Recovery Of Function In Patients Research Articles

Эффективность применения кверцетина у пациентов с ишемическим инсультом и коморбидной патологией

Актуальность. На сегодняшний день существует необходимость внедрения эффективного и безопасного патогенетического лечения мозгового инсульта, направленного на защиту нейронов от ишемического повреждения. Коморбидная патология у пациентов с ишемическим инсультом может оказывать существенное воздействие на течение заболевания и влиять на эффективность восстановления нарушенных функций. Целью исследования было изучение влияния кверцетина на функциональный исход острого периода ишемического инсульта, возникшего у больных на фоне соматической патологии. Материалы и методы. Представлены результаты анализа 639 случаев острого мозгового ишемического инсульта в зависимости от применявшейся схемы лечения и уровня коморбидности. Результаты. Исследуемые группы пациентов были сопоставимы по показателям исходного неврологического дефицита. 98 % из них имели коморбидную патологию с диапазоном значений от 1 до 8 баллов по шкале Чарльсона (среднее значение 3,75 ± ± 1,40 балла). Пациенты с высоким уровнем коморбидности продемонстрировали худшие показатели функционального восстановления в остром периоде ишемического инсульта по шкале инвалидизации (3,3 ± 1,6 балла) по сравнению с пациентами с низким уровнем коморбидности (2,2 ± 1,4 балла) (p < 0,01, U). Изучение эффективности разных схем лечения на фоне коморбидной патологии показало достоверную эффективность назначения кверцетина у пациентов с высокой коморбидностью. Среди пациентов с низкой коморбидностью не было отмечено статистически значимых различий по показателю инвалидизации и выживаемости больных в остром периоде ишемического инсульта. Выводы. У 98 % больных с ишемическим инсультом выявляется коморбидная патология, которая негативно влияет на показатели выживания и функционального восстановления у больных в остром периоде ишемического инсульта. Худшие показатели функционального восстановления продемонстрировали пациенты с высоким уровнем коморбидности по индексу Чарльсона. Применение кверцетина в остром периоде ишемического инсульта продемонстрировало высокую эффективность у больных с высоким уровнем коморбидности, что подтвердило мультимодальный спектр его терапевтических эффектов. Индивидуальный подбор лечебных мероприятий у больных с ишемическим инсультом с учетом сопутствующей патологии повышает эффективность лечения.

Особливості когнітивних порушень при COVID-19

У статті детально висвітлені патогенетичні механізми розвитку когнітивних порушень у хворих на COVID-19, описані особливості когнітивної дисфункції залежно від періоду й тяжкості захворювання, вираженості гіпоксії, застосування штучної вентиляції легенів. Зазначено, що розуміння патогенетичних аспектів, що лежать в основі розвитку когнітивних порушень у пацієнтів, які перенесли COVID-19, є надзвичайно важливим для їх адекватної корекції. Наголошено на доцільності застосування чутливих інструментів когнітивного тестування для моніторингу результатів функціонального відновлення хворих на COVID-19; на необхідності проведення оцінки довгострокового впливу SARS-Cov-2 на когнітивні функції в пацієнтів з COVID-19. Розглянуто місце препаратів з мембраностабілізуючими, нейропротекторними й антиоксидантними властивостями й наведено патогенетичне обґрунтування доцільності їх застосування для лікування когнітивних порушень при COVID-19.

Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial.

ObjectiveWe determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke.MethodsIn this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go–cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups.ResultsWe observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months.ConclusionsIntensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Trial registration: #IRCT20200127046275N1.

Sertraline for Functional Recovery After Acute Ischemic Stroke: A Prospective Observational Study.

