Journal of Rehabilitation Medicine - Clinical Communications

Body awareness, stress and symptoms in autonomic dysfunction in patients with chronic pain: an explorative study

Mon, 24 Jun 2024 00:00:00 -0700

Objective: To assess pain outcomes, stress levels and body awareness among patients with chronic pain and explore potential associations between these variables.

Design: An explorative study.

Methods: Patients with chronic pain in primary and specialist care were assessed regarding pain intensity using the Numerical Rating Scale (NRS; 0–10 point scale) and stress levels using the Stress and Crisis Inventory (SCI-93; 0–140). To assess body awareness, multidimensional assessment of interoceptive awareness (MAIA; 0–5), a widely used self-report measure of interoceptive bodily awareness was used.

Results: Participants (n = 42) reported an average NRS of 4.4, elevated stress levels and low body awareness. Stress levels were moderately correlated with pain intensity (r = 0.53; p < 0.001; 95% confidence interval [CI] 0.25–0.72) and number of pain sites (r = 0.58; p < 0.001; 95% CI 0.32–0.76). The regression analysis showed that pain outcomes predicted stress level scores and explained almost 50% of variance (R²= 0.47, p < 0.001). Moreover, shorter pain duration predicted a higher body awareness (p = 0.04).

Conclusion: In patients with chronic pain, high pain intensity and multiple painful sites seem to be associated with impaired stress regulation. The patients had low body awareness, which was negatively influenced by pain duration.

Can we diagnose sarcopenia using anterior femoral muscle thickness in patients with cardiovascular disease?

Wed, 17 Jan 2024 00:00:00 -0800

Objective: Making the diagnosis of sarcopenia is not always easy and this is especially true for those with cardiovascular disease. The purpose of this study is to investigate whether it is possible to diagnose sarcopenia by using ultrasound-guided measurements of anterior femoral muscle thickness.

Methods: We investigated the utility of ultrasound-guided measurements of anterior femoral muscle thickness in 1075 hospitalized patients with cardiovascular disease (675 men). As a comparison, sarcopenia was assessed by skeletal muscle mass index using bioelectrical impedance analysis and the Asia Working Group for Sarcopenia criteria.

Results: When the receiver operating characteristic curve using muscle thickness was examined, we found this could be used to make the diagnosis of sarcopenia (men: cutoff value 2.425 cm, area under the curve 0.796; women: cutoff value 1.995 cm, area under the curve 0.746). The prevalence of sarcopenia according to the criteria with skeletal muscle mass index was 34.2% in men and 51.8% in women, while its prevalence according to the cutoff value of muscle thickness was 29.2% in men and 36.7% in women.

Conclusion: Ultrasound-guided measurement of the anterior femoral muscle thickness is a simple and useful method to help make the diagnosis of sarcopenia in patients with cardiovascular disease.

A bionic hand versus a replanted hand

Thu, 18 Jan 2024 00:00:00 -0800

Objective: Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand.

Design: Case report.

Subjects: One individual that wished for a better quality of life after unsatisfying hand function following a replantation.

Methods: A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented.

Results: Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed.

Conclusions: The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation.

Clinical relevance: When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.

Effect of resistance training through in-person and teleconferencing sessions in rehabilitation of acute stroke patients

Nikolaos Kintrilis, Antonis Kontaxakis, Anastasios Philippou — Thu, 01 Feb 2024 00:00:00 -0800

Objective: To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention.

Design, Patients and Methods: Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke.

Results: The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index.

Discussion and Conclusion: Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.

Rehabilitation approach after earthquake disaster: a brief report from Turkey

Tuba Tülay Koca, Duran Topak — Mon, 22 Apr 2024 00:00:00 -0700

Devastating earthquake disasters are experienced all over the world. On February 6, 2023, two major earthquakes with magnitudes of Mw 7.7 and 7.6, respectively, occurred centered in Kahramanmaraş, Turkey. It resulted in at least 50,783 deaths and more than 122,000 injuries according to official data. Defining the post-earthquake experiences and earthquake risk assessment well and identifying the deficiencies will guide the coordination, management, and planning of subsequent disasters. In this study, the rehabilitation approaches of earthquake victims with physical injuries in our rehabilitation center are emphasized and the situations that will be encountered in the immediate, intermediate, and long-term periods after the earthquake are summarized.

The multidisciplinary biopsychosocial rehabilitation programme for patients with chronic spinal pain: outcomes with work status as the primary focus

Tue, 16 Jan 2024 00:00:00 -0800

Objective: To assess the efficacy of the multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients as to work status, physical functioning, pain intensity, health-related quality of life and the psychosocial domain.

Design: This is a retrospective, single-centre, observational cohort study.

Subjects/Patients: A total of 209 subjects (mean age 41.5 ± 11.4 years) with chronic spinal pain participated in the rehabilitation programme.

Methods: Evaluations were conducted through standardized questionnaires at baseline and at the end of the rehabilitation programme.

