Number Of Physical Therapy Sessions Research Articles

Cost-effectiveness analysis of Coblation versus mechanical shaver debridement in patients following knee chondroplasty

BackgroundTo compare costs and outcomes following knee chondroplasty with Coblation versus mechanical shaver debridement (MSD) in patients with grade III articular cartilage lesions of the knee.MethodsA decision-analytic model was developed to compare costs and outcomes of the two methods from a US payer perspective. We used published clinical data from a single-center randomized clinical trial (RCT) designed to compare outcomes between Coblation and MSD in patients with grade III articular cartilage lesions of the medial femoral condyle. Following primary knee chondroplasty, patients experienced either treatment success (no additional surgery required) or required a revision over the 4 year follow-up period. Costs associated with the initial chondroplasty, physical therapy sessions through the 6 week postoperative period, and revision rates at 4 years post-surgery were estimated using 2018 US Medicare Physician Fee Schedule. Sensitivity analyses including a 10 year time horizon and threshold analyses were performed to test the robustness of the model.ResultsThe estimated total cost per patient was $4614 and $7886 for Coblation and MSD, respectively, resulting in cost-savings of $3272 in favor of Coblation, making it a dominant strategy because of lower costs and improved clinical outcomes. Threshold analysis showed that Coblation remained dominant even when revision rates were assumed to increase from the base case rate of 14–66%. Sensitivity analyses showed that cost-saving results were insensitive to variations in revision rates, number of physical therapy sessions and the time horizon used.ConclusionCoblation chondroplasty is a cost-saving procedure compared with MSD in the treatment of patients with grade III articular cartilage lesions of the knee.

Evaluation and treatment physiotherapeutic in pain syndrome patellofemoral: case study

Introduction: The patellofemoral pain syndrome is a common condition in orthopedic practice, is defined as a pain or retropatellar in the absence of other diseases of the knee, multifactorial. Objectives: The aim of this study was to investigate the influence of a physiotherapy intervention in a patient with patellofemoral pain syndrome. Methods: We performed a descriptive study, through a case report with physical therapy assessment data and the description of the techniques used during treatment. Results: The results showed range of motion improves, the manifestations of pain and patellar mobility. Conclusion: The proposed physical therapy treatment given to this patient proved to be efficient, but a greater number of physical therapy sessions is required in order to obtain better results.

Correlations and Predictors of the Duration of Physical Therapy in Infants Diagnosed With Congenital Muscular Torticollis

Congenital muscular torticollis (CMT) is the most common musculoskeletal disorder in infancy. The aim of this study was to determine the long-term outcomes of different subtypes of CMT using ultrasonographic (US) diagnostic studies, which could affect the length of physical therapy (PT) in infants with CMT and elicit an early referral. We performed a retrospective analysis of 76 CMT infants who were referred for US investigation and PT between January 2014 and May 2017. The PT duration was 149 ± 72 days, and most infants received PT 2 times/week. The depth ratio and difference between the affected and non-affected bilateral sternocleidomastoid muscle (SCM), passive neck rotation, and lateral flexion were significantly improved after PT. The duration of PT and the number of PT sessions were found to be correlated with initial passive neck rotation (p ＜ 0.001, p ＜ 0.001) and lateral flexion (p = 0.031, p = 0.027). According to linear regression analysis, the initial passive neck rotation was the strongest predictive factor of the duration of PT (p = 0.001) and the number of PT sessions (p ＜ 0.001). Muscular torticollis can be effectively treated by traditional PT. A greater limitation in passive neck rotation requires a longer duration of PT, and attention should be paid to this issue during monitoring of the development of infants with postural torticollis.

Walking While Dialyzing: A Retrospective Observation of Early Mobility and Ambulation for Patients on Continuous Renal Replacement Therapy.

