Rheumatology Rehabilitation Research Articles

Low-level laser therapy on hands of patients with rheumatoid arthritis

Dear Editor, In “letter to editor,” authors Tuner and Hode [1] commented on our study regarding laser therapy on rheumatoid hands [2]. The authors calculated the energy applied per point correctly (0.18 J); however, they did not calculate the total maximal energy administered on each hand, as the applications on the proximal interphalanges, which also received low-level laser therapy (LLLT) on 20 points, were not counted. Thereby, totaling 8.28 J rather than 4.68 J and on average, the patients received 7.56 J per treatment. The doses recommended by the World Association for Laser Therapy mentioned by the authors refer to doses for “arthritis in the hands.” The recommendation does not specify the disease for which the dose is destined, and there is no explanation of how the values were determined. Rheumatoid arthritis (RA) is one of the most important rheumatic diseases and has specific particularities. It is a chronic, autoimmune, systemic inflammatory disorder of unknown etiology that may affect many tissues and organs but principally the synovial joints [3, 4]. In the literature, there are laboratory and animal studies in favor of LLLT for joint inflammation [5–10]; however, few authors have studied the use of LLLT on the hands of patients with RA and we will discuss these papers below. Bliddal et al. (1987) [11] studied 17 patients to determine the efficacy of LLLT on AR of the 36 hands, but found no statistically significant differences 37 between the experimental and control groups. The energy output was 3 J per treatment and the authors concluded that LLLT was not effective on RA. With the same objective, Palmgren et al. (1989) [12] studied 35 patients using an energy output of 7.2 J per treatment and concluded that the intervention was effective to treat the hands on patients with RA. Johannsen et al. (1994) [13] also assessed 22 patients to determine the effectiveness of LLLT on RA of the hands. The energy output per treatment was 23.2 J. As there were no statistically significant differences between the experimental and control groups, the authors state that LLLT is not indicated for the treatment of these patients. Hall et al. (1994) [14] studied 40 patients with the same objective using an energy output of 36 J per treatment. The authors found no statistically significant differences favoring the experimental group and do not recommend the use of LLLT on the hands of patients with RA. Bjordal et al. (2003) [15] carried out a systematic review on doses of low-level laser for joint pain in chronic diseases and report that energy outputs between 0.4 and 19 J are ideal for a reduction in inflammation. Ottawa Panel (2004) [16], Brosseau et al. (2005) [17], and Christie et al. (2007) [18] also carried out systematic reviews on the use of LLLT for RA, which included the studies discussed above [11–14]. In the literature, we found that the doses, powers, wavelengths, and energy outputs vary between studies on LLLT and RA, with the energy applied to the hands of patients ranging from 3 to 36 J. All authors recommend further studies in this field. We performed a controlled, double-blind study, which demonstrated that, using the parameters most often S. M. Meireles :A. Jones : J. Natour Rheumatology Rehabilitation Section, Rheumatology Division, Federal University of Sao Paulo, Sao Paulo, Brazil

Rehabilitation in der Rheumatologie

Rehabilitation in rheumatology focuses on prevention of functional disorders of the musculoskeletal system, maintenance of working ability and prevention of care dependency. Drug treatment alone rarely results in long-term remission, therefore rehabilitative measures must be integrated into rheumatic care. Rehabilitative therapy in rheumatology includes physiotherapy, patient education and occupational therapy. Positive effects of physical therapy methods have been proven by various studies. Patient education and occupational therapy are important tools for stabilizing the course of the disease. To maintain positive rehabilitative results patients have to be involved in the selection of treatment measures and should take an active part in the long-term treatment process. Despite proven efficacy of physical measures there is evidence for a lack of utilization of rehabilitative therapy due to increasing cost pressure in the health care system which will further increase over time.

