To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.
To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.
Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.
Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.
Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.
Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I20%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I2 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I2 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I2 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I2 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.
Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.
via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation
The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18–67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.
BACKGROUND: Post-stroke fatigue (PSF) is a common complaint among stroke survivors and has significant impacts on recovery and quality of life. Limited tools that measure fatigue have been validated in stroke.
AIM: The purpose of this study was to determine the psychometric properties of Fatigue Severity Scale (FSS) in patients with stroke.
DESIGN: Cross-sectional study.
SETTING: Teaching hospital outpatient setting.
POPULATION: Fifty healthy controls (mean age 61.1±7.4 years; 22 males) and 50 patients with stroke (mean age 63.6±10.3 years; 34 males).
METHODS: FSS was administered twice approximately a week apart through face-to-face interview. In addition, we measured fatigue with Visual Analogue Scale – Fatigue (VAS-F) and Short-Form Health Survey 36 version 2 vitality scale. We used Cronbach alpha to determine internal consistency of FSS. Reliability and validity of FSS were determined by intraclass correlation coefficient (ICC) and Spearman correlation coefficient (r).
RESULTS: FSS showed excellent internal consistency for both stroke and healthy groups (Cronbach’s alpha >0.90). FSS had excellent test-retest reliability for stroke patients and healthy controls (ICC=0.93 and ICC=0.90, respectively). The scale demonstrated good concurrent validity with VAS-Fatigue (all r>.60) and a moderate validity with the SF36-vitality scale. Furthermore, FSS was sensitive to distinguish fatigue in stroke from the healthy controls (P<0.01).
CONCLUSIONS: FSS has excellent internal consistency, test-retest reliability and good concurrent validity with VAS-F for both groups.
CLINICAL REHABILITATION IMPACT: This study provides evidence that FSS is a reliable and valid tool to measure post-stroke fatigue and is readily to be used in clinical settings.
Full Text PDF
via Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue – European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):703-9 – Minerva Medica – Journals
Rehabilitation of disabled children and teens no longer involves just training in the use of wheelchairs and providing prostheses to replace missing limbs. Ever-advancing technology has added robots, virtual reality, video screens and other assisting devices and ways to improve the youngsters’ quality of life and family cohesion. There are even (highly expensive) drugs that significantly ameliorate diseases that used to be considered hopeless. One powerhouse behind this revolution is Jerusalem’s ALYN Hospital, a national and comprehensive rehabilitation center for physically challenged and disabled children, adolescents and young adults.
The nonprofit facility, which treats all young patients, regardless of religious belief, nationality or ethnic background, was founded in 1932 by American orthopedist Dr. Henry Keller, who dedicated his life to such children. Working out of an old re-purposed monastery in the capital’s Katamon neighborhood, the medical staff cared for children disabled in the polio epidemic that spread through Israel and the rest of the world in the 1940s and 1950s. ALYN served as a treatment center, residence and school for 200 young patients.
In 1971, the voluntary organization was able to build the impressive Woldenberg Family Hospital complex in Jerusalem’s Kiryat Hayovel neighborhood to serve inpatients and outpatients.
Today, it is one of the world’s leading hospitals specializing in the active and intensive rehabilitation of children who have a broad range of physical disabilities caused not only by various congenital and progressive muscle, nerve and bone diseases, but also feeding disorders, severe respiratory problems, road and home accidents, terrorist attacks and severe burns. Patients who underwent orthopedic operations and neurosurgery also recover and are rehabilitated at ALYN.
The center includes a pre-school daycare center for children aged six months to three years, kindergartens, an after-school integration program and school classes. It provides services including occupational therapy, physiotherapy, hydrotherapy, speech therapy and psychological counseling in addition to support by medical specialists and social workers.
Its director-general since 2011, Dr. Maurit Beeri recently opened ALYN’s Third Annual Conference on Rehabilitation at the capital’s Crowne Plaza Hotel. An accompanying exhibition displayed a large variety of equipment available for disabled youngsters from wheelchairs to electronic devices.
