Functional Outcome Level Research Articles

The effect of physiotherapy intervention on functional outcomes among COVID-19 patients: Clinical experimental study.

COVID-19 is a highly contagious virus that causes pneumonia, which quickly progresses to acute respiratory distress. In the case of COVID-19, physiotherapy is critical in non-invasive support management, postural changes, chest physiotherapy (CPT), and bed mobility. This study aims to look into the effects of physiotherapy intervention on functional outcome levels in COVID-19 patients in the acute stage. A total of 60 severe COVID-19 patients (54 males and 6 females) with a mean age of 50years were studied. The intervention group (n=30) had two daily physiotherapy sessions that included positioning, CPT, cardio exercises, breathing exercises, and early mobility, whereas the control group (n=30) received only standard medical care. Patients were tested twice at the baseline and discharge using peripheral oxygen saturation, respiratory rate (RR) test, dyspnea rate, two-min walk test, and spirometer scores, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The two groups improved significantly between the baseline and discharge ratings. The intervention group, on the other hand, significantly improved all outcome indicators at discharge (p-value=0.00). This study found that physiotherapy management improved oxygen saturation, RR, dyspnea, and lung function tests in COVID-19 patients except in FVC (p-value=0.402) and FEV1(p-value=0.114). Physiotherapist interventions with COVID-19 patients increase respiratory function and treatment time.

Assessments of functional outcomes and its determinants among bipolar disorder patients in Northwest Ethiopia comprehensive specialized hospitals: a multicenter hospital-based study

IntroductionBipolar disorder is a severe and chronic mental illness that could continue for a lifetime. Although it is a leading cause of disability and impairments for significant numbers of patients, the levels of functional outcomes have not been studied in Ethiopia. Therefore, this study aimed to assess the functional outcome levels and associated factors among bipolar disorder patients in Northwest Ethiopia.MethodHospital-based cross-sectional study was employed among bipolar disorder patients attending psychiatric clinics, in Northwest Ethiopia, from April to June 2021. Systematic random sampling was used to get respondents. Descriptive and inferential statistics were done. Data were entered into EpiData version 4.6.02 and exported to SPSS Version 22 for analysis. Bivariable and multivariable binary logistic regression analysis was used to identify the factors associated with functional outcome levels, and p value < 0.05 was considered significant with 95% CI.ResultOf the total 423 study participants approached, only 411 completed the questionnaire, with a response rate of 97.2%. The median (IQR) level of functional outcome was 6 (0–22) and 40% of the study subjects were impaired. Leisure time was the most normal functioning domain (92.2%), whereas cognitive (43.5%) and occupational (41.6%) domains were the most impaired domains. Unemployment (AOR (95%CI) = 3.9 (1.46–10.49), obesity (AOR (95% CI) = 6.5 (1.22–34.58), depressed and manic mood phases (AOR (95%CI) = 5.2 (2.84–9.35) and (AOR (95%CI) = 7.8 (3.31–18.34) respectively, medication non-adherence (AOR (95% CI) = 3.2 (1.71–6.05), and relapsed once or ≥ twice (AOR (95%CI) = 2.2 (1.25–3.98) and (AOR (95%CI) = 8.3 (2.73–25.30), respectively, were some of the important predictor variables that were significantly associated to the functional impairments levels.ConclusionThe median of functional outcomes levels was found in an acceptable range; however, significant numbers of bipolar patients were functionally impaired. Moreover, patients still need unrestricted interventions in the cognitive and occupational functional domains. Socio-demographic, clinical, medication, and psychosocial variables were significantly associated with functional outcomes. Bipolar patients need to be followed and managed to improve their functional outcome and all stakeholders should be involved to achieve the recommended levels.

Timed up-and-go performance is associated with objectively measured life space in patients 3 months after ischemic stroke: a cross-sectional observational study

BackgroundStroke is a common cause of mobility limitation, including a reduction in life space. Life space is defined as the spatial extent in which a person moves within a specified period of time. We aimed to analyze patients’ objective and self-reported life space and clinical stroke characteristics.MethodsMOBITEC-Stroke is a prospective observational cohort study addressing poststroke mobility. This cross-sectional analysis refers to 3-month data. Life space was assessed by a portable tracking device (7 consecutive days) and by self-report (Life-Space Assessment; LSA). We analysed the timed up-and-go (TUG) test, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and the level of functional outcome (modified Rankin Scale; mRS) in relation to participants’ objective (distance- and area-related life-space parameters) and self-reported (LSA) life space by multivariable linear regression analyses, adjusted for age, sex, and residential area.ResultsWe included 41 patients, mean age 70.7 (SD11.0) years, 29.3% female, NIHSS score 1.76 (SD1.68). We found a positive relationship between TUG performance and maximum distance from home (p = 0.006), convex hull area (i.e. area enclosing all Global Navigation Satellite System [GNSS] fixes, represented as a polygon linking the outermost points; p = 0.009), perimeter of the convex hull area (i.e. total length of the boundary of the convex hull area; p = 0.008), as well as the standard ellipse area (i.e. the two-dimensional ellipse containing approximately 63% of GNSS points; p = 0.023), in multivariable regression analyses.ConclusionThe TUG, an easily applicable bedside test, seems to be a useful indicator for patients’ life space 3 months poststroke and may be a clinically useful measure to document the motor rehabilitative process.

