Recovery Of Physical Function Research Articles

Effects of Rehabilitation Robot Training on Physical Function, Functional Recovery, and Daily Living Activities in Patients with Sub-Acute Stroke.

Stroke often results in sensory deficits, muscular weakness, and diminished postural control, thereby restricting mobility and functional capabilities. It is important to promote neuroplasticity by implementing task-oriented exercises that induce changes in patients. Therefore, this study aimed to investigate the effects of rehabilitation robot training on physical function, functional recovery, and activities of daily living (ADLs) in patients with subacute stroke. The study participants were patients with subacute stroke receiving treatment at Hospitals A and B. They were selected as research subjects based on selection and exclusion criteria. The experimental group received rehabilitation robot training in sessions of 30 min, five times weekly, for a total of 20 sessions over four weeks. Conversely, the control group underwent standard rehabilitation equipment training with an identical frequency, duration, and number of sessions. Measurements were taken before and after the training period to assess changes in physical function, functional recovery, and activities of daily living using tools such as the MMT, BBS, FBG, FAC, FIM, and MBI. The results were as follows: in the within-group comparison, the rehabilitation robot training group showed significant differences in MMT, BBS, FBG, FAC, FIM, and MBI (p < 0.05), while the control group showed significant differences in FIM (p < 0.05). Statistically significant differences were observed in the time, group, and time × group interaction effects among the MMT, static seated FBG, dynamic seated FBG, FIM, and MBI (p < 0.05). Based on these results, rehabilitation robotic training resulted in significant improvements in physical function, functional recovery, and activities of daily living in patients with subacute stroke. Based on these findings, providing a basic protocol for a rehabilitation program that applies rehabilitation robot training to patients with subacute stroke may offer more effective treatment and outcomes in the future.

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status.

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery

IntroductionPreoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. Materials and methodsModels were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. ResultsAerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). ConclusionBoth models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.

Effectiveness of Art Therapy Programs in Enhancing Recovery and Rehabilitation in Sports Medicine

Purpose: The general aim of the study was to examine the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine.&#x0D; Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.&#x0D; Findings: The findings reveal that there exists a contextual and methodological gap relating to the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. Preliminary empirical review revealed that art therapy interventions offer a holistic approach to healing, addressing athletes' physical, emotional, and social needs during the recovery process. Through a comprehensive review of empirical studies, the findings demonstrated consistent positive outcomes, including improved physical function, pain management, psychological well-being, and overall recovery among athletes. The study highlighted the importance of interdisciplinary collaboration and patient-centered care in sports medicine rehabilitation, as well as the potential cost-effectiveness of incorporating art therapy into standard practice. These findings underscored the value of art therapy as a complementary intervention in optimizing athletes' recovery and facilitating their successful return to sport.&#x0D; Unique Contribution to Theory, Practice and Policy: The Social Cognitive theory, Self- Determination theory and Biopsychosocial model may be used to anchor future studies on the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. The study provided recommendations that contributed to theory, practice, and policy. The findings emphasized the importance of grounding art therapy interventions in established theoretical frameworks, integrating them into standard rehabilitation protocols, advocating for policy support and reimbursement, fostering collaboration and partnerships, developing standardized protocols and outcome measures, and advancing research and evaluation efforts. These recommendations aimed to optimize the use of art therapy as a holistic and effective intervention for athletes recovering from sports injuries, ensuring equitable access to these services and fostering a culture of innovation in sports medicine rehabilitation.

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

What are the differences in the recovery of physical function and clinical score between patients with steroid-related osteonecrosis of the femoral head and hip osteoarthritis undergoing total hip arthroplasty? A propensity score-matched study.

Steroid-related osteonecrosis of the femoral head (ONFH), arising from steroid administration for underlying diseases, represents a unique pathology for total hip arthroplasty (THA) and typically affects a younger demographic compared to osteoarthritis (OA). Given the significant age-related differences, this study aims to employ propensity score matching to align patient backgrounds between these two diseases and compare physical function. Additionally, our objective is to scrutinize the patterns of clinical score recovery over the course of one year following THA. Using propensity score matching, 29 patients each with steroid-related ONFH and OA were selected. Muscle strength (hip abductor and knee extensor) were assessed before and after THA. Additionally, recovery of the Harris Hip Score (HHS) and Oxford Hip Score (OHS) up to one year postoperatively was analyzed. The steroid-related ONFH group exhibited gender bias and significantly younger age compared to the OA group. Propensity score matching achieved balanced patient backgrounds. Physical function showed trends of lower hip abduction and knee extensor strength on the operative side in the steroid-related ONFH group. Notably, nonoperative knee extensor strength decreased significantly after matching. HHS and OHS were poor in steroid-related ONFH up to three months postoperatively but recovered after six months. Patients with steroid-related ONFH experience positive outcomes in clinical score following THA. Propensity score matching effectively identified muscle weakness on both operative and nonoperative sides, highlighting its utility in comparative analyses.

