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1.
Bone Joint J ; 102-B(1): 82-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888355

RESUMO

AIMS: The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA). METHODS: In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered. RESULTS: Of the 647 THA patients who had surgery in this period through the anterior approach, 257 patients (39.7%) met the inclusion criteria and were scheduled for THA in an outpatient setting. Of these, 40 patients (15.6%) were admitted to the hospital, mainly because of postoperative nausea and/or dizziness. All other 217 patients were able to go home on the day of surgery. All hip-related PROMs improved significantly up to 12 months after surgery, compared with the scores before surgery. There were three readmissions and two reoperations in the outpatient cohort. There were no complications related to the outpatient THA protocol. CONCLUSION: These study results confirm that outpatient THA can be performed safe and successfully in a selected group of patients, with satisfying results up to one year postoperatively, and without outpatient-related complications, readmissions, and reoperations. Cite this article: Bone Joint J 2020;102-B(1):82-89.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Artroplastia de Quadril/estatística & dados numéricos , Atividades Cotidianas , Idoso , Estudos de Casos e Controles , Feminino , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Fraturas Periprotéticas/cirurgia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários
2.
Bone Joint J ; 102-B(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888361

RESUMO

AIMS: Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. METHODS: A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. RESULTS: Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. CONCLUSION: Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42-47.


Assuntos
Articulação do Cotovelo/lesões , Comportamentos Relacionados com a Saúde , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Participação do Paciente , Fraturas do Rádio/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas , Promoção da Saúde , Humanos , Fraturas do Úmero/psicologia , Fraturas Intra-Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Fraturas do Rádio/psicologia , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
3.
Bone Joint J ; 102-B(1): 17-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888370

RESUMO

AIMS: The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open tibial fracture. METHODS: An initial pool of 109 items was generated from previous qualitative data relating to recovery following an open tibial fracture. These items were field tested in a cohort of patients recovering from an open tibial fracture. They were asked to comment on the content of the items and structure of the scale. Reduction in the number of items led to a refined scale tested in a larger cohort of patients. Principal components analysis permitted further reduction and the development of a definitive scale. Internal consistency, test-retest reliability, and responsiveness were assessed for the retained items. RESULTS: The initial scale was completed by 35 patients who were recovering from an open tibial fracture. Subjective and objective analysis permitted removal of poorly performing items and the addition of items suggested by patients. The refined scale consisted of 50 Likert scaled items and eight additional items. It was completed on 228 occasions by a different cohort of 204 patients with an open tibial fracture recruited from several UK orthoplastic tertiary referral centres. There were eight underlying components with tangible real-life meaning, which were retained as sub-scales represented by ten Likert scaled and eight non-Likert items. Internal consistency and test-retest reliability were good to excellent. CONCLUSION: The Wales Lower Limb Trauma Recovery (WaLLTR) Scale is the first tool to be developed from patient data with the potential to assess recovery following an open tibial fracture. Cite this article: Bone Joint J 2020;102-B(1):17-25.


Assuntos
Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medo/psicologia , Fraturas Expostas/psicologia , Fraturas Expostas/reabilitação , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Autoeficácia , Índice de Gravidade de Doença , Fraturas da Tíbia/psicologia , Fraturas da Tíbia/reabilitação , Adulto Jovem
4.
Clin Interv Aging ; 14: 2163-2171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31853176

RESUMO

Purpose: Handgrip strength is a key diagnostic criterion for sarcopenia, and sodium is an essential mineral for muscle contraction. We investigated the association between grip strength and sodium intake using sodium density. Patients and methods: A total of 2982 older adults (aged ≥65 years) from the 2014-2016 Korea National Health and Nutrition Examination Survey were included. Dietary intake was assessed by a 24 hr dietary recall, and grip strength was measured using a digital grip strength dynamometer. Based on the recommendation of the Asian Working Group for Sarcopenia, low grip strength (dynapenia) was defined as <26 kg for men and <18 kg for women. Multivariable logistic regression was performed to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) and to investigate the association between the quartiles of sodium per calorie (mg/1000 kcal; sodium density) and dynapenia. Results: A total of 577 subjects (19.3%) had dynapenia. Subjects in the second quartile of sodium density had the lowest prevalence of dynapenia and were defined as the reference group. Among women, those in the highest quartile of sodium density showed a significantly higher risk for dynapenia (OR 1.51, 95% CI 1.10-2.07). ORs in the first and third quartiles of sodium density were 1.01 (95% CI 0.74-1.38) and 1.18 (95% CI 0.89-1.58), respectively. However, there was no association between sodium density and dynapenia in men. Conclusion: High sodium density was associated with dynapenia in older women. A balanced diet of minerals is important to preserve muscle strength among older adults.


