Dependent Patients Research Articles

Physical therapy in a patient with viral -encephalitis hemi-paresis: A Case report

The purpose of the rehabilitation program is to improve motor skills, coordination, sensory system, mobilization and other existing disorders to achieve activity of daily living (ADL). Physical therapy as part of the multidisciplinary approach can provide core stability exercises, muscular facilitation and stimulation of motion of the upper and lower extremities, balance exercises and mobility exercises, as well as strengthening exercises with PNF facilitation and active stimulation techniques and using the patient's body weight as a training burden. Bobath approach and facilitation exercise can reduce spasticity by strengthening the antagonist muscles. MMT right upper extremity 3/5, left upper extremity 4/5, right lower extremity 2/5, and left lower extremity 3/5. Ashworth scale right upper extremity 1/4, right lower extremity 2/4, and left lower extremity 1/4. Clonus is reduced, the patient can stand with maximum support without clonus for 10 minutes. Trunk impairment scale 12/23 and Barthel index 65/100. Anthropometric examination showed differences in the circumference of the lower extremities, namely the right patella circumference 34-32 cm left, right upper leg 39 cm-left 37 cm, and left lower leg 29-24 cm. Mobilize the patient to a laying position with minimal assistance. Mobilization of the patient is being able to sit with minimal assistance, namely stabilization in the pelvis, sitting to standing with moderate support, which is supported at the knee bilaterally, and standing with support at the knee and pelvic for 10 minutes. This case report concludes that although physiotherapy is done late with strengthening exercise and core stability strengthening techniques, lying down strengthening exercise, it can improve motor skills, coordination, which in turn will increase the patient's independence in carrying out functional activities and ADLs.

Overview of the Treatment Goal, the Method of Evaluating Disease Activity/Physical Function, Activities of Daily Living, and Traditional Care for Systemic or Articular Juvenile Idiopathic Arthritis in Japan.

Juvenile idiopathic arthritis (JIA) is a chronic arthritis of unknown cause that develops in patients younger than 16 years of age and persists for at least 6 weeks. It is an important cause of short- and long-term physical and mental impairments in children. The goal of treatment for JIA is remission. A T2T (treatment-to-target) has been proposed and practiced as a means of achieving remission. The method of evaluating the disease activity of JIA depends on the disease type. For systemic JIA, disease activity is determined by comprehensively considering joint findings, systemic inflammatory findings, changes in inflammatory and synovitis markers, imaging findings, and other factors. For articular JIA other than systemic JIA, the Juvenile Arthritis Disease Activity Score (JADAS-27) is used to evaluate disease activity. The CHAQ (Childhood Health Assessment Questionnaire) and the Japanese version of the modified Rankin Scale (mRS) are mainly used to assess the physical function and ADL. The CHAQ is a global standard assessment method with the advantage that it can be transitioned to the HAQ used in adults, making it useful for international comparisons. The mRS is used to classify the severity of JIA as a chronic disease, and is an indispensable evaluation method in the specific disease procedure in Japan. It is necessary to have pediatric-specific knowledge of growth and development and routine childhood immunizations and to consider transition support tailored to the patient's situation. Ultimately, the goal is to foster the patient's independence and to provide an uninterrupted follow-up in the adult care department. Continuous follow-up will be provided during the schooling (and later, employment) period, and the relationship with the patient will be tailored to their developmental stage. It is also important to understand and communicate the importance of contraception and the drugs that cannot be used during pregnancy.

Validation and Clinical Application of the Japanese Version of the Patient-Reported Experience Measures for Intermediate Care Services: A Cross-Sectional Study.

Older adult patients account for 70% of all hospitalized patients in Japan, and intermediate care based on patient-centered care (PCC) that ensures continuity and quality of care at the interface between home services and acute care services and restores patient's independence and confidence is necessary for them to continue living independently. At present, no concept of intermediate care is established in Japan, and the implementation of PCC has been delayed. Thus, in this study, a Japanese version of the intermediate care evaluation index (patient-reported experience measure (PREM)) was created on the basis of the original PREM developed in the UK, and data in wards with intermediate care functions in Japan were collected to confirm internal consistency and validity from 2020 to 2022. The Japanese version of PREM was found to have a factor structure with two potential factors. Given the clear correlation with the shared decision-making evaluation index, which is the pinnacle of PCC, the theoretical validity of the Japanese version of PREM, which is based on PCC as a theoretical basis, was confirmed.

