Rehabilitation Perspective Research Articles

The Safety and Effectiveness of Early, Progressive Weight Bearing and Implant Choice after Traumatic Lower Extremity Fracture: A Systematic Review.

The goal of this systematic review was to examine existing evidence on the effectiveness of early, progressive weight bearing on patients after traumatic lower extremity fractures and relate these findings to device/implant choice. A search of the literature in PubMed/Medline, Embase, Web of Science, and the Cochrane Library was performed through January 2022. Randomized controlled trials and non-randomized, prospective longitudinal investigations of early, progressive weight bearing in skeletally mature adults after traumatic lower extremity fracture were included in the search, with 21 publications included in the final analysis. A summary of the loading progressions used in each study, along with the primary and additional outcomes, is provided. The progression of weight bearing was variable, dependent on fracture location and hardware fixation; however, overall outcomes were good with few complications. Most studies scored "high" on the bias tools and were predominately performed without physical therapist investigators. Few studies have investigated early, progressive weight bearing in patients after traumatic lower extremity fractures. The available clinical evidence provides variable progression guidelines. Relatively few complications and improved patient function were observed in this review. More research is needed from a rehabilitation perspective to obtain graded progression recommendations, informed by basic science concepts and tissue loading principles.

Classification of Corrosion Severity in Concrete Structures Using Ultrasonic Imaging and Linear Discriminant Analysis

The deterioration of concrete structures due to rebar corrosion is a key issue affecting the safety and service life of civil infrastructure. Reinforced concrete (RC) structures in coastal areas are subjected to harsh environmental conditions that cause rebar corrosion. From the perspective of safety, repair, and structural rehabilitation, it is essential to ascertain the level of corrosion severity and associated damage in RC structures through non-destructive evaluation (NDE) techniques. In this study, the potential of pattern recognition techniques for ascertaining the severity damage at various stages of rebar corrosion in concrete samples was explored. A contact ultrasonic compressional wave transducer pair with 250 kHz centre frequency was used as source and reflected signals from the rebar were acquired using a tied-together scanning approach. To expedite the corrosion process in the laboratory, accelerated corrosion of the embedded rebar was employed. The synthetic aperture focusing technique (SAFT) was applied to reconstruct the image of the concrete subsurface from the acquired B-scans. Two approaches, i.e., the Mahalanobis distance (MD) and linear discriminant analysis (LDA), were adopted; both methods correctly classified the level of corrosion severity and damage to the concrete. The developed pattern recognition techniques can, therefore, be potential tools for generating important information towards economical and timely repair of damaged concrete structures affected by rebar corrosion.

Which screening tool should be used for identifying aspiration risk associated with dysphagia in acute stroke? A Cochrane Review summary with commentary.

Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool. To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke. A summary of the Cochrane Review by Boaden et al. 2021, with comments from a rehabilitation perspective. The review included 25 studies with 3953 participants and 37 screening tests. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing swallow screening tools were the Bedside Aspiration test (combined water swallow and instrumental tool), the Gugging Swallowing Screen (GUSS, water plus other consistencies) and the Toronto Bedside Swallowing Screening Test (TOR-BSST, water only). However, these tests were based on single studies with small sample sizes. It was not possible to explore the influence of sources of heterogeneity. No single swallow screening tool with high accuracy as well as good quality evidence could be identified, but recommendations for further high-quality research are offered.

Gender differences in pulmonary function, physical activity, and quality of life of patients with COPD based on data from the Korea National Health and Nutrition Examination Survey 2015 to 2019 from the Perspective of Pulmonary Rehabilitation.

