Posts Tagged Treatment outcome

[Abstract] Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study

Abstract

Objective

To describe systematic reviews (SRs) of the use of exoskeletons for gait and mobility by persons with neurological disorders and to evaluate their quality as guidance for research and clinical practice.

Data sources

PubMed, EMBASE, Web of Science, CINAHL Complete, PsycINFO, Cochrane Database of Systematic Reviews, PEDro, and Google Scholar were searched from database inception to January 23, 2018.

Study selection

A total of 331 de-duplicated abstracts from bibliographic database and ancestor searching were independently screened by two reviewers, resulting in 109 articles for which full text was obtained. Independent screening of those 109 articles by two reviewers resulted in a final selection of 17 SRs.

Data extraction

Data were extracted by one reviewer using a pretested Excel form with 158 fields and checked by a second reviewer. Key data included the purpose of the SR, methods used, outcome measures presented, and conclusions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 were used to evaluate reporting and methodological quality, respectively, of the SRs.

Data synthesis

The SRs generally were of poor methodological and reporting quality. They failed to report some information on patients (e.g. height, weight, baseline ambulatory status) and interventions (e.g. treatment hours/sessions planned and delivered) that clinicians and other stakeholders might want to have, and often failed to notice that the primary studies duplicated subjects.

Conclusions

Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. Future studies need to address the multiple methodological limitations.

 

via Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

OBJECTIVE:

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

DESIGN:

A single-blinded, 2-sequence, 2-period, crossover-designed study.

SETTING:

Rehabilitation clinics and participant’s home environment.

PARTICIPANTS:

Individuals with disabilities poststroke.

INTERVENTIONS:

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

MAIN OUTCOME MEASURES:

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

RESULTS:

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

CONCLUSIONS:

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

 

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized… – PubMed – NCBI

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] The suitcase packing activity: A new evaluation of hand function

 

Abstract

Study Design

Prospective, repeated-measures study.

Introduction

Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic therapeutic outcomes. At this point in time, a composite test that assesses both unilateral and bimanual hand function in relation to a functional activity is not available.

Purpose of the Study

To establish the reliability and validity of the suitcase packing activity (SPA).

Methods

An expert panel established face and content validity. Eighty healthy, English-speaking volunteers aged between 18 and 45 years were randomly assigned to either 1 or 2 sessions (test-retest reliability). Relative agreement between 2 examiners using an intraclass correlation coefficient (ICC)3,1 determined interrater reliability. Test-retest reliability was determined by using a repeated-measures analysis of variance and an ICC3,2. Concurrent validity was evaluated against 2 well-established hand evaluations using separate tests of correlational coefficients.

Results

Face and content validity were established across 4 focus groups. Our results demonstrate good to excellent interrater reliability (ICC3,1 ≥ 0.93) and good to excellent test-retest reliability (ICC3,2 ≥ 0.83). SPA scores were moderately correlated with the 2-hand evaluations.

Discussion

Through evaluating hand function during participation in a goal-directed activity (eg, packing a suitcase), the SPA exhibits promise in usefulness as a future viable outcome measure that can be used to assess functional abilities following a hand injury.

Conclusion

The SPA is a valid and reliable tool for assessing bimanual and unilateral hand function in healthy subjects.

Source: The suitcase packing activity: A new evaluation of hand function – Journal of Hand Therapy

 

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[ARTICLE] Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study – Full Text

Abstract

Objective: To examine the relationship between patient-rated physician empathy and outcome of botulinum toxin treatment for post-stroke upper limb spasticity.

Design: Cohort study.

Subjects: Twenty chronic stroke patients with upper limb spasticity.

Methods: All patients received incobotulinumtoxinA injection in at least one muscle for each of the following patterns: flexed elbow, flexed wrist and clenched fist. Each treatment was performed by 1 of 5 physiatrists with equivalent clinical experience. Patient-rated physician empathy was quantified with the Consultation and Relational Empathy Measure immediately after botulinum toxin treatment. Patients were evaluated before and at 4 weeks after botulinum toxin treatment by means of the following outcome measures: Modified Ashworth Scale; Wolf Motor Function Test; Disability Assessment Scale; Goal Attainment Scaling.

Results: Ordinal regression analysis showed a significant influence of patient-rated physician empathy (independent variable) on the outcome (dependent variables) of botulinum toxin treatment at 4 weeks after injection, as measured by Goal Attainment Scaling (p < 0.001).

Conclusion: These findings support the hypothesis that patient-rated physician empathy may influence the outcome of botulinum toxin treatment in chronic stroke patients with upper limb spasticity as measured by Goal Attainment Scaling.

