individuals.

Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients.

INTRODUCTION: Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS: This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS: 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION: The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.

Twenty-five years after the introduction of Evidence-based Medicine: knowledge, use, attitudes and barriers among physiotherapists in Italy - a cross-sectional study.

OBJECTIVES: To explore the knowledge, use, attitudes towards Evidence-based Medicine, also known as Evidence-based Practice (EBP), and perceived barriers to its dissemination among physiotherapists. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Members of the Italian Association of Physiotherapists (n=2000) were invited to participate in an online survey about EBP knowledge and use. PRIMARY OUTCOME MEASURES: The survey questionnaire comprised four sections: (1) respondent characteristics; (2) knowledge of EBP principles; (3) attitude, use and perceived effectiveness of EBP; (4) perceived barriers to implementing EBP in clinical practice. RESULTS: Out of 2000 physiotherapists, 1289 participated in the survey (64.5% response rate). Overall, 90% perceived EBP as useful and necessary for their clinical practice. More than 85% stated that they were familiar with the principles of EBP, 75% reported that they were able to search online databases for relevant information and 60% reported that they were able to understand statistical analyses. However, 56% believed that patient preferences and 39% that clinical expertise are not part of the EBP model. Half stated that they understood and could explain the term 'meta-analysis' but only 17% knew what a forest plot is and just 20% correctly judged the finding of a given meta-analysis. Lack of time was reported as the main barrier to EBP. CONCLUSION: The majority of Italian physiotherapists overrated their knowledge about EBP, demonstrating a gap between perceived and actual knowledge of EBP in this population.