Early Physical Rehabilitation Research Articles

Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19

ObjectiveTo examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.DesignRetrospective practice analysis from March 5, 2020, to April 15, 2021.SettingIntensive care units (ICU) at four medical institutions.Patientsn = 3780 adults with ICU admission and diagnosis of COVID-19.InterventionsWe measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital).Measurements and main resultsThe cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2 = 0.68, p < 0.001) demonstrates mechanical ventilation (β = − 0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p < 0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS.ConclusionsGreater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.

Effect of cranial base release and swallowing exercises in rehabilitation of post-operative total thyroidectomy patient. A case report

Thyroidectomy is a widely practiced surgical intervention with low mortality and morbidity rates; however, it can result in long-term complications impacting health and social well-being. Early physical rehabilitation programs have been shown to effectively address issues such as swallowing difficulties and motor function impairment in the neck and shoulders, thereby improving the overall quality of life for patients. This study aimed to assess the impact of cranial base release (CBR) in conjunction with swallowing exercises on the post-surgery recovery of patients undergoing total thyroidectomy. A 29-year-old male patient presented with swelling on the left side of the neck, along with pain during neck movements, speech difficulties, and swallowing issues. The patient's neck range of motion, swallowing impairment score, and neck pain and disability scale were measured both before and after treatment. The patient underwent a six-week rehabilitation program consisting of CBR, swallowing exercises, and conventional physiotherapy sessions twice daily. The combined approach of CBR and swallowing exercises resulted in significant improvements in neck range of motion, swallowing impairment score, and neck pain and disability scale for patients following total thyroidectomy. This study highlights the beneficial effects of integrating CBR with swallowing exercises in the rehabilitation of post-operative total thyroidectomy patient, offering promising outcomes for their recovery.

Early physical rehabilitation dosage in the IntensiveCare Unit predicts hospital outcomes after criticalCOVID-19.

to examine the relationship between physical rehabilitation parameters including a novel approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Retrospective practice analysis from March 5, 2020, to April 15, 2021. Intensive care units (ICU) at four medical institutions. n = 3,780 adults with ICU admission and diagnosis of COVID-19. We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: 1) mortality; 2) discharge disposition; and 3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) "6-Clicks" (6-24, 24=greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m2 and 46% (n=1739) required mechanical ventilation. For 2191 patients with complete data, rehabilitation dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R2= 0.68, p <0.001) demonstrates mechanical ventilation (β = -0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p <0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS. Greater physical rehabilitation exposure early in the ICU is associated with physical function at hospital discharge.

Патогенетическое обоснование остеопатических методов при лечении термических ожогов кожи

The novelty of the present studylies in the application of manual (osteopathic) approach to the treatment of thermal skin burns in patients in the acute period (1-3 days) of a burn injury. Clinical, osteopathic, and analytical methods were used. The study result is thatthe involvement of the underlying tissues in burn process in the projection of the burn wound zone determines thecourse and the forecast of a thermalskin burn of the II-III degree in patients. Osteopathic treatment can stop the course of typical pathological processes and change the pathogenesis of the wound process. It is advisablethat the method of early physical rehabilitation and exposure to osteopathic treatmentaimed at improvingthe course of the wound process in burn wounds already in the diseaseacute periodshould be introduced in clinical practice.

Assessment of Mobility Trajectories Using Wearable Inertial Sensors During Autologous Hematopoietic Cell Transplant

