Improvement In Functional Ability Research Articles

Conservative therapy for lumbar disc herniation

Herniated discs are acommon cause of neurological symptoms that often lead to reduced quality of life. They affect around 20% of 45-56-year olds and, therefore, represent acorrespondingly major challenge for healthcare. Conservative therapy methods are usually used as the first treatment option; surgical interventions should only be considered in special symptom constellations. This study aims to evaluate the effectiveness of conservative therapy methods in the treatment of lumbar disc herniation and to demonstrate their influence on pain reduction and functional improvement. The current valid AWMF guideline was analyzed, and asystematic literature search was conducted to identify relevant information on the conservative treatment of herniated discs. The therapeutic approaches analyzed included physiotherapy, drug treatment, manual therapy and injection therapies. Inclusion criteria covered reviews and meta-analyses from 2019 to 2024. The analysis showed that conservative treatment methods led to asignificant reduction in pain and improvement in functional abilities in the majority of patients. Not all frequently clinical used forms of therapy have been well proven. The results of this study underline the importance of conservative treatment methods as an effective treatment option for herniated discs. In particular, the combination of different treatment approaches can improve treatment outcomes. However, further long-term studies are needed to determine the long-term effects and optimal treatment protocols.

Efficacy of Aromatherapy Against Behavioral and Psychological Disturbances in People With Dementia: A Meta-Analysis of Randomized Controlled Trials

ObjectivesBehavioral and psychological symptoms of dementia (BPSD) are common in people with dementia. Aromatherapy may reduce the frequency and severity of BPSD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of aromatherapy in relieving BPSD and improving functional ability in people with dementia. DesignSystematic review and meta-analysis. Setting and ParticipantsPatients with dementia receiving aromatherapy. MethodsA literature search was conducted using PubMed, Embase, and Cochrane Library for RCTs published before March 2024 comparing aromatherapy with control treatments in patients with dementia. ResultsThere were 15 trials involving 821 patients. Overall, significant reduction in BPSD was observed after 1 month of aromatherapy treatment. Among 15 trials, 9 reported the Cohen-Mansfield Agitation Inventory (CMAI) score, and 7 evaluated the Neuropsychiatric Inventory (NPI) score. The meta-analysis showed significant improvement in CMAI score [weighted mean difference (WMD) −6.31, 95% CI −9.52 to −3.11] and NPI score (WMD −8.07, 95% CI −13.53 to −2.61) in patients receiving 3 to 4 weeks of aromatherapy compared with the control group. Four of the 15 trials reported improvement in depressive mood and 3 trials reported no significant improvement in functional ability. Conclusions and ImplicationsIn conclusion, aromatherapy is a safe and viable nonpharmacologic treatment to improve BPSD in people with dementia and its combination with massage showed higher efficacy.

COVID-19-Associated Cerebellitis: A Case Report and Rehabilitation Outcome.

The COVID-19 pandemic has brought attention to neurological complications, including cerebellitis, characterized by inflammation of the cerebellum. Despite its rare occurrence, cerebellitis has been associated with COVID-19 infection, albeit the pathogenic mechanisms remain unclear. We present the case of a 22-year-old male with acute onset ataxia and dysarthria during a SARS-CoV-2 infection. Diagnostic evaluations ruled out other causes, confirming cerebellitis. Treatment included steroid therapy, vitamin supplementation, physiotherapy, and intravenous immunoglobulins. Rehabilitation focused on enhancing balance, coordination, and daily activities. The patient showed significant improvement in functional abilities, with increased autonomy in daily activities and improved ambulation. Despite persistent mild symptoms, the multidisciplinary rehabilitation approach led to remarkable progress. This case underscores the importance of recognizing and managing neurological complications, such as cerebellitis, in COVID-19 patients. A comprehensive approach combining medical treatment and rehabilitation is essential for optimizing outcomes. Further research is needed to elucidate the pathogenesis and optimal management strategies for such complications.

