Level Of Function In Patients Research Articles

Is Kinesiophobia Associated With Quality of Life, Level of Physical Activity, and Function in Older Adults With Knee Osteoarthritis?

Beyond knee pain itself, the fear of movement, also known as kinesiophobia, recently has been proposed as a potential factor contributing to disability and functional limitation in patients with knee osteoarthritis (OA). Nevertheless, the available evidence on the association of kinesiophobia with patient-reported outcome measures (PROMs) in knee OA remains limited. Among patients with nonoperatively treated knee OA, we asked: (1) Is kinesiophobia associated with decreased quality of life (QoL), functional outcomes, and physical activity? (2) What are the patient disease and psychosocial demographic factors associated with kinesiophobia? This was a multicenter, cross-sectional study of 406 general orthopaedic patients from two urban, referral-based tertiary hospitals in Singapore under a single healthcare group who received nonoperative treatment for knee OA. Between July 2020 and January 2022, a total of 1541 patients were treated for knee OA nonoperatively. Based on that, 60% (923) of patients were rejected due to refusal to participate in the study, 3% (52) of patients were enrolled but did not show up for their appointments for data collection, and a further 10% (160) had incomplete data sets, leaving 26% (406) for this study's analysis. The mean age of patients was 64 ± 8 years, 69% were women, and 81% were Chinese. The level of kinesiophobia in patients was measured using the Brief Fear of Movement scale, a validated 6-item questionnaire ranging from a score of 6 to 24 to measure kinesiophobia in OA, with higher scores representing higher levels of kinesiophobia. In terms of PROMs, the QoL and functional level of patients were measured using the QoL and activities of daily living (ADL) components of the widely validated 12-item Knee Injury and Osteoarthritis Outcome Score (KOOS-12). The KOOS-12 is a questionnaire consisting of 12 items encompassing three domains (QoL, ADL, and pain), with each item ranging from 0 to 4 and higher scores representing worse outcomes. The University of California, Los Angeles (UCLA) Activity Scale was used to measure the level of physical activity in patients. The UCLA score is a descriptive 10-level activity scale ranging from a score of 1 to 10, with higher scores representing greater physical activity levels. A directed acyclic graph, which is a relationship map used to depict and visualize the confounders between the studied variables, was used to identify the confounders between kinesiophobia and PROMs (QoL, function, and physical activity). An ordinal regression model was used to explore: (1) the association between kinesiophobia (as measured using the Brief Fear of Movement scale) and PROMs (as measured using KOOS QoL, KOOS ADL, and the UCLA Activity Scale), adjusting for key confounders such as age, gender, pain, side of arthritis, OA duration/severity, and psychosocial factors (for example, depression, anxiety, and education levels), and (2) the association between kinesiophobia (Brief Fear of Movement scale) and various patient disease and psychosocial demographic factors. After accounting for confounders, greater kinesiophobia (higher Brief Fear of Movement scores) was associated with lower QoL (KOOS QoL score adjusted IQR OR 0.69 [95% confidence interval (CI) 0.53 to 0.90]; p = 0.007) and lower physical activity (UCLA score adjusted IQR OR 0.68 [95% CI 0.52 to 0.90]; p = 0.007); however, there was no association between kinesiophobia and function (KOOS ADL score adjusted IQR OR 0.90 [95% CI 0.70 to 1.17]; p = 0.45). After adjusting for age, gender, OA duration, pain, and BMI, higher levels of anxiety (Patient Health Questionnaire 2 [PHQ-2] anxiety score adjusted OR 2.49 [95% CI 1.36 to 4.58]; p = 0.003) and depression (PHQ-2 depression score adjusted OR 3.38 [95% CI 1.73 to 6.62]; p < 0.001) were associated with higher levels of kinesiophobia. Education level, OA disease severity, side of arthritis (unilateral versus bilateral), and history of previous injury or surgery on the knee were not associated with kinesiophobia. Clinicians should assess for kinesiophobia and other psychological comorbidities such as depression and anxiety at the point of initial evaluation and subsequent follow-up of knee OA with simple validated tools like the Brief Fear of Movement scale (kinesiophobia) in the clinic. This allows for clinicians to identify high-risk individuals and offer evidence-based treatment such as cognitive behavioral therapies with a multidisciplinary team, including a physical therapist and psychologist, to manage these psychological comorbidities and improve outcomes in patients with knee OA. While kinesiophobia was found to be associated with poorer QoL and physical activity, future studies including larger observational cohort studies should be conducted to determine causal and prognostic relationships between kinesiophobia and outcomes in knee OA. Level III, prognostic study.