ObjectiveThis study aimed to characterize mobility patterns using wearable inertial sensors and serial assessment across autologous hematopoietic cell transplant (autoHCT) and investigate the relation between mobility and perceived function in patients with hematologic cancer. DesignProspective longitudinal study. SettingHospital adult transplant clinic followed by discharge. Participants78 patients with hematological cancer receiving autoHCT. Main Outcome MeasuresMobility was measured across 3 clinical phases (pretransplant, pre-engraftment, and post-engraftment) in using inertial sensors worn during prescribed performance tests in the hospital. Perceived function was assessed using validated provider-reported (Eastern Cooperative Oncology Group [ECOG] Performance Status Scale) and patient-reported [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) measures. Trajectories of 5 selected mobility characteristics (turn duration, gait speed, stride time variability, double support time, and heel strike angle) across the clinical phases were also evaluated using piecewise linear mixed-effects models. ResultsUsing Principal Components Analysis, 4 mobility patterns were identified pretransplant: Gait Limitation, Sagittal Sway, Coronal Sway, and Balance Control. Gait Limitation measured pretransplant was significantly inversely associated with perceived function reported by the provider- (β = -0.11; 95% CI: -0.19, -0.02) and patient- (β = -4.85; 95% CI: -7.72, -1.99) post-engraftment in age-adjusted linear regression models. Mobility characteristics demonstrated immediate declines early pre-engraftment with stabilization by late pre-engraftment. ConclusionPatients with hematological cancer experiencing gait limitations pretransplant are likely to have worse perceived function post-engraftment. Mobility declines in early phases post-transplant and may not fully recover, indicating an opportunity for timely rehabilitation referrals. Wearable inertial sensors can be used to identify early mobility problems and patients who may be at risk for future functional decline who may be candidates for early physical rehabilitation.

The effects of higher versus lower protein delivery in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

BackgroundA recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates in patients with acute kidney injury (AKI) receiving higher protein. These alarming findings highlighted the urgent need to conduct an updated systematic review and meta-analysis to inform clinical practice.MethodsFrom personal files, citation searching, and three databases searched up to 29-5-2023, we included randomized controlled trials (RCTs) of adult critically ill patients that compared higher vs lower protein delivery with similar energy delivery between groups and reported clinical and/or patient-centred outcomes. We conducted random-effect meta-analyses and subsequently trial sequential analyses (TSA) to control for type-1 and type-2 errors. The main subgroup analysis investigated studies with and without combined early physical rehabilitation intervention. A subgroup analysis of AKI vs no/not known AKI was also conducted.ResultsTwenty-three RCTs (n = 3303) with protein delivery of 1.49 ± 0.48 vs 0.92 ± 0.30 g/kg/d were included. Higher protein delivery was not associated with overall mortality (risk ratio [RR]: 0.99, 95% confidence interval [CI] 0.88–1.11; I2 = 0%; 21 studies; low certainty) and other clinical outcomes. In 2 small studies, higher protein combined with early physical rehabilitation showed a trend towards improved self-reported quality-of-life physical function measurements at day-90 (standardized mean difference 0.40, 95% CI − 0.04 to 0.84; I2 = 30%). In the AKI subgroup, higher protein delivery significantly increased mortality (RR 1.42, 95% CI 1.11–1.82; I2 = 0%; 3 studies; confirmed by TSA with high certainty, and the number needed to harm is 7). Higher protein delivery also significantly increased serum urea (mean difference 2.31 mmol/L, 95% CI 1.64–2.97; I2 = 0%; 7 studies).ConclusionHigher, compared with lower protein delivery, does not appear to affect clinical outcomes in general critically ill patients but may increase mortality rates in patients with AKI. Further investigation of the combined early physical rehabilitation intervention in non-AKI patients is warranted.Prospero IDCRD42023441059.

Clinician and patient perspectives on the barriers and facilitators to physical rehabilitation in intensive care: a qualitative interview study

ObjectivesThe objective of this study is to explore patient, relative/carer and clinician perceptions of barriers to early physical rehabilitation in intensive care units (ICUs) within an associated group of hospitals...

RISING NEED OF PHYSICAL REHABILITATION IN ICU

This mini-review discusses the importance of physical rehabilitation in Intensive Care Units (ICUs) to mitigate physical, mental, and psychological problems among critically ill patients. Early and customised physical activities that encourage patient movement from in-bed activities to walking are highlighted. A systematic review of 60 trials (n = 5352) showed that physical rehabilitation improves physical function and reduces ICU stay duration compared to conventional treatment. Despite its benefits, physical therapy is underutilised due to perceived safety issues. Recommendations for effective physical rehabilitation include interprofessional collaboration, addressing specific hurdles, and utilising mobility equipment. Patients should be assessed daily for rehabilitation eligibility, and a proactive culture for mobilisation should be promoted. While physical therapy is generally safe, it requires balancing risks and benefits, especially for patients with extended ICU stays. Structured exercise routines and patient engagement are crucial during the ICU stay, and regular evaluation of mobilisation and physical activity outcomes is essential at ICU discharge and follow-up. The overall goal is to enhance patient recovery and independence, emphasising the need for early physical rehabilitation interventions.

