Catálogo de publicaciones - revistas

<jats:p> Objective: To identify prognostic instruments for the planning of care after acute stroke. </jats:p><jats:p> Design: Prospective study. </jats:p><jats:p> Setting: Stroke unit and geriatric rehabilitation unit. </jats:p><jats:p> Subjects: One hundred and fifteen consecutive acute stroke patients ≥65 years old. </jats:p><jats:p> Main outcome measures: Univariate and multivariate survival analyses. Length of hospital stay and residential form up to three months after onset. </jats:p><jats:p> Results: The average length of stay was significantly shorter if age &lt;80 years, male, living with another person, normal sensory ability, Barthel Index (BI) score ≥35 and Rivermead Mobility Index (RMI) score ≥4, assessed 10 days after onset. Multivariate analysis, also including BI subtests, showed that RMI score ≥4, which corresponds to the ability to rise from a chair in less than 15 seconds and remain erect for 15 seconds with or without aid, 10 days after onset, had the greatest impact on early discharge home after acute stroke, together with normal bladder function (BI subtest six), normal sensory ability and living with another person. </jats:p><jats:p> Conclusion: The best predictor of early discharge home, 10 days after stroke onset, was the ability to rise from a chair with or without aid. This simple and quickly conducted test requires no special equipment and in the present study had a very high predictive value. </jats:p>

<jats:p> Objective: To determine within the first 10 weeks post onset the most robust variables in the prediction of recovery of independent gait at six months post stroke. </jats:p><jats:p> Design: A prospective cohort study. </jats:p><jats:p> Subjects: One hundred and one first ever ischaemic middle cerebral artery stroke patients. None of these patients were able to walk at onset and all suffered from a marked hemiplegia. </jats:p><jats:p> Setting: Twenty-four determinants, possibly related to recovery of gait at six months, were measured within 14 days following stroke onset. Based on Functional Ambulation Categories (FAC) independent gait was classified into present (FAC ≥ 4) or absent (FAC &lt; 4). Bivariate logistic regression analysis was used to select determinants. Only significant determinants during the entire 10-week period were used for further weekly multivariate logistic prediction modelling of independent gait at six months post stroke. </jats:p><jats:p> Results: After six months post onset 62% ( N = 63) regained independent gait. Age, Barthel Index, Trunk Control Test, Motricity Index of arm and leg, Brunnstrom Fugl-Meyer stage of leg motor recovery, and type of intervention were significant determinants in bivariate analysis, but age of patient and Barthel Index were the most robust determinants in the final prediction model. Weekly re-evaluation produced sensitivity values between 89% and 96% and specificity values between 53% and 62%. </jats:p><jats:p> Conclusion: In initially non-ambulatory stroke patients age and Barthel Index were the most robust variables during the first 10-week poststroke period in the prediction of independent walking at six months. However, prediction of non-ambulation at six months proved to be less accurate. </jats:p>

<jats:p> Objective: To describe a practical method of setting personalized but specific goals in rehabilitation that also facilitates the use of goal attainment scaling. </jats:p><jats:p> Background: Rehabilitation is a complex intervention requiring coordinated actions by a team, a process that depends upon setting interdisciplinary goals that are specific, clear and personal to the patient. Goal setting can take much time and still be vague. A practical and standardized method is needed for being specific. </jats:p><jats:p> Method: A novel approach to writing specific, measurable, achievable, realistic/ relevant and timed (SMART) goals is developed here. Each goal can be built up by using up to four parts: the target activity, the support needed, quantification of performance and the time period to achieve the desired state. This method can be employed as part of goal attainment scaling and the other levels can be easily and quickly formulated by adding, deleting and/or changing one or more of the (sub)parts. </jats:p><jats:p> Discussion: The success of goal setting and goal attainment scaling depends on the formulation of the goals. The method described here is a useful tool to standardize the writing of goals in rehabilitation. It saves time and simplifies the construction of goals that are sufficiently specific to be measurable. </jats:p>