Functional and Structural Changes in Patients with Spinal Muscular Atrophy Treated in Poland during 12-Month Follow-Up: A Prospective Cohort Study.

Background: In recent years, rapid advances in diagnosis and treatment have been observed in spinal muscular atrophy (SMA) patients. The introduction of modern therapies and screening tests has significantly changed the clinical picture of the disease. The previous classification has, therefore, been replaced by new phenotypes: non-sitters, sitters, and walkers, defined by the patient's functional level. However, despite the change in the clinical picture of the disease, patients still suffer from accompanying structural disorders such as scoliosis or joint contractures. Their presence also significantly affects the acquisition of subsequent motor skills. Due to this, monitoring structural changes and ensuring therapists are aware of improvements or declines in patient functionality are essential components of clinical practice. This study aims to compare the assessment of structural and functional changes after a 12-month follow-up in SMA patients who have already experienced the effects of the disease and are now receiving modern therapy. Methods: We present a study of 34 SMA patients being treated with modern therapies and tested twice 12 months apart. The participants were tested using structural measurements and validated scales such as The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and Hammersmith Functional Motor Scale-Expanded (HFMSE). Results: During the 12-month follow-up, patients showed deteriorating, non-statistically significant structural changes. We also proved that patients showed a trend toward functional improvement. Analyzing the individual scale items, we distinguished which participants obtained the maximum score for a given parameter and no longer had an opportunity to improve during the second examination. Conclusions: Our study proved that most patients improved overall motor function. The examination of structural measurements should become a standard in the evaluation of SMA patients.

Post-stroke spasticity: follow-up and functional implications of chronic long-term treatment with botulinum toxin.

Around 40% of stroke survivor develop spasticity. Plantar flexors (PF) muscles are often affected, with severe functional impairment. The treatment of choice is botulinum toxin type A (BoNT-A) combined with adjuvant treatments. The temporary pharmacological effect implies periodic reassessment and reinjection. These long-term chronic programs require monitoring the functional impact of each cycle and the clinical evolution in relation to aging and repeated interventions. Evaluating changes of functional level in patients with post-stroke spasticity treated with BoNT-A by assessing the long-term maintenance of the therapeutic efficacy. Retrospective longitudinal observational study. Outpatients. Chronic stroke survivors undergoing BoNT-A treatment and subsequent intensive rehabilitation (10 sessions in a day-hospital regime). Medical records of the enrolled patients were consulted. The primary endpoint was the change in PF spasticity by at least 1 point on the Modified Ashworth Scale (MAS) at each cycle. Secondary endpoints were the assessment of possible trends in gait parameters (Six Minute Walking Test [6MWT]; Timed Up and Go [TUG], and 10 Meters Walking Test [10mWT]) pre- and post-injection and at each cycle. Thirty-six patients were enrolled. A reduction of at least one MAS point for PF was recorded after each cycle in all subjects. A time-dependent reduction in the proportion of patients reporting an improvement higher than the minimal clinically important difference (MCID) in 6MWT and 10mWT was observed. In the case of TUG, this data kept stable at all cycles. A one-point increase in the basal functional ambulation classification (FAC) score resulted in a reduction in the probability of having a TUG improvement greater than the MCID. The opposite correlation was found for 6MWT and 10mWT. With the proposed treatment, the clinical significance TUG improvement remains constant throughout repeated cycles and the proportion of patients with improvement in 6MWT and 10mWT tends to decline over time. The predictive value of basal FAC on the functional variables expected improvement may provide a potential treatment targeting tool. These results may deliver prognostic indication allowing an optimized integration of different post-BoNT-A rehabilitation approaches, agreeing with current evidence. Adequate monitoring and treatment protocols are crucial for the stability of functional level and may prevent excessive fluctuations.

Brain activation during processing of mouth actions in patients with disorders of consciousness.

