Multimodal Rehabilitation Program Research Articles

Addition of a Sagittal Cervical Posture Corrective Orthotic Device to a Multimodal Rehabilitation Program Improves Short- and Long-Term Outcomes in Patients With Discogenic Cervical Radiculopathy

ObjectiveTo investigate the immediate and 1-year effects of a multimodal program, with cervical lordosis and anterior head translation (AHT) rehabilitation, on the intensity of pain, disability, and peripheral and central nervous system function in patients with discogenic cervical radiculopathy (CR). DesignA randomized controlled trial with 1-year and 10-week follow-up. SettingUniversity research laboratory. ParticipantsPatients (N=60; 27 men) with chronic discogenic CR, a defined hypolordotic cervical spine, and AHT posture were randomly assigned to a control group (n=30; mean age, 43.9±6.2y) or an intervention group (n=30; mean age, 41.5±3.7y). InterventionsBoth groups received the multimodal program; in addition, the intervention group received the Denneroll cervical traction device. Main Outcome MeasuresAHT distance, cervical lordosis, arm pain intensity, neck pain intensity, and disability (Neck Disability Index [NDI]), dermatomal somatosensory evoked potentials (DSSEPs), and central somatosensory conduction time (N13–N20). Measures were assessed at 3 time intervals: baseline, 10 weeks, and 1-year follow-up. ResultsAfter 10 weeks of treatment, between-group analysis showed equal improvement in arm pain intensity (P=.40), neck pain intensity (P=.60), and latency of DSSEPs (P=.60) in both intervention and control groups. However, also at 10 weeks, there were significant differences between groups, favoring the intervention group for cervical lordosis (P<.0005), AHT distance (P<.0005), amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), and NDI (P<.0005). Although at 1-year follow-up, between-group analysis identified a regression back to baseline values for the control group. Thus, all variables were significantly different, favoring the intervention group at 1-year follow-up: cervical lordosis (P<.0005), AHT distance (P<.0005), latency and amplitude of DSSEPs (P<.0005), N13 to N20 conduction time (P<.0005), intensity of neck and arm pain, and NDI (P<.0005). ConclusionsThe addition of the Denneroll cervical orthotic device to a multimodal program positively affected discogenic CR outcomes at long-term follow-up. We speculate that improved cervical lordosis and reduced AHT contributed to our findings.

Study protocol for a multicentre randomized controlled trial on effectiveness of an outpatient multimodal rehabilitation program for adolescents with chronic musculoskeletal pain (2B Active).

BackgroundChronic musculoskeletal pain (CMP) in adolescents can influence functioning and well-being, and has negative consequences for families and society as well. According to the Fear Avoidance Model, fear of movement and pain catastrophizing can influence the occurrence and maintenance of chronic pain complaints and functional disability. Primary objective is to evaluate the effectiveness of a multimodal rehabilitation program in reducing functional disability for adolescents with CMP compared with care as usual.Methods/DesignPragmatic multicentre parallel group randomized controlled trial. Randomization by minimization (ratio 1:1) and treatment allocation will be concealed, computer-generated and performed by an independent organization. After randomization, data collection and researchers remain blinded. Inclusion of 124 adolescents and their parents is intended. This sample size is based on a 25 % difference in group mean on the primary outcome, with α = 5 %, β = 80 % and expected 15 % loss to follow up. Study population are adolescents (12–21 years) with CMP with an indication for outpatient rehabilitation treatment in the Netherlands.The intervention group receives a Multimodal Rehabilitation Program (MRP), a multidisciplinary outpatient individual rehabilitation program. MRP consists of 2 different treatment approaches: A graded exposure module or a combination module of graded exposure and physical training. Selection of a module depends on the needs of the patient. To both modules a parent module is added. The control group receives care as usual, which is the care currently provided in Dutch rehabilitation centres. Treatment duration varies between 7 and 16 weeks, depending on treatment allocation.Self-reported measurements are at baseline, and at 2, 4, 10 and 12 months after start of treatment. Intention to treat analysis for between group differences on all outcome variables will be performed. Primary outcome is functional disability (Functional Disability Inventory). Secondary outcome variables are fear of pain, catastrophizing, perceived harmfulness, pain intensity, depressive symptoms, and quality of life. Total direct and indirect costs and health related quality of life will be measured. Process evaluation focuses on protocol adherence, patient centeredness and treatment expectations.DiscussionA pragmatic approach was chosen, to ensure that results obtained are most applicable to daily practice.Trial registrationClinicaltrials.gov ID: NCT02181725 (7 February 2014).Funded by Fonds Nuts Ohra, Stichting Vooruit, and Adelante.

