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PMR Buzz Magazine_Oct 2022.pdf

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A quarterly journal scan of popular rehabilitation medicine journals.

PMR Buzz Magazine_Oct 2022.pdf

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PMR
BUZZ
Volume 4, Issue 3, October 2022
Contributors:
• Dr. Ravi Gaur, Associate Professor,
Department of PMR, AIIMS, Jodhpur.
• Dr. Navin BP, Assistant Professor,
Department of Neurorehabilitation,
NIMHANS, Bengaluru.
• Dr. Mahima Agrawal, Assistant Professor,
Department of PMR, JLN Medical
College, Ajmer.
• Dr. Harleen Uppal, Associate Professor,
Dept. of PMR, AIIMS, Nagpur.
• Dr. Vinay Goyal, Associate Professor,
Dept. of PMR, AIIPMR, Mumbai.
Editor & Contributor:
• Dr. Mrinal Joshi, Director & Professor
(PMR), Rehabilitation Research Centre,
SMS Medical College, Jaipur.
Randomized controlled trial of suprascapular nerve blocks for subacute
adhesive capsulitis.
Schiltz M, Beeckmans N, Gillard B, De Baere T, Hatem SM. Randomized controlled trial of suprascapular nerve blocks for subacute
adhesive capsulitis.
Eur J phys rehabil Med 2022; 58: 630-7. European Journal of Physical and Rehabilitation Medicine
Background
Shoulder pain and loss of function remain a therapeutic
challenge in adhesive capsulitis. Suprascapular nerve
blocks, a common treatment in adhesive capsulitis, are
considered a safe and effective method for the
resolution of pain and restoration of shoulder range of
motion (ROM). To our knowledge, no data are
available on the use of suprascapular nerve blocks in
adhesive capsulitis in the subacute phase.
Aim
The aim of this study was to compare the efficacy of
ultrasound-guided suprascapular nerve blocks versus
saline injections for treating adhesive capsulitis in the
subacute phase.
Design
Randomized double-blinded controlled trial; level of
evidence 2.
Setting
out-patient consultation of physical and rehabilitation
Medicine in a general hospital.
Population
Thirty-five patients with subacute adhesive capsulitis.
Methods
Patients were randomly allocated to receive either 3
successive (1-week interval) ultrasound-guided
suprascapular nerve blocks with ropivacaine 5 ml 2
mg/ml (intervention group) or ultrasound-guided
injections of 5 ml sterile saline solution (nacl 0.9%)
(control group), at the floor of the suprascapular fossa.
Primary outcome was shoulder function assessed by
the Constant-Murley Score. Secondary outcomes were
shoulder roM and shoulder pain intensity. assessments
were performed before each injection and 4 weeks
after the last injection.
Results
A significant increase of Constant-Murley Score
(P<0.001), increase of shoulder ROM (all directions:
P<0.011) and decrease of pain (P<0.001), were
observed over time in both study groups. However, no
significant differences were observed between the
intervention and the control group.
Conclusions
three successive suprascapular nerve blocks did not
provide a better outcome than saline injections on
shoulder function, ROM, and pain in subacute adhesive
capsulitis. These negative findings warrant some
considerations on the natural history of adhesive
capsulitis, as well as timing, type, and placebo effects of
injections.
1
2
Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic
Dextrose on Knee Osteoarthritis: A Prospective, Randomized, Double-
Blind Trial.
Hsieh RL, Lee WC. Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic Dextrose on Knee Osteoarthritis:
A Prospective, Randomized, Double-Blind Trial.
Arch Phys Med Rehabil 2022; 103(8): 1505-14.
Objective
To determine whether intra-articular coinjection with
hypertonic dextrose improves the outcome of
hyaluronic acid (HA) prolotherapy for knee
osteoarthritis (OA).
Design
Prospective, randomized, double-blind trial.
Setting
Medical center in Taiwan.
Participants
In total, 104 participants who fulfilled the American
College of Rheumatology clinical and radiographic
criteria for knee OA with a Kellgren-Lawrence score of
2 or 3 were recruited (N=104).
Interventions
The participants were blocked randomized to the
treatment (HA and hypertonic dextrose) or control
(HA and normal saline) group. Ultrasound-guided knee
intra-articular injections were administered once a
week for 3 weeks.
Main Outcome Measures
The primary outcomes were performance-based
physical function measures (regular and fastest walking
speed, stair climbing time, and chair rising time), and the
secondary outcomes were the Western Ontario and
McMaster Universities Osteoarthritis Index
(WOMAC) and Knee Injury and Osteoarthritis
Outcome Score (KOOS). The outcome measures
were assessed before the injections and at 1 week and
1, 3, and 6 months after the injections. The data were
analyzed through repeated-measures analysis of
covariance.
Results
Significant intergroup difference-in-differences favoring
the treatment group were observed for improvements
in stair climbing time (-1.6; 95% confidence interval, -
8.56 to 4.16; P=.38) and WOMAC physical function (-
21.2; 95% confidence interval, -126.05 to 103.83; P
=.045) at 6 months. The group×time interaction effects
favored the treatment group for regular (P=.001) and
fastest walking speed (P=.001) and chair rising time
(P=.038); WOMAC stiffness (P < .001) and physical
function (P = .003); and KOOS for pain (P = .035), other
symptoms (P=.022), and quality of life (P=.012).