Fragility fractures of the pelvis: First 48 cases of surgical treatment at a level 1 trauma center in France

IntroductionLonger life expectancy is accompanied by a higher incidence of fragility fractures of the pelvis (FFP), which has repercussions on mortality and nursing home admissions. Given the paucity of data at French healthcare facilities, we carried out a retrospective study to (1) evaluate how surgical treatment of FFP with posterior displacement (type III and IV according to Rommens and Hofmann) affects a patient's pain, functional status and ability to stay at home and (2) evaluate the postoperative complications and mortality rate. HypothesisSurgery for posteriorly displaced FFP will relieve pain and preserve the patient's independence. MethodsAll the patients over 65 years of age who were operated on for a posterior FFP between January 2015 and August 2020 were included in this prospective, single-center study. The demographics, fracture type, details of the surgical treatment, complications and mortality were analyzed. Pain (visual analog scale, VAS), functional status (Activity of Daily Living [ADL] and Instrumental Activity of Daily Living [IADL]), mobility (Parker score) and rates of nursing home admissions were compared before the fracture, after surgery and at a mean follow-up of 28 months (minimum follow-up of 1 year). ResultsForty-eight patients with a mean age of 75 years were included. Twenty-four of these patients (50%) had at least two comorbidities. The FFPs were either type IV (31/48; 65%) or type III (17/48; 35%). The mean VAS for pain was significantly lower on the first day postoperative (3.5 versus 4.8; p=0.02). This significant reduction continued upon discharge from the hospital (1.95; p=0.003) and persisted at the mean follow-up of 28 months (2.2; p=0.64). The complication rate was 15% (7/48) and the mortality rate at the final review was 15% (7/48). Among the surviving patients, 81% (29/36) returned to living at home. The ADL (5.1 versus 5.8; p=0.09), IADL (5.9 versus 6.9; p=0.15) and Parker score (6.8 versus 8.2; p=0.08) at the final review were not significantly different from the values before the fracture. ConclusionThis is the first French study of patients operated on for an FPP. Fixation of posteriorly displaced fractures allows surviving patients to retain their mobility. Pain relief is achieved quickly and maintained during the follow-up period. Thus, our initial hypothesis is affirmed. The complication rate is not insignificant; given the complexity of this surgery, percutaneous treatment is preferable. Level of evidenceIV; retrospective study.

Inter-tester reliability and agreement of the Cumulated Ambulation Score in acute stroke: The InTRO-CAS-stroke study

TitleInter-Tester Reliability and Agreement of the Cumulated Ambulation Score in Stroke patients: The InTRO-CAS-stroke study ObjectiveTo examine the inter-tester reliability of the total Cumulated Ambulation Score (CAS) and the three activities of the CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with stroke. MethodsAn intertester reliability study. Setting: Participants: 60 participants from a specialized stroke unit with a mean age of 69.10 ± 13.23 years. The CAS describes a patient's independency in three activities – (1) getting in and out of bed, (2) sit to stand from a chair, and (3) walking ability and was assessed by two independent physiotherapists at median day 3 poststroke. Each activity was assessed on a three-point ordinal scale from 0 (not able to) to 2 (independent). The cumulated score for each activity provides a total CAS from 0 to 6, with 6 indicating independent basic mobility. Relative and absolute reliability was evaluated using weighted kappa, the standard error of measurement (SEM) and minimal detectable change (MDC). ResultsThe weighted kappa for the total CAS score was 0.816 and ranged from 0.733 to 0.904 for the 3 CAS activities. The SEM and the MDC of the total CAS was 0.37 and 1.03 respectively. ConclusionsThe intertester reliability of the CAS is almost perfect, and a change of 1 CAS point for the total CAS indicates a real change in basic mobility, at group level and for an individual patient with stroke Clinicaltrials.gov identifierNCT05601089

Digital Technology Enablers of Tele-Neurorehabilitation in Pre- and Post-COVID-19 Pandemic Era - A Scoping Review.

