The Ponseti technique has a higher success rate than any other method now used in physiotherapy practice for the treatment of congenital talipes equinovarus or clubfoot. The study’s objective was to discover proof that using the Ponseti approach for clubfoot challenging functional results and missing limb by prosthetic shoes. A baby girl who was 1 month and 6 days old and had no prior history of complications for either her mother or herself visited Centre for the Rehabilitation of the Paralysed (CRP). We identified her as having unilateral normal clubfeet (left) and missing limb in right, and throughout the casting process, her midfoot scored higher than her hindfoot. On the first casting day, feet had a total Pirani score (PS) of 5.5. Total casting was necessary, and the right feet’s PSs were 1.5 and 1, respectively. Just before the casting, she had manipulation (exercise therapy). After nine casting, Pirani’s score was zero. Afterward, the patient was given the brace and prosthetic in the 4 size. This study’s findings suggest that using the Ponseti approach yields comprehensive clinical and functional results and missing limb by prosthetic shoes.
Aims: To identify effects of educational material among children with clubfoot during bracing stage of treatment by Ponseti method. Methods: This study was a quantitative type quasi-experimental research design. Actually, it was an experiment among specific groups and usual groups. Exercises applied with educational material to the material group or experiment group and only usual exercises applied to the non-material group or the control group. A pre-test (before exercises provided by educational material) and post-test (after exercises provided by educational material) was administered with each subject of both groups to compare the effects on children with clubfoot during bracing stage of treatment by Ponseti method. Results: The mean Pirani score before providing exercises with educational material for right feet among the clubfoot babies were 0.56 ± 0.33 (material group) and after providing exercises with educational material for right feet among the clubfoot babies were 0.43 ± 0.41 (material group). Statistically it was found highly significant (t = 2.99, p greater 0.0003). So, it was concluded that exercises with educational material had significant influence on Pirani score reduction for right feet among the clubfoot babies. The mean Pirani score before providing usual exercises for left feet among the clubfoot babies were 0.5 ± 0.15 (non-material group) and after providing usual exercises for left feet among the clubfoot babies were 0.53 ± 0.48 (non-material group). Statistically it was found significant (t = –0.059, p greater 0.056). So, it was concluded that usual exercises without educational material had influence on Pirani score increased for left feet among the clubfoot babies. Conclusion: The modern treatment of clubfoot is Ponseti method which is very effective, outcome oriented, and less invasive surgical procedure. This study was concluded that exercises with educational material had significant influence on Pirani score reduction among the children with club foot. So, there was significant importance of exercises with educational material rather than usual exercises by verbal instructions.
Aims: Occupational therapy (OT) driving assessments provide the gold standard approach to determine fitness to drive post-injury, medical event, and aging. However, these assessments are time intensive, costly and are associated with lengthy waitlists. As such, there is interest to investigate innovative approaches, including the use of the Trails Making Test B (TMT B), to assist clinicians with their decisions around returning to driving. The aim of this research was to explore potential correlations between TMT B scores and driving assessment outcomes. Methods: Trails Making Test B data were collected between 2010 and 2019 within a publicly funded community-based driving service in Brisbane, which serviced a wide range of client diagnostic groups and age ranges (17–94 years). A retrospective analysis was completed to compare with the on-road OT driving assessment outcome. Results: Results indicate a statistically significant relationship between TMT B score with on-road driving performance, with a higher confidence of predictability in the younger age groups (defined as 63 years or younger). Age is also related to on-road performance, with older clients more likely to fail. A 120 second time cut off may be a clinically relevant marker in predicting on-road performance, particularly for the younger clients. Conclusion: The TMT B is useful tool to assist in the decision making around returning to driving to aid in the timing and need of on-road driving assessment and to potentially assist with decision making in situations where these assessments are not practically available. Clinicians can consider the risk versus the benefits of the test as a predictive tool given their specific contextual environment and access to on-road driving assessments.
