European journal of physical and rehabilitation medicine最新文献

{"title":"Fully remote versus hybrid supervision of pulmonary telerehabilitation in COVID-19: a randomized clinical trial.","authors":"Bruna S Vian, Lígia S Ratti, Mariangela R Resende, Lucieni de O Conterno, Mônica C Pereira","doi":"10.23736/S1973-9087.24.08634-9","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08634-9","url":null,"abstract":"<p><strong>Background: </strong>The restrictions imposed by the COVID-19 pandemic have impeded the traditional rehabilitation process, prompting the widespread adoption of remote programs for the recovery of survivors.</p><p><strong>Aim: </strong>The aim of this study was to evaluate and compare the effectiveness of a pulmonary telerehabilitation program (PTRP) in the exclusively remote modality versus the hybrid modality (remote and face-to-face) in patients with persistent respiratory dysfunction following hospitalization for COVID-19 pneumonia, and to compare the functional capacity of patients who participated in a PTRP with those who did not.</p><p><strong>Design: </strong>A randomised, interventional, prospective clinical trial was conducted. In parallel, an observational cohort study was conducted.</p><p><strong>Setting: </strong>Outpatient rehabilitation clinic and home-based rehabilitation program.</p><p><strong>Population: </strong>Thirty patients post-COVID-19 were randomised into two groups: G1 (fully remote supervision of PTRP) or G2 (hybrid supervision of PTRP). Thirty-seven post-COVID-19 patients were followed up without participating in PTRP (non-intervention group - NIG).</p><p><strong>Methods: </strong>Patients with persistent respiratory dysfunction and reduced functional capacity, as measured by the Six Minute Walk Test (6MWT), after hospitalization for COVID-19 pneumonia, were considered eligible for a PTRP. To assess the efficacy of the PTRP, the primary outcome (I) was distance walked on the 6MWT (6MWD) and the secondary outcome (II) was quality of life as assessed by the SF-36 questionnaire.</p><p><strong>Results: </strong>Both G1 and G2 demonstrated similar improvement in 6MWD, P<0.001 and quality of life (P<0.05). The IG showed higher 6MWD than the NIG (P<0.001). The increase in 6MWD for the IG was 140.5 m, while for the NIG it was 16.8 m (P=0.002).</p><p><strong>Conclusions: </strong>The PTRP was found to be a feasible and highly effective intervention for restoring functional capacity and improving quality of life, regardless of the type of supervision. Furthermore, this functional gain was maintained over the long term. In patients with pulmonary dysfunction, participation in the PTRP improved functional capacity compared with those who were simply advised to resume physical activity during recovery.</p><p><strong>Clinical rehabilitation impact: </strong>Telerehabilitation has been demonstrated to be a viable and efficacious alternative to traditional in-person programs in low-income contexts.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation of post-stroke aphasia by a single protocol targeting phonological, lexical, and semantic deficits with speech output tasks: a randomized controlled trial.","authors":"Elisabetta Banco, Lorenzo Diana, Carlotta Casati, Luigi Tesio, Giuseppe Vallar, Nadia Bolognini","doi":"10.23736/S1973-9087.24.08576-9","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08576-9","url":null,"abstract":"<p><strong>Background: </strong>The defective spoken output of persons with aphasia has anomia as a main clinical manifestation. Improving anomia is therefore a main goal of any language treatment.</p><p><strong>Aim: </strong>This study assessed the effectiveness of a novel, 2-week, rehabilitation protocol (PHOLEXSEM), focused on PHonological, SEmantic, and LExical deficits, aiming at improving lexical retrieval, and, generally, spoken output.</p><p><strong>Design: </strong>A prospective, randomized controlled trial.</p><p><strong>Setting: </strong>In-patient and out-patient population of the Neurorehabilitation Unit of the Istituto Auxologico Italiano IRCCS, Milan, Italy.</p><p><strong>Population: </strong>The sample comprised 44 adults with aphasia due to left brain damage; 22 of them were assigned to the experimental (PHOLEXSEM) group, whereas 22 were assigned to the control group that received the Promoting Aphasics Communicative Effectiveness (PACE) protocol.