Assuntos
Força da Mão , Força Muscular , Inquéritos Nutricionais , Sódio , Atividades Cotidianas , Idoso , Estudos Transversais , Feminino , Força da Mão/fisiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Minerais , Força Muscular/fisiologia , Prevalência , República da Coreia , Sarcopenia/epidemiologia
5.
Medicine (Baltimore) ; 98(52): e18515, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876742

RESUMO

Although functional impairment is very common among patients with major depressive disorder (MDD) and is a necessary diagnostic criterion for MDD, clinicians have not directed their attention beyond the mood symptoms of MDD. We aimed to multi-dimensionally assess the functional abilities of patients with MDD using a standardized scale of adaptive function reported by caregivers or parents to identify the nature and degree of functional impairment in patients with MDD.This study was conducted in 40 depressive patients aged 19 to 60 years. Patients were screened according to the DSM-IV-TR and a Hamilton Depression Rating Scale score ≥8. We administered the parent/caregiver rating form of the Korean Vineland Adaptive Behavior Scale to assess functional outcomes in the patients.Patients with MDD showed significant differences in both global and domain-specific functional abilities compared to those of the normal group (all t > -6.35, P < .05) and the patients' premorbid IQ (all t > 4.30, P < .001). The number of episodes among clinical factors was negatively correlated with overall adaptive functioning (r = -0.32, P < .05) and expressive communication (r = -0.42, P < .01).Our present study replicates existing evidence showing impairment in both broad and various functional areas in patients with MDD, suggesting the importance of quantitatively assessing functional outcomes and acquiring information about functioning from informants other than patients.


Assuntos
Atividades Cotidianas/psicologia , Transtorno Depressivo Maior/psicologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Adulto Jovem
6.
Medicine (Baltimore) ; 98(50): e18326, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852125

RESUMO

BACKGROUND: Vascular dementia (VaD) is the second most common cause of dementia. The treatment of VaD still remains a challenge so far. Traditional Chinese Herbal medicine is a promising therapy due to their multiple components and targets. Shenmayizhi decoction (SMYZD), a Chinese Herbal prescription, has been reported its effective in alleviating cognitive dysfunction in clinical practice. However, strong clinical research of SMYZD in the treatment of VaD was lack. Therefore, we design this study to evaluate the adjuvant role of SMYZD in the treatment of VaD. METHODS: This is a multicenter, randomized, blind, controlled trial. A total of 196 eligible patients will be assigned to receive Ginkgo biloba extracts (GBEs) plus SMYZD granule or GBEs plus SMYZD mimetic granule in a 1:1 ratio. The duration of the trial will be 12 weeks, and a follow-up will be performed at the 24th week. The primary outcomes are the National Institute of Health stroke scale (NIHSS) and the Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog). The secondary outcomes include the Mini-Mental State Examination (MMSE), the traditional Chinese Medicine (TCM) syndrome scale, Activities of Daily Living (ADL), concentrations of hypersensitive C-reactive protein (Hs-CRP), neuron-specific enolase (NSE) and homocysteine (HCY) in serum. Researchers will record any adverse events throughout the trial. DISCUSSION: This study will provide evidences to evaluate the efficacy and safety of SMYZD in combination with GBEs in treatment of VaD, as well as the adjuvant role of SMYZD in combination. TRIAL IS REGISTERED AT CHINESE CLINICAL TRIAL REGISTRY: ChiCTR1800017359.