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, with the fourth highest mortality rate. This study aims to analyze pulmonary function, physical activity, and quality of life (QoL) between genders from the perspective of pulmonary rehabilitation in Korean patients with COPD. This study investigated raw data from the Korea National Health and Nutrition Examination Survey from 2015 to 2019 and included 151 COPD patients (men: 66.55 ± 10.07 years, women: 65.21 ± 11.73) out of 39,759 participants. Pulmonary function, such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), and frequency of physical activities (e.g., physical activity for work and leisure, strengthening exercise, and sitting time a day) and QoL by using EQ-5D-3L, were compared between genders in patients with COPD. Smoking status differed in health-related characteristics between genders (P < .001). In pulmonary function, the FVC (men: 3.48 ± 0.98ℓ, women: 2.53 ± 0.56ℓ, P < .05), FEV1 (men: 2.13 ± 0.93 ℓ, women: 1.88 ± 0.53 ℓ, P < .001), FEV6 (men: 3.16 ± 1.00ℓ, women: 2.46 ± 1.56ℓ, P < .001) and peak expiratory flow (men: 5.61 ± 2.44ℓ/s, women: 4.68 ± 1.53ℓ/s, P < .05) was higher in men, however, predicted FEV1 (men: 66.03% ± 23.13%, women: 79.95% ± 18.45%, P < .05) and predicted FEV1/FVC ratio (men: 59.67% ± 15.02%, women: 74.10% ± 10.49%, P < .001) in women. The frequency of strengthening exercise was higher in men (P < .05). QoL of patients with COPD was not significantly different between genders. To provide correct interventions and pulmonary rehabilitation to patients with COPD, gender differences, including physiological and psychological differences, must be considered.

Is Exercise Beneficial in Patients with Low Back Pain? - A Cochrane Review Summary with Commentary.

The aim of this commentary is to discuss from a rehabilitation perspective the Cochrane Review "Exercise therapy for chronic low back pain" (1) by Hayden JA, Ellis J, Ogilvie R, Malmivaara A and van Tulder MW [1] published by Cochrane Musculoskeletal Group. This Cochrane Corner is produced in agreement with Journal of Rehabilitation Medicine by Cochrane Rehabilitation with views* of the review summary authors in the "implications for practice" section. This summary is based on a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2021, Issue 9, Art. No.:CD009790, DOI: 10.1002/14651858.CD009790.pub2 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. * The views expressed in the summary with commentary are those of the Cochrane Corner author (different than the original Cochrane Review authors) and do not represent the Cochrane Library or Journal of Rehabilitation Medicine.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.

Post-traumatic growth experience of first-line emergency nurses infected with COVID-19 during the epidemic period-A qualitative study in Shanghai, China.

BackgroundIn March 2022, Shanghai, China, was hit by a severe wave of SARS-CoV-2 transmission caused by the Omicron variant strain. The medical staff was greatly infected during this period, which posed a traumatic event for them. Meanwhile, they also experience post-traumatic growth under introspection and positive change. However, the psychological coping and growth after infection with COVID-19 among medical staff have rarely been investigated.ObjectivesTo explore the process and influencing factors of post-traumatic growth among emergency nurses infected with coronavirus disease (COVID-19) so as to provide a new perspective and theoretical basis for psychological rehabilitation or intervention for medical staff who experienced traumatic events.MethodsThe study used a qualitative design based on the phenomenological approach. A purposive sampling method was used to explore the subjective feelings and post-traumatic growth among 13 first-line emergency nurses infected with COVID-19 in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2022. A Seven-step Colaizzi process was used for data analysis.ResultsThemes were described and extracted from the experience and insights at different stages during the fight against the virus. Three main themes, i.e., stress period, adjustment period, and growth period, as well as several sub-themes, were identified.ConclusionFirst-line emergency nurses infected with COVID-19 are a sensitive group that should be given more attention. Investigating how they achieve psychological adjustment and growth in the case of severe trauma can provide valuable references for nursing management and education in the future. Society, hospital and nursing managers should pay more attention to the PTG of nurses and establish supportive PTG strategies, which will benefit the retention rate and career development of nurses.

How effective and safe are non-drug treatments for spatial neglect following non-progressive brain injury? A Cochrane Review summary with commentary.

