Outpatient Rehabilitation Clinic Research Articles

EARLY POST-OPERATIVE CLINICAL OUTCOMES IN PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY COMPARING IN-PERSON CLINIC VERSUS TELEHEALTH-DELIVERED REHABILITATION PROGRAM: A NON-INFERIORITY TRIAL

INTRODUCTION AND AIMS Rehabilitation following total knee arthroplasty (TKA) is essential to mitigate delay in physical recovery and facilitate optimum patient outcomes. Telehealth is emerging as a cost-effective and efficacious delivery method. The aim of this study was to investigate the early post-operative outcomes of patients following a telehealth-delivered rehabilitation program (Tele) compared with those following conventional outpatient rehabilitation (Clinic) in patients following TKA. METHODS A single-blinded, randomized controlled non-inferiority trial was conducted, with 108 participants scheduled for primary TKA randomly allocated to a 6-week, telehealth-delivered rehabilitation program (n=54) or a 6-week supervised, in-person rehabilitation program (n=54). Knee flexion range of motion (KF-ROM) and the Quality of Life subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-QOL) were collected pre-surgery and 7-weeks post-surgery. A linear mixed-effect model was used to assess differences between groups over time for both outcome measures. Change in KOOS-QOL of greater than 10 points was used to establish minimally clinically important change (MCIC), with chi square analyses used to assess between-group differences. RESULTS Baseline KF-ROM measures were 124.1° and 122.2° for telehealth-delivered and in-person groups respectively; and 108.7° and 111.6° at 7-week post-surgery. KOOS-QOL scores were 32.7 and 33.3 at baseline for the respective groups; and 60.9 and 62.9 at week-7. There were no significant differences in between group changes over time for both KF-ROM (mean difference = -2.9°, 95% CI = -7.7 to 1.8; p=0.226) and KOOS-QOL (mean difference = -2.1, 95% CI: -10.0 to 5.9; p=0.611). Chi square analyses revealed no differences between groups meeting the MCIC (Tele = 71%; Clinic = 79%) in KF-ROM (X2 = 0.78, p = 0.377). CONCLUSION Short term outcomes following TKA are not different between telehealth-delivered and conventional supervised rehabilitation. Telehealth may provide an effective rehabilitation option for patients undergoing TKA.

Can We Use the Maximum Phonation Time as a Screening of Pulmonary Forced Vital Capacity in Post-COVID-19 Syndrome Patients?

ObjectiveTo verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to estimate forced vital capacity (FVC) in patients with Post-COVID-19 Syndrome. MethodCross-sectional study involving adult patients, who were admitted to the Intensive Care Unit and referred to the Post-COVID-19 Rehabilitation Outpatient Clinic. Voice function was assessed using a Vocal Handicap Index (VHI) self-assessment questionnaire and MPT tests. To perform the phonatory tests, the patients remained in a standing posture and were instructed to inhale as much air as possible and, during a single exhalation, at usual pitch and loudness, sustain the emission of /a/ and /s/; and in another breath, to perform the ascending numerical count, starting from the number one up to the highest number they could reach. Pulmonary function was assessed by spirometry. The ROC curve was plotted, and FVC values lower than the normal limit by Z-score (5th percentile) were classified as impaired lung function. The predictive values and likelihood ratios were calculated. ResultsA total of 70 patients participated, with 20-30% having a high VHI. Approximately 24% had an FVC impairment and significantly low values of MPT/a/, MPT/s/, MPTC, and CN. The test results showed overall accuracy of 70% and the cutoff points of 9.69, 6.78, 10.60 and 13, respectively, with high sensitivity, predictive negative value and low specificity, predictive positive value, and positive likelihood ratio. ConclusionsOur results suggest that the MPT has moderate discriminatory power for FVC impairment, indicating that it is not a reliable indicator of pulmonary function in the population studied. Therefore, in patients with an MPT of less than 10.60 seconds, or a CN lower than 13, other criteria should be added to improve the diagnostic accuracy and support the decision to perform more complex investigations.Keywords

Lessons learned from investigating patients’ and physiotherapists’ perspectives on the design of a telerehabilitation platform