The impact of resistance training on memory, gait and oxidative stress during periestropause in rats

Aging, especially in female, is complex, involving various factors such as reproductive sensitivity, cognitive and functional decline, and an imbalance in the redox system. This study aims to assess the effectiveness of long-term resistance training as a non-pharmacological strategy to mitigate the impairment of recognition memory, hippocampal redox state, and ambulation in aging female Wistar rats during the periestropause period. Thirty Wistar rats aged 17 months, in periestropause, were distributed into non-trained (NT) and resistance training (RT; stair climbing 3 times per week for 4 months) groups. Before (17 months) and after (21 months) of the RT period, the rats underwent tests for ambulation, elevated plus maze (EPM), open field, and object recognition. Biochemical and histological analyses were conducted on the hippocampus of these animals. Analysis of the results revealed that at 21 months, females in the NT group (21Mo/NT) exhibited a decreased in length (p=0.0458) and an increased in past width (p<0.0479) compared to their measurements at 17 months. However, after 4 months of RT, the female rats aged 21 months (21Mo/RT group) experienced changes in gait components, showing an increase in length (p<0.0008) and a decrease in stride width. Regarding memory, the object recognition test indicated potential cognitive improvement in 21Mo/RT animals, with significant interaction between intervention and age across all three stages of the test (total exploration time, p=0.0001; Test 1, p=0.0003; Test 2, p=0.0014). This response was notable compared to animals in the 21Mo/NT group, which showed a decline in memory capacity (p<0.01). The data showed a significant difference in relation to the age of the animals (p<0.01). The hippocampal redox state markers showed reduced lipid oxidative (p=0.028), catalase (p=0.022), and superoxide dismutase (p=0.0067) in the RT group compared to the NT group. Hippocampal cells from the 21Mo/RT group showed increased citrate synthase enzyme activity (p<0.05) and Nissl body staining (p<0.05). The results of this study demonstrate that RT performed during the periestropause phase leads to significant improvements in functional abilities, cognitive performance, and neuroplasticity in aging female rats.

Impact of sarcopenia on outcomes following lumbar spine surgery for degenerative disease: an updated systematic review and meta-analysis.

This study aimed to consolidate the evidence regarding the prognostic influence of sarcopenia in degenerative lumbar spine surgeries. A literature search of public databases was conducted up to Nov 15, 2023 using combinations of the key words "sarcopenia" and "lumbar spine surgery". Eligible studies were those that focused on adults undergoing decompression or fusion surgery for degenerative lumbar spine diseases, and compared the outcomes between patients with and without preoperative sarcopenia. Primary outcomes were change in ODI and back and leg pain VAS pain scores. Secondary outcomes were changes in Eq.5D, JOA, SFHS-p scores, and LOS. Ultimately, nine retrospective studies with a total of 993 patients were included. Sarcopenic patients exhibited significantly worse functional improvement as assessed by ODI compared to non-sarcopenic patients (pooled standardized mean difference [pSMD] = 0.53, 95% confidence interval [CI]: 0.17-0.90). Back pain (pSMD = 0.31, 95% CI:0.15-0.47) and leg pain (pSMD = 0.21, 95% CI:0.02 - 0.39) improvement were also less in sarcopenic patients. Non-sarcopenic patients had greater improvements in Eq.5D (pSMD = 0.25) and SFHS-p (pSMD = 0.39), and shorter LOS (pSMD = 0.62). As compared to patients without sarcopenia, those with sarcopenia undergoing lumbar spine surgery for degenerative diseases have lower improvements in functional ability, quality of life, physical health, pain relief and extended hospitalization compared to those without sarcopenia.

Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review.

The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.

