Postsurgical Rehabilitation Research Articles

Outcome Measures for Post-Shoulder Injury Surgical Intervention Therapeutic Rehabilitation

The largest external determinant for subject’s length and quality of recovery in the rehabilitation is the severity of injury and subsequent surgery. Additionally, standard timelines for common shoulder exercises and progressions were found. We can potentially use these data for optimizing current post-surgical shoulder rehabilitation.

Rehabilitating Older Adults, Physically and Socially, with an Evidence-based Exercise and Health Education Program

To summarize the prevalence of osteoarthritis (OA) and its associated risks and costs. To report an exercise/health education program that is a clinically effective for post-surgical rehabilitation.

Effectiveness of a home-based telerehabilitation system in patients after total hip arthroplasty: study protocol of a randomized controlled trial

BackgroundThe demand for total hip arthroplasty (THA) is quickly rising given the escalating global incidence of hip osteoarthritis, and it is widely accepted that the post-surgery rehabilitation is key to optimize outcomes. The overall objective of this study is to evaluate the effectiveness of a new telerehabilitation solution, ReHub, for the physical function and clinical outcome improvement following THA. The specific aims of this manuscript are to describe the study design, protocol, content of interventions, and primary and secondary outcomes and to discuss the clinical rehabilitation impact of the expected experimental results.Methods/designThis prospective, randomized, controlled, parallel-group trial will include 56 patients who had undergone primary THA. Patients are randomized to a control group (standard rehabilitation during the 2-week stay in the rehabilitation clinic followed by 3 weeks of unsupervised home-based rehabilitation) or an experimental group (standard rehabilitation during the 2-week stay in the rehabilitation clinic followed by 3 weeks of home-based ReHub-assisted telerehabilitation). The primary outcome is physical performance assessed through the Timed Up-and-Go (TUG) test. Secondary outcomes include independence level, pain intensity, hip disability, hip range of motion, muscle strength, and patient’s perception of clinical improvement.DiscussionProving the clinical and cost-effectiveness of a home-based telerehabilitation program for physical and muscle function following THA could support its systematic incorporation in post-surgical rehabilitation protocols, which should be tailored to the individual and collective needs.Trial registrationClinicalTrial.gov NCT04176315. Registered on 22 November 2019

3D Printed Silicone Meniscus Implants: Influence of the 3D Printing Process on Properties of Silicone Implants.

Osteoarthritis of the knee with meniscal pathologies is a severe meniscal pathology suffered by the aging population worldwide. However, conventional meniscal substitutes are not 3D-printable and lack the customizability of 3D printed implants and are not mechanically robust enough for human implantation. Similarly, 3D printed hydrogel scaffolds suffer from drawbacks of being mechanically weak and as a result patients are unable to execute immediate post-surgical weight-bearing ambulation and rehabilitation. To solve this problem, we have developed a 3D silicone meniscus implant which is (1) cytocompatible, (2) resistant to cyclic loading and mechanically similar to native meniscus, and (3) directly 3D printable. The main focus of this study is to determine whether the purity, composition, structure, dimensions and mechanical properties of silicone implants are affected by the use of a custom-made in-house 3D-printer. We have used the phosphate buffer saline (PBS) absorption test, Fourier transform infrared (FTIR) spectroscopy, surface profilometry, thermo-gravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS), differential scanning calorimetry (DSC), and scanning electron microscopy (SEM) to effectively assess and compare material properties between molded and 3D printed silicone samples.

The effect of graded activity and pain education (GAPE): an early post-surgical rehabilitation programme after lumbar spinal fusion\u2014study protocol for a randomized controlled trial

