Home-based Therapy Research Articles

Home-Based Intermittent Pneumatic Compression Therapy: The Impact in Chronic Leg Lymphedema in Patients Treated for Gynecologic Cancer.

We conducted a prospective study of cancer patients to investigate the efficacy, quality of life, satisfaction, and safety of a home-based intermittent pneumatic compression (IPC) device during the maintenance phase of lower extremity lymphedema. This device has a unique mode designed to mimic the manual lymphatic drainage (MLD) technique and thereby gently facilitate lymphatic draining of proximal extremities. Thirty patients with stage 3 chronic secondary unilateral leg lymphedema in the maintenance phase underwent IPC and conventional compression therapy for 4 weeks at home. The participants were guided to use 1 h course (30 min of MLD-mimicking mode and 30 min of conventional mode) of IPC device twice a day for 4 weeks. We assessed the patients’ limb-volume measurement, quality of life (QOL), and satisfaction four times. There were no significant time-dependent interactions in the inter-limb volume difference ratio (Vratio). In a subgroup analysis, participants who used the home-based IPC device and maintained their routine self-maintenance program of short-stretch bandages (group B, n = 21) showed a more significant decline in Vratio than those who did not maintained their routine care (group A, n = 9). All scores of QOL decreased significantly after the intervention without subgroup difference. All participants were satisfied with the 4-week intervention. This study demonstrated that a home-based IPC device with an MLD-mimicking program is a useful option for maintaining the volume of limbs and improving the QOL of patients with stage 3 chronic leg lymphedema during the maintenance phase.

Home-Based Remedies to Prevent COVID-19-Associated Risk of Infection, Admission, Severe Disease, and Death: A Nested Case-Control Study.

Objective This study aimed at determining the various types of home-based remedies, mode of administration, prevalence of use, and their relevance in reducing the risk of infection, hospital admission, severe disease, and death. Methods The study design is an open cohort of all participants who presented for testing for COVID-19 at the Infectious Disease Treatment Centre (Tamale) and were followed up for a period of six weeks. A nested case-control study was designed. Numerical data were analysed using STATA version 14, and qualitative data were thematically analysed. Results A total of 882 participants made up of 358 (40.6%) cases and 524 (59.4%) unmatched controls took part in the study. The prevalence of usage of home-based remedies to prevent COVID-19 was 29.6% (n = 261). These include drinks (34.1% (n = 100)), changes in eating habits/food (33.8% (n = 99)), physical exercise (18.8% (n = 55)), steam inhalation (9.9% (n = 29)), herbal baths (2.7% (n = 8)), and gurgle (0.7 (n = 2)). Participants who practiced any form of home-based therapy were protected from SARS-CoV-2 infection (OR = 0.28 (0.20–0.39)), severe/critical COVID-19 (OR = 0.15 (0.05–0.48)), hospital admission (OR = 0.15 (0.06–0.38)), and death (OR = 0.31 (0.07–1.38)). Analysis of the various subgroups of the home-based therapies, however, demonstrated that not all the home-based remedies were effective. Steam inhalation and herbal baths were associated with 26.6 (95% CI = 6.10–116.24) and 2.7 (95% CI = 0.49–14.78) times increased risk of infection, respectively. However, change in diet (AOR = 0.01 (0.00–0.13)) and physical exercise (AOR = 0.02 (0.00–0.26)) remained significantly associated with a reduced risk of infection. We described results of thematic content analysis regarding the common ingredients in the drinks, diets, and other home-based methods administered. Conclusion Almost a third of persons presenting for COVID-19 test were involved in some form of home-based remedy to prevent COVID-19. Steam inhalation and herbal baths increased risk of COVID-19 infection, while physical exercise and dietary changes were protective against COVID-19 infection and hospital admission. Future protocols might consider inclusion of physical activity and dietary changes based on demonstrated health gains.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

Can body awareness training improve recovery following stroke: A study to assess feasibility and preliminary efficacy