Neurorehabilitation (NR), a major component of neurosciences, is the process of restoring a patient's damaged/disorganized neurological function, through training, therapy, and education, while focusing on patient's independence and well-being. Since the advent of the COVID-19 pandemic, various applications of telecare and telehealth services surged drastically and became an integral part of current clinical practices. Tele-Neurorehabilitation (TNR) is one of such applications. When rehabilitation services were disrupted globally due to lockdown and travel restrictions, the importance of TNR was recognized, especially in developed, low, and middle-income countries. With exponential deployment of telehealth interventions in neurosciences, TNR has become a distinct stand-alone sub-specialty of neurosciences and telehealth. Digital technologies, such as wearables, robotics, and Virtual Reality (VR) have enabled TNR to improve the quality of patients' lives. Providing NR remotely using digital technologies and customized digital devices is now a reality, and likely to be the new norm soon. This article provides an overview of the needs, utilization, and deployment of TNR, and focuses on digital technology enablers of TNR in pre- and post-COVID-19 pandemic era.

Personality disorder type only sometimes matters: An exploration of patient's personality disorder as a source of variance in early therapeutic alliance.

The study aimed to analyse personality disorders among patients in the early phase of psychotherapy as a source of variance in the quality of the emerging alliance. The sample consisted of 131 individual psychotherapy patients with borderline (BPD), narcissistic (NPD), dependent (DPD) and obsessive-compulsive (OCPD) personality disorders and 131 psychotherapists. Different sources of alliance estimation were included. Therapeutic alliance was operationalized on several dimensions. The hypothesis was tested using an independent samples one-way analysis of variance. The study revealed a significant effect of personality disorder type on early therapeutic alliance quality. BPD patients rated their early alliance the lowest compared to NPD, DPD and OCPD patients. This trend was dominant and replicated regardless of who rated the alliance and which dimension of alliance was estimated. NPD, DPD and OCPD patients have better initial therapeutic alliances than BPD patients, and their alliances do not differ significantly. BPD patients build weaker alliances, and what poses a challenge for them is not only developing a strong and close bond but also conceptualizing goals and reaching agreement on tasks.

Eksplorasi Kesejahteraan Psikologis pada Pasien Brachial Plexus Injury (BPI)

Abstract Background : Brachial plexus injury is an injury to the C1-T1 nerve that most commonly occurs in men of reproductive age. This injury can cause motor and mental disability because it requires more than one surgery with a long recovery time. However, existing rehabilitative services focus more on restoring motor skills or functional abilities and less on evaluating psychological conditions, coping and quality of life. Objectives:The purpose of this study is to determine how the condition of psychological well-being and how BPI patients manage or maintain their psychological well-being. Methods:The method used is qualitative with a phenomenological approach. The number of participants was 6 patients from Soeharso Orthopedic Hospital, Surakarta who were selected through purposive sampling technique. Data was collected by in-depth interviews, then analyzed by content analysis. Results:The results showed that all BPI respondents experienced changes in the dimensions of psychological well-being. Conclusions:The dimensions that have experienced the most changes are self-acceptance, positive relations with others, purpose in life and environmental mastery. In addition, respondents also felt a change in subjective well-being. Adaptive strategies and emotional focused coping are most often used by respondents to maintain psychological well-being and adapt to life changes. By exploring this aspect, it can be taken into consideration in determining intervention that supports patient's independence. Keywords: Psychological well-being, Quality of life, Brachialis Plexus Injury

Short-Wavelength Light-Blocking Filters and Oral Melatonin Administration in Patients With Retinitis Pigmentosa: Protocol for a Randomized Controlled Trial.