Objectives:To describe the practice of physical therapy for patients requiring continuous renal replacement therapy and assess data related to the safety and feasibility of physical therapy interventions.Design:A retrospective observational cohort study.Patients:Surgical and cardiovascular patients receiving continuous renal replacement therapy during a 2-year period from December 2016 to November 2018.Setting:Two ICUs at a single academic medical center.Intervention:Physical mobility and ambulation while on continuous renal replacement therapy.Measurements and Main Results:Therapy data including ICU Mobility Scale score, number of physical therapy sessions with and without ambulation and gait distance, along with safety data including filter life, safety events, and mortality were analyzed. The cohort of patients receiving continuous renal replacement therapy during the 2-year period was 206. Of these, 172 (83.49%) received simultaneous physical therapy. The median ICU Mobility Scale was 5 (interquartile range, 4–7) over a total of 1,517 physical therapy sessions. Ambulation with concomitant continuous renal replacement therapy connected was achieved in 78 patients (37.86%). There were 377 ambulation sessions (24.85% of all sessions) with a mean of 4.83 (sds 4.94) ambulation sessions per ambulatory patient. Patients walked an average of 888.53 feet (sd 1,365.50) while on continuous renal replacement therapy and a daily average of 150.61 feet (sd 133.50). In-hospital mortality was lowest for patients who ambulated (17.95%) and highest for patients who received no therapy (73.53%). Continuous renal replacement therapy filter life was longest for patients who ambulated (2,047.20 min [sd 1,086.50 min]), and shortest in patients who received no therapy (1,682.20 min [sd 1,343.80 min]). One safety event was reported during this time (0.0007% of all physical therapy sessions).Conclusions:Ambulation while on continuous renal replacement therapy was not associated with an increased risk of safety events and was feasible with the use of nonfemoral catheters and dialysis equipment with internal batteries.

Providing patients with direct access to musculoskeletal physiotherapy: the impact on general practice musculoskeletal workload and resource use. The STEMS-2 study

ObjectivesThis study examined the real-world impact of patient direct access to NHS physiotherapy (self-referral) on (a) general practice consultations for musculoskeletal (MSK) conditions and (b) specified clinical management for patients with MSK conditions. Design and settingNatural experiment in four general practices and the associated physiotherapy service. MethodsAnonymised routinely collected data were obtained. MSK coded GP consultations, recorded fit notes, MSK-related prescription medication, X-rays and MRI requests, and referrals to secondary care for patients consulting with MSK conditions were identified and trends described across a 6-year period (June 2011 to June 2017). Joinpoint regression analysis was used to identify any significant changes in GP MSK consultation trends before and after the introduction of self-referral to physiotherapy. Physiotherapy service data examined access methods used by patients (GP referred, GP recommended self-referral, true self-referral) and the number of physiotherapy sessions. ResultsDirect access resulted in inconsistent impact on general practices. In one arm of the experiment a significant increase in GP consultations was observed and in one arm was stable. Exploratory examination of clinical management showed only requests for X-rays (arm 1) and possibly requests for MRI (arm 2) changed over time. Physiotherapy service referrals showed a low uptake of true self-referral (10% and 6%) in each arm respectively. ConclusionThis is the first study to examine the real-world impact of patient direct access to physiotherapy at general practice level. We found no consistent impact of patient direct access on GP MSK workload. Impact on some clinical management was observed but not consistently in the direction suggested by previous studies.

Self-efficacy in patients with chronic musculoskeletal conditions discharged from physical therapy service: A cross-sectional study.

