Rehabilitation Exercises Research Articles

An Actively Vision-Assisted Low-Load Wearable Hand Function Mirror Rehabilitation System

The restoration of fine motor function in the hand is crucial for stroke survivors with hemiplegia to reintegrate into daily life and presents a significant challenge in post-stroke rehabilitation. Current mirror rehabilitation systems based on wearable devices require medical professionals or caregivers to assist patients in donning sensor gloves on the healthy side, thus hindering autonomous training, increasing labor costs, and imposing psychological burdens on patients. This study developed a low-load wearable hand function mirror rehabilitation robotic system based on visual gesture recognition. The system incorporates an active visual apparatus capable of adjusting its position and viewpoint autonomously, enabling the subtle monitoring of the healthy side’s gesture throughout the rehabilitation process. Consequently, patients only need to wear the device on their impaired hand to complete the mirror training, facilitating independent rehabilitation exercises. An algorithm based on hand key point gesture recognition was developed, which is capable of automatically identifying eight distinct gestures. Additionally, the system supports remote audio–video interaction during training sessions, addressing the lack of professional guidance in independent rehabilitation. A prototype of the system was constructed, a dataset for hand gesture recognition was collected, and the system’s performance as well as functionality were rigorously tested. The results indicate that the gesture recognition accuracy exceeds 90% under ten-fold cross-validation. The system enables operators to independently complete hand rehabilitation training, while the active visual system accommodates a patient’s rehabilitation needs across different postures. This study explores methods for autonomous hand function rehabilitation training, thereby offering valuable insights for future research on hand function recovery.

EMG model calibration and trajectory tracking of rehabilitation exoskeleton by asynchronous tele-training

ABSTRACT This study presents a novel kinematic tracking model, designed for a networked exoskeleton system that is asynchronously taught by a remote therapist. The therapist’s rehabilitation exercises are quantitatively assessed using a monocular vision system. The resultant metrics are then transmitted asynchronously over the network to patients equipped with exoskeletons. The exoskeleton utilises these metrics as reference paths for exercises, complemented by electromyography (EMG) feedback. This work introduces a calibration approach aimed at estimating angular positions by utilising EMG observations. The calibration model establishes real-time correlations between polynomial reference positions. We further explore redundant kinematics, incorporating an EMG observer for linear, time-variant rehabilitation tracking control. Our methodology is validated using vision-based metric data and experimental EMG measurements including shoulder flexion, elbow flexion, and rowing-like movements. Computer simulations demonstrate the system’s ability to reliably, robustly, and effectively follow desired trajectories. This research offers a promising approach for remote personalized rehabilitation.

Short-term exercise training benefits pulmonary arterial hypertension patients.

Studies have shown exercise rehabilitation training improves exercise tolerance in pulmonary arterial hypertension (PAH) patients. However, implementing such programs in developing countries can be challenging. We investigated the benefits of short-term exercise rehabilitation training for PAH patients in a developing country. This study was a prospective study of adult PAH patients attending the cardiology outpatient unit of a tertiary referral hospital. The patients were equally divided into an intervention group and a control group. We measured hemodynamic characteristics and six-minute walking distance (6MWD) before and after four weeks of exercise rehabilitation training. The Shapiro-Wilk normality test was performed, followed by an independent t-test or Mann-Whitney test to statistically compare the data. We included 28 patients aged 29.1 ± 11 years. We found no significant differences in all hemodynamic characteristics between the groups before and after the rehabilitation (all p-values >0.05). The intervention group showed a significant increase in 6MWD (300.6 ± 90.8 (95% CI: 248.2, 352.9) vs 436.3 ± 58.8 (95% CI: 402.3, 470.2), p-value <0.001) and consequently, the Δ6MWD in the intervention group was remarkably higher (17.1 ± 48.3 (95% CI: -10.8, 44.9) vs 115.36 ± 54.69 m (95% CI: 83.8, 146.9), p-value <0.001). A short-term exercise rehabilitation training safely improved the exercise tolerance of patients with PAH. Our findings may lead to the improvement of rehabilitation strategies for this detrimental disease in countries with limited resources.

Research on the Motion Control Strategy of a Lower-Limb Exoskeleton Rehabilitation Robot Using the Twin Delayed Deep Deterministic Policy Gradient Algorithm.