Severe Disease Activity and Complications of Immunosuppressive Therapy: A Challenge for Acute Hospital-based Rehabilitation in Rheumatology

Acute rehabilitation refers to the multidisciplinary rehabilitative treatment of patients in continuing need of integrated acute and rehabilitative longterm care. As a result of the advances in acute rheumatology and improved emergency services, an increasing number of patients survive episodes of severe disease and complications of immunosuppressive therapy. These patients require not only treatment of their acute medical problems but also specialized multidisciplinary acute rehabilitation starting as early as possible during their hospital stay. We describe 4 typical cases from the major fields of rheumatology. (1) Acute rehabilitation of a 63-year-old woman with rheumatoid arthritis after replacement of both preexisting knee endoprostheses in one session and removal of the left hip endoprosthesis due to infection and sepsis. (2) Rehabilitation of a 29-year-old man with a 7-year history of ankylosing spondylitis who lived in an adjustable easy chair for 2 years due to severe pain prior to admission. (3) A 61-year-old woman with active refractory Wegener's granulomatosis who developed respiratory insufficiency due to aspergillus and pseudomonas pneumonia. (4) The acute rehabilitation of a 21-year-old woman with systemic lupus erythematosus and a history of 14 laparotomies due to severe acute pancreatitis and multiple gut perforations. Acute rehabilitation was complicated by a large defect of the abdominal wall and significant critical illness polyneuropathy. Our report points out differences between acute, postacute, and longterm rehabilitation, describes the mobilization of patients in acute rheumatology units, and defines specific problems encountered in acute hospital-based rehabilitation of rheumatological patients.

Patient experiences of rehabilitation in rheumatology: association with process and outcome

Objective: To evaluate health-care experiences of patients following inpatient rheumatology rehabilitation and to assess the association between these experiences and aspects of health-care delivery and patient characteristics.Methods: Data were collected from 435 patients with a rehabilitation stay of ≥ 1 week at 12 institutions in Norway in 2006. At discharge, patients completed the Rehabilitation Patient Experiences Questionnaire (Re-PEQ), which includes four important aspects of patient experiences. Multiple regression analysis was used to assess associations between Re-PEQ scores, health-care process, health and sociodemographic variables.Results: A total of 412 (94.7%) patients completed the Re-PEQ; scores ranged from 69 (social environment) to 83 (care/organization) on the 0–100 scale, where 100 represents the best possible experience. The social environment scale had the largest component of variation explained by the independent variables, which included number of doctor visits, amount of group education, and individual exercise (p < 0.01). The type of institution, number of doctor visits, mental health, and gender also explained significant components of variation in the other Re-PEQ scale scores.Conclusion: Patients reported good experiences with rheumatology rehabilitation. Areas where poorer experiences emerged can help target areas for future initiatives aimed at improving the quality of care. Health and sociodemographic variables should be controlled for in studies of patient experiences.

Anwendung der ICF in der rheumatologischen Rehabilitation

The International Classification of Functioning, Disability, and Health (ICF) created by the World Health Organization provides both a framework and a classification comprehensively covering domains of function and disability in rheumatologic patients. The ICF can be used as a universal language understood by medical doctors, health professionals, researchers, patients, and other groups. It is based on an integrative biopsychosocial model of functioning. For its implementation in rheumatology and medicine in general, practical ICF-based tools such as the ICF Core Sets are necessary. These Sets, which were developed in a standardized scientific process, consist of the ICF categories that are most relevant for a specific group of patients, e.g. chronic patients with rheumatoid arthritis. In rheumatologic rehabilitation, patient problems, medical findings, treatment goals, and treatment concepts can be structured by applying the ICF, ICF Core Sets, and an ICF assessment sheet to patients. In outcomes research, ICF Core Sets can support the selection of relevant outcome domains.

Rheumatology rehabilitation: adding life to years

Rheumatology rehabilitation: adding life to years

The impact of introducing an ICF-based rehabilitation tool on staff satisfaction with multidisciplinary team care in rheumatology: an exploratory study

Objective: To investigate the impact of introducing a rehabilitation tool on multidisciplinary team members' satisfaction with team functioning, team conferences and written information exchange. Design: Pretest posttest design. Setting: Day patient and inpatient wards of a rheumatology rehabilitation clinic. Subjects: Members of two multidisciplinary teams. Interventions: The introduction of an electronic version of the Rehabilitation Activities Profile. Main measures: The Group Environment Scale and questionnaires on satisfaction with team conferences and administrative procedures administered before (T1) and 12 months after (T2) the introduction of the Rehabilitation Activities Profile. Results: The Group Environment Scale cohesion subscale was significantly higher at T2 than at T1 in the day patient setting (mean difference 1.9; 95% confidence interval (CI) 0.3; 3.4), whereas in the inpatient setting the Group Environment Scale cohesion and the order and organization subscales were significantly lower (mean differences -3.0; 95% CI -4.7; -1.3 and -2.7; 95% CI -4.3; -1.1, respectively). Satisfaction with team conferences was significantly higher at T2 compared with T1 in the day patient setting (mean difference total score 0.6; 95% CI 0.3; 1.0), but not in the inpatient setting (mean difference -0.3; 95% CI -0.7; 0.2). In both settings, the proportions of health professionals spending >10 minutes on administrative tasks per patient contact were significantly higher at T2 than at T1. Conclusions: In the day patient setting, the introduction of a rehabilitation tool had a positive effect on team members' satisfaction with team functioning and team conferences, whereas in the inpatient setting the effect was absent or the opposite. In both settings, the time spent on administrative tasks increased.