Physical functional recovery in the early period after hospitalization for COVID-19: impact of hypertension and outcome prediction model

The aim – to study the influence of hypertension (HT) on the dynamics of natural recovery of physical functional status in the early period after hospitalization for COVID-19 and to develop a model for predicting recovery results at 1 month after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % women) were included in the study, 176 of whom underwent the 6-minute walk test (6MWT) using an extended protocol within 1-2 days before discharge. A repeat visit to assess the dynamics of natural recovery was performed at 1 month after discharge.Results and discussion. Pre-discharge 6-minute walk distance was 378±57 m in patients with HT and 418±75 m without it, p=0.001, during the second visit – 440±52 versus 478±68, p=0.002; the achieved percentage of the individually predicted distance was 67.4±10.5 vs. 69.5±13.6 % and 81.6±9.9 vs. 81.9±15.7 %, respectively, p&gt;0.05 for both visits. The increase in heart rate during the test at visit 1 was 18.5±8.3 versus 30.1±19.3 bpm, p&lt;0.001, the percentage of chronotropic reserve utilizatoin was 21.3±9.6 % versus 29.2±11.4 %, p&lt;0.001. During the second visit, residual manifestations of this trend were observed, with an increase in HR by 24.0±9.5 vs. 30.8±12.1, p=0.003 and the use of chronotropic reserve of 28.1±10.1 % vs. 33.4±12.4 %, respectively, p=0.029. The developed multivariate linear regression model explained 59 % of the variability in the achieved percentage of the individually predicted 6-minute walk distance at 1 month after discharge. The use of machine learning allowed to create an artificial neural network based regression model that used age, height, use of remdesivir in treatment, and SBP and DBP values at the time of discharge as predictors, and explained 90 % of observed variability.Conclusions. Hospitalized patients with COVID-19 were characterized by a decrease in the general physical functional status as assessed by 6MWT at the time of discharge and incomplete recovery after 1 month. Presence of hypertension was associated with more pronounced disturbances of the autonomic regulation of heart rate, but did not affect the reached percentage of the distance walked. The proposed artificial neural network based regression model allows for a high accuracy prediction of the 6MWT results at 1 month after discharge, which can be used in the selection of candidates for cardiopulmonary rehabilitation programs.

Essential amino acids in total knee and hip joint replacement: a narrative review

The increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA.

Life-Space of Older Adults after Discharge from Skilled Nursing Facilities

ObjectivesDescribe (1) patient or caregiver perceptions of physical function in 30 days after skilled nursing facility (SNF) discharge indicated by Life-Space Assessment (LSA) scores, and (2) patient and caregiver factors associated with LSA scores. DesignSecondary analysis of baseline and outcomes data from the cluster randomized trial of the Connect-Home transitional care intervention. Setting and ParticipantsSix SNFs in North Carolina. Patient and caregiver dyads with LSA scores (N = 245). MethodsSNF patients or their caregivers serving as proxy reported the life-space of the SNF patient using the LSA tool, a measure of environmental and social factors that influence physical mobility. Simple scores for highest life-space attained depending on equipment and/or caregiver support range from 0 to 5, with higher scores indicating greater mobility. Multiple linear regression models for simple LSA scores and Composite Life-Space (0-120), adjusted for treatment, time via a COVID pandemic indicator, and treatment × COVID effect as fixed effects, were used to estimate the association of patient and caregiver variables and life-space. ResultsPatients had a mean age of 76.3 years, 62.6% were female, and 74.7% were white. Caregivers were commonly female (73.9%) and adult children of the patient (46.5%). The mean Composite Life-Space score was 22.6 (16.09). The mean Assisted Life-Space score (range: 0-5) was 1.6 (1.47), and 76.3% of patients could not move beyond their bedroom, house, and yard without assistance of another person. Higher Composite Life-Space scores were associated with lower levels of cognitive impairment and shorter SNF length of stay. Conclusions and ImplicationsSNF patients and their caregivers reported very low LSA scores in 30 days after SNF care. Findings indicate the need for care redesign to promote recovery of physical function of older adults after SNF discharge, such as optimizing SNF rehabilitative therapy and adding postdischarge rehabilitative supports at home.

