Outpatient Rehabilitation Department Research Articles

Legal regulation of rehabilitation in the field of health care

The article notes that the law guarantees everyone the right to health care and medical assistance. A full-scale invasion calls for the development and updating of legal acts on ensuring a person’s right to medical assistance, in particular, to the provision of rehabilitation services. It is noted that rehabilitation assistance is aimed at a number of main areas, firstly, at supporting the functions of the patient’s body during the exacerbation of chronic diseases. Secondly, for warning, early diagnosis of disorders of the organs and systems of the patient’s body. The third direction is aimed at full or partial restoration of damaged organs or systems and compensation of lost functions of affected organs or systems. The fourth direction is related to the prevention and reduction of the degree of disability. The author emphasizes that the lack of competent and effective medical rehabilitation in Ukraine is a multifactorial problem: there is an insufficient number of inpatient and outpatient rehabilitation departments; lack of medical personnel - rehabilitation specialists, psychologists; there is not enough rehabilitation equipment; there is a need for adequate educational programs for physicians. In the article, the author emphasizes that one of the tasks of the state is to help persons with disabilities realize their constitutional rights; implementation of state policy in the field of rehabilitation of persons with disabilities, support for their integration into society, and the full-scale war on the territory of Ukraine causes an increasing urgency and need for the rehabilitation of persons injured as a result of hostilities. Such factors of the population’s health, such as the increase in morbidity, injuries, temporary loss of working capacity, premature mortality of the population require the development of the rehabilitation medicine market of Ukraine and its legal regulation. The article notes that the positive aspects are the development of new medical rehabilitation technologies, including those based on telemedicine and IT technologies, the preparation of new professional standards for medical rehabilitation at the modern level in accordance with international recommendations. All this requires the effective functioning of the system, which first of all requires the improvement and development of regulatory and legal support in the field of rehabilitation.

Turnover intention of foreign trained physicians in German rehabilitation facilities—a quantitative study

BackgroundGermany’s medical specialist shortage is an acute challenge, especially in the rehabilitation segment. One countermeasure is to recruit foreign trained physicians (FTP), but the high turnover of FTP is a burden on the departments that train them and integrate them professionally. Preliminary research showed that currently one in three physician positions in German Pension Insurance (DRV) contract facilities is filled by FTP.This paper examines factors related to turnover intention of FTP in German rehabilitative departments.MethodologyIn spring 2022, we surveyed FTP across all inpatient and outpatient rehabilitation departments under the German Pension Insurance, using a two-stage cross-sectional approach. We conducted an online survey of FTP and developed a specialized questionnaire that captured sociodemographic, occupation related and professional biographical data, turnover intention, satisfaction, difficulties with professional integration and departmental structural characteristics. To analyze retention within the rehabilitation field, we used a measure of turnover intention, taking into account the direction of potential turnover, residency requirements and considerations of returning to the rehabilitation field. The data was evaluated in a subgroup analysis comparing FTP with and without turnover intention using Fisher’s exact tests.ResultsThe sample includes n = 145 FTP, 119 stating no turnover intention and 27 with turnover intention. More than half of FTP with turnover intention wished to move to an acute care hospital. FTP with turnover intention are comparatively younger and came to Germany and were employed in the rehabilitation departments more recently, indicating an earlier career stage. Besides, career-related and regional factors show the strongest relation to turnover intention.Discussion and conclusionThe results reveal a group of “established FTP” whose professional integration has been successfully completed. FTP with turnover intention are comparatively younger, career-oriented physicians for whom work in a rehabilitative facility is a career springboard to gain a foothold in acute care clinics. A limitation is that FTP with turnover intention are difficult to reach and may be underrepresented in our sample.

An update on the access to inpatient rehabilitation facilities across Tunisia in 2023.

Considering the growing global need and the complexity of health conditions, an intensive rehabilitation in inpatient departments is fundamental. Yet, in Tunisia, the distribution of Inpatient Rehabilitation Facilities is not illustrated. To perform an update concerning the rehabilitation's beds-ratio /1000 Tunisian-inhabitants in 2023. Data were collected from the Tunisian Ministry of Health, the Eastern Mediterranean Regional Office, and the National Institute of Statistics websites. The findings revealed a total number of rehabilitations' beds 132 among a total of 20000 hospital beds with a rehabilitations' beds-ratio equal to 0.01/1000 inhabitants. Only three Inpatient Rehabilitation Facilities were identified in Tunisia covering the Greater Tunis, North East, and Center east districts. There was inequity of distribution since the beds ratio is 1.07/1000 in the North east, 0.02/1000 in the Greater Tunis and 0 in the North West and the South of Tunisia. This update highlighted the alarmingly low rehabilitation's beds-ratio in Tunisia, coupled to a significant regional disparity. Increasing beds in the existing Inpatient Rehabilitation Facilities and extending outpatient rehabilitation departments with inpatient units might be considered urgent solutions.