Background: Neuroprotective and neurorestorative effects have been postulated for selective serotonin-reuptake inhibitors (SSRI). We hypothesized that sertraline, which is characterized by less severe adverse effects and more stable pharmacokinetics than classic SSRI, is associated with improved functional recovery in acute ischemic stroke patients with motor deficits.Methods: Prospective observational study of consecutive acute ischemic stroke patients who received sertraline for clinically suspected post-stroke depression (PSD) or at high risk for PSD. Eligibility comprised acute motor deficit caused by ischemic stroke (≥2 points on NIHSS motor items) and functional independence pre-stroke (mRS ≤1). Decision to initiate treatment with SSRI during hospital stay was at the discretion of the treating stroke physician. Patients not receiving sertraline served as control group. Favorable functional recovery defined as mRS ≤2 was prospectively assessed at 3 months. Multivariable logistic regression analysis was used to explore the effects of sertraline on 3-months functional recovery. Secondary outcomes were frequency of any and incident PSD (defined by BDI ≥10) at 3 months.Results: During the study period (03/2017–12/2018), 114 patients were assigned to sertraline (n = 72, 62.6%) or control group (n = 42, 37.4%). At study entry, patients in sertraline group were more severely neurologically affected than patients in the control group (NIHSS: 8 [IQR, 5–11] vs. 5 [IQR, 4–7]; p = 0.002). Also, motor NIHSS scores were more pronounced in sertraline than in control group (4 [IQR 2–7] vs. 2 [IQR 2–4], p = 0.001). After adjusting for age and baseline NIHSS, multivariable regression analysis revealed a significant association between sertraline intake and favorable functional outcome at 3 months (OR 3.10, 95% CI 1.02–9.41; p = 0.045). There was no difference between both groups regarding the frequency of any depression at 3 months (26/53 [49.1%] vs. 14/28 [50.0%] patients, p = 0.643, BDI ≥10). However, fewer incident depressions were observed in sertraline group patients compared to patients in control group (0/53 [0%] vs. 5/28 [17.9%] patients, p = 0.004).Conclusions: In this non-randomized comparison, early treatment with sertraline tended to favor functional recovery in patients with acute ischemic stroke. While exploratory in nature, this hypothesis needs further investigation in a clinical trial.

ENHANCEMENT OF STERNAL CLOSURE WITH NOVEL HARDENING BONE PUTTY ACCELERATES POST-OPERATIVE RECOVERY

BACKGROUND Regaining and maintaining sternal stability is key to recovering from cardiac surgery and resuming normal life. MontageTM (ABYRX, Irvington, NY, USA) is a settable, resorbable putty that adheres to bleeding bone and achieves rigid sternal fixation following application (Image). We evaluated feasibility, safety, and efficacy of enhanced sternal closure (ESC) with a novel bone putty to accelerate post-operative functional recovery in patients receiving median sternotomy. METHODS AND RESULTS A single-center, single-blinded (participant only), randomized controlled trial was performed (NCT03365843). Consenting patients for elective cardiac surgery via sternotomy received sternal closure using either 8-10 cc of bone putty with wire cerclage (ESC) or wire cerclage alone (control). To date, 32 patients with ESC and 25 control patients reached 6 weeks with 100% follow-up. Student t-test and Fischer's exact test analyzed continuous (mean ± SEM) and categorical variables (Table). Both groups had similar BMI. There were no device-related safety concerns. The ESC group had a shorter time to discharge. Bedside spirometry was used when COVID-19 restrictions allowed. At 5 days or discharge, more patients with ESC recovered to 60% of their baseline FVC (22/28 patients vs 11/23 patients; p=0.04; ESC vs Control). A Likert-type 11-point scale quantified incisional, chest wall, and back pain/discomfort. The ESC group had less incisional pain while resting and at post-operative day 5 or discharge; while breathing at day 5 or discharge; while sleeping at day 5 or discharge and 2 weeks; and while walking at day 5 or discharge. The ESC group had less chest wall pain at day 3 and day 5 or discharge; and less back pain at day 3 and day 5 or discharge. Standardized patient-reported outcomes measures assessed health-related quality of life (EQ-5D index) and physical disability (Health Assessment Questionnaire). ESC improved physical functional recovery with a lower HAQ Index at day 5 or discharge, 2 weeks, and 4 weeks. More patients with ESC recovered to baseline HAQ at 2 weeks and 4 weeks. ESC increased EQ-5D Index scores for quality of life at day 5 or discharge, 2 weeks, and 4 weeks. More patients with ESC recovered to baseline EQ-5D Index by 5 days or discharge. CONCLUSION Enhanced sternal closure with a novel hardening bone putty for rigid fixation accelerates patient recovery. ESC improved ventilatory recovery, reduced pain, and accelerated recovery to baseline function and quality of life. Earlier hospital discharge with ESC may provide substantial cost benefits for the healthcare system. Regaining and maintaining sternal stability is key to recovering from cardiac surgery and resuming normal life. MontageTM (ABYRX, Irvington, NY, USA) is a settable, resorbable putty that adheres to bleeding bone and achieves rigid sternal fixation following application (Image). We evaluated feasibility, safety, and efficacy of enhanced sternal closure (ESC) with a novel bone putty to accelerate post-operative functional recovery in patients receiving median sternotomy. A single-center, single-blinded (participant only), randomized controlled trial was performed (NCT03365843). Consenting patients for elective cardiac surgery via sternotomy received sternal closure using either 8-10 cc of bone putty with wire cerclage (ESC) or wire cerclage alone (control). To date, 32 patients with ESC and 25 control patients reached 6 weeks with 100% follow-up. Student t-test and Fischer's exact test analyzed continuous (mean ± SEM) and categorical variables (Table). Both groups had similar BMI. There were no device-related safety concerns. The ESC group had a shorter time to discharge. Bedside spirometry was used when COVID-19 restrictions allowed. At 5 days or discharge, more patients with ESC recovered to 60% of their baseline FVC (22/28 patients vs 11/23 patients; p=0.04; ESC vs Control). A Likert-type 11-point scale quantified incisional, chest wall, and back pain/discomfort. The ESC group had less incisional pain while resting and at post-operative day 5 or discharge; while breathing at day 5 or discharge; while sleeping at day 5 or discharge and 2 weeks; and while walking at day 5 or discharge. The ESC group had less chest wall pain at day 3 and day 5 or discharge; and less back pain at day 3 and day 5 or discharge. Standardized patient-reported outcomes measures assessed health-related quality of life (EQ-5D index) and physical disability (Health Assessment Questionnaire). ESC improved physical functional recovery with a lower HAQ Index at day 5 or discharge, 2 weeks, and 4 weeks. More patients with ESC recovered to baseline HAQ at 2 weeks and 4 weeks. ESC increased EQ-5D Index scores for quality of life at day 5 or discharge, 2 weeks, and 4 weeks. More patients with ESC recovered to baseline EQ-5D Index by 5 days or discharge. Enhanced sternal closure with a novel hardening bone putty for rigid fixation accelerates patient recovery. ESC improved ventilatory recovery, reduced pain, and accelerated recovery to baseline function and quality of life. Earlier hospital discharge with ESC may provide substantial cost benefits for the healthcare system.