Assuntos
Demência Vascular/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Atividades Cotidianas , Idoso , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Extratos Vegetais/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Neurol Neurochir Pol ; 53(6): 449-457, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31845749

RESUMO

BACKGROUND AND AIMS: The present study aimed to assess the frequency of spasticity in a single-centre cohort of stroke patients in a one-year follow-up, its predictors, and its impact on the activities of daily living (ADL) and health-related quality of life (HRQoL). MATERIAL AND METHODS: A group of 121 consecutive patients with hemiparesis (aged 73 ± 11 years) was selected for further observation, out of 381 Stroke Department patients during one year. At three follow-up assessments three, six and 12 months after stroke, muscle tone and muscle weakness were rated using Modified Ashworth Scale (MAS) and Medical Research Council (MRC); Activities of Daily Living (ADL) and Health Related Quality of Life (HRQoL) were evaluated using the Barthel Index (BI), Modified Rankin Scale (mRS) and an SF-36 questionnaire. RESULTS: Fifty five of 121 (45%) patients after three months had developed spasticity (MAS ≥ 1), and in 19 of the 121 (15%) this spasticity was severe. After one year, 33/94 (35%) patients showed spasticity, and in 19/94 (20%) it was severe. Baseline muscle weakness (MRC), stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and greater disability (BI), were the most significant predictors of persistent post-stroke spasticity. Patients with spasticity had worse HRQoL in terms of their physical functioning, role limitations, physical pain, and vitality. CONCLUSION: Spasticity, which affects a significant proportion of stroke survivors, was present in 35% of our patients at 12 months after stroke. It has a major impact on both ADL and HRQoL. Severe disability and muscle weakness are the most important predictors of persistent post-stroke spasticity.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Espasticidade Muscular , Prevalência , Qualidade de Vida
8.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(12): 979-984, 2019 Dec 24.
Artigo em Chinês | MEDLINE | ID: mdl-31877594

RESUMO

Objective: To explore the incidence and clinical characteristics of sarcopenia in hospitalized elderly patients with coronary heart disease and search for the related factors. Methods: This study was a single-center observational study. According to the inclusion criteria, elderly patients hospitalized with coronary heart disease from Peking Union Medical College Hospital between December 2017 and December 2018 were enrolled. The patients were divided into sarcopenic group and non-sarcopenic group according to the diagnostic criteria of the Asian Working Group for Sarcopenia. Activities of daily living of the patients were assessed (including ADL and IADL) . Comorbidity of the patients was evaluated by the Charlson comorbidity index (CCI). Long-term medication use of the patients was recorded to assesse whether there was polypharmacy. The nutritional status of the patients was examined by the mini nutritional assessment-short form (MNA-SF). The full tandem stance time of the patients was evaluated. The history of falls over the previous year, urinary incontinence, and living conditions of the patients were also recorded. Multivariate logistic regression was used to analyze the related factors for sarcopenia of elderly patients with coronary heart disease. Results: A total of 364 patients were enrolled in the study. The patients were aged 65-96 (74.6±6.5) years and there were 218 (59.9%) male patients. There were 264 cases of stable coronary heart disease and 100 cases of acute coronary syndrome. The median number of long-term used medication was 7. One hundred and fifty-two (41.8%) patients were complicated with type 2 diabetes, 38 (10.4%) patients were complicated with anxiety/depression, and 98 (26.9%) patients had the history of falls over the previous year. Eighty-two (22.5%) patients were complicated with urinary incontinence, 12 patients (3.3%) were complicated with malnutrition and 33 patients (9.2%) were living alone. There were 81 (22.3%) sarcopenic patients and 283 (77.7%) non-sarcopenic patients among all the hospitalized elderly patients with coronary heart disease. The sarcopenic patients were more older, with lower body mass index(BMI)(both P<0.001), higher CCI and more long-term used medication (both P<0.05), higher proportions of malnutrition, urinary incontinence, history of falls, and living alone (all P<0.05) compared to non-sarcopenic patients. ADL and IADL scores of sarcopenic patients were significantly lower than those of non-sarcopenic patients (both P<0.001). There was also a higher proportion of unable to accomplish full tandem stance among sarcopenic patients compared to non-sarcopenic patients (P<0.001). Moreover, higher hs-CRP level (P=0.047) , lower albumin level (P=0.004) and significantly lower prealbumin level (P<0.001) were observed in sarcopenic patients compared to non-sarcopenic patients. Stepwise multivariate binomial logistic regression analysis revealed that male (OR=5.036, 95%CI 1.782-14.230, P=0.002), low BMI (OR=0.883, 95%CI 0.796-0.980, P=0.019), as well as low prealbumin level (OR=0.990, 95%CI 0.980-1.000, P=0.045) were related factors for sarcopenia among elderly patients with coronary heart disease. Conclusions: Sarcopenia is a geriatric condition commonly seen in hospitalized elderly patients with coronary heart disease. Male, low BMI, and low prealbumin level were the factors related to sarcopenia for older adults with coronary heart disease.


