Home Physiotherapy Research Articles

Congenital Muscular Torticollis: Study of 30 Cases

Torticollis is a rare condition caused by retraction of the sternocleidomastoid muscle (SCM), most often diagnosed in infants and children. The diagnosis is clinical, with the head and neck assuming an asymmetric spontaneous attitude with a mobility deficiency. Spontaneous evolution is generally reassuring, and it is the fibrous forms that necessitate treatment with home postures and physiotherapy. Surgical treatment is reserved for persistent torticollis after the age of 12 to 18 months. We report a retrospective study of 30 children treated for TMC over a period of 12 years, with ages ranging from 2 to 12 years. All our patients underwent surgical treatment, with a satisfactory overall result; one child was taken back for recurrence. The aim of this study is to analyze the various pathological and therapeutic aspects of this condition.

Rehabilitation after reverse total shoulder arthroplasty: a survey of members of the American Shoulder and Elbow Surgeons

Surgeons disagree about whether patients should undertake home physical therapy (HPT) or formal physical therapy (FPT) after undergoing reverse total shoulder arthroplasty (RTSA). Recent studies suggest that HPT is as effective as FPT, but surgeons who perform RTSA may believe that FPT continues to have a role. Our primary purpose was to describe the opinions and self-reported practices of surgeons who perform RTSA regarding prescribing physical therapy (PT) after surgery. We also sought to identify factors associated with prescription of FPT. A survey was distributed electronically from May to September 2023 to the 1076 members of the American Shoulder and Elbow Surgeons who were practicing in the United States at that time. Of these surgeons, 237 (22%) responded to the survey. Anonymous responses were collected via Qualtrics, including demographic data and information about the RTSA implant systems used. Descriptive statistics were used to analyze surgeon characteristics, implant types, and rehabilitation practices. Multivariate logistic regression was used to identify surgeon, procedure, and implant characteristics associated with the likelihood of FPT prescription. Because some respondents reported using multiple RTSA implant types and some did not answer implant-specific questions, a total of 225 RTSA implant types were included. Forty-six percent of respondents reported that they recommended FPT for every patient; 64% said they typically prescribe FPT. A smaller proportion of respondents who had completed a hand and upper-extremity fellowship said that they prescribed FPT compared with those who had not completed such a fellowship. However, PT prescription was not associated with any other studied characteristics, such as number of years in practice or whether the surgeon tended to repair the subscapularis. On average, respondents estimated that 92% of their patients received either FPT or HPT. Respondents also reported varying timeframes for starting PT activities after surgery. For example, 50% of respondents reported recommending passive shoulder range of motion below the shoulder level within the first postoperative week, whereas 73% recommended waiting 2-6 weeks for active shoulder range of motion below shoulder level. Most surveyed surgeons prescribe FPT and/or HPT after primary RTSA, with a slight preference for FPT. Surgical factors did not influence rehabilitation preferences. Further randomized studies to investigate the impact of PT on clinical outcomes of RTSA are needed.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.

The effect of a six-week home physiotherapy program on symptoms and activities of daily living in post-COVID-19 patients following hospital discharge

Introduction: Patients following the acute stage of Severe Acute Respiratory Syndrome Coronavirus 2 were shown to present with persisting symptoms including fatigue, dyspnea, joint pain, and chest pain. The aim of this study was to investigate the effect of a 6-week home physiotherapy program on the psychological and physical symptoms, as well as the physical abilities to perform activities of daily living in post-COVID-19 patients. Methods: The subjects were 39 adult patients who had been diagnosed with COVID-19 and had been hospitalized at the University Clinical Center of Kosovo. Patients initially underwent a physiotherapy assessment 2-3 weeks after discharge from the hospital, including sociodemographic data, psychological and physical symptoms, and functional performance in daily activities using the Patient-Specific Functional Scale (PSFS). Based on their functional capacity, the patients received two types of brochures for a home physiotherapy program that was carried out over the next 6 weeks. Upon the completion of the physiotherapy program, 23 patients reported for the second physiotherapy assessment. The Mann–Whitney Wilcoxon test was used for comparison of the variables obtained during the first and second assessments. Results: Pre–post analysis showed that the symptoms including excessive fatigue, difficulty breathing, and insomnia were significantly less present following the home physiotherapy program (p = 0.005; p = 0.008; p = 0.034). On the PSFS scale, the mean score increased from 5.2 (2.1) to 7.8 (0.5) for stair climbing, from 5.5 (1.8) to 8.8 (1.6) for walking longer distances, and from 3.7 (3.2) to 4.0 (5.6) for running. Conclusion: Although limited by the absence of a control group, the findings from this study indicate that home physiotherapy intervention can be feasible and effective in enhancing psychological and physical symptoms, as well as activities of daily living in post-COVID-19 patients following hospitalization.