In the past 2 decades, several attempts have been made to promote a correct diagnosis and possible restorative interventions in patients suffering from disorders of consciousness. Sensory stimulation has been proved to be useful in sustaining the level of arousal/awareness and to improve behavioural responsiveness with a significant effect on oro-motor functions. Recently, action observation has been proposed as a stimulation strategy in patients with disorders of consciousness, based on neurophysiological evidence that the motor cortex can be activated not only during action execution but also when actions are merely observed in the absence of motor output, or during listening to action sounds and speech. This mechanism is provided by the activity of mirror neurons. In the present study, a group of patients with disorders of consciousness (11 males, 4 females; median age: 55 years; age range: 19-74 years) underwent task-based functional MRI in which they had, in one condition, to observe and listen to the sound of mouth actions, and in another condition, to listen to verbs with motor or abstract content. In order to verify the presence of residual activation of the mirror neuron system, the brain activations of patients were compared with that of a group of healthy individuals (seven males, eight females; median age: 33.4 years; age range: 24-65 years) performing the same tasks. The results show that brain activations were lower in patients with disorders of consciousness compared with controls, except for primary auditory areas. During the audiovisual task, 5 out of 15 patients with disorders of consciousness showed only residual activation of low-level visual and auditory areas. Activation of high-level parieto-premotor areas was present in six patients. During the listening task, three patients showed only low-level activations, and six patients activated also high-level areas. Interestingly, in both tasks, one patient with a clinical diagnosis of vegetative state showed activations of high-level areas. Region of interest analysis on blood oxygen level dependent signal change in temporal, parietal and premotor cortex revealed a significant linear relation with the level of clinical functioning, assessed with coma recovery scale-revised. We propose a classification of the patient's response based on the presence of low-level and high-level activations, combined with the patient's functional level. These findings support the use of action observation and listening as possible stimulation strategies in patients with disorders of consciousness and highlight the relevance of combined methods based on functional assessment and brain imaging to provide more detailed neuroanatomical specificity about residual activated areas at both cortical and subcortical levels.

Intraoperative neuromonitoring potentials and evidence of preserved neuronal circuitry below the anatomical and functional level in patients with complex spinal dysraphism undergoing detethering reoperations.

Spina bifida represents one of the most common birth defects, occurring in approximately 1-2 children per 1000 live births worldwide. The functional level of patients with spina bifida is highly variable and believed to be correlated with the anatomical level of the lesion. The variable clinical picture is well established, but the correlation with anatomical level and intraoperative neuromonitoring (IONM) data has not been investigated. Furthermore, the potential for preserving function beyond the apparent clinical level has also not been investigated. The objective of this research was to determine the presence and level of intraoperative transcranial motor evoked potential (tcMEP) and triggered electromyography (tEMG) responses, and the association of these responses with preoperative clinical function and radiographic data in pediatric cases of complex tethered cord release reoperations. A single-center retrospective review of pediatric patients with complex spinal dysraphism undergoing detethering reoperations was conducted. Preoperative demographic and clinical data, including the radiographic and clinical level of dysraphism, were collected. IONM, including tcMEPs and tEMG responses, were obtained and compared with preoperative clinical data. Descriptive analysis was performed, by patient for demographics and by case for surgeries performed. In 100% of 21 cases of complex detethering reoperations, representing 20 patients, intraoperative tcMEPs could be generated at (4.8%) or below (95.2%) the level of clinical function. Compared with the preoperative clinical examination, 5 cases (23.8%) demonstrated tcMEP responses that were 1 level below the clinical function level, 11 cases (52.4%) were 2 levels below, and 4 cases (19.0%) were 3 levels below. Overall, 18 of 21 cases showed tEMG responses at or below the level of clinical function; of these, 7 cases (33%) were 1 level below and 3 (14%) were ≥ 2 levels below the clinical function level. The presence of positive stimulation potentials below the level of clinical function in patients with complex spinal dysraphism undergoing detethering reoperations indicates a degree of preserved neuronal connectivity. These findings suggest novel future treatment approaches for these patients, including using devices targeted to stimulation of these neurological pathways.

Socio-demographics, Causes of Injuries, and Rehabilitation Injury Categories in a Commercial Motorcycle Road-Related Orthopedics and Neurological Surgery Cohort in Eldoret, Kenya