Assuntos
Doença das Coronárias , Sarcopenia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino
9.
ABCS health sci ; 44(3): 167-171, 20 dez 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047667

RESUMO

INTRODUÇÃO: A Tendinopatia do Manguito Rotador (TMR) acarreta dor e prejuízo na função do ombro, porém não se sabe se ambas na mesma proporção. OBJETIVO: Verificar se a intensidade dolorosa se correlaciona com a função do membro superior em sujeitos com TMR. MÉTODOS: Estudo observacional transversal, com 60 indivíduos com TMR. Utilizou-se a Escala Visual Analógica (EVA) para avaliar a dor e o questionário Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) para função do ombro. Para análise dos dados foi realizada estatística descritiva (médias e desvio-padrão, apresentação numérica e percentual) e aplicada a correlação de Spearman utilizando nível de significância de 5%. RESULTADOS: A dor média pela EVA foi de 5,02 (moderada). Verificou-se limitação leve (pontuação média de 34,43) nas 30 questões do questionário DASH. Em relação aos módulos opcionais, no módulo destinado a atletas/músicos, não houve limitação dos sujeitos que praticavam este (média de pontuação de 11,82). No módulo referente ao trabalho houve limitação leve (média de pontuação de 35,38). Houve correlação baixa entre dor e a função do ombro (rs=0,2949; p=0,0222). CONCLUSÃO: Embora os sujeitos com TMR apresentassem dor moderada, a correlação foi fraca entre dor e função do ombro.


INTRODUCTION: Rotator Cuff Tendinopathy (RMR) causes pain and impairment in shoulder function, but it is not known if both in the same proportion. OBJECTIVE: Verify whether pain intensity correlates with upper limb function in subjects with RMR. METHODS: Cross-sectional observational study of 60 individuals with RMR. The Visual Analogue Scale (VAS) was used to assess pain and the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) for shoulder function. For data analysis, descriptive statistics (means and standard deviation, numerical and percentage presentation) were performed and Spearman correlation was applied using a significance level of 5%. RESULTS: The average pain by VAS was 5.02 (moderate). Mild limitation (mean score 34.43) was found in the 30 questions of the DASH questionnaire. Regarding the optional modules, in the module intended for athletes/musicians, there was no limitation of the subjects who practiced this (average score of 11.82). In the work module there was a slight limitation (average score 35.38). There was a low correlation between pain and shoulder function (rs=0.2949; p=0.0222). CONCLUSION: Although subjects with RMR had moderate pain, the correlation was weak between pain and shoulder function.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atividades Cotidianas , Manguito Rotador/patologia , Dor de Ombro , Extremidade Superior/patologia , Tendinopatia , Lesões do Manguito Rotador , Lesões do Ombro
10.
Adv Exp Med Biol ; 1101: 149-166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31729675

RESUMO

As an integral part of the body, the limb poses dexterous and fine motor grasping and sensing capabilities that enable humans to effectively communicate with their environment during activities of daily living (ADL). Hence, limb loss severely limits individuals' ability especially when they need to perform tasks requiring their limb functions during ADL, thus leading to decreased quality of life. To effectively restore limb functions in amputees, the advanced prostheses that are controlled by electromyography (EMG) signal have been widely investigated and used. Since EMG signals reflect neural activity, they would contain information on the muscle activation related to limb motions. Pattern recognition-based myoelectric control is an important branch of the EMG-based prosthetic control. And the EMG-based prosthetic control theoretically supports multiple degrees of freedom movements  that allows amputees to intuitively manipulate the device. This chapter focuses on EMG-based prosthetic control strategy that involves utilizing intelligent computational technique to decode upper limb movement intentions from which control commands are derived. Additionally, different techniques/methods for improving the overall performance of EMG-based prostheses control strategy were introduced and discussed in this chapter.