Genetic influence on treatment outcomes in patients with pain-related temporomandibular disorders.

Single nucleotide polymorphisms (SNPs) may influence pain susceptibility and impact treatment response in pain-related temporomandibular disorders (TMDp). Explore the role of COMT (rs4646310, rs6269, rs4818, rs4680) and OPRM1 (rs1799971) genotypes in regulating treatment response. Sixty TMDp patients (55 females and 5 males), diagnosed with the Diagnostic Criteria for TMD (DC/TMD), underwent standardised treatment (information and education, home physical therapy, occlusal splint) for 6 months. Treatment outcomes included: pain intensity, pain-free mouth opening, jaw functional limitation, depression, and anxiety. Genotyping for COMT and OPRM1 SNPs was performed using DNA from buccal mucosa swabs and TaqMan assays. Statistical analysis was carried out to compare the changes in treatment outcomes and the influence of genotypes on treatment response. Significantly less pain reduction was observed in minor allele carriers of rs4646310, and rs4680 compared to dominant homozygous (p < .025). Minor allele carriers of rs1799971 and rs4646310 demonstrated worsening in pain-free mouth opening while dominant homozygous exhibited improvement (p < .025). Significantly less anxiety reduction was observed in minor allele carriers of rs4646310 compared to dominant homozygous (p = .003). Of the all variables assessed in the regression model, carrying a minor allele of rs1799971 predicted a poorer treatment response considering pain-free mouth opening while carrying a minor allele of rs4646310 predicted less pain and less anxiety reduction. Our findings indicate that certain SNP variants of the COMT and OPRM1 genes were associated with poorer treatment response and may therefore play a significant role in the classification of TMDp patients. Also, assessment of patient genotype could potentially aid in predicting treatment response.

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

BackgroundEarly discharge of frail older adults from post-acute care service may result in individuals’ reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home.MethodsA quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient’s Global Impression of Change (PGICS) was used to determine changes in participants’ perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults.ResultsTwenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs.ConclusionFindings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients’ global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program.Clinical trial registrationRetrospectively registered NCT05915156 (22/06/2023).

Physical Therapy Utilization After Single-level Posterior Lumbar Fusion.

Retrospective cohort study. Characterize physical therapy (PT) utilization following single-level posterior lumbar fusion (PLF). PLF is a common procedure that is increasing in frequency. After such surgeries, PT may be considered to facilitate mobilization and return to activities. However, the usage of such therapy has not been well-characterized in the literature. Patients undergoing single-level PLF were identified from the 2010 to 2021 PearlDiver administrative database. These patients were stratified based on usage of therapy, home versus outpatient therapy, and timing of therapy within the year after surgery. To determine predictors of therapy, patient characteristics were determined and multivariable regressions were performed. A total of 213,240 patients undergoing single-level PLF were identified, of which therapy was done in the year after surgery for 63,231 (29.0%, of which home therapy accounted for 16.5% of therapy visits). Of those who utilized PT, the average number of visits was 10.6±10.6. Home therapy peaked within the first month after surgery and outpatient therapy peaked at month two. Factors associated with any PT following PLF in decreasing odds ratio (OR) were having commercial insurance (OR: 1.68), being from the Northeast (OR: 1.41), age (OR: 1.13 for 70+ of age) female sex (OR: 1.09), and ECI (OR: 1.04 per point) ( P <0.001 for all). Of those who received therapy, factors associated with home PT utilization were being from the Northeast (OR: 2.55), age (OR: 1.91 for 70+ of age), Medicaid insurance (OR: 1.48), female sex (OR: 1.39), and interbody fusion (OR:1.07) ( P <0.001 for all). After single-level PLF, the minority of patients received home or outpatient PT. Of those who did, there was significant variation in the number of visits, with nonmedical factors such as insurance plan and geographic region being strongly associated suggesting room for more consistent practice patterns. Level 3.

