| 1. |
- Tibaek, Sigrid, et al.
(författare)
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Can pelvic floor muscle training improve quality of life in men with mild to moderate post-stroke and lower urinary tract symptoms?
- 2017
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 53:3, s. 416-425
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Lower urinary tract symptoms (LUTS) have a significant impact on quality of life (QoL) in post-stroke patients. AIM: The aim of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on QoL parameters in men with post-stroke LUTS. DESIGN: Randomized, controlled and single-blinded trial. SETTING: Outpatients, University Hospital. POPULATION: Thirty-one men, median age 68 (interquartile range 60-74) years, with post-stroke LUTS were included. Thirty participants completed the study. METHODS: The participants randomized to the treatment group were treated in a systematic, controlled and intensive PFMT program over 3 months (12 weekly sessions). The participants randomized to the control group did not receive specific LUTS treatment. The effect was measured on the 36-Item Short Form Health Survey (SF-36) and the Nocturia Quality-of-Life (N-QoL) Questionnaire. RESULTS: The results on SF-36 indicated significant improvement within pre- and post-test in the domains emotional role (median 77 to 100, P=0.03) and vitality (median 65 to 70, P=0.03) in the treatment group, but not the control group. There were no statistically significant differences between groups at pre-test, post-test or 6-month follow-up. The results on N-QoL indicated statistically significant differences between pre- and post-test in the bother/concern domain in both groups and in sleep/energy for the control group, but not the treatment group. There were no statistically significant differences between groups. CONCLUSIONS: PFMT may improve the emotional health and vitality domains of QoL in men with mild to moderate post-stroke and LUTS; however the improvements in the treatment group were not significantly better than for the control group. PFMT did not improve nocturia-related QoL. CLINICAL REHABILITATION IMPACT: This study is the first to evaluate the effect of PFMT on QoL parameters in men with mild to moderate post-stroke and LUTS. The results indicate some short-term effect on SF-36 but none on N-QoL. However, further studies with larger sample sizes and with less restrictive inclusion and exclusion criteria are requested.
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| 2. |
- Ertzgaard, Per, et al.
(författare)
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Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomised placebo-controlled trial.
- 2018
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 54:4, s. 507-17
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient’s everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment.AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mollii®, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP.DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design.SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants’ homes and all follow-ups were performed in the two rehabilitation clinics.POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment.METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each, followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks.RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS.CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies.CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient’s own rehabilitation goals is recommended and may increase the value of the evaluated concept.
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| 3. |
- Ertzgaard, P., et al.
(författare)
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Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
- 2018
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 54:4, s. 507-517
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient's everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants' homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient's own rehabilitation goals is recommended and may increase the value of the evaluated concept.
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| 4. |
- Filipe, A., et al.
(författare)
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White Book on Physical and Rehabilitation Medicine in Europe Introductions, Executive Summary, and Methodology
- 2018
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 54:2, s. 125-155
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Tidskriftsartikel (refereegranskat)abstract
- The White Book (WB) of Physical and Rehabilitation Medicine (PRM) in Europe is produced by the 4 European PRM Bodies (European Academy of Rehabilitation Medicine - EARM, European Society of PRM - ESPRM, European Union of Medical Specialists - PRM Section, European College of PRM-ECPRM served by the European Union of Medical Specialists-PRM Board) and constitutes the reference book for PRM physicians in Europe. It has now reached its third edition; the first was published in 1989 and the second in 2006/2007. The WB has multiple purposes, including providing a unifying framework for European countries, to inform decision-makers on European and national level, to offer educational material for PRM trainees and physicians and information about PRM to the medical community, other rehabilitation professionals and the public. The WB states the importance of PRM, a primary medical specialty that is present all over Europe, with a specific corpus disciplinae, a common background and history throughout Europe. PRM is internationally recognized and a partner of major international bodies, including the World Health Organization (WHO). PRM activities are strongly based on the documents of the United Nations (UN) and WHO, such as the Convention of the Rights of Persons with Disabilities (2006), the World Report on Disability (2011), the WHO Global Disability Action Plan 2014-2021 (2014) and the WHO initiative "Rehabilitation 2030: a call for action" (2017). The WB is organized in 4 sections, 11 chapters and some appendices. The WB starts with basic definitions and concepts of PRM and continues with why rehabilitation is needed by individuals and society. Rehabilitation focuses not only on health conditions but also on functioning. Accordingly. PRM is the medical specialty that strives to improve functioning of people with a health condition or experiencing disability. The fundamentals of PRM, the history of the PRM specialty, and the structure and activities of PRM organizations in Europe are presented, followed by a thorough presentation of the practice of PRM, i.e. knowledge and skills of PRM physicians, the clinical field of competence of PRM, the place of the PRM specialty in the healthcare system and society, education and continuous professional development of PRM physicians, specificities and challenges of science and research in PRM. The WB concludes with the way forward for the specialty: challenges and perspectives for the future of PRM.