Results: Patients were more likely to be at work. Sick leave and work VAS changed significantly. Patients in blue-collar jobs are less likely to return to work. Pain intensity, physical functioning, health-related quality of life and lumbar and cervical range of motion improved significantly.

Conclusion: The multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients improved the rate of return to work. In daily clinical practice, attention must be given to reducing mobility issues in daily life in order to get patients back to work. The occupational therapist should give patients with blue-collar jobs sufficient attention early in the programme in order to achieve a higher rate of return to work.

Clinicians’ perceptions of manual handling policies in stroke rehabilitation: a qualitative focus group study

Salem F. Alatawi — Tue, 16 Apr 2024 00:00:00 -0700

Objectives: The professional literature guides manual handling in numerous health care settings. The effects of these guidelines on stroke rehabilitation and the clinical communication of health care professionals are unknown. This paper aims to investigate the perspectives of nurses and physiotherapists on handling guidelines in their professions to identify conflicts in opinions to provide optimum care to people with stroke.

Design: A qualitative focus group study.

Methods: Three focus groups were conducted. The participants were physiotherapists or nurses with 1 year of stroke care experience. The data were thematically analysed.

Results: Nineteen participants (12 physiotherapists and 7 nurses) were interviewed. The data analysis revealed 3 themes. First, “The application of handling in stroke rehabilitation” includes clinical reasoning and real-world handling practices. The second theme, “Physical Effects on Therapists,” examines the long-term effects of manual handling on therapists, including work-related musculoskeletal disorders. The final theme, “Conflicts among health care professionals,” investigates stroke rehabilitation equipment conflicts between nurses and physiotherapists.

Conclusion: The study concludes that stroke transfer guidelines in the specialised literature may impact health care professionals’ perspectives. Conflicts among health care professionals can impair teamwork. Thus, health care professionals should work together as stroke rehabilitation teams to develop unified transfer guidelines that aid rehabilitation and avoid work-related musculoskeletal disorders.

Defining Patient Profiles After the 2023 Kahramanmaraş, Turkey Earthquake

Tuba Tülay Koca — Tue, 02 Apr 2024 00:00:00 -0700

Objective: On 6 February 2023, 2 earthquakes with magnitudes of 7.7 and 7.6 mW occurred in Pazarcık and Elbistan districts of Kahramanmaraş province (Turkey) and affected 11 provinces in total, especially Hatay, Malatya, and Adıyaman. Here, we report 3 earthquake victims in order to define patients profiles.

Case reports: Three patients who were taken to the orthopedic and neurological rehabilitation program in our inpatient Physical Medicine and Rehabilitation unit after the earthquake are presented. Our first case, a 46-year-old man, remained in the debris for 8.5 h. His left leg was left in the wreckage, and he later developed a drop foot on the left due to compartment syndrome, which developed with pain and swelling in the left calf. There is no fasciotomy procedure. Venous Doppler was reported to be within normal limits. Our second case is a 52-year-old man who was in the debris for 36 h and has a left braxial plexus injury and a left drop foot. He has Buerger’s disease in his medical history. The third case is an 8-year-old girl trapped in rubble during the earthquake with a right orbital fracture and a left foot transmetarsal amputation. She has no neurological signs.

Discussion: The patients that apply to our Physical Medicine and Rehabilitation clinic are especially amputees, patients with traumatic brain injury, spinal cord injury, peripheral nerve damage, plexus damage, multiple fractures, joint limitations and soft tissue loss in the musculoskeletal system. After the earthquake, we encountered patients from a wide variety of spectrums in our clinic. In addition to primary musculoskeletal injuries, they also experience systemic problems affecting the musculoskeletal system. Additionally, thrombosis, infection, renal failure, and multiple organ failures may also occur.

Conclusion: Countries should develop guidelines for disaster preparedness and establish coordination units that can take quick action, make decisions, and communicate in times of disaster. A good definition of patient clinical profiles after the earthquake will ensure early intervention and prevent permanent disability and functional losses.

Changes in functional connectivity following intensive attention training in patients with traumatic brain injury. A pilot study

Hanna Persson, Tie-Qiang Li, Gabriela Markovic — Tue, 16 Jan 2024 00:00:00 -0800

Objective: To explore functional connectivity after intensive attention training in the chronic phase after traumatic brain injury as clinical evidence indicates that intensive attention training improves attention dysfunction in persons with traumatic brain injury.

Design and subjects: A case series study. Two young adults, 13- and 18-months post traumatic brain injury, with traumatic brain injury induced attention deficits were assigned to 20 h of intensive attention training and neuroimaging.

Methods: Functional magnetic resonance imaging during a psychomotor vigilance test was conducted pre- and post-intervention.

Results: The neuroimaging indicated both increased and decreased connectivity density in frontal, posterior and subcortical brain regions, for some regions with separate change patterns for left and right hemisphere respectively, and an overall reduction in variability in functional connectivity.

Conclusion: The changed and decreased variability of functional connectivity in various brain regions, captured by fMRI during a psychomotor vigilance test after direct attention training in a small sample of persons with traumatic brain injury, suggests further studies of functional connectivity changes in neural networks.