Frontloading Home Physical Therapy Visits for Patients With Heart Failure: A Multi-center Randomized Controlled Trial.

Frontloading home care visits has been found to be effective in the nursing profession but has not been investigated in physical therapy (PT) practice. This study aimed to examine the impact of frontloading home PT visits on function in persons with heart failure (HF). This was a prospective multi-center randomized controlled trial with blinded raters. A total of 82 ambulatory patients with a primary diagnosis of HF discharged from an acute care facility to home care participated in the study. Subjects were randomly allocated to an experimental frontloaded group (FLG) or control group (CG) for 4 weeks. FLG visit frequencies were five sessions per week for 2 weeks, and three sessions per week for 2 weeks. The CG received two sessions per week for 4 weeks. Functional measures including the 2-minute step test (2MST), 2-minute walk test (2MWT), gait speed (GS), Timed Up and Go (TUG), and 30-second chair rise test (30-CRT) were collected at the onset of care, at the end of 2 weeks and 4 weeks. The groups were statistically similar at baseline for all measures. All subjects significantly improved scores in all functional measures over time, within-subject main effect (p < .01). Significant between-subject effects were noted for 30-CRT (p = .04). Interaction effects were noted for GS (p = .03) and TUG test (p = .02). This is the first study to report meaningful improvements in function in individuals with HF. Significant treatment effect differences between the FLG and CG were found for GS, TUG, and 30-CRT. Future studies should examine the use of a standardized intervention to validate the effectiveness of frontloading home visits on quality of life and readmission rates.

Patients’, physiotherapists’ and other stakeholders’ experiences and perceptions about supported home physiotherapy for people with musculoskeletal conditions: a qualitative study

ObjectivesExercise, support and advice are the key treatment strategies of musculoskeletal problems. The aims of this study were to determine patients’, physiotherapists’, and other stakeholders’ perspectives about supported home physiotherapy for the management of musculoskeletal problems and to identify the barriers and facilitators to rolling out this model of physiotherapy service delivery. MethodsThis study was conducted as part of a process evaluation run alongside a large trial designed to determine whether supported home physiotherapy is as good or better than a course of in-person physiotherapy. Forty interviews were conducted with 20 trial participants, 15 physiotherapists, and 5 other stakeholders. The interviews were semi-structured and based on interview guides. Each interview was transcribed and a three-tiered coding tree was developed. ResultsSix key themes were identified. Supported home physiotherapy (i) is convenient for some patients, (ii) does not always align with patients’ and therapists’ expectations about treatment (iii) is suitable for some but not all, (iv) can reduce personal connection and accountability, (v) has implications for physiotherapists’ workloads, and (vi) has barriers and facilitators to future implementation. ConclusionsFindings suggest that patients are far more accepting of supported home physiotherapy than physiotherapists assume. This model of service delivery could be rolled out to improve access to physiotherapy and to provide a convenient and effective way of delivering physiotherapy to some patients with musculoskeletal conditions if our trial results indicate that supported home physiotherapy is as good or better than in-person physiotherapy. Clinical trial registry numberACTRN12619000065190 Contributions of this Paper•The findings from this study suggest that supported home physiotherapy is likely to be an acceptable model of service delivery for some musculoskeletal conditions.•The most notable and perhaps hardest barriers to overcome will be patients’ beliefs about the importance of hands-on therapy, and physiotherapists’ beliefs that patients will accept nothing less.•Time will tell whether the recent COVID-19 experience will have a lasting impact on the widespread acceptance of supported home physiotherapy.

Comparison the Effect of Rehabilitation at Home and Outpatient Physiotherapy after Total Knee Arthroplasty Surgery on Quality of Life and Knee Function: A Clinical Trial Study.