Around 30% of stroke survivors experience spatial neglect. Spatial neglect hinders rehabilitation outcomes and increases the risk of injury. Non-pharmacological interventions are available, yet their efficacy is unknown. To evaluate the effectiveness of non-pharmacological interventions for spatial neglect (inattention) following stroke and other non-progressive brain injuries. A summary of the Cochrane Review by Longley et al. 2020, with comments from a rehabilitation perspective. A total of 43 studies were included in meta-analysis and the quality of evidence was very low for all analyses. The benefits or risks associated with each intervention for spatial neglect including visual treatment, prism adaptation training, body awareness, mental function, movement treatment, non-invasive brain stimulation, electrical stimulation, and acupuncture remain unclear. Evidence in support or against the treatments is sparse and more rigorous studies are needed to evaluate their efficacy. Clinicians should continue to follow current guidelines when available to meet patients' rehabilitation goals.

Goal-Setting in clinical practice: a study of health-care professionals’ perspectives in outpatient multidisciplinary rehabilitation of patients with spinal cord injury

Purpose Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals’ perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury. Materials and methods An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality. Results Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach. Conclusions We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients’ perspectives in the practice is needed. Implications for rehabilitation To strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting. Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI. SMART goals are not always the right way to formulate rehabilitation goals. A flexible and pragmatic approach is needed to reach a balance between the patients’ complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.

Are Cannabis and Cannabinoids Effective for Symptomatic Treatment in People With Multiple Sclerosis?: A Cochrane Review Summary With Commentary.

Are Cannabis and Cannabinoids Effective for Symptomatic Treatment in People With Multiple Sclerosis?: A Cochrane Review Summary With Commentary.

COVID-19, cardiac involvement and cardiac rehabilitation: Insights from a rehabilitation perspective - State of the Art.

Since the beginning of the pandemic, many novel coronavirus disease 2019 (COVID-19) patients have experienced multisystem involvement or become critically ill and treated in intensive care units, and even died. Among these systemic effects, cardiac involvement may have very important consequences for the patient's prognosis and later life. Patients with COVID-19 may develop cardiac complications such as heart failure, myocarditis, pericarditis, vasculitis, acute coronary syndrome, and cardiac arrhythmias or trigger an accompanying cardiac disease. The ratio of COVID-19 cardiac involvement ranges between 7 and 28% in hospitalized patients with worse outcomes, longer stay in the intensive care unit, and a higher risk of death. Furthermore, deconditioning due to immobility and muscle involvement can be seen in post-COVID-19 patients and significant physical, cognitive and psychosocial impairments may be observed in some cases. Considering that the definition of health is "a state of complete physical, mental and social well-being", individuals with heart involvement due to COVID-19 should be rehabilitated by evaluating all these aspects of the disease effect. In the light of the rehabilitation perspective and given the increasing number of patients with cardiac manifestations of COVID-19, in this review, we discuss the rehabilitation principles in this group of patients.

Healthcare professionals’ experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study

Purpose There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. Methods Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. Results The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: “Frustration” includes the informants’ doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. Conclusions The informants’ frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team’s need for additional time and support. IMPLICATIONS FOR REHABILITATION Healthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identities In order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from experts For appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretation The rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language

Does time spent in rehabilitation make a difference on activity limitation and impairment in people with stroke? - A Cochrane Review summary with commentary.

The aim of this commentary is to discuss from a rehabilitation perspective the Cochrane Review “The effect of time spent in rehabilitation on activity limitation and impairment after stroke”[1] by Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J.,1 published by Cochrane Stroke Group. This Cochrane Corner is produced in agreement with the Journal of Rehabilitation Medicine by Cochrane Rehabilitation with views* of the review summary author in the “implications for practice” section.

STUDY ON THE EFFECT OF MINDFULNESS COGNITIVE BEHAVIOR THERAPY IN THE TREATMENT OF ANXIETY DISORDER -- BASED ON THE PERSPECTIVE OF INDIVIDUAL REHABILITATION

STUDY ON THE EFFECT OF MINDFULNESS COGNITIVE BEHAVIOR THERAPY IN THE TREATMENT OF ANXIETY DISORDER -- BASED ON THE PERSPECTIVE OF INDIVIDUAL REHABILITATION

Current Status and Future Perspectives of the Active Knee Joint Rehabilitation Device