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| 5. |
- Marklund, Ingela, et al.
(författare)
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Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke
- 2023
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 59:2, s. 136-144
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients' mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes. DESIGN: Longitudinal cohort study.SETTING: Outpatient clinic in Stockholm, Sweden.POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT.METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention.RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results.CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT.CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.
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| 6. |
- Papp, Marian E., et al.
(författare)
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Effects of yogic exercises on functional capacity, lung function and quality of life in participants with obstructive pulmonary disease : a randomized controlled study
- 2017
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - 1973-9087 .- 1973-9095. ; 53:3, s. 447-461
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge of hatha yogic exercises, the most used yoga style, for increasing functional capacity in patients with obstructive pulmonary diseases remains limited. AIM: The aim was to evaluate the effects and feasibility of hatha yoga (HY) compared to a conventional training program (CTP) on functional capacity, lung function and quality of life in patients with obstructive pulmonary diseases. DESIGN: Randomized clinical trial. SETTING: The study was performed at the Karolinska University Hospital, Stockholm, among outpatients. POPULATION: Thirty-six patients with obstructive pulmonary disease. METHODS: Forty patients were randomized with 36 (24 women, median age =64, age range: 40-84 years) participating in HY (N.=19) or CTP (N.=17). Both HY and CTP involved a 12-week program with a 6-month follow-up. Functional capacity (using the 6-Minute Walk Test), lung function (spirometry), respiratory muscle strength (respiratory pressure meter), oxygen saturation (SpO2), breathlessness (Borg), respiratory rate (f) and disease-specific quality of life (CRQ) were measured at baseline, at 12 weeks and at a 6-month follow-up. RESULTS: Testing for interactions (group x time) with ANOVAs showed significant effects on the CRQ fatigue (P=0.04) and emotional (P=0.02) domains, with improvements in the CTP group after the 12-week intervention (P=0.02 and 0.01, respectively) but not in the HY group. No between group effects emerged, however, within each group, significant improvements emerged for the six-minute walk distance (6MWD) after 12-week intervention (HY: mean difference 32.6 m; CI: 10.1-55.1, P=0.014; CTP: mean difference 42.4 m; CI: 17.9-67.0, P=0.006). Secondary outcomes: within-group improvements in CRQ appeared in both groups. Within the HY group, f decreased and SpO2 increased. Improved effects after follow-up emerged only for the CTP group for diastolic blood pressure (P=0.05) and CRQ emotional and fatigue domain (P=0.01). CONCLUSIONS: There were no between-group differences. After 12 weeks, 6MWD improved significantly within both groups. Within the HY group, improvements in the CRQ mastery domain, f and SpO2 emerged. Within the CTP group, there were improvements in lung function parameter forced vital capacity, respiratory muscle strength and all CRQ-domains. The CTP also exhibited effects on CRQ after the 6months follow-up. CLINICAL REHABILITATION IMPACT: Limited effects of HY and CTP emerged. HY seems feasible and safe as a form of physical exercise for pulmonary disease patients. As part of the rehabilitation, HY may constitute an alternative to other physical training activities and may be a useful addition to formal rehabilitation programs.
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| 7. |
- Paramasivam, Abinethaa, et al.
(författare)
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The International Classification of Functioning, Disability and Health Core Set for deafblindness. Part I : a systematic review of outcome measures
- 2023
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 59:5, s. 615-627
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Forskningsöversikt (refereegranskat)abstract
- INTRODUCTION: The International Classification of Functioning, Disability, and Health (ICF), developed by the World Health Organization, is a classification framework that focuses on the health and functioning of people with disabilities. As part of an ICF Core Set development, four studies need to be conducted, one of which is a systematic review. This study presents part 1 of the systematic review that aims to describe the outcome measures identified in the literature related to functioning in individuals with deafblindness. EVIDENCE ACQUISITION: The research team screened articles from eight scientific databases, three journals, and Google Scholar (March 2011 to September 2022). Articles were included if they studied individuals with deafblindness aged 18 and older. Studies that examined genetics or laboratory experiments involving animals were excluded. Data were extracted into a logbook with key descriptors such as study location and design, age of study population, and instruments/outcome measures used, which were further categorized into one of the following types: 1) standardized; 2) patient-reported measures, standardized (PT-S); 3) patient-reported measures, not standardized (PT-not S); 4) health professional, reported measures, standardized (HP-S); 5) Technical measures; 6) other measures (parent-reported standardized and laboratory measures).EVIDENCE SYNTHESIS: The review included 147 studies, of which most were conducted in Europe (47.6%) and North America (27.9%). Of the 314 identified outcome measures, 57 were Standardized, 59 were Patient Reported-Standardized (PT-S), 178 were patient reported non-standardized (PT-Not S) variables, 11 were health professional reported, standardized, five were technical, and four were classified as other measures.CONCLUSIONS: Most instruments measured functioning in daily activities and the mental health of individuals with deafblindness. Three deafblind-specific instruments were identified in this study, highlighting the need for more deafblind-specific instruments to be developed and utilized in research.