EXAMINING THE ASSOCIATION BETWEEN DOMAINS OF FRAILTY AND 6-MONTH CHANGES IN HEALTH-RELATED QUALITY OF LIFE, LIVING STATUS, AND TREATMENT DECISIONAL REGRET AMONG OLDER PATIENTS REFERRED FOR CARDIAC SURGERY

<h3>BACKGROUND</h3> Both age and frailty function as key preoperative risk factors for cardiac surgery. Age alone is usually a poor marker for predicting older patients' health status, most likely due to failure to reflect functional status in the measurement. Frailty status, which takes function into account, may be a better measure for older patients' health status. <h3>METHODS AND RESULTS</h3> The overall goal of this research was to determine the impact of varying degrees of frailty on the functional recovery of patients who undergo cardiac surgery. Specific objectives were as follows: (1) Determine the association between domains of frailty and change in HRQoL at baseline and 6 months post-surgery, (2) Determine the association between domains of frailty and dependent living status at 6 months post-surgery (3), determine the association between domains of frailty and treatment decisional regret at 6 months post-surgery. A prospective cohort pre-post design was used to evaluate the exposure (frailty)and resulting outcomes (change in HRQoL; dependent living status; treatment decisional regret). The primary outcome was HRQoL, measured preoperatively and at 6 months using EQ-5D-3L/EQ-VAS. Secondary outcomes were, dependent living status and treatment decisional regret, measured using the Functional Independence questionnaire. Worse ADL function was positively associated with higher levels of impairment in mobility and usual function HRQoL from baseline to 6 months. As well, worse ADL function was negatively associated with greater HRQoL improvement in men as measured by index scores and across all procedure types as measured by EQ-VAS. Worse mobility function was negatively associated with higher levels of improvement in HRQoL in isolated AVR patients. Lastly, those with worse ADL function had higher odds of experiencing a dependent living status 6 months after surgery (aOR = 2.06 (1.42, 3.00)), and worse ADL (aOR = 1.89 (1.35, 2.65) and cognitive (aOR = 1.77 (1.26, 2.47) function had higher odds of regretting their decision to have surgery. <h3>CONCLUSION</h3> The current study showed domain-specific frailty, particularly poor pre-operative ADL function, is negatively associated with an individual's capacity to return to optimal HRQoL post-operatively, independent living status and positively associated with experience of decisional regret. The evidence-based data has the potential to better inform patients who are at risk for loss of HRQoL and independence with cardiac surgery, allowing them to make decisions in line with values and preferences. Educating patients these risks is an important aspect of patient-centered care and individualized decision-making based on patient priorities.