The medical community is beginning to recognize that retinitis pigmentosa (RP), due to its disabling progression, eventually leads to a reduction in the patient´s quality of life, a direct economic impact, and an increase in the burden on the health care system. There is no curative treatment for the origin of the disease, and most of the current interventions fail in reducing the associated negative psychological states, such as anxiety and depression, which lead to increased variability of vision and pose a continuous threat to the patient's independence. The aim of this study is to assess the effect of oral melatonin (OM) administration alone and combined with short-wavelength light (SWL)-blocking filters on patients with RP and test their effectiveness in improving the level of stress and sleep problems in many of these patients. We have developed a low-cost therapy protocol for patients with RP with sleep disorders and negative psychological stress. Patients will be randomized to receive a combined intervention with SWL-blocking filters and OM, SWL-blocking filters alone, or OM alone. There will also be a nonintervention arm as a control group. This study will be conducted across 2 retinal units in patients with RP with sleep disorders and high perceived stress and anxiety score reports. Patients will be assessed in the preintervention period, weekly during the 4 weeks of intervention, and then at 6 months postintervention. The primary outcomes are the differences in changes from baseline to postintervention in hormone release (α-amylase, cortisol, and melatonin) and sleep quality, as measured with the visual analog scale. Secondary outcome measures include clinical macular changes, as measured with optical coherence tomography and optical coherence tomography angiography; retinal function, as measured using the visual field and best-corrected visual acuity; sleep data collected from personal wearables; and several patient-reported variables, such as self-recorded sleep diaries, quality of life, perceived stress, and functional status. This project is still a study protocol and has not yet started. Bibliographic research for information for its justification began in 2020, and this working group is currently seeking start-up funding. As soon as we have the necessary means, we will proceed with the registration and organization prior to the preliminary phase. In this feasibility randomized clinical controlled trial, we will compare the effects of SWL blocking alone, administration of OM alone, and a combined intervention with both in patients with RP. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as applied to additional inherited retinal dystrophies. The goal of presenting this protocol is to aid recent efforts in reducing the impact of sleeping disorders and other psychological disorders on the quality of life in patients with RP and recovering their self-autonomy. In addition, the results of this study will represent a significant step toward developing a novel low-cost therapy for patients with RP and validating a novel therapeutic target. PRR1-10.2196/49196.

Using "functional hand" protocol to improve hand function following a spinal cord injury: an explorative study.

A cervical spinal cord injury often affects hand control, causing ineffective grasping and handling functions, with a negative impact on patient's independence and quality of life. Literature recognises scientific evidence only for surgical or instrumental re-education approaches. The purpose of this study is to present the "functional hand" protocol, a physiotherapy tool that, to date, represents a good clinical practice but has no supporting literature. a longitudinal-single cohort study was conducted at Spinal Unit- Azienda Usl Piacenza. Patients with spinal cord injury at C5-C7 neurologic level, older than 18 years, with correct comprehension of Italian language were recruited. All patients were evaluated with Action Research Arm Test (ARAT) scale to state hand functionality; positive/negative history of Functional Hand protocol was deducted by physiotherapy discharge letters on first spinal unit hospitalisation. six patients were involved in the study; three of them had a positive history of protocol application. ARAT scores differences showed that patients who underwent functional hand protocol had a lower impairment, a better ability to produce cylindrical and cuboid sockets. Functional hand protocol reached a preliminary evidence as effective tool to improve hand recovery in tetraplegic patients; future studies should confirm these conclusions on larger samples, and verify protocol effectiveness in addition to other treatment strategies (functional electric stimulation/ transcranial direct current stimulation/robotic assisted therapy).