EULAR revised recommendations for the management of fibromyalgia

ObjectiveThe original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were ‘expert opinion’.MethodsA multidisciplinary group from 12...

Pain rehabilitation with language interpreter, a multicenter development project

Abstract Aims To describe patients with persistent pain participating in multimodal rehabilitation with language interpreter (MMRI) with regard to demographic data, pain, anxiety, depression, fear of movement, health related quality of life before and after rehabilitation. Methods The university rehabilitation departments in Lund and Stockholm developed multimodal rehabilitation programmes for patients who cannot participate in ordinary programmes due to insufficient knowledge in Swedish. From 2014 to 2015, 50 patients participated in the MMRI. Data was collected at admission and discharge with instruments from the Swedish quality registry for pain rehabilitation. The assessments included health related quality of life (EQ5D), anxiety and depression (HADS), fear of movements (TSK), disability (PDI). Preliminary results Fifty patients participated in MMRI. Seventy-eight percent were women, and 88% were born outside Europe. Compared to patients participating in Swedish regular rehabilitation programmes (MMR), the level of education was low, 44% had finished high school (55% in MMR in Sweden) and 8% university (27% in MMR in Sweden). Also the distribution of pain differed; in MMRI 40% reported pain with varying localization compared to 33% in MMR. Both groups were frequent health care seekers, even though MMRl’s patients reported a higher frequency of visits than MMR regular patients; 94% of MMRl’s patients compared to 70% MMR patients were seeking physicians more than 4 times due to pain during the previous year. Both groups report very low health related quality of life. In the MMRI group, at admission, the EQ5Dindex was 0.088 (md) (MMR 0.157). This can be compared with 0.83, the value for the Swedish norm population. Conclusions Patients participating in MMRI, compared to patients participating in MMR, reported poorer health, higher rate of visit to physicians due to pain and less higher education than other, Swedish speaking pain patients attending to the country pain programmes.

Effect of Dry Needling on Spasticity, Shoulder Range of Motion, and Pressure Pain Sensitivity in Patients With Stroke: A Crossover Study

ObjectiveThe purpose of this study was to determine the effects of the inclusion of deep dry needling (DDN) in spastic shoulder muscles into a rehabilitation program on spasticity, pressure pain sensitivity, and shoulder range of motion in subjects who had experienced a stroke. MethodsA controlled, repeated-measures, crossover, double-blinded, randomized trial was conducted. Twenty patients who have had a stroke were randomly assigned to receive rehabilitation alone or rehabilitation combined with DDN over the upper trapezius, infraspinatus, subscapularis, and pectoralis mayor muscles on the spastic shoulder. Subjects received both interventions separated at least 15 days apart. Each intervention was applied once per week over 3 weeks. Spasticity (Modified Ashworth Scale), pressure pain thresholds over the deltoid and infraspinatus muscles and C5-C6 zygapophyseal joint, and shoulder range of motion were collected 1 week before and 1 week after each intervention by a blinded assessor. ResultsReduction in spasticity was similar after both conditions for the upper trapezius, pectoralis major, and subscapularis muscles. A greater number of individuals receiving DDN exhibited decreased spasticity within the infraspinatus muscle. The analysis of covariance showed that all pressure pain thresholds, shoulder abduction, and external rotation of the shoulder increased significantly more after DNN intervention (P < .05). Shoulder flexion showed similar changes after both conditions. ConclusionsOur results suggest that inclusion of DDN into a multimodal rehabilitation program was effective for decreasing localized pressure sensitivity and improving shoulder range of motion in individuals who had experienced stroke; however, we did not observe significant differences in muscle spasticity.

Co-creation of an ICT-supported cancer rehabilitation application for resected lung cancer survivors: design and evaluation.