Conclusions
Compared with HA plus normal saline coinjections, HA
plus dextrose coinjections resulted in more significant
improvements in stair climbing time and physical
function at 6 months, effectively decreased pain, and
improved physical function and physical functional
performance from 1 week to 6 months. HA plus
dextrose coinjections could be a suitable adjuvant
therapy for patients with knee OA.
3
Preventive treatment with alendronate of loss of bone mineral density in
acute traumatic spinal cord injury. Randomized controlled clinical trial.
Fernández Dorado, M.T., Díaz Merino, M., García Marco, D. et al. Preventive treatment with alendronate of loss of bone mineral
density in acute traumatic spinal cord injury. Randomized controlled clinical trial.
Spinal Cord 2022; 60: 687–693.
Study design
Randomized controlled clinical trial of two parallel
groups.
Objectives
Analyse the efficacy of primary prevention with
alendronate on the loss of bone mass which occurs
during the first year of traumatic SCI, measured by
double-energy X-ray bone densitometry (DXA).
Setting
National Hospital for Paraplegics (HNP), Toledo, Spain.
Methods
We included 52 people admitted to the HNP with
traumatic SCI Grade A and B on the ASIA Impairment
Scale and less than 8 weeks of progression, which were
randomized to one of the two treatment groups. Both
groups received calcifediol and a calcium-enriched diet
for 52 weeks. Only one group was administered
alendronate 70 mg weekly. The dose of alendronate
was adjusted according to changes in serum b-CTX.
Results
52 Participants were randomized. Of the 26 assigned to
each group, 4 patients were lost in the alendronate
group and 3 in the control group. The random
distribution of women was asymmetrical, so we
analysed the effect of treatment on men. In the total left
hip, the mean (SD) decrease in bone mass was -22.791%
(10.768) in the control group compared to the mean
(SD) decrease of -2.693% (6.283) in the same location
in the alendronate group (p < 0.0001). No patient
presented related adverse events.
Conclusion
Alendronate administered for one year in the first 8
weeks after traumatic SCI decreases bone loss in the
hip in men. This treatment is well tolerated.
4
The Impact of Spasticity and Contractures on Dependency and Outcomes
from Rehabilitation.
1
Stephen Ashford , Barbara Singer, Hilary Rose1, Lynne Turner‐Stokes
J Int Soc Phys Rehabil Med 2022;5:97-104.
Background
Acquired brain injury (ABI) can result in severe physical
impairment causing difficulty with moving which, if not
actively managed, can lead to contracture and
deformity. Delayed access to rehabilitation may result
in more contracture, with potential to increase
duration of rehabilitation, cost and therapy time
required.
Objective
Describe the amount of therapy input for patients
undergoing specialist in-patient rehabilitation following
ABI, the differences in the type of therapy received by
people with and without contracture and/or spasticity,
and the impacts on functional outcomes including care
needs and cost of care.
Materials and Methods
A cohort analysis of prospectively collected data from
426 patients with ABI in a UK tertiary inpatient
rehabilitation program. The Neurological impairment
Scale (NIS) was used to identify the presence of
spasticity or contracture. The Northwick Park Therapy
Dependency Assessment (NPTDA) was used to
calculate the therapy hours and type of treatment
provided to people with and without spasticity and/or
contracture. Outcomes (change in function and
independence) were compared including the UK
Functional Assessment Measure (UK FIM+FAM).
Results
The Male/Female ratio was 63:37% with a mean age:
44.0(SD 13) years and a mean length of stay in specialist
inpatient rehabilitation: 103 (SD 49) days. Aetiology:
Stroke (63%), Trauma (20%); Hypoxia (7%): Other
(10%). Patients with contractures were significantly
more dependent than those without, both on
admission and discharge. They stayed on average 31
days longer (95%CI 21.1, 40.5) (P=0.001) with an
additional mean episode cost of £25,588 (95%CI
£18.085, 34,043) (P<0.001). Despite this, they made
similar overall functional gains resulting in similar long-
term savings in the cost of ongoing care.
Conclusion
Routine collection of the NPTDA supported
quantification of the impact of spasticity and
contracture on therapy inputs, length of stay, functional
gains, and costs. People with contractures following
ABI require more therapy time in rehabilitation to
achieve similar functional gains, but nevertheless were
cost‐efficient to treat.
5
The preliminary results of physiotherapy scoliosis-specific exercises on
spine joint position sense in adolescent idiopathic scoliosis: A randomized
controlled trial.
Akyurek, Elcin1; Zengin Alpozgen, Ayse2; Akgul, Turgut3. The preliminary results of physiotherapy scoliosis-specific exercises on
spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial.
Prosthetics and Orthotics International: October 2022 - Volume 46 - Issue 5 - p 510-517.
Background
It has been observed that there are difficulties in
maintaining spinal harmony in the absence of
proprioceptive information, which has an important
role in achieving postural control in scoliosis. One of
the tests used to evaluate proprioceptive mechanisms
is joint position reproduction.
Objective(s)
The main aim of our study was to investigate the effect
of physiotherapy scoliosis-specific exercise (PSSE) on
spine joint reposition (JR) sense. The second aim was to
determine the effects of PSSE on the angle of trunk
rotation (ATR), posture, and deformity perception in
adolescent idiopathic scoliosis.
