Longer Rehabilitation Research Articles

Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.
 PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.
 MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.
 RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.
 DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.
 CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.

Efficacy of stage I rehabilitation of medical workers with moderate course of interstitial lung damage associated with COVID-19

Aim of the study was to evaluate the effectiveness of early rehabilitation methods for medical workers with severe or moderate lung damage caused by a new coronavirus infection, who are in intensive care units, to improve lung ventilation, gas exchange and bronchial clearance, correct muscle weakness, increase overall physical endurance, mobility, psycho-emotional stability.Material and methods. We examined 53 COVID-19 women with moderate lung injury at stage I of rehabilitation, divided into two groups: main (n = 31, medical personnel) and control (n = 22, working outside of contact with pulmotropic risk factors, including no risk of SARS-CoV-2 infection). Early rehabilitation was carried out in the intensive care unit and in the infectious diseases hospital of City Clinical Hospital No. 2, for patients with COVID-19 rehabilitation plan was drawn up in accordance with temporary guidelines for the medical rehabilitation of a new coronavirus infection.Results and discussion. It was established, that rehabilitation in the conditions of the intensive care unit and the specialized department can significantly reduce the severity of dyspnea, anxiety and depression, positively affects the increase in exercise tolerance, and helps to reduce the activity of systemic inflammation. In patients who have industrial contact with patients with COVID-19, the effectiveness of rehabilitation measures is lower than in the comparison group.Conclusions. To increase the effectiveness of stage I of the rehabilitation of medical workers with COVID-19 and lung damage, it is necessary to conduct more intensive and longer rehabilitation than indicated in the current guidelines.

Impact of Symptomatology, Clinical and Radiological Severity of COVID-19 on Pulmonary Function Test Results and Functional Capacity during Follow-Up among Survivors.

One of the most commonly observed complications after COVID-19 is persistent pulmonary impairment. The aim of this study was to evaluate the impact of individual factors during the acute phase of COVID-19 on subsequent pulmonary function test results. The study involved 46 patients who were admitted to hospital due to respiratory failure caused by SARS-CoV-2 and who were assessed during follow-up visits at 3 and 9 months after discharge. Patients were divided into two subgroups according to the severity of respiratory failure. The severe group included patients requiring mechanical ventilation or HFNOT. The results of the study showed that a severe course of the disease was associated with a lower FVC and a higher FEV1/FVC ratio 3 months after discharge (both p < 0.05). In addition, it has been revealed that the length of hospitalization is a factor that negatively impacts the FEV1, FVC and TLC values measured at follow-up after 3 months. Furthermore, the obtained results identify the presence of cough in the acute phase of the disease as a factor having a positive impact on several PFT parameters (especially the FEV1/FVC ratio) as well as the 6MWT outcome after 3 months. The FVC improved significantly (p < 0.05) between the follow-up visits. The findings may indicate that COVID-19-induced respiratory dysfunction is usually temporary and spontaneously resolves during recovery. Recovery is slower in those who required more intensive oxygenation. The results of this study may be useful in identifying patients who require more intensive and longer rehabilitation after COVID-19.

Increasing daily duration of rehabilitation for inpatients with sporadic inclusion body myositis may contribute to improvement in activities of daily living: A nationwide database cohort study

To analyse the association between the daily duration of rehabilitation for inpatients with sporadic inclusion body myositis and improvement in activities of daily living, using a Japanese nationwide inpatient administrative claims database. Data were extracted regarding inpatients with sporadic inclusion body myositis who had undergone rehabilitation between 1 April 2018 and 31 March 2021. The mean daily duration of rehabilitation was categorized into 2 groups: > 1.0 h (longer rehabilitation) and ≤ 1.0 h (shorter rehabilitation). The main outcome was improvement in activities of daily living from admission to discharge, measured using the Barthel Index. For the main analysis, a generalized linear model was used. In total, 424 patients with sporadic inclusion body myositis met the eligibility criteria for inclusion in the study. The main analysis found a significant difference in improvement in activities of daily living between the longer rehabilitation and shorter rehabilitation groups after adjusting for confounders (risk ratio (95% confidence interval), 1.37 (1.06-1.78)). A longer daily duration of rehabilitation results in improved activities of daily living for inpatients with sporadic inclusion body myositis.