Introduction: The most quintessential elbow condition among athletes, especially tennis players, is lateral epicondylalgia, familiar as lateral epicondylitis. Individuals employed in professions that involve frequent physical exertion or repetitive movements are also susceptible to potential risk. This case report intents to present a brief overview of the patient’s treatment and rehabilitation for lateral epicondylalgia by using specific problem-oriented treatments. Case Report: In this case report, we report a case of a 35-year-old female patient who had chronic lateral epicondylitis on right elbow for three months. On physical examination, Numeric Pain Rating Scale (NPRS), Quick DASH, and Patient-rated Tennis Elbow Evaluation score and activities were evaluated on the initial visit to physical therapy and after discharge. By the time she attended three times a week for four weeks, she received conventional therapy lateral epicondylitis. Additionally, she also received a wide range of physiotherapy to stabilize the scapula, more specifically the middle and lower trapezius and strengthening of serratus anterior muscle. This helped to correct deformities, reduce pain, and restore elbow function. The patient reported NPRS = 8/10, Quick DASH = 72.7, and PR-TEE = 89 on the initial visit. At discharge the patient reported a 3 on NPRS, Quick DASH = 15.9, and PR-TEE = 34 with ability to return to full work and no associated symptoms or complaints. Conclusion: The combination of conventional physiotherapy intervention with scapular muscle activation and strengthening was comparatively effective in relieving the patient’s lateral epicondylalgia and push the patient to a higher level of functional activity within only four weeks.
Aim: To determine the number of people having swallowing difficulties among traumatic brain injury patient. Methods: This is a quantitative type of cross-sectional survey study where 117 samples were assigned purposively from Dhaka Medical College Hospital (DMCH). The Swallowing Disturbance Questionnaire (SDQ) was used for the study. Data were analyzed by using descriptive statistical analysis (SPSS = Statistics package for social science) method. Results: On an average, most of the participants 90.60% (106) were males and other participants 9.40% (11) were females. The maximum numbers of participants 25.6% (30) were in the age range 18–27 years. The majority numbers of participants 33.30% (39) were at secondary level education. The maximum numbers of respondents 22.20% (26) found were day laborer (driver, rickshaw puller, and masons). Most of the participants 63.20% (74) had injuries in 0–2 months earlier. Among 117 participants, 76 (64.95%) participants had no swallowing difficulties (dysphagia) and 41 (35.05%) participants had swallowing difficulties (dysphagia). Conclusions: Swallowing difficulty (dysphagia) is a common problem in patients with traumatic brain injury (TBI). Researchers explored the prevalence of swallowing difficulty among TBI patients. In this study, among 117 participants most of the participants 90.60% (106) were males and 9.40% (11) participants were females. So, swallowing difficulty is common in TBI patients who are associated with other condition of swallowing. According to SDQ score among 117 participants, (35.05%) participants had swallowing difficulties. So, TBI patients are vulnerable for presence of swallowing difficulties.
Aims: The literature provides numerous medical therapies for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and spinal cord lesion following spinal tumor surgery separately. Spinal cord injuries from CIDP-related spinal tumors have no evidence-based rehabilitation methods. This case report discusses CIDP, spinal cord lesion owing to a spine tumor, and tertiary care interdisciplinary rehabilitation. It shows how medical knowledge, clinical reasoning, and evidence guide outcome measures, care plans, and clinical decisions help to overcome CIDP. Methods: In this report, we follow a 27-year-old male who began experiencing gradual paresthesia and mild weakening in his lower extremities for six weeks. After two months, the lumbar spine had the initial operation (laminectomy) because of the extreme pain. After the operation, he was pain-free, able to walk, and even started riding again. Pain in his lower midback, similar to cramping, and moderate swelling in his left ankle forced him into a wheelchair three years after his initial operation (intradural-extramedullary spinal space-occupying lesion at L2–L5 level). After the second operation (laminectomy), he had trouble in walking, lost sensation below the knees on both legs, and experienced mild incontinence. As the patient was confined to a wheelchair, he was standing with the help of two people. Significant main muscle group weakening was one of the first noticeable symptoms. Therapeutic exercise, balance training, functional training, and progressive endurance activities were the main components of the intervention. Berg balance score increased from 5 to 23, which is an eligible score for discharge. Results: Clinical outcomes for the man with spinal cord lesion and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) were improved with interdisciplinary therapy. The patient underwent a first lumbar spine operation, which initially eased pain and allowed him to walk and ride again after feeling gradual paresthesia and minor weakened in his lower extremities. Conclusion: For this patient with CIDP with spinal cord lesion due to spinal tumor, effective collaborative team communication and interdisciplinary management worked to optimize clinical decision making and recovery.