</p><p><strong>Methods: </strong>All participants were treated 30-min daily for two weeks. The PHOLEXSEM training included 3 sets of exercises: 1) non-word, word, and phrase repetition; 2) semantic feature analysis by naming; 3) phonemic, semantic, and verb recall. Treatment effects were evaluated with tasks and items different from those used for training, to assess generalization effects.</p><p><strong>Results: </strong>After the PHOLEXSEM treatment, repetition, naming, lexical retrieval and sentence comprehension improved more than in the control - PACE - group, with gains generalizing to non-trained items. These improvements were independent of aphasia chronicity and only marginally influenced by demographic factors.</p><p><strong>Conclusions: </strong>The 2-week PHOLEXSEM training, by targeting spoken output, ameliorates different aspects of aphasia, ranging from speech production (i.e., phonology and lexical retrieval) to comprehension.</p><p><strong>Clinical rehabilitation impact: </strong>The PHOLEXSEM training is a useful and easy-to-administer intervention to improve post-stroke language deficits in adults of different ages, levels of education, duration, type, and severity of aphasia.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between muscle strength and echogenicity using greyscale ultrasound software: a diagnostic accuracy study in kidney transplant candidates.","authors":"Carolina Acuña-Pardo, Elena Muñoz-Redondo, Lou Delcros-Forestier, Yulibeth G Curbelo, Carlos Rodríguez-Hernández, Delky Meza-Valderrama, Dolores Sánchez-Rodríguez, Julio Pascual, Maria J Pérez-Sáez, Ester Marco","doi":"10.23736/S1973-9087.24.08496-X","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08496-X","url":null,"abstract":"<p><strong>Background: </strong>Advanced chronic kidney disease disrupts the delicate equilibrium between protein anabolism and catabolism, leading to alterations in muscle quantity, quality, and function. Musculoskeletal ultrasound emerges as a promising assessment tool due to its widespread availability and high reliability.</p><p><strong>Aim: </strong>To evaluate the efficacy of rectus femoris (RF) echogenicity, measured using greyscale software, in identifying diminished muscle quality and strength in candidates for kidney transplant.</p><p><strong>Design: </strong>Post-hoc diagnostic accuracy study.</p><p><strong>Setting: </strong>Outpatients in a multimodal prehabilitation program pre kidney transplantation (KT).</p><p><strong>Population: </strong>Patients on the waiting list for KT.</p><p><strong>Methods: </strong>Sensitivity, specificity, likelihood ratios and area under the curve (AUC) for diagnostic efficacy of echogenicity (index test) assessed with the ImageJ software greyscale as a potential marker of quadriceps muscle weakness (reference test) were calculated. Muscle weakness was considered as maximal voluntary isometric contraction of the quadriceps (Q-MVIC) <40% of body weight. Other variables included body composition parameters derived from multifrequency electrical bioimpedance, upper limb muscle strength (handgrip), and RF thickness assessed by ultrasound.</p><p><strong>Statistical tests: </strong>Chi-square, t-Student, Pearson correlation coefficients (r), bivariate and multivariate logistic regression models. Statistical significance level ≤0.05.</p><p><strong>Results: </strong>Of 112 patients (mean age: 63.6, 76% male), 72 (63.7%) exhibited quadriceps weakness, while 80 (70.8%) had some degree of overhydration (extracellular water/total body water ratio >0.390). The echogenicity cut-off point of highest concordance with muscle weakness was 70, boasting a sensitivity of 83%, specificity of 57%, and AUC of 0.671 (CI 95% 0.570-0.772 [P=0.003]). Echogenicity >70 was associated with a 3.4-fold higher risk of muscle weakness (crude OR = 3.4 [CI95% 1.4 to 8.0]), which persisted after adjusting for age, height, weight and RF thickness.</p><p><strong>Conclusions: </strong>The RF echogenicity exhibits fair validity in identifying muscle weakness among candidates for KT. However, it cannot be endorsed as a standalone diagnostic tool in this population.</p><p><strong>Clinical rehabilitation impact: </strong>Early identification of muscle weakness would advance efforts to mitigate morbidity and mortality through targeted measures.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivation in veterans with an acute/subacute ischemic stroke did not improve cognition and functional motor recovery but reduced deaths.","authors":"Meheroz H Rabadi, Chao Xu","doi":"10.23736/S1973-9087.24.08563-0","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08563-0","url":null,"abstract":"<p><strong>Background: </strong>The role of motivation per se in the presence or absence of depression in stroke-related cognitive and functional motor recovery has not been studied.