Background: Today, living standards and medical technology are improving, and the aging global population is increasing. However, more and more older adults are suffering from knee diseases. This will seriously affect patients’ daily life and their mental state. In many studies, repetitive physical exercises and motor activities in real-world environments have been shown to help improve knee muscle strength and restore damaged nerves. Therefore, physical knee therapy is very necessary. The use of rehabilitation training devices for movement therapy has shown great potential. Objective: This study aimed at exploring the structural features, functions, and development status of the knee rehabilitation training device. Method: This review explores the structure and function of various current knee rehabilitation devices based on structural and kinematic properties of the knee joint in relation to requirements of physical knee rehabilitation. This paper aims to present a systematic guideline and outline a reference for future designers of rehabilitation devices. Results: By analyzing the structure and movement of the knee joint and combining the strategies of physical knee rehabilitation, movement requirements during knee rehabilitation training are concluded. According to the structure, drive form, transmission mode, and rehabilitation environment of knee rehabilitation devices, the devices are classified and compared; some typical features are summarized; some current problems are analyzed, and the future trends and development directions of rehabilitation devices are discussed. Conclusion: Current rehabilitation equipment has a variety of structures and functions, but a good balance between weight and volume is hardly maintained. The protection of the body needs to be further improved. Many knee rehabilitation devices are only concepts, not physical objects, and lack clinical trial data. Power sources and drives are large and heavy, which can compress the knee joint and burden the patient. Strong and lightweight materials should be chosen to assist knee rehabilitation. It will be a good development in the future.

Interdisciplinary perspectives of rehabilitation in adult brachial plexus palsies

The aim of this study is to demonstrate that the interdisciplinary approach could have a positive result on the rehabilitation program in brachial plexus paralysis in adults. The prevalence of brachial plexus injuries is currently increasing worldwide, mainly due to the growing number of car accidents, extreme sports or work-related injuries. In this study we chose to present an analysis of one complex surgical case of brachial plexus paralysis, with clinical and electrophysiological investigations. (1) Background: Current reconstructive surgical nerve transfer procedures aim to rehabilitate elbow flexion in such cases. Surgical strategies are based not only on clinical evaluation or investigations by magnetic resonance imaging but also on classical electrophysiological methods, such as electromyography (EMG). (2) Methods: Along with the other types of therapies already established, in the case of this pathology, Transcranial Magnetic Stimulation (TMS) is also used, which provides valuable information about cortical reorganization models concomitant with surgical procedures for nerve reconstruction in the last 3 decades. (3) Results: The study shows that interdisciplinary leads to a faster and more complex rehabilitation of the patient with brachial plexus paralysis and that electrophysiological signals could predict constant motor benefits when associated with rehabilitation programs. Keywords: brachial plexus; electromyography; transcranial magnetic stimulation; neuroplasticity;

Cross-Disciplinary Practices and Perspectives of Auditory Rehabilitation for Adults With Cochlear Implants

Purpose: The objective of this study was to examine cross-disciplinary clinical practice approaches and professional characterizations of auditory rehabilitation (AR) for adults with cochlear implants (CIs). Method: A survey was distributed nationally to audiologists, speech-language pathologists, and physicians. Included professionals self-identified as hearing health care providers for adults with CIs. Survey topics included the scope of AR, practice patterns and professional roles in service delivery, and barriers to providing comprehensive adult AR services. Results: Sensory management services were reported as standard audiological practice but were considered within the scope of AR by less than half of the 63 participating clinicians. Nearly 80% of respondents viewed counseling and instruction services as components of AR. In addition, 97% believed that the scope of AR practice included perceptual training, but these elements were provided less often than any other component. Audiologists commonly provided counseling and instruction, sometimes in conjunction with speech-language pathologists. Multidisciplinary approaches generally enhanced the breadth and depth of services offered by providers. Common obstacles to comprehensive AR practice included inadequate reimbursement, limited patient uptake, and a scarcity of available and qualified providers. Conclusions: The survey results illustrated varied clinical practice patterns and a range of professional perspectives regarding AR for adults with CIs. A deeper examination of the critical barriers to a more standard narrative and approach is warranted to guide the advancement of comprehensive AR for adults with CIs.