Introduction: Alzheimer’s disease (AD) is a degenerative disease and dementia is a neurological condition which is significantly caused by AD. Sometimes it is found at early to middle age which is associated with cognitive and functional impairment. There is no significant curative treatment till now but only symptomatic treatment in available. Aim of this study is to describe evidence-based physiotherapy management for fall prevention associated with Alzheimer’s disease. Case Report: This is a case-based study which features an elderly man who has just fallen for the few times and has early Alzheimer’s disease (AD). In literature, exercise therapy is proven to be effective for fall management. Exercise was demonstrated by the physiotherapist and follow-up was done on a regular basis. The fall prevention exercise included core muscle strength training, cue gait training, fall prevention strategy, and task-based functional activity practice focused on Alzheimer’s symptoms. The patient was assessed with the Tinetti Patient Oriented Mobility Assessment (POMA) and Berg Balance Scale score (BBS). The initial score was 8/28 for POMA and 19/56 for BBS, and after 8 weeks it was recorded as 19/28 and 21/56. Oxford muscle grading system was used for measuring strength. Conclusion: Final outcomes suggested minor improvements in balance, strength of lower limbs, functional activities. This case study focuses on the importance of physical exercise to improve balance and prevent consequences of fall.
Aims: The negative role of anger expression in chronic pain has been described. However, there is a poor understanding of the impact of anger and perceived injustice in the therapeutic alliance in this setting. The aim was to review the current literature examining anger and perceived injustice and its impact on the therapeutic alliance in the context of chronic pain. Methods: In July 2020 a search was carried out of electronic databases [Academic Search Complete, Allied and Complementary Medicine Database (AMED), Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus]. Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. Results: The initial search yielded 255 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was three papers to be reviewed. In total 225 patients were analyzed. Of the papers reviewed, all showed a negative correlation between perceived injustice and patient rating of the therapeutic alliance. Anger expression is the mediator of the proposed perceived injustice and therapeutic alliance relationship. Conclusion: The review addresses the potential role of anger expression in the modulation of the therapeutic alliance. The assessment of anger expression in chronic pain patients may be beneficial. Clinicians should be aware of its implications on the therapeutic alliance. The review highlights the need for further research which could lead to potential therapeutic interventions for such patient groups.
Aims: Research objectively evaluating physical activity (PA) and sleep in adults with hypermobile Ehlers–Danlos syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD) is lacking. Furthermore, it is not clear to what extent frequently occurring symptoms in these patients are related to their PA and sleep. Therefore, a cross-sectional study was performed to objectively evaluate, and identify factors contributing to, PA and sleep in adults with hEDS and G-HSD. Methods: Twenty female adults with hEDS, 23 with G-HSD, and 32 healthy controls participated. Physical activity and sleep were measured using two tri-axial ActiGraphs worn over seven consecutive days. Furthermore, questionnaires evaluating frequently occurring symptoms were completed. Regression analysis was performed to determine major contributors to PA and sleep. Results: Daily step counts were significantly lower in both patient groups compared to the control (CTR) group (p lessthan 0.04) and to the recommended 7500 steps (p≤0.001). Other PA and sleep variables did not differ between the groups. In the hEDS group, body mass index and kinesiophobia were related to PA, explaining 53% of the variance in step counts. In the G-HSD group, 18.5% of the variance in step counts could be attributed to the variance in pain impact. Conclusion: Adults with hEDS and G-HSD had lower step counts than healthy peers, which may be partially due to kinesiophobia and the impact of pain respectively. No differences in objectively measured sleep parameters were identified. Treatment focusing on fear-avoidance beliefs and pain relief could potentially increase daily step counts and benefit overall health in these patients.