<jats:p>Goal attainment scaling is a mathematical technique for quantifying the achievement (or otherwise) of goals set, and it can be used in rehabilitation. Because several different approaches are described in the literature, this article presents a simple practical approach to encourage uniformity in its application. It outlines the process of setting goals appropriately, so that the achievement of each goal can be measured on a 5-point scale ranging from -2 to +2, and then explains a method for quantifying the outcome in a single aggregated goal attainment score. This method gives a numerical T-score which is normally distributed about a mean of 50 (if the goals are achieved precisely) with a standard deviation of around this mean of 10 (if the goals are overachieved or underachieved). If desired, the approach encompasses weighting of goals to reflect the opinion of the patient on the personal importance of the goal and the opinion of the therapist or team on the difficulty of achieving the goal. Some practical tips are offered, as well as a simple spreadsheet (in Microsoft Excel) allowing easy calculation of the T-scores.</jats:p>

<jats:sec><jats:title>Objective:</jats:title><jats:p> To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality. </jats:p></jats:sec>

<jats:sec><jats:title>Objective</jats:title><jats:p> To explore the effects of aerobic training adding to home-based exercise program on motor function and muscle architectural properties in children with Duchenne muscular dystrophy. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> This is a prospective randomized controlled study. </jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p> Pediatric neuromuscular clinic in a tertiary care center. </jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p> Children with Duchenne muscular dystrophy. </jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p> Children were randomly divided into two groups whereby 12-weeks aerobic training was additionally given in treatment group in contrast to the control group which received only home-based exercise program. </jats:p></jats:sec><jats:sec><jats:title>Main Measures</jats:title><jats:p> Motor Function Measure and Six Minute Walk Test were used for clinical evaluation, and muscle architectural properties (thickness, pennation angle and fascicle length) were measured by ultrasound imaging. Both groups were assessed at baseline and after 12-weeks of training. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Median age of children was 7.9 years in the treatment group and 8.6 years in the control group ( p &gt; 0.05). Significant improvements were obtained for Motor Function Measure and Six Minute Walk Test from baseline to 12-weeks in the treatment group; Motor Function Measure total score changed from 83.2 (6.1) to 86.9 (4.0) vs. 82.3 (10.2) to 80.4 (9.4) points in the control group ( p  =  0.006 ); 6 Minute Walk Test distance changed from 395.3 (46.6) to 413.0 (52.3) vs. 421.7 (64.4) to 393.8 (68.2) meters in the control group ( p &lt; 0.001). However, muscle architectural parameters did not change during study period ( p &gt; 0.05). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Aerobic training may be of additional value in improving motor function and performance with no remarkable effect on muscle architectural properties. </jats:p></jats:sec>

<jats:sec><jats:title>Objective</jats:title><jats:p> There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand–arm bimanual intensive training, hand–arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. </jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p> We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. </jats:p></jats:sec><jats:sec><jats:title>Review methods</jats:title><jats:p> To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand–arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand–arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( − 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy. </jats:p></jats:sec>

<jats:sec><jats:title>Objective</jats:title><jats:p> Robot-assisted gait training (RAGT) is often used as a rehabilitation tool for neurological impairments. The purpose of this study is to investigate the effects of rehabilitation with robotic devices on quality of life and depression. </jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p> Two electronic databases (MEDLINE and Scopus) were searched for studies from inception up to December 2022. </jats:p></jats:sec><jats:sec><jats:title>Review methods</jats:title><jats:p> Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses, studying each one’s mental and physical health and depression. Random effect meta-analyses were run using standardized mean difference and 95% confidence interval (CI). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 853 studies were identified from the literature search. 31 studies (17 RCTs and 14 non-RCTs) including 1151 subjects met the inclusion criteria. 31 studies were selected for the systematic review and 27 studies for the meta-analysis. The outcome measure of mental health significantly improved in favor of the RAGT group in RCTs and non-RCTs (adjusted Hedges’g 0.72, 95% CI: 0.34–1.10, adjusted Hedges g = 0.80, 95% CI 0.21-1.39, respectively). We observed a significant effect of RAGT on physical health in RCTs and non-RCTs (adjusted Hedges’g 0.58, 95% CI 0.28, 0.88, adjusted Hedges g = 0.73, 95% CI 0.12, 1.33). After realizing a sensitivity analysis in RCTs, a positive impact on depression is observed (Hedges’ g of −0.66, 95% CI −1.08 to −0.24). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> This study suggests that RAGT could improve the quality of life of patients with neurological impairments. A positive impact on depression is also observed in the short term. Further studies are needed to differentiate grounded and overgrounded exoskeletons as well as RCT comparing overground exoskeletons with a control group. </jats:p></jats:sec>