How effective and safe are current interventions for sexual dysfunction following stroke? A Cochrane Review summary with commentary.

Sexual dysfunction (SD) is experienced by 50% of stroke survivors, and it is identified as critical in their rehabilitation management, but often remains unaddressed. To evaluate the effectiveness and adverse events of currently available interventions for SD following stroke. A summary of the Cochrane Review by Stratton et al. 2020, with comments from a rehabilitation perspective. Three randomized control trials with a total of 212 participants were included. Evidence quality was very low for all assessed interventions (pharmacological, psycho-educational and physical therapy). The efficacy of pelvic floor muscle training for lower urinary tract symptoms and erectile dysfunction remains uncertain. Pharmacological interventions may improve sexual functioning, while psychoeducation show little to no difference on sexual functioning outcomes. The effectiveness of current rehabilitation interventions for SD following stroke remains uncertain due to the low quality of evidence and limited sample size. Further studies with improved methodology should investigate rehabilitation interventions for SD in stroke survivors to improve their quality of life.

Barriers to personal hygiene in persons with spinal cord injury during the COVID-19 pandemic and lockdown

Personal hygiene is the most important measure to prevent coronavirus disease 19 (COVID-19). The pandemic has put persons with disabilities into various challenges. People with spinal cord injury (SCI) are facing these obstacles more because of their altered physiology and increased susceptibility to COVID-19. Through telerehabilitation, hurdles were identified in two paraplegic individuals, such as safe water sources, concerns regarding self-catheterization, increased dependence on care partner, hygiene of assistive aids/wheelchairs, availability of dressing materials for pressure injury dressing, and sanitary pads for menstrual hygiene. To the best of our knowledge, these are the first cases to describe hygiene concerns of SCI people during the COVID-19 pandemic and its rehabilitation implications. Considering the population with disabilities, we should improve access to primary care at the community level regarding personal hygiene. For a large population with disabilities such as SCI who are at risk, simple health education, awareness, and economic ways of hygienic practices can be a saviour.

The Effect of Individual Combination Therapy on Children with Motor Deficits from the Perspective of Comprehensive Rehabilitation

Objective: The paper presents the results of a research survey focused on individual combination therapy in individuals with motor deficits during childhood. The research was carried out in 2020/2021. Two patients were selected based on predetermined relevant criteria and participated in the research survey. Intervention approaches within the research survey were focused on the development of the motor skills of the chosen patients suffering from cerebral palsy or dyspraxia. Furthermore, the patients’ social adaptability was supported together with their independence and self-sufficiency in coping with everyday tasks. Sample: Two patients (N = 2) participated in the research survey based on intended sampling (i.e., motor deficit, age 7–9 years, participation in rehabilitation interventions max. 4 times a month). Based on the predetermined criteria, the two patients were contacted, one of which (N = 1) was diagnosed with cerebral palsy diparesis (ICD-10; G80.1: spastic diplegic cerebral palsy, 8.8 years of age), and the other patient (N = 1) suffered from developmental dyspraxia (ICD-10; F82: a specific developmental disorder of motor functions, 7.4 years of age). The single-case research design method was applied to process the results. This type of qualitative research enabled us to study in detail a small number of participants, specifically in our research (N = 2), one individual patient who suffered from cerebral palsy and the other individual patient diagnosed with developmental dyspraxia. The choice of two individual patients would help us to obtain a better idea of the effect of the chosen combination therapy. A standardized modified FIM test (Functional Independence Measure) was used to present the results. Results: The presented results of the research survey using the single-case research design method point to the following findings. The chosen intervention method using combination therapy demonstrably improved the patients’ conditions within the monitored indicators. When the intervention was omitted and only the usual rehabilitation procedures were conducted, the patients’ conditions deteriorated and decreased to the initial values. Conclusion: Based on the presented results, combination therapy appears to be an effective approach for individuals with motor deficits at a younger school age. The combination of selected rehabilitation approaches using classical procedures as well as robotically assisted therapy is desirable in practice as it meets the requirements for rehabilitation in the 21st century. The survey results offer conclusions and recommendations for practice regarding the research topic.