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1.
Artigo em Inglês | MEDLINE | ID: mdl-33567748

RESUMO

As part of COVID-19 consequences, it has been estimated that 5% of patients affected by this disease will require admission to the intensive care unit (ICU), and physical therapy techniques have been implemented in patients with other conditions admitted to ICU. The aim of the present study is to summarize all the available information about the implementation of physical therapy management in critically ill patients. From three clinical guidelines already published, we performed a search in PubMed, Scopus, ScienceDirect, and CINAHL, including systematic reviews, clinical guidelines, and randomized controlled trials, among others. Data extraction was performed independently by two reviewers. Quality assessment was developed through the AMSTAR-2 tool and PEDro Scale. A narrative synthesis was performed and 29 studies were included. The information extracted has been classified into four folders: ICU environment in COVID-19 (security aspects and management of the patient), respiratory physiotherapy (general indications and contraindications, spontaneously breathing and mechanically ventilated patient approaches), positional treatment, and exercise therapy (safety aspects and progression). The implementation of physiotherapy in patients affected with COVID-19 admitted to the ICU is a necessary strategy that prevents complications and contributes to the stabilization of patients in critical periods, facilitating their recovery.


Assuntos
Estado Terminal/reabilitação , Modalidades de Fisioterapia , Terapia por Exercício , Humanos , Unidades de Terapia Intensiva
2.
Artigo em Inglês | MEDLINE | ID: mdl-33578678

RESUMO

The COVID-19 emergency has imposed distanced education and has interrupted most rehabilitation services. Adolescents with disabilities have been isolated, and the burden on their families has been exacerbated. A cross-sectional survey was administered to adolescents with disability and to parents of disabled children to describe their experience during lockdown and their concerns or expectations about rehabilitation. A sample of 53 adolescents and 239 parents completed the survey. Adolescents were ages 13-18 years old (45.3% female). Most parents were between 35 and 55 years old (84.9% female). While 53.6% of the parents reported no positive effects of the lockdown, 92.5% of the adolescents expressed favorable consequences. The increased time spent with family members was judged positively by 27.2% of parents and by 64.2% of adolescents. Concern for their child's disability was expressed by 47.3% of parents, while 73.6% of adolescents expressed concerns regarding the ban on meeting friends. In both groups, anxiety symptoms were correlated with the fear of contracting COVID-19 and with financial problems. Parents would have liked even more remote support from school and healthcare professionals, which was available for most participants. Thus, socioeconomic support, assistive technology and telerehabilitation strategies might help families with disabilities during a lockdown.


Assuntos
Controle de Doenças Transmissíveis , Crianças com Deficiência/reabilitação , Adolescente , Adulto , Estudos Transversais , Família , Feminino , Humanos , Relações Interpessoais , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Comportamento Social , Inquéritos e Questionários
3.
Artigo em Inglês | MEDLINE | ID: mdl-33578949

RESUMO

Introduction: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership National Health Service (NHS) foundation Trust successfully delivered PrAISED through a video-calling platform during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS: This qualitative case-study aimed to identify participants that video delivery worked for, to highlight its benefits and its challenges. Interviews were conducted between May and August 2020 with five participants with dementia and their caregivers (n = 10), as well as five therapists from the Lincolnshire partnership NHS foundation Trust. The interviews were analysed through thematic analysis. RESULTS: Video delivery worked best when participants had a supporting caregiver and when therapists showed enthusiasm and had an established rapport with the client. Benefits included time efficiency of sessions, enhancing participants' motivation, caregivers' dementia awareness, and therapists' creativity. Limitations included users' poor IT skills and resources. DISCUSSION: The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele-rehabilitation, but success is reliant on having a caregiver and an enthusiastic and known therapist.


Assuntos
Demência/reabilitação , Telerreabilitação , Cuidadores , Inglaterra/epidemiologia , Humanos , Pandemias , Medicina Estatal
4.
Bone Joint J ; 103-B(2): 294-298, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517721

RESUMO

AIMS: The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS: A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS: The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION: For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.


Assuntos
Deambulação Precoce , Fixação Intramedular de Fraturas/métodos , Cuidados Pós-Operatórios/métodos , Fraturas da Tíbia/cirurgia , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/reabilitação , Humanos , Modelos Anatômicos , Tíbia/lesões , Tíbia/fisiologia , Tíbia/cirurgia , Fraturas da Tíbia/reabilitação , Suporte de Carga
5.
Medicine (Baltimore) ; 100(3): e24364, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546072

RESUMO

ABSTRACT: Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited.To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA.An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome.The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = -0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4-6).These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.