This study aimed to investigate self-efficacy levels of patients after finishing rehabilitation for chronic musculoskeletal conditions and identify factors related to self-efficacy. Two hundred and eight patients aged >40 years with musculoskeletal disorders were included. Self-efficacy was assessed by the Chronic Pain Self-Efficacy Scale (CPSS), and regression analyses were used to test six predictors of self-efficacy: age, symptom duration, number of physical therapy sessions, postdischarge pain intensity, perceived clinical improvement, and cognitive reassurance. Self-efficacy was compared between patients who reported improvement and worsening of their clinical condition, and a cutoff value for self-efficacy was established using receiver operating characteristic curve analyses to distinguish patients with severe pain from those with mild to moderate pain. Better perceived clinical improvement (Beta = -0.37, p = 0.000), lower pain intensity (Beta = -0.33, p = 0.000), and a lower number of physical therapy sessions (Beta = -0.12, p = 0.027) were related to greater self-efficacy. No significant associations were observed between self-efficacy and age, symptom duration, and cognitive reassurance. The patients who reported improvement had greater self-efficacy (204.76 ± 52.80) than those who reported worsening of their clinical condition (145.45 ± 44.18; p = 0.000). A CPSS score of 172 points (sensitivity of 0.77; specificity of 0.72) may indicate low self-efficacy. A higher perception of self-efficacy after discharge from physiotherapy is associated with better perceived clinical improvement, lower pain intensity, and a lower number of physical therapy sessions. Therefore, interventions to support patients' exercise-based rehabilitation should include self-efficacy, which may affect the prognosis of patients with chronic conditions.

Effectiveness of Home-based Physiotherapy on Functional Outcome among Stroke Participants in India

Background: Stroke is one of the leading causes of mortality and disability, especially physical impairments that significantly limits the activities of daily living (ADLs). Stroke survivors who eventually return home post discharge from hospital need to undergo a home-based rehabilitation as their needs cannot be met exclusively in the hospital. Thus, home based rehabilitation provides an alternative to hospital-based treatment and helps patients form a therapeutic connection to their activities of daily living. Therefore, this study was done to analyze the effects of home -based physiotherapy on ADL’s in participants with stroke. Material and Method: 119 stroke participants registered with Health care at Home from January 2018 to December 2018 were included in the main analysis who received average 66.6 number of physiotherapy sessions in the form of exercise therapy, approximately for 45-60 minutes. The Barthel Index (BI) scores as a functional outcome were recorded fortnightly. Findings: The study demonstrated that the home-based physiotherapy program significantly improved functional outcome in stroke participants. Conclusion: Based on the analysis, it is concluded that home-based physiotherapy improves functional outcomes in terms of activities of daily living of stroke participants. Study also revealed some initial insights on the stroke cases that did not show considerable improvement.

Transperineal three-dimensional ultrasound for analyzing the effects of perineal stretching with EPI-NO® in women with multiple pregnancies: a pilot study

Objective To compare the changes in the pelvic floor of women with twin pregnancies who practiced muscle stretching with the EPI-NO® vaginal dilator, as assessed using transperineal three-dimensional ultrasound (3DUS). Method This prospective cross-sectional case-control study included nulliparous women in the third trimester of their multiple pregnancies and divided them into the control group (CG, n = 9) and EPI-NO® group (EpiG, n = 9). During pretreatment, the women underwent transperineal 3DUS to establish the morphometric measurements of the pelvic floor. The CG received guidance regarding pelvic floor muscles, whereas the EpiG underwent weekly physical therapy sessions with the EPI-NO® dilator for 20 min/day. Following this treatment, all women were reassessed using transperineal 3DUS, and the diameter of the EPI-NO® balloons of the women in the EpiG was measured (epinometry). Paired samples t-test was used for comparative analysis. Results The EpiG showed improved perineal distensibility, which was evidenced by the increase in sagittal diameter at rest (p < .01). Transperineal 3DUS among women in the EpiG showed a significant increase in the sagittal measurement (p = .02), hiatal circumference at rest (p = .03), and epinometry values (diameter of the EPI-NO® balloon; p < .01). The increase in epinometry values was directly correlated (p = .02) with the number of physical therapy sessions. Conclusion EPI-NO® increased pelvic floor distensibility in women with twin pregnancies, as confirmed using transperineal 3DUS and epinometry. This device promoted an increase in perineal distensibility with a single use; however, better results would be obtained with additional sessions.

