ABSTRACT Introduction The Patient Evaluation Measure (PEM) is a region-specific patient reported outcome measure (PROM) for hand and wrist disorders, first introduced in English for patients with ...hand surgery in 1995. The purpose of the study was to assess the psychometric properties of the translated and cross-culturally adapted Slovenian version of PEM (PEM-Slo). Methods The study was designed as a single-centre observational prospective study conducted from July 2020 to March 2021. The psychometric evaluation was performed on fifty-one patients with miscellaneous hand and wrist disorders. Reliability was tested for internal consistency and test-retest reliability. Convergent and divergent validity, responsiveness, floor and ceiling effect, and interpretability with the determination of minimal detectable change (MDC) and minimal clinically important difference (MCID) were assessed. Results The PEM-Slo has excellent internal consistency (Cronbach’s α 0.932) and good to excellent test-retest reliability (intraclass correlation coefficient=0.874). Convergent validity was proved with high to moderate correlations of PEM-Slo with DASH, grip strength and self-care, usual activities, and pain EQ-5D-5L subscales, whereas no correlation of PEM-Slo with EQ-5D-5L mobility and anxiety/depression subscale confirmed divergent validity. The PEM-Slo responsiveness was high (standardised response mean=1.42, effect size=1.25). MDC was 18.01 and MCID was 17.31. No floor or ceiling effect was found. Conclusion The PEM-Slo is a reliable, valid and responsive PROM for Slovenian-speaking patients with hand and wrist disorders.
There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the ...efficacy of night-time splinting at different stages of CTS.
Forty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the
for pain and paraesthesia. The patients further completed the
(BCTQ) and a shorter version of the
(QuickDASH).
In the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the
and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the
. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found.
This study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS. Int J Occup Med Environ Health. 2020;33(6):771-80.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Summary
Aim
To evaluate the efficacy of combined physical and occupational therapy in comparison with physical therapy alone in patients with conservatively treated distal radius fracture.
Methods
...Sixty-one participants, conservatively treated after a distal radius fracture, were included in a randomized and single-blind trial. Group A had physical therapy only (
n
= 31) and group B had physical and occupational therapy (
n
= 30). The assessment was performed three times: upon inclusion in the study in the first week after removal of the cast (T1), immediately after the end of the rehabilitation (T2), and 1 month after completing the rehabilitation (T3). The passive wrist range-of-motion, grip strength, and Disabilities of Arm, Shoulder and Hand (DASH) score were used as rehabilitation outcomes.
Results
Rehabilitation outcomes were analyzed using two-way mixed analysis of variance. The effect of time was statistically significant (
p
< 0.001) for all outcomes. The group (therapy) factor was statistically significant for grip strength only (
p
= 0.038). The interaction effect was statistically significant for rotation (
p
= 0.034) and grip strength (
p
= 0.021). A comparison between time points T3:T1 showed statistically significant difference in grip strength in favor of group B 67 % (95 % CI 60–74 %) versus group A 53 % (95 % CI 45–61 %),
p
= 0.024.
Conclusion
The combined therapy resulted in a statistically significant increase of grip strength in comparison with isolated physical therapy in the period of 12–16 weeks after the fracture. This effectiveness was not confirmed with DASH score results.
Summary
Purpose
To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best ...short-term functional results.
Methods
In the retrospective analysis of the results of 3 surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5—83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Čretnik and Kosanović) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruščić) included 61 (23.3%) patients. The rehabilitation protocol for group C included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2 weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6 months.
Results
Patients from group C achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in group B, one in group C, and none in group A.
Conclusions
Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruščić.
The article deals with the role of physical and rehabilitation medicine in treating patients in health resorts. In addition, it focuses on doctrinal and clinical foundation for balneorehabilitation ...at Slovene health resorts. The article features a short historical overview of balneorehabilitation in Slovenia. Modern planning aspects and monitoring of medical rehabilitation as well as criteria for thermal cure referrals are also presented. Current issues dealing with patient referral to medical rehabilitation are also emphasized in this paper. Furthermore, the author describes the importance of integrated approaches within health resorts and rehabilitation with balneorehabilitation for health tourism. The author also discusses standard as well as novel diagnostic and therapeutic rehabilitation methods.