Primary total knee arthroplasty (TKA) is an effective procedure to better function and relief the pain in advanced osteoarthritis patients. This study aimed to evaluate the effectiveness and safety of outpatient clinic-based setting of physiotherapy versus home-based rehabilitation (HBR) for functional recovery immediately after primary TKA procedure. This randomized clinical trial study was conducted on patients underwent TKA in 2021-2022. Participants were randomly allocated to either "usual care" or a "home-based rehabilitation" in a 1:1 ratio. The primary outcome measurement of this study was the Knee Society Score (KSS). The secondary outcome was patient quality of life using the 36-item Short Form Survey Instrument (SF-36). Data were entered into the SPSS software 25 and analyzed. In this study, 80 patients who underwent TKA in equal proportion in two outpatient physiotherapy (36 women; average age 64.37 ± 5.12 years) and home rehabilitation (33 women; average age 62.4 ± 4.87 years) groups were examined. The findings our study showed that after the intervention (3 and 5 months after the operation), there was no significant difference between the two groups in terms of the quality of life (total score) (P > 0.05). KSS had no significant difference between the two groups (P > 0.05). This randomized controlled trial found no significant differences in the outcomes of rehabilitation using either a HBR or a traditional outpatient physiotherapy model.

Referral of community-dwelling older adults from eight emergency departments in Canada: A secondary analysis of cross-sectional data from the interRAI multinational emergency department (ED) cohort study

Background: Emergency Department (ED) overcrowding, unnecessary hospitalization, and alternate level of care has been identified as a major issue in Canada and around the world. This problem especially impacts older adult populations, who are at elevated risk of functional decline and adverse events in hospital-centric systems. This study uses data from the interRAI ED Contact Assessment (ED-CA)[1], a comprehensive geriatric assessment used in the ED, to improve our understanding of ED systems of referral to community resources.&#x0D; Target Audience: ED staff in clinical and leadership positions interested in better understanding community referral processes to improve care for community-dwelling older adults.&#x0D; Methods: This study is a secondary analysis of cross-sectional Canadian data from a cohort study of elderly ED patients. The cohort of community-dwelling patients aged 65 and older presented to the ED between April 2017 and July 2018. They were screened and recruited in 10 EDs across Ontario, Quebec, and Newfoundland. The data were analyzed using frequency and logistic regression analyses, then the results were interpreted in collaboration with two geriatricians and one physiotherapist.&#x0D; What was done: This study explored referral patterns and identified predictors of referral from the ED to five different community health services (occupational therapy, physiotherapy, home care, social work, and/or specialized geriatric services) for supporting community-dwelling older adults. &#x0D; Results: We found that the sample (n=1055) was frail, with high needs and a high risk of ED revisit and institutionalization. Over half of the sample was referred to home care, occupational therapy, and/or physiotherapy, while only 16% were referred to specialized geriatric services. Most patients received multiple referrals from the ED. Province was the most impactful predictor for referral to occupational therapy or physiotherapy (OR for Ontario vs. Quebec=62.12, 95% CI [19.04, 202.70]) and home care (OR for Ontario vs. Quebec=12.09, 95% CI [5.81, 25.17]), while having an unstable condition was the most impactful predictor for social work referral (OR=5.51, 95% CI [3.78, 8.02]) and weight loss was the most impactful predictor for specialized geriatric service referral (OR=8.13, 95% CI [5.49, 12.04]). Other notable predictors included having overwhelmed family members, self-rated health, and having had a fall in the last 90 days.&#x0D; Key Learnings: Occupational therapy, physiotherapy, home care, social work, and specialized geriatric services are distinct services, specialized in addressing a specific set of care needs. We learned that specialized geriatric services are underutilized and may be poorly understood.&#x0D; Next Steps: To improve the quality of ED care, we have provided recommendations for restructuring care processes to promote shifts in clinical culture, evidence-informed decision-making, and proactive referral to community health services.&#x0D;

Abstract 107: Endovascular Therapy for Tandem Vertebral and Basilar Artery Occlusion in a Patient with Low NIHSS