Preoperative Factors Influencing Functional Rehabilitation after Major Lower Limb Amputation and Validation of a Preoperative Scoring Tool

Introduction: The ability to walk with prosthesis is a major determinant of functional independence after major lower limb (MLL) amputation. The Blatchford Leicester Allman-Russell Tool (BLARt) score is a potentially valuable tool that can predict the functional outcome after MLL amputation. The study aimed to identify preoperative factors that influence functional rehabilitation after MLL amputation and validation of BLARt score. Methods: This retrospective study analyzed 71 patients referred for rehabilitation postamputation. The level of functional outcome at 6 and 12 months were recorded using Special Interest Group in Amputee Medicine grading. Preoperative factors and BLARt score were analyzed for association with functional outcome. Results: BLARt score was found to have a significant correlation with functional outcome in 6 and 12 months. BLARt showed a fair to good predictive ability with an area under the receiver operating characteristic curve of 0.713 (SE 0.61, 95% confidence intervals 0.593–0.832) and 0.705 (SE 0.061, 95% confidence intervals 0.585–0.825) for the nonfunctional outcome at 6 and 12 months, respectively. Preoperative mobility was the only significant risk factor that was associated with functional mobility (P = 0.02). Conclusion: With the validation analysis showing a fair to good predictive ability, BLARt score does serve its proposed role in risk stratification.

751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation

Abstract Introduction To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation. Method This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome. Results A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome. Conclusions Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.

Effectiveness of individualized, goal directed institutional based rehabilitation programme in children with developmental delay disorders, in a region with limited rehabilitation accessibility.

To evaluate effectiveness of individualized, goal directed rehabilitation protocol in improving functional outcomes in children with developmental delay disorders in a region with limited rehabilitation accessibility and to explore if goal setting influences changes observed in functional levels. Children (6 months to 17 years) with developmental delay, who visited as out-patients to the Department of Physical Medicine and Rehabilitation and whose care givers were willing to participate in the study, were enrolled for a period of one year. Individualized rehabilitation protocol targeting the child's specific problems with a simultaneous home programme was performed. A single group pre-post study design was used to assess the protocol's effectiveness. Goal attainment scale (GAS), Gross Motor Function Classification System (GMFCS) Level, Gross Motor Functional Measure (GMFM) and Manual Ability Classification System (MACS) were administered pre and post-intervention monthly for 3 months. Statistical analysis was done using SPSS statistics version-22. Total of 32 children participated in the study. Significant differences between pre and post scores of GAS score (Wilcoxon's signed rank test [W value] = 4.937, p-value < 0.005), GMFCS (W value: -3.435, p-value < 0.005), GMFM (W value: 4.937, p-value < 0.005) and MAC score (W value: -4.714, p-value < 0.005) were noted at 3 months. No correlation was observed between the GAS pre-post score and GMFM, GMFCS and MAC pre-post scores. An effective rehabilitation programme in children with developmental delay should be individualized and should be goal directed to achieve maximum functional improvement. Improvement in the goals set were independent of the improvement in functional outcome levels. Care-givers play a pivotal role in both individualization and goal setting for rehabilitation, especially in a region with limited rehabilitation accessibility.

Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke.

Information about the impact of functional outcome after stroke is currently missing on health-related quality of life, survival and costs. This information would be valuable for health economic evaluations and for allocation of resources in stroke health care. Data on 297 Swedish patients included in the Third International Stroke Trial were analysed including functional outcome at six months (measured by Oxford Handicap Scale), health-related quality of life up to 18 months (EQ-5D-3L) and survival up to 36 months. We used record linkage to collect data on costs up to 36 months, using national patient registers. Patients with a better functional outcome level at six months had a significantly better health-related quality of life at 18 months (p < 0.05), better long-term survival (p < 0.05) and lower costs (p < 0.001), for all time points up to 36 months. The difference in costs was mainly due to differences in days spent in hospital (p < 0.005). This study showed an association between functional outcome at six months and health-related quality of life up to 18 months, and costs up to 36 months. Functional outcome six months after stroke is an important determinant of health-related quality of life, survival and costs over 36 months. Effective interventions aimed at reducing short-term disability levels are therefore also expected to reduce the overall burden of stroke.

