Guidelines For Rehabilitation Of Patients Research Articles

Discord Between the Facial and Maxillary Midline and Intermaxillary Midline Among the Population of Asir, Saudi Arabia

Objective: To determine the proportion of Saudi population in the Asir region that displayed discordance between the facial and maxillary midline and intermaxillary midline, to form an informative guideline for esthetic rehabilitation of patients. Material and Methods: We evaluated 2418 Saudi citizens using positioning guides of the orthopantomography machine to record the relationship of the dental midline to the facial midline. The relationship of the maxillary midline to that of the mandible was observed clinically, and diagnostic mounting of particular cases was performed for confirmation. The examination was carried out by four trained observers (two dentists and two radiology technicians) to overcome the parallax effect. The cases with disagreements were repeated. The record was grouped into (1) coincidence, (2) deviation of the mandible to the right, and (3) deviation to the left. The relationship between facial-dental midline concordance and intermaxillary concordance was assessed using the Chi-squared test. Results: Facial and maxillary midline did not coincide in 42.5% participants, whereas intermaxillary midline discordance was observed in 51.5%. Among those exhibiting discordance, 57% had right discordance and 43% had left discordance. Conclusion: A significant proportion of the population displayed discordance between the facial-maxillary midline as well as the intermaxillary midline. The female population showed not only a higher number of intermaxillary discordance than males but also a significant number of intermaxillary discordance towards the right.

Chronic low back pain and psychological comorbidity : A review

Back pain is acommon, disabling problem in Germany. Previous research has evaluated associations between low back pain (LBP), depression, and fear. The results should provide ideas of how to optimize preventive measures, give guidelines for rehabilitation of patients with LBP, and to develop new therapies. Asystematic review of the literature including primary publications and meta-analyses using set search criteria in PubMed was performed. A meta-analysis was then done. In all, 34studies met the inclusion and quality criteria, whereby 14studies were included in the meta-analysis. In the literature, significantly different depression scores were reported for people with LBP compared to a healthy control group. The pain perception in persons with LBP is associated with depression and fear. The correlation between depression and pain perception was highly significant in 5studies (p< 0.01) and significant in 8studies (p< 0.05). Fear and pain perception were highly significant in 4studies (highly significant, p< 0.01) and significant in 3studies (p< 0.05); 5studies had no significant results. The studies were very heterogeneous. The results can improve the understanding of the complexity of LBP perception and its therapy. The generalization of the results is limited. To cover the correlation of psychosocial and lifestyle factors and pain perception of LBP, further research is required. To obtain aclearer picture of pain perception in persons with LBP, standardized pain assessment would be beneficial. In addition, we recommend that future studies follow standardized procedures to allow greater comparability.

Guiding the failing heart to exercise.

Guiding the failing heart to exercise.

National Survey of Rehabilitation after Critical Illness

This paper reports the results of a survey of compliance with the National Institute of Health and Clinical Excellence (NICE) clinical guideline 83 (CG83) Rehabilitation after Critical Illness1 in NHS hospitals in England. A data collection tool, structured around the detailed recommendations, was distributed throughout the 28 critical care networks in England. Usable data were returned from 59 intensive care units. The overall results show that 52% of units are fully compliant with rehabilitation guidelines for patients within the ICU. This decreases to 48% prior to discharge to the ward. Further reduction in compliance is then seen during the ward stay (27%), prior to discharge from hospital (33%) and at 2–3 months following discharge from intensive care (31%). There are health inequalities in this area that are proving challenging to overcome. Further evidence of the best way to deliver rehabilitation and its long-term health and economic benefits is required.

Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.

Development of a guideline for rehabilitation of patients with low back pain-- phase 2: analysis of data of the classification of therapeutic procedures

Initiated by the Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte), the project is aimed at developing an evidence-based guideline for rehabilitation of patients with low back pain (LBP). Guideline development will be based on a systematic review of the literature, an analysis of the treatment procedures currently employed in rehabilitation, inclusion of the patients' perspectives as well as consultation of experts' panels of clinically experienced physicians and therapists. Formulation of the guideline will then be carried out in a structured consensus building process. This article is focused on analysing the present situation with regard to the treatments received by patients insured by the BfA, using data from routine documentation according to the Classification of Therapeutic Procedures (KTL, Klassifikation Therapeutischer Leistungen). The analysis is intended to provide indications of a basic need to implement a common guideline as well as, simultaneously, to explore possible deficits in present treatment practices, hence to define priorities requiring special attention in the framework of guideline development. As a result of a systematic literature review, the KTL-defined therapeutic procedures that had emerged as relevant in the rehabilitation of LBP patients were aggregated into so-called therapeutic modules which then formed the basis of the analysis. In all, more than 46,000 KTL-data of 2438 patients with a diagnosis of "low back pain" (M54.5 ICD-10) were included. In the rehab centres investigated, rehabilitation of patients with LBP follows a multidimensional, multiprofessional therapeutic strategy. More than 90 % of all patients receive treatments from the modules "medical training therapy", "health education", "physiotherapy", and "physical therapy". Treatments provided to a majority of the patients are massage (78 %), electrotherapy (67 %) as well as psychotherapy (68 %). Women more frequently than men receive therapies belonging to the "psychological treatments" and "occupational therapies" modules; younger patients receive more of the "training therapies", and more often. When treatments are compared across centres, a large variability in the therapeutic procedures provided becomes apparent. This high degree of variability suggests that development and implementation of a common clinical practice guideline for rehabilitation of patients with chronic low back pain should receive priority attention.

Considerations when testing and training the respiratory muscles.

The purpose of this review is to describe the muscles of respiration, mechanisms that lead to their dysfunction, and unique features of the respiratory muscles that should be considered when designing testing and training protocols for patients with respiratory compromise. The diaphragm's unique shape is an important determinant of its function. Respiratory pathophysiology combined with systemic abnormalities may result in inspiratory muscle weakness, fatigue, and injury. The specificity of training principle, as it applies to respiratory muscle training in patients with respiratory compromise, will be described. Precautions related to this type of training will also be outlined. In conclusion, a better understanding of the mechanisms contributing to inspiratory muscle dysfunction will assist physical therapists in designing the most appropriate training programs. This article, along with the other articles in this focus on respiratory muscle training, will provide therapists with scientifically based guidelines for rehabilitation of patients with impaired respiratory muscle function.

Isokinetic Evaluation of the Ankle Invertors and Evertors

The purpose of this study was to develop normative strength dues (absolute peak torque and relative peak torque) for the ankle inverters and evertors in normal adults by using the Cybex dynamometer. Differences in strength between men and women, as we// as between dominant leg and nondominant leg, were also compared. Absolute peak torque of the two muscle groups in men were significantly higher (p < 0.001) than in women. When expressed as relative peak torque, however, only the left evertors in men were significantly stronger than the corresponding side in women. No Significant difference in strength ( p < 0.01) was found between the dominant leg and nondominant leg with the exception of the evertors in women when tested at 30 degrees per second. The ratios between the strength of the evertors and invertors were also presented; however, no apparent trend was noted. The data presented could provide a guideline for rehabilitation of patients.'J Orthop Sports Phys Ther 1984;5(5):246-252.