Methods
Twenty-nine patients with adolescent idiopathic
scoliosis (mean age 13.79 ± 1.82 years) were randomly
allocated to two groups. “Schroth” exercises were
applied to the PSSE group for 8 weeks (16 sessions).
The control group was placed on the waiting list.
Patients' JR error (dual inclinometer), ATR
(scoliometer), posture parameters (PostureScreen
Mobile, Posterior Trunk Asymmetry Index, and
Anterior Trunk Asymmetry Index), and deformity
perception (Walter Reed Visual Assessment Scale
[WRVAS]) were assessed at the first session and at the
end of 8 weeks.
Results
The initial demographic characteristics, Cobb
(thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24
degrees) and ATR (thoracal: 5.86 ± 3.98 degrees;
lumbar: 5.66 ± 3.33 degrees) and clinical test
parameters of the groups (JR, posture parameters, and
WRVAS) were similar (P > .05). According to the
findings, thoracal and lumbar JR error values (P < .05),
ATR (P < .001), posture parameters (P < .001), and
WRVAS (P = .048) were significantly improved in the
PSSE group. Besides, when the groups were compared,
a significant difference was found in favor of PSSE
except for the deformity perception (P < .05).
Conclusions
Schroth exercises have a positive contribution for
improving JR sense of the spine, vertebral rotation, and
posture.

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PMR Buzz Magazine_Oct 2022.pdf

  • 1. PMR BUZZ Volume 4, Issue 3, October 2022 Contributors: • Dr. Ravi Gaur, Associate Professor, Department of PMR, AIIMS, Jodhpur. • Dr. Navin BP, Assistant Professor, Department of Neurorehabilitation, NIMHANS, Bengaluru. • Dr. Mahima Agrawal, Assistant Professor, Department of PMR, JLN Medical College, Ajmer. • Dr. Harleen Uppal, Associate Professor, Dept. of PMR, AIIMS, Nagpur. • Dr. Vinay Goyal, Associate Professor, Dept. of PMR, AIIPMR, Mumbai. Editor & Contributor: • Dr. Mrinal Joshi, Director & Professor (PMR), Rehabilitation Research Centre, SMS Medical College, Jaipur.
  • 2. Randomized controlled trial of suprascapular nerve blocks for subacute adhesive capsulitis. Schiltz M, Beeckmans N, Gillard B, De Baere T, Hatem SM. Randomized controlled trial of suprascapular nerve blocks for subacute adhesive capsulitis. Eur J phys rehabil Med 2022; 58: 630-7. European Journal of Physical and Rehabilitation Medicine Background Shoulder pain and loss of function remain a therapeutic challenge in adhesive capsulitis. Suprascapular nerve blocks, a common treatment in adhesive capsulitis, are considered a safe and effective method for the resolution of pain and restoration of shoulder range of motion (ROM). To our knowledge, no data are available on the use of suprascapular nerve blocks in adhesive capsulitis in the subacute phase. Aim The aim of this study was to compare the efficacy of ultrasound-guided suprascapular nerve blocks versus saline injections for treating adhesive capsulitis in the subacute phase. Design Randomized double-blinded controlled trial; level of evidence 2. Setting out-patient consultation of physical and rehabilitation Medicine in a general hospital. Population Thirty-five patients with subacute adhesive capsulitis. Methods Patients were randomly allocated to receive either 3 successive (1-week interval) ultrasound-guided suprascapular nerve blocks with ropivacaine 5 ml 2 mg/ml (intervention group) or ultrasound-guided injections of 5 ml sterile saline solution (nacl 0.9%) (control group), at the floor of the suprascapular fossa. Primary outcome was shoulder function assessed by the Constant-Murley Score. Secondary outcomes were shoulder roM and shoulder pain intensity. assessments were performed before each injection and 4 weeks after the last injection. Results A significant increase of Constant-Murley Score (P<0.001), increase of shoulder ROM (all directions: P<0.011) and decrease of pain (P<0.001), were observed over time in both study groups. However, no significant differences were observed between the intervention and the control group. Conclusions three successive suprascapular nerve blocks did not provide a better outcome than saline injections on shoulder function, ROM, and pain in subacute adhesive capsulitis. These negative findings warrant some considerations on the natural history of adhesive capsulitis, as well as timing, type, and placebo effects of injections. 1
  • 3. 2 Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic Dextrose on Knee Osteoarthritis: A Prospective, Randomized, Double- Blind Trial. Hsieh RL, Lee WC. Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic Dextrose on Knee Osteoarthritis: A Prospective, Randomized, Double-Blind Trial. Arch Phys Med Rehabil 2022; 103(8): 1505-14. Objective To determine whether intra-articular coinjection with hypertonic dextrose improves the outcome of hyaluronic acid (HA) prolotherapy for knee osteoarthritis (OA). Design Prospective, randomized, double-blind trial. Setting Medical center in Taiwan. Participants In total, 104 participants who fulfilled the American College of Rheumatology clinical and radiographic criteria for knee OA with a Kellgren-Lawrence score of 2 or 3 were recruited (N=104). Interventions The participants were blocked randomized to the treatment (HA and hypertonic dextrose) or control (HA and normal saline) group. Ultrasound-guided knee intra-articular injections were administered once a week for 3 weeks. Main Outcome Measures The primary outcomes were performance-based physical function measures (regular and fastest walking speed, stair climbing time, and chair rising time), and the secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). The outcome measures were assessed before the injections and at 1 week and 1, 3, and 6 months after the injections. The data were analyzed through repeated-measures analysis of covariance. Results Significant intergroup difference-in-differences favoring the treatment group were observed for improvements in stair climbing time (-1.6; 95% confidence interval, - 8.56 to 4.16; P=.38) and WOMAC physical function (- 21.2; 95% confidence interval, -126.05 to 103.83; P =.045) at 6 months. The group×time interaction effects favored the treatment group for regular (P=.001) and fastest walking speed (P=.001) and chair rising time (P=.038); WOMAC stiffness (P < .001) and physical function (P = .003); and KOOS for pain (P = .035), other symptoms (P=.022), and quality of life (P=.012). Conclusions Compared with HA plus normal saline coinjections, HA plus dextrose coinjections resulted in more significant improvements in stair climbing time and physical function at 6 months, effectively decreased pain, and improved physical function and physical functional performance from 1 week to 6 months. HA plus dextrose coinjections could be a suitable adjuvant therapy for patients with knee OA.
