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1. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the united states: Stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain (Review) (Volume 95, Issue 5, May 2014, Pages 986-995.e1)

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.

Authors: Ma, VY., Chan, L., Carruthers, KJ.

2. Early Physical Medicine and Rehabilitation for Patients With Acute Respiratory Failure: A Quality Improvement Project (Article) (Volume 91, Issue 4, April 2010, Pages 536-542)

Objectives: To (1) reduce deep sedation and delirium to permit mobilization, (2) increase the frequency of rehabilitation consultations and treatments to improve patients' functional mobility, and (3) evaluate effects on length of stay. 

Design: Seven-month prospective before/after quality improvement project. 

Setting: Sixteen-bed medical intensive care unit (MICU) in academic hospital. 

Participants: 57 patients mechanically ventilated 4 days or longer. 

Intervention: A multidisciplinary team focused on reducing heavy sedation and increasing MICU staffing to include full-time physical and occupational therapists with new consultation guidelines. 

Main Outcome Measures: Sedation and delirium status, rehabilitation treatments, functional mobility. 

Results: Compared with before the quality improvement project, benzodiazepine use decreased markedly (proportion of MICU days that patients received benzodiazepines [50% vs 25%, P=.002]), with lower median daily sedative doses (47 vs 15mg midazolam equivalents [P=.09] and 71 vs 24 mg morphine equivalents [P=.01]). Patients had improved sedation and delirium status (MICU days alert [30% vs 67%, P<.001] and not delirious [21% vs 53%, P=.003]). There were a greater median number of rehabilitation treatments per patient (1 vs 7, P<.001) with a higher level of functional mobility (treatments involving sitting or greater mobility, 56% vs 78%, P=.03). Hospital administrative data demonstrated that across all MICU patients, there was a decrease in intensive care unit and hospital length of stay by 2.1 (95% confidence interval: 0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20% increase in MICU admissions compared with the same period in the prior year. 

Conclusions: Using a quality improvement process, intensive care unit delirium, physical rehabilitation, and functional mobility were markedly improved and associated with decreased length of stay.

Authors: Needham, DM., Korupolu, R., Zanni, JM., Pradhan, P., Colantuoni, E., Palmer, JB., Brower, RG., Fan, E.

3. Updating the Minimal Important Difference for Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease (Article) (Volume 91, Issue 2, February 2010, Pages 221-225)

Objective: To establish the minimal important difference (MID) for the six-minute walk distance (6MWD) in persons with chronic obstructive pulmonary disease (COPD). Design: Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD. 

Setting: Outpatient pulmonary rehabilitation program at 2 teaching hospitals. 

Participants: Seventy-five patients with COPD (44 men) in a stable clinical state with mean age 70 years (SD 9y), forced expiratory volume in one second 52% (SD 21%) predicted and baseline walking distance 359 meters (SD 104m). 

Interventions: Not applicable. 

Main Outcome Measures: Participants completed the six-minute walk test before and after a 7-week pulmonary rehabilitation program. Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD. 

Results: The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters, compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change (P=.004). Anchor-based methods identified an MID of 25 meters (95% confidence interval 20-61m). There was excellent agreement with distribution-based methods (25.5-26.5m, κ=.95). A change in 6MWD of 14% compared with baseline also represented a clinically important effect; this threshold was less sensitive than for absolute change (sensitivity .70 vs .85). 

Conclusions: The MID for 6MWD in COPD is 25 meters. Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline. These data support the use of 6MWD as a patient-important outcome in research and clinical practice.

4. Observation of Amounts of Movement Practice Provided During Stroke Rehabilitation (Article) (Volume 90, Issue 10, October 2009, Pages 1692-1698)

Objective: To investigate how much movement practice occurred during stroke rehabilitation, and what factors might influence doses of practice provided. 

Design: Observational survey of stroke therapy sessions. 

Setting: Seven inpatient and outpatient rehabilitation sites. 
Participants: We observed a convenience sample of 312 physical and occupational therapy sessions for people with stroke. Interventions: Not applicable. 