Aims: Insurance medicine being only in a few countries a recognized medical specialty, there are only in some countries registered insurance physicians. Yet in all countries, medical doctors carry out assessments in the context of the social security framework. In countries where there are no registered insurance physicians, these assessments are being carried out by doctors whose education and training are determined by history and national legislation. The aim of this study was to describe and compare the postgraduate education and training of physicians involved in insurance medical work in 15 European countries. Methods: We organized a European expert meeting consisting of three phases: a preparatory phase in order for 21 participants to prepare themselves for the meeting, a written phase at the meeting, an oral phase with systematic rounds of questions and discussion followed by analysis and classification of data. Results: Education and training requirements for physicians involved in insurance medical work differ in Europe, as do the actual available training and education programs offered, both at the start and throughout the career in this field. The current situation varies from nonexistent in three countries to a full postgraduate program leading to a registered medical specialization in seven countries. Continuous medical education also varies from nonexistent, through general to specific insurance medical training in eight countries. Conclusion: Harmonization of the postgraduate education and training program of the physicians involved in the insurance medical work in Europe is needed. Setting the basis for European standards in insurance medicine education and advocating for competence-based training are not only the conditions for European recognition but would also further insurance medicine as a medical specialty.
Aims: Community rehabilitation is a key component of health services within stroke care. Ongoing challenges exist as to how to best capture outcomes for these services, especially considering the multi-faceted service delivery and flexible focus on individual need. A goal setting tool, such as the multidisciplinary goal attainment measurement (MGAM), may be useful to objectively measure client outcomes that are meaningful and relevant to individuals within this complex environment. This study aims to review MGAM client outcomes within a stroke population in a community rehabilitation context. Methods: Pre and post goal outcome data was collected by multidisciplinary team members with stroke survivors, across the domains of impairment, activity/participation, and knowledge/information. These pre and post scores were compared with each other, as well as a measure of everyday functioning. Results: Clinically significant average change scores and statistically significant changes pre and post intervention were found across all domains on the MGAM. There were no correlations noted between MGAM and length of stay, quality of life and everyday functioning outcomes. Conclusion: As evidenced in the stroke population of this study, MGAM offers a unique outcome measure different to other clinical measures as it captures client outcomes that are relevant and meaningful to individual need across a range of domains within a multi-disciplinary setting. These formalized goal setting practices and outcomes, such as the MGAM, may assist in providing standardized outcome processes across various community rehabilitation settings.
Aims: To describe patients’ experiences of being diagnosed with multiple sclerosis (MS) and their needs for support and guidance in the first year with the disease. Methods: A qualitative, semistructured interview study with five patients with MS was conducted. Data were transcribed and analyzed using interpretative phenomenological analysis. Results: Three themes emerged: Frightening to get the diagnosis, needs from family and network, and the importance of continuity in contacts with nurses. The participants struggled with thoughts about serious disabilities and stigmatization, although for some the disease moved more into the background after a period. The patients expressed a need for support and guidance from both families and nurses. They primarily used their families for support, and this was influenced by the family’s emotional involvement. Family members typically did not have the necessary experience to give appropriate guidance. The patients were aware of the impact the disease had on their families, and this sometimes stopped them from seeking support from them. The nurse should develop the contact with the individual patient to become familiar with the patient’s illness narrative and previous coping strategies so to better provide holistic care. Conclusion: Being diagnosed with MS gives rise to frightening thoughts about the future and the fear of stigmatization. Patients need support and guidance from both their families and the nurses at the MS clinic. Nurses should consider the family’s role and how to involve the resources available from family members. It is important that the nurses develop a close relationship with the patient. The possibility of contact nurses may be a useful solution for providing targeted support and guidance to patients diagnosed with multiple sclerosis.
Aims: The overall aim was to describe and examine if there is a difference between men and women in fall-related self-efficacy (SE). Another aim was to examine the strength of associations between fall-related SE and physical function and health-related quality of life (QoL) in community-living individuals poststroke. Methods: A cros-ssectional study was conducted within two weeks of admission to rehabilitation or first week follow-up after discharge from hospital. Used tests were fall-related self-efficacy (FES-S), Functional Ambulation Classification (FAC), 10 meter walking test (10 mWT), the functional independence measure (FIM), and health-related QoL (EQ5D). The analysis was based on 37 individuals with a mean age off 68.5 years. Results: The results showed that physical factors but not QoL had association with perceived confidence in task performing without falling. No gender difference was shown. Conclusion: In this study physical function was associated with fall-related SE.