</p><p><strong>Aim: </strong>This study aimed to determine the role of motivation on cognition and functional motor recovery in patients after an acute and subacute ischemic stroke.</p><p><strong>Design: </strong>Prospective, observational, single-center study.</p><p><strong>Setting: </strong>Enrollment was undertaken in an inpatient neurorehabilitation facility.</p><p><strong>Population: </strong>A total of 125 veterans with stroke were admitted to an inpatient neurorehabilitation facility.</p><p><strong>Methods: </strong>Recovery locus of control (RLOC) measured the degree of motivation. The primary outcome measures were changes from baseline in the Action Research Arm Test (ARAT), total and sub-scores of Functional Independence Measures (TFIM), and the 2-minute walk test (2-MWT) on discharge from the IRF.</p><p><strong>Results: </strong>The mean age of the study sample was 65±9.3 years, they were mainly non-Hispanic white (N.=92, 74%) men (N.=119, 95%) admitted 9±11 days after acute stroke. When the sample was divided into less motivated (score 0-25, N.=32) and motivated (score ≥ 26, N.=93) as measured by the total RLOC for a statistical median of 26, the two groups had similar baseline characteristics including admission depression, TFIM, ARAT, and 2-MWT scores. The change in the primary outcome measure scores from baseline was similar between the two groups. Motivated group veterans had a lower all-cause mortality rate at 12 months than less motivated veterans (P=0.001).</p><p><strong>Conclusions: </strong>A higher level of motivation irrespective of the degree of depression did not improve cognitive or functional motor recovery scores. However, motivated veterans had a lower all-cause mortality at 12 months.</p><p><strong>Clinical rehabilitation impact: </strong>The result of this study has important implications in clinical practice highlighting that motivated patients are more likely to be discharged home and have a lower all-cause mortality.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of diagnosis and rehabilitation of dysphagia in patients with spinal cord injury: a systematic review.","authors":"Roberta Zupo, Beatrice Poggi, Nicole Caggiano, Giulio Varrone, Fabio Castellana, Silvia Natoli, Rodolfo Sardone, Antonio Nardone, Chiara Pavese","doi":"10.23736/S1973-9087.24.08614-3","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08614-3","url":null,"abstract":"<p><strong>Introduction: </strong>Latest epidemiological metrics put a global prevalence of 20.6 million people suffering from spinal cord injury (SCI), leading to a burden of functional disability, deterioration in quality of life and reduced life expectancy. A thorough statement of diagnostic methods and treatment protocols for swallowing disorders after SCI stands as a major priority to streamline patient care and cost-sharing. Here we have provided a systematic overview of the evidence on diagnostic and rehabilitation protocols of dysphagia in the SCI population.</p><p><strong>Evidence acquisition: </strong>The literature was searched in six electronic databases up to April 30^th, 2024. Screening the 521 retrieved articles for inclusion criteria resulted in the selection of 43 studies that reported assessment tools and rehabilitation protocols for dysphagia in patients with SCI. Two researchers extracted the data in parallel, and inter-rater reliability (IRR) was used to estimate inter-coder agreement and then κ statistic to measure accuracy and precision. Based on PRISMA concepts and quality assessment steps, a k coefficient of at least 0.9 was obtained in all data extraction steps. All reports were assessed for risk of bias using the NIH Quality Assessment Toolkit. The study protocol was registered on PROSPERO (CRD42023449137).</p><p><strong>Evidence synthesis: </strong>Dysphagia assessment methods were collected and grouped into four different macro categories (clinical assessment, rating scale, self-reported questionnaire, and instrumental assessment). It was found that the Bedside Swallow Evaluation (BSE) for the clinical assessment category (50%), the Bazaz score (32.5%) for the rating scale category, the Eating Assessment Tool-10 (EAT-10) (44.4%) for the self-reported questionnaire category, and the Videofluoroscopic Study of Swallowing (VFSS) (48.9%) for the instrumental assessment category were the most representative tools. The rehabilitation protocols described included either an early oral feeding exclusion or a consistency-modified oral intake, postural adaptations, oxygen therapy with a high-flow nasal cannula combined with indirect/direct therapy, specific exercises, and neuromuscular electrical stimulation.