Purpose Home self-rehabilitation exercises for musculoskeletal conditions are a valuable complement to rehabilitation plans. Telerehabilitation systems using artificial intelligence can provide reliable solutions and empower patients by providing them with guidance and motivating them to engage in rehabilitation plans and activities. This study aims to understand the patient’s and physiotherapist’s perspective on the requirements of effective face-to-face physiotherapy sessions to inspire the design of a telerehabilitation platform to be used in home settings. Methods The authors used an ethnography-informed approach through observation and semi-structured interviews with patients (n = 13) and physiotherapists (n = 10) in two outpatient rehabilitation clinics. The AEIOU framework was used to structure and analyse the observation. Thematic analysis was used to code and analyse the data collected from the observations and the interviews. Results Patients’ and physiotherapists’ perspectives emphasise the need for exercise instruction clarity, evolution monitoring, and feedback. In the absence of the physiotherapist, in home settings, patients feel insecure and fear execution difficulties and limited exercise instructions, while physiotherapists struggle with controlling patients’ home exercise performance. Telerehabilitation is seen as an opportunity to move further into home self-rehabilitation programs. Conclusions Besides home exercise monitoring and guidance, telerehabilitation platforms must allow personalization and effective communication between patients and physiotherapists.

Implementation of a Provincial Long COVID Care Pathway in Alberta, Canada: Provider Perceptions.

A novel, complex chronic condition emerged from the COVID-19 pandemic: long COVID. The persistent long COVID symptoms can be multisystem and varied. Effective long COVID management requires multidisciplinary, collaborative models of care, which continue to be developed and refined. Alberta's provincial health system developed a novel long COVID pathway. We aimed to clarify the perspectives of multidisciplinary healthcare providers on the early implementation of the provincial long COVID pathway, particularly pathway acceptability, adoption, feasibility, and fidelity using Sandelowki's qualitative description. Provider participants were recruited from eight early-user sites from across the care continuum. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Participants participated in structured or semi-structured virtual interviews (both group and 1:1 were available). Structured interviews sought to clarify context, processes, and pathway use; semi-structured interviews targeted provider perceptions of pathway implementation, including barriers and facilitators. Analysis was guided by Hsieh and Shannon as well as Sandelowski. Across the eight sites that participated, five structured interviews (n = 13 participants) and seven semi-structured interviews (n = 15 participants) were completed. Sites represented primary care (n = 4), outpatient rehabilitation (n = 3), and COVID-19 specialty clinics (n = 2). Qualitative content analysis was used on transcripts and field notes. Provider perceptions of the early implementation outcomes of the provincial long COVID pathway revealed three key themes: process perceptions; awareness of patient educational resources; and challenges of evolving knowledge.

Characterization of telerehabilitation visits and patient satisfaction in outpatient physical medicine and rehabilitation clinics from March 2020 to November 2021.

To explore the usability of and satisfaction with telerehabilitation services provided to rehabilitation patients with various diagnoses at two large urban medical facilities during the Covid-19 pandemic. This was a usability study and all patients that received telerehabilitation services from March 2020 to November 2021 were included. Of the 4,070 surveys sent via mail or email links to RedCap, 405 were completed (10% Response Rate). Participants completed demographic surveys, surveys on the telerehabilitation visit characteristics, telerehabilitation usability, and overall satisfaction with the visit. Patients were mostly women (64.4%), White, non-hispanic (74.3%) and English speaking (99%). Most patients were seen via telerehabilitation due to Covid-19 restrictions (37.1%). Patients were generally satisfied with their telerehabilitation visit (3.64 out of 4). Additionally, patients generally found telerehab to be useful (6.4 out of 7), easy to use (6.3 out of 7), effective (6.2 out of 7), satisfactory (6.3 out of 7) and comparable to in-person visits (6.5 out of 7). Patients generally reported feeling satisfied and comfortable with telerehabilitation visits, and felt they were comparable to in-person visits. Future research should examine the impact of socioeconomic factors on telerehabilitation use, with a focus on education level and non-English speakers.

Predictors of a Preference for Telemedicine Virtual Visits in Patients Undergoing Cancer Rehabilitation.