Aims: Congenital clubfoot is a deformity of the lower extremity manifested by foot adduction/inversion, cavus and plantar flexion. Its incidence varies within 0.5–7 per 1000 live births worldwide. Genetic predisposition, environmental factors and combination of them are assumed to have etiological factor. A number of trials have been made to cure clubfoot long years ago. But none of them was as effective as the Ponseti method which is better for success rate and the outcome is affected by many factors. Early diagnosis and treatment should be the main paradigms to decrease the risk of physical disability due to clubfoot. The study was aimed at assessing the practice of management and its outcome. Methods: Facility based retrospective medical record assessment was carried out. The retrieved and qualified data was entered into statistical package for the social sciences for analysis and then output is described and discussed. Results: The basic Ponseti principles and guidelines were practiced in Mekelle hospital considering some limitations. Physiotherapists were the health professionals who make all the clinical decision makings in the setup. The incidence of case relapse was 14.7%, and the rate of tenotomy was 70.6%. However, the facility scored overall success rate of 77.9%. Conclusion: In Mekelle hospital, basic principles and guidelines of Ponseti method were practiced with some deviations. The rate of relapse and failure is also slightly higher. Deep social awareness about clubfoot management, grading the rate of tenotomy and reducing the treatment side effect is mandatory to achieve good outcome.
Aims: Due to well organized medical and daily care for children with spina bifida (SB) in many countries the number of adult patients with SB is increasing. After reaching adulthood individuals suffering from SB have to organize their medical care and assistance in their daily life mostly on their own. The aim of this study is to illustrate living conditions of adults with SB in Germany and to find out if lesion level as well as an individual’s independence influence these conditions. Methods: Questionnaires were sent out to adults suffering from SB living in German speaking countries. Included were questions concerning medical history, need for support in activities of daily living (ADL) in the form of the Barthel index and their current living conditions. Non parametric statistic was used to examine interdependencies. Results: In the study were 261 individuals with a median age of 26 years (range 18 to 49) included. Of the participants 92% had a neurological deficit with a lesion level mainly in the lumbar region (64%) followed by the thoracic (25%) and the sacral (11%) region. Concerning the living conditions we found a lack of autonomy in people suffering from SB. This is reflected by e.g. their housing situation, on the one hand, with only 32% of the individuals living on their own or with a partner, and their financial situation, with only 22% of the individuals being financially self-sufficient. The Barthel index, a measuring instrument of independence in performing ADL, was significantly related to the lesion level and many aspects of daily life (e.g. communication and financial situation). Conclusion: It is an enormous medical success that many children with SB reach adulthood nowadays. However many of these individuals stay dependent on support in various aspects for their whole life. So it is crucial important that care and therapy in childhood and later on are optimized with respect to the functional outcome to enable adults suffering from SB to live a self-determined life within the limitations of the primary underlying disease. The Barthel index ilustrates the restrictions that adults with SB face and their general influence on a self-determined life.
The purpose of the study is to try to establish if maladaptive beliefs effect recovery times and poor outcomes in whiplash associated disorders (WAD). In May 2017 the following databases were searched from their inception until June 2017: SPORT Discuss, CINAHL, PsycINFO, MEDLINE, Ovid MEDLINE, Cochrane, AMED, Embase. A combination of sensitive search strategies was used for locating articles on maladaptive beliefs and WAD. Hand-searching of relevant journals and citation tracking were used to maximise the identified study pool. A total of 189 references were retrieved and an additional three studies were identified through different sources, 178 remained after the removal of duplicates. For 43 references, the full text was assessed, and 7 studies were included. The methodological quality was assessed independently by two assessors. Data extraction was carried out using a standardised data extraction form. Most articles scored a high overall quality and fourteen percent (14%) of articles (1 out of 7) were rated with moderate overall quality. Meta-analysis was not undertaken due to the heterogeneity of prognostic factors, outcome measures and methods used. Four out of the seven studies presented a correlation between catastrophising and disability in at least one follow-up time point (3, 6 or 12 months) whilst three studies found a correlation between fear-avoidance and disability. Four of the studies showed an association between maladaptive beliefs (catastrophising or fear avoidance) and pain and two found a negative effect. Our findings show that outcomes, such as pain and disability, were found to be associated with maladaptive beliefs (catastrophising and fear avoidance).