Functional recovery after first episode psychosis rehabilitation in an early intervention psychosis center in Iceland

Because of the early onset and disabling symptoms of schizophrenia spectrum disorders many individuals with these disorders are unemployed from an early age and disability pension rates are high. The aim of this study was to assess functional recovery and identify vocational predictors among young first episode psychosis patients registered in an early intervention psychosis center in Iceland in 2010-2020. The study is a retrospective cohort study based on the medical records of those who were discharged from Laugaras, the only early intervention psychosis program in Iceland after six months or longer rehabilitation in 2010-2020 (n=144). Univariate and multivariate logistic regression was used to identify vocational predictors. 75% of patients were unemployed at admission to the early intervention center but over half of the patients were employed or in school at discharge. Vocational rehabilitation was the strongest vocational predictor (OR 13.93, 95% CI 3.85-63.89). Other vocational predictors were those that reflect a disabling psychiatric disorder and social functioning before the onset of early intervention. 66% of patients had a history of cannabis use which had a negative impact on employment and education at discharge. In spite of intensive rehabilitation at an early intervention center, almost half of the patients were neither employed nor in school at discharge. The strongest vocational predictor was vocational rehabilitation which was also one of few vocational predictors that can be influenced by admission to an early intervention psychosis center. It therefore seems important to ensure that effective vocational rehabilitation is readily available at early intervention psychosis centers.

Disappointment and frustration, but long-term satisfaction: patient experiences undergoing treatment for a chronic Achilles tendon rupture\u2014a qualitative study

BackgroundDelayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4 weeks, the rupture is defined as “chronic”, and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient knowledge of patient experiences of sustaining and recovering from a chronic Achilles tendon rupture.MethodsTo evaluate patients’ experiences of suffering a chronic Achilles tendon rupture, semi-structured group interviews were conducted 4–6 years after surgical treatment using a semi-structured interview guide. The data were analyzed using qualitative content analysis described by Graneheim and Lundman.ResultsThe experiences of ten patients (65 ± 14 years, 7 males and 3 females) were summarized into four main categories: (1) “The injury”, where the patients described immediate functional impairments, following either traumatic or non-traumatic injury mechanisms that were misinterpreted by themselves or the health-care system; (2) “The diagnosis”, where the patients expressed relief in receiving the diagnosis, but also disappointment and/or frustration related to the prior misdiagnosis and delay; (3) “The treatment”, where the patients expressed high expectations, consistent satisfaction with the surgical treatment, and addressed the importance of the physical therapist having the right expertise; and (4) “The outcomes”, where the patients expressed an overall satisfaction with the long-term outcome and no obvious limitations in physical activity, although some fear of re-injury emerged.ConclusionsAn Achilles tendon rupture can occur during both major and minor trauma and be misinterpreted by both the assessing health-care professional as well as the patient themselves. Surgical treatment and postoperative rehabilitation for chronic Achilles tendon rupture results in overall patient satisfaction in terms of the long-term outcomes. We emphasize the need for increased awareness of the occurrence of Achilles tendon rupture in patients with an atypical patient history.

Эффективность методов LASIK и LASЕK в достижении прогнозированного результата при эксимерлазерной коррекции миопии и миопического астигматизма