Introduction Basilar artery occlusion (BAO) is a devastating minority stroke subtype with variable clinical presentations and high mortality.1,2 The National Institute of Health Stroke Scale (NIHSS) cutoff for poor outcomes is lower in BAO compared to anterior circulation large vessel occlusions (LVO) due to the scale’s weighted scoring towards cortical signs.3,4 To bridge this gap, Alemseged et.al created the underutilized posterior circulation (PC) NIHSS as an improved stroke assessment tool in PC LVO to better identify endovascular therapy (EVT) candidates. 5 Current randomized trials point to mixed evidence regarding EVT for BAO; although recent studies such as Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION)6 and Basilar Artery Occlusion Chinese Endovascular Trial (BAOCHE)7 suggest positive results of EVT within 24hrs. Smaller retrospective subgroup analyses demonstrated EVT for BAO with low NIHSS has good clinical outcome of modified Rankin Scale (mRS) 0‐2 at 3 months in 60‐70% of patients4,8. We present a case of tandem vertebrobasilar artery occlusion in a patient with subacute symptoms and low NIHSS treated with mechanical thrombectomy. Methods '‐ Results 41‐year‐old male with past medical history of hypertension, insulin dependent diabetes and active smoking presented with worsening vertigo, nausea and vomiting for 3 weeks with progression to right sided headache and syncope. EMS noted right facial weakness prompting transport to nearest primary stroke center where CT head non‐contrast showed right cerebellar infarct and CT angiogram (CTA) head and neck showed right vertebral artery occlusion with basilar extension. Intravenous thrombolytic (IVT) was deferred due to unclear last known well. He was treated with aspirin 324mg and transferred to our tertiary stroke center. Arrival NIHSS was 1 for right upper extremity ataxia. Premorbid mRS was 0. Repeat CTA redemonstrated right vertebrobasilar artery tandem occlusion. CT perfusion was without mismatch. Patient underwent emergent mechanical thrombectomy with ADAPT to TICI3 revascularization with future plan for possible angioplasty and stenting of R vertebral stenosis. Subsequently admitted to neurocritical care unit and treated with dual antiplatelet therapy. Initially maintained on aspirin and Cangrelor infusion, then transitioned to aspirin and Plavix without hemorrhagic conversion. Diffusion weighted MRI brain showed right cerebellar and right pontine infarcts. Hospital course was complicated by severe intractable hiccups due to area postrema syndrome; ultimately resolved with baclofen and gabapentin after extensive unsuccessful medication trails. NIHSS remained 1 for ataxia throughout admission, although exam also revealed mild unsteady gait requiring home physical therapy and a walker on discharge. Post‐stroke mRS was 1 on discharge; 3‐month mRS is pending. Conclusion Evidence regarding EVT for low NIHSS BAO remains varied with some studies showing superior benefit with IVT alone9 while others suggest improved outcomes with EVT in mild to moderate deficits.4,8 One prospective study particularly revealed better outcomes in EVT for BAO due to tandem occlusions similar to this case.10 Given the potential devastating sequalae of BAO and limited overall treatment options, EVT should remain a strong contender for treatment of PC LVO, especially in patients with milder neurologic deficits or tandem occlusions. Additionally, heightened use of PC‐NIHSS may better prognosticate candidates for EVT.

Enhanced Recovery After Surgery (ERAS) Protocol in Geriatric Hip Fractures: An Observational Study.

Geriatric hip fractures are the new global pandemic. It is predicted to reach 7.3-21.3 million cases worldwide by 2050. Even with optimal care, geriatric patients suffer a higher morbidity and mortality rate when compared with the general populationand often demand expensive hospital aftercare. This study aims to assess the implications of the successful adoption of the enhanced recovery after surgery (ERAS) protocol in the management of geriatric hip fractures in an Indian facility. This is a retrospective study conducted in a tertiary care hospital in India and reported following REporting of studies Conducted using the Observational Routinely collected health Data (RECORD) guidelines.We included all geriatric patients over 60 years of age who were admitted with hip fractures for surgical management between January 2021 and January 2023. The individual perioperative components of the ERAS protocol focus on key areas such as preoperative nutritional support, effective multimodal analgesia with optimal pain control, fluid management, and early postoperative mobilization. Thirty-eight geriatric patients with a mean age of 77.5 (± 9.6) years were included for analysis. Twenty-three patients sustained intertrochanteric fractures and underwent fixation with proximal femur nailing and the remaining had 15 sustained neck or femur fractures of which 11 underwent hemiarthroplasty surgery and the remaining four underwent a total hip replacement. The mean time to surgery was 2 (± 0.2) days. Eighty-two percent (n=31) of the patients were mobilized with a walking frame within a day after surgery and were followed up after discharge with home physiotherapy. The mean time to ambulation was 2 (± 0.62) days. The mean length of stay was 4 (± 1.6) days. We had a 30-day readmission rate of 5.2% (n=2) and a 30-day mortality rate of 5.2% (n=2). The one-year mortality rate was 13% (n=5). Management of geriatric hip fractures requires exceptional interdisciplinary coordination and carefully planned strategies to optimize patient care.With the implementation of the ERAS protocol, we could perceive clinical benefits in terms of early recovery and short length of hospital stay in patients with hip fractures. Further comparative studies are required, which can determine the relative importance of individual measures in the ERAS protocol and understand their longer-term outcomes in hip fracture surgeries.