Assuntos
Amputação/reabilitação , Extremidade Inferior/lesões , Caminhada/fisiologia , Idoso , Amputação/métodos , Amputados/reabilitação , Estudos de Coortes , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Saúde Pública
6.
BMC Psychol ; 9(1): 27, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557930

RESUMO

BACKGROUND: This study aimed to culturally translate the Attribution Questionnaire (AQ) to the Swedish language and examine the reliability and validity of the new Swedish version to measure stigma towards disability pension applicants in the Swedish context among psychiatrists and general practitioners. METHODS: The AQ was translated from the original English version into Swedish using the recommended guidelines for cultural translation of questionnaires. Steps included forward/back-translation, use of expert committee and pretesting. Cronbach's alpha was used to determine internal consistency and structural equation modelling (SEM) was used to test the responsibility model of stigma compared to the original English version. RESULTS: 1,414 physicians completed the questionnaire (23.6%). Cultural translation resulted in many modifications to the original questionnaire to increase the external validity. Internal reliability of the AQ Swedish version (AQ-S) was 0.733 and is considered acceptable. Pity and Segregation-coercion sub-scales showed limited consistency. SEM findings show that the responsibility model of stigma is an acceptable fit for the Swedish setting. CONCLUSION: Findings show that the AQ-S is comparable to the other versions of the AQ and is a reliable measure to assess and monitor stigma among physicians in the Swedish setting. Our study shows that cultural translation does not significantly impact the validity of the questionnaire.


Assuntos
Comparação Transcultural , Clínicos Gerais/psicologia , Pensões , Estigma Social , Inquéritos e Questionários/normas , Atitude do Pessoal de Saúde , Humanos , Análise de Classes Latentes , Transtornos Mentais/reabilitação , Psiquiatria , Psicometria , Reprodutibilidade dos Testes , Suécia
7.
Medicine (Baltimore) ; 100(4): e23907, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530188

RESUMO

BACKGROUND: Infantile cerebral palsy refers to brain damage in infants and young children during their development, causing brain dysfunction, mainly manifested as dyskinesia, which may be complicated by mental retardation, epilepsy, and bone and joint developmental disorders. Clinical practice shows that acupuncture can effectively treat children with cerebral palsy, but it needs to be proven. This research will systematically evaluate the clinical effectiveness and safety of acupuncture and moxibustion in the treatment of children with cerebral palsy, and provide evidence-based evidence for it. METHOD: Search the following databases, including CNKI, WANFANG, China Biomedical Database, VIP, PubMed, Embase, the Cochrane Library, Web of Science. The retrieval time is from the establishment of the databases to October 2020, collecting all clinical randomized controlled studies of acupuncture and moxibustion treatment of children with cerebral palsy. Two investigators independently extract and evaluate the data of the included studies, and use RevMan V.5.3 software to conduct meta-analysis of the included literature. RESULT: This study evaluates the effectiveness and safety of acupuncture and moxibustion in the treatment of children with cerebral palsy through indicators such as Gross Motor Function Measure Scale, the Modified Ashworth Scale, and so on. CONCLUSION: This study will provide reliable evidence-based evidence for the clinical application of acupuncture and moxibustion in the treatment of children with cerebral palsy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/7GUF5.


Assuntos
Terapia por Acupuntura , Paralisia Cerebral/reabilitação , Metanálise como Assunto , Moxibustão , Revisões Sistemáticas como Assunto , Terapia por Acupuntura/efeitos adversos , Paralisia Cerebral/fisiopatologia , Criança , Protocolos Clínicos , Humanos , Destreza Motora , Moxibustão/efeitos adversos , Projetos de Pesquisa
8.
Medicine (Baltimore) ; 100(4): e24477, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530262