  • 4. 3 Preventive treatment with alendronate of loss of bone mineral density in acute traumatic spinal cord injury. Randomized controlled clinical trial. Fernández Dorado, M.T., Díaz Merino, M., García Marco, D. et al. Preventive treatment with alendronate of loss of bone mineral density in acute traumatic spinal cord injury. Randomized controlled clinical trial. Spinal Cord 2022; 60: 687–693. Study design Randomized controlled clinical trial of two parallel groups. Objectives Analyse the efficacy of primary prevention with alendronate on the loss of bone mass which occurs during the first year of traumatic SCI, measured by double-energy X-ray bone densitometry (DXA). Setting National Hospital for Paraplegics (HNP), Toledo, Spain. Methods We included 52 people admitted to the HNP with traumatic SCI Grade A and B on the ASIA Impairment Scale and less than 8 weeks of progression, which were randomized to one of the two treatment groups. Both groups received calcifediol and a calcium-enriched diet for 52 weeks. Only one group was administered alendronate 70 mg weekly. The dose of alendronate was adjusted according to changes in serum b-CTX. Results 52 Participants were randomized. Of the 26 assigned to each group, 4 patients were lost in the alendronate group and 3 in the control group. The random distribution of women was asymmetrical, so we analysed the effect of treatment on men. In the total left hip, the mean (SD) decrease in bone mass was -22.791% (10.768) in the control group compared to the mean (SD) decrease of -2.693% (6.283) in the same location in the alendronate group (p < 0.0001). No patient presented related adverse events. Conclusion Alendronate administered for one year in the first 8 weeks after traumatic SCI decreases bone loss in the hip in men. This treatment is well tolerated.
  • 5. 4 The Impact of Spasticity and Contractures on Dependency and Outcomes from Rehabilitation. 1 Stephen Ashford , Barbara Singer, Hilary Rose1, Lynne Turner‐Stokes J Int Soc Phys Rehabil Med 2022;5:97-104. Background Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitation, cost and therapy time required. Objective Describe the amount of therapy input for patients undergoing specialist in-patient rehabilitation following ABI, the differences in the type of therapy received by people with and without contracture and/or spasticity, and the impacts on functional outcomes including care needs and cost of care. Materials and Methods A cohort analysis of prospectively collected data from 426 patients with ABI in a UK tertiary inpatient rehabilitation program. The Neurological impairment Scale (NIS) was used to identify the presence of spasticity or contracture. The Northwick Park Therapy Dependency Assessment (NPTDA) was used to calculate the therapy hours and type of treatment provided to people with and without spasticity and/or contracture. Outcomes (change in function and independence) were compared including the UK Functional Assessment Measure (UK FIM+FAM). Results The Male/Female ratio was 63:37% with a mean age: 44.0(SD 13) years and a mean length of stay in specialist inpatient rehabilitation: 103 (SD 49) days. Aetiology: Stroke (63%), Trauma (20%); Hypoxia (7%): Other (10%). Patients with contractures were significantly more dependent than those without, both on admission and discharge. They stayed on average 31 days longer (95%CI 21.1, 40.5) (P=0.001) with an additional mean episode cost of £25,588 (95%CI £18.085, 34,043) (P<0.001). Despite this, they made similar overall functional gains resulting in similar long- term savings in the cost of ongoing care. Conclusion Routine collection of the NPTDA supported quantification of the impact of spasticity and contracture on therapy inputs, length of stay, functional gains, and costs. People with contractures following ABI require more therapy time in rehabilitation to achieve similar functional gains, but nevertheless were cost‐efficient to treat.