Regular exercise training improves overall physical fitness and quality of life in postmenopausal women. The exigent training frequency depends on a user-specified training aim. The aim of this study ...was to confirm the benefits of regular once a week exercise training for the maintenance of fitness in postmenopausal women. The test group included 20 postmenopausal women (65 +/- 3.1 years) who have been attending the exercise training program conducted by the physiotherapist once a week for three years. The age-matched control group included 20 healthy women (65.5 +/- 2.4 years) who did not regularly attend the training program. The outcomes were: right and left lateral trunk flexion, right and left shoulder flexion, right and left grip strength, endurance capacity of the trunk extensors, lower limb muscle strength (1' chair stand test), and balance (one-leg standing duration time with eyes open and closed). Women from the test group achieved statistically significant better results in the following outcomes: right lateral trunk flexion (15.4 cm: 12.6 cm, p < 0.001), left lateral trunk flexion (15.4 cm: 12.6 cm, p = 0.001), trunk extension muscle endurance (53.4 s: 40.5 s, p < 0.001), lower limb muscle strength (28.4 x: 25 x, p < 0.001), and one-leg standing duration time with open eyes (33.5 s: 19.7 s, p < 0.001). The results suggest that a regular once a week exercise training program designed and conducted by the physiotherapist, may be helpful in the improvement or maintenance of flexibility, muscle strength and capacity, and balance in postmenopausal women. The better fitness proved by our study could be a result of other causes and not solely that of the designed training program.
Svjetska zdravstvena organizacija je opredijelila rehabilitaciju kao aktivan proces
namijenjen osposobljavanju ljudi sa smanjenim mogućnostima i ograničenjima u
sudjelovanju. Rehabilitacija je ...kompleksan interdisciplinarni proces u kojem osobe
s različitim stanjima, poslije ozljeda ili bolesti postižu najveći mogući stupanj samostalnog
funkcioniranja unutar uže i šire društvene okoline. Rehabilitacija se dijeli na
ranu, daljnju, kasnu i obnavljajuću, a obzirom na organizaciju zdravstvenog sistema
moguće ju je izvoditi na primarnoj, sekundarnoj i tercijarnoj razini. Lječilišno liječenje
u Republici Sloveniji je uređeno Zakonom (»Zakon o zdravstvenem varstvu in zdravstvenem
zavarovanju«) i Pravilima (»Pravila obveznega zdravstvenega zavarovanja«).
Osigurano je u primjeru da omogućuje ispunjavanje barem jednog od nabrojanih uvjeta:
značajno poboljšanje zdravstvenog stanja, povratak funkcionalnih i radnih sposobnosti,
sprječavanje napredovanja bolesti ili pogoršanja zdravstvenog stanja za duže
vrijeme, smanjenje učestalosti bolovanja (odsutnosti s posla) ili bolničkog liječenja.
Liječilišno liječenje koje nije neposredan nastavak bolničkog liječenja moguće je obaviti
stacionarno ili ambulantno.
Balneorehabilitacija s hidroterapijom jedna je od najčešćih vrsta liječenja bolesnika
s kroničnom nezloćudnom boli. Plivanje udružuje kineziološke i balneološke učinke
(dinamičko gibanje – plivanje i specifične učinke ljekovite vode). Dinamički učinak
plivanja je sa balneološkog vidika važan zbog kinezioterapijskih i kinezioprofilaktičnih
učinaka.
Slovenija obiluje bogatim nalazištima termalnih i termomineralnih voda. Naše najstarije
organizirano lječilište u Rogaškoj Slatini seže u 1665. godinu kad su slatinsku
vodu proglasili ljekovitom, mada arheološka istraživanja dokazuju korištenje ljekovite
vode još u rimskim vremenima. Prvi zakon o ustanavljanju rehabilitacijskih centara u
Sloveniji datira iz 1968. godine kad su se ustanovile i lječilišne ustanove sa rehabilitacijskim
posteljama i kad su opredijelili prve standarde kvalitete u pojedinim lječilištima.
Danas je rehabilitacija nadišla okvire, odnosno zidove zdravstvenih ustanova i
prerasla u dobrodošlog doživotnog suputnika zdravstveno osvješćenog i odgovornog
pojedinca. Lječilišne općine su 2014. godine sudjelovale razmjerno visokim udjelom
turističkih noćenja u državi – 31,9%. Suvremena balneorehabilitacija poseže na
područje lječilišnog turizma koje predstavlja najuspješniji segment slovenske turističke
ponude. Izvanredne prirodne danosti s lječililišnim čimbenicima predstavljaju slovenskim
lječilištima važnu prednost na osnovu koje su razvila specifičnu ponudu s
kvalitetnim, bogatim i tržno zanimljivim turističkim proizvodom kojim se natječu na
širem europskom tržištu.