The motion control system of a lower-limb exoskeleton rehabilitation robot (LLERR) is designed to assist patients in lower-limb rehabilitation exercises. This research designed a motion controller for an LLERR-based on the Twin Delayed Deep Deterministic policy gradient (TD3) algorithm to control the lower-limb exoskeleton for gait training in a staircase environment. Commencing with the establishment of a mathematical model of the LLERR, the dynamics during its movement are systematically described. The TD3 algorithm is employed to plan the motion trajectory of the LLERR's right-foot sole, and the target motion curve of the hip (knee) joint is deduced inversely to ensure adherence to human physiological principles during motion execution. The control strategy of the TD3 algorithm ensures that the movement of each joint of the LLERR is consistent with the target motion trajectory. The experimental results indicate that the trajectory tracking errors of the hip (knee) joints are all within 5°, confirming that the LLERR successfully assists patient in completing lower-limb rehabilitation training in a staircase environment. The primary contribution of this study is to propose a non-linear control strategy tailored for the staircase environment, enabling the planning and control of the lower-limb joint motions facilitated by the LLERR.

EngageHealth: a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings

BackgroundStroke survivors who receive more rehabilitation therapy achieve better functional outcomes. The amount of rehabilitation that patients receive is, however, limited due to constraints of the healthcare system.ObjectiveTo assess whether EngageHealth, a mobile device application designed to deliver stroke rehabilitation exercises using asynchronous video recordings, increases the amount of outpatient rehabilitation in stroke patients and improves their upper extremity function and quality of life.DesignProspective single-arm study consisting of a 2-week pre-intervention phase without EngageHealth followed by a 4-week intervention period with EngageHealth.SettingAmbulatory care.ParticipantsTwenty-four stroke patients with upper extremity impairment were recruited at the Stanford Stroke Center outpatient clinic.InterventionsParticipants were instructed to use the EngageHealth application daily.Main outcome measuresAdherence, user experience, and change in the upper extremity Fugl-Meyer (UE-FM), Quality of Life in Neurological Disorders (Neuro-QoL), and Stroke Impact Scale (SIS).ResultsOf 23 participants, five (22%) used the application for 17 days, six (26%) used the application for 9–16 days, and 12 (52%) used it &amp;lt; 9 days. Sixty-three percent of participants would recommend the application to other stroke survivors, with fifty percent indicating they would continue using the application, if available. During the pre-intervention phase, there were no changes in hand function. During the intervention period, participants improved by 4 points on the UE-FM (P &amp;lt; 0.01), and 15 points in the hand-function domain of SIS (P = 0.03). Videos of participants' exercises were successfully recorded, allowing the clinician to review videos of the participants' completed tasks asynchronously. In-depth interviews revealed that participants viewed the EngageHealth application favorably, and that their perceived usefulness of the exercises affected their motivation.ConclusionsUse of the EngageHealth application in the home environment may improve upper extremity function in subacute/chronic stroke patients. Additional support strategies should be implemented in future studies to improve adherence. These findings from a prospective single-arm study, support the design of a randomized controlled trial to determine the efficacy of long-term use of the EngageHealth application.

Role of Irisin in exercise training-regulated endoplasmic reticulum stress, autophagy and myogenesis in the skeletal muscle after myocardial infarction.

Patients with heart failure (HF) are often accompanied by skeletal muscle abnormalities, which can lead to exercise intolerance and compromise daily activities. Irisin, an exercise training (ET) -induced myokine, regulates energy metabolism and skeletal muscle homeostasis. However, the precise role of Irisin in the benefits of ET on inhibiting skeletal muscle atrophy, particularly on endoplasmic reticulum (ER) stress, autophagy, and myogenesis following myocardial infarction (MI) remains unclear. In this study, we investigated the expression of Irisin protein in wild-type mice with MI, and assessed its role in the beneficial effects of ET using an Fndc5 knockout mice. Our findings revealed that MI reduced muscle fiber cross-sectional area (CSA), while downregulating the expression of Irisin, PGC-1α and SOD1. Concurrently, MI elevated the levels of ER stress and apoptosis, and inhibited autophagy in skeletal muscle. Conversely, ET mitigated ER stress and apoptosis in the skeletal muscle of infarcted mice. Notably, Fndc5 knockout worsened MI-induced ER stress and apoptosis, suppressed autophagy and myogenesis, and abrogated the beneficial effects of ET. In conclusion, our findings highlight the role of Irisin in the ET-mediated alleviation of skeletal muscle abnormalities. This study provides valuable insights into MI-induced muscle abnormalities and enhances our understanding of exercise rehabilitation mechanisms in clinical MI patients.