Neurological and Orthopedic Diseases in Dogs and Cats Submitted to Physiotherapy

Background: The goals of physical therapy are to maximize functional recovery, improve mobility, and restore well-being and quality of life. In the veterinary literature, there is a dearth of data on physical therapy in small animal practice. Therefore, this study aimed to identify the main neurological and orthopedic diseases in canine and feline patients seen at the physical therapy service of an animal hospital. Concomitantly, we collected demographic and clinical information on patients, including sex, breed, physical therapy modalities, number and frequency of physical therapy sessions, duration of treatment, and rate of functional recovery.Materials, Methods &amp; Results: The records of animals with neurological and orthopedic diseases seen at the Physical Therapy department of a university-affiliated animal hospital were reviewed. The animals were divided into two groups: I) dogs and cats with neurological diseases and II) dogs and cats with orthopedic diseases. Both groups were distributed according to species, age, sex and race. Dogs and cats were classified into three age groups: puppies (≤ 1 year old), adults (&gt; 1 year and ≤ 10 years old) and elderly (&gt; 10 years old). A total of 384 records were retrieved, of which 370 (96.4%) were of dogs and 14 (3.6%) of cats. Neurological cases accounted for 66% of the total (n = 253), with 243 cases in dogs (96%) and 10 in cats (4%). Among orthopedic cases (n = 131, accounting for the remaining 34%), 127 were in dogs (97%) and only 4 in cats (3%). In the neurological dysfunction group, intervertebral disc disease (72.4%) was the most common diagnosis. Among the orthopedic disorders, femur fracture (23.1%) was most prevalent. In group I (neurological), 66.7% of outcomes in canine patients and 44.4% in felines were considered satisfactory. In group II (orthopedic), 61% of outcomes in dogs and 66.7% in cats were considered satisfactory.Discussion: Physical therapy has many applications in small-animal practice. After spinal cord decompression surgery in dogs with IVDD, for instance, it helps maintain and recover motor and sensory function, and is considered safe and well-tolerated in dogs after thoracolumbar hemilaminectomy with disc fenestration. Physical therapy also plays an important role after surgical repair of fractures and dislocations, aiding recovery of range of motion and return to functional activity. The most probable explanation for the wide variation in number of physical therapy sessions can be explained by owners’ satisfaction with the level of recovery achieved by the animal, often leading to discontinuation of physical therapy. The high rate of unsatisfactory outcomes in feline patients can be explained by the type of injury (spinal trauma) and the degree of neurological dysfunction. Adult female dogs were most likely to be referred to the physical therapy sector, and the Dachshund and Poodle breeds were most prevalent. Patients in the neurological dysfunction group had the highest average duration and number of sessions. Massage, stretching, passive joint mobilization, and neuromuscular electrical stimulation (NMES) were the most commonly used modalities in all physical therapy protocols. Satisfactory functional recovery was achieved in more than 60% of cases in both groups. The absence of a control group and the lack of standardization of physical therapy modalities precluded a more definitive confirmation of the results obtained in terms of functional recovery.

Therapeutic Advantages of Frequent Physical Therapy Sessions for Patients With Lumbar Spinal Stenosis.

A retrospective study of a randomized clinical trial and a prospective study of patients with lumbar spinal stenosis (LSS). The aim of this study was to identify the effects of the number of physical therapy (PT) sessions on clinical outcomes of patients with LSS. Supervised PT for patients with LSS has been reported to lead to better short-term outcomes in terms of disability and leg pain than unsupervised exercise. However, no studies have investigated the relationship between the number of PT sessions and the therapeutic effects in patients with LSS. All patients received exercise therapy for 6 weeks. Included were 43 patients receiving supervised PT twice a week (P2 group), 38 patients receiving supervised PT once a week (P1 group), and 43 patients receiving a home exercise program alone (HE group). Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), a numerical rating scale (NRS) of back pain and leg pain, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at baseline and at 6 weeks. At 6 weeks, the P2 group showed significant improvements in ZCQ physical function, back and leg pain on the NRS compared with the P1 group (P < 0.05). Compared with the HE group, the P2 group showed significant improvements in ZCQ symptom severity and physical function, back and leg pain on the NRS, and JOABPEQ gait disturbance (P < 0.05). There were no significant differences in mean changes after 6 weeks between the P1 and HE groups. Six weeks of supervised PT twice a week resulted in significant short-term improvements in symptom severity, physical function, back and leg pain, and gait disturbance compared with once a week and/or home exercise alone. Patients with LSS should be treated with intensive and supervised exercise programs to obtain maximum benefit of exercise therapy. 3.