Dynamics of anxiety, depression, and quality of life after early physical rehabilitation of patients who underwent surgical correction of acquired mitral valve defect: clinical prospective randomized study

BACKGROUND: The activation of the patient from the day after an acquired mitral valve (MV) defect with standard cardiorehabilitation surgery and further physical training at an early uncomplicated inpatient stage of the postoperative period appears promising to improve not only the functional status but also the quality of life (QL).&#x0D; AIM: Our aim was to examine the effect of early physical rehabilitation on the dynamics of anxiety, depression, and QL in patients after surgical correction of the MV defect.&#x0D; MATERIALS AND METHODS: The study included 80 patients (median age 60.8 [47.5; 69.0] years) who underwent surgical correction of an acquired MV defect. Starting from the 7th day after the surgery, patients were assessed for functional status, and the intensity of the training load was selected, and this was done again on the 24th day after the surgery. Moreover, the QL parameters on the SF-36 scale and levels of anxiety and depression on the Hospital Anxiety and Depression Scale (HADS) were evaluated. The control group (n=47) underwent a standard cardiac rehabilitation program from 1st day after surgery. In the main group (n=33), based on the results of the cardiopulmonary exercise testing, physical training on a treadmill was initiated for 14 days, from the 8th day after the surgery, in addition to a personalized training program.&#x0D; RESULTS: In addition to improving the functional state, early physical training improved the dynamics of QL indicators in the main group. After 14 days of treadmill training, the physical health component increased from a median of 35.1 to 64.4 (p=0.03), and the mental health component from a median of 49.1 to 82.1 (p=0.03). In addition, after the early physical rehabilitation program in the main group, the number of people without anxiety and depression, according to the HADS scale, significantly increased from 9% to 27.3% (p=0.04), whereas the dynamics of the QL, anxiety, and depression levels in the control group were not significant.&#x0D; CONCLUSION: Early physical rehabilitation, including moderate-intensity workouts with an individual calculation of the speed / angle of the treadmill, starting from 8 days after surgical correction of the acquired MV defect demonstrated efficacy in improving the QL and reducing anxiety and depression levels 24 days after surgery.

A group concept mapping and ethnographic study of intensive care rehabilitation culture.

Early physical activity and physical rehabilitation are advocated in the critical care unit for patients recovering from critical illness. Despite this, there are still many factors associated with implementation of early physical rehabilitation into routine critical care and practice. One such factor that has been consistently identified is unit culture, yet there is little understanding of how or why the culture of a critical care unit impacts on implementation of early rehabilitation. To develop a detailed understanding of the cultural barriers and enablers to the promotion and implementation of physical activity and early mobilization in National Health Service (NHS) critical care units in the United Kingdom (UK). A mixed-methods, two-phase study incorporating online group concept mapping (GCM) and ethnography. GCM will be conducted to provide a multistakeholder co-authored conceptual framework of rehabilitation culture. Ethnographic observations and interviews will be conducted of culture and behaviours in relation to the implementation and promotion of early physical activity and rehabilitation in two NHS critical care units in the North East of England. The results of the Group Concept Mapping and ethnographic observations and interviews will be triangulated to develop a contextual framework of rehabilitation culture in critical care. This study will provide a detailed understanding of barriers and facilitators in relation to providing a positive rehabilitation culture in the critical care unit.

The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review.

Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to the severity of their illness. Care is also required to maintain the position and integrity of the ECMO cannula. However, they experience a range of effects due to prolonged bed rest. This systematic review examined the possible effects of the early mobilization in patients on ECMO. The database PUBMED was searched by using appropriate keywords: "rehabilitation", "mobilization", "ECMO" and "extracorporeal membrane oxygenation". The selection criteria for the article search were the following: (a) studies published in the last five years, (b) descriptive studies, (c) randomized studies, (d) published in the English language and (e) studies in adults. A total of 259 studies were found, 8 of which were finally selected. Most of the studies showed that early intensive physical rehabilitation related to a decrease in in-hospital stay and a reduction in the duration of mechanical ventilation and doses of vasopressors. In addition, improvements in the functional status and rate of mortality were observed along with a reduction in health care costs. Exercise training should be a fundamental part of the management of patients on ECMO.

Propensity-Matched Study of Early Cardiac Rehabilitation in Patients With Acute Decompensated Heart Failure.

The impact of early implementation of cardiac rehabilitation (CR) in heart failure (HF) patients remains to be elucidated. This study sought to determine whether CR during HF hospitalization could improve prognostic outcomes in patients with acute decompensated HF. We analyzed patients with HF enrolled in the JROADHF (Japanese Registry of Acute Decompensated Heart Failure) registry, a retrospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. Eligible patients were divided into 2 groups according to CR during hospitalization. The primary outcome was a composite of cardiovascular death or rehospitalization due to cardiovascular event after discharge. The secondary outcomes were cardiovascular death and cardiovascular event rehospitalization. Out of 10 473 eligible patients, 3210 patients underwent CR. Propensity score matching yielded 2804 pairs. Mean age was 77±12 years and 3127 (55.8%) were male. During a mean follow-up of 2.8 years, the CR group had lower incidence rates of the composite outcome (291 versus 327 events per 1000 patient-years; rate ratio, 0.890 [95% CI, 0.830-0.954]; P=0.001) and rehospitalization due to cardiovascular event (262 versus 295 events per 1000 patient-years; rate ratio, 0.888 [95% CI, 0.825-0.956]; P=0.002) than the no CR group. In-hospital CR was associated with an improvement in Barthel index for activities of daily living (P=0.002). Patients with very low Barthel index at admission were benefited by CR in comparison with patients with independent Barthel index (very low; hazard ratio, 0.834 [95% CI, 0.742-0.938]: independent; hazard ratio, 0.985 [95% CI, 0.891-1.088]; P for interaction=0.035). CR implementation during hospitalization was associated with better long-term outcomes in patients with acute decompensated HF. These data support the need for a randomized, controlled, adequately powered trial to definitively test the role of early physical rehabilitation in hospitalized patients with HF.

95 Evaluation of a Simulation Curriculum to Improve Nursing-Led Early Physical Rehabilitation of Critically Ill Children

OBJECTIVES/GOALS: Early pediatric intensive care unit (PICU) mobilization is safe and associated with improved outcomes. Nursing-specific mobility training is desired and improves mobilization compliance. Thus, our aim is to implement a nurse-targeted, simulation-based early mobility curriculum to determine if it increases the frequency of PICU mobilizations. METHODS/STUDY POPULATION: We will conduct a single center pre-post interventional study of an in situ nurse-targeted, simulation-based early mobility curriculum. We will prospectively evaluate mobilization events in 100 patients admitted during the pre-intervention phase (n=50) and the post-intervention phase (n=50). Inclusion criteria are children ages 1 day to 17 years old admitted to the PICU for ≥3 days. Exclusion criteria include specific mobility contraindications. PICU-wide deployment will be complete when &gt;80% of nurses have participated in the curriculum. Demographic and clinical information will be obtained. Mobility data obtained will include number of nursing-led mobilizations, highest level of mobility achieved, and potential safety events. Data will be collected from the EMR and the nurse caring for the patient. RESULTS/ANTICIPATED RESULTS: The primary endpoint will be the change in the number of nursing-led mobilization events per patient day. The secondary effectiveness outcome is the highest level of mobility achieved by patients during mobilization events in a day. A final secondary end point will be safety events defined as unplanned extubations, medical device dislodgement, falls, and cardiac arrests. Descriptive statistics for continuous variables will be presented as the median and interquartile range and categorical variables will be expressed as percentages. The effect of the simulation curriculum on the clinical outcomes will be assessed using mixed-effects models. Due to the lack of normality in number of nurse-led mobilizations and highest level of mobility achieved, the analysis will be performed using log-normal models. DISCUSSION/SIGNIFICANCE: We hypothesize that we will demonstrate the crucial importance of hands-on nursing education to improve and increase early mobility of critically ill children