Influence of Surgical Mask on Exertion Perception and Select Physiological Parameters During an Incremental Test in Healthy Subjects

Background: During cardiac or pulmonary rehabilitation exercises, the use of a surgical mask may not be well tolerated by patients, especially those experiencing dyspnea during certain activities due to their underlying health conditions. The purpose of this study was to describe the influence of a surgical mask on exertion perception and some physiological parameters during an incremental test in healthy subjects. Methods: A descriptive study involving 16 healthy adult individuals was conducted. The BRUCE incremental protocol was performed twice, with and without the use of a surgical mask. Results: No significant changes were found in vital signs, such as heart rate (p: 0.8684), mean arterial pressure (p: 0.2781), and peripheral oxygen saturation (p: 0.5314). However, the respiratory rate showed a significant difference (p: 0.023). Furthermore, significant differences were observed in the distance covered (p: 0.0005), duration (p: 0.0003), and measured intensity (METs) (p: 0.0117). Metabolic acidosis (p: 0.032), hypocapnia (p: 0.238), and hyperlactatemia (p: 0.024) were detected in the analysis of arterial gases. Oxygenation parameters, such as PaO2 (p: 0.038) and PaO2/FiO2 ratio (p: 0.038), were higher in the mask-off trial. Conclusion: Surgical masks induce negative changes in METs, distance covered, and duration during an incremental treadmill test. Although no significant impact on vital signs was observed, the use of a surgical mask resulted in statistically significant but not clinically relevant decreases in oxygenation parameters. The stages of the Bruce protocol were achieved differently when participants wore a surgical mask. conclusion: During a treadmill incremental test, surgical masks induce negative changes in MET, distance covered, and duration. Although no significant impact was observed on vital signs, wearing a surgical mask resulted in statistically significant but not clinically relevant decreases in oxygenation parameters. The stages of the Bruce protocol were achieved differently when participants wore a surgical mask.

Efficacy of respiratory support therapies during pulmonary rehabilitation exercise training in chronic obstructive pulmonary disease patients: a systematic review and network meta-analysis

BackgroundExercise training is fundamental in pulmonary rehabilitation (PR), but patients with chronic obstructive pulmonary disease (COPD) often struggle with exercise intolerance. Respiratory support during exercise in COPD patients may be a beneficial adjunct therapy. In this study, the effect of different respiratory support therapy during pulmonary rehabilitation exercise training in COPD patients was assessed through a network meta-analysis.MethodsFive databases were searched to obtain randomized controlled trials involving different respiratory support therapies during PR exercise training in COPD patients. The Cochrane Handbook tool was employed to assess the risk bias of included studies. Network meta-analysis was performed using the STATA software. The study protocol was registered at PROSPERO (CRD42023491139).ResultsA total of 35 studies involving 1321 patients and 6 different interventions were included. Network meta-analysis showed that noninvasive positive pressure ventilation (NPPV) is superior in improving exercise capacity (6-Minute Walk Test distance, peak work rate, endurance time), dyspnea, and physiological change (peak VO2, tidal volume, minute ventilation and lactate level) in stable COPD patients who were at GOLD stage III or IV during PR exercise training. The final surface under the cumulative ranking curve value indicated that NPPV therapy achieved the best assistive rehabilitation effect.ConclusionsThe obtained results indicate that NPPV is most powerful in assisting exercise in severe COPD patients under stable condition. Researchers should focus more on the safety, feasibility, and personalization of interventions. Furthermore, there is a need for additional high-quality trials to assess the consistency of evidence across various respiratory support approaches.Trial registrationThe study was registered at PROSPERO (CRD42023491139).

Exercise is medicine: how should medicine embrace exercise as a key therapeutic tool?