Background Impairments in body awareness are common after stroke and are associated with decreased participation and performance in everyday activities. Objectives To explore the feasibility and safety of a body awareness program after stroke, and identify the preliminary efficacy of class-based lessons compared to home-based lessons on sensation, body awareness, motor impairment and quality of life. Methods A two-armed pilot randomized controlled trial with a nested qualitative descriptive study was conducted. Individuals with a diagnosis of stroke (at least three months post injury) were randomized to either class-based face-to-face body awareness lessons or home-based individually performed body awareness lessons. Outcome measures were safety, feasibility, sensation, body awareness, motor impairment, self-efficacy and quality of life. Semi-structured interviews were used to allow greater exploration and understanding of participants’ experience of the program. Results Twenty participants were randomized, 16 participants completed the program. Feasibility was greater in the class-based group. No adverse events were detected. The class-based group led to improvement in body awareness (p = 0.002), quality of life (p = 0.002), and the arm (p = 0.025) and leg (p = 0.005) motor impairment scores. Qualitative data similarly indicated that the class-based group experienced a stronger sense of awareness, achievement and connection than the home-based group. Conclusions Body awareness training was safe, feasible and acceptable in people with stroke. Individuals in the class-based group showed greater benefit compared to those receiving home-based therapy.

The Lived Experiences of Clinical Mental Health Counseling Internship Students Providing Home-Based Therapy

The Lived Experiences of Clinical Mental Health Counseling Internship Students Providing Home-Based Therapy

Implementing Home-based Prevention Physical Therapy: A Scoping Review and Path to Launch of HOP-UP-PT.

The purpose of this study was to conduct a scoping review of the available service delivery models related to home-based fall prevention programs led by rehabilitation professionals and to describe the path to launching one such program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Topics of review included: Medicare and private billing structures available for current prevention programs and traditional rehabilitation, the Affordable Care Act and its application to reimbursement of preventive services and direct access care models, and a comparative review of CMS' Patient Driven Group Model (PDGM) home health benefit and Medicare Part B billing and reimbursement. Additionally, a path to launch one prevention-focused program, HOP-UP-PT, is described. There is emerging evidence that upstreaming fall prevention programs can help reduce falls and have money-saving downstream effects. A reimbursement model for this type of programming must be established in order ensure long-term sustainability. Although there is evidence that home-based prevention programs such as HOP-UP-PT can reduce falls and fall-risk metrics among an older adult population, there is not a clear and sustainable payment pathway, which limits proliferation of similar programs. Therefore, this preventative care model which has emerging evidence of cost savings will require reimbursement restructuring beyond what is available with existing payment models.

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial.

BackgroundPatient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning.ObjectiveThis study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP.MethodsThe study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up.ResultsBoth the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes.ConclusionsThe stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.Trial RegistrationISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203International Registered Report Identifier (IRRID)RR2-https://doi.org/10.1186/s12891-020-3174-z

Unsupervised IMU-based evaluation of at-home exercise programmes: a feasibility study

BackgroundThe benefits to be obtained from home-based physical therapy programmes are dependent on the proper execution of physiotherapy exercises during unsupervised treatment. Wearable sensors and appropriate movement-related metrics may be used to determine at-home exercise performance and compliance to a physical therapy program.MethodsA total of thirty healthy volunteers (mean age of 31 years) had their movements captured using wearable inertial measurement units (IMUs), after video recordings of five different exercises with varying levels of complexity were demonstrated to them. Participants were then given wearable sensors to enable a second unsupervised data capture at home. Movement performance between the participants’ recordings was assessed with metrics of movement smoothness, intensity, consistency and control.ResultsIn general, subjects executed all exercises similarly when recording at home and as compared with their performance in the lab. However, participants executed all movements faster compared to the physiotherapist’s demonstrations, indicating the need of a wearable system with user feedback that will set the pace of movement.ConclusionIn light of the Covid-19 pandemic and the imperative transition towards remote consultation and tele-rehabilitation, this work aims to promote new tools and methods for the assessment of adherence to home-based physical therapy programmes. The studied IMU-derived features have shown adequate sensitivity to evaluate home-based programmes in an unsupervised manner. Cost-effective wearables, such as the one presented in this study, can support therapeutic exercises that ought to be performed with appropriate speed, intensity, smoothness and range of motion.