Debate: Intermittent Hemodialysis versus Continuous Kidney Replacement Therapy in the Critically Ill Patient: The Argument for CKRT

Continuous kidney replacement therapy (CKRT) is well entrenched as one of the dominant KRT modalities in modern critical care practice. Since its introduction four decades ago, there have been considerable innovations in CKRT machines that have improved precision, safety, and simplicity. CKRT is the preferred KRT modality for critically ill patients with hemodynamic instability. Early physical therapy and rehabilitation can be feasibly and safely provided to patients connected to CKRT, thus obviating concerns about immobility. Although randomized clinical trials have not shown a mortality difference when comparing CKRT and intermittent hemodialysis, CKRT allows precision delivery of solute and fluid removal that can be readily adjusted in the face of dynamic circumstances. Accumulated evidence from observational studies, although susceptible to bias, has shown that CKRT, when compared with intermittent hemodialysis, is associated with better short- and long-term kidney recovery and KRT independence. Critical care medicine encompasses a wide range of sick patients, and no single KRT modality is likely to ideally suit every patient in every context and for every condition. The provision of KRT represents a spectrum of modalities to which patients can flexibly transition in response to their evolving condition. As a vital tool for organ support in the intensive care unit, CKRT enables the personalization of KRT to meet the clinical demands of patients during the most severe phases of their illness.

Effect of early postoperative rehabilitation with aerobic exercise on functional status and cardiac remodeling in patients after heart valve surgery

Aim. To develop a program for early physical rehabilitation of inpatients after heart valve surgery and to evaluate its effectiveness and safety.Material and methods. The study included 80 patients with valvular heart disease (VHD) after elective on pump valve surgery. Patients in the control group (n=47) underwent standard cardiac rehabilitation after surgery; patients of the main group (n=33) additionally, starting from the 8th day after the intervention, had 14-day treadmill training with the program selection, taking into account the results of cycle ergometry spirometry (CES). A week after the operation and at the end of the training course (median, 24 days after the operation), cardiac remodeling and functional status was assessed according to echocardiography and CE, respectively.Results. For 7 days after surgery, patients of both groups were comparable. During physical training in the main group, there were no lifethreatening cardiac arrhythmias, episodes of ischemia, desaturation, as well as intracardiac hemodynamics deterioration. With a 14-day training, CES showed a significant increase in exercise tolerance (ET) in the main group from a median of 50 to 75 W (p=0,002), peak oxygen uptake (VO2peak) from 11,7 to 13,4 ml/kg/min (p=0,001). For 24 days after surgery in the control group, there was a trend towards improvement in ET and VO2peak, but without significant changes (p=0,09/p=0,08).Conclusion. Early inhospital rehabilitation, including physical training of moderate intensity with an individual treadmill speed and incline angle, starting from day 8 after surgery, showed effectiveness and safety in the form of an increase in ET and VO2peak, while not worsening hemodynamic parameters.

Early pulmonary and physical rehabilitation in cooperative patients in the respiratory ICU

Early pulmonary and physical rehabilitation in cooperative patients in the respiratory ICU

Early physical rehabilitation effectiveness in frail older patients hospitalized for community-acquired pneumonia: analysis of a nationwide database in Japan.