RESUMO

ABSTRACT: According to the analysis to find out how demographic and clinical characteristics influent the dysphagia outcome after stroke, furthermore, giving some insights to clinical treatment.One hundred eighty post-stroke dysphagia (PSD) patients were enrolled in this retrospective study at the stroke rehabilitation department. The outcome measurements are beside water swallow test at discharge and length of stay at hospital. Twenty-five demographic and clinical variables were collected for this study. Logistic regression and multilinear regression were utilized to estimate models to identify the risk and protect predictors of PSD outcome.Mouth-opening degree, drooling severity scale (DSS) level, mini-mental state exam (MMSE) level, Barthel index and Berg balance scale were significant different between recovered and unrecovered group. Type of stroke, MMSE degree, DSS and hemoglobin level shown significant predictive value for PSD outcome in logistic regression. In addition, obstructive sleep apnea (OSA) and DSS degree were important risk factors for PSD outcome. Gender, body mass index, drinking, hypertension, recurrent stroke, water swallow test level on admission, Berg balance scale, DSS and days between onset to admission shown significant predictive value for length of stay of PSD patients.PSD outcome was influenced by type of stroke, MMSE degree, DSS and hemoglobin level significantly and obstructive sleep apnea act as an important risk role for PSD recovery.


Assuntos
Transtornos de Deglutição/reabilitação , Tempo de Internação/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Estudos de Casos e Controles , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
9.
Medicine (Baltimore) ; 100(4): e24488, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530266

RESUMO

BACKGROUND: To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA). METHODS: Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included. RESULTS: Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P  < .05). There is no evidence that thermal mineral waters is unsafe for treating OA. CONCLUSION: Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA.


Assuntos
Balneologia/métodos , Águas Minerais/uso terapêutico , Osteoartrite/reabilitação , Manejo da Dor/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(4): e24083, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530202

RESUMO

BACKGROUND: Migraine is a chronic paroxysmal incapacitating neurological disorder, which endangers the health of human worldwide ranking as the third most prevalent medical condition. There are no comprehensive estimates of treatments for migraine. We will conduct this systematic review and Bayesian network meta-analysis (NMA) to synthesis quantitative and comparative evidence on the efficacy and tolerability of all the known pharmacological and non-pharmacological interventions for migraine. METHOD: We will perform the systematic electronic search of the literature utilizing MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing & Allied Health (CINAHL), and PsycINFO. We will only include randomized controlled trials (RCTs) of high quality which appraise the efficacy or safety of any potential pharmacological or non-pharmacological interventions in the treatment of patients with migraine. The traditional pairwise meta-analyses will be performed to anticipate the heterogeneities and publication bias and the NMA will be conducted within a Bayesian hierarchical model framework to obtain estimates for all valuable treatments for migraine. The entire heterogeneity will be quantified by Q statistic and I2 index. Other analyses included sensitivity analyses, meta-regression, and subgroup analyses will also be conducted. The whole process will be conducted using in R-3.6.0 software. RESULTS: This study will obtain the efficacy and tolerability of all potential treatments for migraine, aiming at providing consolidated evidence to help make the best choice of interventions. The results will be published in a peer-reviewed journal. DISCUSSION: This Bayesian network meta-analysis may be the first attempt to quantitatively synthesize the efficacy and tolerability of all potential treatments for migraine. And this method can ensure us to fully utilize both the direct and indirect evidence as well as gain the comparative estimates displayed in the derived hierarchies. Besides, we have registered this protocol on the international prospective register of systematic review (PROSPERO) (CRD42020157278).


Assuntos
Terapias Complementares/métodos , Transtornos de Enxaqueca/terapia , Preparações de Plantas/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Teorema de Bayes , Doença Crônica , Terapias Complementares/efeitos adversos , Humanos , Transtornos de Enxaqueca/reabilitação , Transtornos de Enxaqueca/cirurgia , Metanálise em Rede , Preparações de Plantas/administração & dosagem , Preparações de Plantas/efeitos adversos , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
11.
Medicine (Baltimore) ; 100(3): e23939, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545968

RESUMO

BACKGROUND: Bile acid is an essential factor that plays a role in metabolic regulation, but how bile acid is regulated after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains unclear. This meta-analysis aimed to investigate changes in the levels of fasting bile acids following RYGB and SG. METHODS: A systematic literature search of the PubMed, EMBASE, Cochrane Library and Web of Science databases through July 2020 was performed in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The concentrations of bile acids were evaluated. RESULTS: Thirteen studies with 289 patients were included. Our results showed that patients who underwent RYGB had increased levels of fasting total bile acids, primary bile acids, secondary bile acids, conjugated bile acids, and unconjugated bile acids, but no significant differences in all these bile acid levels were observed in patients who underwent SG. Furthermore, 12a-hydroxylated bile acid levels and the 12a-hydroxylated/non-12a-hydroxylated bile acid ratio also increased following RYGB. CONCLUSION: In this study, we found that fasting bile acid levels, especially 12a-hydroxylated bile acids levels, were increased after RYGB. However, no differences in fasting bile acid levels were observed following SG.