Assuntos
Membros Artificiais , Eletromiografia , Atividades Cotidianas , Humanos , Movimento , Qualidade de Vida
11.
J Surg Oncol ; 120(8): 1497-1504, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31705571

RESUMO

BACKGROUND AND OBJECTIVES: Few reports have investigated patient experiences following total en bloc sacrectomy. The aims of this study were to obtain a deeper understanding of patients' personal experiences, needs, and satisfaction with the treatment to reveal areas in which perioperative and long-term patient care can be improved. METHODS: A qualitative design was applied to examine patient experiences and supportive care needs. Patients treated between 2007 and 2017 were identified from our institutional database. RESULTS: A total of 28 survivors were interviewed (13 females, age 13-75 years). Eight themes were identified: the effect of surgery on patients' (a) daily lives, (b) social activities, (c) work or school activities, (d) and family lives; (e) acceptance of ostomy surgery; (f) need for guidance regarding long-term rehabilitation; (g) satisfaction with the medical services provided in the hospital; and (h) satisfaction with the treatment outcomes. CONCLUSION: Total en bloc sacrectomy can yield satisfactory oncological outcomes; however, the procedure is a life-changing event for patients and their families. Physicians must provide long-term support and guidance after surgery to enable patients to fully understand and cope with the changes in their lives.


Assuntos
Neoplasias Ósseas/terapia , Sobreviventes de Câncer/psicologia , Pessoas com Deficiência/psicologia , Qualidade de Vida , Sacro/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Estomia/psicologia , Satisfação do Paciente , Adulto Jovem
12.
Acta Chir Orthop Traumatol Cech ; 86(5): 348-352, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748110

RESUMO

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.


Assuntos
Fraturas Ósseas/complicações , Traumatismos da Perna/cirurgia , Paraplegia/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Transferência Tendinosa/métodos , Acetábulo/lesões , Atividades Cotidianas , Adulto , Idoso , Humanos , Plexo Lombossacral/lesões , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Paraplegia/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos
13.
Bone Joint J ; 101-B(11): 1431-1437, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674251

RESUMO

AIMS: It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS: Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS: Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION: Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.


Assuntos
Artroplastia de Quadril/reabilitação , Nível de Saúde , Atividades Cotidianas , Adulto , Assistência ao Convalescente/estatística & dados numéricos , Artroplastia de Quadril/métodos , Transplante Ósseo/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/reabilitação , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários
14.
Medicine (Baltimore) ; 98(46): e17582, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725606

RESUMO

RATIONALE: Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem neuromuscular disease characterized by myotonia and muscle weakness and wasting of distal and axial muscles. People with DM1, due to the disease progression, are often concerned about their ability to carry out and participate in the activities of daily living. Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy to face such difficulties. Aim of this case-study was to demonstrate the effects of a combined approach by using conventional plus robotic training in rare neuromuscular diseases, such as DM1. PATIENT CONCERNS: A 46-year-old woman came to our observation complaining of difficulty in opening fist after strong voluntary muscle contraction for about 20 years. Over the years, she referred swallowing difficulties for solid foods, balance impairment complicated by tendency to stumble and falls, fatigability, hand muscle weakness with difficulty to open bottles and lifting weights, and daytime sleepiness DIAGNOSIS:: Paraparesis in DM1. INTERVENTIONS: The patient underwent 2 different trainings. The first period of treatment was carried out by using conventional physiotherapy, 6 times a week (twice a day) for 4 weeks. Then, she underwent a two-month specific task-oriented robotic rehabilitation training for the gait impairment using an overground exoskeleton, namely Ekso-GT, combined to the conventional therapy. OUTCOMES: The patient, after the EKSO training, gained a significant improvement in walking, balance and lower limbs muscle strength, as per 10-meter walking test and Left Lower Limb Motricity Index. Neurophysiological data (electroencephalography and surface electromyography) were also collected to more objectively assess the functional outcomes. LESSONS: Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy. Emerging and advancing robotic technologies can enhance clinical therapeutic outcomes by allowing therapists to activate and/or modulate neural networks to maximize motor and functional recovery.


Assuntos
Exoesqueleto Energizado , Distrofia Miotônica/reabilitação , Plasticidade Neuronal , Modalidades de Fisioterapia , Treinamento de Resistência/métodos , Atividades Cotidianas , Terapia Combinada , Eletromiografia , Feminino , Humanos , Pessoa de Meia-Idade , Distrofia Miotônica/fisiopatologia , Resultado do Tratamento
16.
Zhongguo Zhen Jiu ; 39(10): 1034-40, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31621252