Análisis del efecto de la fisioterapia temprana en la recuperación funcional de pacientes con quemaduras en miembros inferiores

IntroductionRecovery of activities of daily living in burn patients depend on timely and effective care, including physical rehabilitation. AimTo evaluate functional activity in lower limb burn patients after early rehabilitation. MethodsA retrospective, longitudinal, and analytic trial was conducted in order to assess the association between the number of physiotherapy sessions and the functional outcome in lower limb burn patients. Uni-, bi-, and multivariate analyses were performed in order to determine the distribution characteristics of the sample, and any significant association between variables. ResultsAfter a review of data from 32 patients that fulfilled trial enrolment criteria, a simple association was shown between complete joint motion, sitting position, standing and walking vs. the number of physiotherapy sessions, but failed to maintain or improve muscle strength. Multivariate analysis demonstrated a positive correlation between the number of physiotherapy sessions and sitting position, but a negative one when mechanical ventilation was related to standing/walking. ConclusionThe early administration of physiotherapy helps in the functional recovery of burn patients; nevertheless it is critical to consider that catabolic processes impair motion.

Efficacy and Tolerability of Progen, a Nutritional Supplement Based on Innovative Plasma Proteins, in ACL Reconstruction: A Multicenter Randomized Controlled Trial.

Background:New biologic strategies are arising to enhance healing and improve the clinical outcome of anterior cruciate ligament (ACL) reconstruction.Purpose:To evaluate the efficacy of a new oral nutritional supplement (Progen) that contains hydrolyzed collagen peptides and plasma proteins, a hyaluronic acid–chondroitin sulfate complex, and vitamin C.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:The study included patients who underwent ACL reconstruction with hamstring autografts using the same fixation method. All patients received the same analgesia and physical therapy (PT) protocol and were randomized to receive either the nutritional supplement (supplemented group) or no additional therapy (control group). Patients were followed up at days 7, 30, 60, and 90. Pain was assessed by use of a visual analog scale (VAS) and by analgesic consumption. Clinical outcome was assessed via International Knee Documentation Committee (IKDC) score and the number of PT sessions. Perceived efficacy and tolerability were rated on a 5-point Likert scale. Graft maturation was assessed by a blinded musculoskeletal radiologist using magnetic resonance imaging. The number of adverse events (AEs) was recorded.Results:The intention-to-treat analysis included 72 patients, 36 allocated to the supplemented group and 36 to the control group, with no significant differences regarding demographic and preoperative characteristics. Both groups showed significant improvement in pain and function (measured by VAS and IKDC scores) during the 90-day follow-up period (P < .001 for both), without significant differences between groups. The supplemented group had fewer patients that needed analgesics (8.5% vs 50.0%; P < .05) and attended fewer PT sessions (38.0 vs 48.4 sessions; P < .001) at 90 days and had a higher IKDC score at 60 days (62.5 vs 55.5; P = .029) compared with the control group. Patient- and physician-perceived efficacy was considered significantly higher in the supplemented group at 60 and 90 days (P < .05). Perceived tolerability of the overall intervention was better in the supplemented group at 30, 60, and 90 days (P < .05). Graft maturation showed more advanced degrees (grades 3 and 4) in the supplemented group at 90 days (61.8% vs 38.2%; P < .01). No intolerance or AEs associated with the nutritional supplement treatment were reported.Conclusion:The combination of the nutritional supplement and PT after ACL reconstruction improved pain, clinical outcome, and graft maturation. Nutritional supplementation showed higher efficacy during the second month of recovery, without causing AEs.Registration:NCT03355651 (ClinicalTrials.gov identifier).