Comparison of Four Nutritional Screening Tools for Predicting Postoperative Adverse Events Following Degenerative Spinal Deformity Surgery.

A retrospective study. To compare the mini nutritional assessment-short form (MNA-SF), geriatric nutritional risk index, prognostic nutritional index (PNI), and preoperative serum albumin level as predictors of postoperative adverse events (AEs) in degenerative spine deformity (DSD) patients. Although various nutritional screening tools have been well evaluated in patients undergoing spinal fusion surgery, the most suitable tool for the DSD population remains uncertain at present. The authors reviewed consecutive patients who underwent thoracolumbar fusion surgery for DSD between August 2016 and May 2023. Four screening tools were used to assess preoperative nutritional status. Patients were divided into two categories according to each screening tool, and the four screening tools were compared regarding their predictive power for postoperative AEs, including the rates of extended length of hospital stays (LOS), complications, and readmission within three months. Physical functional indicators such as time to first ambulation, nonhome discharge, and postoperative LOS were assessed as secondary outcome measures. A multivariable logistic regression analysis was used to identify factors associated with postoperative AEs. A total of 228 patients were included. The demographic characteristics, underlying disease, and magnitude of correction were not significantly different between well-nourished and malnourished groups. The nutritional risks shown by MNA-SF and albumin level were significantly associated with infectious complications ( P <0.05). The nutritional risk shown by MNA-SF was significantly associated with nonhome discharge, prolonged postoperative LOS (12.5±8.2 vs. 10.3±6.1, P =0.039), and delayed ambulation (3.7±2.1 vs. 2.2±1.8, P =0.001). Multivariable logistic regression revealed that PNI <50 was significantly associated with total AEs and minor AEs after DSD surgery. PNI was significantly associated with the incidence of total AEs and minor AEs, while preoperative albumin level and MNA-SF were more effective in predicting postoperative infectious complications and delayed recovery of physical function, respectively. Level III.

Predicting Delayed In-Hospital Recovery of Physical Function After Total Knee Arthroplasty

ObjectiveTo identify patients at high risk of delayed in-hospital functional recovery after knee replacement surgery by developing and validating a prediction model, including a combination of preoperative physical fitness parameters and patient characteristics. DesignRetrospective cohort study using binary logistic regression. SettingUniversity hospital, orthopedic department. Participants260 adults (N=260) (≥18y) with knee osteoarthritis awaiting primary unilateral total knee arthroplasty and assessed during usual care between 2016 and 2020. InterventionNot applicable. Main Outcome MeasuresTime to reach in-hospital functional independence (in days), measured by the modified Iowa Level of Assistance Scale. A score of 0 means completely independent. Potential predictor variables are a combination of preoperative physical fitness parameters and patient characteristics. ResultsBinary logistic regression modeling was applied to develop the initial model. A low de Morton Mobility Index (DEMMI), walking aid use indoors, and a low handgrip strength (HGS) were the most important predictors of delayed in-hospital recovery. This model was internally validated and had an optimism-corrected R2 of 0.07 and an area under curve of 61.2%. The probability of a high risk of delayed in-hospital recovery is expressed by the following equation:Phighrisk=(1/(1+e(−(2.638−0.193×DEMMI+0.879×indoorwalkingaid−0.007×HGS))))×100%. ConclusionsThe model has a low predictive value and a poor discriminative ability. However, there is a positive association between preoperative physical fitness and postoperative recovery of physical function. The validity of our model to distinguish between high and low risk, based on preoperative fitness values and patient characteristics, is limited.

Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes.

Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A prognostic model and pre-discharge predictors of post-COVID-19 syndrome after hospitalization for SARS-CoV-2 infection.