BackgroundLung cancer (LC) patients experience high symptom burden and significant decline of physical fitness and quality of life following lung resection. Good quality of survivorship care post-surgery is essential to optimize recovery and prevent unscheduled healthcare use. The use of Information and Communication Technology (ICT) can improve post-surgery care, as it enables frequent monitoring of health status in daily life, provides timely and personalized feedback to patients and professionals, and improves accessibility to rehabilitation programs. Despite its promises, implementation of telehealthcare applications is challenging, often hampered by non-acceptance of the developed service by its end-users. A promising approach is to involve the end-users early and continuously during the developmental process through a so-called user-centred design approach. The aim of this article is to report on this process of co-creation and evaluation of a multimodal ICT-supported cancer rehabilitation program with and for lung cancer patients treated with lung resection and their healthcare professionals (HCPs).MethodsA user-centered design approach was used. Through semi-structured interviews (n = 10 LC patients and 6 HCPs), focus groups (n = 5 HCPs), and scenarios (n = 5 HCPs), user needs and requirements were elicited. Semi-structured interviews and the System Usability Scale (SUS) were used to evaluate usability of the telehealthcare application with 7 LC patients and 10 HCPs.ResultsThe developed application consists of: 1) self-monitoring of symptoms and physical activity using on-body sensors and a smartphone, and 2) a web based physical exercise program. 71 % of LC patients and 78 % of HCPs were willing to use the application as part of lung cancer treatment. Accessibility of data via electronic patient records was essential for HCPs. LC patients regarded a positive attitude of the HCP towards the application essential. Overall, the usability (SUS median score = 70, range 35–95) was rated acceptable.ConclusionsA telehealthcare application that facilitates symptom monitoring and physical fitness training is considered a useful tool to further improve recovery following surgery of resected lung cancer (LC) patients. Involvement of end users in the design process appears to be necessary to optimize chances of adoption, compliance and implementation of telemedicine.

A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial.

To compare the effects of a 3-week multimodal rehabilitation involving supervised high-intensity interval training (HIIT) on female breast cancer survivors with respect to key variables of aerobic fitness, body composition, energy expenditure, cancer-related fatigue, and quality of life to those of a standard multimodal rehabilitation program. A randomized controlled trial design was administered. Twenty-eight women, who had been treated for cancer were randomly assigned to either a group performing exercise of low-to-moderate intensity (LMIE; n=14) or a group performing high-intensity interval training (HIIT; n=14) as part of a 3-week multimodal rehabilitation program. No adverse events related to the exercise were reported. Work economy improved following both HIIT and LMIE, with improved peak oxygen uptake following LMIE. HIIT reduced mean total body fat mass with no change in body mass, muscle or fat-free mass (best P<0.06). LMIE increased muscle and total fat-free body mass. Total energy expenditure (P=0.45) did not change between the groups, whereas both improved quality of life to a similar high extent and lessened cancer-related fatigue. This randomized controlled study demonstrates that HIIT can be performed by female cancer survivors without adverse health effects. Here, HIIT and LMIE both improved work economy, quality of life and cancer-related fatigue, body composition or energy expenditure. Since the outcomes were similar, but HIIT takes less time, this may be a time-efficient strategy for improving certain aspects of the health of female cancer survivors.

Patient expectations for a multimodal pain rehabilitation programme: active participation and coping skills. A qualitative study

Purpose: To describe what patients with chronic pain expect from a multimodal pain rehabilitation programme.Material and method: Qualitative interviews were used to uncover expectations about a multimodal rehabilitation programme offered at the Pain and Rehabilitations Centre, The University Hospital; Linköping, Sweden. Sixteen women and two men (mean age 37 years; standard deviation 10 years) with chronic benign pain participated. The interviews were analysed using qualitative content analyses.Results: To participate actively in the multimodal pain rehabilitation programme and to learn adequate coping strategies to improve daily life emerged as a main category. It was based on the following four categories comprising expectations about: participating actively in the programme, interacting with the professionals and fellow patients, cognitive effects of the programme and tools for coping, and explicit effects from the programme.Conclusions: Many patients expressed expectations which may reflect that the information before the programme had started rehabilitation process at the time point for this study. The results could be applied in rehabilitation programmes by acknowledging expectations to interact with professional team members and fellow patients, by early addressing of positive and negative expectations about the future pain and by incorporating and strengthen expectations of learning to cope with pain.Implications for RehabilitationPatients' expectations to interact with professional team members and fellow patients by participating actively in the pain rehabilitation programme should be acknowledged in each rehabilitation situation.Patients expressed both positive and negative expectations about their future pain situation and these expectations should be addressed as early as possible in the rehabilitation screening process.Patients' expectations of learning to cope with pain should be incorporated and strengthened in multimodal pain rehabilitation programmes.

MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE

Event Abstract Back to Event MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE David J. Clark1* 1 Carrick Institute of Clinical Neuroscience and Rehabilitation, United States Background: A 69 year old woman presented with chief complaints of difficulty moving the left leg during walking, subjective problems with maintaining balance, back and hip pain, and difficulty driving. Symptoms began twelve years prior subsequent to a fall and head injury. MRI one year prior to presentation discovered extensive and non-specific white matter changes likely secondary to small vessel ischemic disease. Methods: Neurological examination revealed freezing during dual tasking of gait, Grade 2 on the Unified Parkinson’s Disease Rating Scale (UPDRS) on the left side during finger tapping and fist making tests, small amplitude titubation, normal strength and sensation in all 4 limbs. VNG testing revealed large amplitude square wave jerks with a right bias, saccadic horizontal pursuits with gains as follows: 0.1 Hz 0.66, at 0.2 Hz 0.77, and at 0.4 Hz 0.58. VNG showed saccadic vertical pursuits with gains as follows: at 0.1 Hz 0.63, at 0.2 Hz 0.40 and 0.4 Hz 0.22. Patient was treated with a three day multimodal rehabilitation program utilizing a gap stimulus and small amplitude saccades. Then, for two weeks the patient was placed on an anti-inflammatory diet, and supplement protocol featuring turmeric, resveratrol and omega fatty acids. Results: After the initial three days of treatment the horizontal pursuit gains had changed to the following: at 0.1 Hz 62, at 0.2 Hz 75 and at 0.4 Hz 0.73. The amplitude of the square wave jerks had decreased. After two weeks of the anti-inflammatory diet and supplementation the horizontal pursuit gains had improved as follows: at 0.1 Hz 0.82, at 0.2 Hz 0.74, at 0.4 Hz 0.72. The frequency of the square wave jerks was unchanged but the amplitude was smaller than before treatment. The patient reported that driving was no longer difficult. Patient did not exhibit freezing during dual tasking of gait. Fist making and finger tapping tests were Grade 1 UPDRS. Conclusion: The author suggests further investigation into the combination of multimodal forms of neurorehabilitation with anti-inflammatory diet and supplementation in the treatment of patients with saccadic pursuits and square wave jerks subsequent to head injury. Keywords: smooth pursuit eye movements, Head injury, Gait Disorders, Neurologic, Square wave jerks, driving Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016. Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016 Citation: Clark DJ (2016). MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION PROGRAM IMPROVE PURSUITS AND DRIVING ABILITY IN 69 YEAR OLD FEMALE . Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00062 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 01 Sep 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. David J Clark, Carrick Institute of Clinical Neuroscience and Rehabilitation, Cape Canaveral, FL, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

ProKaSaRe Study Protocol: A Prospective Multicenter Study of Pulmonary Rehabilitation of Patients With Sarcoidosis.

BackgroundAvailable data assessing the efficacy of pulmonary rehabilitation for patients with chronic sarcoidosis are scant; for Germany, there are none at all.ObjectiveTo gain information about the benefit of in-house pulmonary rehabilitation for patients with chronic sarcoidosis and for the health care system, we intend to collect data in a prospective multicenter “real-life” cohort trial.MethodsProKaSaRe (Prospektive Katamnesestudie Sarkoidose in der pneumologischen Rehabilitation) [Prospective Catamnesis Study of Sarcoidosis in Pulmonary Rehabilitation] will assess a multimodal 3-week inpatient pulmonary rehabilitation program for adult patients with chronic sarcoidosis over a 1-year follow-up time. Defined specific clinical measurements and tests will be performed at the beginning and the end of the rehabilitation. In addition, questionnaires concerning health-related quality of life and the patients’ symptoms will be provided to all patients. Inclusion criteria will be referral to one of the 6 participating pulmonary rehabilitation clinics in Germany for sarcoidosis and age between 18 and 80 years. Patients will only be excluded for a lack of German language skills or the inability to understand and complete the study questionnaires. To rule out seasonal influences, the recruitment will take place over a period of 1 year. In total, at least 121 patients are planned to be included. A descriptive statistical analysis of the data will be performed, including multivariate analyses. The primary outcomes are specific health-related quality of life (St George’s Respiratory Questionnaire) and exercise capacity (6-minute walk test). The secondary outcomes are several routine lung function and laboratory parameters, dyspnea scores and blood gas analysis at rest and during exercise, changes in fatigue, psychological burden, and generic health-related quality of life (36-item Short Form Health Survey).ResultsFunding was obtained on October 12, 2010; enrollment began on January 15, 2011 and was completed by January 14, 2012. Results are anticipated late summer 2015.ConclusionsDue to the large number of participants, we expect to obtain representative findings concerning the effectiveness of pulmonary rehabilitation for patients with sarcoidosis and to provide a dataset of assessed objective and subjective short- and long-term changes due to pulmonary rehabilitation. The results should form the basis for the planning of a randomized controlled trial.Trial RegistrationGerman Clinical Trials Register: DRKS00000560; https://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000560 (Archived by WebCite® at http://www.webcitation.org/6dKb5X87R)

Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes

Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes

Patients with chronic pain: One-year follow-up of a multimodal rehabilitation programme at a pain clinic

Background and aimsMultimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. MethodsA prospective, observational study with a one-year follow-up was performed. SubjectsA total of 42 individuals (38 females, age 44.0±12.3 years and 4 men age 40±8.5 years) with different pain diagnoses were included. After a team assessment, the patients began a programme that lasted about three months. The MMR programme contained coordinated, individually adapted treatments administered individually or in groups, and was based on cognitive behavioural principles. Questionnaires regarding health-related quality of life (HRQoL) (EQ-5D), insomnia (ISI), mental health (HADS), pain-related disability (PDI), kinesiophobia (TSK), current pain intensity (VAS) and sense of coherence (SOC) were used at the start of the MMR and at follow-up. Demographic data were collected from the patient records. ResultsThe PROM at baseline showed substantial pain problems with low HRQoL (EQ-5D index of 0.1±0.282, and EQ VAS of 32.67±20.1), moderate insomnia (ISI 18.95±6.7), doubtful cases of depression and anxiety (HADS-depression 9.35±4.1 and HADS-anxiety 9.78±3.95), presence of pain-related disability (PDI 39.48 ±12.64), kinesiophobia (TSK 40.8±9.8), as well as moderate current pain (VAS 61.31±20.4). The sense of coherence was weak (SOC of 51.37±14). At one-year follow-up, significant (p≤0.05) improvement occurred on the EQ-5D index, EQ VAS, ISI, PDI and TSK. In the logistic regression analysis, no significant associations could be identified. ConclusionsMMR for patients with complex pain problems can be a successful treatment alternative at conventional pain clinics. ImplicationsSince access to rehabilitation clinics in Sweden may be limited, the availability of MMR can increase by providing this type of intervention in pain clinics. Increased knowledge of MMR in different settings can also contribute to increased understanding and collaboration between pain clinics and rehabilitation units.

PTH-302 Enhanced recovery after surgery after malignant colorectal resection in elderly: a single centre experience

<h3>Introduction</h3> Enhanced recovery after surgery (ERAS) employs a multi-modal rehabilitation programme to aid post operative recovery following colorectal resections. ERAS can be applied in both laparoscopic and open surgery. The aim of the study is to assess ERAS versus conventional post operative care in malignant colorectal cancer resections (CRC) at a single institution. <h3>Method</h3> This is a retrospective study carried out at Macclesfield District General Hospital. ERAS became an integrated into colorectal surgery in 2008. Descriptive data, patient factors and post-operative features were collected for all elective malignant colorectal resections. <h3>Results</h3> See Table 1 <h3>Conclusion</h3> Despite a prolonged operative time, ERAS resulted in a shorter hospital stay (p &lt; 0.05). Departures from ERAS can result in delayed hospital discharge, which can occur in the presence of major surgical complications (ileus, anastomotic leak, collections). A targeted rehabilitation programme especially in the elderly patients can provide a cost effective earlier recovery. <h3>Disclosure of interest</h3> None Declared.