</p><p><strong>Conclusions: </strong>Methods of diagnosis and rehabilitation protocols for dysphagia in SCI patients appear inconsistent. Further rigorous studies are needed to achieve better clinical handling in SCI settings while lowering the load of patient morbidity and related healthcare costs.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shear wave elastography in the assessment of gastrocnemius spastic muscle elasticity: influences of ankle position and muscle contraction.","authors":"Marine Devis, Frédéric Lecouvet, Thierry Lejeune, Gaëtan Stoquart","doi":"10.23736/S1973-9087.24.08733-1","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08733-1","url":null,"abstract":"<p><strong>Background: </strong>Following upper motor neuron syndromes (UMNS), intrinsic viscoelastic muscle properties such as elastic stiffness may be altered, which leads to muscle hyper-resistance to passive mobilization. So far, no gold standard assessment of hyper-resistance, whether clinical or instrumental, is available. Shear wave elastography (SWE) has been increasingly used for non-invasive evaluation of elastic stiffness of skeletal muscles in people with hyper-resistance.</p><p><strong>Aim: </strong>Our study aimed to evaluate the validity of SWE at ankle neutral resting position (ANRP). Additional objectives included assessing the influence of ankle position, muscle contraction, and laterality on elastic stiffness, and evaluating the reproducibility and responsiveness of SWE.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Setting: </strong>Outpatients of the physical and rehabilitation medicine department of a university hospital in Brussels.</p><p><strong>Population: </strong>Thirty hemiparetic patients following UMNS with hyper-resistance in gastrocnemii muscles.</p><p><strong>Methods: </strong>Elastic stiffness was quantified by shear wave velocity (SWV) measurements of gastrocnemii muscles. A higher SWV corresponds to a higher elastic stiffness. Measurements were performed on the affected and less-affected limbs in ANRP, in passive dorsiflexion and during isometric contraction. Assessments were performed 3 times. Criterion validity, reproducibility, and responsiveness were evaluated. A linear mixed model was used to study position and laterality effect.</p><p><strong>Results: </strong>In ANRP, reproducibility was excellent and SWV was significantly higher in the affected limb than in the less-affected limb. This laterality effect disappeared in passive dorsiflexion and was even reversed during isometric contraction. SWV was significantly higher on both sides in passive dorsiflexion and during contraction than in ANRP.</p><p><strong>Conclusions: </strong>Our results suggest that SWE measurements in ANRP are reliable and may provide a more valid measurement of gastrocnemii elastic stiffness following UMNS.</p><p><strong>Clinical rehabilitation impact: </strong>SWE may be a useful clinical tool as an extension of the physical exam for longitudinal monitoring of passive muscle elastic stiffness, to assist with treatment decisions and to better quantify the therapeutic effect of procedures to reduce muscle overactivity. However, a standardized protocol should be used. ANRP seems to be the most valid position for assessing gastrocnemius elastic stiffness in neurological populations. This should be kept in mind for the choice of positioning in further studies.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise rehabilitation in post COVID-19 patients: a randomized controlled trial of different training modalities.","authors":"Johanna Sick, Verena Steinbacher, Daniel Kotnik, Florian König, Tim Recking, Dominik Bengsch, Daniel König","doi":"10.23736/S1973-9087.24.08487-9","DOIUrl":"https://doi.org/10.23736/S1973-9087.24.08487-9","url":null,"abstract":"<p><strong>Background: </strong>Long-lasting symptoms (>12 weeks) following a COVID-19 infection are defined as the post-COVID-19 syndrome (PCS), often manifesting as fatigue and reduced exercise capacity. Thus, exercise has been suggested as a non-pharmacological therapy.</p><p><strong>Aim: </strong>To investigate the effects of endurance vs. concurrent exercise on physical function, symptoms and quality of life in individuals with PCS, that did not need hospital admission during acute COVID-19.