Post-COVID-19 syndrome (PCS) has been increasingly recognized as an emerging problem: 50% of patients report ongoing symptoms 1 year after acute infection, with most typical manifestations (fatigue, dyspnea, psychiatric and neurological symptoms) having potentially debilitating effect. Early identification of high-risk candidates for PCS development would facilitate the optimal use of resources directed to rehabilitation of COVID-19 convalescents. To study the in-hospital clinical characteristics of COVID-19 survivors presenting with self-reported PCS at 3 months and to identify the early predictors of its development. 221 hospitalized COVID-19 patients underwent symptoms assessment, 6-min walk test, and echocardiography pre-discharge and at 1 month; presence of PCS was assessed 3 months after discharge. Unsupervised machine learning was used to build a SANN-based binary classification model of PCS development. PCS at 3 months has been detected in 75% patients. Higher symptoms level in the PCS group was not associated with worse physical functional recovery or significant echocardiographic changes. Despite identification of a set of pre-discharge predictors, inclusion of parameters obtained at 1 month proved necessary to obtain a high accuracy model of PCS development, with inputs list including age, sex, in-hospital levels of CRP, eGFR and need for oxygen supplementation, and level of post-exertional symptoms at 1 month after discharge (fatigue and dyspnea in 6MWT and MRC Dyspnea score). Hospitalized COVID-19 survivors at 3 months were characterized by 75% prevalence of PCS, the development of which could be predicted with an 89% accuracy using the derived neural network-based classification model.

The efficacy of a blended intervention to improve physical activity and protein intake for optimal physical recovery after oncological gastrointestinal and lung cancer surgery, the Optimal Physical Recovery After Hospitalization (OPRAH) trial: study protocol for a randomized controlled multicenter trial

BackgroundImproving physical activity, especially in combination with optimizing protein intake, after surgery has a potential positive effect on recovery of physical functioning in patients after gastrointestinal and lung cancer surgery. The aim of this randomized controlled trial is to evaluate the efficacy of a blended intervention to improve physical activity and protein intake after hospital discharge on recovery of physical functioning in these patients.MethodsIn this multicenter single-blinded randomized controlled trial, 161 adult patients scheduled for elective gastrointestinal or lung cancer surgery will be randomly assigned to the intervention or control group. The purpose of the Optimal Physical Recovery After Hospitalization (OPRAH) intervention is to encourage self-management of patients in their functional recovery, by using a smartphone application and corresponding accelerometer in combination with coaching by a physiotherapist and dietician during three months after hospital discharge. Study outcomes will be measured prior to surgery (baseline) and one, four, eight, and twelve weeks and six months after hospital discharge. The primary outcome is recovery in physical functioning six months after surgery, and the most important secondary outcome is physical activity. Other outcomes include lean body mass, muscle mass, protein intake, symptoms, physical performance, self-reported limitations in activities and participation, self-efficacy, hospital readmissions and adverse events.DiscussionThe results of this study will demonstrate whether a blended intervention to support patients increasing their level of physical activity and protein intake after hospital discharge improves recovery in physical functioning in patients after gastrointestinal and lung cancer surgery.Trial registrationThe trial has been registered at the International Clinical Trials Registry Platform at 14–10-2021 with registration number NL9793. Trial registration data are presented in Table 1.

Effect of Comprehensive Nursing Intervention in Patients with Urinary Incontinence After Radical Prostatectomy

Objective: To explore and analyze the clinical effect of comprehensive nursing intervention in patients with urinary incontinence after radical prostatectomy. Methods: 84 patients with urinary incontinence after radical prostatectomy admitted to the Urology Department between May 2021 and May 2023 were included in this study. The patients were divided into a comprehensive group and a control group, with 42 cases in each group through a double-blind mechanism. The comprehensive group received comprehensive nursing care, and the control group received primary nursing care. The duration of indwelling urinary catheters and urinary incontinence; psychological performance and living conditions were compared between the two groups. Results: The duration of the indwelling urinary catheter and urinary incontinence of the patients in the comprehensive group were significantly shorter than that in the control group (P &lt; 0.05). Before nursing, there was no statistically significant difference in the anxiety, depression, and other psychological manifestations between the two groups (P &gt; 0.05); after nursing, the comprehensive group’s anxiety, depression, and other psychological manifestations of the comprehensive group were significantly lower than those of the control group (P &lt; 0.05). Before nursing, there was no statistically significant difference in the physical function, mental state, emotional state, and physical recovery of the patients between both groups (P &gt; 0.05); after nursing, the physical function, mental state, emotional state, physical recovery of the patients in the comprehensive group were significantly better than those of the control group. Besides, the living conditions of the patients in the comprehensive group were also significantly better than the control group’s (P &lt; 0.05). Conclusion: Comprehensive nursing intervention can effectively improve symptoms of urinary incontinence after radical prostatectomy, reduce inner pressure, and improve living standards.