Multimodal Rehabilitation Program in Thoracic Surgery

One of the main principles of medicine is that advances in nowledge and technological developments lead to improvements n patient care. In the area of surgery, 2 indisputably significant dvances have emerged in the last 20 years, namely, minimally nvasive surgery and multimodal rehabilitation programs, also nown Fast Track protocols or Enhanced Recovery After Anestheia (ERAS) programs. The aim of both developments is the same: o minimize surgical aggression, thereby improving post-operative ecovery. Comparative, validated data are available from numerous studes to show the benefits of these protocols for both patients reduced morbidity and improved quality of life) and the healthcare ystem (shorter hospital stays),1 but the degree of implemenation needs to be examined. ERAS protocols are in essence ultidisciplinary, and a lack of coordination between the varius specialist areas sometimes makes them difficult to introduce. ut what are ERAS programs, exactly? To paraphrase Kehlet, he father of multimodal surgical rehabilitation, ERAS is a ombination of perioperative strategies supported by evidenceased medicine and aimed at improving recovery after surgical nterventions.2 ERAS protocols revisit conventional perioperative practices and valuate the specific key points of each procedure, analyzing the cientific evidence for the perioperative management of patients ndergoing major surgery, to produce guidelines for helping coorinated teams improve postoperative care. These protocols cover different phases in the care of surgical atients, and address issues such as shortening the preoperaive fasting period, giving carbohydrate-rich drinks before surgery, etection of malnutrition in the preoperative period, need for reventive analgesia, early postsurgical mobilization, rapid reintrouction of oral intake of fluids and food, and prompt withdrawal of nnecessary catheters and tubes. Each of these individual measures

The Effects of a Multimodal Rehabilitation Program on Symptoms and Ground-Reaction Forces in Runners With Patellofemoral Pain Syndrome.

Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP. To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/ motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP. Pre- to post- quasi-experimental. Gait-analysis laboratory and private physical therapy clinic. 21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo). An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management. The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured. Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (-19.2 pts), VAS-W (-28.7 pts), and VAS-R (-32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028). This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.

Effects of a 4-week multimodal rehabilitation program on quality of life, cardiopulmonary function, and fatigue in breast cancer patients.

PurposeThis study examines the effects of a rehabilitation program on quality of life (QoL), cardiopulmonary function, and fatigue in breast cancer patients. The program included aerobic exercises as well as stretching and strengthening exercises.MethodsBreast cancer patients (n=62) who had completed chemotherapy were randomly assigned to an early exercise group (EEG; n=32) or a delayed exercise group (DEG; n=30). The EEG underwent 4 weeks of a multimodal rehabilitation program for 80 min/day, 5 times/wk for 4 weeks. The DEG completed the same program during the next 4 weeks. The European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire (EORTC QLQ-C30), EORTC Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23), predicted maximal volume of oxygen consumption (VO2max), and fatigue severity scale (FSS) were used for assessment at baseline, and at 2, 4, 6, and 8 weeks.ResultsAfter 8 weeks, statistically significant differences were apparent in global health, physical, role, and emotional functions, and cancer-related symptoms such as fatigue and pain, nausea, and dyspnea on the EORTC QLQ-C30; cancer-related symptoms involving the arm and breast on the EORTC QLQ-BR23; the predicted VO2max; muscular strength; and FSS (p<0.050), according to time, between the two groups.ConclusionThe results of our study suggest that a supervised multimodal rehabilitation program may improve the physical symptoms, QoL, and fatigue in patients with breast cancer.

"Change is possible": Patients' experience of a multimodal chronic pain rehabilitation programme.

To explore patients' experiences of activity, participation and quality of life one year after a rehabilitation programme for chronic pain, and to determine the impact of the programme on their current life situation. Qualitative study with emergent design. The 14 informants were patients with chronic pain who had participated in rehabilitation at a pain clinic. Individual semi-structured interviews were analysed with inductive, qualitative content analysis. The core theme "Change is possible" and the themes "A life ruled by pain" (the situation before rehabilitation), "The penny's dropped" (experience during rehabilitation) and "Live a life, not only survive" (the situation at the time of the interviews) emerged from the data. These themes represent a process through which, during and after rehabilitation, the informants integrated earlier disabling symptoms into a functioning lifestyle. Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others.