The effect of a motor relearning on balance and postural control in patients after stroke: An open-label randomized controlled trial.

Balance and postural control impairments are common in stroke patients, increasing fall risk and limiting their daily and social activities. Current research lacks comprehensive studies evaluating the efficacy and long-term effects of task-specific training on balance and postural control among stroke patients, especially when considering biomechanical and posturographic assessments. A randomized controlled trial included 63 subacute stroke patients recruited from the outpatient rehabilitation department. Participants were randomly assigned to the MRP group (n=32), receiving task-specific training based on MRP, or the CPT group (n=31), receiving conventional physical therapy. Both groups completed an 8-week intervention (3 sessions/week; 1 h./session). Balance and postural control were assessed at baseline, post-intervention, and 3-month follow-up using the Berg Balance Scale (BBS) and posturography. The MRP group exhibited significantly larger improvements than the CPT group in both BBS scores (p=0.001, d=2.98, 95% CI [2.25, 3.70]) and Balance Index scores (p=0.001, d=2.83, 95% CI [2.12, 3.53]) after the intervention. These improvements were sustained at 3-month follow-up. The findings suggest that task-specific training based on MRP is more effective than CPT for improving balance and postural control. The MRP intervention may enhance the motor learning and neural plasticity of the patients, leading to better functional outcomes. However, the study's open-label design represents a limitation, and further research with adequate blinding is needed. Task-specific training based on MRP was superior to CPT for improving balance and postural control in subacute stroke patients. Participants undergoing MRP exhibited significant and clinically relevant improvements that were sustained at follow-up.

Reliability and validity of the Hebrew version of the International Spinal Cord Injury Activities and Participation Basic Data Set.

The International Spinal Cord Injury (SCI) Activities and Participation Basic Data Set (APBDS) was created to facilitate comparisons of levels of function and disability in SCI individuals worldwide. Evaluating the reliability and validity of the APBDS's Hebrew translation was our goal. Observational, cross-sectional study. University and Outpatient Rehabilitation Department of a Medical Center. Individuals with spinal cord injury (SCI). The APBDS's Hebrew version was administered to fifty individuals with SCI. Reliability was evaluated through Cronbach Alpha Test and a test-retest method. Validity was determined by testing for convergence with the World Health Organization Disability Assessment Scale (WHODAS) 2.0 and the Medical Outcomes Short Form Health Survey (SF-12). The Hebrew APBDS had a high test-retest reliability (ICC=0.792) and an adequate Cronbach alpha test (α=0.792). Significant convergent validity was partial with both the WHODAS 2.0 (strong in the self-care objective (r=-0.648) and subjective (r=-0.666), moderate in the total objective (r=-0.640) and subjective (r=-0.570) domains of the APBDS) and the SF-12 (moderate between the total objective domain and the Physical composite score (r=0.378), poor with the Mental composite score (r=0.310)). Although the Hebrew APBDS's moderate reliability and validity warrants further research, it opens new vistas regarding assessment of SCI individuals' satisfaction, activity, and participation. We feel that this data set may be used in the long-term follow-up of SCI individuals in the Sheba SCI rehabilitation registry.

Comparative analysis of osteopathic correction and standard comprehensive rehabilitation of patients with posttraumatic contractures of the upper limb joints