Main Outcome Measures: We recorded numbers of repetitions in specific movement categories and data on potential modifying factors (patient age, side affected, time since stroke, FIM item scores, years of therapist experience). Descriptive statistics were used to characterize amounts of practice. Correlation and regression analyses were used to determine whether potential factors were related to the amount of practice in the 2 important categories of upper extremity functional movements and gait steps. 

Results: Practice of task-specific, functional upper extremity movements occurred in 51% of the sessions that addressed upper limb rehabilitation, and the average number of repetitions/session was 32 (95% confidence interval [CI]=20-44). Practice of gait occurred in 84% of sessions that addressed lower limb rehabilitation and the average number of gait steps/session was 357 (95% CI=296-418). None of the potential factors listed accounted for significant variance in the amount of practice in either of these 2 categories. 

Conclusions: The amount of practice provided during poststroke rehabilitation is small compared with animal models. It is possible that current doses of task-specific practice during rehabilitation are not adequate to drive the neural reorganization needed to promote function poststroke optimally.

Authors: Lang CE, MacDonald JR, Reisman DS, Boyd L, Jacobson Kimberley T, Schindler-Ivens SM, Hornby TG, Ross SA, Scheets PL.

5. Effect of exercise on physical function, daily living activities and quality of life in the frail older adults: A meta-analysis (Article)

Objectives: To determine the effect of exercise on the physical function, activities of daily living (ADLs), and quality of life (QOL) of the frail older adults. 

Data Sources: Relevant articles published between 2001 and June 2010 were searched in PubMed, MEDLINE, EMBASE, the Chinese Electronic Periodical Service, CINAHL, and the Cochrane Library databases. 

Study Selection: The participants were selected based on the predetermined frailty criteria and randomly assigned to either an exercise or control group. The intervention for the exercise group was a single or comprehensive exercise training program, whereas usual care was provided to the control group. 

Data Extraction: The characteristics and outcome measures of the included studies were identified independently by 2 investigators. 

Data Synthesis: The effect sizes of physical function assessed by the timed up and go test, gait speed, the Berg Balance Scale (BBS), the ADL questionnaires, and QOL measured by the Medical Outcomes Study 36-Item Short-Form Health Survey were calculated, using a weighted mean difference (WMD) and a 95% confidence interval (CI) to represent the results. Compared with the control group, the exercise group increased their gait speed by.07m/s (95% CI.02.11), increased their BBS score (WMD=1.69; 95% CI.562.82), and improved their performance in ADLs (WMD=5.33; 95% CI 1.01-9.64). The exercise intervention had no significant effects on the Timed Up & Go test performance and the QOL between the groups. 

Conclusions: Exercise is beneficial to increase gait speed, improve balance, and improve performance in ADLs in the frail older adults.

Authors: Chou, CH., Hwang, CL., Wu, YT.

▶ 가장 많이 읽힌 논문(Most Read) & 초록(Abstract)

1. Biomechanical analysis of the sit-to-stand motion in elderly persons (Published in issue: July 1992)

The sit-to-stand motion of ten healthy subjects, 65 to 76 years old, was evaluated using kinematic, force plate, and electromyographic data to characterize the sit-to-stand motion. Kinematic data collected by video, muscle activity monitored by surface electromyography, and ground reaction forces analyzed by a piezoelectric force plate were used for analysis. Using these synchronized data, three phases of the sit-to-stand motion were identified-phase 1, weight shift; phase 2, transition; and phase 3, lift. A consistent pattern of trunk and lower extremity motion was observed, and two distinct upper extremity movement strategies were identified. The onset of muscle activity occurred in the following order: erector spinae, rectus femoris, and vastus medialis (phase 1); biceps femoris, gluteus maximus, and rectus abdominus (phase 2). This characterization of the sit-to-stand motion for a small population of healthy elderly subjects serves as a basis for identifying problems in elderly patients who demonstrate difficulty getting up from a chair.

Authors: Millington PJ, Myklebust BM, Shambes GM.

2. Not All Facial Paralysis Is Bell's Palsy: A Case Report (Published in issue: July 1999)

Bell’s palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell’s palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell’s palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell’s palsy, and indications for prompt, appropriate referral for additional diagnostic services.