</p><p><strong>Design: </strong>Parallel-group, single-center, randomized controlled trial.</p><p><strong>Setting: </strong>This study was conducted at the University of Vienna.</p><p><strong>Population: </strong>Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.</p><p><strong>Methods: </strong>Participants were randomized to either 12 weeks of supervised endurance training (ED) or concurrent training (CT), or a non-exercising control group (C). As the primary outcome, VO<inf>2</inf>peak was assessed pre and post intervention. Secondary outcomes were handgrip and lower body strength, heart rate variability, symptoms, health-related quality of life (HRQoL) and concentration performance. The main effects for time and group as well as the time*group interaction were assessed via a 2x2 analysis of variance. Additionally, within-group pre-post testing was performed.</p><p><strong>Results: </strong>Taking the study protocol into account, 42 subjects could be included in the analysis (N.=14 in each group). A significant time*group interaction favoring both exercise conditions was found for VO<inf>2</inf>peak (partial Eta²=0.267; ED: +3.9 mL/min/kg; CT: +3.2 mL/min/kg). The Fatigue Severity Score significantly decreased in ED (Hedges' g=0.63) and CT (Hedges' g=0.82) from pre to post, but not in C. Breathlessness and lower body strength improved most in CT. Significant within-group improvements in HRQoL and the number of PCS symptoms occurred in all groups.</p><p><strong>Conclusions: </strong>Both exercise regimes led to increases in VO<inf>2</inf>peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.</p><p><strong>Clinical rehabilitation impact: </strong>The results show that in this population both exercise regimes are feasible and safe and lead to improvements in various health domains.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy, and typical development.","authors":"Charlotte Johnson, Ann Hallemans, Pieter Meyns, Silke Velghe, Nina Jacobs, Evi Verbecque, Katrijn Klingels","doi":"10.23736/S1973-9087.24.08472-7","DOIUrl":"10.23736/S1973-9087.24.08472-7","url":null,"abstract":"<p><strong>Background: </strong>Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood.</p><p><strong>Aim: </strong>To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD).</p><p><strong>Design: </strong>Cross-sectional case-control study.</p><p><strong>Setting: </strong>Different outpatient settings and the community.</p><p><strong>Population: </strong>Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]).</p><p><strong>Methods: </strong>We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01).</p><p><strong>Results: </strong>Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η²=0.25-0.66 [P<0.001], total: η²=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012).</p><p><strong>Conclusions: </strong>There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits.</p><p><strong>Clinical rehabilitation impact: </strong>The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"956-969"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-inferiority of hybrid outpatient telerehabilitation for patients with back pain: 3-month follow-up of a randomized controlled trial.","authors":"Richard Albers, Stella Lemke, David Fauser, Sebastian Knapp, Gert Krischak, Matthias Bethge","doi":"10.23736/S1973-9087.24.08458-2","DOIUrl":"10.23736/S1973-9087.24.08458-2","url":null,"abstract":"<p><strong>Background: </strong>International studies identified comparable or better effects for telerehabilitation compared with face-to-face rehabilitation or no rehabilitation in people with back pain. In German rehabilitation centers, a standardized back school for patients with back pain is provided usually face-to-face as part of a multimodal rehabilitation program.</p><p><strong>Aim: </strong>To examine the non-inferiority of a three-week, digitally assisted, multimodal rehabilitation that applies a digital version of a standardized back school (intervention group [IG]) against the same rehabilitation program applying the back school face-to-face (control group [CG]).</p><p><strong>Design: </strong>Our study was a non-blinded multicenter randomized controlled trial. Recruitment was conducted from 2022 to 2023. We analyzed outcomes at the end of rehabilitation and 3 months later.</p><p><strong>Setting: </strong>Implementation of the study and enrollment of participants was conducted in 8 German outpatient rehabilitation centers.</p><p><strong>Population: </strong>Rehabilitants aged 18-65 years with back pain were included.