Attitudes and use patterns for mobile technology and upper extremity home exercises in stroke survivors in the United States

Introduction The use of mobile technology (MT) in home-based occupational therapy is expected to continue growing. This study describes daily use patterns for MT and upper extremity (UE) home exercise programs (HEPs) for community-dwelling stroke survivors in the United States. Method Cross-sectional survey. Data were analyzed using descriptive statistics and bivariate comparisons. Results N = 61 (30 stroke and 31 controls). Individuals with stroke had similar levels of knowledge, skill, and use of MT compared with non-disabled age-matched adults. Stroke participants used MT more frequently for information searching, social media, and reminders compared to control participants. Stroke participants were motivated to improve UE function (93.3%) and reported a need for additional HEP training (56.7%). Perceived facilitators to improve UE use included talking to peers (73.3%), getting more information (73.3%), and talking to a therapist (63.3%). Conclusions MT may have multiple potential benefits when integrated into occupational therapy practice including supporting instrumental ADLs, facilitating social connection, and increasing adherence to UE HEPs. Future work should focus on maximizing adherence and providing performance feedback through the use of social media to promote peer support and consistent remote communication using text messaging, phone calls, or video calls to deliver information and reminders on exercises.

Feasibility of a "Salvage Regimen" Using Home-based Intravenous Meropenem Therapy With a Delamanid/Bedaquilline Containing Regimen in the Management of MDR/XDR Pediatric Tuberculosis.

The prevalence of multidrug resistant (MDR) tuberculosis (TB) with additional resistance to fluoroquinolones or second-line injectables (MDRFQ/SLI)/extensively drug-resistant TB (XDR-TB) in children is high in Mumbai. There are limited therapeutic options available in management of such children. Carbapenems, although approved for this indication, requires 2 to 3 daily injections, which are cumbersome. Bedaquilline (Bdq) and Delamanid (Dlm), the new antitubercular drugs still remain inaccessible to this subset of patients caused by conditional approvals. Hence, newer strategies to combat MDRFQ/SLI/XDR-TB needs to be explored. To study feasibility and interim outcomes of a "salvage regimen" using home-based carbapenem therapy through peripherally inserted central catheter as part of a longer (18-20 months) optimized background regimen including Dlm or Bdq or both in pediatric MDRFQ/SLI/XDR-TB patients who failed a standard MDR-TB regimen under the National Tuberculosis Elimination Programme in Mumbai, India. Retrospective descriptive analysis study. National Tuberculosis Elimination Programme medical records of all MDRFQ/SLI/XDR-TB patients enrolled at the pediatric TB clinic at BJ Wadia Hospital for Children, Mumbai who were initiated on such "salvage regimen" during the period between April 2018 and December 2020 were retrospectively studied. Treatment outcomes and adverse events were described. Of the 15 patients enrolled, mean age of the patient population was 12.53 ± 2.47 years and the female:male ratio was 13:2. Seven patients had XDR-TB while 8 patients had MDRFQ/SLI. Most common adverse event noted was dyselectrolytemia (3 patients). Catheter-related complications were reported in 5 patients and included catheter blockage, leak, and thrombosis. Sputum culture conversion was reported in all of the patients. One child mortality was reported and 2 patients were lost to follow up during study period. Home-based meropenem therapy using peripherally inserted central catheter is feasible with few adverse effects. This can be a promising strategy in the management of MDRFQ/SLI/XDR-TB when an effective oral regimen cannot be otherwise constituted and needs to be explored further.

Efficacy of balance training on postural control in patients with rotator cuff disease: a randomized controlled study.

We evaluated the efficacy of adding balance training to a physical therapy program on postural control and health-related quality of life in patients with rotator cuff disease. Forty-two participants were randomly allocated to the control and intervention groups. Both groups received physical therapy (education, stretching, supervised strength training, and home exercise program) 3 days/week for 6 weeks. The intervention group was instructed to perform balance exercises at home. The primary outcomes were the stability index, the Fourier transformation (F5 and F6), the weight distribution index, and the fall index, as assessed by the posturography during eight conditions with different combinations of standing (solid surface, pillows, and different head positions) and vision (eyes open/closed). The secondary outcomes included the Western Ontario Rotator Cuff Index to assess the health-related quality of life, the Shoulder Pain and Disability Index, and the Numeric Pain Rating Scale. The adherence to in-person and home-based therapy was high (>83%). The intervention group significantly improved the stability index, F5, and F6 parameters but each in only one condition (P < 0.05). No significant improvement was found in the conditions for the other primary outcomes and in the health-related quality of life. (P > 0.05). We conclude that adding the balance training protocol to the physical therapy program does not improve postural control and health-related quality of life in patients with rotator cuff disease.

Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2)

Background: Home-based rehabilitation exercise following Total Hip Arthroplasty (THA) shows similar outcomes compared to supervised outpatient rehabilitation exercise. Little is known about patients' experiences with home-based rehabilitation, and this study aimed to investigate how patients perceived home-based rehabilitation exercise and general physical activity after THA, focusing on facilitators and barriers. Methods: Semi-structured interviews of qualitative design were conducted with 22 patients who had undergone THA and who had performed home-based rehabilitation exercise. The study took place in a regional hospital in Denmark between January 2018 and May 2019. Data were analyzed using an interpretive thematic analysis approach, with theoretical underpinning from the concept ‘conduct of everyday life’. The study is embedded within the Pragmatic Home-Based Exercise Therapy after Total Hip Arthroplasty-Silkeborg trial (PHETHAS-1). Results: The main theme, ‘wishing to return to the well-known everyday life’, and the subtheme ‘general physical activity versus rehabilitation exercise’ were identified. Generally, participants found the home-based rehabilitation exercise boring but were motivated by the goal of returning to their well-known everyday life and performing their usual general physical activities. Participants enrolled in the PHETHAS-1 study used the enrollment as part of their motivation for doing the exercises. Both pain and the absence of pain were identified as barriers for doing home-based rehabilitation exercise. Pain could cause insecurity about possible medical complications, while the absence of pain could lead to the rehabilitation exercise being perceived as pointless. Conclusions: The overall goal of returning to the well-known everyday life served as a facilitator for undertaking home-based rehabilitation exercise after THA along with the flexibility regarding time and place for performing exercises. Boring exercises as well as both pain and no pain were identified as barriers to the performance of home-based rehabilitation exercise. Participants were motivated towards performing general physical activities which were part of their everyday life.

POS-713 PROOF OF CONCEPT FOR A POINT OF CARE AFFORDABLE DIALYSIS SYSTEM

Peritoneal dialysis (PD) is a home-based renal replacement therapy (RRT), which avoids the need for hospital-based treatment and expensive machinery and often allows patients to continue to work. As such, PD may be a favourable dialysis modality for many patients in lower-middle-income regions where the number of people treated with RRT is projected to more than double by 2030. One barrier to increasing access to PD is that current manufacture and transportation of PD fluid can be both financially and environmentally costly.

POS-712 Peritoneal Dialysis-Associated Peritonitis During Hospitalization for Unrelated Reasons

Peritoneal dialysis (PD) is a home-based renal replacement therapy. Because hospital staff are not often familiar with PD and its complications, PD patients may have an excess risk of developing PD-related peritonitis during hospital admission for unrelated reasons, and the outcome may be affected.

Metabolic Profile Correction in Patients with Obstructive Sleep Apnea Depends on the Duration of CPAP Therapy Sessions

Obstructive sleep apnea (OSA) is a common, heterogeneous chronic disease with sleep fragmentation, metabolic and cardiovascular disorders. Continuous Positive Air Pressure (CPAP) therapy is the primary treatment for patients with OSA. However, the effects of long-term CPAP therapy with night sessions &gt; 6 hours remain poorly understood. The aim of the study was to study the effects of different durations of night sessions of CPAP therapy on the “metabolic profile” of patients with severe OSA. Materials and methods. In a retrospective case-control study comparing two CPAP-therapy regimens by matching pairs from among patients with verified severe OSA (apnea-hypopnea index&gt; 30/h), arterial hypertension, obesity of I-II degrees according to the WHO classification (1997), signed informed consent, 2 groups of 18 people each were formed, comparable in age, anthropometric and somnographic indicators, using CPAP therapy 4-6 hours / night and more than 6 hours / night, respectively. Patients received CPAP therapy for a year, visits were carried out at 3, 6 and 12 months. The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. The optimal therapeutic level of CPAP therapy was titrated at home using devices for automatic selection of therapeutic pressure (PR System One REMstar Auto CPAP Machine with A-Flex (Philips Respironics, USA)) within 7 days after the diagnostic study. To assess the compliance of OSA patients at 3-6-12 months of CPAP-therapy, we used the original compliance analysis program Encore Pro v.2.14 (Philips Respironics, USA). Results. With the initial comparability of the groups, by the 3rd month of therapy, patients with CPAP &gt; 6 h/night showed a statistically significant advantage over the patients with 4-6 h CPAP-therapy in ESS, neck circumference and testosterone. By the 6th month, statistically significant differences of BMI, VAI, leptin, oral glucose tolerance test, fasting insulin, HOMA-IR, lipid metabolism (HDL, LDL, triglycerides, Apo-B) appeared. By the 12th month of therapy, the CPAP group &gt; 6 h/night had a statistically significant advantage in waist circumference, fasting blood glucose and uric acid. Differences between groups at control points persisted throughout the observation period. Conclusions. Long-term home-based CPAP therapy with sessions &gt; 6 h/night has an advantage over therapy with sessions 4-6 h/night in achieving a rapid and pronounced improvement in metabolic profile and hormonal levels in patients with severe OSA.