Эксимерлазерная коррекция аномалий рефракции вошла в офтальмологическую практику как одна из самых эффективных хирургических методик, позволяющая путем изменения кривизны роговицы корригировать нарушения рефракции, в том числе при миопии и миопическом астигматизме. Как правило, такая коррекция применяется у пациентов молодого трудоспособного возраста, приобретает особую социальную значимость и требует использования наиболее точных и безопасных технологий, которые бы гарантировали достижение быстрого эффекта с минимальным периодом реабилитации. В работе были проанализированы результаты оперативного лечения 60 пациентов (103 глаза) с миопией различной степени и миопическим астигматизмом. Среди пациентов было 28 мужчин (41 %) и 32 женщины (59 %) в возрасте от 18 до 47 лет (средний возраст 25,0 ± 2,5 года). Исследуемые пациенты были распределены на две группы. Первую группу составили 29 пациентов (50 глаз), которым была выполнена коррекция зрения методом laser-assisted in situ keratomileusis (LASIK). Всем пациентам проводились стандартные офтальмологические обследования (визометрия, ауторефрактометрия, биомикроскопия, прямая офтальмоскопия, тонометрия, периметрия) и рефракционная диагностика, включавшая кератотопографию с пахиметрией (Orbscan, Bausch &amp; Lomb Inc., США), аберрометрию (Zуwave, Bausch &amp; Lomb Inc., США), оптическую когерентную томографию переднего отрезка глаза (Visante OCT, Carl Zeiss Meditec, Германия), оптическую биометрию оптическим биометром IOLMaster (Carl Zeiss Meditec, Германия). Достижение рефракционного результата оценивалось на 1-й день, через 1 месяц, через 6 месяцев и через 1 год после операции. Все оперативные вмешательства выполнялись на эксимерном лазере Allegretto WaveLight EX500 (Alcon, США). Через месяц после эксимерлазерной коррекции методом LASIK ожидаемый результат остроты зрения был достигнут на 46 глазах (80,7 %), а при применении методики laser epithelial keratomileusis (LASEK) — на 31 глазу (58,5 %), что свидетельствует о более долгом периоде реабилитации при применении методики LASEK. Через полгода прогнози­руемая острота зрения без коррекции в группе, где оперативное вмешательство выполнялось методом LASЕK, была достигнута на 46 глазах (86,8 %), в то время как в группе, где оперативное вмешательство выполнялось методом LASIK, была достигнута на 50 глазах (100 %) (разница не достоверна, р &gt; 0,05). Через 1 год после проведенной эксимерлазерной коррекции некорригированная острота зрения независимо от степени миопии составила 0,92 ± 0,04 Ед в первой группе при максимальной остроте зрения с коррекцией на этих глазах до операции — 0,86 ± 0,05 Ед (разница не достоверна, р &gt; 0,05) и 0,74 ± 0,10 Ед во второй группе при максимальных показателях корригируемой остроты зрения до операции — 0,92 ± 0,03 Ед (разница достоверна, р &lt; 0,05). Несколько большая разница достигнутых показателей максимальной некорригированной остроты зрения до операции при выполнении эксимерлазерной коррекции по методу LASЕK объясняется развитием субэпителиальной фиброплазии в 3,77 % случаев, что влияло на средние показатели конечного результата.

Depression a common condition in older hospitalized chronic patients-a transversal study

Objective: To examine the prevalence of depression among older hospitalized patients and its relation to chronic diseases. Method: A transversal study was conducted in a Regional Hospital in South Albania which included a total of 100 hospitalized chronic patients. The study lasted one month and the Patient Health Questionnaire (PHQ-9) was used for the data collection. Each participant completed a validated Albanian version of the questionnaire. Patients diagnosed with various pathologies who presented for examination but were not admitted to the hospital were excluded from the study. For the data analyses were used descriptive statistics. Results: Participants’ mean age was 55.9 ± 18.45. 46 % of patients were female and 54% were male. The results of variables assessing the depression were as follows: 24% of female patients report “Little interest or pleasure in doing things” nearly every day; 15% of female and 11% of male patients report “Feeling down, depressed, or hopeless”; 39% of female and 24% of male patients feel “tired or have little energy”. The diagnosis was significantly associated with the trend for depression, p&lt;0.05. The most frequent diagnoses diagnosis were hypertension, diabetes, and stroke respectively 23.00%, 14.00%, and 10.00%. Conclusion: Depressive symptoms occur more commonly in older hospitalized patients with chronic diseases. They require a longer rehabilitation time, which influences the day hospital stay. For improving the quality of care and life of this patient a routine depression screening and more support from nurses are recommended.