</p><p><strong>Methods: </strong>284 patients with back pain were randomized into the IG or CG using computer-generated block randomization. We excluded 14 patients as they withdrew their consent and requested removal of their data. We finally included 270 patients (IG: N.=127, CG: N.=143). The primary outcome was self-reported pain self-efficacy (10-60 points). Secondary outcomes were, amongst others, current health status and pain.</p><p><strong>Results: </strong>Our primary adjusted intention-to-treat analysis demonstrated that hybrid digitally assisted rehabilitation was non-inferior to face-to-face rehabilitation at the end of rehabilitation (b=-0.55; 95% CI=-2.75 to ∞) and at the 3-month follow-up (b=0.24; 95% CI=-2.86 to ∞). These results were in line with a non-adjusted intention-to-treat analysis, an adjusted complete case analysis, and an adjusted per-protocol analysis. Secondary outcomes were tested for superiority. Our primary adjusted intention-to-treat analysis found no significant group differences in the secondary outcomes.</p><p><strong>Conclusions: </strong>This study provides evidence that hybrid digitally assisted rehabilitation in patients with back pain is a sound alternative to face-to-face rehabilitation in an outpatient rehabilitation setting.</p><p><strong>Clinical rehabilitation impact: </strong>Hybrid digitally assisted rehabilitation can improve flexibility and access to rehabilitation. Further studies should examine which components and which time frame of rehabilitation can be digitized without any loss of effectiveness.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"1009-1018"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials.","authors":"Cristiano Sconza, Valentina Palloni, Domenico Lorusso, Federico Guido, Giacomo Farì, Lucrezia Tognolo, Ezio Lanza, Fabrizio Brindisino","doi":"10.23736/S1973-9087.24.08544-7","DOIUrl":"10.23736/S1973-9087.24.08544-7","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-guided lavage (UGL) is a minimally invasive percutaneous treatment for rotator cuff calcific tendinopathy (RCCT). It involves the use of a syringe containing saline and/or anesthetic solution injected directly into the calcification allowing aspiration of the fragmented calcific material. The aim of this systematic review is to investigate if UGL is effective in improving pain, function, quality of life, range of motion (ROM), and in promoting complete resorption of calcifications in patients with RCCT.</p><p><strong>Evidence acquisition: </strong>Only randomized controlled trials considering people diagnosed with RCCT, at any stage and at any time of the onset of symptoms treated with UGL, were included. Embase, CENTRAL, CINHAL, PEDro and MEDLINE were explored up until May 2024. Two independent authors selected randomized controlled trials by title and abstract; afterwards, the full text was thoroughly evaluated. The risk of bias (ROB) was assessed using the Cochrane risk of bias 2 (ROB2) tool and the certainty of evidence was evaluated through the GRADE approach.</p><p><strong>Evidence synthesis: </strong>Seven studies (709 subjects) were included. Overall, three studies were judged as low risk of bias. Pooled results showed non-significant differences between UGL and extracorporeal shock-wave therapy (ESWT) at 12 weeks (SMD=-0.52, 95% CI -1.57, 0.54, P=0.34, I²=93%) and at 26 weeks (MD=-1.20, 95% CI -2.66, 0.27, P=0.11, I²=82%), while a significant difference favoring UGL (SMD=-0.52, 95% CI -0.85, -0.19, P=0.002, I²=38%) resulted at 52 weeks. In regard to function, pooled results showed non-significant difference between UGL and ESWT at 6 weeks (MD=3.34, 95% CI -11.45, 18.12, P=0.66, I²=79%) and at 52 weeks (SMD=0.10, 95% CI -0.40, 0.60, P=0.69, I²=30%). Considering the rate of resorption of calcifications between UGL combined with subacromial corticosteroid injection (SCI) versus injection alone, pooled results showed significant difference favoring UGL at <52 weeks (RR=1.63 95% CI 1.34, 1.98, P<0.00001, I²=0%). Certainty of evidence ranged from low to very low.</p><p><strong>Conclusions: </strong>UGL seems to be a reasonable and safe treatment for RCCT, however compared to other non/mini-invasive approaches, UGL showed doubtful results in controlling pain and increasing function and rate of calcifications resorption. These results should be interpreted with caution because certainty of evidence ranged from low to very low.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"995-1008"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}