A survey on the short to medium-term satisfaction of neurological patients treated by functional surgery for the correction of limb deformities

Objectives Functional surgery (FS) is often used to correct congenital or acquired deformities in neurological patients. Along with functional results, short- and medium-term patient satisfaction should always be considered a key goal of surgery and rehabilitation. The aim of this study is to assess the short to medium-term satisfaction of patients who underwent FS and its correlation with perceived improvements. Methods Invitation to an anonymous online survey was sent via e-mail to all neurological adult patients or caregivers of children who underwent lower or upper limb FS over the 2018–2020 period. The survey investigated patients’ satisfaction with the surgery and the variation in pain, ADLs, level of independence, body image, self-esteem, social interaction skills, participation in social events, leisure activities and sports, and use of orthoses or walking aids. Descriptive data analysis was performed. Correlations were assessed using Kendall’s tau. Results 122 out of 324 adults and 53 out of 163 children’s caregivers filled out the questionnaire, with a response rate approaching 40%. Eighty-three percent of adult respondents and 87% of the children’s caregivers were satisfied or very satisfied in the short and medium terms and reported their expectations had been met. Satisfaction was significantly correlated (p < 0.01) with improvements in functional abilities, social participation, self-esteem, and pain reduction. Half of the adults and 40% of children stopped using their orthoses or replaced them with lighter ones. Dissatisfaction and worsened conditions were reported by <10% of the respondents. Conclusion According to patients and caregivers, FS was satisfactory in the short and medium terms, following improvements in all the ICF domains for most patients.

From injury to rehabilitation: How kinesiology taping helps patients with first metatarsophalangeal joint sprain (turf toe) in pain reduction, gait parameters and functional ability improvement. A randomized clinical trial

ObjectiveTurf toe is a common sports injury that may affect mobility and functional ability. For complete recovery, rehabilitation modalities are required to overcome these issues. This study investigated whether kinesio taping (KT) would reduce pain, improve gait performance, and enhance the functional capacity of turf toe patients undergoing physical therapy. Methodssixty patients with grade II turf toe (age; 25–30 years) assigned randomly into three treatment groups; KT applied alongside an exercise program conducted three times/week for 12 successive weeks. (KT group; n = 20), placebo taping plus exercise (Placebo group; n = 20), or exercise only (Control group; n = 20). Pain, gait parameters, and functional ability assessed using VAS, 3D gait analysis, and 6MWT respectively pre- and post-treatment. ResultsThere was a significant post-treatment decrease in VAS score in the KT group lower than the control or placebo group and a significant increase in 6MWT distance in the KT group higher than the control or placebo group (p < 0.001). Additionally, there was a significant post-treatment increase in step length, stride length, cadence and velocity of KT group higher than control and placebo group (p < 0.05). There was no significant difference in gait parameters between control and placebo groups post treatment (p > 0.05). ConclusionsThe findings of the study demonstrated that KT is a useful complementary modality to exercise in patients with turf toe, as it may result in more favorable improvements to pain, gait characteristics, and functional abilities. Further studies should be conducted to assess the long-term effects, different KT application methods, and tailored treatment protocols on turf toe.

The Effects of Two Interventions between Elastic Therapeutic Taping with Exercise and Sham Taping with Exercise on Pain Intensity, Knee Disability Reduction, Leg Strength, and Functional Ability Improvement for Gonarthrosis Patients at the Moderate Level

OBJECTIVE: To investigate the effects of elastic therapeutic taping with exercise on the pain, disability, muscle strength, and functionality of knee in patients with moderate knee osteoarthritis (OA) compared with the sham taping technique with exercise.METHODS: Eighty patients with moderate knee OA (Kellgren-Lawrence grade II-III) were randomized and separated into 2 groups, including an elastic therapeutic taping group and a sham taping group. Both groups received the same homework exercise. The assessments were performed at baseline, and 2 weeks and 12 weeks after the elastic therapeutic taping application. Pain level, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale, muscle strength, Time Up and Go and Sit-to-Stand were used for the evaluation.RESULTS: Patients that received elastic therapeutic taping and the sham taping technique with exercise demonstrated improvement in pain level, the WOMAC scale, muscle strength, Time Up and Go and Sit-to-Stand after 12 weeks of the applications, but the results showed a statistically significant difference in the outcome measurement of pain level, the WOMAC scale, and Time Up and Go between the 2 groups (p &lt; 0.01, p = 0.03 and p = 0.03 respectively).CONCLUSION: Elastic therapeutic taping with exercise can be an effective intervention for pain relief, reduced knee disability, and Time Up and Go in patients with moderate knee OA when compared with the sham taping technique with the exercise group.