Beeri, who graduated from the Hebrew University Medical Faculty and trained as a pediatrician at the Hadassah University Medical Center in Jerusalem, had never heard about ALYN until, as a medical resident, she was sent to work there for a few months. She saw there that children in wheelchairs could be taught to walk.
“I went and felt in love with it. It was a big discovery for me. If you want to create a real change in the life of a child, this is the place you should be.”
Health, she said at the conference attended by some 200 doctors, nurses, physiotherapists, occupational therapists and other, “is not just the absence of disease. It is to grow and develop, to enjoy well-being. Over a billion people in the world – one in seven – suffer from some type of disability. They have three times the risk of the non-disabled to be hurt in the health system, and half lack accessibility to a decent health system.”
While 250 million people around the globe need eyeglasses and don’t have them and many disabled people lack wheelchairs and other basic equipment, humanity is still much better off today than 200 years ago, said Beeri. Medical technology is developing at a rapid pace – faster than the health system does, so not all get the rehabilitation they need.
Over 17% of Israelis have some kind of physical disability, but today’s Israeli medical students “don’t hear the word ‘rehabilitation.’ They aren’t exposed to it in their studies.
They are not told what physiotherapists, occupational therapists, speech pathologists and audiologists do.” Child rehabilitation here is nevertheless more advanced than in many countries, she added, but even so, many significant things are lacking.”
Only recently did the Health Ministry open a rehabilitation division (headed by Dr. Tsaki Ziv-Ner) to coordinate such functions. “The future is very promising. There is more awareness of the rights of disabled; the problem is in the details. Everyone has the right to live with honor and as much independence as they can.”
DR. KEREN Politi, a pediatric neurologist at ALYN, told the participants that only a few decades ago, there was little to do to help children. “But thanks to genetics, we can give treatments, prevent problems and improve their quality of life – even with spinal muscular atrophy (SMA, which affects about 80 Israeli children) and Duchenne muscular dystrophy.
“We can influence gene regulation. We can give treatment with medical cannabis or with blood from the umbilical cord,” she said. “We can insert healthy genes into sick cells using exon skipping [a form of RNA splicing used to cause cells to “skip” over faulty or misaligned sections of genetic code, creating a shorter but still functional protein].”
A new drug approved by the US Food and Drug Administration named Spinraza that costs NIS 2 million a year per patient can help SMA kids hold up their head better, roll over, crawl and even stand. If the child is treated within 13 weeks of diagnosis, said Politi, they do much better. But covering the bill for all SMA children would gobble up a third of the annual increase to the basket of health services. “There are a lot of things we don’t know, such as how early to start. Maybe it could be given to the fetus, but there is a risk that this might cause leukemia.
Another drug, in an earlier stage of development, would be in pill form and threaten the sales of Spinraza if it proves just as effective, but there is as yet no evidence of longterm benefits.”
Medical cannabis for children is controversial.
“There are three types, and they have 60 different chemicals. Cannabis was used even in the 1850s for headaches and seizures, but its medical use declined as drug companies [falsely] claimed it was addictive and caused violence and psychosis. In the last 20 years, however, it has been brought back and used for numerous medical purposes in all ages.”
Every large Israeli pediatrics department tries cannabis oil on some children. “At ALYN,” said Politi, many parents want it for painful spasms and other things, but I dispense it carefully, not for children with normal cognition.”
Umbilical cord blood is being used experimentally to turn regular cells from the bone marrow into stem cells that can produce growth factors and have an anti-inflammatory effect. There is a group at Duke University in North Carolina that is looking at use of umbilical cord blood on cerebral palsy, but it has not brought about a big change.”
One of her young patients who suffered damage due to separation of her mother’s placenta got umbilical cord blood, but it didn’t help with the seizures. But medical cannabis was tried and he was able to sleep at night for the first time without crying.
PROF. TAMAR Weiss, a University of Haifa expert in the use of technology for rehabilitation, noted that there “is huge and accelerating growth in use of technologies. Almost every day there is something new. It took 50 years for half of public to get a telephone, and much less for smartphone. In rehabilitation, we have not yet reached this speed. We have to use ‘disruptive technologies’ – innovation that creates a new market and eventually disrupts an existing market, displacing established firms and products. But not all paradigm shifts mean an improvement in treatment,” she said. More than half of all rehabilitation technologies that came to the market in the last decade are not used today or they are underused because people didn’t know how to use it. Children from Gaza, for example, were given many devices for their disability but when they went home, they were just put in the closet.