Assuntos
Ácidos e Sais Biliares/análise , Jejum/metabolismo , Gastrectomia/reabilitação , Derivação Gástrica/reabilitação , Jejum/fisiologia , Gastrectomia/métodos , Derivação Gástrica/métodos , Humanos , Obesidade/cirurgia
12.
Medicine (Baltimore) ; 100(3): e24074, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546010

RESUMO

ABSTRACT: Limitation of wrist range of motion (ROM) is a common complication of distal radius fractures (DRFs) in geriatric patients. The present study aimed to evaluate the effectiveness of rehabilitation in the restoration of wrist ROM after geriatric DRF. Eighty-eight geriatric patients with DRF, 59 women and 29 men aged 71.69 ±â€Š6.232 years participated in the study. The time from wrist immobilization to rehabilitation was 12.89 ±â€Š5.318 weeks. Daily rehabilitation was performed 30 minutes a day for 8 weeks. Active wrist ROM was measured before and at 2, 4, and 8 weeks after rehabilitation. Data were analyzed by the repeated measures multivariate analysis of variance (MANOVA), one-way MANOVA, and analysis of variance (ANOVA). Repeated measures MANOVA suggested a significant time effect for ROM (Wilks Lambda = 0.002, F = 7500.795, P < .001). Compared with before rehabilitation, each wrist ROM was significantly improved at 2, 4, and 8 weeks after rehabilitation. The one-way MANOVA demonstrated that changes in ROM were significantly different between groups (Wilks Lambda = 0.007, F = 559.525, partial eta square = 0.993, P < .001), indicating that patients in the short-term stiffness group (≤3 months) had a significantly greater increase in ROM than patients in the long-term stiffness group (>3 months). The results of this study suggest an 8-week daily rehabilitation program for geriatric patients with limited ROM <3 months after DRF.


Assuntos
Exercícios de Alongamento Muscular , Fraturas do Rádio/reabilitação , Traumatismos do Punho/reabilitação , Idoso , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 100(3): e23906, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545960

RESUMO

BACKGROUND: This study will evaluate the clinical effect of vestibular rehabilitation (VR) on benign paroxysmal positional vertigo (BPPV). METHODS: In this study, we will identify relevant trials on the topic published in MEDLINE, EBASE, Web of Science, Cochrane Library, Scopus, CINAHL, CBM, and CNKI from inception to the present. We will also search conference proceedings, thesis/dissertation, ongoing trials in clinical trial registry, and reference lists of included studies. Two researchers will independently carry out record selection, data extraction, and study quality assessment, respectively. Any disagreement will be arbitrated and solved with the help of a third researcher. If necessary, we will conduct random-effects meta-analysis to pool the effect estimates of included trials determined to be acceptable heterogeneity. RESULTS: We will summarize the latest evidence to assess the effect of VR for the treatment of patients with BPPV. CONCLUSION: The findings of this study will help determine whether or not VR is effective in treating BPPV. OSF REGISTRATION: osf.io/k83y5.


Assuntos
Vertigem Posicional Paroxística Benigna/reabilitação , Posicionamento do Paciente , Modalidades de Fisioterapia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento
14.
JAMA ; 325(7): 646-657, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33591346

RESUMO

Importance: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis or whether it may worsen knee symptoms. Objective: To determine whether high-intensity strength training reduces knee pain and knee joint compressive forces more than low-intensity strength training and more than attention control in patients with knee osteoarthritis. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted at a university research center in North Carolina that included 377 community-dwelling adults (≥50 years) with body mass index (BMI) ranging from 20 to 45 and with knee pain and radiographic knee osteoarthritis. Enrollment occurred between July 2012 and February 2016, and follow-up was completed September 2017. Interventions: Participants were randomized to high-intensity strength training (n = 127), low-intensity strength training (n = 126), or attention control (n = 124). Main Outcomes and Measures: Primary outcomes at the 18-month follow-up were Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown). Results: Among 377 randomized participants (mean age, 65 years; 151 women [40%]), 320 (85%) completed the trial. Mean adjusted (sex, baseline BMI, baseline outcome values) WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity group and the control group (5.1 vs 4.9; adjusted difference, 0.2; 95% CI, -0.6 to 1.1; P = .61) or between the high-intensity and low-intensity groups (5.1 vs 4.4; adjusted difference, 0.7; 95% CI, -0.1 to 1.6; P = .08). Mean knee joint compressive forces were not statistically significantly different between the high-intensity group and the control group (2453 N vs 2512 N; adjusted difference, -58; 95% CI, -282 to 165 N; P = .61), or between the high-intensity and low-intensity groups (2453 N vs 2475 N; adjusted difference, -21; 95% CI, -235 to 193 N; P = .85). There were 87 nonserious adverse events (high-intensity, 53; low-intensity, 30; control, 4) and 13 serious adverse events unrelated to the study (high-intensity, 5; low-intensity, 3; control, 5). Conclusions and Relevance: Among patients with knee osteoarthritis, high-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months. The findings do not support the use of high-intensity strength training over low-intensity strength training or an attention control in adults with knee osteoarthritis. Trial Registration: ClinicalTrials.gov Identifier: NCT01489462.