Single Implant-Retained Mandibular Overdentures: A Literature Review.

The absence of teeth, known as edentulism, poses considerable obstacles in prosthodontic care and greatly affects a person's well-being. Conventional complete dentures frequently lead to problems like instability and insufficient retention, especially in the lower jaw. Fortunately, the introduction of dental implants has transformed the way we approach edentulous patients, as they now offer support and enhanced retention for removable prostheses, thus revolutionizing their treatment. While a consensus exists on using two implants for retaining mandibular overdentures, the associated cost may be prohibitive for economically disadvantaged individuals. As a solution, the concept of single implant-retained mandibular overdentures has emerged, catering to individuals with limited financial resources and complete tooth loss. This review explores the efficacy and suitability of the single implant overdenture approach, along with an overview of treatment options for edentulous patients, including traditional dentures, tooth-supported overdentures, and implant-supported overdentures. The preservation of bone, improvements in functional abilities, and psychological benefits associated with overdentures are discussed. Moreover, various classifications and prosthetic options for implant overdentures, specifically for mandibular cases, are presented. This literature review aims to provide a comprehensive understanding of possible treatment options and focus on the single implant-retained mandibular overdenture approach and its implications in prosthodontic rehabilitation for edentulous patients.

Analysis of the effectiveness of the teaching reform of traditional Chinese medicine nursing courses in colleges and universities based on the CIPP evaluation model

Abstract In Chinese medicine nursing education in higher education, using the CIPP model to evaluate the teaching reform of the curriculum is the key to improving the quality of teaching. This study analyses the effectiveness of this reform to promote the further development of nursing education. The study used qualitative and quantitative methods to collect and analyse relevant teaching data by constructing an evaluation system. The study results showed that students’ practical ability improved significantly after the teaching reform, with the most significant Improvement in functional ability, self-learning and management ability, and teamwork ability. The student satisfaction survey results showed that overall satisfaction reached 4.65 points (out of 5). Meanwhile, the teaching ability of teachers was also significantly improved, in which the scores of informatisation teaching ability and innovative teaching ability reached 8.776 and 23.03 respectively. The teaching reform based on the CIPP model effectively enhanced the teaching quality of the TCM Nursing course, strengthened students’ practical skills, improved students’ satisfaction, and improved teachers’ teaching ability.

A clinical study to evaluate the efficacy of Raktamokshana with Ghati Yantra in Gridhrasi w.s.r. to Sciatica

Gridhrasi, one among the Vatavyadhi, is characterised by Stambha, Ruk, Toda, Grahana and Spandhana. It starts from Sphik pradesha and radiates down through the Prushtabhaga of Kati, Uru, Janu, Jangha and Pada. Kandara gets afflicted by the vitiated Vata to produce the clinical features of Gridhrasi. The two Kandara, one extending distally from Paarshni to toes and other extending above from the Paarshni to the Vitapa are involved. Sciatica is defined as a radiating pain along the course of the sciatic nerve and is felt in the back, buttocks, posterior of the thigh, legs and the foot. Sciatica has been reported to occur in 1 to 10% of the population, most commonly in the age group of 25 - 45 years. Single sitting of Raktamokshana was carried out and the parameters were reviewed after 7 days, 14 days and 21 days and changes in parameter were documented. There was significant reduction in the subjective symptoms such as pain, stiffness, numbness, twitching, functional disability and improvement in functional ability. Further, there was improvement in the objective parameters such as SLR test, Lasegue Test, femoral nerve stretch test and there was increased range of movements like flexion and extension when compared to before treatment. Raktamokshana using Ghati Yantra has proven effective both clinically and statistically in relieving the symptoms thus providing promising results in Gridhrasi.