Introduction. Prolonged immobilization of the upper limb after various injuries leads to persistent contracture. Contractures of the upper limb joints are a severe orthopedic pathology that leads to a long-term decrease in working capacity and permanent disability. In the absence of treatment, the persistent changes in the articular elements can develop. Patients with contractures of the upper limb joints get treatment for a long time in polyclinics and hospitals, but the treatment does not always lead to the desired results. At the same time, an essential condition for treatment in outpatient medical institutions is the possibility of daily self-care and independent movement of the patient, as well as daily visits to a medical institution, but it is not always possible. In this regard, the search for treatment methods with comparable effectiveness, but requiring a signifi cantly smaller number of medical procedures and, accordingly, visits to specialized institutions, is relevant. Osteopathic correction could potentially be among these methods.The aim of the study is to compare the effectiveness of osteopathic correction and standard complex rehabilitation of patients with post-traumatic contractures of the upper limb joints.Materials and methods. The study involved 40 patients suffering from post-traumatic contractures of the upper extremities. Two groups were formed by the method of simple randomization: the main group (20 people who received osteopathic correction — 3 sessions with a frequency of 1 time in 7 days), and the control group (20 people who received standard complex rehabilitation, which included physiotherapy, physiotherapy exercises and mechanotherapy, daily for 10 days). The osteopathic status, the motion range of the upper limbs joints, and the hand muscles strength were assessed in all patients at the beginning and at the end of the study.Results. A statistically signifi cant (p<0,05) increase in the motion range and the hand muscles strength was found in both groups at the end of the study. In patients of the main group, receiving osteopathic correction, a statistically signifi cant decrease (p<0,05) in the detection frequency of some regional and local somatic dysfunctions was observed.Conclusion. The obtained results indicate the comparable results of the osteopathic correction of the upper limb joints post-traumatic contractures, and of the standard complex rehabilitation. Since osteopathic correction of post-traumatic contractures is carried out once every 7–10 days, it can be recommended for patients who, for various reasons, cannot regularly visit outpatient rehabilitation departments for a long time.

Effects of Service Quality and Patient Satisfaction on Patient Adherence at the Outpatient Rehabilitation Department of Fatmawati National Hospital in Jakarta

Introductions: The quality of services and patient satisfaction play an important role in increasing patient adherence. Fatmawati hospital is the national tertiary hospital in Indonesia that has a rehabilitation outpatient department as one of its excellent services. The rehabilitation outpatient department deals with patients that have chronic diseases. Many studies reported that patients with chronic disease verge on having less satisfaction and adherence. Meanwhile, patient satisfaction is used to evaluate health providers' quality. Therefore, this research intended to assess the effect of rehabilitation outpatient service quality and patient satisfaction on patient adherence at Fatmawati hospital. Methods: Cross-sectional study was conducted from December 2021 – to February 2022. Two hundred patients were included with a convenient sampling method. SPPS 25 Software was run to analyze the pilot study data, descriptive statistics, and multivariate regression. Results: According to the finding of this study, most patients had a positive experience in terms of service quality and patient satisfaction. As a result, its have a significant and positive effect on patient adherence. The structural equation Y = 7,502+0,211(X1)+0,822(X2) represents if service quality and patient satisfaction are equal to zero or constant, then patient adherence has a value of 7,502 units. If the quality of service were increased by one unit, the other variable equal to zero and constant, the value of patient adherence would increase by 0,211. On the other hand, patient adherence will be increased by 0,822 units when one unit increases patient satisfaction. Conclusion: The results suggest that improving service quality and patient satisfaction is an effective strategy for health providers in improving patient adherence in the rehabilitation outpatient department.

Effects of COVID-19 on Outpatient Visitation of Japanese Parkinson’s Disease and Parkinsonism Patients Receiving Rehabilitation

Background: Rehabilitation is effective for preventing progression of Parkinson’s disease (PD) and parkinsonism, but access to services during the COVID-19 pandemic was difficult. The Japanese already practice high levels of social distancing and personal restraint and are keenly aware of dangers related to infectious disease. We therefore presume that many patients discontinued rehabilitation due to behavioral restraint. Objectives: We investigated whether PD patients and parkinsonism patients attending outpatient rehabilitation facilities in Japan initiated rehabilitation interruptions and their associated reasons before and during the COVID-19 pandemic. Methods: Subjects were PD and parkinsonism patients attending a neurology clinic outpatient rehabilitation department in Japan before and during the first year of the COVID-19 pandemic (February 1, 2019, to January 31, 2021). Patients lost to follow-up were investigated as to how long they attended rehabilitation until interruption. We classified factors causing rehabilitation interruption into COVID-19-related factors, disease factors and social reasons. Results: Among 259 subjects (125 men, 134 women, mean age: 76.6 ± 8.5 years), 133 patients (51.4%) initiated interruption of rehabilitation therapy. Cumulative incidence of interruption events was significantly higher during than before the COVID-19 pandemic (p < 0.001). COVID-19-related factors dramatically increased as a reason for interruption after the pandemic started, but disease-related and social factors gradually increased thereafter. Incidences of disease-related and social factors before and during the COVID-19 pandemic were not different. Conclusions: Cumulative incidence of interruption events increased in Japanese PD and parkinsonian patients attending an outpatient rehabilitation facility during the COVID-19 pandemic, primarily due to COVID-19-related factors. Patients and their families need education and guidance to facilitate continuous rehabilitation.