Aims: To identify factors explaining return to work (RTW) 12 months after a multimodal rehabilitation (MMR) intervention in the REHSAM II project. Methods: The present study is a secondary assessment of the data from the randomized controlled trial REHSAM II. A total of 97 participants with persistent musculoskeletal pain were randomly allocated to MMR + web-based education or only MMR. The subjects were followed from baseline to 12 months. The baseline variables from the outcome measures were used to identify predictors. The associations between the dependent variable (i.e., RTW) and independent variables (i.e., baseline variables) were analyzed with univariate and multiple logistic regression models. Results: The univariate regression analyses showed that pain and disability level, the capacity to perform a task in relation to pain, hospital and psychiatric care, medication for insomnia, catastrophizing, self-assessed work ability compared with lifetime best, satisfaction with life, ability for coping and controlling work situation, ability for coping with life outside work, and sense of responsibility for managing health condition were significantly associated with RTW. In the final multiple regression model, RTW was predicted by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ score) (p=0.003, OR=0.961) and EuroQol (EQ-5D index) (p=0.017, OR=7.283) Conclusion: Psychosocially related pain and health-related quality of life predicted RTW in the final model. The results confirm that RTW is a multidimensional problem involving a complex interaction of many factors.
Assistive technologies (AT) are increasingly used in rehabilitation to support the fulfillment of client occupations, particulary the elderly.Indeed, the use of technology is now seen as an effective mean to meet various needs for this population.Several researches are concerned with assistive technologies, their use and design.This article aims to provide an overview of current knowledge about assistive technologies in rehabilitation.Several questions are addressed concerning the different actors concerned in the use of assistive technologies and the main families of AT considered in the literature.A synthesis of knowledge had been made with the methodology of interpretative approach of Pope et al. (2007).In addition to targeting the differents actors of the technological continuum, this review found that a varied nomenclature and classification are used when it comes to assistive technologies.It also pointed out that the design
Aims: To systematically review the evidence for the effectiveness of combining cognitive behavioural therapy (CBT) and exercise versus exercise alone in the management of patients with non-specific chronic low back pain (NSCLBP). Methods: Electronic search of CINAHL, PUBMED, Sports Discuss, SCOPUS, AMED, MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, between 1990 – July 2017; complemented by hand searching of citation lists and citation tracking. Two independent reviewers screened titles and abstracts from the retrieved search results. Studies were considered based on PRISMA guidelines. Data was extracted based on Cochrane the Handbook of Systematic Reviews guidelines; the Cochrane Data Collection Form for Intervention Reviews (RCTs only), was customized and utilized. Risk of bias assessment was undertaken utilizing the Cochrane Back Review Group recommendations employing two independent reviewers. Meta-analysis was used to produce a weighted average for primary outcome measures, namely pain and disability. Results: Four studies were included (n = 406 participants); all studies provided post intervention results on pain and disability. Meta-analysis showed no significant difference between groups for both pain and disability, post intervention in the short term (pain; SMD -0.02, 95% CI -0.23 to 0.19; disability; SMD 0.06, 95% CI -0.15 to 0.27); medium term (pain; SMD -0.01, 95% CI -0.24 to0.22; disability; SMD 0.00, 95% CI -0.23 to 0.23); and long term (pain; SMD 0.06, 95% CI -0.18 to 0.29; disability; SMD -0.06, 95% CI -0.39 to 0.27). Conclusion: The findings from this review reveal that there is no significant difference between groups; that is, there is moderate level evidence that the addition of CBT to exercise for patients with NSCLBP does not improve pain and disability outcomes in either the short, medium, or long term; however, both interventions (CBT plus exercise and exercise alone) produce favourable outcomes.