The purpose of this retrospective study was to examine the use of virtual visits (telemedicine) at our cancer rehabilitation outpatient clinics from March 2020 to August 2021, when virtual visits became more widely available, and to identify any demographic and clinical variables making patients more likely to favor virtual over in-person visits. There were 3971 outpatient encounters (2020 virtual and 1951 in-person visits from a total of 1638 patients) in our cancer rehabilitation outpatient clinics during this time frame. Significant findings in both the univariate and multivariate analyses were race (P < .001 and P = .006, respectively), cancer type (P < .001 for both), and distance to the clinic (P < .001 for both). Our research showed that virtual visits were accepted by patients with cancer, and that younger age (62 compared to 65), non-White race/ethnicity, solid tumor, and shorter distance to the clinic were associated with a preference for virtual over in-person visits.

The Effect of Shoulder Pain on Sleep Quality

Objective: Shoulder pain, a common musculoskeletal issue, is most prevalent in patients aged 50-59. It can cause sleep problems, reducing sleep quality. We aimed to explore the relationship between sleep quality, pain, and disability in patients with shoulder pain, despite limited literature on this issue.&#x0D; Material-Method: Study involved 91 patients aged 18-80 with persistent shoulder pain sought out at a physical medicine and rehabilitation outpatient clinic. Factors such as age, gender, education, symptom duration, body mass index (BMI), occupation, and pain severity were recorded. Severity of pain was assessed using the visual analogue scale (VAS), pain and disability using the Shoulder Pain and Disability Index (SPADI), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI).&#x0D; Results: Average age was 54.9. 63% of patients were female and 28% were male. 14% of them had heavy work above shoulder level. A positive correlation was detected between PSQI and VAS and SPADI (p value 0.004 and 0.003, respectively). No significant relationship was found between PSQI and BMI and symptom duration (p value 0.464 and 0.718, respectively). While there was a significant difference in SPADI values between two groups with and without heavy work above the shoulder level, no significant difference was detected in PSQI values (p value 0.021 and 0.36, respectively).&#x0D; Conclusion: We found that the patient's VAS and SPADI values and sleep quality were negatively related to shoulder pain. Sleep disturbance due to pain at night can also affect daytime disability. Pain and sleep quality disorders can enter a vicious circle.

Does interferential current provide additional benefit to orthopedic rehabilitation for the patients with proximal humeral fractures? A randomized controlled study

BackgroundApproximately 80% of all proximal humeral fractures (PHFs) are non-displaced or minimally displaced fractures, which can be treated with conservative treatment. This study investigated the effect of interferential current (IFC) added to orthopedic rehabilitation on shoulder function, pain, and disability in patients with PHF.MethodsThis study was a prospective, double-blind, randomized, placebo-controlled conducted in physical medicine and rehabilitation outpatient clinic. Thirty-five patients were randomly separated into the IFC group (n = 18) and the sham group (n = 17). The orthopedic rehabilitation program was applied to all patients by the same physiotherapist three times a week for four weeks. Patients in the IFC group received the intervention for 20 minutes 3 times a week before the exercise. The same pads were performed for the sham group, but no electrical stimulation was applied. Constant-Murley score (CMS) for shoulder function, visual analog scale (VAS) activity pain, disabilities of the arm, shoulder, and hand (DASH) score, and paracetamol intake were recorded post-treatment, at 6 weeks and 18 weeks post-treatment.ResultsThe demographic and fracture characteristics were not different between the groups. Significant differences were observed in the IFC and sham group in intragroup comparisons of total CMS, VAS activity pain, DASH score, and paracetamol intake over time (p < 0.001). Significant improvement over time was valid for all pairwise comparisons in both groups. However, no significant differences were detected between the IFC and sham group.ConclusionIFC added to orthopedic rehabilitation could not appear to be an electrotherapy modality that could potentially benefit shoulder function and disability in patients with PHF.

Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation

Objective: This study aims to determine the frequency of cervicogenic dizziness in patients suffering from neck pain and observe the efficacy of cervicogenic dizziness (CGD) rehabilitation. Material and Method: It was a retrospective study. The patients aged between 18 and 65 who attended the physical medicine and rehabilitation outpatient clinic and suffered from neck pain were included in the study. Pregnants and patients with a history of cervical surgery, missing data, or attending the rehabilitation program irregularly were excluded. Demographic data, treatment protocols, laboratory and radiology results, and Dizziness Handicap Inventory Scores in the 1st and 3rd month after rehabilitation were obtained from the health database. The frequency and reasons for cervicogenic dizziness and the efficacy of the rehabilitation program were observed. P &lt; 0.05 was considered statistically significant. Results: Totally, 443 patients were analyzed. 288 patients were female, and 155 were male. The mean age was 50.31 ± 14.06. Cervical disc herniation was determined in 40% (n = 178) of the patients, cervical spondylosis was observed in 11.5% (n = 51) of patients, 45.5% (n = 202) of patients had myofascial pain syndrome and 1.5% (n = 6) of patients defined trauma. Neck pain was associated with dizziness in 8.57% (n = 38). Cervicogenic dizziness was determined in 8.1% of the patients, and the most common reasons were myofascial trigger points and cervical disc hernia. Patients who accepted the cervicogenic rehabilitation program had a better Dizziness Handicap Inventory Score in the 1st and 3 rd month controls. Conclusion: Cervicogenic dizziness was determined in 8.1% of patients suffering from neck pain. It was detected that the most common reason was cervical pathologies, and the patients benefited from rehabilitation program.

Treatment of fibromyalgia among patients with mastalgia and fibromyalgia improved mastalgia.

The aim of this study is to examine the effect of fibromyalgia (FM) treatment on mastalgia by performing fibromyalgia screening in patients who applied for mastalgia and whose underlying cause could not be found. Patients who applied to Kocaeli University General Surgery Outpatient Clinic between November 2017 and November 2020 with breast pain were included (n=120). Patients without cancer, systemic disease, previous breast surgery, and breast mass larger than 3 cm (n=30) were referred to the Physical Therapy and Rehabilitation Outpatient Clinic. A total of 13 patients (43%) were diagnosed with FMS. Twelve of them were given selective serotonin-noradrenaline reuptake inhibitor (duloxetine) treatment for 3 months. Turkish version of the Short Form - 36 (SF-36) quality of life scores, Visual Analog Scale (VAS), Cardiff breast pain score before and after treatment were compared. The remaining 17 patients were followed as only mastalgia. Patients with fibromyalgia and mastalgia had similar demographic results. At the end of the 3rd month, the complaints of breast pain completely regressed in all of the patients. Statistically significant changes were detected in VAS score, the number of trigger points, and SF-36 quality of life scores, Cardiff breast pain score after duloxetine treatment. In the presence of unexplained mastalgia, fibromyalgia should be kept in mind. Duloxetine treatment improved the breast pain and quality of life in patients with mastalgia and fibromyalgia.

An Integrated Stroke Transitional Care Intervention Improves Physical Functioning, Self-Management and Patient Experience in Older Adults with Stroke and Multimorbidity: A Multisite Pragmatic Randomized Controlled Trial