A Nationwide pilot project to develop rehabilitation services for patients with cardiovascular diseases.

ObjectiveTo measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases.MethodsSeventeen hospital and outpatient medical centres from 13 regions of the Pilot Project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation.ResultsThe pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients’ stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017.ConclusionDespite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.LAY ABSTRACTWithin the 5-year follow-up, we evaluated the implementation of a three-phase rehabilitation programme based on the multidisciplinary approach for patients with cardiovascular diseases in 17 healthcare institutions located in 13 cities of the Russian Federation. By the end of 2017, phases 1 and 2 cardiac rehabilitation fully corresponded to the main principles stated in the Russian clinical guidelines. All patients underwent educational sessions and physical exercise. The implementation of phase 3 cardiac rehabilitation proved to be the most difficult one to implement as it required the establishment of separate outpatient cardiac rehabilitation departments with the necessary sports gear and specialists. Thus, further improvement of rehabilitation programs is necessary. Special attention needs to be focused on the standards and principles of providing phase 3 cardiac rehabilitation followed by the introduction of the three-phase cardiac rehabilitation in other regions of the country.

The effectiveness of Kinesio Taping® for mobility and functioning improvement in knee osteoarthritis: a randomized, double-blind, controlled trial

Objective: To evaluate the effectiveness of the Kinesio Taping® method for mobility and functioning improvement for patients with knee osteoarthritis (KO). Design: Randomized, double-blinded, controlled trial. Setting: Outpatient rehabilitation department. Subjects: A total of 187 subjects with symptomatic I–III grade KO participated; of these, 157 subjects were included in the analyses (intervention group, n = 81 (123 knees); control group, n = 76 (114 knees). Intervention: The intervention group received a specific Kinesio Taping application, and the control group received non-specific knee taping for a month. Main measures: Changes in Knee injury and Osteoarthritis Outcome Scores (KOOS), knee active range of motion, 10-Meter Walk, and the five times sit to stand tests (5xSST) were assessed at baseline, after four weeks of taping, and a month post taping intervention. Subjective participants’ experiences and opinions on the effect of knee taping were evaluated. The chosen level of significance was p < 0.05. Results: The mean age of participants was 68.7 ± 9.9 in intervention group and 70.6 ± 8.3 in control group (p > 0.05). The change from baseline in gait speed in the intervention group after taping month was +0.04 ± 0.1 m/s, at follow-up +0.06 ± 0.1 m/s; in control group +0.07 ± 0.1 m/s, and +0.09 ± 0.1 m/s; the change in time needed to accomplish 5xSST was –2.2 ± 3.2 seconds, at follow-up –2.4 ± 3.1 seconds; in control group –2.8 ± 3.6 seconds, and –2.4 ± 4 seconds. Improved knee flexion and enhancement in functioning assessed by KOOS were noticed in both groups, with lasting improvement to follow up. No difference in the change in the above-mentioned outcomes was found between groups (p > 0.05). Fewer subjects (6.2% (5) vs. 21.1% (16), χ2 = 7.5, df = 2, p = 0.024) from Kinesio Taping group were unsure if taping alleviated their mobility and more intervention group patients indicated higher subjective satisfaction with the effect of knee taping to symptom and mobility alleviation than control group (p < 0.005). Conclusion: Investigated Kinesio Taping technique did not produce better results in mobility and functioning improvement over non-specific knee taping; however, it had higher patient-reported subjective value for symptom attenuation and experienced mobility enhancement.

The necessity of rehabilitation in children with Down syndrome

Abstract Introduction: Children with Down syndrome have associated impairments of the musculoskeletal system and connective tissue (joint hypermobility), and of the neurologic system (hypotonia, mental retardation, developmental delay). Aim: We conducted a retrospective study that had in view the quantification of the number of children suffering from Down syndrome who attended rehabilitation programmes in the Rehabilitation Department of “Louis Ţurcanu” Emergency Children’s Hospital Timisoara for a 3-year period (between November 2016 and October 2019). Methods: The study included 21 children with Down syndrome; their age ranged from 2 weeks to 15 years, with 52% of the children being in the 0-12 months group. All patients were included in a rehabilitation programme of the outpatient Rehabilitation Department (with 10 daily sessions) every 6 months. Results: We point out the importance of the rehabilitation team in the management of children with Down syndrome. Conclusion: The physical therapy programme should be for a long term, it should be started as early as possible (even in the first weeks of life) and followed continuously through the entire growth period and also during adulthood.