Effect of Early Rehabilitation Nursing on Functional Recovery of Patients with Dyskinesia after Craniocerebral Trauma

Effect of Early Rehabilitation Nursing on Functional Recovery of Patients with Dyskinesia after Craniocerebral Trauma

What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations.

There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.

ЗАСТОСУВАННЯ Α-ГЛІЦЕРИЛФОСФОРИЛХОЛІНУ В СХЕМІ КОМПЛЕКСНОГО ЛІКУВАННЯ ДЛЯ ФУНКЦІОНАЛЬНОГО ВІДНОВЛЕННЯ ПІСЛЯ МОЗКОВОГО ПІВКУЛЬОВОГО ІШЕМІЧНОГО ІНСУЛЬТУ

The article considers the influence of α-glycerylphosphorylcholine in the scheme of comprehensive therapy on the dynamics of functional recovery in patients with cerebral hemispheric ischemic stroke. Against the background of the progressive growth of acute cerebral infarction, the problem of timely care is relevant. Timely treatment of stroke, based on evidence-based medicine, along with early activation and rehabilitation of patients is designed to reduce mortality and subsequent disability of patients. Given that cholinergic insufficiency and structural and functional damage of neurons play an important role in the pathogenesis of post-stroke disorders, the use of medicines for their correction, in particular α-glycerylphosphorylcholine, is justified. Choline alfoscerate, a precursor of acetylcholine and phosphatidylcholine, is broken down by enzymes into choline and glycerophosphate when ingested, and the choline thus obtained is able to improve neuronal functionality in patients with neurodegenerative and vascular diseases. The study revealed a significantly better recovery of impaired motor and cognitive functions after cerebral hemispheric stroke under the influence of comprehensive therapeutic and rehabilitation measures using active rehabilitation methods in conjunction with α-glycerylphosphorylcholine. The results obtained during the study allow us to report the advantage of a combination of methods of active rehabilitation and the use of the pharmacological agent α-glycerylphosphorylcholine. The feasibility and efficacy of α-glycerylphosphorylcholine are related to its ability to reduce motor and cognitive deficits after ischemic stroke. The scheme of comprehensive treatment of patients in acute and restorative periods of cerebral hemispheric ischemic stroke with the use of α-glycerylphosphorylcholine helps to increase the effectiveness of functional recovery after an acute cerebral accident, and can be used in the use of therapeutic and rehabilitation programs for patients after cerebral hemispheric ischemic stroke to reduce the post-stroke deficit.

GDNF to the rescue: GDNF delivery effects on motor neurons and nerves, and muscle re-innervation after peripheral nerve injuries.

Peripheral nerve injuries commonly occur due to trauma, like a traffic accident. Peripheral nerves get severed, causing motor neuron death and potential muscle atrophy. The current golden standard to treat peripheral nerve lesions, especially lesions with large (≥ 3 cm) nerve gaps, is the use of a nerve autograft or reimplantation in cases where nerve root avulsions occur. If not tended early, degeneration of motor neurons and loss of axon regeneration can occur, leading to loss of function. Although surgical procedures exist, patients often do not fully recover, and quality of life deteriorates. Peripheral nerves have limited regeneration, and it is usually mediated by Schwann cells and neurotrophic factors, like glial cell line-derived neurotrophic factor, as seen in Wallerian degeneration. Glial cell line-derived neurotrophic factor is a neurotrophic factor known to promote motor neuron survival and neurite outgrowth. Glial cell line-derived neurotrophic factor is upregulated in different forms of nerve injuries like axotomy, sciatic nerve crush, and compression, thus creating great interest to explore this protein as a potential treatment for peripheral nerve injuries. Exogenous glial cell line-derived neurotrophic factor has shown positive effects in regeneration and functional recovery when applied in experimental models of peripheral nerve injuries. In this review, we discuss the mechanism of repair provided by Schwann cells and upregulation of glial cell line-derived neurotrophic factor, the latest findings on the effects of glial cell line-derived neurotrophic factor in different types of peripheral nerve injuries, delivery systems, and complementary treatments (electrical muscle stimulation and exercise). Understanding and overcoming the challenges of proper timing and glial cell line-derived neurotrophic factor delivery is paramount to creating novel treatments to tend to peripheral nerve injuries to improve patients’ quality of life.