U članku smo ispostavili samo pojedine standardne pristupe i nabrojali suvremene
dijagnostičke i terapijske metode unutra cjelovite balneorehabilitacije. Uvjeti za normalnu pokretljivost su normalan opseg pokretljivosti zglobova, mišićna moč, ustrajnost
i usklađenost pokreta. U primjeru smetnji pokretljivosti poštujemo sljedeći red u
sastavljanju terapijskih vježbi, isprva povećamo opseg pokreta, na to uključimo vježbe
mišićne moći i ustrajnosti, kinezioterapijski program nadograđujemo vježbama koordinacije
i brzine izvođenja pokreta odnosno tjelesne aktivnosti. Tjelesne vježbe imaju
dokazane brojne pozitivne učinke na kosti, kralježnične pločice, zglobnu hrskavicu i
mišiće. Tjelesna aktivnost poboljšava i raspoloženje, povoljno utječe na depresiju, samoocjenjivanje
i ponašanje na radnome mjestu, što je posljedica povećane aktivnosti
adrenalina i lučenja neurotransmitora (serotonina, noradrenalina i dopamina). Hidroterapija,
posebice u sklopu balneoterapije, korisno utječe na stanje zglobova zbog izvođenja
vježbi u vodi koja u razdoblju rane rehabilitacije omogućuje izvođenje vježbi
u rasterećenju (suspenziji), a u naprednijem stadiju i vježbi jačanja mišićne moći, poboljšava
koordinaciju, podstiče disanje, krvni optok i metabolizam te ima pozitivan
psihički učinak. Smanjenje boli u vodi je moguća posljedica učinkovanja hidrostatskog
pritiska na tijelo i učinka topline na živčane okrajke kao i poradi mišićne relaksacije. Toplo
ljekovito blato podiže razinu beta-endorfina u plazmi čime se obrazlaže analgetički
i antispastički učinak balneoterapije. Brojne bolesti, u koje ubrajamo i sindrom bolnih
križa, su psihosomatskog izvora. Na ovu skupinu bolesti snažno utiče psihički i socijalni
status pojedinca kao i kvaliteta života. Uspjeh hidroterapije u prirodnim lječilištima
je najvjerovatnije rezultat kombiniranog djelovanja nekih specifičnih zdravstvenih čimbenika
i nespecifičnih čimbenika kao što su promjena okoline, rasterećenje i mogućnost
razonode, što je u skoro idealnom obliku omogućeno u lječilištima i njihovoj neposrednoj
okolini.
Fizikalna i rehabilitacijska medicina predstavlja neizostavni dio lječilišne ponude
za sve upućune odlukom nacionalnog zdravstvenog fonda kao i bolesnika koji sami
plaćaju lječilišno liječenje i rehabilitaciju te sve one koji u okviru lječilišnog turizma žele
spojiti ugodno sa zdravstveno korisnim. Ta medicinska struka je najdjelotvornija ukoliko
se poštuju indikacije i kontraindikacije za (balneo)rehabilitaciju i izvodi interdisciplinarnim
pristupom timova koje vode specijalisti fizikalne i rehabilitacijske medicine.
Regular exercise training improves overall physical fitness and quality of life in postmenopausal women. The exigent training frequency depends on a user-specified training aim. The aim of this study ...was to confirm the benefits of regular once a week exercise training for the maintenance of fitness in postmenopausal women. The test group included 20 postmenopausal women (65±3.1 years) who have been attending the exercise training program conducted by the physiotherapist once a week for three years. The age-matched control group included 20 healthy women (65.5±2.4 years) who did not regularly attend the training program. The outcomes were: right and left lateral trunk flexion, right and left shoulder flexion, right and left grip strength, endurance capacity of the trunk extensors, lower limb muscle strength (1’ chair stand test), and balance (one-leg standing duration time with eyes open and closed). Women from the test group achieved statistically significant better results in the following outcomes: right lateral trunk flexion (15.4 cm: 12.6 cm, p<0.001), left lateral trunk flexion (15.4 cm: 12.6 cm, p=0.001), trunk extension muscle endurance (53.4 s: 40.5 s, p<0.001), lower limb muscle strength (28.4 x: 25 x, p<0.001), and one-leg standing duration time with open eyes (33.5 s: 19.7 s, p<0.001). The results suggest that a regular once a week exercise training program designed and conducted by the physiotherapist, may be helpful in the improvement or maintenance of flexibility, muscle strength and capacity, and balance in postmenopausal women. The better fitness proved by our study could be a result of other causes and not solely that of the designed training program.
Low back pain is one of the most frequent health problems of contemporary people. Therapy is usually conservative and symptomatic because in the most part of cases the etiology remains unknown. ...Evidence based medicine is putting itself in front also in the field of low back pain diagnosis and treatment. The therapy for low back pain is thoroughly and scientifically rigorously analized by the professionals from the Cochrane Collaboration. There are still not published enough randomized controlled studies to conclude about the effectiveness of most frequently used physical therapy modalities. There is a necessity for additional researching in that field.
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