  • 6. 5 The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Akyurek, Elcin1; Zengin Alpozgen, Ayse2; Akgul, Turgut3. The preliminary results of physiotherapy scoliosis-specific exercises on spine joint position sense in adolescent idiopathic scoliosis: A randomized controlled trial. Prosthetics and Orthotics International: October 2022 - Volume 46 - Issue 5 - p 510-517. Background It has been observed that there are difficulties in maintaining spinal harmony in the absence of proprioceptive information, which has an important role in achieving postural control in scoliosis. One of the tests used to evaluate proprioceptive mechanisms is joint position reproduction. Objective(s) The main aim of our study was to investigate the effect of physiotherapy scoliosis-specific exercise (PSSE) on spine joint reposition (JR) sense. The second aim was to determine the effects of PSSE on the angle of trunk rotation (ATR), posture, and deformity perception in adolescent idiopathic scoliosis. Methods Twenty-nine patients with adolescent idiopathic scoliosis (mean age 13.79 ± 1.82 years) were randomly allocated to two groups. “Schroth” exercises were applied to the PSSE group for 8 weeks (16 sessions). The control group was placed on the waiting list. Patients' JR error (dual inclinometer), ATR (scoliometer), posture parameters (PostureScreen Mobile, Posterior Trunk Asymmetry Index, and Anterior Trunk Asymmetry Index), and deformity perception (Walter Reed Visual Assessment Scale [WRVAS]) were assessed at the first session and at the end of 8 weeks. Results The initial demographic characteristics, Cobb (thoracal: 19.41 ± 7.03 degrees; lumbar: 20.76 ± 7.24 degrees) and ATR (thoracal: 5.86 ± 3.98 degrees; lumbar: 5.66 ± 3.33 degrees) and clinical test parameters of the groups (JR, posture parameters, and WRVAS) were similar (P > .05). According to the findings, thoracal and lumbar JR error values (P < .05), ATR (P < .001), posture parameters (P < .001), and WRVAS (P = .048) were significantly improved in the PSSE group. Besides, when the groups were compared, a significant difference was found in favor of PSSE except for the deformity perception (P < .05). Conclusions Schroth exercises have a positive contribution for improving JR sense of the spine, vertebral rotation, and posture.
  • 7. 6 Functional Resistance Training Improves Thigh Muscle Strength after ACL Reconstruction: A Randomized Clinical Trial. PALMIERI-SMITH, RIANN M., BROWN, SCOTT R, WOJTYS, EDWARD, KRISHNAN, CHANDRAMOULI Medicine & Science in Sports & Exercise: October 2022 - Volume 54 - Issue 10 - p 1729-1737. Purpose Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction, resulting in prolonged disability and increased risk for reinjury and osteoarthritis. Functional resistance training (FRT) combines resistance training with task-specific training and may prove beneficial in restoring quadriceps strength. The primary purpose of this study was to determine if a walking-specific FRT program (e.g., resisted walking) improves knee strength in individuals after ACL reconstruction. Methods Thirty participants were randomized into one of three groups: 1) FRT with a customized knee BRACE applied to the ACL leg, 2) FRT with elastic BAND tethered to the ankle of the ACL leg, or 3) a TARGET MATCH condition where no resistance was externally applied. Participants in all groups received training while walking on a treadmill 2–3 times per week for 8 wk. Isometric knee extension and flexion strength were measured before the start of the intervention, after the intervention (POST), and 8 wk after intervention completion (POST-2). Results The BRACE group had greater knee extensor strength compared with the TARGET MATCH group at POST and POST-2 (P < 0.05). The BRACE group had greater knee flexor strength than the TARGET MATCH group at POST and POST-2 (P < 0.05) and the BAND group at POST (P < 0.05). Conclusions FRT applied via a customized knee brace results in improvements in knee extensor and flexor strength after ACL reconstruction. FRT is a beneficial adjuvant to ACL rehabilitation and leads to better strength compared with standard of care.
  • 8. 7 American and European Guidelines on Disorders of Consciousness: Ethical Challenges of Implementation. Farisco, Michele PhD; Salles, Arleen PhD Journal of Head Trauma Rehabilitation: July/August 2022 - Volume 37 - Issue 4 - p 258-262. The recently published Guidelines on Disorders of Consciousness (DoCs) by the European Academy of Neurology (EAN)1 and by the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)2 stand as the most ambitious international attempts to provide clear and standardized recommendations to clinicians working with patients with DoCs. They offer an updated, timely, and wide-ranging list of recommendations for the diagnosis, prognosis, and clinical care of affected patients. However, while commendable, the guidelines pose a number of questions, including some related to the practical implementation of their recommendations. For example, both documents rightly consider that the integration of behavioural and instrumental assessments is the best strategy to improve diagnostic accuracy and quality of care. Yet, the operationalization of this recommendation in actual clinical settings, where the necessary technology, for example, functional magnetic resonance image (fMRI), might not be available or convenient to use, remains an open issue. The potential unavailability of the required technology or of the necessary expertise for use in some contexts might undermine the reliability, practical value, and ethical impact of some recommendations. These are not minor concerns because the practical inapplicability of specific recommendations has clear ethical implications: it might directly impact patients' well-being, their right to the best possible care, the communication between clinicians and family members, and overall shared decision-making and unintentionally lead to unequal and unfair treatment of some patients. In this commentary, we propose a responsibility- oriented strategy to address some of the practical and normative barriers to implementation. We begin by summarizing the main points of the 2 guidelines. Next, we outline a Distributed Responsibility Model (DRM) based on a distributed multilevel understanding of responsibility as a means to better understand and address barriers to the implementation of the recommendations. While we do not aim at elaborating an in-depth analysis of all the relevant factors, we hope to set the stage for a more inclusive and comprehensive discussion that involves diverse relevant stakeholders (i.e., clinicians, researchers, and hospital managers, among others).