BackgroundPatients with chronic low back pain undergoing lumbar spinal fusion (LSF) are physically inactive and thereby at risk of poor health. Barriers to being physically active need to be acknowledged in post-surgical rehabilitation. The primary objective of this randomized controlled trial (RCT) is to examine the effect of an early active intervention consisting of graded activity and pain education (GAPE) on sedentary behaviour in a population of patients undergoing LSF. The secondary objective is to examine the effect of GAPE on disability, pain, fear of movement, self-efficacy for exercise, and health-related quality of life.MethodsThe study is an RCT planned to include 144 patients undergoing LSF at 1–2 levels for low back pain caused by degeneration of the lumbar spine. The patients will be randomly assigned to receive either usual care or usual care plus GAPE. GAPE consists of nine individual physiotherapist-guided sessions over a 10-week period. The overall purpose is to reduce sedentary behaviour, by educating the patient about pain and, based on a cognitive behavioural perspective, gradually strengthen the patient’s self-efficacy to be physically active and reduce fear of movement. The physiotherapist will plan the intervention in collaboration with the patient. Based on a semi-structured interview and observations of the patient in their home, they will set individually functional goals. The primary outcome will be a reduction in sedentary behaviour, measured by an accelerometer at baseline (pre-surgery) and at 3 and 12 months post-surgery. Secondary outcomes will include disability, pain, fear of movement, self-efficacy for exercise, and quality of life. Secondary outcome data will be collected at baseline (pre-surgery) and at 3, 6 and 12 months post-surgery.DiscussionWe hypothesize that, compared with the “usual care group”, GAPE will primarily lead to a significant reduction in sedentary behaviour, and secondarily a reduction in disability, pain intensity, and fear of movement; further, it will increase the patient’s self-efficacy for exercise and quality of life.Trial registrationwww.clinicaltrials.gov NCT04103970, Registered on 24 September 2019

CORR® International-Asia-Pacific: Closing the Loop-Focus Early and Often on Your Patients' Postsurgical Rehabilitation Program.

CORR® International-Asia-Pacific: Closing the Loop-Focus Early and Often on Your Patients' Postsurgical Rehabilitation Program.

Postsurgical Intestinal Rehabilitation Using Semisynthetic Glucagon‐Like Peptide‐2 Analogue (sGLP‐2) at a Referral Center: Can Patients Achieve Parenteral Nutrition and sGLP‐2 Independency?

Teduglutide, a semisynthetic analogue of glucagon-like peptide-2 (sGLP-2), increases intestinal absorption of fluids and nutrients, reducing the need for parenteral nutrition (PN). This report aims to describe our experience with sGLP-2 in a cohort of adult patients with short-bowel syndrome. This is a prospective observational study on adult patients initially evaluated in our specialized intestinal rehabilitation program that received sGLP-2 from June 2014 to March 2020. Autologous gastrointestinal reconstruction surgery (AGIRS) was performed in 108 patients; 68.5% (74 of 108) achieved intestinal sufficiency with standard medical therapy. Seventeen patients were treated with sGLP-2; 66.5% (8 of 12) received treatment for a mean time of 25.8 weeks (3.4-54.0) and could suspend PN. One patient reinitiated treatment due to renal lithiasis and acute renal failure. Currently, 7 of 12 patients (53.8%) continue without PN for a mean time of 165.6 weeks. Volume, energy, and days of PN were reduced in all patients. No serious adverse events were registered. Four of 7 patients (57.1%) who discontinued PN could also discontinue sGLP-2. Therefore, the use of sGLP-2 increased the overall success rate of PN independency after AGIRS to 76% (82 of 108). This study confirmed that sGLP-2 should be considered as part of the standard therapy for postsurgical medical rehabilitation treatment in patients with chronic intestinal failure. We add to the current knowledge that some patients can discontinue both PN and sGLP-2 in the long term, achieving complete recovery of their quality of life.

The impact of multijoint symptoms on patient-reported disability following surgery for lumbar spine osteoarthritis

Background ContextIn the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. PurposeDocument the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. DesignProspective study of consecutive patients followed to 12-month postsurgery. Patient SamplePatients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. Outcomes MeasuresPatient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and “pain/stiffness/swelling most days of the month” indicated on a homunculus (a joint site count was derived). Assessments: Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. MethodsOutcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. ResultsIn all, 165 patients were included. The mean age was 67 years (range: 44–90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). ConclusionsMultijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.