Methodological considerations in PISCES 3: a randomized, placebo-controlled study of intracerebral stem cells in subjects with disability following an ischemic stroke

Background and hypothesisAt present, there are no medical interventions proven to improve functional recovery in patients with subacute stroke. We hypothesize that the intraparenchymal administration of CTX0E03, a conditionally immortalized neural stem cell line, linked with a standardized rehabilitation therapy regimen for the upper limb, would improve functional outcomes in patients 6–12 months after an index ischemic stroke.Study designPISCES III was designed as a multicenter prospective, sham-controlled, outcome-blinded randomized clinical trial. Eligibility required a qualifying ischemic stroke 6–12 months prior to surgical intervention. Patients must be between 35 and 75 years of age and have residual moderate or moderately severe disability (mRS 3 or 4), with the preservation of some residual upper limb movement. All patients received a standardized regimen of home physical therapy following the intervention.Study outcomesThe primary outcome measure is improvement in the modified Rankin Scale (mRS) of disability at 6 months post treatment. Secondary outcomes include assessment of activities of daily living (Barthel Index), functional mobility (Timed Up and Go; Fugl Meyer Assessment), neurological impairment (NIHSS), upper limb function (Chedoke Arm and Hand Inventory), as well as patient related quality of life and global rating scales.DiscussionPISCES III was designed as a randomized trial directly comparing the effects of intraparenchymal injection of a conditional stem cell line vs. sham procedure in patients with subacute stroke. This is one of the first studies of this type to include a standardized minimum rehabilitation protocol. As there are a limited number of studies evaluating invasive stem cell administration in the chronic setting of CNS injury, study design considerations are discussed.

Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub® platform

Purpose After a total knee arthroplasty (TKA), ensuring rehabilitation is continued at home is essential for a successful recovery. The aim of this randomized clinical trial (NCT04155957) was to demonstrate the safety and efficacy of an interactive telerehabilitation system (ReHub®) to guide and provide feedback during exercise in the postoperative period of a fast-track TKA program. Methods Fifty-two patients who underwent TKA were randomized to intervention (N = 26) or control (N = 26). Upon discharge, they followed a 4-week plan of 5 daily exercises and up to 10 physiotherapy home visits. The intervention group performed exercises with ReHub® autonomously, control did not use any auxiliary device. Data were collected 1) on the day of discharge, 2) after 2 weeks and 3) after 4 weeks. Results Telerehabilitation patients showed higher adherence to exercise (p = 0.002) and greater quadriceps strength (p = 0.028). No significant differences between groups were found in other outcomes. Only 1 adverse event was linked to ReHub®. Patients gave the platform high System Usability Scale scores (83/100). Conclusion Interactive telerehabilitation with ReHub® during a post-TKA exercise program is effective, safe, and well-received by patients. It provides real-time performance feedback and ensures communication. Quadriceps strength and adherence to the exercise plan are improved with ReHub®.

Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery

Objectives: Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT. Methods: A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago). Results: A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1). Conclusions: There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.