RESUMO

OBJECTIVE: To observe the clinical efficacy and correlation of electroacupuncture combined with proprioceptive neuromuscular facilitation (PNF) on proprioception and motor function of lower limbs in stroke patients. METHODS: A total of 96 stroke patients were randomized into an electroacupuncture (EA) group, a PNF group and a combination group, 32 cases in each one. In the EA group, acupuncture was applied at cephalic motor and sensory areas, Huantiao (GB 30), Yanglingquan (GB 34), Xuanzhong (GB 39), Zusanli (ST 36) and Sanyinjiao (SP 6) on affected side, and electroacupuncture was adopted at Yanglingquan (GB 34) and Xuanzhong (GB 39), continuous wave and 2 Hz in frequency for 20 min, once every day. In the PNF group, PNF was performed for 20 min, once a day. In the combination group, electroacupuncture was given before PNF, once a day. 4 weeks as one course and totally 3 courses were required, the effect was followed up after half a year. Before treatment, after 4, 8, 12 weeks of treatment and in follow-up, the average trace error (ATE) and Time, the scores of Fugl-Meyer scale (FMA) and modified Barthel index (MBI) were observed in the 3 groups. Correlation analysis between ATE, Time and FMA was performed. RESULTS: ① The total effective rate in the combination group was 90.3% (28/31), which was superior to 64.5% (20/31) in the EA group and 62.5% (20/32) in the PNF group (P<0.05). ②After 4, 8, 12 weeks of treatment and in follow-up, the ATE and Time in the 3 groups were reduced compared with before treatment (P<0.05, P<0.01). After 8, 12 weeks of treatment and in follow-up, the ATE in the combination group were lower than the EA group and the PNF group (P<0.05, P<0.01). After 12 weeks of treatment and in follow-up, the Time in the combination group were lower than the EA group and the PNF group (P<0.05, P<0.01). ③After 4, 8, 12 weeks of treatment and in follow-up, the FMA scores in the EA group and the combination group were increased compared with before treatment (P<0.01). After 8, 12 weeks of treatment and in follow-up, the FMA scores in the PNF group were increased compared with before treatment (P<0.01). After 8, 12 weeks of treatment and in follow-up, the FMA scores in the combination group were higher than the EA group and the PNF group (P<0.05, P<0.01). ④After 4, 8, 12 weeks of treatment and in follow-up, the MBI scores in the 3 groups were increased compared with before treatment (P<0.01). After 8, 12 weeks of treatment and in follow-up, the MBI scores in the combination group were higher than the EA group (P<0.01). After 12 weeks of treatment and in follow-up, the MBI scores in the combination group were higher than the PNF group (P<0.01). ⑤ The correlation coefficients of ATE, Time and FMA were from 0.4 to 0.75 (P<0.05), suggesting a moderate intensity correlation. CONCLUSION: Electroacupuncture, PNF and combination therapy can improve proprioception and motor function of lower limbs and activities of daily living, and combination therapy has a better effect. Proprioception and motor function have a strong correlation in the recovery of stroke patients.


Assuntos
Eletroacupuntura/métodos , Hemiplegia/terapia , Acidente Vascular Cerebral , Atividades Cotidianas , Humanos , Extremidade Inferior , Propriocepção , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
17.
Zhongguo Zhong Yao Za Zhi ; 44(14): 2902-2913, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31602832