Commercial motorcycle road related orthopedics and neurological injuries are one of the major causes of short- and long-term consequences requiring timely interdisciplinary referrals and in-patient physiotherapy rehabilitation together with out-patient follow-ups, to maintain and improve physical and functional level of patients. Spinal cord injuries and fractures of the vertebra and lower extremities remain one of the causes of mortality, impairments and disability to the riders, passengers and pedestrians. The objective of the study was to explore socio-demographic characteristics, causes of injuries, rehabilitation injury categories following commercial motorcycle road-related orthopedics and neurological surgery, Eldoret, Kenya. In this prospective cohort study, purposive sampling was adopted to select a sample size of 79 participants for a 6 months period of March 2021-July 2022 in 5 level hospitals, Eldoret, Kenya. The data was entered and analyzed with SPSS 20. The findings show that, from the patients’ bio-data during the study period, 79 out 150 were admitted with commercial motorcycle road-related orthopedics and neurological injuries for surgery with a prevalence rate 53%. All (100%) participants from socioeconmic backgrounds used commerical motorcycles as means of public transport. Male participants constituted to 62% and 38% females with a ratio of male to female of 4.9:3. Majority (94%) of participants were aged between 18 to 44 years with 62% aged between 18-34 years. Sixty-six per cent (66%) were admitted to orthopedics while 34% in neurological wards. All (100%) of the participants reported physical impairments and functional limitations with reduced independence level following commercial motorcycle road-related orthopedics and neurological injuries. All (100%) were referred for post-operative physiotherapy by orthopedics and neurological surgeons. More than half (62%) participants did not intend to continue with outpatient and follow-up physiotherapy rehabilitation. Majority (78%) paid their hospital health bills out of pocket with 51% coming from needy socio-economic class. However, 75% of the participants had requested for a waiver from a social worker. Based on the findings, the study concludes that interdisciplinary referral for post-operative physiotherapy by orthopedics and neurological surgeons were excellent. As a result, there is need for out-patient post-operative physiotherapy follow-ups and sensitization of NHIF registration and uptake by workers in informal sectors.

Effect of Vastus Medialis Oblique Strengthening Versus Mulligan Knee Taping Technique (Mcconnell Tape) on Patellofemoral Pain Syndrome: A Comparative Study.

This study aims to determine the effectiveness of Vastus medialis oblique (VMO) strengthening and conventional therapy treatment (group A) andMulligan knee taping technique(McConnell tape) and conventional therapy treatment (group B) in patients with patellofemoral pain syndrome by VAS for pain andKPS for anterior knee pain scale is to compare VMO strengthening Versus Mulligan knee taping technique using McConnell tape in patellofemoral pain syndromeusing VAS for assessing pain and Kujala patellofemoral scale to assess knee pain and function. The most frequent cause of knee discomfort with retro patellar orperipatellar pain is patellofemoral pain syndrome (PFPS). The need for further studies to better understand the causes and treatment of PFPS is essential to provideoptimal care for individuals experiencing pain in the knee. Physical therapy is considered the most effective treatment for PFPS, but more research is needed todetermine each individual's best course of action. Proper diagnosis is the key to successful treatment and prevention of PFPS. Early intervention is also important forbetter outcomes. Patellofemoral pain syndrome (PFPS), which is often used interchangeably with "anterior knee pain" or "runner's knee," is the clinical entity ofstiffness or pain or both on prolonged sitting with the knees flexed and pain with activities that load the patellofemoral joint, such as climbing or descending stairs,squatting, running and kneeling. Varieties of conservative treatments are suggested, like quadriceps strengthening, stretching, braces and straps, electrotherapy, footorthosis, patellar taping, etc. Hence, a comparison between the vastus medialis obliqus muscle strengthening and patellar taping was undertaken to determine theireffectiveness concerning pain and function. A well-organized research study was conducted over 12 months to investigate the impact of strengthening the vastusmedialis oblique muscle and applying conventional therapy treatment. Group A received this combination of treatments, while Group B was assigned a treatmentprotocol involving the use of McConnell tape along with conventional therapy treatment. After taking informed and written consent, 30 subjects diagnosed withunilateral or bilateral PFPS were randomly selected and allocated into two groups - Group A (VMO muscle strengthening and conventional therapy treatment) andGroup B (Mulligan knee taping technique (McConnell tape) and conventional therapy treatment). Both groups received 6 therapy sessions every alternate day for 6weeks. The visual analog scale (VAS) and Kujala patellofemoral scale (KPS) measured pre and post-pain and function. "T-Test" was used for statistical analysis. Therewas a significant improvement in pain and function in patients with Patellofemoral pain syndrome at the end of 6 weeks regarding VAS and KPS within both groups,i.e., groups A and B (p&lt;0.01). But there was no significant difference regarding improvement in pain and functional status in patients with Patellofemoral painsyndrome at the end of 6 weeks in terms of VAS and KPS between groups. The effect of conventional therapy treatment along with VMO muscle strengthening issimilar to the conventional therapy treatment along with patellar taping in improving pain and functional level in patients with patellofemoral pain syndrome at theend of 6 weeks.