Introduction

Stroke is a leading cause of adult disability (1, 2). Damage to the descending tracts and sensory-motor networks results in the positive and negative signs of the upper motor neurone syndrome (UMNS) (1–3). The upper limb is commonly involved after stroke, with up to 69% of patients having arm weakness on admission to hospital (4). Recovery of upper limb function has been found to correlate with the degree of initial paresis and its topical distribution according to the cortico-motoneuronal representation of arm movements (5–9).

Spasticity is a main feature of UMNS. It is defined as a state of increased muscle tone with exaggerated reflexes characterized by a velocity-dependent increase in resistance to passive movement (10). Upper limb spasticity has been found to be associated with reduced arm function, low levels of independence and high burden of direct care costs during the first year post-stroke (11). It affects nearly half of patients with initial impaired arm function, with a prevalence varying from 17% to 38% of all patients at one year post-stroke (11). Up to 13% of patients with stroke need some form of spasticity treatment (drug therapy, physical therapy or other rehabilitation approaches) within 6–12 months post-onset (11, 12). Botulinum toxin type A (BoNT-A) has been proven safe and effective for reducing upper limb spasticity and improving arm passive function in adult patients (13, 14). While current literature reports highly patient-specific potential gains in function after BoNT-A treatment, there is inadequate evidence to determine the efficacy of BoNT-A in improving active function associated with adult upper limb spasticity (13).

Empathy refers to the ability to understand and share the feelings, thoughts or attitudes of another person (15). It is an essential component of the physician-patient relationship and a key dimension of patient-centred care (15, 16). This is even more important in rehabilitation medicine, where persons with disabilities often report encountering attitudinal and environmental barriers when trying to obtain rehabilitative care and express the need for better communication with their healthcare providers (17).

To the best of our knowledge, no previous research has investigated the influence of physician empathy on patient outcome after spasticity treatment. The aim of this study was to examine the relationship between patient-rated physician empathy and clinical outcome of BoNT-A treatment for upper limb spasticity due to chronic stroke. […]

Continue —> Journal of Rehabilitation Medicine – Influence of physician empathy on the outcome of botulinum toxin treatment for upper limb spasticity in patients with chronic stroke: A cohort study – HTML

 

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[Abstract] Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report

Purpose: Cognitive Orientation to daily Occupational Performance (CO-OP) has demonstrated an effect on skill performance, compared with the usual outpatient rehabilitation, in people living with stroke when implemented by occupational therapists. This study explored refining CO-OP for delivery by both occupational therapists and physiotherapists.

Method: Two cases were recruited and treated using the CO-OP approach, which augments task-specific training with cognitive strategies and guided discovery. Case 1 was a 79-year-old woman, 31 days after parietal stroke, and Case 2 was a 45-year-old man, 62 days after bilateral brain stem stroke. Case 1 withdrew from the study for medical reasons. Outcome measures applied were the Canadian Occupational Performance Measure, the Stroke Impact Scale (SIS), the Self-Efficacy Gauge, the Berg Balance Scale, the Box and Block Test, and the 2-minute walk test.

Results: After 10 sessions, Case 2 made gains in most measures, including a 22-point gain in the SIS mobility domain.

Conclusion:The therapists reported that the combined delivery required additional communication with the patients but was feasible. Case 2 reported physical and mobility gains larger than the mean changes seen in past CO-OP research. Although these results cannot be generalized, findings suggest that the inter-professional application of CO-OP warrants further investigation.

Source: Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report: Physiotherapy Canada: Vol 0, No 0

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[ARTICLE] Upper extremity recovery after ischaemic and haemorrhagic stroke: Part of the SALGOT study – Full Text HTML/PDF

Abstract

Introduction The purpose was to explore if there are differences in extent of change in upper extremity motor function and activity capacity, in persons with ischaemic versus haemorrhagic stroke, during the first year post stroke.

Patients and methods One hundred seventeen persons with stroke (ischaemic n = 98, haemorrhagic n = 19) and reduced upper extremity function 3 days after onset were consecutively included to the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) from a stroke unit. Upper extremity motor function (Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE)) and activity capacity (Action Research Arm Test (ARAT)) were assessed at 6 assessments during the first year; age and initial stroke severity were recorded. Differences between groups in extent of change over time of upper extremity motor function and activity capacity were analysed with mixed models repeated measurements method.

Results Significant improvements were found in function and activity in both groups within the first month (p = 0.001). Higher age and more severe stroke had a negative impact on recovery in both groups. Larger improvements of function and activity were seen in haemorrhagic stroke compared to ischaemic, both from 3 days to 3- and 12 months, and from 1 month to 3 months. Both groups reached similar levels of function and activity at 3 months post stroke.

Conclusion Although persons with haemorrhagic stroke had initially lower scores than those with ischaemic stroke, they had a larger improvement within the first 3 months, and thereafter both groups had similar function and activity.

Continue —> Upper extremity recovery after ischaemic and haemorrhagic stroke: Part of the SALGOT study

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ARTICLE: Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial

…VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities…

μέσω Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial.

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