Staged Procedures after Failing Ring Fixators of Lower Limb? Series of 15 Cases Abstract

Background: Failure of the fixators is a challenging, especially in the presence of osteoporosis, bone defect, pin track infection and joint stiffness. This study aims at evaluating the functional outcomes of the lower limb proposed two-stage management of non-union after failed ring external fixation. Patients and Methods: 15 patients (six females) with age range 22-65 years enrolled in this study. Four had femoral fractures and eleven with tibial fractures. All were due to high-energy trauma and all were open ones (3 grade (I), 8 grade (II) and 4 grade (III)). Categorised AO classification, 5 type (A), 4 type (B) and 6 type (C). They initially treated by ring external fixators and had radiological signs of non-union. Treatment involved removal of external fixators, pin track and blood tests until no active infection. Non-union managed by refreshing the fracture ends, opening the medullary canal, packing the non-union with autogenous bone grafts then realigning the fracture properly and stabilizing it with locked plate or interlocking nail. Results: Average duration of nonunion 9.8 months. Average delay prior to osteosynthesis after removal of external fixation 15 days. All non-unions healed on an average 5.2 months. According to the Karlstrom-Olerud scores, final functional outcome score was excellent 7cases, good 5 cases, accepted 2 cases and poor one case. Conclusions: Two-stage treatment of non-union of long bone after ring fixation is an effective tool and may be a favorable option with low risk of complications and a high level of functional outcomes.

Feasibility, Technique, and Principles of Tension- and Energy-Free Laparoscopic Radical Prostatectomy with Lateral Intrafascial Dissection of the Neurovascular Bundles with the Use of a High-Definition Optical Device

RADICAL RETROPUBIC PROSTATECTOMY (RRP) with nervesparing technique is based on the finding that cavernosal nerves, which are responsible for ejaculation, continence, and erectile function, pass around the bladder neck, the proximal part of the prostate, and the seminal vesicles directly to the apex caudally. The main objectives of RRP for clinically localized prostate cancer are oncologic clearance coupled with good functional outcomes for urinary continence and erectile function.1 Open RRP is still considered the gold standard.2,3 Furthermore, as more prostate cancers are detected at a younger age, patients expect a high level of functional outcome after surgical therapy.2 All RRPs are performed with either an anterograde, retrograde, or a combined approach. In our opinion, the Huland and Studer technique is one of the best technical improvements during the last decade for RRP to preserve the neurovascular bundles (NVBs). Graefen and associates2 developed a combined anterograde-retrograde technique with a lateral approach to the NVB using a “peanut” sponge stick to push the bundle laterally and downward. With this technique, we acquired anatomic knowledge during laparoscopic and robot-assisted radical prostatectomy that we have applied in our daily practice to develop a tension-free and energy-free laparoscopic radical prostatectomy (LRP) with pure lateral intrafascial dissection of the NVB. At our institution, we have performed LRP since 1997. After completing more than 3000 procedures, we have achieved results comparable to those of RRP with the conventional technique.4 In January 2005, we introduced the robot-assisted laparoscopic prostatectomy (RALP). After an initial experience of almost 400 cases, in which we reproduced our laparoscopic technique, we developed a new technique for the dissection of the NVBs. In consideration of the technique described by Graefen and colleagues,2 combined with the anatomic knowledge that we have acquired during our laparoscopic and robotic daily practice, we developed a tension-free and energy-free RALP with pure lateral intrafascial dissection of NVBs.5 In June 2007, when we introduced in our department the new high-definition (HD) optical device from Karl Storz (Tuttlingen, Germany), we realized that we were able to identify some anatomic structures learned during our robot experience. With this experience and with the encouraging short-term functional results of the lateral tension-free and energy-free RALP,5 we wondered whether the same approach was possible using conventional laparoscopy with the HD optical device assistance. We used the HD camera, HD 16:9 monitor, and 10-mm, 0degree lens from Storz. The launch of Image 1® HD marks an important improvement over standard definition (SD) and even over first-generation HD technologies. It provides, in our opinion, excellent vision that allows an expert surgeon to better recognize the anatomy learned during the robot experience. In this way, it makes him or her able to perform a more precise dissection with conventional laparoscopic instrumentation.

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