The Efficacy and Safety of a Combination of Thiocolchicoside and Etoricoxib in Low Back Pain (ESCoTEL): A Randomized Active-Controlled Trial.

Background Low back pain (LBP) is a global health concern. Management of LBP aims at pain relief facilitating improvement of functional ability. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of therapy. However, the selection of NSAIDs is challenging given the range of underlying etiologies and severity. The current study aimed to compare the efficacy and safety of two available fixed-dose combinations (FDCs), namely, a dual FDC (DFC) of etoricoxib (60 mg) and thiocolchicoside (4 mg) versus a triple FDC (TFC) of chlorzoxazone (500 mg), diclofenac (50 mg), and paracetamol (325 mg). Methodology A total of 200 eligible adult subjects aged 18-70 years with a history of LBP and muscle spasm for ≤14 days and Wong-Baker Faces Pain score >4 were enrolled after obtaining written informed consent and randomized in a 1:1 allocation ratio to be treated with either DFC or TFC for 28 days. Efficacy was assessed based on the change in score from baseline (before treatment) to day 28 on the Wong-Baker Faces Pain Scale and the Oswestry Disability Index (ODI) questionnaire, as well as the proportion of subjects who improved upon treatment. Safety was assessed based on adverse events and clinical laboratory test results. Results A significant decrease in pain intensity (p < 0.001) and significant improvement in functional ability (p < 0.001) was observed after treatment with either DFC or TFC. The decrease in Wong-Baker Faces Pain score and ODI, from baseline, was comparable between the treatment groups. However, more subjects with very severe pain at baseline showed ≥30% improvement upon treatment with DFC than with TFC (~25% versus ~12%; p = 0.172). Also, significantly more crippled subjects with very severe functional disability showed improvement in the DFC group compared to the TFC group (~26% versus ~4%; p = 0.008). No adverse events or clinically relevant laboratory test results were evident. Conclusions Both DFC and TFC were comparable in efficacy and safety for the management of recent-onset LBP. However, significantly more subjects with very severe pain or functional disability showed improvement after 28 days when treated with DFC compared to TFC.

The Effect of Contrast Bath Therapy and Knee Pad Device on Pain, Range of Motion, and Functional Disability in Patients With Osteoarthritis Knee: A Randomized Control Trial.

Background and objective A degenerative joint condition mostly affecting the weight-bearing joints is osteoarthritis (OA). The majority of the time, it involves the knee joint. Pain and stiffness are common in grade 1 and 2 OA. And that's the main reason people ask for help. Physiotherapy treatment can be helpful for symptomatic management of early OA. Along with exercises, contrast bath therapy (CBT) is a therapeutic alternative to medication to alleviate pain and stiffness in OA. Many studies have been done using the traditional water immersion CBT. However, there is a paucity of studies on contrast therapy given using a device. This study intends to find the effect of a knee pad device(KPD) on pain, range of motion, and functional disability in knee OA patients when compared with CBT. Methods About 60 patients having unilateral knee OA were selected and randomly divided into two groups: group A received CBT for 20 minutes, and group B was treated with a KPD for 20 minutes and the Otago exercise programwas given in both groups for 30 minutes. Both groups received treatment for three sessions per week for two weeks.Outcome measures used for assessment at baseline and post-treatment were visual analog scale (VAS), knee range of motion, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, and distance covered in a two-minute walk test. Results Both the groups showed significant improvement post-treatment (p < 0.05). Group B showed more significant improvement when compared with group A. The enhancement in VAS (2.39, p < 0.020), range of motion (2.11, p < 0.039), WOMAC (2.09, p < 0.04), and two-minute walk test (2.03, p < 0.046) showed improvement in functional ability. Conclusion The findings of this study showed that both groups showed improvementfollowing treatment, but that the use of a KPD in combination with strengthening and balance retraining is more efficient in reducing pain and enhancing quality of life in patients with grade 1 or 2 knee OA than conventional CBT.