OGC O01 Minimally invasive or open oesophagectomy for localised oesophageal cancer: long-term follow-up of the ROMIO pragmatic randomised controlled trial

Abstract Background Patients with localised oesophageal cancer are frequently offered neoadjuvant treatment and surgery, with the benefit of improved survival but an expected at least short term negative impact on quality of life (QoL). Minimally invasive surgical techniques may reduce the QoL impacts by reducing tissue damage. The ROMIO study compared hybrid with open oesophagectomy, to test the hypothesis that hybrid allows faster recovery whilst maintaining the survival benefit of surgery. We have previously reported no evidence of a difference in early complications or recovery of physical function. Here we present the results of the comparison of longer term QoL and survival. Methods A pragmatic multi-centre randomised controlled trial was conducted in nine UK cancer centres. Patients with localised adenocarcinoma or squamous cell cancer were selected by multi-disciplinary teams for oesophagectomy with or without neoadjuvant treatment. Patients were randomly allocated to laparoscopic abdominal surgery and thoracotomy (hybrid) or open oesophagectomy. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons, and intra-operative photographs of key surgical components. Here we report on survival, and patient reported outcomes measured using the EORTC QLQ-C30, over 2 to 3 years post-randomisation. Results At enrolment 469 (89%) of 527 participants had an adenocarcinoma, 371 (71%) had a clinically staged T3 or T4a tumour, 296 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. Kaplan-Meier estimates of survival at 24 months were 66% in the hybrid surgery group (95% confidence interval 60% to 71%) and 65% in the open surgery group (95% confidence interval 57% to 69%) with the difference between the two groups being consistent with chance. Preliminary analyses did not provide evidence of a difference in patient reported quality of life following the two surgical approaches. Conclusions In contrast to the previous MIRO study, the ROMIO study has not identified any differences between hybrid and open surgery in complications, short-term recovery of physical function, or survival and quality of life over two to three years post-randomisation. Both approaches remain common in UK practice, with ROMIO providing evidence of their safety. Potentially, a fully minimally invasive approach, as investigated in the ROMIO phase 2b substudy and the TIME study, is required to realise the potential benefits of minimally invasive approaches.

Efficacy and safety of thoracoscopic-guided multiple paravertebral block for video-assisted thoracoscopic lobectomy surgery: a randomized blinded controlled study

BackgroundParavertebral block (PVB) has been increasingly popular for postoperative analgesia. However, few studies estimated the efficacy and safety of multiple PVB using thoracoscope-assisted technique for intraoperative analgesia and postoperative pain management for video-assisted thoracoscopic lobectomy (VATS LOBECTOMY).MethodsA total of 120 patients scheduled to undergo VATS LOBECTOMY were randomly assigned into two groups: a placebo group and a PVB group in a ratio of 1:2. Thoracoscopic-guided multi-point PVB was carried out with 0.5% ropivacaine (PVB group) or 0.9% NaCl (placebo group) at the beginning and the end of surgery. The primary endpoint was consumption of intraoperative opioid.ResultsConsumption rate of intraoperative opioids was significantly lower in the PVB group (878.14 ± 98.37 vs. 1,432.20 ± 383.53 for remifentanil; 123.83 ± 17.98 vs. 266.42 ± 41.97 for fentanyl). Postoperatively, significantly longer duration of using patient-controlled intravenous analgesia for the first time, reduced times of analgesic pump pressing, and less rescue analgetic consumption were observed in the PVB group. Visual analog scale scores at rest and during exercising were significantly lower in the PVB group at all time points within the first 48 h after surgery. The PVB group was also associated with significantly higher total QoR-40 scores and lower incidence of analgesia-related adverse events.ConclusionsThoracoscopic-guided multiple PVB was a simple and effective technique in controlling pain both intra- and postoperatively for VATS LOBECTOMY. It was also associated with the absence of detrimental effects attributed to opioid overuse and benefits of the early resumption of activity and physical function recovery. Therefore, this regional anesthesia technique should be advocated as part of a multimodal analgesia protocol for VATS LOBECTOMY.