An Exploration of the Impact of Initial Timing of Physical Therapy on Safety and Outcomes After Concussion in Adolescents.

Physical therapy (PT) is a management strategy increasingly recognized to facilitate recovery after concussion. The purpose of this study was to investigate the safety and outcomes of multimodal impairment-based PT at varying time points after injury in youth diagnosed with concussion. Data were extracted retrospectively from medical records for patients who received PT for concussion-related impairments. Patient records were categorized into 3 cohorts on the basis of the timing of PT implementation: 0-20 days following injury (early intervention), 21 to 41 days following injury (middle intervention), and 42 or more days following injury (late intervention). The primary outcome measure was Post-Concussion Symptom Inventory score from the beginning to the end of the PT episode of care. Additional outcome measures included number of PT sessions, duration of PT episode of care (days), and occurrence of unplanned visits to a health care provider. A total of 120 patient records (mean age of 14.77 years) were analyzed. Thirty-three, 39, and 48 individuals were categorized into the early, middle, and late intervention cohorts, respectively. There were no significant differences between intervention cohorts with regard to symptom change on the Post-Concussion Symptom Inventory from the beginning to the end of the PT episode of care, unplanned health care visits, number of PT sessions, or duration of PT episode of care. Early initiation of PT may be safe and tolerable. Future prospective studies are needed to explore the efficacy of PT services administered early following injury to help characterize an optimal care plan for youth following concussion.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A210).

Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial.

BackgroundIntegrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions.ObjectiveThe objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA.DesignThe design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial.SettingThe setting included 143 primary care physical therapist practices.ParticipantsThe participants were 208 people who had hip/knee OA and were 40 to 80 years of age.Interventione-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA.MeasurementsPrimary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.ResultsThe e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy.LimitationsThe response rate at 12 months was 65%.ConclusionsThe blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.

Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture.

Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC). 109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT = 0-3 and high PT = 4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake. We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On the other hand, PT, time since injury and medication seemed to be associated with the presence of muscle contracture. Our results suggest that, in subacute and chronic patients with DOC, PT could have an impact on patients' spasticity and muscles contractures. Beside PT, other factors such as time since onset and medication seem to influence the development of muscle contractures. These findings support the need for frequent PT sessions and regular re-evaluation of the overall spastic treatment for patients with DOC.

Conservative treatment for patients with subacromial impingement: Changes in clinical core outcomes and their relation to specific rehabilitation parameters.

BackgroundImpaired patient-reported shoulder function and pain, external-rotation strength, abduction strength, and abduction range-of-motion (ROM) is reported in patients with subacromial impingement (SIS). However, it is unknown how much strength and ROM improves in real-life practice settings with current care. Furthermore, outcomes of treatment might depend on specific rehabilitation parameters, such as the time spent on exercises (exercise-time), number of physiotherapy sessions (physio-sessions) and number of corticosteroid injections, respectively. However, this has not previously been investigated. The purpose of this study was to describe changes in shoulder strength, ROM, patient-reported function and pain, in real-life practice settings, and explore the association between changes in clinical core outcomes and specific rehabilitation parameters.MethodsPatients diagnosed with SIS at initial assessment at an outpatient hospital clinic using predefined criteria’s, who had not undergone surgery after 6 months, were included in this prospective cohort study. After initial assessment (baseline), all patients underwent treatment as usual, with no interference from the investigators. The outcomes Shoulder Pain and Disability Index (SPADI:0–100), average pain (NRS:0–10), external rotation strength, abduction strength and abduction ROM, pain during each test (NRS:0–10), were collected at baseline and at six month follow-up. Amount of exercise-time, physio-sessions and steroid-injections was recorded at follow-up. Changes in outcomes were analyzed using Wilcoxon Signed-Rank test, and the corresponding effect sizes (ES) were estimated. The associations between changes in outcomes and rehabilitation parameters were explored using multiple regression analyses.ResultsSixty-three patients completed both baseline and follow-up testing. Significant improvements were seen in SPADI (19 points, ES:0.53, p < 0.001) and all pain variables (median 1–1.5 points, ES:0.26–0.39, p < 0.01), but not in strength and ROM (ES:0.9–0.12, p > 0.2). A higher number of physio-sessions was significantly associated with larger improvements in external rotation strength (0.7 Newton/session, p = 0.046), and higher exercise-time was significantly associated with decrease in average pain (−0.2 points/1,000 min, p = 0.048).DiscussionPatient-reported function and pain improved after six months of current care, but strength and ROM did not improve. This is interesting, as strengthening exercises is part of most current interventions. While two significant associations were identified between self-reported rehabilitation parameters and outcomes, the small gains per physio-session or 1,000 min of exercise-time reduces the clinical relevance of these relationships. Collectively, the findings from this study indicate room for improvement of the current rehabilitation of SIS, especially with regard to core clinical outcomes, such as strength and range of motion.

Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: a retrospective analysis of medical claims data

Parkinson's disease is a complex condition that is best managed by specialised professionals. Trials show that specialised allied health interventions are cost-effective, as compared with usual care. We aimed to study the long-term benefits of specialised physiotherapy using the ParkinsonNet approach in real-world practice. We did an observational study, retrospectively analysing a database of health insurance claims that included a representative population of Dutch patients with Parkinson's disease, who were followed for up to 3 years (Jan 1, 2013, to Dec 31, 2015). Eligibility criteria included having both a diagnosis of Parkinson's disease and having received physiotherapy for the disease. Allocation to specialised or usual care physiotherapy was based on the choices of patients and referring physicians. We used a mixed-effects model to compare health-care use and outcomes between patients treated by specialised or usual care physiotherapists. The primary outcome was the percentage of patients with a Parkinson's disease-related complication (ie, visit or admission to hospital because of fracture, other orthopaedic injuries, or pneumonia) adjusted for baseline variables. We compared physiotherapist caseload, the number of physiotherapy sessions, physiotherapy costs, and total health-care costs (including hospital care, but excluding community care, long-term care, and informal care) between the groups, and used a Cox's proportional hazard model for survival time to establish whether mortality was influenced by treatment by a specialised physiotherapist. We analysed 2129 patients (4649 observations) receiving specialised physiotherapy and 2252 patients (5353 observations) receiving usual care physiotherapy. Significantly fewer patients treated by a specialised physiotherapist had a Parkinson's disease-related complication (n=368 [17%]) than patients treated by a usual care physiotherapist (n=480 [21%]; odds ratio 0·67, 95% CI 0·56-0·81, p<0·0001). The annual caseload of patients per therapist was significantly higher for specialised physiotherapists (mean 3·89 patients per therapist [SD 3·91]) than usual care physiotherapists (1·48 [1·24]). Patients who saw specialised physiotherapists received fewer treatment sessions (mean 33·72 [SD 26·70]) than usual care physiotherapists (47·97 [32·11]). Consequently, expenditure was lower for specialised than usual care physiotherapists, both for direct costs (mean €933 [SD 843] vs €1329 [1021]; annual difference €395, 95% CI 358-432, p<0·0001) and total health-care expenditure (€2056 [3272] vs €2586 [3756]; €530, 391-669, p<0·0001). Mortality risk was lower for patients receiving specialised physiotherapy (134 [6%]) compared with patients receiving usual care physiotherapy (205 [9%], p=0·001) before correction for baseline variables, although Cox's survival model showed no significant difference between the two (hazard ratio 0·86, 95% CI 0·69-1·07, p=0·195). These results confirm the findings from controlled trials, and offer evidence that specialised physiotherapy as delivered through ParkinsonNet is associated with fewer Parkinson's disease-related complications and lower costs in real-world practice. Neurologists can facilitate specialised physiotherapy by specific referral to such experts. None.