Impact of a Diverting Stoma in an Enhanced Recovery Programme for Rectal Cancer

PurposeThe association of a loop ileostomy decreases the severity of complications after rectal surgery but can increase the postoperative stay. The aim of this study is to investigate if a diverting ileostomy influences the postoperative outcomes in a series of patients included in a multimodal rehabilitation program (MMRP). MethodsWe analysed a series of 104 patients that underwent elective surgery with primary anastomosis for rectal adenocarcinoma using a MMRP: 66 men and 38 women, with a median age of 64 (IQR: 55–75) years. Group A included patients with an associated loop ileostomy, and Group B, those without a protective stoma. ResultsGroup A=58, group B=46 patients with neither differences in age, ASA, BMI and other risk factors nor in the surgical approach (laparoscopic in 34%), although there were more neoadjuvant treatments in group A: 77.5 vs 36.9%; P=.001. In group A, the most common operation was total mesorectal excision (96%) and in the group B, a subtotal mesorectal excision (90%). There were no differences in postoperative complications (Group A 34.4 vs group B 28.2%; P=.322), anastomotic leaks (8.3 vs 10.8%; P=.475), or postoperative ileus (20.7 vs 10.9%; P=.140), neither in postoperative stay (7.9 vs 6.9 days; P=.058), readmissions (7 vs 13.6%; P=.22) nor postoperative stay including readmissions (8.4 vs 9.1 days; P=.49). ConclusionsThe association of a loop ileostomy does not extend the length of stay nor increases the rate of complications in patients that underwent a rectal resection with anastomosis included in a MMRP.

One-year follow-up of body awareness and perceived health after participating in a multimodal pain rehabilitation programme – A pilot study

Purpose: To evaluate body awareness and perceived health in patients with chronic pain after participation in a multimodal rehabilitation (MMR) programme and at 1-year follow-up. Method: Thirty-nine patients participated in a 5-week outpatient MMR programme. They were evaluated with the main outcome measures: the Body Awareness Scale (BAS) using an interview (BAS-I) and a movement test (BAS-Obs), the Nottingham Health Profile (NHP) and the Sense of Coherence (SOC). A subgroup analysis was conducted based on the BAS-Obs scores at the start of the MMR programme with cut-off at the upper quartile ≥ 26 point, classified as low body awareness; the three lower quartiles were classified as moderate/high body awareness. Results: All patients improved on the BAS-Obs and the BAS-I from the start to the end of the MMRP (p < 0.001) and at 1-year follow-up on four of the BAS-Obs subscales (p < 0.005). The moderate/high body awareness group improved on BAS-I, NHP and SOC (p < 0.01) and on two BAS-I subscales (p < 0.005), while the low body awareness group improved on one subscale (p = 0.003). Conclusion: Our results suggest that the use of the BAS-Obs assessment to identify patients with high or low levels of body awareness could play an important part in understanding the individual's clinical needs and be useful for developing an effective rehabilitation programme for patients with chronic pain.

Impacto del estoma derivativo en un protocolo de rehabilitación multimodal en cirugía de recto

PurposeThe association of a loop ileostomy decreases the severity of complications after rectal surgery but can increase the postoperative stay. The aim of this study is to investigate if a diverting ileostomy influences the postoperative outcomes in a series of patients included in a multimodal rehabilitation program (MMRP). MethodsWe analyzed a series of 104 patients that underwent elective surgery with primary anastomosis for rectal adenocarcinoma using a MMRP: 66 men and 38 women, with a median age of 64 (IQR: 55-75) years. Group A included patients with an associated loop ileostomy, and Group B, those without a protective stoma. ResultsGroup A = 58, group B = 46 patients without differences in age, ASA, BMI and other risk factors, nor in the surgical approach (laparoscopic in 34%), although there were more neoadjuvant treatments in group A: 77.5 vs. 36.9%; P=.001. In group A, the most common operation was total mesorectal excision (96%) and in the B, a subtotal mesorectal excision (90%). There were no differences in postoperative complications (Group A 34.4 vs. group B28.2%; P=.322), anastomotic leaks (8.3 vs. 10.8%; P=.475), or postoperative ileus (20.7 vs. 10.9%; P=.140), neither in postoperative stay (7.9 vs. 6.9 days; P= .058, readmissions (7 vs. 13.6%; P= .22), or postoperative stay, including readmissions (8.4 vs. 9.1 days; P= .49). ConclusionsThe association of a loop ileostomy does not extend the length of stay nor increases the rate of complications in patients that underwent a rectal resection with anastomosis included in a MMRP.