RESUMO

To systematically evaluate the efficacy and safety of Shenxiong Glucose Injection in the treatment of cerebral thrombosis.Randomized controlled trials( RCTs) of Shenxiong Glucose Injection for cerebral thrombosis were screened out by searching CNKI,Wan Fang,VIP,Sino Med,Cochrane Library,PubMed,EMbase,and Web of Science in a systematic way,and the Meta-analysis on finally included studies was conducted by using Handbook 5. 1 evaluation criteria and tools and Rev Man 5. 3 software. GRADE system( GRADE pro 3. 6. 1) was used to grade the evidence quality of key outcome indicators. A total of 25 studies were included,with a total sample size of 2 286 cases,1 144 in the experimental group and 1 142 in the control group. The results of Meta-analysis showed that the total effective rate of Shenxiong Glucose Injection combined with ozagrel in the treatment of cerebral thrombosis was better than that of ozagrel alone( RR = 1. 26,95%CI [1. 20,1. 32],P<0. 000 01); the total effective rate of conventional treatment plus Shenxiong Glucose Injection and ozagrel for cerebral thrombosis was better than that of conventional treatment combined with ozagrel( RR = 1. 26,95%CI [1. 09,1. 46],P = 0. 002). In addition,Shenxiong Glucose Injection combined with ozagrel could reduce the incidence of adverse reactions( RR = 0. 38,95%CI [0. 24,0. 60],P < 0. 000 1),improve the neurological impairment( MD14 d=-7. 19,95% CI[-9. 16,-5. 22],P< 0. 000 1; MD30 d=-5. 34,95% CI [-5. 85,-4. 83],P < 0. 000 1; MD42 d=-7. 03,95% CI [-7. 79,-6. 28],P<0. 000 01; MD60 d=-6. 18,95%CI [-6. 55,-5. 81],P< 0. 000 01; MD90 d=-4. 90,95% CI [-5. 74,-4. 06],P<0. 000 01),and improve activities of daily living( ADL)( MD = 15. 00,95%CI [12. 20,17. 80],P<0. 000 01). The mortality was only included in one study,and the sample size was small,requiring to be further verified by a large sample size. The adverse reactions mainly included lung infection,skin pruritus,gastrointestinal reaction and so on,all of which could be tolerated or disappeared without affecting the treatment. Based on the available data and methods,Shenxiong Glucose Injection combined with ozagrel for cerebral thrombosis could improve the total effective rate,neurological impairment,and ability of daily living,with no serious adverse reactions. The evidence quality level of GRADE system was low in the evaluation of total effective rate,mortality and incidence of adverse reactions.However,the quality of the included researches was not high,requiring rigorously designed and internationally standardized clinical trials with a large sample size to improve the quality of evidence.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Trombose Intracraniana/tratamento farmacológico , Atividades Cotidianas , Glucose/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Rev Lat Am Enfermagem ; 27: e3183, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596417

RESUMO

OBJECTIVE: describe the self-care and functionality levels of patients with multiple sclerosis and determine whether sociodemographic, clinical and functional variables interfere with self-care and/or functionality. METHOD: correlational, cross-sectional study with a quantitative approach performed with individuals in outpatient follow-up. We collected sociodemographic and clinical data and applied the Appraisal of Self-care Agency Scale, the Barthel index, the Lawtton and Brody Scale, and the instrument to investigate the performance in Advanced Activities of Daily Living. We performed descriptive and inferential analysis. RESULTS: most patients were classified as "having self-care" (82.14%); with moderate dependence (51.19%) for the basic activities of daily living, partial dependence for the instrumental activities of daily living (55.95%), and more active for the advanced activities of daily living (85.71%). Patients with longer disease duration had a higher number of disabilities and, in those with better socioeconomic and educational profile, the functionality was better. CONCLUSION: disease duration was strongly correlated with a higher number of disabilities and better socioeconomic and educational profiles showed to be protective factors for functionality. Care planning should consider the needs observed by the multidisciplinary team, stimulating the development of self-care, functionality and sociability.


Assuntos
Atividades Cotidianas , Esclerose Múltipla/fisiopatologia , Autocuidado , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
19.
Niger J Clin Pract ; 22(10): 1324-1327, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607719

RESUMO

Background: Acute cerebral infarction threats human health and life safety. The edaravone is a new antioxidant and hydroxyl radical scavenger, which is the novel scavenger for clinical use, mainly for nervous system diseases. Objective: The purpose of this study is to observe the clinical treatment effects of edaravone on the degree of improvement of neurological impairment and functional movement impairment in patients with acute cerebral infarction. Method: A total of 130 patients admitted to our hospital because of acute cerebral infarction from December 2015 to May 2017 were selected for group analysis. These patients were divided into a control group (n = 65) and a treatment group (n = 65) with a random odd-even method. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these two groups were tested and compared. Results: The total treatment efficiency of conventional treatment in the control group was significantly lower than the combination treatment in the treatment group (P < 0.05). The inter-group differences in the National Institutes of Health Stroke Scale, activities of daily living, and Fugl-Meyer assessment scores after the treatment were significant between these two groups (P < 0.05). The posttreatment effect on the treatment group was superior to that on the control group (P < 0.05). The adverse reaction rate of the treatment group did not significantly vary from that of the control group (P > 0.05). Conclusion: Edaravone can significantly improve the degree of neurological impairment during acute cerebral infarction, functional movement, and living quality with a definite effect and high safety. Thus, this drug has a good prospect in clinical treatment.


Assuntos
Infarto Cerebral/tratamento farmacológico , Edaravone/uso terapêutico , Depuradores de Radicais Livres/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Pirazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Atividades Cotidianas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
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