Rehabilitation of patients after lumbar microdiscectomy

Objective: to investigate movement-based therapy (kinesitherapy) effectiveness in the rehabilitation of patients after lumbar microdiscectomy.Patients and methods. We enrolled 90 patients (33 men and 57 women, mean age — 59.78±12.0 years) after lumbar microdiscectomy due to the ineffectiveness of conservative management of discogenic lumbosacral radiculopathy. One-half of the participants (45 patients: 15 men and 30 women, mean age — 60.24±12.0 years) underwent kinesitherapy under the supervision of a physician; in other 45 patients (18 men and 27 women, mean age — 59.33±11.0 years), kinesitherapy was not included in the radiculopathy treatment protocol. We assessed pain intensity with visual analogue scale (VAS) and disability using the Roland-Morris scale (RMS) before surgery, ten days after the surgery, and 1, 3, and 6 months after surgery.Results and discussion. We observed a significant decrease in pain intensity - up to 4 points on the VAS, and an improvement in activities of daily living up to 10 points on the RMS 10 days after microdiscectomy. After six months, there was a decrease in pain intensity according to the VAS to 2 points in the kinesitherapy group and to 3 points in the group without kinesitherapy (p=0.088), as well as an improvement in activities of daily living according to RMS up to 5 points in the kinesitherapy group and up to 8 points in the group without kinesitherapy (p=0.003). Reoperations were required in two of 45 patients in the group without kinesitherapy (4.4%) and in one of 45 patients (2.2%) in the kinesitherapy group (p≥0.05).Conclusion. Kinesitherapy can improve functional recovery in patients after lumbar microdiscectomy.

The Effects of Mindfulness-Based Stress Reduction Training on Hope, Psychological Well-Being, and Functional Recovery in Patients with Schizophrenia.

This study tested the effects of mindfulness-based stress reduction (MBSR) training on multiple outcomes in patients with schizophrenia. We compared MBSR, psychoeducation, and control groups in a randomized controlled research design. Outcome measures assessed hope, psychological wellbeing, and functional recovery over three time points in 137 participants. The results of this study indicate that MBSR training was more effective in terms of increasing the level of hope, psychological well-being, and functional recovery of schizophrenia patients when compared with psychoeducation and control patients.

Ginkgo Biloba Extract Is Comparable With Donepezil in Improving Functional Recovery in Alzheimer's Disease: Results From a Multilevel Characterized Study Based on Clinical Features and Resting-State Functional Magnetic Resonance Imaging.

Background: Ginkgo biloba extract (GBE) and donepezil have been reported to be effective in patients with Alzheimer’s disease (AD). Nonetheless, how these drugs impact spontaneous brain activities and how they consequently improve functional recovery are currently unclear.Objectives: This study was to explore the efficacy of GBE vs. donepezil and their add-on efficacy on functional recovery and the adaption of spontaneous brain activities following pharmacologic treatment in patients with AD.Methods: Patients with AD were enrolled and assigned to the GBE group (n = 50), the donepezil group (n = 50), or the combined group (n = 50). Neuropsychological assessments, including minimum mental state examination (MMSE), Alzheimer’s disease assessment scale-cognition (ADAS-Cog), instrumental activity of daily living (IADL), geriatric depression scale (GDS), neuropsychiatric inventory (NPI), and quality of life in Alzheimer’s disease (QOL-AD), were conducted at baseline, 1 month, 3 months, and 6 months. Resting-state functional magnetic resonance imaging (rs-fMRI) was collected to compare the amplitude of low-frequency fluctuation (ALFF), percent amplitude of fluctuation (PerAF), regional homogeneity (ReHo), and degree centrality (DC) at baseline and 6 months.Results: No major significant differences were detected in all comparisons between groups across all follow-up time points. For intragroup comparison, MMSE and ADAS-Cog scores differed significantly across all follow-ups in three groups. The combined group showed significant improvement of GDS scores between baseline and 6 months (p = 0.007). The GBE group (p = 0.044) and donepezil group (p = 0.012) demonstrated significant improvement of NPI scores between baseline and 6 months. Significant correlations were observed between IADL and ALFF in the right gyrus rectus (p = 0.03) and in the left superior cerebellum gyrus (p = 0.01), between GDS and ALFF in the right middle temporal gyrus (p = 0.01), between NPI and PerAF in the left fusiform gyrus (p = 0.03), and between MMSE and ReHo in right superior frontal gyrus (p = 0.04).Conclusion: GBE was comparable with donepezil in the improvement of functional recovery in patients with AD while the combined application of GBE and donepezil seems unnecessary. GBE-mediated improvement of functional recovery was characterized by decreased ALFF values in the right gyrus rectus and decreased PerAF values in the left fusiform gyrus. These featured variations of imaging metrics in specific brain regions may serve as biomarkers in the monitoring of the therapeutic efficacy of GBE.