Background: The hospital-to-home transition for older adults with stroke is often fragmented, resulting in hospital readmissions and reduced quality of life, patient satisfaction and safety. There is limited evidence for strategies to improve transitions in care for older adults with stroke and multimorbidity. This study aimed to test, in real-world clinical practice, the effectiveness of the Transitional Care Stroke Intervention (TCSI) versus usual care on health outcomes, patient experience, and health and social service use costs in older adults (&gt; 55 years) with stroke and multimorbidity (&gt; 2 chronic conditions).&#x0D; Methods: This pragmatic randomized controlled trial was conducted among older adults with a stroke and multimorbidity discharged from the hospital to the community using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional team from hospital-based outpatient stroke rehabilitation clinics (Physiotherapist, Occupational Therapist, Speech Language Pathologist, Registered Nurse, and Social Worker). The TCSI is a complex, integrated intervention which includes care coordination/system navigation support, phone/video visits, monthly interprofessional case conferences, and an online resource to support system navigation. Data analysis was performed by intention to treat. The primary outcome was risk of hospital readmission (all-cause) after 6 months. Secondary outcomes were mental and physical functioning, depressive symptoms, stroke self-management, patient experience, number of hospital days and readmissions, number of ED visits, survival rates to first hospital and ED visit, risk of ED visits, and health and social service use costs. Older adults with stroke were engaged as co-investigators and informed the research design, implementation, and evaluation through participation in the Patient Partner Advisory and the TCSI Steering Committees.&#x0D; &#x0D; Results: Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Most participants were men (60%), with an average of 7 comorbid conditions, and 78% had experienced their first-ever stroke. No significant group differences were seen for the baseline to six-month risk of hospital readmission (all-cause). However, stroke survivors in the intervention group reported higher levels of physical functioning (SF-12 Physical Component Summary Score mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005) compared with the usual care group. No significant group differences were seen for the other secondary outcomes.&#x0D; Discussion: The TCSI improved physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs compared to usual care.&#x0D; Conclusion:The results provide evidence for the effectiveness of an integrated intervention to optimize transitional care outcomes for older adults with stroke and multimorbidity receiving outpatient stroke rehabilitation services.&#x0D; Suggestions for future research: Future research is needed to further evaluate this intervention in diverse settings and populations, with a larger sample size and a full economic evaluation. &#x0D; &#x0D; &#x0D;

Stroke severity to determine musculoskeletal symptoms in family caregivers.

the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score(FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. NCT04901637 (1) Stroke survivors highly depend on informal caregivers for daily living. (2) Family caregivers are at an increased risk of experiencing musculoskeletal problems. (3) The caregivers' musculoskeletal symptoms are related to the level of the patient disability. (4) Preventive medicine should become a part of nursing education for family caregivers.

Gravidade do AVC e determinação dos sintomas musculoesqueléticos dos cuidadores familiares

Objective: the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. Method: the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients’ physical health and disability level. Results: a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients’ Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. Conclusion: according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients’ functional capacity and disability levels. Clinical trials number: NCT04901637

Use and attitudes towards digital technologies in addiction rehabilitation in the SARS-CoV-2 pandemic

Abstract Background Before the start of the pandemic, digital technologies were hardly used in addiction rehabilitation in Germany - also due to the lack of a legal framework. During the SARS-CoV-2 pandemic, the funding agencies enabled their use. The aim of the study is to describe the use of and attitudes towards digital technologies in addiction rehabilitation from the perspective of both clinic management and rehabilitation patients. Methods Clinic management of all 1044 outpatient and inpatient addiction rehabilitation clinics in Germany were asked in summer 2022 to complete an online questionnaire on the use of and attitudes towards digital technologies in addiction treatment. 415 clinics provided answers (response rate 40%). In addition, 460 rehabilitation patients from 34 different clinics were questioned in written form (mean age 46.0 years (SD: 13.3), 73% male; 81% alcohol addiction). Results According to the clinic management, digitally conducted therapies were carried out in individual therapy (inpatient: 22% vs. outpatient 62%), group therapy (4% vs. 37%), family-oriented interventions (55% vs. 51%), and pre-admission interviews (45% vs. 45%). Among the rehabilitation patients, 10% in inpatient and 37% in outpatient rehabilitation stated that they had used digitally conducted therapies. 87% of the clinic management felt that digital therapy offers were useful during the pandemic, and 84% were in favour of using them beyond the pandemic. Among rehabilitation patients, the approval rate was 85% and 59% respectively. Conclusions Digital technologies were used for different therapy services in addiction rehabilitation. The majority of both clinic management and rehabilitation patients were in favour of this, even beyond the pandemic. For further use after the pandemic, the establishment of a legal, financial and organisational framework is required. Non-inferiority studies (comparing digital to face-to-face) could add to the evidence. Key messages • Digital technologies were used for therapeutic purposes (e.g. individual therapy, group therapy, family-oriented interventions) by a large proportion of addiction clinics during the pandemic. • The majority of clinic management and rehabilitation patients are in favour of the use of digital technologies in addiction rehabilitation even beyond the pandemic.