Background: As chronic diseases and the aging population increase, exercise is becoming more and more essential along with medical treatment for recovering and maintaining individuals’ physical health. Furthermore, the demand for exercise-based interventions in this context is growing. Although most healthcare professionals recognize the effectiveness and necessity of exercise, the “Exercise is Medicine” initiative has not been established in clinical settings. We aim to discuss the effectiveness and importance of exercise in the treatment and management of diseases and how exercise should be considered a key therapeutic tool in medicine.Current Concepts: Exercise-related mechanisms and their influence on body structure and function should be considered in disease management. It is necessary to understand these interactions and monitor their effects on the entire body. During recovery after an injury, exercise rehabilitation is provided as program customized according to the phase and function levels, the clinical pathway of which is feasible and effective. Exercise programs for maintaining the functioning and physical and mental health of people with disabilities should be developed by considering individuals’ functional levels, disability types, and conditions. Correct posture, microbreaks, and regular exercise are key to managing musculoskeletal pain.Discussion and Conclusion: To ensure the effectiveness of the “Exercise is Medicine” initiative, exercise should be included in the National Health Insurance System after clarifying the indications and clinical effectiveness of exercise therapy and defining specific procedures. Furthermore, increased awareness and changes in the attitude of healthcare professionals and patients toward exercise are necessary. It is now time for the medical community to ponder over and pool its wisdom on how to adopt exercise as a key therapeutic tool.

Suspension training improves bilateral isometric strength asymmetry of knee muscles in people with multiple sclerosis

IntroductionMost people with multiple sclerosis are diagnosed with bilateral strength asymmetry in the lower limbs. Strength asymmetry increases muscle metabolic cost, muscle fatigability, postural instability, gait disturbance, imbalance, and risk of falling, and negatively affects the quality of life in PwMS. So far, the effects of rehabilitation exercises on reducing the asymmetric index in this population has not been studied convincingly. The purpose of this study was to investigate the effect of suspension exercise on bilateral isometric strength asymmetry of knee muscles in patients with multiple sclerosis. Materials & methodsIn this randomized controlled trial, twenty-seven female patients were purposively selected as the statistical sample and randomly divided into the control (n = 13, age: 34.72 ± 5.01 years) and exercise (n = 14, age: 37.62 ± 4.58 years) groups. The control group received routine care while the exercise group received the suspension exercise protocol. Isometric muscle strength and bilateral asymmetry were measured at baseline and after 8 weeks. The Biodex isokinetic dynamometer was used to measure the maximal voluntary isometric contraction of the flexor and extensor muscles of the knee. The analysis of covariance was used to analyze the data. ResultsThe isometric strength of the knee extensor muscles in the weak leg at the angle of 20° and in both legs at the angle of 70° in the exercise group improved significantly. Furthermore, the strength of the knee flexor muscles in the exercise group was increased. The amount of bilateral strength asymmetry in the knee flexor and extensor muscles at the angle of 70° significantly decreased in the exercise group. Discussions & conclusionsThese data suggest that suspension training is a practical approach to manage bilateral asymmetry in knee flexor and extensor muscle strength in patients with an EDSS of less than four.

Effect of Sitting Baduanjin exercise on early rehabilitation of sepsis patients with non-invasive ventilation : a randomized controlled trial

BackgroundFor patients with sepsis receiving non-invasive ventilation (NIV), early rehabilitation is crucial. The Sitting Baduanjin (SBE) is an efficient early rehabilitation exercise suitable for bed patients. There is no consensus about the effect of SBE on the early rehabilitation of septic patients with NIV. This study focused on how the SBE affected the early rehabilitation of sepsis patients with NIV.Methods96 sepsis patients with NIV were randomly assigned to either an Baduanjin group that received the SBE based on the routine rehabilitation exercise (n = 48) or a control group (n = 48) that received routine rehabilitation exercise. The primary outcome was the Medical Research Council(MRC)score, and the Barthel Index score, the duration of NIV, length of ICU stay, length of total stay, hospitalization expense as secondary outcomes.ResultsA total of 245 sepsis patients were screened, with 96 randomly assigned. The study was completed by 90 patients out of the 96 participants.Results revealed that the MRC score increased in both groups, but the improvement of muscle strength in Baduanjin group was more obvious, with statistical significance (p < 0.001).There was statistically significantly difference between the two groups in Barthel Index at the day of transfer out of ICU(P = 0.028).The patients in the Baduanjin group had an average reduction of 24.09 h in the duration of NIV and 3.35 days in total length of hospital stay compared with the control group (p < 0.05).Of note, the Baduanjin group had significantly reduction the total hospitalization expense. No serious adverse events occurred during the intervention period.ConclusionsIn patients with sepsis, the SBE appears to improve muscle strength and activities of daily living (ADL), and lowed the duration of NIV, the length of the total stay, and the hospitalization expense.Trial registrationThe study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR1800015011 (28/02/2018).