Problemorientiertes Lernen (POL) in der Rehabilitation am Beispiel eines Patienten mit Spondylitis ankylosans

Through innovative teaching and learning methods relevant topics in rehabilitation can be conveyed effectively. Therefore, in this paper a papercase for problem-oriented learning (POL) is presented concerning rehabilitation in rheumatology, exemplified by a patient with ankylosing spondylitis. This papercase can be applied in the integrated course Rehabilitation, Physical Medicine and Naturopathic Treatment, the curricular part of teaching rehabilitation during the medical training according to the 9 (th) revision of the Federal Medical Licensing Regulations (Approbationsordnung). In addition the teaching material presented can be used in other courses, such as elective courses for non-medical professionals of the interdisciplinary rehabilitation team. First experiences gathered with the papercase in the Health and Nursing Sciences study programme of the Faculty of Medicine of Martin-Luther-University Halle-Wittenberg are reported.

Rehabilitation in rheumatoid arthritis: a critical review

This article considers the evidence for effectiveness and timing of rehabilitation for people with rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow-up periods, small sample sizes). Evidence to date is that symptomatic relief results from thermotherapy, laser therapy, acupuncture and assistive devices. In the short-term, comprehensive occupational therapy (in established rheumatoid arthritis), orthoses, and mind-body approaches can help maintain function. Over at least a one-year period, the following are effective in reducing pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic exercise therapy, hand exercises and hydrotherapy; and cognitive-behavioural therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long-term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well-designed clinical trials are needed recruiting people with early disease using patient-centred outcomes.

Unsupervised home exercise and/or self-monitoring of symptoms does not improve pain or function in patients with osteoarthritis

Summary of Ravaud P, Giraudeau B, Logeart I, Larguier JS, Rolland D, Treves R, Euller-Ziegler L, Bannwarth B and Dougados M (2004): Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2×2 factorial design. Annals of Rheumatic Disease 63: 703–708. (Prepared by Gro Jamtvedt, Norwegian Directorate for Health and Social Affairs and Kåre Birger Hagen, National Resource Centre for Rehabilitation in Rheumatology, Oslo, Norway)

Long-term follow-up and prognosis of work capacity in the early stage of chronic polyarthritis

Work disability (WD) in early rheumatoid arthritis (RA) has not been extensively evaluated in Germany. Therefore, the occurrence of WD pension within the first seven years of RA and prognostic indicators of the first year including the duration of sick leave (SL) were analyzed. Within the first year of RA according to the ACR 1987 criteria, 141 gainfully employed patients were entered into a prospective multicenter study (61% females, mean age 47 +/- 9 years, mean disease duration 6 +/- 3.5 months). One hundred and ten patients (78%) participated in a reevaluation (postal questionnaire) after a mean follow-up of 6.1 +/- 0.4 years. Predictors of WD pension were identified in univariate analyses and in backward multivariate Cox regression analyses (p < 0.05) with Hazard-ratios [H-R] as measures of WD risk. Of 110 patients 53 (48%) were still employed at reexamination. WD due to RA occurred in 5% after one year disease duration, in 15% after 2 years, in 20% after 3 years, and in 28% after 6.5 years. Other reasons for leaving the labor force were found in 24%. High pain intensity, radiographic erosions, comorbidity and the pain behavior of avoidance were associated with WD only in univariate analyses. Age > 45 years [H-R 6.3] and the following job-related prognostic indicators were identified in the multivariate analyses: working under pressure of time [H-R 9.0], limited joint motion interferring with job tasks [H-R 5.9], feeling overworked [H-R 3.8] and work status (unskilled blue-collar workers vs white-collar professionals and self-employed persons) [H-R 3.4]. In an alternative final Cox-regression model the variables feeling overworked and work status were replaced by SL duration > 8 weeks within the first year of RA [H-R 7.1]. Since WD frequently occurs already within the first 3 years (20%) adequate interventions resulting from the prognostic indicators have to begin early in the course of RA. Apart from the rheumatological treatment and rehabilitation focusing on the reduction of pain, improved coping with pain, reduced joint destruction and improved mobility particularly working under pressure of time should be avoided and the work place has to be adjusted in case of limited joint motion interferring with job tasks. SL of several weeks duration already within the first year of RA is a red flag for impending WD.