Effect of Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) on Compensatory Articulation in Children With Cleft Palate/Lip.

Objective. This investigation researched the effectiveness of the PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) method to address compensatory articulation errors in children with cleft palate. Design. Single-subject AB multiple baselines across participants and behaviors. Setting. Pediatric outpatient rehabilitation department in a local hospital in a metropolitan city. Participants. The investigation consisted of 3 participants (ages = 4:4 to 12:8) born with bilateral complete cleft lip and palate. All participants underwent several reconstructive surgeries to repair their lips and palates. Interventions. The PROMPT treatment was provided for 45 minutes 3 times a week for 4 weeks (3 weeks for Participant 2). Main Outcome Measure. Therapy sessions addressed anterior lingual speech motor phonemes across 3 tiers (syllables, words, and phrases). Results. Direct visual observation of data obtained throughout this investigation indicate potential positive effects and significant correlation between improvements in sound production at 3 tiers and the implementation of the PROMPT technique. Speech intelligibility was judged by 3 blinded listeners who were unfamiliar with children with speech disorders or with cleft palate speech. All listeners identified and judged improvement in overall speech intelligibility over the course of this investigation. Listeners examined speech samples selected from sessions 3, 6, 9, and 12. Conclusion. The findings in this investigation provide a potential relationship on the effectiveness of the PROMPT method and attainment of accurate speech productions in children with cleft palate producing compensatory articulation errors, resulting in improvement in overall speech intelligibility.

Development of a clinical prediction rule to identify patients with plantar heel pain likely to benefit from biomechanical anti-pronation taping: A prospective cohort study

ObjectivesTo develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT). DesignA prospective cohort study. SettingAn outpatient rehabilitation department in a general hospital. ParticipantsSeventy-five patients with PHP. Main Outcome MeasuresAfter completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement. ResultsTwenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%. ConclusionsA CPR has been developed to identify patients with PHP likely to benefit from BAPT.

Training adults with acquired brain injury how to help-seek when wayfinding: an understudied critical life skill

ABSTRACTThe objective of this study was to investigate the efficacy of a group treatment protocol called NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress) to train help-seeking when wayfinding for individuals with acquired brain injury (ABI). Seven participants completed the NICE group treatment in an outpatient rehabilitation department at a university medical centre. A single subject multiple baseline design was employed to evaluate the efficacy of the NICE group treatment. The Social Behaviour Rating Scale and the Executive Function Route-Finding Task- Revised were repeated measures used to evaluate potential changes in help-seeking and wayfinding. Secondary outcome measures included pre- and post-treatment evaluation of social problem solving and social cognition. Results revealed that all participants improved on measures of help-seeking and wayfinding. Patterns of improvement and implications for rehabilitation are discussed. This is the first experimental study to evaluate the treatment of help-seeking behaviours and discuss its application to wayfinding in adults with ABI. Preliminary evidence supports further investigation of the NICE group treatment protocol.

Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial

Background: Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS). Objective: To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue. Methods: A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength – CIS20r) and participation (Impact on Participation and Autonomy scale – IPA). Results: Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = −0.81; 95% confidence interval (CI), −3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35). Conclusion: The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.