Functional recovery of patients with intracerebral haemorrhage and cerebral infarction after rehabilitation.

To investigate potential differences in functional recovery after rehabilitation between intracerebral haemorrhage and cerebral infarction, we retrospectively compared the outcomes of patients with intracerebral haemorrhage (N = 208) and cerebral infarction (N = 480) who were consecutively discharged from our convalescent rehabilitation hospital between January 2013 and December 2018. Functional improvement was estimated by functional independence effectiveness measurements (proportion of potential for improvement achieved) upon discharge. Univariate analysis showed no significant differences in functional improvement between the two groups possibly because of the demographic variations upon admission. Multiple regression analysis demonstrated that the impact and type of factors related to functional improvement (functional independence measure upon admission, age, length of hospital stay, and time to admission after onset) were similar in both groups. Nevertheless, stratified analysis revealed, compared with patients with cerebral infarction, better improvement in patients with intracerebral haemorrhage that were admitted early after onset (<20 days), which exhibited high or moderate severity upon admission (functional independence measure: 36-89), or had a long hospital stay (>129 days). The present study showed differences as well as similarities in functional recovery between two stroke subtypes and suggests that better functional improvement might be expected in patients with intracerebral haemorrhage compared with those with cerebral infarction through an earlier start of intensive rehabilitation or longer rehabilitation in the hospital even if they exhibited relatively severe impairment upon admission. The type of stroke should be taken into consideration when predicting functional recovery and planning rehabilitation management in stroke patients.

Should rehabilitation goals reflect all aspects of functioning in relation to a biopsychosocial ICF perspective?

Purpose To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective. Materials and methods A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules. Results One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 “Walking” and d570 “Looking after one’s health.” For long-term goals, d850 “Remunerative Employment” and d920 “Recreation and Leisure” were the most frequent. Conclusion The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance. Implications for rehabilitation Health professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set. The rehabilitation plan should contain goals and a description of patient’s contextual factors and both should be equally valued and combined in a description of functioning. In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.

103. Factors associated with motor, sensory, bladder and bowel function recovery after traumatic cauda equina injury (TCEI)

BACKGROUND CONTEXT Traumatic cauda equina injury (TCEI) is usually caused by spine injury at L1 or below, and can result in motor and/or sensory impairments and/or neurogenic bowel and bladder. PURPOSE This study was undertaken to examine the factors that can potentially predict motor, sensory, bowel, and bladder function to aid in prognosis and optimal management. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE The study cohort included individuals with any neurological severity of injury (American Spinal Injury Association Impairment Scale [AIS] A to D) and single neurological levels from L1 up to and including S3 at admission to acute care at an RHSCIR facility as assessed using the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). Patients were not required to have bowel and/or bladder dysfunction at admission to acute care. OUTCOME MEASURES Lower extremity motor score (LEMS), neurological level of injury, and voluntary anal contraction (VAC) were obtained from the admission and discharge International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Change in bowel and bladder function was assessed by the Functional Independence Measure (FIM), and walking status was assessed by either FIM or Spinal Cord Independence (SCIM) at admission and discharge. METHODS Multiple logistic regression analysis was used to determine which of the following variables were associated with independent walking in a predictive model: age at the time of injury, sex, neurological level of injury (categorized as 3 groups), time from injury to surgery, LOS in an acute care facility, LOS in a rehabilitation facility, and rehabilitation onset. Multiple linear regression analyses were performed to determine which of the above variables were associated with the following dependent variables: (a) change in LEMS; and (b) change in bowel and bladder scores. Stepwise variable selection methods (p-values for a variable to enter and stay in the model set to 0.30 and 0.10 respectively) were applied to all regression models. Four final models obtained included significant predictors from stepwise variable. RESULTS The cohort included 214 participants who were predominantly male (76.6%) with a mean age of 39.9±17.3 years who mostly had a fall-related injury (48.8%) at the L1 neurological level (48.1%). Multiple logistic regression analysis indicated that independent walking at discharge was associated with male sex, surgery later than 24 hours from injury, and longer length of stay (LOS) in the acute and rehabilitation facilities. Multiple linear regression analysis showed that shorter time from injury to rehabilitation facilities and longer rehabilitation LOS were significant independent predictors of improvement in bowel function. Further, older age, female sex, and longer rehabilitation LOS were associated with improvement in bladder function. Greater LEMS improvement was associated with having a spine injury at the L1 level (vs L3-S3). CONCLUSIONS Our results suggest that independent walking after TCEI is associated with sex, time of surgery, and in-patient LOS. Bowel and bladder function recovery was improved in those with longer rehabilitation LOS, and bladder function recovery was improved in females. Older age and longer time to surgery were associated with improved bladder function. This study provides key information for rehabilitation goal planning and communication with individuals and their families with regards to prognostication. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The effectiveness of vocational rehabilitation on work participation: a propensity score matched analysis using nationwide register data.