Edukasi Program Latihan Fisioterapi Pada Penderita Stroke Di Posyandu Lansia Desa Sanggung

One of the health problems is stroke. Stroke is a disease affecting the body's movement and functional systems which is the main factor in neurological disorders. Stroke is the second highest cause of death and the third leading cause of disability at world level. Stroke can affect the whole body such as paralysis, impaired cognitive function, difficulty speaking, emotional difficulties, pain and problems in daily life activities. Posyandu Ngudi Saras is one of the posyandu for the elderly in Sanggung Village. There is a shortage of physiotherapists in this place, which is one of the obstacles faced by residents in Sanggung Village. Apart from that, there is a lack of education about physiotherapy exercise programs, especially for stroke sufferers. This can be seen from the patient not continuing the exercise program at home so that his condition worsens and when carrying out activities he depends on other people. Based on these problems, we offer a solution by providing education about physiotherapy exercise programs from sitting to standing and from standing to walking to patients and families. This physiotherapy exercise program is useful for increasing the patient's independence in carrying out activities, especially when walking and standing. Activities are carried out door to door in the homes of stroke sufferers and with an interpersonal approach. Community service through this form of educational activity has been carried out and can increase the knowledge of stroke sufferers and their families.

Treatment of Bowel Syndrome with Constipation: An Experience with The Agonist of Guanylate Cyclase Receptor in Advanced Age Patients

Background Irritable bowel syndrome is a very common condition in the elderly, and it can also be extremely disabling being able to go to undermine the patient's independence. We wanted to conduct a study on the Territory to test a recently approved molecule for treating a variant with constipation-predominant irritable bowel syndrome, testing the treatment in a cohort of elderly subjects and comparing the results with those of other existing therapies. Here we exposed the results of our experience.
 Material and Methods We conducted an open-label study in the general medicine setting, enrolling patients who appeared eligible for drug treatment with the study drug during the medical examination. So we examined 20 elderly patients. Half of the patients were treated with linaclotide 290 mcg, the other 50% with macrogol 27.6 g (25%) and psyllium 2 sachets/day (25%), continuing the treatment up to 12 weeks.
 Results There was a reduction of bloating in 70% of the Linaclotide group and 80% of the macrogol and psyllium group, an improvement/reduction of tenesmus in 100% of patients in the three groups, with a change in the quality of stool occurring with Bristol Stool Scale assessment. 60% of patients failed to complete therapy in 3 months.
 Conclusions Linaclotide is an innovative drug increasingly gaining space in the pharmacopoeia in the possession of doctors for treating intestinal disorders on a functional basis. The limited experience has shown little tolerance of Linaclotide compared to treatments for longer in force, especially in the elderly.

Spinal Cord Injury Patients Exhibit Changes in Motor-Related Activity and Topographic Distribution.

Spinal Cord Injury (SCI) is a common disease that usually limits the patient's independence by affecting their motor function. SCI patients usually present neuroplasticity, which allows brain signals transmission through spread pathways. Some innovative rehabilitation therapies, such as functional electrical stimulation (FES) or Brain-computer interfaces (BCIs) jointly with motor neuroprostheses, provide hope for functional restoration. BCIs require the analysis of event-related EEG potentials (ERPs). Movement-related cortical potentials (MRCPs) and event-related desynchroni-zation and synchronization (ERD/ERS) are the most commonly studied ERPs during motor activity. ERPs of healthy subjects may vary from SCI patients. Thus, this study aimed to compare ERPs between healthy subjects and SCI patients during upper-limb movements (forearm supination and pronation, and hand open). Differences between controls and SCI patients were shown in terms of ERPs' amplitude as well as in topographic maps. Changes in amplitude were more substantial in ERD potentials than in MRCPs, while topographic maps showed better localization of all features in healthy patients. The level of SCI injury determines the patients' mobility. A comparison between complete, partial and no motor function subjects showed lower values of feature's amplitudes in the latter group.Clinical Relevance- This demonstrates the existence of significant statistical differences between healthy and SCI subjects, and might be helpful when performing SCI rehabilitation techniques such as designing BCI and neuroprostheses, or analyzing and understanding the brain plasticity process.

Diabetes in old age

Diabetes is one of the most common chronical diseases in old age. More than 50 % of the patients are older than 65years. Elderly with diabetes often suffer from functional or cognitive deficits that should be registered in therapy. These include special geriatric syndromes like memory failure, frailty, falls, immobility or higher vulnerability for drug interactions. Comorbidity und functional deficits influence each other. Simple therapy regimens should be preferred to avoid polypharmacia and to preserve patient's independence. Specific risks of old age under new antidiabetic drugs should be noted. Check-ups and treatment of diabetic complications, especially the diabetic foot should be consequently induced considerating age-specific features.