Outpatient Fully Endoscopic Cervical Unilateral Laminotomy for Bilateral Decompression with Virtual Postoperative Monitoring

Objective: Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a promising novel surgical approach. However, to date, there is a paucity of data regarding safety, efficacy, and functional outcomes following CE-ULBD.Methods: The aim of this study was to investigate the outcomes of outpatient CE-ULBD combined with postoperative smartphone-based continuous physiological monitoring and virtual follow-up. Results: We included a total of 23 patients in our study group. The mean age was 69.1±2.5 years. A significant postoperative reduction of the visual analogue scale for neck pain (4.1±0.6 pre- vs. 2.3±0.5 post-surgery; P&lt;0.0001) and upper extremity pain (2.6±0.6 vs. 1.1±0.3; P=0.0012) was reported alongside a significant improvement in the Neck Disability Index (18.6±2.5 vs. 9.1±2.5; p=0.032). Eleven patients were monitored with continuous physiological monitoring via a smartphone app (SPINEHealthie ). Those patients were more likely to be outpatients (p=0.0002) and less likely to have postoperative inpatient clinic utilization (p&lt;0.0001). Continuous physiological monitoring suggested a trend towards higher levels of function in patients following CE-ULBD. Conclusion: : Our early results suggest that outpatient CE-ULBD followed by virtual postoperative monitoring is a safe and efficient therapeutic intervention for symptomatic cervical spinal stenosis.

504 Topical adenosine treatment inhibits inflammation and mucus production in viral acute rhinosinusitis

OBJECTIVES/GOALS: Viral acute rhinosinusitis (ARS), a.k.a, the common cold, affects millions every year. The symptoms caused by viral ARS dramatically affect the general well-being and functional levels of patients, causing work and school absence, and antibiotic abuse. In this study, we examined the therapeutic potential of topical adenosine in viral ARS METHODS/STUDY POPULATION: Rhinosinusitis was induced in WT and adenosine receptor (AR) knockout mice by respiratory syncytial virus (RSV) infection in the upper airways. Mice were subjected to adenosine or vehicle control within the sinuses. Adenosine receptor expression, inflammatory cytokine expression, and histologic mucus and inflammation score was assessed. The effect of endogenous adenosine accumulation within the sino-nasal tract was assessed in adenosine deaminase knockout (ADA-/-) mice. RESULTS/ANTICIPATED RESULTS: Topical administration of adenosine significantly inhibited the expression of pro-inflammatory cytokines, mucus production, and cell damage in the nose of mice with viral ARS, without prolonging virus clearance. This inhibitory effect was primarily mediated by the A2A adenosine receptor (AR). We also examined and compared the expression of ARs in the nasal tissue, trachea, and lungs. The nasal tissue exhibited the lowest baseline expression of ARs as compared to the lung and trachea which was further downregulated following adenosine treatment. Additionally, accumulation of endogenous adenosine in ADA-/- mice showed no signs of inflammation within the nasal tissue. Together, we demonstrated that topical adenosine effectively decreased inflammation and mucus production in a mouse model of viral ARS. DISCUSSION/SIGNIFICANCE: Previously, we found that topical adenosine dramatically enhances mucociliary clearance in the nose and sinuses. In this study, we found that nasal topical adenosine effectively decreased inflammation and mucus production in viral ARS. Our data suggest that nasal topical adenosine is an effective topical therapeutic option for viral ARS.

Functional level and its relationship to upper extremity function, pain, and muscle stiffness in children with Duchenne muscular dystrophy.

The progressive symptoms of Duchenne muscular dystrophy (DMD) negatively affect upper extremity skills, and this may have an effect that reduces the independence of daily life. The purpose of this study is to investigate the relationship between functional level and upper extremity function, pain, and stiffness in children with DMD. A total of 38 children with DMD were participated. The functional level of the upper and lower extremities was assessed using Brooke scale and Vignos scale. Upper extremity function, pain and stiffness were assessed using Upper Limb Short Questionnaire (ULSQ). The correlation between ULSQ and Brooke and Vignos scales was calculated. A moderate positive correlation was calculated between ULSQ total scores and Vignos scale (r = 0.52, p < 0.001) and Brooke scale (r = 0.65, p < 0.001). There was a moderate positive correlation between Vignos scale scores and ULSQ subscores of function (r = 0.42, p < 0.05) and stiffness (r = 0.56, p < 0.001); no significant correlation was found between pain scores and Vignos scale (p = 0.053). There was a moderate positive correlation between the function (r = 0.54, p < 0.001), pain (r = 0.40, p < 0.05), and stiffness (r = 0.62, p < 0.001) subscores of the ULSQ with the Brooke scale. In our study, there was a significant relationship between the functional level of patients with DMD and upper extremity function, pain, and muscle stiffness.

