Abstract Objective To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals. Data Sources Comprehensive ...bibliographic searches using MEDLINE, Google Scholar, and UpToDate , (June, 2013). Data Extraction Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain. Data Synthesis Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations. Conclusions Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.
Background
International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, data show ...that only a small proportion of these patients utilise rehabilitation.
Objectives
First, to assess interventions provided to increase patient enrolment in, adherence to, and completion of cardiac rehabilitation. Second, to assess intervention costs and associated harms, as well as interventions intended to promote equitable CR utilisation in vulnerable patient subpopulations.
Search methods
Review authors performed a search on 10 July 2018, to identify studies published since publication of the previous systematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL); the National Health Service (NHS) Centre for Reviews and Dissemination (CRD) databases (Health Technology Assessment (HTA) and Database of s of Reviews of Effects (DARE)), in the Cochrane Library (Wiley); MEDLINE (Ovid); Embase (Elsevier); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); and Conference Proceedings Citation Index ‐ Science (CPCI‐S) on Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and also searched two clinical trial registers. We applied no language restrictions.
Selection criteria
We included randomised controlled trials (RCTs) in adults with myocardial infarction, with angina, undergoing coronary artery bypass graft surgery or percutaneous coronary intervention, or with heart failure who were eligible for cardiac rehabilitation. Interventions had to aim to increase utilisation of comprehensive phase II cardiac rehabilitation. We included only studies that measured one or more of our primary outcomes. Secondary outcomes were harms and costs, and we focused on equity.
Data collection and analysis
Two review authors independently screened the titles and s of all identified references for eligibility, and we obtained full papers of potentially relevant trials. Two review authors independently considered these trials for inclusion, assessed included studies for risk of bias, and extracted trial data independently. We resolved disagreements through consultation with a third review author. We performed random‐effects meta‐regression for each outcome and explored prespecified study characteristics.
Main results
Overall, we included 26 studies with 5299 participants (29 comparisons). Participants were primarily male (64.2%). Ten (38.5%) studies included patients with heart failure. We assessed most studies as having low or unclear risk of bias. Sixteen studies (3164 participants) reported interventions to improve enrolment in cardiac rehabilitation, 11 studies (2319 participants) reported interventions to improve adherence to cardiac rehabilitation, and seven studies (1567 participants) reported interventions to increase programme completion. Researchers tested a variety of interventions to increase utilisation of cardiac rehabilitation. In many studies, this consisted of contacts made by a healthcare provider during or shortly after an acute care hospitalisation.
Low‐quality evidence shows an effect of interventions on increasing programme enrolment (19 comparisons; risk ratio (RR) 1.27, 95% confidence interval (CI) 1.13 to 1.42). Meta‐regression revealed that the intervention deliverer (nurse or allied healthcare provider; P = 0.02) and the delivery format (face‐to‐face; P = 0.01) were influential in increasing enrolment. Low‐quality evidence shows interventions to increase adherence were effective (nine comparisons; standardised mean difference (SMD) 0.38, 95% CI 0.20 to 0.55), particularly when they were delivered remotely, such as in home‐based programs (SMD 0.56, 95% CI 0.37 to 0.76). Moderate‐quality evidence shows interventions to increase programme completion were also effective (eight comparisons; RR 1.13, 95% CI 1.02 to 1.25), but those applied in multi‐centre studies were less effective than those given in single‐centre studies, leading to questions regarding generalisability. A moderate level of statistical heterogeneity across intervention studies reflects heterogeneity in intervention approaches. There was no evidence of small‐study bias for enrolment (insufficient studies to test for this in the other outcomes).
With regard to secondary outcomes, no studies reported on harms associated with the interventions. Only two studies reported costs. In terms of equity, trialists tested interventions designed to improve utilisation among women and older patients. Evidence is insufficient for quantitative assessment of whether women‐tailored programmes were associated with increased utilisation, and studies that assess motivating women are needed. For older participants, again while quantitative assessment could not be undertaken, peer navigation may improve enrolment.
Authors' conclusions
Interventions may increase cardiac rehabilitation enrolment, adherence and completion; however the quality of evidence was low to moderate due to heterogeneity of the interventions used, among other factors. Effects on enrolment were larger in studies targeting healthcare providers, training nurses, or allied healthcare providers to intervene face‐to‐face; effects on adherence were larger in studies that tested remote interventions. More research is needed, particularly to discover the best ways to increase programme completion.
Background
Cardiovascular disease is the most common cause of death globally. Traditionally, centre‐based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid ...recovery and prevent further cardiac illness. Home‐based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015.
Objectives
To compare the effect of home‐based and supervised centre‐based cardiac rehabilitation on mortality and morbidity, exercise‐capacity, health‐related quality of life, and modifiable cardiac risk factors in patients with heart disease.
Search methods
We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied.