OSTEOPATIJOS EFEKTYVUMAS REABILITACIJOS PROCESE

Vykdant intensyvią reabilitacijos programą pacientams, besiskundžiantiems apatinės nugaros dalies skausmu, praktinėje veikloje fizinės medicinos ir reabilitacijos gydytojai susiduria su nuolatiniu klausimu, kokias reabilitacijos priemones parinkti pacientui ir kaip sudaryti kuo optimalesnę reabilitacijos programą, kad būtų pasiektas geriausias gydymo rezultatas. Atliktas tyrimas gali palengvinti šią užduotį, atskleidžiant kol kas Lietuvos mokslinėje literatūroje nenagrinėjamo gydymo metodo, osteopatijos, panaudojimo ir efektyvumo galimybes. Tikslas. Palyginti osteopatinės procedūros ir laisvo kybojimo metodu pagrįstos kineziterapijos procedūros kaip sudedamųjų reabilitacijos dalių poveikį pacientams, besisukundžiantiems apatinės nugaros dalies skausmu. Metodai. Tyrimas buvo atliktas 2014 - 2015 metų lapkričio - balandžio mėnesiais. Tyrime dalyvavo į Vilniaus universiteto ligoninės Santariškių klinikų Ambulatorinės reabilitacijos skyrių kreipęsi pacientai dėl apatinės nugaros dalies skausmų ir savarankiškai sutikę dalyvauti tyrime. Pradinis pacientų būklės įvertinimas pagal parengtą protokolą buvo atliekamas per dvi pirmas darbo dienas, skaičiuojant nuo atvykimo į reabilitacijos programą dienos. Atlikta anketinė apklausa, kurią sudarė dokumentinė dalis ir funkcinės būklės klausimynai. Kliniškai vertinta skausmo charakteristika ir atliktas stuburo funkcinės būklės ištyrimas naudojant kompiuterizuotą įrangą „Insight 7000 Subluxation Station“. Pacientai atsitiktiniu būdu suskirstyti į dvi homogeniškas grupes: eksperimentinę ir kontrolinę, kurioms sudarytos vienodos reabilitacijos programos, besiskiriančios papildomai taikomom procedūrom. Eksperimentinės grupės pacientams buvo papildomai taikomos standartizuotos osteopatinės procedūros, o kontrolinės grupės pacientams - laisvo kybojimo metodu pagrįstos kineziterapijos procedūros. Visose tiriamųjų grupėse procedūros buvo atliekamos tų pačių specialistų ir taikant tas pačias metodikas. Antrasis vertinimas atliktas tą pačią arba kitą dieną baigus reabilitacijos programą. Statistinė duomenų analizė atlikta naudojant SPPS 20.0 programą bei MS Excel. Rezultatai. Tyrime dalyvavo 43 pacientai, 30 (69,8%) moterų ir 13 (30,2%) vyrų. Amžiaus vidurkis 44,4 metai ± 12,8, jauniausias pacientas buvo 23 metų amžiaus, vyriausias – 68 metų amžiaus. 93% visų tiriamųjų sudarė reguliariai dirbantys asmenys. Tiriamųjų pasiskirstymas pagal skausmo fazes: ūmi fazė – 9 (20,9 %) tiriamieji; poūmė - 2 (4,7 %), o lėtinio skausmo paūmėjimo fazė – 32 (74,4 %) tiriamieji. Taikant reabilitacijos programą, skausmo intensyvumas pagal SAS vertinimo skalę sumažėjo vidutiniškai nuo 5,79 ± 1,92 iki 3,37 ± 1,90 balo (p&amp;lt; 0,05). Nustatytas statistiškai reikšmingas pokytis vertinat Roland – Morris klausimynu: pacientų pirminių įvertinimų vidurkis buvo 8,63 ± 6,65, po reabilitacinio gydymo 4,79 ± 3,15 (p&amp;lt;0,05). Oswestry klausimyno analizės duomenimis, didžioji dalis pacientų - 53,5% prieš reabilitaciją buvo vidutinio sunkumo negalios lygyje. Po taikytos reabilitacijos funkcinės būklės apribojimas daugeliui sumažėjo iki minimalios negalios – atitinkamai tai sudarė 28 (65%) pacientai. Ištyrus kontrolinės ir eksperimentinės grupių pacientus pagal SAS, jų funkcinę būklę ir palyginus abiejų grupių tiriamuosius po reabilitacijos, nustatyta, kad rodikliai labiau pagerėjo pacientų grupėje, kuriems buvo taikytos osteopatinės procedūros (p&amp;lt;0,05). Išvados. 1. 93% visų tiriamųjų, atvykusių dėl apatinės nugaros dalies skausmų, sudarė reguliariai dirbantys asmenys. 2. Taikyta reabilitacijos programa patikimai sumažino skausmo intensyvumą pagal SAS nuo 5,79 ± 1,92 iki 3,37 ± 1,90 balo (p&amp;lt; 0,05). 3. Funkcinės būklės pagerėjimą patikimai atspindėjo funkcinių testų duomenys: pagal Oswestry negalios indeksą po reabilitacijos programos funkcinės būklės apribojimas daugeliui sumažėjo iki minimalios negalios – atitinkamai tai sudarė 65 % visų pacientų; Roland-Morris negalios įvertis vidutiniškai sumažėjo nuo 8,63 ± 6,65 iki 4,79 ± 3,15 balo (p&amp;lt;0,05). 4. Patikimo skirtumo tarp pacientų stuburo funkcinės būklės prieš ir po reabilitacijos programos nenustatyta (p&gt;0.05). 5. Stebėti statistiškai reikšmingas skausmo sumažėjimas ir funkcinės būklės pagerėjimas pacientams, kuriems buvo taikytos osteopatinės procedūros lyginant su pacientais, kuriems buvo taikytos laisvo kybojimo metodu pagrįstos kineziterapijos procedūros. 6. Osteopatija turėtų būti įtraukta į reabilitacijos procesą, nes tai yra efektyvus gydymo metodas.