Fitness AfteR Oesophagectomy (FARO): study protocol for an external pilot trial of the impact of rehabilitation on quality of life after surgery for oesophageal cancer

Introduction Curative treatment of gastro-oesophageal cancer encompasses surgery and peri-operative chemo(radio)therapy. Oesophagectomy carries significant morbidity and mortality with an adverse impact upon patients’ quality of life (QoL). Advancements in oncological treatment and surgical techniques have resulted in incremental prognostic gains with increasing focus on survivorship and optimising QoL. Despite enhanced recovery pathways, patients receive no assistance to improve physical functioning and QoL in the recovery period following hospital discharge. Post-operative rehabilitation has demonstrated improvement in physical fitness and psychosocial wellbeing among other cancer subtypes. There is a need to develop rehabilitative interventions that improve and restore patients’ QoL following an oesophagectomy. The aim of the FARO (Fitness AfteR Oesophagectomy) pilot trial is to determine if a pragmatic, patient-directed rehabilitation programme following oesophagectomy improves patients’ QoL. Methods The FARO study is a prospective, single-centre, parallel group, open-label, two-arm pragmatic randomised controlled external pilot trial that will run over 24 months. The trial aims to recruit 60 patients undergoing oesophageal cancer surgery. Patients will be randomized to receive standard clinical care or post-operative rehabilitation (alongside standard clinical care) in a 1:1 ratio. The rehabilitation intervention encompasses a 12-week home-based programme with weekly step-count targets, completion of resistance exercises and dietary monitoring. The primary outcome is patients’ health-related quality of life (assessed by the EORTC QLQ-C30 and OG-25 questionnaires). Secondary outcomes include cardiopulmonary fitness, functional impact of sarcopenia and biochemical nutritional markers. Outcomes are measured at baseline (at discharge from hospital post-oesophagectomy), 6 weeks, 3- and 6 months post-surgery. Discussion This external pilot trial aims to assess if a patient-directed rehabilitation programme following oesophagectomy restores and improves patients’ HR-QOL and recovery of physical functioning. Further, the trial aims to obtain adequate pilot data to plan a future definitive UK-wide trial of perioperative rehabilitation following oesophagectomy. Trial registration number: ISRCTN Registry ISCRTN73024784; Pre-results

Recovery of Gait in Children and Adolescents After Pediatric Femoral Shaft Fracture Treated with Intramedullary Nail Fixation: A Longitudinal Prospective Study.

Femoral shaft fractures in school-aged children are commonly treated with intramedullary nail fixation. Outcomes such as time to healing, alignment and non-union, leg length discrepancy, and refractures, and other complications are often reported based on radiographic findings. There are limited reports on physical function, including objective quantitative measures. The aim was to study the progress and recovery of gait after femoral shaft fracture in children and adolescents. Inclusion criteria were individuals 6 to 16 years of age with a femoral shaft fracture treated with intramedullary nails. Exclusion criteria were pathologic fractures and other physical impairments or injuries that influenced gait.At 6 and 12 weeks, assessments of mobilization and weight bearing were performed at clinical hospital follow-ups.At 3, 6, 9, and 12 months, physical examinations of passive range of motion, stair walking, and three-dimensional gait analysis, including temporospatial, movement (kinematics), and force (kinetics) data, were performed. Seventeen participants, with a median of 9.2 (interquartile range 6.5 to 11.3) years of age were included. At 6 weeks, 14 of 16 (88%) used walking aids and at twelve weeks, 25% did. Sixty-nine percent could walk up and down stairs at 6 weeks and 100% at 12 weeks. At 3 months, 3 participants walked with a speed below 100cm/second and had clear deviations in gait pattern compared with the control group. Three participants had no deviations in gait patterns at 3 months. Gait patterns had normalized in most participants at 6 months. Hip and knee extension moments were decreased up to 6 months compared with the control group. Hip extensor muscle work was increased on the fractured side compared with the control group. Early recovery, between 6 and 12 weeks postoperatively, was noted in basic performance tests after femoral shaft fractures in children and adolescents. Three-dimensional gait analysis revealed normalization of gait patterns at 6 months. Information on the expected time and degree of recovery of physical function could guide the rehabilitation process. Level III.