  • 9. 8 The TWIST Tool Predicts When Patients Will Recover Independent Walking After Stroke: An Observational Study. Marie-Claire Smith, Alan P Barber, Benjamin J Scrivener, Cathy M Stinear Neurorehabil Neural Repair. 2022 Jul;36(7):461-471. Background The likelihood of regaining independent walking after stroke influences rehabilitation and hospital discharge planning. Objective This study aimed to develop and internally validate a tool to predict whether and when a patient will walk independently in the first 6 months post-stroke. Methods Adults with stroke were recruited if they had new lower limb weakness and were unable to walk independently. Clinical assessments were completed one week post-stroke. The primary outcome was time post-stroke by which independent walking (Functional Ambulation Category score > 4) was achieved. Cox hazard regression identified predictors for achieving independent walking by 4, 6, 9, 16, or 26 weeks post- stroke. The cut-off and weighting for each predictor was determined using b-coefficients. Predictors were assigned a score and summed for a final TWIST score. The probability of achieving independent walking at each time point for each TWIST score was calculated. Results We included 93 participants (36 women, median age 71 years). Age < 80 years, knee extension strength Medical Research Council grade > 3/5, and Berg Balance Test < 6, 6 to 15, or > 16/56, predicted independent walking and were combined to form the TWIST prediction tool. The TWIST prediction tool was at least 83% accurate for all time points. Conclusions The TWIST tool combines routine bedside tests at one week post-stroke to accurately predict the probability of an individual patient achieving independent walking by 4, 6, 9, 16, or 26 weeks post-stroke. If externally validated, the TWIST prediction tool may benefit patients and clinicians by informing rehabilitation decisions and discharge planning.
  • 10. 9 Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. Fausto Salaffi, Sonia Farah, Claudia Mariani, Piercarlo Sarzi-Puttini , Marco Di Carlo Pain Pract. 2022 Sep 13.Online ahead of print. Objective The goal of this study was to explore additional evidence of convergent and discriminant validity of the Central Sensitization Inventory (CSI) in a large sample of subjects with fibromyalgia (FM). Methods Patients were consecutively enrolled for a cross- sectional assessment comprehensive of three FM- specific measures (the revised Fibromyalgia Impact Questionnaire [FIQR], the modified Fibromyalgia A s s e s s m e n t S t a t u s [ m o d F A S ] , a n d t h e Polysymptomatic Distress Scale [PDS]) and of CSI. To test the convergent validity, the Spearman's rho was used to measure the degree of correlation between the variables CSI and the FM-specific measures. To assess discriminant validity, CSI scores were grouped according to FIQR disease severity states, and differences between these groups studied with the Kruskal-Wallis test. Interpretative cutoffs were established with the interquartile reconciliation approach. Results The study included 562 FM patients, 199 (35.4%) were classified as having central sensitization syndrome (CSI >40). CSI was largely correlated with modFAS (p = 0.580; p < 0.0001), FIQR (p = 0.542; p < 0.0001), and PDS (p = 0.518; p < 0.0001). The differences between the CSI scores in accordance with the FIQR were significant (p < 0.000001). CSI cutoffs proposed for FM: 21 between remission and mild severity, 30 between mild and moderate severity, 37 between moderate and severe disease, and 51 between severe and very severe disease. Conclusion The current study successfully showed additional evidence of the convergent and discriminant validity of the CSI in FM patients.
  • 11. 10 Ultrasound-guided Genicular Nerve Blockade With Pharmacological Agents for Chronic Knee Osteoarthritis: A Systematic Review. Yeow Leng Tan, Edmund Jin Rui Neo, and Tze Chao Wee Background Ultrasound-guided (ULSD-g) genicular nerve blocks (GNB) using pharmacological agents for pain control in chronic knee osteoarthritis (OA) are gaining in popularity. There lacks a systematic review to evaluate the ULSD techniques and pharmacological agents used during the intervention, and to assess the knee’s function postintervention. Objectives Our study aimed to determine the clinical characteristics of patients with chronic knee OA selected for ULSD-g GNB, describe the various ULSD- g techniques and pharmacological agents used to target the genicular nerves, and evaluate the primary outcomes of pain and function. Study Design Systematic review. Methods We looked at patients with chronic knee OA with symptoms or disease features of at least 3 months and the use of ULSD guidance for GNB using either local anesthetic agents and/or corticosteroids or alcohol. Two major electronic databases (Medline/PubMed and EMBASE) were searched from their inception through August 2021, without language restriction. After removing duplicates, 2 reviewers independently reviewed the abstracts of 340 records. Nine of the 10 full texts that were reviewed were selected for inclusion. A third reviewer was involved in resolving disagreements. Two reviewers extracted relevant information pertaining to study types, patient characteristics, intervention details, outcome measures, and adverse effects. This was followed by independent verification for accuracy. Results Data synthesis: Nine studies were included with a total of 280 patients who had symptoms or disease features of at least 3 months. The National Institute of Health’s Study Quality Assessment Tools were used for quality appraisal, of which 8 studies were at least of fair quality. All studies involved targeted at least the superior medial, superior lateral, and inferior medial genicular nerves. ULSD techniques relied on bony, soft tissue, or periarterial landmarks; either local anesthetic agents and/or corticosteroids or alcohol were used in the injections. Follow-up intervals for pain and functional assessments were heterogeneous, ranging from one week to 6 months postprocedure. Sustained improvements in both pain and knee function were observed for up to 6 months regardless of the choice of pharmacological agents. Minimal adverse effects were reported. Limitations Meta-analysis was not performed due to heterogeneity of study designs, ULSD techniques, pharmacological agents used, and dosages administered. Only one study targeted additional genicular nerves; conclusions regarding the therapeutic blockade of these nerves could not be made. Conclusions There is fair evidence to at least target the superior medial genicular nerve, inferior medial genicular nerve, and Inferior medial genicular nerve using local anesthetics, corticosteroids, or alcohol to reduce pain and to improve knee function in patients with chronic knee OA under ULSD guidance. The procedure is safe but more research is needed to determine the optimal interventional approach.