Objective Research on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. Methods Representative Finnish register data were used to examine 3199 recently employed individuals aged 30-55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008-2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). Results Vocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0-13.7], 8.9 (95% CI 7.6-10.2), and 7.2 (95% CI 6.1-8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. Conclusions Vocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.

Analysis of the effects and influence factors of primary total hip arthroplasty in the treatment of senile femoral neck fractures

Objective To analyze the effects and influence factors of primary total hip arthroplasty in the treatment of senile femoral neck fractures, and to increase the excellent rate of hip joint function recovery. Methods Retrospective analysis was applied to study the clinical data of one hundred and ten senile femoral neck fractures patients who underwent primary total hip arthroplasty in the 210th Hospital of People's Liberation Army from January 2014 to March 2016, to explore the main factors affecting postoperative recovery of hip joint function.Univariate analysis was used to analyze the factors influencing the clinical efficacy of the patients in terms of gender, age, body mass index, cause of injury, type of fracture and postoperative rehabilitation time, and Logistic regression analysis was used for multivariate analysis. Results The 110 senile femoral neck fractures patients obtained primary total hip arthroplasty, 36 cases have seen excellent hip joint function recovery, 54 good, 15 fair, and 5 poor, with an excellent rate of 81.8 % (90/110). Single factor analyses found that body mass index, preoperative concomitant diseases, surgical approach, operation time, total blood loss, postoperative analgesia, discrepancy in bilateral lower limb lengths, postoperative rehabilitation time and postoperative complications were significantly related to hip joint function recovery (χ2=8.528, 12.742, 9.912, 8.131, 10.404, 10.171, 12.406, 6.412, 10.362, P<0.05). According to the multivariate analysis, body mass index, surgical approach, total blood loss, postoperative analgesia, discrepancy in bilateral lower limb lengths, and postoperative rehabilitation time were the main factors affecting hip joint function recovery (Wald χ2=6.213, 4.543, 9.156, 6.287, 5.461, 3.698, 95%CI=1.17~6.74, 1.43~9.15, 1.03~5.82, 1.29~9.35, 0.05~0.62, 0.12~0.93, P<0.05). Conclusion Primary total hip arthroplasty may lead to excellent curative effects for elderly patients with femoral neck fracture.Smaller body mass index, minimally invasive approach, less discrepancy in bilateral lower limb lengths, postoperative analgesia, less total blood loss and longer postoperative rehabilitation time may facilitate postoperative recovery for hip joint function. Key words: Total hip Arthroplasty; Femoral Neck Fracture; Senile; Hip Joint Function; Influencing Factor

Multiple hybrid sutures of bucket handle injury on the lateral and medial meniscus of the knee

The objective of the study is to show possibilities of several combinations of suture techniques in a rare bicompartmental bucket handle injury. According to specific injury characteristics, combined suturing techniques...