Inter-professional collaboration to improve outpatient attendance rates on a cochlear implant aural rehabilitation programme

Background:The cochlear implant (CI) programme at Changi General Hospital started in 2010. As the number of patients gradually increased over the years, a review of attendance rates from 2010 to 2016 showed that CI patients were not compliant in attending post-surgical aural rehabilitation sessions. A significant number of no-shows or appointment cancellations without rescheduling suggest that patients may not be motivated enough to go through aural rehabilitation. Hence, it was hard to evaluate clinical outcomes, which was demoralising for both the patient and health-care professionals involved. As transdisciplinary care is often involved in the aural rehabilitation process, we reviewed the existing CI clinical pathway to identify gaps in services, and with better fostering of inter-professional collaboration (IPC) in 2017, we compared the difference in outpatient aural rehabilitation attendance rates for patients seen before and after 2017.Methods:A retrospective review was undertaken of the outpatient administrative system to look at appointment cancellation rates before and after IPC for CI patients undergoing post-surgical aural rehabilitation from 2010 to 2019. A paired-sample t-test of significance was used, with the level of significance set at p=0.05. Problem analysis using the Problem, Intervention, Comparison, Outcomes framework helped in identifying the possible reasons for non-compliance with aural rehabilitation attendance. Inter-professional education among audiologists, otologists and speech therapists allowed for a close-knit IPC.Results:There were 78 patients with CIs from 2010 to 2019. Of these, 46 patients were implanted between 2010 and 2016, and 32 were implanted after IPC was introduced in 2017. The median cancellations rates were significantly reduced from 23% to 15%, with a p-value of 0.00. Days to switch-on and aural rehabilitation, number of appointment cancellations and total number of individual visits were significant independent predictors of the percentage of cancellations in regression analysis.Conclusion:Future studies are warranted to see if IPC can indirectly drive clinical outcomes, given that IPC encouraged better compliance with aural rehabilitation attendance post CI. It is imperative to have IPC in this dynamic health-care landscape with increasing complexities. IPC cannot be achieved without a close-knit relationship among the relevant health professionals.

Non-Surgical Management and Post-Surgical Rehabilitation of Carpal Tunnel Syndrome: An Algorithmic Approach and Practical Guideline

: One of the most common forms of entrapment neuropathy is Carpal Tunnel Syndrome (CTS). There are various treatment options for CTS. However, there are no clear and structured guidelines. This review classified the existing treatments and developed an algorithm to help physicians to choose the best option for their patients. Treatment options were summarized in three sections: non-surgical management of CTS, post-operative management of CTS, and practical open carpal tunnel release post-op protocol. The physicians can prescribe multiple treatment options to CTS patients. Corticosteroid in oral or injectable form has strong evidence in pain control and functional improvement in the short term. Shockwave therapy and nocturnal wrist splints display moderate therapeutic effects. Post carpal tunnel release rehabilitation can be started a few days after the operation.

Quantifying Dysfunction of the Lumbar Multifidus Muscle After Radiofrequency Neurotomy and Fusion Surgery: A Preliminary Study.

The multifidus is an important muscle for the active stabilization of the spine. Unfortunately, clinical procedures such as posterior lumbar fusion (PLF) and radio frequency neurotomy (RFN) cause injury to these muscles affecting their function. However, evaluating multifidus function using traditional biomechanical methods is challenging due to its unique anatomical features. The change in muscle shear modulus during contraction has been corrected to force generation for several skeletal muscles. Therefore, the change in shear modulus can be used to quantify muscle contraction. The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. We used our recently developed protocol which consists of measuring changes of multifidus shear modulus at lying prone, sitting up, and sitting up with the arms lifted. In healthy individuals, the median multifidus shear modulus increased progressively from prone, sitting, and sitting with arms raised: 18.55 kPa, 27.14 kPa, and 38.45 kPa, respectively. A moderate increase in shear modulus for these body positions was observed in PLF patients: 9.81 kPa, 17.26 kPa, and 21.85 kPa. In RFN patients, the shear modulus remained relatively constant: 14.44 kPa, 16.57 kPa, and 17.26 kPa. Overall, RFN and PLF caused a reduction in the contraction of multifidus muscles. However, the contraction of multifidus muscle slightly increased during multifidus activation in PLF patients, while it did not change in RFN patients. These preliminary measurements suggest that the proposed protocol using SWE can provide important information about the function of individual spine muscles to guide the design and evaluation of postsurgical rehabilitation protocols.