  • 12. 11 Validity and reliability of Turkish transcultural adaptation of the Prosthetic Limb Users Survey of Mobility. Sevgin Yosmaoglu, Gul Yazicioglu, Yasin Demir, Koray Aydemir, Hayri Baran Yosmaoglu Prosthet Orthot Int. 2022 Aug 25.Online ahead of print. Background Amputee-specific, self-assessment mobility scales are essential to evaluate mobility in lower-limb amputees. Objectives To evaluate the validity and reliability of a Turkish translation and adaptation of the Prosthetic Limb Users Survey of Mobility. Study design This is a validation study. Methods Turkish translation of the Prosthetic Limb Users Survey of Mobility (PLUS-M-T) from its original was performed following the rules of intercultural adaptation and translation methods. The PLUS-M-T and its 12-item short form were applied to '100 induviduals with limb loss twice in 3-day intervals. The structural validity analysis was determined by calculating the correlation with the Amputee Mobility Scale, which is a valid, reliable scale for assessing the functional level in amputees. The Cronbach alpha coefficient was calculated to analyze the internal consistency. The interclass correlation coefficient (ICC) and Spearman correlation coefficient (r) were calculated, and the test- retest reliability was determined. Results A positive, high correlation was found between the first application and its repetition of both PLUS-M-T (ICC = 0.85, r = 0.94, P < 0.001) and 12-item short form (ICC = 0.92, r = 0.93, P < 0.001). The internal consistency was high for both PLUS-M-T (Cronbach alpha = 0.94) and 12-item short form (Cronbach alpha = 0.91). A positive, high correlation was found between the scores obtained from the Amputee Mobility Scale and PLUS-M-T (r = 0.84, P < 0.001) and 12 question short form (r = 0.77, P < 0.001). Conclusion Turkish translation of the PLUS-M questionnaire is a valid and reliable scale for assessing the mobility of individuals who have undergone lower-extremity amputation using a prosthesis.
  • 14. Supports patients initiatives programs In Cerebral Palsy, In Spasticity, Abridged Prescribing Information (BACLOF) Active Ingredient: each tablet of BACLOF contains: baclofen 10, 25 mg, BACLOF liquid contains baclofen 5mg/5ml, 100 ml bottle. Indication: treatment of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. Dosage: Tablets: Initiate with a low dosage, preferably in divided doses, administered orally. Increase gradually based on clinical response and tolerability. The maximum dosage is 80 mg daily (20 mg four times a day). When discontinuing, reduce the dosage slowly. Liquid: adults: One 5ml spoonful (5mg) 3 times a day for 3 days; Two 5ml spoonfuls (10mg) 3 times a day for 3 days; Three 5ml spoonfuls (15mg) 3 times a day for 3 days; Four 5ml spoonfuls (20mg) 3 times a day for 3 days.Elderly:Smalldosesshouldbeusedatthe start oftreatment, the dosebeing titrated graduallyagainst the response,under carefulsupervision.Paediatric population(0to<18years):Adosageof0.75-2mg/kg bodyweight shouldbeused.In children over ten years of age, however a maximum daily dosage of 2.5mg/kg body weight may be given. Treatment is usually started with half a 5ml spoonful (2.5mg) given 4 times daily. The recommended daily dosages for maintenance therapy are as: 12 months – 2 years: Two to four 5ml spoonfuls (10-20mg), 2 years – 6 years: Four to six 5ml spoonfuls (20-30mg); 6 years – 10 years: Six to twelve 5ml spoonfuls (30-60mg). Contraindications: hypersensitivity to baclofen or any component of this product. Warning and precautions: Abrupt discontinuation of baclofen has resulted in serious adverse reactions including death; therefore, reduce the dosage slowly when baclofen is discontinued. Neonatal withdrawal symptoms can occur; gradually reduce the dosage and discontinue baclofen before delivery. Baclofen can cause drowsiness and sedation. Patients should avoid the operation of automobiles or other dangerous machinery until they know how the drug affects them. Advise patients that the central nervous system effects of baclofen may be additive to those of alcohol and other CNS depressants. Baclofen can cause exacerbation of the following: psychotic disorders, schizophrenia, or confusional states; autonomic dysreflexia; epilepsy. Use with caution in patients with these condition. Pregnancy & Lactation: Pregnancy: Based on animal data, may cause fetal harm. At recommended oral doses, baclofen is present in human milk. There are no human data on the effects of baclofen on milk production and on breastfed infant. Interaction: CNS depressants like benzodiazepines, antihistamine, antipsychotic, and alcohol etc., may cause increased sedative effects. Morphine (epidural) may cause hypotension and dyspnea. Laboratory Test Interactions may cause false elevation of AST (aspartate aminotransferase), alkaline phosphatase, or blood glucose. Adverse reactions: most common drowsiness, dizziness, and