Observational Study of Repeat Immunoadsorption (RIA) in Post-COVID ME/CFS Patients with Elevated ß2-Adrenergic Receptor Autoantibodies-An Interim Report.

There is increasing evidence for an autoimmune aetiology in post-infectious Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). SARS-CoV-2 has now become the main trigger for ME/CFS. We have already conducted two small proof-of-concept studies on IgG depletion by immunoadsorption (IA) in post-infectious ME/CFS, which showed efficacy in most patients. This observational study aims to evaluate the efficacy of IA in patients with post-COVID-19 ME/CFS. The primary objective was to assess the improvement in functional ability. Due to the urgency of finding therapies for post-COVID-Syndrome (PCS), we report here the interim results of the first ten patients, with seven responders defined by an increase of between 10 and 35 points in the Short-Form 36 Physical Function (SF36-PF) at week four after IA. The results of this observational study will provide the basis for patient selection for a randomised controlled trial (RCT), including sham apheresis, and for an RCT combining IA with B-cell depletion therapy. Trial registration number: NCT05629988.

Investigative and Usability Findings of the Move-D Orthotic Brace Prototype for Upper Extremity Tremors in Pediatric Patients: An Unblinded, Experimental Study

Tremors affect pediatric and adult populations, with roughly 3% of people worldwide experiencing essential tremors. Treatments include medication, deep brain stimulation, occupational/physical therapy, or adaptive equipment. This unblinded experimental pre-test–post-test study was performed (April–September 2021) at Children’s Health of Orange County, evaluating the effectiveness of Move-D, a novel orthotic brace, on pediatric tremors. Ten participants (14–19 years old) experiencing upper extremity tremors (5 essential, 2 dystonic, 1 coarse, 1 postural, and 1 unspecified) were enrolled. Participants completed a usability survey and performance was measured utilizing the Bruininks–Oseretsky Test of Motor Proficiency, second edition, with and without the brace, using one-sided t-tests of mean differences. Move-D improved age-equivalent scores for fine motor precision by 20.5 months and upper limb coordination by 15.1 months. Manual coordination percentile rankings increased by 2.9%. Manual dexterity performance was unaffected. The usability survey revealed that 7/10 participants agreed or strongly agreed that they could move their arm freely while wearing the brace, the brace reduced their tremors, and they felt comfortable wearing the brace at home. Through standardized testing and findings from the usability survey, Move-D showed an improvement of functional abilities in a pediatric population with tremors.

Multidisciplinary inpatient rehabilitation for older adults with COVID-19: a systematic review and meta-analysis of clinical and process outcomes

BackgroundOlder adults are at increased risk for disease severity and poorer prognosis following COVID-19 infection. The aim of this systematic review and meta-analysis is to explore the impact of multidisciplinary rehabilitation in the acute or post-acute hospital setting for older adults with COVID-19.MethodsThe Cochrane library, EMBASE, Cinahl and Medline (via EBSCO), PubMed, and Web of Science were systematically searched in June 2022 and a repeat search was completed in March 2023. Screening, data extraction and quality appraisal were conducted independently by two reviewers. Studies reporting outcomes for older adults following multidisciplinary rehabilitation (provided by two or more Health and Social Care Professionals) were included. Both observational and experimental study designs were included. The primary outcome was functional ability. Secondary outcomes included discharge disposition, acute hospital and rehabilitation unit length of stay, mortality, primary and secondary healthcare utilisation, and long-term effects of COVID-19.ResultsTwelve studies met the inclusion criteria, comprising a total of 570 older adults. Where reported, older adults stayed in the acute hospital for a mean of 18 days (95%CI, 13.35- 23.13 days) and in rehabilitation units for 19 days (95%CI, 15.88–21.79 days). There was a significant improvement in functional ability among older adults with COVID-19 who received multidisciplinary rehabilitation (REM, SMD = 1.46, 95% CI 0.94 to 1.98). The proportion of older adults who were discharged directly home following rehabilitation ranged from 62 to 97%. Two studies reported a 2% inpatient mortality rate of older persons during rehabilitative care. No study followed up patients after the point of discharge and no study reported on long term effects of COVID-19.ConclusionsMultidisciplinary rehabilitation may result in improved functional outcomes on discharge from rehabilitation units/centres for older adults with COVID-19. Findings also highlight the need for further research into the long-term effect of rehabilitation for older adults following COVID-19. Future research should comprehensively describe multidisciplinary rehabilitation in terms of disciplines involved and the intervention provided.