Characterization Of Muscle Inflammation Susceptibility: A Potential Prognostic Factor For Optimal Post-surgical Rehabilitation

BACKGROUND: Many individuals with end-stage osteoarthritis undergo elective total hip/knee arthroplasty (THA/TKA) to relieve pain and improve mobility and quality of life. However, ~35% suffer long-term mobility impairment following surgery. Previously, we have shown this may be in part due to muscle inflammation susceptibility (MuIS(+)), an overt pro-inflammatory state localized to skeletal muscle surrounding the diseased joint, found in some but not all TKA/THA patients. PURPOSE: We are interrogating the hypotheses that a) MuIS(+/-) status will result in a differential perioperative expression profile that may partially explain low functional outcomes, and b) resistance training rehabilitation will more effectively overcome MuIS(+) status than usual care for effective recovery post-surgery. METHODS: Muscle samples were leveraged from our ongoing two-site, randomized, controlled trial (N=84). Participants were dichotomized to MuIS status (+/-) based on surgical (SX) muscle gene expression of Fn14 which drives pro-inflammatory signaling via NFκB. MuIS(+/-) samples were probed for pro-inflammatory gene and protein expression targets, and indices of skeletal muscle function. Preliminary perioperative comparisons were made using two-tailed T-tests; alpha P≤0.05. RESULTS: 84 participants (29M/55F; 62±8yrs; BMI 30.7±5.4kg/m2) undergoing THA/TKA were assessed. Thus far, 37 have been clustered as MuIS(+) (n=14, ~4-fold greater Fn14 mRNA) or MuIS(-) (n=23). SX thigh muscle mass (TMM), quadriceps power and torque were lower (P<0.05) than the contralateral limb (CTR). Additionally, skeletal muscle fibrosis and type II cross-sectional area were greater in the SX leg and MuIS(+) respectively (P<0.05). Tumor necrosis factor-α receptor and IL-6 trended higher in MuIS(+) (P>0.05). Phosphorylated (P)-RPS6 was lower in the SX leg and P-4E-BP1 was significantly lower in MuIS(+) (P>0.05). CONCLUSIONS: Preliminary results suggest patients undergoing TKA/THA exhibit more inflammation on the SX limb, accompanied by lower TMM, torque and power. MuIS(+) leads to greater inflammation and blunted anabolic signaling, highlighting the profound impact of muscle inflammation and emphasizing the potential value in perioperative MuIS assessment to inform optimal post-surgical care. Grant: R01HD084124

The Impact Of Sports Science-based Prehabilitation On Spontaneous Physical Activity After Major Abdominal Cancer Surgery

Complex surgery for abdominal cancer often leads to postoperative complications that may prevent post-surgical rehabilitation in old, frail, or malnourished patients. Prehabilitation is an emerging alternative strategy that has the potential to speed recovery and may be analogous to athletic preparations for gameday. For optimal physiological improvement to occur in a limited time period prior to the surgery, cancer patients undergoing prehabilitation interventions must work closer to their maximal physiological capacity (albeit a very low level) in a manner similar to that of competitive athletes. PURPOSE: To determine the effect of a 4-week sports science-based prehabilitation program on spontaneous physical activity in cancer patients who undergo major abdominal surgery. METHODS: Twenty-two cancer patients (63±11 years) who underwent major abdominal surgery were studied. Fourteen patients participated in a 4-week exercise and nutrition prehabilitation program prior to abdominal surgery. The sport-science based program comprised of an interdisciplinary approach, including blood flow restriction exercise and a daily sports nutrition supplement containing L-citrulline, creatine monohydrate, and whey protein. The remaining 8 patients served as controls. Physical activity of both groups was monitored for 5 days after surgery. Accelerometers were used to quantify number of steps, energy expenditure, and sedentary time. RESULTS: The prehabilitation group recorded 47.4% more total steps for 5 days after abdominal surgery than the control group (16,032±5,194 vs.10,877±5,182 total steps/5 days, p=0.037). The prehabilitation group had a greater amount of total energy expenditure than the control group (5,555±3,400 vs. 2,971±1,572 total kcal/5 days, p=0.028). There was no significant difference in total sedentary time between the two groups (5,064±597 vs. 5,414±514 min/5 days). CONCLUSIONS: This prehabilitation program composed of cutting-edge sports science practices significantly improved spontaneous physical activity after major surgery in older patients with abdominal cancers.