Behavioral Assessment of Patients with Disorders of Consciousness.

Severe brain injury is associated with a period of impaired level of consciousness that can last from days to months and results in chronic impairment. Systematic assessment of level of function in patients with disorders of consciousness (DoC) is critical for diagnosis, prognostication, and evaluation of treatment efficacy. Approximately 40% of patients who are thought to be unconscious based on clinical bedside behavioral assessment demonstrate some signs of consciousness on standardized behavioral assessment. This finding, in addition to a growing body of literature demonstrating the advantages of standardized behavioral assessment of DoC, has led multiple professional societies and clinical guidelines to recommend standardized assessment over routine clinical evaluation of consciousness. Nevertheless, even standardized assessment is susceptible to biases and misdiagnosis, and examiners should consider factors, such as fluctuating arousal and aphasia, that may confound evaluation. We review approaches to behavioral assessment of consciousness, recent clinical guideline recommendations for use of specific measures to evaluate patients with DoC, and strategies for mitigating common biases that may confound the examination.

A comparison of the effect of knee muscle taping versus core muscle taping on balance, pain and functional performance in patients with patellofemoral pain syndrome

IntroductionPatellofemoral pain syndrome is one of the most common musculoskeletal disorders which mostly affect young females. A widespread treatment for this condition is muscle taping. This study aimed to compare the effect of knee muscle taping versus core muscle taping on balance, pain, and functional activity in patients with patellofemoral pain syndrome.MethodsOverall, 26 females with patellofemoral pain syndrome were randomly divided into 2 groups: knee muscle taping group (&lt;i&gt;n&lt;/i&gt; = 13) and core muscle taping group (&lt;i&gt;n&lt;/i&gt; = 13). Pain, functional activity, and balance were measured before and 48 hours after the intervention by using the visual analogue scale, Functional Index Questionnaire, and Y Balance Test and Functional Reach Test, respectively.ResultsThe within-group comparison showed a significant pain decrease and functional improvement in both groups. However, balance improved significantly only in the core muscle taping group 48 hours after the intervention compared with baseline. The between-group comparison showed no significant difference in variables between the 2 groups at the assessed time points.ConclusionsBoth the knee and core muscle taping treatment caused improvement in pain and functional level of patients with patellofemoral pain syndrome. Also, no superiority of either treatment was demonstrated.

POST-OPERATIVE REHABILITATION IN TRAUMATIC DISTAL BICEPS TENDON RUPTURE WITH ULNAR ARTERY INJURY AND ULNAR NERVE NEUROPATHY MANAGED WITH SURGICAL RECONSTRUCTION

The Biceps Brachia is an anterior arm muscle consisting of two heads that bridge the shoulder girdle to the forearm. The distal biceps tendon from both heads may converge or remain anatomically separate before attachment to the radial tuberosity. The incidence of distal biceps rupture is 1.2/100,000 per year and is mostly seen in middle-aged men. The rupture of the biceps tendon is a relatively less common lesion making this case unique. Physiotherapy rehabilitation post-surgery is found to be effective; it includes management of pain, increase range of motion exercises, strengthening exercises, muscle energy technique, cardiovascular fitness, all these together helps to improve patient outcomes. A case of the 40-year-old female is presented in this case report who underwent traumatic glass-cut injury in proximal forearm resulting in distal bicep-tendon repair with ulnar artery injury and ulnar nerve neuropathy. After surgical reconstruction patient presented with pain in the shoulder, elbow, and wrist, reduced range of motion, strength, and grip strength leading to difficulty in performing activities of daily living. Surgical history, clinical findings, outcomes, and rehabilitation are mentioned in this report. We report that there is a significant improvement in stability, range of motion, muscle strength, relief from pain, and improvement in the patient's functional level and outcomes.