Pulmonary Rehabilitation Accelerates the Recovery of Pulmonary Function in Patients With COVID-19.

Objectives: To evaluate the effect of in-hospital pulmonary rehabilitation (PR) on short-term pulmonary functional recovery in patients with COVID-19.Methods: Patients with COVID-19 (n = 123) were divided into two groups (PR group or Control group) according to recipient of pulmonary rehabilitation. Six-min walk distance (6MW), heart rate (HR), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO), and CT scanning were measured at the time of discharge, 1, 4, 12, and 24 weeks.Results: At week one, both PR group and Control group showed no significant changes in pulmonary function. At 4 and 12 weeks, 6MW, HR, FVC, FEV1, and DLCO improved significantly in both groups. However, the improvement in the PR group was greater than the Control group. Pulmonary function in the PR group returned to normal at 4 weeks [FVC (% predicted, PR vs. Control): 86.27 ± 9.14 vs. 78.87 ± 7.55; FEV1 (% predicted, PR vs. Control) 88.76 ± 6.22 vs. 78.96 ± 6.91; DLCO (% predicted, PR vs. Control): 87.27 ± 6.20 vs. 77.78 ± 5.85] compared to 12 weeks in the control group [FVC (% predicted, PR vs. Control): 90.61 ± 6.05 vs. 89.96 ± 4.05; FEV1 (% predicted, PR vs. Control) 94.06 ± 0.43 vs. 93.85 ± 5.61; DLCO (% predicted, PR vs. Control): 91.99 ± 8.73 vs. 88.57 ± 5.37]. Residual lesions on CT disappeared at week 4 in 49 patients in PR group and in 28 patients in control group (p = 0.0004).Conclusion: Pulmonary rehabilitation could accelerate the recovery of pulmonary function in patients with COVID-19.

The Effect of Scapular Muscle Strengthening on Functional Recovery in Patients With Lateral Elbow Tendinopathy: A Pilot Randomized Controlled Trial.

There is a lack of consensus on the best management approach for lateral elbow tendinopathy (LET). Recently, scapular stabilizer strength impairments have been found in individuals with LET. The purpose of this study was to compare the effectiveness of local therapy (LT) treatment to LT treatment plus a scapular muscle-strengthening (LT + SMS) program in patients diagnosed with LET. Prospective randomized clinical trial. Multisite outpatient physical therapy. Thirty-two individuals with LET who met the criteria were randomized to LT or LT + SMS. Both groups received education, a nonarticulating forearm orthosis, therapeutic exercise, manual therapy, and thermal modalities as needed. Additionally, the LT + SMS group received SMS exercises. The primary outcome measure was the patient-rated tennis elbow evaluation; secondary outcomes included global rating of change (GROC), grip strength, and periscapular muscle strength. Outcomes were reassessed at discharge, 6, and 12months from discharge. Linear mixed-effect models were used to analyze the differences between groups over time for each outcome measure. The average duration of symptoms was 10.2 (16.1)months, and the average total number of visits was 8.0 (2.2) for both groups. There were no significant differences in gender, age, average visits, weight, or height between groups at baseline (P > .05). No statistical between-group differences were found for any of the outcome measures. There were significant within-group improvements in all outcome measures from baseline to all follow-up points (P < .05). The results of this pilot study suggest that both treatment approaches were equally effective in reducing pain, improving function, and increasing grip strength at discharge as well as the 6- and 12-month follow-ups. Our multimodal treatment programs were effective at reducing pain and improving function up to 1year after treatment in a general population of individuals with LET.

Pain control and functional improvement in patients treated by autologous conditioned serum after failure of platelet rich plasma treatments in knee osteoarthritis.