The efficacy of vestibular rehabilitation in people reporting dizziness with multiple sclerosis: a systematic review and meta-analysis

Objectives Dizziness is estimated to affect 49%–75% of people with multiple sclerosis and has a significant impact on quality of life. Current management includes medications, lifestyle modifications and exercise therapies such as vestibular rehabilitation. The aim of this study was to evaluate the efficacy of vestibular rehabilitation in people reporting dizziness with multiple sclerosis. Methods Six electronic databases were searched from earliest date until October 2016. Search terms were based on three concepts; multiple sclerosis, dizziness and vestibular rehabilitation. All studies were screened independently by two authors according to pre-determined eligibility criteria. Standardised mean differences (effect sizes) and 95% CI were calculated to describe differences between groups (eg, intervention and control) and pooled in a meta-analysis where two or more studies were clinically homogeneous. The quality of evidence of the body of evidence was assessed using the GRADE approach. Results Two randomised controlled trials were identified with a total of 65 participants. In both studies, dizziness was measured using the patient reported Dizziness Handicap Inventory. Low quality evidence indicates there is no significant effect for vestibular rehabilitation on improving symptoms of dizziness compared with a control group of people with multiple sclerosis (SMD (95% CI) 0.76, (–0.19 to 1.70)). The quality of the meta-analysis was limited due to imprecision of results and risk of bias. The two studies identified only used a short period of vestibular rehabilitation (six to eight weeks). Conclusions There is low quality evidence that vestibular rehabilitation has no effect on dizziness in the multiple sclerosis population. Given the efficacy of vestibular rehabilitation in other causes of dizziness, further high quality studies with longer rehabilitation periods are required.

Early curative effects and influencing factors of primary total hip replacement for senile femoral neck fractures

Objective To investigate the early curative effects and influencing factors of primary total hip replacement for senile femoral neck fractures. Methods Between January 2013 and May 2015, 116 elderly patients with femoral neck fracture underwent primary total hip replacement. They were 34 males and 82 females, with an average age of 70.2 years. By the Garden classification, we had 23 cases of type Ⅰ, 34 cases of type Ⅱ, 38 cases of type Ⅲ, and 21 cases of type Ⅳ. Their clinical data were statistically analyzed, including gender, age, body mass index (BMI), preoperative concomitant diseases, Garden classification, injury causes, operative indexes, postoperative rehabilitation time, and postoperative complications. Single factor analyses were conducted to find out the relative factors using χ2 test before multiple factors analyses using logistic regression to screen the significant factors influencing hip functional recovery. Results The 116 patients obtained follow-ups for 12 to 23 months (mean, 18.3 months). According to the Harris hip scores for hip function at the last follow-up evaluation, 36 cases were excellent, 52 good, 20 fair, and 8 poor, giving a good to excellent rate of 75.9%. Single factor analyses found that age, BMI, operation time, surgical approach, discrepancy in bilateral lower limb lengths, postoperative analgesia, total blood loss, postoperative rehabilitation time, and postoperative complications were significantly related to hip functional recovery (P<0.05). Logistic regression analyses found that BMI, surgical approach, discrepancy in bilateral lower limb lengths, postoperative analgesia, total blood loss, and postoperative rehabilitation time were the main factors influencing hip function recovery (P<0.05). Conclusions Primary total hip replacement may lead to fine early curative effects for elderly patients with femoral neck fracture. Smaller BMI, minimally invasive approach, less discrepancy in bilateral lower limb lengths, post-operative analgesia, less total blood loss, and longer postoperative rehabilitation time may facilitate hip function recovery. Key words: Femoral neck fractures; Arthroplasty, replacement, hip; Factor analysis, statistical; Elderly

Closing Verses Opening Wedge High Tibial Osteotomy: an Evidence-Based Review.