Searching for rehabilitation articles on MEDLINE and EMBASE. An example with cross-over design

Objective: To analyze the usefulness of MEDLINE and EMBASE biomedical databases in rehabilitation and to identify descriptors and text words necessary to do a comprehensive search.Methods: We looked for articles published since 1990 relating to neurologic, orthopedic, respiratory, urologic, and rheumatologic rehabilitation. We looked for all descriptors and text words pertinent to rehabilitation and linked them with “cross-over.”Results: We found 165 articles in MEDLINE and 159 in EMBASE with an overlap of only 17% of articles. Only 32% of the articles in MEDLINE and 35% in EMBASE were relevant. Of the 214 nonoverlapping articles, 84% were published in journals present in both databases, but were indexed differently.Conclusion: At least two databases must be used to ensure a comprehensive literature search. Searching in EMBASE after MEDLINE we gained 25 articles (32%). Bibliographic search in rehabilitation is particularly complex because of the heterogeneity of the subject matter. Cooperation between an information professional and a clinician is essential to ensure a comprehensive search.

Rheumatologic Rehabilitation Series—Volume 5: Surgical Rehabilitation

Rheumatologic Rehabilitation Series—Volume 5: Surgical Rehabilitation

Rheumatologic Rehabilitation Series Volume I: Assessment and Management

Book Review| Online July 01 1999 Rheumatologic Rehabilitation Series Volume I: Assessment and Management Rheumatologic Rehabilitation Series Volume I: Assessment and Management. Jeanne L. Melvin, MS, OTR, FAOTA, & Gail M. Jensen, PhD, PT (Eds.) ( 1998). American Occupational Therapy Association, 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824-1220. 446 pp., $40.00 (members), $50.00 (nonmembers). ISBN: 1-56900-086-7 Olga Baloueff, ScD, OTR Olga Baloueff, ScD, OTR Search for other works by this author on: This Site PubMed Google Scholar Author & Article Information Online Issn: 1943-7676 Print Issn: 0272-9490 Copyright © 1999 by the American Occupational Therapy Association, Inc.1999 The American Journal of Occupational Therapy, 1999, Vol. 53(4), 411–412. https://doi.org/10.5014/ajot.53.4.411b Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Olga Baloueff; Rheumatologic Rehabilitation Series Volume I: Assessment and Management. Am J Occup Ther July/August 1999, Vol. 53(4), 411–412. doi: https://doi.org/10.5014/ajot.53.4.411b Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentThe American Journal of Occupational Therapy Search Advanced Search This content is only available via PDF. Copyright © 1999 by the American Occupational Therapy Association, Inc.1999 Article PDF first page preview Close Modal You do not currently have access to this content.

Rheumatological rehabilitation in older adults

Rheumatological rehabilitation in older adults

Management of work disability. Resources for vocational rehabilitation.

To review the state-federal vocational rehabilitation (SF-VR) system and its utilization by persons with rheumatic conditions. SF-VR system instruction manuals, and literature on rheumatology rehabilitation, work disability, and rehabilitation counseling were reviewed. National and Massachusetts state SF-VR system data on persons with "arthritis and rheumatism" were analyzed. The SF-VR system is used by a small proportion of persons with rheumatic diseases. Fifty-two percent of clients with arthritis are employed after receiving services. Although evidence indicates that VR services for persons with rheumatic conditions improves their chances for reemployment, the SF-VR system is underutilized.

Research in Physical Medicine and Rehabilitation

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.

Research in Physical Medicine and Rehabilitation

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.

Book Review: Rehabilitation in Rheumatology — The Team Approach

Book Review: Rehabilitation in Rheumatology — The Team Approach

Book Review: Rehabilitation in Rheumatology — the Team Approach

Book Review: Rehabilitation in Rheumatology — the Team Approach