Impact of the orofacial muscular rehabilitation exercise on facial expression recovery post-orthognathic surgery

ObjectiveThis study aimed to evaluate the impact of myofunctional rehabilitation of the orofacial muscles through specific exercises on the recovery of facial expression in patients following orthognathic surgery. Material and MethodsThe study included 62 patients who underwent Le Fort I and sagittal split ramus osteotomy (SSRO). Patients were divided into two groups: the first group started immediate post-operative myofunctional rehabilitation of the orofacial muscles through specific exercises. In contrast, patients in Group II did not undergo any myofunctional rehabilitation post-operative exercises. The recovery of facial expressions postoperatively was evaluated in both calm and smiling states by comparing the differences between 3D facial scanning data of chosen facial anatomical structures collected at five key time points: pre-surgery (D0), 2 days (D2), 14 days (D14), 1 month (D30), and 3 months (D90) postoperatively. ResultsThe analysis revealed that characteristic angles and lengths experienced significant changes post-surgery, with ∠chRnchL and ∠chRsnchL decreasing at D2 and normalizing by D30 in the experimental group, while the control group showed a slower recovery, normalizing by D90. The ChL-R length decreased at D2, returning to normal by D30 in the experimental group and D90 in the control group. The height Li-Ls increased at D2 and normalized by D30 in calm and smiling expressions across single and double jaw surgery patients. These findings underscore the more rapid recovery in the experimental group compared to the control group (P < 0.05; P < 0.005; P < 0.0001). ConclusionInitiating myofunctional rehabilitation immediately following orthognathic surgery enhances facial muscle function recovery, improves patient confidence, and expedites social reintegration. This approach is crucial for functional and psychological benefits.

‘Making a connection’: a qualitative study of experiences from a cancer telerehabilitation program

PurposeSpecialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer.MethodA qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis.Results‘A feeling of connection’ was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities.ConclusionWe identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer.

Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients.

Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function. The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA. 72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention. In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p= 0.001, p= 0.002, p= 0.001, p= 0.001, p= 0.001, respectively) after 12 weeks of treatment. The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise.

Research progress in pulmonary rehabilitation in patients who have been weaned off mechanical ventilation: A review article.

Patients who have been treated with mechanical ventilation for more than 72 hours are susceptible to symptoms such as hypoxia and respiratory muscle fatigue after weaning, which may result in weaning difficulty and delay, as well as an increased incidence of negative emotions such as anxiety and depression. Correct pulmonary rehabilitation exercise technique and timing can improve the weaning success rate, reduce the disability rate, and reduce the incidence of pulmonary infection, as well as reduce medical expenses. This article provides a review of pulmonary rehabilitation interventions for mechanically ventilated patients, searching relevant literature through databases such as CNKI and PubMed, aiming to provide guidance for the successful weaning of mechanically ventilated patients. We selected articles related to pulmonary rehabilitation interventions for mechanically ventilated patients from CNKI (China National Knowledge Infrastructure) and PubMed over the years. This article provides a comprehensive review of the research on lung rehabilitation for patients who are mechanically ventilated during the weaning process in an effort to serve as a guide for a successful transition from mechanical ventilation. Early pulmonary rehabilitation training can effectively increase the pulmonary function level and ventilation function of patients and reduce the duration of mechanical ventilation and hospitalization, and is an effective, safe, and feasible treatment method.