To assess the efficacy of autologous conditioned serum (ACS) for the treatment of patients with knee osteoarthritis after failure of medical treatments and platelet rich plasma (PRP) injections. Knee osteoarthritis is the most common form of arthritis. Prior to prosthetic surgery these patients might benefit from medical treatments, physiotherapy, and in case of their ineffectiveness, from autologous blood component injections. We have treated 30 patients with Kellgren-Lawrence I-III knee osteoarthritis with ACS after failure of standard medical treatments/physiotherapy and platelet rich plasma (PRP) injections for a full cycle, within the previous year from enrollment. ACS administration was performed in all patients with mild side effects and produced prompt (1month) improvements of VAS and Lequesne scales in 67% of patients and this result persisted at 6 and 12 months. No relationship between the rate of response and Kellgren-Lawrence scale at enrollment was observed whilst responders had a significantly higher amount of interleukin-1 receptor antagonist (IL1-RA) in ACS as compared to nonresponders. The present study confirms the efficacy of ACS in pain control and functional recovery of patients with knee osteoarthritis resistant to medical and PRP treatment. These results were obtained in a well-defined cohort of resistant patients and seem to be related with IL1-RA content in injected ACS.

Efficacy of central extracorporeal life support for patients with fulminant myocarditis and cardiogenic shock.

OBJECTIVESFulminant myocarditis with cardiogenic shock requires extracorporeal life support (ECLS) and has poor outcomes. To improve outcomes, we have converted patients with severely impaired cardiac and multiorgan function from peripheral to central ECLS. In this study, we reviewed these patients’ clinical outcomes and investigated associated factors.METHODSWe retrospectively studied 70 consecutive patients with fulminant myocarditis under peripheral support from 2006 to 2020. Forty-eight patients underwent surgical conversion to central support, and the remaining patients continued peripheral support. The end point was survival and ventricular assist device-free survival.RESULTSMore severe pulmonary congestion and multiorgan failure were present in patients with central than peripheral support. Weaning from ECLS was achieved in 95% and 62% of patients with peripheral and central support, respectively. Five-year survival was not significantly different between patients with central and peripheral support (71.2% vs 87.5%, respectively; P = 0.15). However, the ventricular assist device-free survival rate was significantly higher in patients with central than peripheral support (82.2% vs 52.0%, respectively; P = 0.017). A peak creatine kinase-MB level of >180 IU/l, rhythm disturbance and aortic valve closure were detrimental to functional recovery in patients with central support.CONCLUSIONSConversion to central ECLS is feasible and safe in patients with fulminant myocarditis. Patients with severe myocardial injury as shown by a high creatine kinase-MB level, rhythm disturbance and aortic valve closure should be converted to a durable left ventricular assist device.

Preoperative physical activity predicts postoperative functional recovery in gastrointestinal cancer patients

Purpose The present study aimed to investigate the association between preoperative physical activity (PA) and postoperative functional recovery in gastrointestinal cancer patients. Materials and methods In this prospective study, we included 101 patients who underwent colorectal or gastric cancer surgery. Primary outcome was 6-minute walk distance (6MWD) decline ratio ((postoperative 6MWD value – preoperative 6MWD value)/preoperative 6MWD value × 100 (%)), which was determined as postoperative functional recovery. Patients were divided into two groups according to the median of 6MWD decline ratio: above the median (non-decline group) and below the median (decline group). The International Physical Activity Questionnaire (IPAQ-SV) (the usual seven-day short version) was used to assess preoperative PA and sedentary time. Multivariate logistic regression analysis was performed to identify predictive factors of postoperative functional recovery. Results Preoperative PA (odds ratio (OR): 3.812; 95% confidence interval (CI): 1.326–10.956; p = 0.01), 6MWD (OR: 1.006; 95% CI: 1.002–1.011; p < 0.01), C-reactive protein (OR: 4.138; 95% CI: 1.383–12.377; p = 0.01), and combined resection (OR: 3.425; 95% CI: 1.101–10.649; p = 0.03) were associated with postoperative functional recovery. Conclusions Preoperative PA is a predictor of postoperative functional recovery in patients who undergoing gastrointestinal cancer surgery. Implications for rehabilitation The association between preoperative physical activity (PA) and postoperative functional recovery has been unclear in gastrointestinal cancer patients. We indicated that preoperative PA predicts postoperative functional recovery. Patients who low preoperative PA need to be monitored carefully in the postoperative course. Patients with low preoperative PA may need enhanced postoperative rehabilitation to reduce postoperative functional decline.