Knee osteoarthritis is a common and disabling disorder made worse by lower extremity malalignment [3]. Medial knee arthrosis is the most common indication for high tibial osteotomy (HTO). Surgical techniques include closing wedge osteotomy, opening wedge osteotomy, dome osteotomy, progressive callus distraction, and chevron osteotomy [4, 7]. Opening and closing wedge osteotomies are the most common. While lateral closing wedge HTO was once considered standard of care, both techniques have advantages and disadvantages, and neither has proven clinical superiority [3]. Technique selection, therefore, is largely driven by surgeon preference. Jackson [4] first described the closing wedge technique in the 1960s and demonstrated improvements in patient function and pain. This technique, however, is associated with fibular osteotomy or proximal tibiofibular joint release, possible peroneal nerve injury, longer rehabilitation, and a more challenging conversion to total knee arthroplasty [1, 6, 9]. Disadvantages of medial opening wedge osteotomy, on the other hand, include the possible need for bone graft, higher rates of nonunion, and the risk of collapse [9]. Reviewed here, Duivenvoorden’s article describes the mid-term follow-up on 92 patients randomized to high tibial opening wedge or closing wedge osteotomy for varus deformity and medial compartment OA. They investigated clinical and radiographic outcomes, in addition to survival rate, at a mean of 7 years postoperatively. The specific aims of this review are to (1) interpret this study’s findings and (2) to evaluate the validity of the authors’ conclusions and recommendations.

Bilateral Transfemoral Lower Extremity Transplantation: Result at 1 Year

Upper limb transplantation has become a treatment option for upper limb amputees with good midterm results. Lower extremity transplantation has never been considered for fear of poor results. The authors present a bilateral transfemoral transplantation of lower extremities performed to a 22-year patient at 12 months of follow-up. The donor was a full HLA-mismatched female multiorgan donor. CMV status was D-/R-. A primary CMV infection coincident with an acute rejection occurred at 3 months and responded to treatment. At 1 year, the Tinel's sign is at malleolar level, there is active knee extension and active plantar flexion of the foot. The patient is walking between parallel bars. Further substantial improvements are expected with longer rehabilitation and follow-up.

464 – A prospective study of patients absconding from a psychiatric hospital in Iran

Introduction Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways. Objectives Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether. Aim To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran. Methods A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding. Results Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence. Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family. Conclusion The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.

Videogame Based Neglect Rehabilitation: A Role for Spatial Remapping and Multisensory Integration?

Post-stroke recovery is negatively affected by the presence of visuo-spatial neglect: patients with this diagnosis are more impaired in terms of independence, get lower scores on disability tests, and require longer rehabilitation period (Stone et al., 1992; Katz et al., 1999; Di Monaco et al., 2011). In light of the functional implications that characterize this pathology, it is not surprising that the development of efficient rehabilitation techniques is an important aim of the present research on neglect (Cappa, 2008). Videogames (VG) may offer an effective alternative to traditional behavioral and cognitive rehabilitation as they can integrate cognitive training with high flexibility in a daily life scenario (Rose et al., 2005; Tsirlin et al., 2009). The introduction of low cost, effective tracking devices like Sony's PlayStation Eye™ and PlayStation Move™, Nintendo's Wii Remote Plus™, and Microsoft's Kinect™ were soon recognized as a major source of inspiration for rehabilitation. However, commercially available VG, developed with the aim of amusement, do not match rehabilitation guidelines (i.e., use of meaningful functional activities, management of cognitive impairments through compensatory strategies and retraining skills (Wilson, 2008) posing the question of their applicability in this domain (Laver et al., 2011a). For this reason, ad hoc VG engines have been developed, based on these tracking devices, that do provide the monitoring and adaptation capabilities required by rehabilitation games (Pirovano et al., 2012). With a careful design of the virtual environments, rehabilitation sessions can become even more engaging for patients and increase their motivation (Thornton et al., 2005; Laver et al., 2011b; Pirovano et al., 2012). Enriched environments (Risedal et al., 2002), intense practice (Nudo et al., 2001), the possibility to tailor a rehabilitation session to patient's needs, to tune the degree of difficulty to patient's competences, and to enhance interaction during rehabilitation through an immediate feedback to the patient (Sveistrup, 2004) are the most promising features of VG approaches. It has also been suggested that a scenario including meaningful objects, rather than abstract geometric targets as stimuli, could be more motivating and encouraging for patients engaged in motor recovery programs leading to positive outcomes (Laver et al., 2011b; Sedda et al., 2013; Mainetti et al., 2013).