Analysis of functional efficiency and risk of falls in patients with different types of dementia - preliminary observations.

Dementia is a multifactorial neurological disease that affects 50 million people worldwide. It is a disorder that impairs cognitive functions, functional efficiency, balance and gait. It contributes to an increased risk of falls, reduces independence in everyday activities and deepens disability. The aim of the study was to investigate the correlation between dementia and independence related to functional efficiency and risk of falls in the elderly. The eligibility criterion for participation in the study was age over 60, the presence of cognitive disorders, including dementia, and the ability to move with the use of orthopaedic equipment or independently. A total of 51 people participated in the study, including 13 people who underwent rehabilitation procedures. Each subject was evaluated once for cognitive abilities using two types of tests: the ADL scale, MMSE (Mini-Mental state Examination) and three physical fitness tests: SPPB (Short Physical Performance Battery), TUG (Timed Up & Go) and FRT (Functional Reach Test). The average score of the MMSE test was 13.29±6.23 points, the average of the ADL scale was 4.20±1.23 points. A positive correlation was found between the level of dementia and the independence of the examined person, as well as a positive relationship between the MMSE test and the result of the Functional Reach Test, and the relationship between the ADL scale and the SPPB and 'Get-Up and Go' tests. It has been demonstrated inter alia that static balance and functional efficiency depends on the patient's independence in everyday activities, and the level of dementia may suggest the patient's dynamic balance. In addition, the need for a broader analysis of targeted studies was recognized to confirm the conclusions obtained.

Pendampingan Spiritual dalam Asuhan Keperawatan Sebagai Upaya Penyembuhan Pasien

Nursing care is a series of interactions between nurses and patients with the aim of achieving the patient's independence in caring for himself, nursing care that is given holistically including biological, psychological, sociological, and spiritual aspects. This study aims to see what factors influence spiritual accompaniment in nursing care. The method used in this research is a literature review by taking data sources through garuda.ristekbrin.go.id which was published in the 2015-2021 period, can be downloaded on March 2-4, 2021. After selecting and identifying according to inclusion criteria, there are 13 article reviewed. The results showed that the factors that influence spiritual assistance in nursing care as a patient's healing are knowledge, perceptions, and good attitudes about spiritual health in addition to motivation, family support, and self-efficacy of nurses in fulfilling spiritual needs. Then the factor of a nurse's length of work also becomes a supporter of spiritual assistance. Spiritual health is very effective in supporting the healing process for patients. Suggestions for nurses to increase knowledge and attitudes about the spiritual needs of patients, so as to produce good nursing care.

Functional assessment using 3D movement analysis can better predict health-related quality of life outcomes in patients with adult spinal deformity: a machine learning approach.

Adult spinal deformity (ASD) is classically evaluated by health-related quality of life (HRQoL) questionnaires and static radiographic spino-pelvic and global alignment parameters. Recently, 3D movement analysis (3DMA) was used for functional assessment of ASD to objectively quantify patient's independence during daily life activities. The aim of this study was to determine the role of both static and functional assessments in the prediction of HRQoL outcomes using machine learning methods. ASD patients and controls underwent full-body biplanar low-dose x-rays with 3D reconstruction of skeletal segment as well as 3DMA of gait and filled HRQoL questionnaires: SF-36 physical and mental components (PCS&MCS), Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), and visual analog scale (VAS) for pain. A random forest machine learning (ML) model was used to predict HRQoL outcomes based on three simulations: (1) radiographic, (2) kinematic, (3) both radiographic and kinematic parameters. Accuracy of prediction and RMSE of the model were evaluated using 10-fold cross validation in each simulation and compared between simulations. The model was also used to investigate the possibility of predicting HRQoL outcomes in ASD after treatment. In total, 173 primary ASD and 57 controls were enrolled; 30 ASD were followed-up after surgical or medical treatment. The first ML simulation had a median accuracy of 83.4%. The second simulation had a median accuracy of 84.7%. The third simulation had a median accuracy of 87%. Simulations 2 and 3 had comparable accuracies of prediction for all HRQoL outcomes and higher predictions compared to Simulation 1 (i.e., accuracy for PCS = 85 ± 5 vs. 88.4 ± 4 and 89.7% ± 4%, for MCS = 83.7 ± 8.3 vs. 86.3 ± 5.6 and 87.7% ± 6.8% for simulations 1, 2 and 3 resp., p < 0.05). Similar results were reported when the 3 simulations were tested on ASD after treatment. This study showed that kinematic parameters can better predict HRQoL outcomes than stand-alone classical radiographic parameters, not only for physical but also for mental scores. Moreover, 3DMA was shown to be a good predictive of HRQoL outcomes for ASD follow-up after medical or surgical treatment. Thus, the assessment of ASD patients should no longer rely on radiographs alone but on movement analysis as well.