Pacientų po judamojo aparato traumų ir sergančių lėtinėmis neurologinėmis ligomis psichoemocinė būklė

Darbe analizuojama psichologinio darbo Reabilitacijos, fizinės ir sporto medicinos centre (RFSMC) dinamika, atsižvelgiant į pacientų srautų ir procedūrų pasiskirstymą tarp jo padalinių, bei atvykusių pacientų psichoemocinės būklės tyrimai. Tikslas - ištirti pacientų po judamojo aparato traumų ir sergančių lėtinėmis neurologinėmis ligomis srautų pokyčius per paskutinius dešimt metų bei apsilankiusių pacientų psichoemocinės būklės rodmenis per paskutinius penkerius metus. Statistiniai duomenys apima 2006 -2015 metus. Pas RFSMC psichologus lankėsi 7027 pacientai, kuriems buvo suteiktos 40 658 procedūros, priklausomai nuo sudarytos psichologo programos. Didžiausi pacientų srautai stebimi 2015 metais (panašūs skaičiai stebimi 2011 ir 2012 metais). Išlieka tendencija, kad pacientų skaičius auga, atitinkamai ir suteiktų medicinos psichologo paslaugų skaičius didėja būtent 2015 metais. Siekiant įvertinti apsilankiusių pacientų psichoemocinės būsenos dinamiką, buvo pasirinkti pacientai, apsilankę ambulatorinėje reabilitacijoje po judamojo aparato traumų ir sergantys lėtinėmis neurologinėmis ligomis 2010 - 2015 metų laikotarpiu. Psichologinės paslaugos buvo suteiktos 2944 pacientams. Pacientų po judamojo aparato traumų nerimo išreikštumo lygis pagal A.S. Zingmond Nerimo ir depresijos skalę (HADS), jiems atvykus į ambulatorinės reabilitacijos skyrių, buvo aukštesnis, lyginant su pacientų, sergančių lėtinėmis neurologinėmis ligomis. Depresinių reakcijų nestebėta arba jos buvo žemo lygio. Pacientų, sergančių lėtinėmis neurologinėmis ligomis ir kuriems buvo taikytos psichologinės procedūros, nerimo ir depresinės reakcijos sušvelnėjo. Pacientų atvykimo ir išvykimo metu aukšto lygio depresinių reakcijų nestebėta.

Factors Associated with the Outcome of Ultrasound-Guided Trochanteric Bursa Injection in Greater Trochanteric Pain Syndrome: A Retrospective Cohort Study