Therapeutic analysis of Herbert screw fixation for capitellar fractures via the anterior approach in adolescent patients

ObjectiveThe aim of this study is to analyze the efficacy of open reduction and Herbert screw fixation for coronal fractures of the capitellum via the anterior approach in adolescents.MethodsWe retrospectively analyzed the clinical and imaging data of 15 adolescents with capitellar fractures who were admitted to our hospital from May 2014 to May 2019. The fracture was reduced through the cubital crease incision via the anterior approach and was internally fixated with Herbert screws. A follow-up was conducted after the operation to examine fracture healing and elbow function. The postoperative functional recovery of patients was evaluated with the Mayo Elbow Performance index (MEPI) and the Broberg-Morrey rating system.ResultsPatients underwent surgery 3.7 days after injury on average. Intraoperative fracture reduction was satisfactory. No vascular injury or nerve injury occurred. Bony union occurred in an average of 6 weeks after the operation. All adolescents completed a 12- to 36-month follow-up. At the last follow-up, the Mayo Elbow Performance index was considered excellent in 12 patients and good in three patients. The Broberg-Morrey score was considered excellent in 12 patients, good in two patients, and fair in one patient.ConclusionOpen reduction with Herbert screw fixation via the anterior approach is a feasible surgical method for the treatment of coronal fractures of the capitellum in adolescents.Levels of evidenceTherapeutic, retrospective study-Level IV

Analysis of Prognostic Risk Factors Determining Poor Functional Recovery After Comprehensive Rehabilitation Including Motor-Imagery Brain-Computer Interface Training in Stroke Patients: A Prospective Study.

Objective: Upper limb (UL) motor function recovery, especially distal function, is one of the main goals of stroke rehabilitation as this function is important to perform activities of daily living (ADL). The efficacy of the motor-imagery brain-computer interface (MI-BCI) has been demonstrated in patients with stroke. Most patients with stroke receive comprehensive rehabilitation, including MI-BCI and routine training. However, most aspects of MI-BCI training for patients with subacute stroke are based on routine training. Risk factors for inadequate distal UL functional recovery in these patients remain unclear; therefore, it is more realistic to explore the prognostic factors of this comprehensive treatment based on clinical practice. The present study aims to investigate the independent risk factors that might lead to inadequate distal UL functional recovery in patients with stroke after comprehensive rehabilitation including MI-BCI (CRIMI-BCI).Methods: This prospective study recruited 82 patients with stroke who underwent CRIMI-BCI. Motor-imagery brain-computer interface training was performed for 60 min per day, 5 days per week for 4 weeks. The primary outcome was improvement of the wrist and hand dimensionality of Fugl-Meyer Assessment (δFMA-WH). According to the improvement score, the patients were classified into the efficient group (EG, δFMA-WH > 2) and the inefficient group (IG, δFMA-WH ≤ 2). Binary logistic regression was used to analyze clinical and demographic data, including aphasia, spasticity of the affected hand [assessed by Modified Ashworth Scale (MAS-H)], initial UL function, age, gender, time since stroke (TSS), lesion hemisphere, and lesion location.Results: Seventy-three patients completed the study. After training, all patients showed significant improvement in FMA-UL (Z = 7.381, p = 0.000**), FMA-SE (Z = 7.336, p = 0.000**), and FMA-WH (Z = 6.568, p = 0.000**). There were 35 patients (47.9%) in the IG group and 38 patients (52.1%) in the EG group. Multivariate analysis revealed that presence of aphasia [odds ratio (OR) 4.617, 95% confidence interval (CI) 1.435–14.860; p < 0.05], initial FMA-UL score ≤ 30 (OR 5.158, 95% CI 1.150–23.132; p < 0.05), and MAS-H ≥ level I+ (OR 3.810, 95% CI 1.231–11.790; p < 0.05) were the risk factors for inadequate distal UL functional recovery in patients with stroke after CRIMI-BCI.Conclusion: We concluded that CRIMI-BCI improved UL function in stroke patients with varying effectiveness. Inferior initial UL function, significant hand spasticity, and presence of aphasia were identified as independent risk factors for inadequate distal UL functional recovery in stroke patients after CRIMI-BCI.