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| 8. |
- Paukkunen, Maija, et al.
(författare)
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Measuring the determinants of implementation behavior in multiprofessional rehabilitation
- 2023
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : EDIZIONI MINERVA MEDICA. - 1973-9087 .- 1973-9095. ; 59:4, s. 488-501
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. AIM: To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. DESIGN: A two-round Delphi study. SETTING: National-level online survey. POPULATION: Purposively recruited experts in multiprofessional rehabilitation (N.=25). METHODS: Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of >= 4 by >= 75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of <= 74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). RESULTS: After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of >= 0.78 and S-CVI/Ave of 0.93. CONCLUSIONS: A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. CLINICAL REHABILITATION IMPACT: A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.
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| 9. |
- Persson, Carina Ulla, 1970, et al.
(författare)
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Measurement properties of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) using Rasch analysis.
- 2017
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Ingår i: European journal of physical and rehabilitation medicine. - : Edizioni Minerva Medica S.p.A.. - 1973-9095 .- 1973-9087. ; 53:6, s. 848-55
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Tidskriftsartikel (refereegranskat)abstract
- A previous small-sample (n=150) Rasch analysis of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) suggested problems regarding response categories and redundant items that need confirmation in larger samples with more severe strokes.To evaluate the measurement properties of the SwePASS in patients with acute stroke.A multicentre, cross-sectional study.Two stroke units in Western Sweden.The study cohort included 250 consecutive inpatients undergoing rehabilitation after acute stroke.The SwePASS assessments were performed once within the first four days after admission to the stroke units. The data were analysed according to the Rasch measurement model regarding targeting, model fit, reliability, response category function, local dependence and differential item functioning.Postural control of 250 patients (median age, 76.5 years) was assessed with the SwePASS within median of two days after admission to the stroke units. The SwePASS covered a continuum of different levels of postural control, but had suboptimal targeting with insufficient representation of lower and higher levels of postural control. The reliability was high, the item fit statistics were generally acceptable and there was no differential item functioning by sex, age and stroke localization. However, response categories did not function as expected for four of the 12 SwePASS items and five items exhibited local dependency.The SwePASS exhibited several promising measurement properties. To improve the scale, poor targeting, illogical response categories and local dependency should be addressed.The SwePASS provides valuable clinical information regarding postural control in the acute phase after stroke.
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| 10. |
- Peterson, Gunnel, 1959-, et al.
(författare)
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Neck-related function and its connection with disability in chronic whiplash-associated disorders : secondary analysis of a randomized controlled study
- 2021
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 57:4, s. 607-619
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: More than 40% of individuals with whiplash injury experience persistent neck pain and disability years later, called whiplash-associated disorders (WAD). A randomized controlled trial evaluated three exercise interventions in WAD and found that neck-specific exercise (NSE) and NSE with a behavioral approach (NSEB) significantly improve disability compared to prescribed physical activity (PPA). However, the relationship between neck-related function and disability is inconclusive and needs to be further investigated. AIM: The present study compares the effect of NSE, NSEB, and PPA on neck muscle endurance (NME), active cervical range of motion (AROM), grip strength, and pain intensity immediately before and after the physical tests, and neck disability in individuals who are below or above the cut-off for normative reference values regarding NME, AROM, and grip strength. DESIGN: Follow-up to a multicenter randomized clinical trial. SETTING: Primary healthcare centers and hospital outpatient services. POPULATION: The selected population of this study included 216 patients with persistent WAD grades II and III. METHODS: This is a secondary analysis including 12 months' follow-up. NME, AROM, grip strength, pain, and self-reported disability were recorded at baseline, 3, 6, and 12 months. Linear mixed models were used, and sub-group analyses evaluated by non-parametric tests. RESULTS : NSE and NSEB resulted in greater improvements compared to PPA (P<0.01) in ventral (only males) and dorsal NME, AROM, and pain intensity during testing. We found no significant between-group differences in grip strength and no significant differences between the NSE and NSEB groups. Improvement in disability was seen at the 12-month follow-up of NSE and/or NSEB for individuals both below and above the cut-off reference values for NME and AROM. Individuals in the PPA group below the reference values for NME and AROM reported increasing disability at 12 months compared to baseline. CONCLUSIONS: The results suggest that neck-specific exercises (i.e., NSE, NSEB) improve clinical function and decrease disability in chronic WAD compared to PPA, but PPA can increase disability for patients with low neck-related function. CLINICAL REHABILITATION IMPACT : Higher neck-related function seems to be important for reduced disability in persistent WAD grades II and III. Neck-specific exercises could lead to higher neck-related function.
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