Contractile rate of force development after anterior cruciate ligament reconstruction-a comprehensive review and meta-analysis.

Comprehensive review and meta-analysis. The recovery in rapid force production measured as the rate of force development (RFD) is not clear after anterior cruciate ligament reconstruction (ACLR). To evaluate (a) time-course change of between-limb asymmetries in isometric knee extension/flexion RFD in individuals post-ACLR and (b) differences in RFD between individuals post-ACLR and healthy controls. A literature search of Web of Science, SPORTDiscus, PubMed-MEDLINE, and ScienceDirect identified 10 eligible studies (n=246) assessing RFD after ACLR. Standard mean difference (SMD) for early-phase (<100ms) knee extensor RFD was -1.07 (95% CI: -1.46, -0.68) when comparing ACLR vs uninjured limb, while SMD for late-phase (≥100ms) RFD was -0.85 (95 CI%: -1.27, -0.42). SMD for early- and late-phase knee flexor RFD was -0.74 (95% CI: -1.19, -0.29) and -0.79 (95% CI: -1.19, -0.39), respectively. Comparing ACLR limbs to uninjured controls, knee extensor SMD for early- and late-phase RFD was -1.42 (95% CI: -2.10, -0.73) and 1.09 (95% CI: -1.81, -0.38). For the knee flexors, SMD for early- and late-phase RFD was -0.78 (95% CI: -1.96, -0.39) and -1.14 (95% CI: -1.60, -0.67). Anterior cruciate ligament reconstruction limbs demonstrated sustained post-surgical suppression in RFD capacity for the knee extensors/flexors compared to the contralateral limb as well as to healthy controls. Monitoring of RFD should be considered throughout rehabilitation and return to sport (RTS) after ACLR to assess the effectiveness of post-operative rehabilitation. Post-surgical ACLR rehabilitation should include training interventions to enhance RFD.

Rehabilitation of the Throwing Athlete—How to Get Them Back to Sport

Rehabilitation of the overhead athlete must take into account the loads required to perform their sport early in the postoperative treatment. While general concepts of range of motion and strength specific to the surgical repair are important, enhanced surgical and rehabilitative techniques have resulted in fewer complications and an expedited return to play progression. The biomechanical rehabilitative needs of the sport should include but not be limited to rotator cuff stability, scapular stability, core strength, hip mobility, hip stability, contralateral arm strength, and posterior kinetic chain strength. This chapter will address these rehabilitative approaches as the athlete transitions from postsurgical rehabilitation to optimal throwing performance.

Gait speed is a preoperative indicator of postoperative events after elective proximal aortic surgery

ObjectiveThe study objective was to evaluate whether 5-m gait speed, an established marker of frailty, is associated with postoperative events after elective proximal aortic surgery. MethodsWe performed a retrospective review of 435 patients aged more than 60 years who underwent elective proximal aortic surgery, defined as surgery on the aortic root, ascending aorta, or aortic arch through median sternotomy. Patients completed a 5-m gait speed test within 30 days before surgery. We evaluated the association between categoric (slow, ≤0.83 m/s and normal, >0.83 m/s) and continuous gait speed and the likelihood of experiencing the composite outcome before and after adjustment for European System for Cardiac Operative Risk Evaluation II. The composite outcome included in-hospital mortality, renal failure, prolonged ventilation, and discharge location. Secondary outcomes were 1-year mortality and 5-year survival. ResultsOf the study population, 30.3% (132/435) were categorized as slow. Slow walkers were significantly more likely to have in-hospital mortality, prolonged ventilation, and renal failure, and were less likely to be discharged home (all P < .05). The composite outcome was 2 times more likely to occur for slow walkers (gait speed categoric adjusted odds ratio, 2.08; 95% confidence interval, 1.27-3.40; P = .004). Moreover, a unit (1 m/s) increase in gait speed (continuous) was associated with 73% lower risk of experiencing the composite outcome (odds ratio, 0.27; 95% confidence interval, 0.11-0.68; P = .006). ConclusionsSlow gait speed is a preoperative indicator of risk for postoperative events after elective proximal aortic surgery. Gait speed may be an important tool to complement existing operative risk models, and its application may identify patients who may benefit from presurgical and postsurgical rehabilitation.