Selection criteria
We included randomised controlled trials, including parallel group, cross‐over or quasi‐randomised designs) that compared centre‐based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home‐based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation.
Data collection and analysis
Two review authors independently screened all identified references for inclusion based on pre‐defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created.
Main results
We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.
No evidence of a difference was seen between home‐ and centre‐based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = ‐0.13, 95% CI ‐0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health‐related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI ‐0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home‐based participants.
Authors' conclusions
This update supports previous conclusions that home‐ and centre‐based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health‐related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence‐based, home‐based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre‐based programme or a home‐based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home‐ and centre‐based cardiac rehabilitation reported in the included short‐term trials can be confirmed in the longer term and need to consider adequately powered non‐inferiority or equivalence study designs.
Hamstring strain injuries are common among athletes and often require rehabilitation to prepare for timely return to sport performance, while also minimizing re-injury risk. Return to sport is ...typically achieved within weeks of the injury, but subsequent athlete performance may be impaired and re-injury rates are high. Improving these outcomes requires rehabilitation practitioners (e.g. Athletic Trainers and Physical Therapists) to understand the etiology and mechanisms of hamstring strain injury; know how to perform a thorough clinical examination; and progress loading to the site of injury in a safe and effective manner. This narrative review discusses current clinical concepts related to these aspects of hamstring strain injury rehabilitation, with the aim of helping practitioners improve athlete outcomes. Collectively, this knowledge will inform the implementation of evidence-based rehabilitation interventions.
784 A Burn Resting Hand Orthosis Fit Checklist Warthman, Renee; Martinez, Andria; Murray, Derek ...
Journal of burn care & research,
03/2022, Volume:
43, Issue:
Supplement_1
Journal Article
Peer reviewed
Open access
Abstract
Introduction
Resting hand orthoses (RHO) are often used to manage hand burns but can be difficult for inexperienced clinicians to fabricate, assess, and utilize without causing complications ...to the patient. Previously we had shared data on how we reduced RHO related complications by utilizing burn and hand certified staff to fabricate RHOs.
Methods
Advanced clinicians certified in either hand, burn, or both were queried to describe the methodology they utilized to fabricate an effective RHO. From this query, a list of conditions was created. These conditions were presented to the entire group of certified clinicians and re-examined. Conditions were recorded if consensus was reached on their inclusion for a guide to fabricate a successful RHO.
Results
A 14-condition checklist, with 8 essential items, was developed. It is intended that this checklist can be utilized by less experienced clinicians to guide safe and effective RHO management.
Conclusions
The checklist is a straightforward way to assess commonly identified issues with RHO and offers a potential resource to manage effective fabrication for novice or inexperienced clinicians.
Abstract
Introduction
Early positioning of the burn patient to prevent scar contracture is a fundamental aspect of the therapy treatment plan1. Positioning is complicated by different types of ...grafting including cultured epidermal autograft (CEA). Use of CEA requires a period of airing out and therefore positioning devices must allow adequate air flow to the posterior aspect of the grafted limb while immobilizing the extremity. Previous lower extremity net devices have been presented for use2-3, however this design increases hip flexion which can promote contracture. Additionally, there is no similar net device presented for use for the upper extremity.
Methods
Both the upper extremity and lower extremity net device designs are made using 1” PVC pipe. A mix of Tee, 90⁰ and 45⁰ couplers are used to link together the PVC pipe. A PVC cutter is needed to cut the pieces. Once the pieces have been fit together and are aligned, the pieces are secured with a bonding PVC adhesive. The devices are then sanitized for patient use. A double layer of burn netting is used over the device to support the extremity while not allowing too much slack. The following graphics provide a basic template for an average adult adjusting lengths and width as needed. For the lower extremity, a measurement from the fold of the buttocks to the heel is needed to determine overall length of the device. The average cost for 1 lifter is $15-20. Additional custom plantar foot plates can be added to the lower extremity device to prevent ankle dorsiflexion as demonstrated by the poster presentation by Dean et. al. 3 For the upper extremity, an armboard or use of bedside table can be used to support the device. These particular designs are an outline for adult patients, although could be modified for pediatrics.
Results
Net devices for the upper and lower extremity allow good positioning of limb while providing adequate air flow and off-loading during the required air out periods using CEA. These designs provide a template for burn therapists to utilize as a baseline. This particular lower extremity device decreases hip flexion as compared to other existing devices. The upper extremity template provides an option that has not previously been articulated.
Conclusions
Positioning the upper and lower extremity after CEA application can be achieved using custom net devices. Net devices provide a cost-effective, quick and simple solution that allow adequate ventilation to the posterior aspect of the limb while maintaining a good position during immobilization.
Abstract
Introduction
Glossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in ...flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.
The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.
Methods
The patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.
Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.
Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.
Results
Through the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.
Conclusions
Upon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.
PDF