Effect of isokinetic hip flexors strength training on walking in persons with subacute stroke: Feasibility study

Use of isokinetic muscle strengthening is spreading in neurological rehabilitation, especially to improve gait in stroke patients. However, contrary to ankle and knee muscles, hip flexors strengthening stay few investigated in this population. The aim of our study was to determine the feasibility and the effects of an isokinetic training of paretic hip flexors on several gait parameters (gait speed and endurance, perceived exertion), muscle strength (ilio-psoas), spasticity and also balance, transfers and stair-climbing abilities. Twelve hemiparetic participants who had suffered from a first episode of stroke were randomized into two groups during a fifteen months period. During six weeks, the control group benefited from ten usual physiotherapy sessions each week, whereas the experimental group undertook the same number of physiotherapy sessions but three of those were dedicated to isokinetic exercises. The Con-Trex Isokinetic Dynamometer was used to perform eccentric hip flexors strengthening sessions. Analytic and functional assessments were carried out at the inclusion time (T0) and after six weeks of rehabilitation (T1). Our early results highlighted a significant improvement for the primary endpoint (ten meters walking test) for the experimental group only (P = 0.028) and for most of the secondary endpoints of this group, except the peak torque (P = 0.463) and the power of paretic hip flexors (P = 0.249). These early results seem to indicate a beneficial effect of isokinetic hip flexors strengthening protocol in subacute stroke gait rehabilitation. Those results must be confirmed in further studies.

Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines

We assessed the effect of four-corner intercarpal fusion with locking plate without bone graft on daily activities and pain in patients with stage II and III scapholunate advanced collapse and scaphoid nonunion. Twenty-one patients who underwent four-corner fusion with scaphoidectomy without bone graft were evaluated with the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Visual Analog Scale (VAS) pain scores before and 16 months after surgery. We also compared postoperative grip strength between the operated and the healthy side. A principal component analysis was used to establish the relationship between functional benefit, immobilization period and number of physiotherapy sessions. We compared our results with published data. VAS and QuickDASH scores improved significantly. Loss of strength was observed postoperatively. QuickDASH score improved the most with a short immobilization period. No significant difference was found relative to the literature for follow-up time, range of motion, grip strength and QuickDASH score. All patients had bone fusion after 1 year. Four-corner fusion with locking plate is a procedure that reduces pain and improves functional scores. Our results are equal to those reported in the literature with bone graft. The union rate seemed high despite the absence of bone graft but was only assessed by x rays. This study allowed us to establish a treatment guideline: a shorter immobilization leads to better recovery.

The effects of the number of physical therapy sessions on pain, disability,and quality of life in patients with chronic low back pain

Background/aim: The aim of this study was to investigate and compare the effect of different physical therapy (PT) session numbers on pain, impairment. and quality of life in patients with chronic low back pain (LBP).Materials and methods: In this prospective, randomized-controlled, single-blind trial, a total of 60 patients with chronic LBP were divided into 2 groups with simple randomization within the scope of the study. A PT program of a total of 10 sessions was applied for patients in Group 10 (n = 30) and a total of 15 sessions for patients in Group 15 (n = 30). The main outcome measures were fingertip-to-floor distance (FFD), a visual analog scale (VAS), the modified Oswestry Disability Index (mODI), and the Nottingham Health Profile (NHP).Results: We found statistically significant differences in both groups between the before-treatment (BT) and after-treatment (AT) results in terms of all evaluation parameters. We detected significant differences between the 2 groups in terms of AT VAS, mODI, NHP Pain, and NHP Total; however, no significant differences were found in terms of FFD and the other NHP subdimension levels.Conclusion: We determined that 15 treatment sessions were more effective than 10 sessions on pain and disability in patients with chronic LBP.