Ethical issues of do not resuscitate in cancer patients: A narrative review from a nursing perspective

This narrative review aims to examine the ethical issues of do not resuscitate order (DNR) in cancer patients from a nursing perspective. Keywords were obtained based on Medical Subject Headings with titles related to the topic of the article. The data was obtained by searching English keywords (cardiopulmonary resuscitation, cancer, dilemma, oncology) in the title and abstract of the PubMed, Scopus, and Web of Science databases without time limits to access published foreign studies. Also, to access published Persian studies, Iranian websites, including Scientific Information Database, Magiran, and Iranmedex scientific databases, were searched with equivalent Persian keywords. Also, based on the determined keywords, a free search was also conducted in the Google Scholar search engine. The study on the implementation of DNR orders by healthcare providers has been of interest to medical staff, patients, and their families in the past. The issue of choosing between life and death to reduce pain and suffering and the lack of facilities to treat patients in the last stages of the disease is one of the main reasons for making a DNR order, especially in cancer patients who are going through the last stages of their lives. In various studies, various aspects of the treatment staff's and patients' attitudes were examined, but the most attention is paid to factors such as the doctor's moral competence, the patient's independence, the quality of life, and adopting the right time for this order. In these studies, it has been shown that the DNR order is widely used in patients with advanced cancers. Therefore, managers and policymakers in the health field should provide a platform for training the medical care team, especially nurses, in the field of various aspects of the ethical competence of DNR and interaction with these patients and their families.

Do Knee Joint Orthoses Affect the Functional Status of Stroke Patients? A Literature Review

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up &amp; Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

Effectiveness of early rehabilitation in hand burns.

Hand burn trauma occurs quite commonly and the outcome of hand burns can significantly impact self-care daily function, work and employment, leisure activities, and overall health-related quality of life. The overall goal of the management of hand burn trauma is to optimize hand function. Rehabilitation and restoration of hand function are critical for the patient's independence and re-integration into society and work. The purpose of this study is to present our experience with 105 hand burn trauma patients admitted and treated in our burn center and to show the efficacy of early rehabilitation on their ability to return to their prior social life and work. In our study, we included that 105 patients with acute severe hand burn trauma were hospitalized in Gulhane burn center between 2017 and 2021. They underwent rehabilitation program daily sessions. Patients with hand burns are evaluated by ranges of motions (ROM), grip strength, Cochin Hand Function Scale (CHFS), and Michigan Hand Questionnaire (MHQ) 12 months after the injury. Overall, mean digital total active motion were >180°. The mean values for grip strength of dominant hand for men were 27.2±9.3 kg, for women were 22.0±8.8 kg and non-dominant hand for men were 24.05±13.8 kg, for women were 17.8±10.3 kg. Total score of 5 items was 19.0 in CHFS. The mean overall score on the MHQ was 62.3±27.4. All obtained data were within normal or accepted functional ranges. Spearman correlation coefficient indicates a negative correlation between MHQ and CHFS (p≤0.01). A comprehensive rehabilitation program is essential in helping patients to regain optimal function after hand burn trauma. Physiotherapy and occupational therapy is most beneficial when started at the time of admission.