Frailty is a significant predictor of prognosis in older patients with community-acquired pneumonia (CAP). No effective therapy has been reported in frail patients with CAP, with frailty determined using the Hospital Frailty Risk Score (HFRS). To investigate whether early physical rehabilitation intervention would effectively minimize adverse outcomes in frail older patients (determined using the HFRS) hospitalized for CAP. This retrospective cohort analysis involved patients with CAP aged ≥ 65years enrolled in the Japanese Diagnostic Procedure Combination Database between 2014 and 2020 and assessed as being frail. We compared 30-day mortality and readmission rates for patients who did and who did not receive physical rehabilitation within three days of admission and evaluated the association between outcomes and receiving early physical rehabilitation using Cox regression models and inverse probability weighting (IPW) for sensitivity analysis. The analysis involved 31,133 frail older patients hospitalized for CAP (mean age 84.3 ± 6.3years; females, 49.1%), including 11,515 (37.0%) who received early physical rehabilitation. Cox regression analysis showed that early physical rehabilitation intervention was inversely associated with 30-day mortality and readmission rates. The IPW model also showed similar results. Early physical rehabilitation was associated with reduced risks of 30-day mortality, overall in-hospital mortality, and 30-day readmission rates in frail older patients with CAP. Early physical rehabilitation in frail older patients hospitalized for CAP may improve outcomes. This finding highlights the importance of simultaneously introducing the HFRS and early physical rehabilitation intervention into clinical practice for frail older patients with CAP.

Classification and risk factors of Post COVID-19 condition: a longitudinal study in the Belgian population

Abstract Background Since the onset of the COVID-19 pandemic, most research has focused on the pathophysiology and management of the acute symptoms of COVID-19, yet some people tend to experience symptoms beyond the acute phase of infection, that is, Post COVID-19 condition (PCC). However, evidence on the prevalence of PCC, its symptoms, and mechanisms are still scarce. This study aimed to assess the distribution, patterns of symptoms, and associated factors of PCC in adult with confirmed COVID-19 infection in Belgium. Methods This is a longitudinal cohort study of Belgian adult population with recent COVID-19 infection confirmed via a molecular test and systematically recruited via national tracing call centers. A total of 5181 people were followed-up using online questionnaires at the time of their infection and 3 months later (from April 2021 to February 2022). Their physical, social and mental health was evaluated as well as their acute COVID-19 symptoms and persistent PCC symptoms. These different variables were self-reported. Results Half of the participants reported PCC (49.6%). The most frequent persistent symptoms 3 months after infection were fatigue (28%), headache (18%), and memory problems (12%). Women (OR = 1.67,CI95%=1.40-1.99), people with a lower level of education (OR = 1.23,CI95%=1.02-1.48), obese people (OR = 1.23,CI95%=1.02-1.48), people with chronic disease (OR = 1.97,CI95%=1.40-2.77), and people with a higher number of acute COVID-19 symptoms (OR = 2.56, CI95%=1.83-3.58) or hospitalised (OR = 2.19,CI95%=1.25-3.82) were more likely to report PCC. Finally, a latent class analysis on the 29 PCC symptoms highlighted 3 different classes of symptoms. Conclusions With the growing number of people infected with COVID-19, PCC is becoming an important public health issue. To allow people with PCC to recover, it is essential to have a multidisciplinary approach and to provide early post-acute physical and psychological rehabilitation interventions according to symptom patterns.

Effectiveness of Early Physical Therapy Rehabilitation in Patient With Juvenile Rheumatoid Arthritis

A diverse group of idiopathic inflammatory arthritis that affects children under the age of 16 and lasts six weeks or longer is known as juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis (JRA). It causes joint pain and morning stiffness, and the affected joints swell and become difficult to move. During flares, patients may experience flu-like symptoms such as muscle aches and fatigue. Disease-modifying antirheumatic drugs (DMARDs)are the mainstay of rheumatoid arthritis (RA) treatment. If necessary, immunosuppressive medications can be administered in stages. Nonsteroidal anti-inflammatory drugs (NSAIDs) are pain relievers for joints. Physical therapy treatment aims to reduce pain, improve joint range, correct movement patterns, strengthen weak structures, improve cardiovascular endurance, and improve patients' quality of life.We present a case of a 12-year-old boy who presented to the hospital with knee pain and an inability to walk without assistance after falling on the ground one month prior. Medical history revealedthat the patient had juvenile rheumatoid arthritis, which was confirmed on investigations. The consultant physician referred the patient for pre-rehabilitation physiotherapy before corrective surgery.

Early physical rehabilitation vs standard care for intracerebral hemorrhage stroke: A protocol for systematic review and meta-analysis: Retraction.

Early physical rehabilitation vs standard care for intracerebral hemorrhage stroke: A protocol for systematic review and meta-analysis: Retraction.