Background: Trochanteric bursa injections of corticosteroids and local anesthetics have been shown to provide pain relief for the treatment of greater trochanteric pain syndrome (GTPS). However, symptom recurrence and incomplete symptom relief are common. The reason for the variation in response is unclear but may be related to disease-, treatment-, or patient-related factors. Objective: To determine whether there are factors related to patient, treatment, or disease that can predict either the magnitude or duration of response to ultrasound-guided trochanteric bursa injections for GTPS. Study Design: Retrospective evaluation. Setting: A university hospital outpatient center. Methods: Potential study participants were patients who underwent ultrasound-guided trochanteric bursa injection at an outpatient rehabilitation department. Follow-up interviews were performed in a hospital visit at 1, 3, and 6 months after injection. The Harris Hip Score and the Verbal Numeric Pain Scale were used to evaluate clinical effectiveness of pain reduction and functional improvement at baseline, 1, 3, and 6 months after treatment. Clinical data and ultrasound findings were obtained to assess the possible predictive factors for a good and durable response to ultrasound-guided trochanteric bursa injection. Results: Patients receiving ultrasound-guided trochanteric bursa injections had a statistically significant improvement in pain and hip function at 1, 3, and 6 months after the last injections. Of the 137 patients, 110 (80.3%), 95 (64.9%), and 77 (56.2%) patients achieved successful outcomes according to their 1, 3, and 6-month follow-up evaluations, respectively. Univariate analysis showed that patients with knee osteoarthritis and lumbar facet joint or sacroiliac joint pain experienced less therapeutic effect than those without the conditions at 6 months post-injection. Logistic regression analysis showed that the significant outcome predictors at the 6-month followup were facet joint or S-I joint pain (odds ratio = 0.304, P = .014) and knee osteoarthritis (odds ratio = 0.329, P = .021). Age, gender, body mass index, and pain duration were not independent predictors of a clinically successful outcome. There was no statistically significant association between effective treatment and the ultrasound findings of tendinosis, bursitis, partial or fullthickness tear, and enthesopathic changes. Limitations: Retrospective chart review without a control group. Conclusions: This study suggests that knee osteoarthritis and lower back pain might be associated with a poor outcome of ultrasound-guided trochanteric bursa injection for GTPS. Assessment of these clinical factors should be incorporated into the evaluation and counseling of patients with GTPS who are candidates for ultrasound-guided trochanteric bursa injection. Key words: Bursa injection, corticosteroid, greater trochanteric pain syndrome, knee osteoarthritis, lower back pain, lumbar facet joint, ultrasonography, S-I joint pain

Focal Muscle Vibration Improves Gait in Parkinson's Disease: A Pilot Randomized, Controlled Trial.

In Parkinson's disease (PD), gait disorders lead to increased risk of falls and patients' reduced participation and independence. Several observations suggest that a single session of focal muscle vibration (fMV) applied to trunk or lower limb muscles during gait may improve several gait variables in patients with PD. The possible long-term beneficial effects of repetitive sessions of fMV (r-fMV) on gait of patients with PD have been investigated. A randomized, controlled trial study has been conducted in an outpatient rehabilitation department. Twenty patients with PD diagnosis have been randomized in two groups: "real" or "sham" r-fMV application to quadriceps and paraspinal muscles in patients with PD. Gait was evaluated with objective gait analysis, and a number of variables, including velocity, step length, stride length, percentage of stance, double support duration, cadence, swing velocity, and step width, have been measured. Gait analysis was performed before and 24 hours and 1 and 3 weeks after r-fMV. After real, but not sham, r-fMV, patients with PD had significant gait improvement as a result of increased walking velocity and stride length. The r-fMV-induced beneficial after effects lasted at least 1 week after the end of stimulation. Data emerging from our pilot randomized, controlled trial study suggest that r-fMV may improve gait disorders in patients with PD. r-fMV might be a feasible, safe approach for possibly improving gait disorders in patients with PD and might enhance the impact of specific rehabilitation programs in PD.

Brief report: Effects of exercise and self-affirmation intervention after traumatic brain injury.

Physical exercise has been proven to be an effective method for improving cognition and mood, but little is known about its benefits among individuals with traumatic brain injury. This pilot study investigated the feasibility of a combined exercise and self-affirmation intervention (IntenSati) for enhancing cognition and mood in individuals with TBI. It was hypothesized that this intervention would improve individuals' cognition and mood following the completion of the program. This intervention was held at an outpatient rehabilitation department in an urban medical center. A wait-list control design was conducted. Twenty-one adult participants-at least 12-months post-TBI-enrolled in the study. Twelve of them completed the study. Assessment was conducted at three time-points throughout the study using neuropsychological and self-report measures to evaluate participants' cognition and mood. Following initial evaluation, participants were assigned into either the immediate intervention group or the waitlist control group. During the intervention, participants attended the program twice a week over the course of 8 weeks. Debriefing was conducted following the completion of the program. Both independent t tests and paired t tests were utilized. Results indicated that the intervention group experienced less depressive symptoms following the completion of the IntenSati program compared to the waitlist control group. Participants also reported having less depressive symptoms, experienced more positive affect, and had a higher quality of life following the completion of the program. Moderate-to-large effect sizes were found on decrease in negative affect. However, results associated with cognitive benefits were mixed. The participants tolerated the program well and reported satisfaction with the program. Results from this study indicated that the IntenSati exercise program is a feasible and beneficial intervention for individuals with TBI as supported by the positive impact on their mood and quality of life.