Exercícios isométricos possuem alta responsividade para membros inferiores

Introdução: Para a reabilitação pós-cirúrgica do ligamento cruzado anterior, os vastos medial e lateral precisam ser trabalhados visando uma boa recuperação. Discute-se a respeito dos exercícios isométricos e isotônicos a serem utilizados na fase de reabilitação, tendo seus resultados divergentes na literatura. Objetivo: Assim, o objetivo do presente estudo é comparar a ativação dos vastos medial e lateral em exercícios isométricos e isotônicos. Métodos: Participaram deste estudo 11 sujeitos (sete homens e quatro mulheres), fisicamente ativos e com experiência em musculação. Foi realizada a anamnese, a avaliação antropométrica, o teste de carga de 10 repetições máximas (RM), o teste de contração voluntária isométrica máxima e o teste de agachamento. Resultados: No vasto lateral da coxa direita, a atividade eletromiográfica foi significativamente maior na contração voluntária isométrica máxima em relação ao agachamento dinâmico (p&lt;0,05). O mesmo foi observado na coxa esquerda (p&lt;0,05). Conclusão: O recrutamento dos vastos medial e lateral em exercícios isométricos é maior em relação a exercícios isotônicos.

FEAR-AVOIDANCE AND SELF-EFFICACY PSYCHOSOCIAL FACTORS ARE ALTERED AFTER PARTIAL MENISCECTOMY AND ASSOCIATED WITH REHABILITATION OUTCOMES

Little research has examined how psychosocial factors change over time and influence rehabilitation outcomes following meniscectomy. This information can inform the need to assess and address psychosocial factors in meniscectomy rehabilitation. The purpose of this study was to examine changes in fear-avoidance and self-efficacy psychosocial factors from pre-surgery to one year after meniscectomy and their associations with rehabilitation outcomes. The hypothesis was that psychosocial factors would improve following meniscectomy, and less improvement in psychosocial factors would be associated with less improvement in rehabilitation outcomes. Prospective cohort. Twenty-five patients with partial meniscectomy participated. Testing time points were pre-surgery, after post-surgical rehabilitation, and one-year post-surgery. Fear avoidance (pain catastrophizing and kinesiophobia) and self-efficacy (knee-related activity) psychosocial factors were assessed with the Pain Catastrophizing Scale (PCS), the Tampa Scale for Kinesiophobia (TSK-11), and Knee Activity Self-efficacy (KASE) questionnaires; respectively. Rehabilitation outcomes were quadriceps strength, evaluated with isokinetic testing at 60 °/sec; knee pain, measured with the Numeric Pain Rating Scale (NPRS); and self-reported knee function, measured with the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). PCS scores improved from pre-surgery to after post-surgical rehabilitation, while TSK-11 and KASE scores improved from pre-surgery to after post-surgical rehabilitation and from after post-surgical rehabilitation to 1-year post-surgery. Pre-surgery PCS and KASE scores were associated with 1-year post-surgery NPRS score (r = 0.50) and quadriceps peak torque (r = 0.48), respectively. From pre-surgery to 1-year post-surgery, change in TSK-11 score was associated with change in NPRS score (r = 0.65), and change in KASE score was associated with change in IKDC-SKF score (r = 0.44). From pre-surgery to after post-surgical rehabilitation, changes in TSK-11 and KASE scores were associated with changes in NPRS (TSK-11, r = 0.47; KASE, r = -0.50) and IKDC-SKF scores (TSK-11, r = -0.39; KASE, r = 0.71). From after post-surgical rehabilitation to 1-year post-surgery, changes in KASE score was associated with changes in IKDC-SKF score (r = 0.59). Assessment of pain catastrophizing and knee activity self-efficacy pre-surgery might help to identify patients at risk for sustained knee pain and quadriceps muscle weakness. Decreasing kinesiophobia and increasing knee activity self-efficacy were associated with improved knee pain and function. 2b.