Exploring rehabilitation options and resources of support for stroke survivors in Eldoret, Kenya: qualitative study

BackgroundStroke is a major cause of death and disability in adults globally. Most post-stroke survivors experience various impairments which requires rehabilitation. Likewise, returning home after a stroke represents challenging moments full of struggle. This study, therefore, explores options of rehabilitation and resources of support for stroke survivors in Eldoret, Kenya.MethodA qualitative descriptive approach was used to conduct the study. The study utilised semi-structured interviews. Fifteen dyads of stroke survivors (10 men and 5 women; aged 40–75 years) were enrolled from a rehabilitation outpatient clinic (Medical Park Physical Therapy) in Eldoret, Kenya. Interviews were conducted at the patients’ house, and an inductive approach was used to enable thematic content analysis.ResultsTwo dominant themes and several categories emerged from the participants; these included the following: (1) rehabilitation services available for stroke survivors and (2) resources of support.ConclusionsThe study found that stroke units are only available at the national hospitals and not accessible to many. Patients receive physiotherapy and occupational therapy services during hospital stay but has poor access post discharge. Transport, distance, and lack of finances have been highlighted as the main challenges. There is scarcity of speech therapist as well as advanced orthotics for stroke rehabilitation. From a clinical perspective, healthcare system should be better structured to accommodate continuity of care post discharge for stroke survivors.

Fibromiyaljili kadınlarda fiziksel aktivite ile ağrı, interoseptif farkındalık ve kişisel iyi oluş arasındaki ilişki: Kesitsel çalışma

Aim: In this study, the effect of physical activity level on pain, interoceptive awareness, and personal well-being in women with fibromyalgia was investigated.&#x0D; &#x0D; Methods: Fifty female patients diagnosed with fibromyalgia syndrome who applied to the physical medicine and rehabilitation outpatient clinic were evaluated as follows: Demographics (age, occupational status, and body mass index (BMI)) were recorded, pain levels were evaluated with visual analog scale (VAS), physical activity levels were evaluated with the international physical activity questionnaire (IPAQ), personal well-being were evaluated with the personal well-being index adult form (PWI-A) and interoceptive awareness were evaluated with multidimensional assessment of interoceptive awareness (MAIA).&#x0D; &#x0D; Results: The mean age of the participants was 50.96±8.35, and the mean BMI was 27.74±4.01. Fifty-four % of the participants had low physical activity levels and 46% had moderate physical activity levels. The mean MAIA total score was 19.44±3.73 and the mean VAS was 6.32±1.69. In correlation analysis, a large negative statistically significant relationship between VAS and PWI-A (p

The Effect of Probiotic Consumption Status and Quality of Life in Patients with Fibromyalgia

Aim: Recent studies have suggested that disruptions in the gut microbiota could potentially contribute to the pathogenesis of chronic pain and fibromyalgia syndrome (FMS) by affecting the gut microbiota-brain axis. The increasing prevalence of fibromyalgia syndrome has prompted investigations into the impact of probiotic food consumption, which regulates the microbiota, on quality of life.&#x0D; Material and Methods: The study included 99 patients diagnosed with fibromyalgia syndrome who presented to our Physical Medicine and Rehabilitation outpatient clinic. A questionnaire was administered to assess the patients' knowledge and consumption of probiotic foods, and the Short Form-12 Health Survey(SF-12) was used to gather data and assess health-related quality of life.&#x0D; Results: Of the 99 patients who completed the questionnaire, 89 were female and 10 were male. In response to the question, "Do you know what probiotics are?"7.4% of primary school graduates,64.7% of high school graduates, and 78.6% of university graduates answered affirmatively. When asked, "Have you experienced any benefits from probiotic foods?" 21.2% responded positively, and among those who experienced benefits, the most common accompanying issue (37.04%) was Irritable Bowel Syndrome(IBS). Fibromyalgia syndrome patients who consumed yogurt as a probiotic had higher physical function subdomain scores on the SF-12 Health Survey.&#x0D; Conclusion: The high level of education in FMS patients increased the awareness of probiotics. Probiotic consumption may have a improving effect on irritable bowel syndrome and constipation associated with FMS.Training on probiotics and increasing the frequency of use of probiotics, the quality of life of FMS patients can be increased and accompanying symptoms can be reduced.