The Impact of Exercise-Based Rehabilitation on ACL Patients: A Comprehensive Review in the Context of China’s Healthcare System

This journal review investigates the effectiveness of exercise-based rehabilitation in assisting ACL patients to return activity level. The main objective of this review is to analyze how exercise-based rehabilitation influences recovery for ACL clients within a Chinese healthcare system. The specific exercise-based rehabilitation that were investigated as part of the study included Nordic, hamstring exercises, aquatic workouts; suspension training and lastly eccentric isokinetic. The outcome factors for ACL healing were improved muscle strength and proprioception, remarkable functional stability levels, regain of full range of motion as well free of pain and reduced risk to re-injury. The retrieval of relevant scholarly sources were gathered from extensive use online databases and publications. The results of the research showed that exercise rehabilitation programs contributed to successful treatment of ACL injuries in Chinese patients. The literature has indicated that aquatic exercises and Nordic hamstring have proved to be successful in enhancing the muscle strength, proprioception among Chinese ACL patients. In addition, suspension training led to the improvement of functional stability and return-to play. Secondly, the study results indicated that rehabilitation training was appropriate for relieving pain and enhancing ROM in people with ACL injuries. Lastly, eccentric kinetic exercise was proven effective in decreasing the chances of re-injury and as a physical activity post injury. Recommendations in the study include targeted exercise-based rehabilitation therapies, and as required instituting combined exercise treatment among patients with ACL.

Determination of the internal loads experienced by proximal phalanx fracture fixations during rehabilitation exercises.

Phalangeal fractures are common, particularly in younger patients, leading to a large economic burden due to higher incident rates among patients of working age. In traumatic cases where the fracture may be unstable, plate fixation has grown in popularity due to its greater construct rigidity. However, these metal plates have increased reoperation rates due to inflammation of the surrounding soft tissue. To overcome these challenges, a novel osteosynthesis platform, AdhFix, has been developed. This method uses a light-curable polymer that can be shaped in situ around traditional metal screws to create a plate-like structure that has been shown to not induce soft tissue adhesions. However, to effectively evaluate any novel osteosynthesis device, the biomechanical environment must first be understood. In this study, the internal loads in a phalangeal plate osteosynthesis were measured under simulated rehabilitation exercises. In a human hand cadaver study, a plastic plate with known biomechanical properties was used to fix a 3mm osteotomy and each finger was fully flexed to mimic traditional rehabilitation exercises. The displacements of the bone fragments were tracked with a stereographic camera system and coupled with specimen specific finite element (FE) models to calculate the internal loads in the osteosynthesis. Following this, AdhFix patches were created and monotonically tested under similar conditions to determine survival of the novel technique. The internal bending moment in the osteosynthesis was 6.78 ± 1.62Nmm and none of the AdhFix patches failed under the monotonic rehabilitation exercises. This study demonstrates a method to calculate the internal loads on an osteosynthesis device during non-load bearing exercises and that the novel AdhFix solution did not fail under traditional rehabilitation protocols in this controlled setting. Further studies are required prior to clinical application.

Summary of Best Evidence to Address Kinesiophobia Post Percutaneous Coronary Intervention: An Evidence-Based Review.

The objective of this study is to systematically explore and summarize the best evidence on intervention programs for patients with kinesophobia following percutaneous coronary intervention (PCI) to provide a comprehensive reference for clinical practice interventions. Evidence on interventions for kinesophobia post-PCI was retrieved from Chinese and international integrated databases, treatment guidelines, and websites of professional associations, including systematic reviews and expert consensuses. The evidence considered in this study extends up to May 2022, encompassing information available since the inception of the databases. Two researchers independently evaluated the articles included in the review and extracted and summarized the available evidence. By extracting and integrating data from the 14 articles included in this review, we identified six categories: pre-intervention assessment, psychological intervention, health education, rehabilitation training, social support, and quality control. A total of 21 pieces of evidence were summarized, including mental health assessment, physical fitness evaluation, timing and content of health education, development of personalized exercise prescriptions, and risk control. In clinical settings, using evidence-based practices requires developing feasible intervention programs based on comprehensive consideration of hospital resources, allocation of medical personnel, and consideration of patients' preferences to reduce the kinesophobia of patients post-PCI and improve their compliance with exercise rehabilitation.

Exploring the Potential Applicable Groups for Traditional Chinese Rehabilitation Exercise (TCRE) [Letter

Exploring the Potential Applicable Groups for Traditional Chinese Rehabilitation Exercise (TCRE) [Letter

The application of ERAS in the perioperative period management of patients for lung transplantation

ObjectiveTo explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation. MethodsWe retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores. ResultsComparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05). ConclusionThe ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.