The Effectiveness of Nonoperative Treatment for Anterior Cruciate Ligament Rupture on Patient-Reported Outcomes and Muscular Strength: A Critically Appraised Topic.

Clinical Scenario: Anterior cruciate ligament (ACL) ruptures are one of the most common injuries in young athletic populations. The leading treatment for these injuries is ACL reconstruction (ACL-r); however, nonoperative treatments are also utilized. Following ACL-r, patients experience prolonged muscle weakness and atrophy of the quadriceps muscle group, regardless of rehabilitation. Nonoperative treatment plans following ACL injury exist, but their outcomes are less familiar, in spite of providing insight as a nonsurgical "control" for postsurgical rehabilitation outcomes. Therefore, the purpose of this critically appraised topic was to evaluate quadriceps strength and function following nonoperative ACL rehabilitation using objective and subjective measures including isokinetic dynamometry, the single-leg hop test, and the International Knee Documentation Committee (IKDC) subjective knee form. Focused Clinical Question: What are the effects of nonoperative treatment on peak isokinetic knee-extensor torque, the single-leg hop tests, and the IKDC in patients who have sustained an ACL rupture? Summary of Key Findings: Patients who underwent nonsurgical ACL treatment produced limb symmetry index, with the side-to-side torque difference expressed as a percentage, and values at or above 90% for all 4 single-leg hop tests and strength tests similar to ACL-r patients. All studies showed individuals had higher IKDC scores at baseline collection when compared with patients who underwent ACL-r but showed lower IKDC scores at long-term follow-up compared with ACL-r patients. Clinical Bottom Line: Nonoperative treatments of ACL injuries yield similar long-term results in quadriceps strength as ACL-r. Due to the quality of evidence and the absence of randomized controlled trials on this topic, these outcomes should be considered with caution. Strength of Recommendation: The Oxford Centre for Evidence-Based Medicine taxonomy recommends a grade of B for level 2 evidence with consistent findings.

Comparative study between early mobilizations vs late mobilization after flexor tendon repair in the hand

Objective The aim was to study the different types of mobilization after flexor tendon repair and their effect on the prognosis of healing and rehabilitation. Background Tendon injuries are the second most common hand injury type. Most tendon injuries require surgical repair and rehabilitation to restore hand function. Postsurgical rehabilitation improves the functions and outcomes and is an essential step in managing repaired tendons. Patients and methods The study included 60 patients after repair of flexor tendons in the hand, who were divided into early, intermediate, and late groups as A, B, and C, respectively (randomized controlled clinical trial). To clarify the timing distribution of rehabilitation after tendon repair, the authors subdivided the patients into three groups: early rehabilitation ( 6 weeks) after tendon repair. The period selection ( 6 week) was based on the physiology of tendon healing. The resurgery rate and the use of rehabilitation resources after tendon repair were calculated. Complications were studied and compared (reduced range of finger movement, rupture of the repair, and flexor tendon adhesion). Results The resurgery rate was highest (12.08%) in those commencing rehabilitation more than 6 weeks after tendon repair, and lowest (3.81%) in those commencing it within 1 week. Patients in the early rehabilitation group required fewer rehabilitation sessions (median: 11.5 sessions) than did those in the intermediate (29 sessions) and late (33 sessions) rehabilitation groups. Conclusion The early rehabilitation group exhibited the lowest resurgery rate and used the fewest rehabilitation resources. Compared with late rehabilitation, early or intermediate rehabilitation conferred protective effects against resurgery and fewer complications.