Lower Quadrant Edema Patient-Reported Outcome Measure Is Reliable, Valid, and Efficient for Patients with Lymphatic and Venous Disorders.

The main aims of this study were: (1) to create a patient-reported outcome measure (PROM) item bank for measuring the impact of lower quadrant edema (LQE) on physical function using item response theory and (2) to assess reliability, validity, and administration efficiency of LQE PROM scores based on computerized adaptive test (CAT) and the reliability of a 10-item short form (SF). This retrospective study included data from patients treated in outpatient rehabilitation clinics for lower quadrant edema who responded to all 30 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. LQE-CAT-generated scores were assessed for reliability, validity, and administration efficiency. LQE-SF-generated scores were assessed for reliability. The total cohort included 4894 patients (mean [SD] age = 65 [14] y; range = 14-89 y). A set of 20 items was selected for the item bank based on support for its unidimensionality and fit to the item response theory model, with reliability estimates greater than 0.92 for CAT and SF administration modes. No items demonstrated differential item functioning with respect to tested variables. After controlling for scores at intake, scores discriminated among multiple patient groups in clinically logical ways with better outcomes observed for patients who were younger with less chronic symptoms and fewer comorbidities. Scores were responsive to change but the effect size was small (0.4). There were negligible floor and ceiling effects. CAT administration of the item bank required an average of 6.1 items (median = 5). Scores correlated highly with full-bank scores (Pearson correlation coefficient = 0.98). Scores on the LQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with lower quadrant edema. The LQE CAT and SF are suitable for research and routine clinical care. Reasons for the small effect size for change scores should be studied. The newly developed LQE PROM was reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with LQE, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory-based measure, the LQE PROM allows administration of condition-specific functional questions with low response burden for patients. The 10-item LQE-SF offers a feasible alternative administration mode when CAT administration is not available. This study supports a transition to PROMs that are based on modern measurement approaches to achieve the combined benefits of high accuracy and efficiency.

Botulinum toxin type A for spasticity in cerebral palsy patients: Which impact on popliteal angle to hamstring length? A proof-of-concept study.

Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait. The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients. In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018. Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent). Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle -51.7∘± 11.0∘, modified popliteal angle of -39.5∘± 11.0∘, passive knee extension of -14.0∘± 8.7∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p< 0.01), popliteal angle 41.3∘± 7.0∘ (p< 0.001), modified popliteal angle -32.9∘± 10.4∘ (p< 0.001), passive knee extension -4.0∘± 4.2∘ (p< 0.05) and 10MWT 12.6 ± 4.8 seconds (p< 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection. Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle.

Functional Capacity in COVID-19 related Acute Respiratory Distress Syndrome Survivors

Background/Purpose:: The aim of this retrospective study is to determine the functional capacity, global muscle weakness and quality of life in COVID-19 survivors. Acute respiratory distress syndrome survivors frequently develop impaired physical function, quality of life, and muscle weakness.&#x0D; Methods: Acute respiratory distress syndrome survivors related to COVID-19 underwent standardized physical clinical evaluation, Medical Research Council-sumscore, hand-grip strength, 6-minute walk test, 5 repetition-chair-stand test, timed up and go test and Short form-36 evaluation following 4-6 weeks after hospital discharge in Physical Medicine and Rehabilitation Outpatient Clinic.&#x0D; Results: Fifteen patients (10 men, 5 women) with median age 69 years and length of intensive care unit stay 10 days were analyzed. There were impairments in 6-minute walk test, 5 repetition-chair-stand test, hand-grip strength and, Role-physical, Role-emotional and Social functioning domains of Short form-36. 6-minute walk distance was negatively correlated with timed up and go. SF-physical functioning was positively correlated with hand-grip strength, Medical Research Council-sumscore and 5 repetition-chair-stand. SF-general health was positively correlated with hand-grip strength.&#x0D; Conclusion: There were varying degrees of functional impairment in survivors. Therefore, it could add advantage to assess these patients after nearly 4-6 weeks following discharge in order to ascertain rehabilitation needs and giving appropriate therapies.