Demographic Characteristics and Functional Levels of Patients With Fragility Fractures Who Accept Tele-rehabilitation as an Alternative to Face-to-face Home Rehabilitation

There is a gap in the evidence on telerehabilitation (TR) for people with fragility fractures. It is unclear whether this group with recent falls who are often frail with cognitive changes will accept tele-rehabilitation and functional gains can be achieved using this approach. Prospective observational study of consecutive patients admitted with femoral or pelvic fracture to a hospital-based home rehabilitation service (HRS) between January and November 2017. Using tablets, multidisciplinary rehabilitation was provided via videoconferencing and use of exercise apps. Patients chose a face-to-face visit or TR. Information on demographic characteristics, functional levels, the total number of therapy sessions, TR episodes, reasons for non-acceptance of TR, and patient-reported experience using TR was collected. Fifty-two patients with hip and pelvic fractures were admitted to the HRS and 35 (67.3%) received TR. Patients who did not accept TR were older, frailer and more likely to be female than those who received TR. Of the 17 who did not receive TR, 6 were deemed unsuitable by staff due to hearing, vision or cognitive problems and 3 refused. The TR group achieved acceptable functional gains. In the TR group on average, participants had 13.63 (± 7.29) home visits however they only elected to have 3.43 (± 2.48) sessions delivered via TR. TR was acceptable to a subset of hip fracture patients but face-to-face was the preferred mode of delivery. More research is needed to understand patients’ preferences and beliefs, and the influence of clinician attitudes on uptake of TR.

Long-term result of a second or third two-stage revision total knee arthroplasty for infected total knee arthroplasty

BackgroundPersistent or recurrent infection after two-stage revision total knee arthroplasty (TKA) for the treatment of an infected TKA is a dreaded complication. The purpose of the current study was to determine the ability of a second or third two-stage revision TKA to control infection, evaluate the long-term survivorship of the TKA prosthesis, and measure the functional outcome after a second or third two-stage revision TKA for reinfection.MethodsWe evaluated 63 patients (65 knees) with failed two-stage TKA treated with a second or a third two-stage revision TKA. There were 25 men and 38 women (mean age, 67 ± 10.2 years). The mean follow-up from the time of a second two-stage TKA revision was 15.1 years (range, 10 to 19 years) and the mean follow-up from the time of a third two-stage TKA revision was 7 years (range, 5 to 10 years).ResultsOverall, infection was successfully controlled in 49 (78%) of 65 knees after a second two-stage revision TKA was performed. In the remaining 16 knees, recurrent infection was successfully controlled in 12 knees (75%) after a third two-stage revision TKA. Survivorship, free of implant removal for recurrent infection, was 94% at 15.1 years (95% CI, 91 to 100%). Survival free of revision TKA for mechanical failure was 95% (95% CI, 92 to 100%).ConclusionsThe results of the current study suggest that a second or a third two-stage revision TKA is a reasonable option for controlling infection, relieving pain, and achieving a satisfactory level of function for patients with infected TKAs.

Factors associated with social support for family members who care for stroke survivors.

IntroductionVascular strokes are a primary cause of long-term disability for adults, with many social consequences for the patient, the family and healthcare systems worldwide.AimTo investigate the relation between patients' and caregivers' characteristics, as well as burden and depression, and the social support received by carers for stroke victims in Greece.MethodPatients and caregivers were recruited from community settings in the Attica region of Greece, using purposive sampling. They completed a set of questionnaires during face-to-face interviews. Correlational and multiple regression analyses were performed to identify factors associated with caregivers' perceptions of social support.ResultsIn total, 109 dyads of patients and their respective caregivers were recruited. The patients' mean age was 69.3 years, while caregivers' mean age was 58.0 years; 51.4% of patients were males, whereas 67.9% of the caregivers were females. The majority of both patients and caregivers were married, with an annual family income less than €10,000. The level of perceived social support was significantly associated with patients' or caregivers' annual family income, caregivers' working status and the daily caring hours (p < 0.01). Greater perceived support was significantly associated with a lower care burden BCOS (r = 0.29, p < 0.01) and female gender (p = 0.023), but not with the patient's functional level nor with depression (p > 0.05).

The Level of Distress From Fatigue Reported in the Final Two Months of Life by a Palliative Care Population: An Australian National Prospective, Consecutive Case Series

ContextFatigue is the most commonly reported symptom in life-limiting illnesses, although not much is known about the distress it causes patients as they approach death. ObjectivesTo map the trajectory of distress from fatigue reported by an Australian palliative care population in the last 60 days leading up to death. MethodsA prospective, longitudinal, consecutive cohort study using national data from the Australian Palliative Care Outcomes Collaboration between July 1, 2013, and December 31, 2018. Patients were included if they had at least one measurement of fatigue on a 0–10 numerical rating scale in the 60 days before death. Descriptive statistics were used to analyse patients by diagnostic cohort and functional status. ResultsA total of 116,604 patients from 203 specialist palliative care services were analyzed, providing 501,104 data points. Distress from fatigue affected up to 80% of patients referred to palliative care, with the majority experiencing moderate or severe distress. Malignant and nonmalignant diagnoses were equally affected, with the neurological cohort showing the greatest variability. The degree of distress correlated with a patient's functional level; it worsened as a patient's function declined until a patient became bedbound when the reporting of distress reduced. ConclusionsDistress from fatigue is high in this cohort of patients. Interventions to reduce this distress need to be a research priority.