Assuntos
Articulação do Joelho/fisiologia , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Treinamento de Resistência/métodos , Idoso , Índice de Massa Corporal , Força Compressiva , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Dor/etiologia , Dor/reabilitação , Medição da Dor , Método Simples-Cego
15.
Medicine (Baltimore) ; 100(5): e24331, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592877

RESUMO

ABSTRACT: To retrospectively analyze the functional outcomes and complications in patients who underwent hip arthroplasty with enhanced recovery after surgery (ERAS) program for femoral neck fractures.Between June 2015 and May 2019, 1138 patients with femoral neck fractures were treated in our department. According to the Garden classification system, 467 cases were type III and 671 cases were type IV with an average age of 74.9 ±â€Š8.8 years (range, 59-96 years). All patients underwent hip arthroplasty with ERAS. The clinical outcomes of these patients were retrospectively analyzed at the final follow-up using the Harris hip score (HHS).The median follow-up was 21.2 months (range, 6-36 months). The mean time to surgery and the length of hospitalization after surgery were 2.4 and 2.2 days, respectively. Eight hundred and fifty-two patients (74.9%) were operated within 48 hours from admission, 1052 cases (92.4%) were discharged within 48 hours after surgery. Twelve patients (1.05%) were readmitted for prosthetic dislocation. None of the patients suffered from infection, periprosthetic fractures, and/or prosthetic loosening. The HHS at the final follow-up was 92.7 ±â€Š7.6, with an excellent or good rate of 90.2%.Patient-oriented ERAS optimizes the interventional measures during the perioperative period for geriatric patients with femoral neck fractures and can improve their short-term clinical outcomes without increased readmission rates.


Assuntos
Artroplastia de Quadril/reabilitação , Recuperação Pós-Cirúrgica Melhorada , Fraturas do Colo Femoral/reabilitação , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Feminino , Fraturas do Colo Femoral/cirurgia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(6): e24631, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578580

RESUMO

RATIONALE: The Pisa syndrome (PS) is defined as a kind of reversible postural deformity which causes a lateral trunk flexion of 10 degrees or more. A prevalence of approximately 7.4% to 10.3% of patients with Parkinson disease (PD) also have PS. Though unbalanced function of the basal ganglia network and impaired visual-spatial functions including parietal cortices in PS is known, the pathophysiology of PS remains to be unclear. PATIENT CONCERNS: A 67-year-old male patient with PD visited our Rehabilitation outpatient department because of his trunk which involuntarily deviated to the left side when he stood up. DIAGNOSES: Based on the history, physical examination, X-ray images, Tc-99m brain TRODAT-1 single-photon emission computed tomography (SPECT), and regional cerebral perfusion Tc-99m ethyl cysteinate dimer SPECT, the patient was diagnosed with PD with PS. INTERVENTIONS: The patient refused our recommendation of admission for pharmaceutical treatment due to personal reasons and was only willing to accept physical training programs at our outpatient department. OUTCOMES: We arranged functional neuroimaging of the brain to survey possible neurologic deficits. The patient's images of ethyl cysteinate dimer SPECT and TRODAT SPECT showed abnormalities, including hypoperfusion and diminished dopamine transporter uptake, in the areas of the basal ganglia network and other brain regions. LESSONS: Based on previous literature and the imaging of our patient, we hypothesize that PS results from unbalanced function of the basal ganglia network and impaired visual-spatial functions of bilateral parietal cortices.