New Internet of Medical Things for Home-Based Treatment of Anorectal Disorders.

Home-based healthcare provides a viable and cost-effective method of delivery for resource- and labour-intensive therapies, such as rehabilitation therapies, including anorectal biofeedback. However, existing systems for home anorectal biofeedback are not able to monitor patient compliance or assess the quality of exercises performed, and as a result have yet to see wide spread clinical adoption. In this paper, we propose a new Internet of Medical Things (IoMT) system to provide home-based biofeedback therapy, facilitating remote monitoring by the physician. We discuss our user-centric design process and the proposed architecture, including a new sensing probe, mobile app, and cloud-based web application. A case study involving biofeedback training exercises was performed. Data from the IoMT was compared against the clinical standard, high-definition anorectal manometry. We demonstrated the feasibility of our proposed IoMT in providing anorectal pressure profiles equivalent to clinical manometry and its application for home-based anorectal biofeedback therapy.

Assessment of Home-based Physical Therapy in Stroke Patients

Introduction: Stroke is one of the most serious health problems of the modern society. Aim: The aim of the study was to assess the effects of 6-month home-based rehabilitation in stroke patients. Material and Methods: The study included 37 patients (35% were women and 65% were men) after ischaemic stroke. Study patients received 6-month home-based physical therapy in Kielce County (Gmina Chęciny and Gmina Łopuszno). The study used the Barthel Index, the Timed Up and Go Test and the Modified Rankin Scale. Physical therapy included kinesiotherapy methods (such as active and assisted exercises), physiotherapy methods (electrotherapy, laser therapy) and special methods (PNF and kinesiotaping). Results: The study showed significant differences in the results between the pre- and post-rehabilitation assessments. Before rehabilitation, the majority of study patients (22 people, 60%) scored between 21 and 85 points according to the Barthel Index, which suggests moderately severe disability. After rehabilitation, this number was reduced to 20 patients (54%). With respect to the Timed Up and Go Test, most study patients (25 people, 68%) both before and after rehabilitation needed 10 to 19 seconds to perform the test, indicating limited functional mobility. The degree of disability according to the Modified Rankin Scale was 4 in 23 study patients (62%) before rehabilitation and in 27 study patients (73%) after rehabilitation. A total of 8 study patients (22%) before rehabilitation had very severe disability with a result of 5 according to the Modified Rankin Scale; only 3 study patients (0.1%) did not show any improvement after rehabilitation. Conclusions: 1. Home-based physiotherapy performed over a period of 6 months had a very beneficial influence on increasing independence in stroke patients. 2. A significant gait quality improvement was seen in stroke patients. 3. The degree of disability in study patients was considerably reduced.

Towards Home-based Therapy: The Development of a Low-cost IoT-based Transcranial Direct Current Stimulation System

Transcranial direct current stimulation (tDCS), a neuromodulation technique that is painless and noninvasive, has shown promising results in assisting patients suffering from brain injuries and psychiatric conditions. Recently, there has been an increased interest in home-based therapeutic applications in various areas. This study proposes a low-cost, internet of things (IoT)-based tDCS prototype that provides the basic tDCS features with internet connectivity to enable remote monitoring of the system's usage and adherence. An IoT-enabled microcontroller was programmed with C++ to supply a specific dose of direct current between the anode and cathode electrodes for a predefined duration. Each tDCS session's information was successfully synchronized with an IoT cloud server to be remotely monitored. The accuracy of the resulting stimulation currents was close to the expected values with an acceptable error range. The proposed IoT-based tDCS system has the potential to be used as a telerehabilitation approach to enhance safety and adherence to home-based noninvasive brain stimulation techniques.