Ultrasound-guided transforaminal epidural injection with fluoroscopy confirmation for the treatment of unilateral lumbar radiculopathy: A randomized controlled non-inferiority study

BackgroundUltrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). MethodsA total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at −15 %. ResultsThe accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (−4.9 % (95 %CI: −12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn’t differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. ConclusionsUS-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

The Impact of N-acetylcysteine on Major Depression: Qualitative Observation and Mixed Methods Analysis of Participant Change during a 12-week Randomised Controlled Trial

N-acetylcysteine (NAC) is a novel therapeutic agent with multiple mechanisms of action in the central nervous system and a favourable side effect profile. Clinical evidence indicates that adjunctive NAC may reduce the severity of depressive symptoms in individuals with major depressive disorder (MDD). A 12-week randomised controlled trial of 2,000 mg/day adjunctive NAC for MDD found no significant improvement at the primary endpoint (week 12) but did see improvements at the post-discontinuation interview (week 16). Within the context of patient-centered treatment, mixed-methods qualitative analysis was also included to explore factors that may determine individual responses to adjunctive NAC treatment. These data were drawn, under blinded conditions, from clinician notes recorded in the case report form. Using the DSM-5 symptom profile for MDD as the initial framework, themes were developed and explored. Frequencies were compared between placebo and NAC groups. Per protocol analysis of individual themes across the six interviews revealed group differences in favour of NAC for overall depressive affect, optimism, relationships and reduced functional impairment. This study provides further evidence for the utility of the mixed methods approach complimenting the primary findings using traditional quantitative analyses, as well as being able to capture additional, often more subtle, evidence of individual symptom-level change that reflects improvement in functional abilities in response to NAC supplementation. The use of mixed methods to explore outcomes from psychiatric studies should be considered in future to work towards improved patient-centred care and both confirm quantitative findings and generate novel hypotheses.

Physiotherapy Modalities and Physiotherapy Modalities and its Effect on The Development of Functional Ability in Children with Cerebral Palsyits Effect on The Development of Functional Ability in Children with Cerebral Palsy

In Indonesia, currently there are various physiotherapy intervention modalities for children with special needs, especially in cerebral palsy. The Bobath concept is a holistic approach to solving the problems of individuals with movement disorders and postural control as a result of lesions in the central nervous system. The purpose of this study was to determine the effect of physiotherapy modalities on functional abilities in children with cerebral palsy. This research was an experimental type that had a control variable with a nonequivalent control group design, but in this design the experimental group and the control group were not randomly selected, functional ability measuring tool used gross motor functional movement (GMFM). All respondents received treatment 16 times (2 times per week), measured as fisrt post-test, followed by treatment 16 times (2 times per week) measured as second post-test. The first post-test (16 times) and the second post-test (32 times), these data were compared. The results of the repeated measured ANOVA test in the control group revealed that there was a significant difference in functional ability after the bobath concept treatment (p=0.060; x1=-0.714; x2=-2.714) and after the bobath concept and taping treatment (p=0.027; x1=-2.400; x2=-6.000). But, there was found not significant after the bobath concept and stretching treatment (p =0.071; x1=-0.333; x2=-3.667), and after the bobath concept and infrared treatment (p=0.126; x1=-1.000; x2=-2.500). The results of the Freadman test there was a significant difference in functional ability after the bobath concept and massage treatment (p=0.023). The conclusion, there was a significant difference in functional ability improvement after being given treatment by the bobath concept, bobath concept plus taping, and/or bobath concept plus massage.