A successful item for rehabilitation is video on a screen so disabled children can move. There are relatively cheap virtual reality devices that can benefit them and are easy to use. A company named SenSerum offers a virtual playground that children with autism can use to jump as if they were on a real trampoline.
“There is a need to find a way for robots to copy human movements, and the technology should be inexpensive, small in size and light in weight. They should be adaptable to the intelligence and abilities of each child and be able to document changes and improvements.”
Robots are very good for disabled kids because “they repeat and are consistent. They can provide exact, continuous quantitative feedback through sensors,” Weiss said. Obviously, robots alone are not enough. They must be complemented by human therapists.
ALYN PHYSIOTHERAPIST Orit Bartov presented the benefits of “intelligent wheelchairs” with built-in sensors to prevent collisions and “eye-drivers” that enable steering with one’s eyes. Children can visit the zoo along with the family using a respirator that’s the size of a laptop. There are cheap children’s plastic and metal wheelchairs for the developing countries.”
While physiotherapy in the 1990s was aimed at strengthening one joint at a time, said Bartov, today it involves rehabilitating the whole body, creating balance, control of movement and coordination.
“Muscle tone is not an aim but a means. There is cognitive rehabilitation, not just medical but also biological, psychological and social. We have to learn about the longterm effects of operations on muscle and use new knowledge in engineering, neuroscience and rehabilitation to create new interventions.”
It takes about a decade for knowledge to be translated from development of technology into a product used in the field.
“We used to try to change the patient, but it’s more important to change the patient’s environment to suit him,” she explained.
The physiotherapist’s take-home message is that the disabled patient should always be the focus; we are not technicians but evidence-based clinicians; there is no alternative to using your hands; and don’t be afraid to try something new.”
ALYN RECENTLY set up a program called PELE (Child Solutions) to create individualized products for helping children with special needs identified by therapists or family members. Professionals and volunteers in engineering and other fields donate their time to design what they need, said Dana Hochstein Mann, the director of ALYNnovation to match the innovative products with manufacturers around the world who want, through cooperation, to bring it to the world market.
Mann noted that zippers developed by Under Armor for the disabled to close with one hand have expanded their use to the wider public. “A child asked Nike to make a shoe with a zipper in the back to make it easy to put on. Now they are being made as a fashionable item for the general public. Companies such as ReWalk and OrCam, are talking about accessibility for the disabled all the time.”
Israel became the “Startup Nation,” said Mann, for good reasons.
“We are not satisfied with situations that need improvement. We don’t like failure, but it is acceptable, as it’s better for an entrepreneur to try something than having never tried; one learns from failure. Due to the lack of funds in Israel, creative solutions result.
It’s a minuscule market without neighboring countries where we can sell products, so one can start small and then grow and think global.” In the rehabilitation field, all these conditions are beneficial, she concluded.
PERHAPS THE most inspiring speaker was a young man who reached the stage on his wheelchair via a ramp. Shahar Botzer, who was born with paralyzed legs but whose arms are functional, heads 2B Community, a venture capital group that invests in young, small-to-medium businesses with potential for significant growth and a turnover of over NIS 1 million a year.
It aims not only at making money but also has a social goal and strict standards that examine the business’s ethical conduct in a wide variety of parameters, including fair employment, environmental protection and contribution to the community.
Married and with a family, Botzer clearly exemplifies what ALYN would want all its “graduates” to strive for.
The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation.
Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively.
Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant.
People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke.
The quality of life in neurological disorders (Neuro-QoL) is a U.S. National Institutes of Health initiative that produced a set of self-report measures of physical, mental, and social health experienced by adults or children who have a neurological condition or disorder.
To describe the content of the Neuro-QoL at the item level using the World Health Organization’s international classification of functioning, disability and health (ICF).