weakness. Overdose: Symptoms: Patients may present in coma or with progressive drowsiness, lightheadedness, dizziness, somnolence, accommodation disorders, respiratory depression, seizures, or hypotonia progressing to loss of consciousness. Treatment: includes gastric decontamination, maintaining an adequate airway and respirations. (Prepared on 23rd Feb 2020. It is recommended to refer full prescribing information before prescription. For further medical information, please write to: Intas Pharmaceuticals Ltd., Corporate House, Near Sola Bridge, SG highway, Thaltej, Ahmedabad-380054, Gujarat, India. productqueries@intaspharma.com.) Abridged Prescribing Information (BACLOF LIQUID) Active Ingredient: each tablet of BACLOF contains: baclofen 10, 25 mg, BACLOF liquid contains baclofen 5mg/5ml, 100 ml bottle. Indication: treatment of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. Dosage: Tablets: Initiate with a low dosage, preferably in divided doses, administered orally. Increase gradually based on clinical response and tolerability. The maximum dosage is 80 mg daily (20 mg four times a day). When discontinuing, reduce the dosage slowly. Liquid: adults: One 5ml spoonful (5mg) 3 times a day for 3 days; Two 5ml spoonfuls (10mg) 3 times a day for 3 days; Three 5ml spoonfuls (15mg) 3 times a day for 3 days; Four 5ml spoonfuls (20mg) 3 times a day for 3 days.Elderly:Smalldosesshouldbeusedatthe start oftreatment, the dosebeing titrated graduallyagainst the response,under carefulsupervision.Paediatric population(0to<18years):Adosageof0.75-2mg/kg bodyweight shouldbeused.In children over ten years of age, however a maximum daily dosage of 2.5mg/kg body weight may be given. Treatment is usually started with half a 5ml spoonful (2.5mg) given 4 times daily. The recommended daily dosages for maintenance therapy are as: 12 months – 2 years: Two to four 5ml spoonfuls (10-20mg), 2 years – 6 years: Four to six 5ml spoonfuls (20-30mg); 6 years – 10 years: Six to twelve 5ml spoonfuls (30-60mg). Contraindications: hypersensitivity to baclofen or any component of this product. Warning and precautions: Abrupt discontinuation of baclofen has resulted in serious adverse reactions including death; therefore, reduce the dosage slowly when baclofen is discontinued. Neonatal withdrawal symptoms can occur; gradually reduce the dosage and discontinue baclofen before delivery. Baclofen can cause drowsiness and sedation. Patients should avoid the operation of automobiles or other dangerous machinery until they know how the drug affects them. Advise patients that the central nervous system effects of baclofen may be additive to those of alcohol and other CNS depressants. Baclofen can cause exacerbation of the following: psychotic disorders, schizophrenia, or confusional states; autonomic dysreflexia; epilepsy. Use with caution in patients with these condition. Pregnancy & Lactation: Pregnancy: Based on animal data, may cause fetal harm. At recommended oral doses, baclofen is present in human milk. There are no human data on the effects of baclofen on milk production and on breastfed infant. Interaction: CNS depressants like benzodiazepines, antihistamine, antipsychotic, and alcohol etc., may cause increased sedative effects. Morphine (epidural) may cause hypotension and dyspnea. Laboratory Test Interactions may cause false elevation of AST (aspartate aminotransferase), alkaline phosphatase, or blood glucose. Adverse reactions: most common drowsiness, dizziness, and weakness. Overdose: Symptoms: Patients may present in coma or with progressive drowsiness, lightheadedness, dizziness, somnolence, accommodation disorders, respiratory depression, seizures, or hypotonia progressing to loss of consciousness. Treatment: includes gastric decontamination, maintaining an adequate airway and respirations. (Prepared on 23rd Feb 2020. It is recommended to refer full prescribing information before prescription. For further medical information, please write to: Intas Pharmaceuticals Ltd., Corporate House, Near Sola Bridge, SG highway, Thaltej, Ahmedabad-380054, Gujarat, India. productqueries@intaspharma.com.) Disclaimer: The matter content in this infographic is solely for educational purposes only. It does not intend either directly or indirectly expressly or impliedly to promote, propagate, advertise or otherwise endorsing any particular product or brand. The matter content in this infographic does not make any representation or warranties with respect to the efficacy, accuracy, usefulness or applicability, or fitness, or completeness for any particular purpose. The content has been created by editorial board of PMR buzz with an unconditional educational grant from Intas Pharmaceuticals Pvt. Ltd.. The creators of this infographic hereby disclaim any and all liability to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this infographics, which is provided as is, and without warranties. 0000000