Assuntos
Doença de Parkinson/diagnóstico por imagem , Idoso , Humanos , Masculino , Neuroimagem , Compostos de Organotecnécio , Doença de Parkinson/reabilitação , Compostos Radiofarmacêuticos , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
17.
Spinal Cord Ser Cases ; 7(1): 13, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579904

RESUMO

STUDY DESIGN: An online survey. OBJECTIVES: To follow-up with and re-query the international spinal cord community's response to the Coronavirus Disease 2019 (COVID-19) pandemic by revisiting questions posed in a previous survey and investigating new lines of inquiry. SETTING: An international collaboration of authors and participants. METHODS: Two identical surveys (one in English and one in Spanish) were distributed via the internet. Responses from both surveys were pooled and analyzed for demographic and response data. RESULTS: Three hundred and sixty-six respondents were gathered from multiple continents and regions. The majority (63.1%) were rehabilitation physicians and only 12.1% had patients with spinal cord injury/disease (SCI/D) that they knew had COVID-19. Participants reported that the COVID-19 pandemic had caused limited access to clinician and support services and worsening medical complications. Nearly 40% of inpatient clinicians reported that "some or all" of their facilities' beds were being used by medical and surgical patients, rather than by individuals requiring inpatient rehabilitation. Respondents reported a 25.1% increase in use of telemedicine during the pandemic (35% used it before; 60.1% during), though over 60% felt the technology incompletely met their patients' needs. CONCLUSION: The COVID-19 pandemic has negatively impacted the ability of individuals with SCI/D to obtain their "usual level of care." Moving forward into a potential "second wave" of COVID-19, patient advocacy and efforts to secure access to thorough and accessible care are essential.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Reabilitação Neurológica/estatística & dados numéricos , Traumatismos da Medula Espinal/reabilitação , Telemedicina/estatística & dados numéricos , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos
19.
Khirurgiia (Mosk) ; (1): 55-61, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395513

RESUMO

OBJECTIVE: To develop the optimized complex programs, including general magnetotherapy, fractional microablative therapy with a CO2 laser, electromyostimulation with biofeedback of the pelvic floor muscles, and a special exercise therapy complex in late rehabilitation programs for women of different age after reconstructive plastic surgery for rectocele. MATERIAL AND METHODS: There were 200 women of childbearing, peri- and menopausal age with rectocele grade II-III and 20 healthy women of comparable age. All patients were divided into 4 groups by 50 womes: main group, two comparison groups and control group. Surgical treatment of rectocele was followed by long-term postoperative rehabilitation including symptomatic therapy, general magnetotherapy, and electromyostimulation with biofeedback of the pelvic floor muscles, intra-vaginal fractional microablative therapy with a CO2 laser and special complex of therapeutic physical education. RESULTS: General magnetotherapy in early (1 day) postoperative period and complex rehabilitation in long-term postoperative period (within a month after surgery) including 2 procedures of intra-vaginal microablative fractional therapy with carbon dioxide laser, electromyostimulation with biological connection of the pelvic floor muscles and special complex of therapeutic physical education ensured more significant improvement of uterine blood flow regardless age and baseline disorders in the uterine arteries in patients with rectocele. In our opinion, this is primarily due to vasoactive effects of general magnetotherapy, recovery of circulation via relief of spasm in the arteries and arterioles, improved vein contractility and venous outflow. These processes combined with electrical stimulation and therapeutic exercises of pelvic floor muscle followed by their reinforcement, as well as fractional microablative therapy ensured significant vascular effect.


Assuntos
Lasers de Gás , Terapia de Campo Magnético , Distúrbios do Assoalho Pélvico/reabilitação , Retocele/reabilitação , Retocele/cirurgia , Útero/irrigação sanguínea , Técnicas de Ablação , Fatores Etários , Biorretroalimentação Psicológica , Terapia por Estimulação Elétrica , Terapia por Exercício , Feminino , Humanos , Lasers de Gás/uso terapêutico , Diafragma da Pelve/irrigação sanguínea , Diafragma da Pelve/inervação , Distúrbios do Assoalho Pélvico/cirurgia , Gravidez , Procedimentos Cirúrgicos Reconstrutivos
20.
Addict Sci Clin Pract ; 16(1): 4, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413619

RESUMO

The COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic's broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.


Assuntos
/psicologia , Modelos Psicológicos , Transtornos Relacionados ao Uso de Opioides/psicologia , Pandemias , Meio Social , /epidemiologia , Comorbidade , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Prevalência , Política Pública , Pesquisa , Risco
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