We assessed the Neuro-QoL for its content coverage of functioning and disability relative to each of the four ICF domains (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify items into categories within each ICF domain and computed the percentage of categories within each ICF domain that were represented in the Neuro-QoL items.
All items of Neuro-QoL could be mapped to the ICF categories at the second-level classification codes. The activities and participation domain and the mental functions category of the body functions domain were the areas most often represented by Neuro-QoL. Neuro-QoL provides limited coverage of the environmental factors and body structure domains.
Neuro-QoL measures map well to the ICF. The Neuro-QoL–ICF-mapped items provide a blueprint for users to select appropriate measures in ICF-based measurement applications.
Hemianopia leads to severe impairment of spatial orientation and mobility. In cases without macular sparing an additional reading disorder occurs. Persistent visual deficits require rehabilitation. The goal is to compensate for the deficits to regain independence and to maintain the patient’s quality of life. Spontaneous adaptive mechanisms, such as shifting the field defect towards the hemianopic side by eye movements or eccentric fixation, are beneficial, but often insufficient. They can be enhanced by training, e.g., saccadic training to utilize the full field of gaze in order to improve mobility and by special training methods to improve reading performance. At present only compensatory interventions are evidence-based.
OBJECTIVE: This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).
METHODS: Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and post-intervention; individuals in the yoga group also rated programme satisfaction. Mann-Whitney/Wilcoxon and the Wilcoxon Signed Rank tests were used to evaluate between- and within-group differences for the total and sub-scale QOLIBRI scores, respectively.
RESULTS: No significant differences emerged between groups on the QOLIBRI pre- or post-intervention. However, there were significant improvements on overall quality-of-life and on Emotions and Feeling sub-scales for the intervention group only. The overall QOLIBRI score improved from 1.93 (SD = 0.27) to 2.15 (SD = 0.34, p = 0.01). The mean Emotions sub-scale increased from 1.69 (SD = 0.40) to 2.01 (SD = 0.52, p = 0.01), and the mean Feeling sub-scale from 2.1 (SD = 0.34) to 2.42 (SD = 0.39, p = 0.01).
CONCLUSION: Adults with ABI experienced improvements in overall quality-of-life following an 8-week yoga programme. Specific improvements in self-perception and negative emotions also emerged. High attendance and satisfaction ratings support the feasibility of this type of intervention for people with brain injury.
Background: The visual impairments caused by stroke have the potential to affect the ability of an individual to perform activities of daily living. An individual with visual impairment may also have reduced level of independence. The purpose of this review was to investigate the impact on quality of life from stroke related visual impairment, using subjective patient reported outcome measures.
Methods: A systematic search of the literature was performed. The inclusion criteria required studies to have adult participants (aged 18 years or over) with a diagnosis of a visual impairment directly resulting from a stroke. Studies which included visual impairment as a result of other intracranial aetiology, were included if over half of the participants were stroke survivors. Multiple scholarly online databases and registers of published, unpublished and ongoing trials were searched, in addition articles were hand searched. MESH terms and alternatives in relation to stroke and visual conditions were used. Study selection was performed by two authors independently. Data was extracted by one author and verified by a second. The quality of the evidence was assessed using a quality appraisal tool and reporting guidelines.
Results: This review included 11 studies which involved 5646 participants, the studies used a mixture of generic and vision-specific instruments. The seven instruments used by the included studies were the EQ-5D, LIFE-H, SF-36, NEI VFQ-25, VA LV VFQ-48, SRA-VFP and DLTV.
Conclusion: A reduction in quality of life was reported by all studies in stroke survivors with visual impairment. Some studies used generic instruments, therefore making it difficult to extract the specific impact of the visual impairment as opposed to the other deficits caused by stroke. The majority of studies (8/11) primarily had participants with visual field loss. This skew towards visual field loss and no studies investigating the impact ocular motility prevented a comparison of the effects on quality of life due to different visual impairments caused by stroke. In order to fully understand the impact of visual impairment following stroke on quality of life, further studies need to use an appropriate vision-specific outcome measure and include all types of visual impairment which can result from a stroke.