Pain and Disability of Conservatively Treated Distal Radius Fracture: A Triple-Blinded Randomized Placebo-Controlled Trial of Photobiomodulation Therapy.

Objective: Many patients with distal radius fracture (DRF) experience pain and disability after removal of the cast. The aim of this study was to investigate if photobiomodulation therapy (PBMT) applied after cast removal provides an add-on effect to a home-based exercise program in rehabilitation after DRF. Methods: In this triple-blinded placebo-controlled trial, 50 patients with conservatively treated DRF were randomized to receive either active PBMT or placebo PBMT after cast removal in addition to a home-based exercise therapy program. The outcome measures were the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaire, night pain (NP), and consumption of analgesic medication (AM) and were evaluated after cast removal at 4 (baseline), 8, 12, and 26 weeks after injury. NP and AM were also evaluated 7 weeks after injury (end of active/placebo PBMT). Results: There was a significant between-group difference in PRWHE scores in favor of active PBMT 8, 12, and 26 weeks after DRF. NP and consumption of AM were significantly lower in the active PBMT group from 7 to 26 weeks. There was a minimum clinically important improvement between the groups in favor of active PBMT in total score at 12 weeks, in pain subscore at 8, 12, and 26 weeks, and in disability subscore at 8 and 12 weeks. Conclusions: PBMT is safe and has long-term positive effect on pain and disability in DRF patients, when applied in combination with a home-based rehabilitation exercise program. Clinical Trial registration number: NCT03014024.

Reaching the third 95 using community ART delivery models.

Differentiated service delivery of HIV care, defined as an approach that simplifies and adapts HIV services to better serve the needs of people with HIV and to optimise the available resources in health systems, 1 WHOUpdated recommendations on service delivery for the treatment and care of people living with HIV. https://www.who.int/publications/i/item/9789240023581Date: 2021 Date accessed: November 24, 2021 Google Scholar is increasingly becoming important to HIV epidemic control. These models aim to provide care that is tailored to the individual and reduce strain on health systems. Various models have been used, including multimonth dispensation, home-based antiretroviral therapy (ART) delivery, and community adherence groups. 2 Huber A Pascoe S Nichols B et al. Differentiated service delivery models for HIV treatment in Malawi, South Africa, and Zambia: a landscape analysis. Glob Health Sci Pract. 2021; 9: 296-307 Crossref PubMed Scopus (1) Google Scholar In The Lancet HIV, Mohammed Limbada and colleagues 3 Limbada M Macleod D Situmbeko V et al. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trial. Lancet HIV. 2021; (published online Nov 26.)https://doi.org/10.1016/S2352-3018(21)00242-3 Summary Full Text Full Text PDF PubMed Google Scholar report findings from their cluster-randomised, non-inferiority trial comparing viral load suppression in community models of ART delivery with standard of care. In this trial, which was done in Lusaka, Zambia, participants were assigned to receive ART at a health-care facility (SoC group), home-based delivery (HBD group), or via adherence clubs (AC group). 12 month viral suppression was 99·2% (95% CI 98·4–99·8) in the AC group, 98·7% (97·5–99·6) in the HBD group, and 98·3% (96·6–99·7) in the SoC group. Both differentiated models of ART delivery were found to be non-inferior to the SoC group (p<0·0001). In addition, the authors found that access to viral load measurement and retention in the community models were better compared with facility ART delivery. These findings suggest that scale up of such models of care could be beneficial in reaching viral suppression and improved retention. Rates of viral suppression in a cohort of people with stable HIV from two community models of ART delivery versus facility-based HIV care in Lusaka, Zambia: a cluster-randomised, non-inferiority trial nested in the HPTN 071 (PopART) trialCommunity models of ART delivery were as effective as facility-based care in terms of viral suppression. Full-Text PDF Open Access