Effectiveness of using a chatbot to promote adherence to home physiotherapy after total knee replacement, rationale and design of a randomized clinical trial

BackgroundRehabilitation is essential to optimize outcomes after surgical procedures in musculoskeletal disorders. However, adherence to rehabilitation continues to be an important barrier, since compliance with the programs is not always as desired, which may have a negative impact on clinical results.MethodsRandomized controlled trial aimed at to determining the effectiveness of using a virtual assistant (i.e., chatbot) to promote adherence to home rehabilitation. Overall, seventy patients under 75, undergoing total knee replacement, who have a personal smartphone and are familiar with its use, will be assigned into the control (standard care) or the experimental (standard care plus virtual assistant) group. Adherence (primary outcome) will be assessed three months after surgery. The WOMAC questionnaire, knee pain and system usability scale will be also outcomes of interest at three months and one year. Overall, an analysis of variance will look for possible time, group and time*group interactions.DiscussionThe expected result is to determine whether the use of a chatbot that interacts with the patient can increase adherence to post-surgical home physiotherapy, and result in better clinical results (functional and pain) than standard care.Trial registrationclinicaltrials.gov id. NCT05363137

Homecare Strategies For Parkinson's Diseass

Parkinson's disease is also called 'The shaking palsy'. It is a disease of movement disorder, it has non motor features such as cognitive impairment, autonomic dysfunction, disorder of sleep, depression and hyposmia are part of disease. There is not complete cure on this in with the help of medicine, with the help of physiotherapy treatment is also important in Parkinson's disease. With physiotherapy home exercises are important to maximize functional ability and minimize secondary complications.

The Relationship Between Family Involvement in Physiotherapy Home Programs and Activity Daily Living in Post-stroke Patients

The inability to carry out daily activities is one of the challenges that stroke patients face due to weakness in their extremities. It leads to a decrease in mobility function, which prevents the fulfilment of activity. To improve their functional ability, patients undergo physiotherapy treatment. However, there is limited time for patients to exercise at the hospital. Yet, doing exercise is vital for post-stroke patients. Therefore, home programs are crucial for stroke patient rehabilitation. Family support is necessary to ensure that patients do their home program. It could increase enthusiasm and motivate patients to be consistent in their treatment, especially in their homes. An analytic observational study with a cross-sectional design was used to see the relationship between family involvement in physiotherapy home programs and activity daily living (ADL) in poststroke patients. The sampling technique used was purposive sampling with inclusion and exclusion criteria. Questionnaires were used to assess family involvement in the Physiotherapy home program, and the Index Barthel was used to measure the ADL of stroke patients. Spearman Test was used to examine the relationship between both variables. All statistical analyses were performed using SPSS. Normality tests showed the failure of the number of rearing data (p&lt;0.05). Spearman test revealed that both groups had a significant relationship (p=0.000). There is a relationship between family involvement in the Physiotherapy home program and ADL in post-stroke patients.&#x0D; Keywords: stroke, physiotherapy, relationship, activity daily living, home program

The Potential for Effect of a Six-Week Training Program for Gait Aid Use in Older People with Dementia with Unsteadiness of Gait: A Pilot Study

This study examined the potential for effect of a six-week gait aid training program for people with dementia on spatiotemporal gait outcomes, perception of use, and falls with gait aid use. The program utilised four 30-min physiotherapy home visits, scheduled at weeks 1/2/3/6, and was enhanced by carer-supervised practice. Falls and the physiotherapist's clinical judgement of participants achieving safe gait aid use during and after the program were described. Perception ratings at each visit were measured using Likert scales which, along with the spatiotemporal outcomes using the gait aid (Time-Up-and-Go-Test, 4-m-walk-test, Figure-of-8-Walk-Test with/without a cognitive task) at weeks 1 and 6, and at weeks 6 and 12 (6-week post-program), were examined with ordinal logistic regression analyses. Twenty-four community-dwelling older people with dementia and their carers participated. Twenty-one (87.5%) older people achieved safe gait aid use. Twenty falls occurred, and only one faller was using their gait aid when they fell. Walking speed, step length, and cadence significantly improved when walking with the gait aid at week 6 compared with week 1. No significant improvements in spatiotemporal outcomes were retained at week 12. Physiotherapists were more likely to agree that gait aid use had improved walking safety among older people with dementia with subsequent training visits. Larger studies of the gait aid training program are needed for this clinical group.