Internal medicine patients admitted without COVID-19 during the outbreak.

BackgroundThe first case of COVID‐19 in Israel was reported on February 21, 2020. Shaare Zedek (SZ), a 1000‐bed tertiary care medical centre in Jerusalem, Israel, cared for a significant number of these patients. While attention focused on COVID‐19 patients, uninfected patients were admitted to decreasing numbers of available internal medicine (IM) beds as IM departments were converted to COVID‐19 isolation wards. As a result of the increase in COVID‐19 patients, closure of IM wards, re‐assignment of staff and dynamic changes in available community placement options, we investigated the impact of the outbreak on IM patient not admitted for COVID‐19.MethodsWe reviewed IM admissions during March 15‐April 30, 2020 for patients without COVID‐19. Characteristics assessed included number of admissions, age, length of stay, mortality rate, number of discharges, number discharged home and functional status of the patients. Data were compared with the previous 3 years (2017‐2019) during the same time period.ResultsDuring March 15‐April 30, 2020 there were 409 patients admitted to IM compared with a mean of 557 over the previous 3 years. Fewer patients were admitted to the ED and the IM wards during the outbreak. There was no significant difference between the two groups with regards to gender, in‐hospital mortality rate, number discharged, number discharged home and patient functional level. Patients admitted during the outbreak to IM were younger (74.85 vs 76.86 years) and had a mean shorter hospital length of stay (5.12 vs 7.63 days) compared with the previous 3 years.ConclusionWhile the characteristics of patients admitted to IM during the outbreak were similar, hospital length of stay was significantly shorter. Internal management processes, as well as patient preferences may have contributed to this observation. An infectious disease outbreak may have a significant effect on uninfected admitted patients.

Diabetic Kidney Disease in Older People with Type 2 Diabetes Mellitus: Improving Prevention and Treatment Options.

Age-related metabolic and renal changes predispose older people to an increased risk of diabetes mellitus and diabetic kidney disease, respectively. As the prevalence of the ageing population is increasing, because of increased life expectancy, the prevalence of older people with diabetic kidney disease is likely to increase. Diabetic kidney disease is associated with an increased risk of adverse outcomes and increased costs to healthcare systems. The management includes promotion of a healthy lifestyle and control of cardiovascular risk factors such as hyperglycaemia, hypertension and dyslipidaemia. Older people are a heterogeneous group of people from a community-living fit and independent person to a fully dependent individual residing in a care home. Therefore, management in this age group should be based on a patient's functional level adopting tight metabolic control in the fit individual and relaxed targets in the frail person. However, despite the maximum available therapy, a significant number of patients with diabetic kidney disease still progress to renal failure and experience adverse cardiac outcomes. Therefore, future research is required to explore methods of early detection of diabetic kidney disease and to investigate novel therapeutic interventions to further improve the outcomes.

Assessment of the effectiveness of physiotherapy after surgical treatment of the cervical or lumbar spine

Objective. The aim of the study was to assess the effectiveness of physiotherapy, including assessment of the functional level of patients after surgical treatment of the spine. Material and methods. The study involved 46 people after cervical or lumbar spine surgery. The research was carried out using the author's questionnaire, the Oswestry questionnaire was used to assess the level of disability in people with lumbar pain. The NDI questionnaire was used to assess the degree of disability in people with cervical pain. The study was conducted before and after the ZUS-rehabilitation program, i.e. 3 weeks after it was started. Results. The intensity of lumbar pain before the stay remained strong, while after rehabilitation the pain remained moderate. The intensity of cervical pain before rehabilitation remained strong, while after rehabilitation the pain was mild. Before rehabilitation of patients after lumbar spine surgery the degree of disability was moderate and severe, while after rehabilitation it was mild and to a lesser extent moderate. In patients after cervical spine surgery, the level of disability before the stay was moderate and severe, but after physiotherapy - mild. Conclusions. The implemented physiotherapy program of patients after spine surgery is effective in reducing pain and improving the functioning of patients in daily activities. However, it is still necessary to verify and improve the methods of post operative physiotherapy of the spine so as to increase efficiency and therapy effectiveness in all evaluated domains.