Search

Introduction: Total knee arthroplasty (TKA) commonly cause physical impairments, which necessitate physiotherapy post-operatively. Low-intensity pulsed ultrasound is an adjuvant treatment to conventional physiotherapy; however, its effects on TKA recovery require further investigation. The study aimed to ascertain the outcome of adding low-intensity pulsed ultrasound therapy into conventional physiotherapy on recovery from physical impairments after TKA. Methods: This assessor-blinded quasi-experimental study was conducted in a tertiary medical centre in Central Malaysia. Patients with TKA due to grade III and IV knee osteoarthritis (Kellgren-Lawrence grading system) were alternately allocated into either an experimental group (n=10) or a control group (n=10). Other than low-intensity pulsed ultrasound as received by the experimental group's participants, the two groups received the same amount and content of conventional physiotherapy. Participants' pain, knee swelling, active knee flexion range, and quadriceps strength were assessed at baseline, week 1 of the intervention, and the 1-week follow-up. The two interventions' effects were analysed using a mixed model ANOVA. Results: The pain score and knee swelling decreased (P<0.05), while the knee flexion range and quadriceps strength increased significantly (P<0.001) after both interventions. The experimental group had a significantly lower pain score [3.07(2.18) at visual analogue scale] and a greater active knee flexion range [80.48(26.42) degrees] compared to the control group [pain score=4.29(1.54); knee flexion=67.00(25.15) degrees] following the interventions. There were no significant interaction effects for all outcomes. Conclusion: The combination of low-intensity pulsed ultrasound into a conventional physiotherapy program demonstrated more promising results in pain alleviation and knee motion recovery following TKA. [ABSTRACT FROM AUTHOR]

Children with disability require comprehensive and continuous rehabilitation. Community-based rehabilitation (CBR) was developed to fulfil this need and has benefited children of various ages both in the rural and urban societies. In Malaysia, the government largely fund rehabilitation of children at the CBR centers. However, to date research data on the outcome of CBR on children with disability in the country is scarce. This study was intended to determine the outcome of CBR and its associated factors among children with disability. Outcome of rehabilitation was determined with regard to changes in activity of daily living ability with the use of the Barthel Index at 6 months post-CBR. Analysed factors were age, baseline score of the Barthel Index, frequency of attendance in therapy sessions and number of therapy received. Data was analysed using paired t test, Wilcoxon signed ranks test and Spearman correlation test. A total of 220 children with disability aged 4 to 18 years and 220 caretakers from 29 selected CBR centres in Pahang, Terengganu and Kelantan participated in this study. The results showed a small increase in the Barthel Index score of the children, with mean change ± SD equals 0.90 ± 4.54 (p=0.003) following rehabilitation. Attendance to therapy sessions was low, with <50% attended three quarter or more sessions of the total sessions offered. No analysed factors were found to be associated with the change in the Barthel Index (p>0.05). As a conclusion, the outcome gained through CBR is too small for the duration of rehabilitation implemented. The delivery of CBR program need to be reviewed and enhanced to improve its effectiveness on children with disability. [ABSTRACT FROM AUTHOR]

BACKGROUND: The benefits of engaging informal carers or family in the delivery of therapy intervention for people with stroke have not been well researched. OBJECTIVES: To assess the effectiveness of a home-based carer-assisted in comparison to hospital-based therapist-delivered therapy for community-dwelling stroke survivors. METHODS: An assessor blinded randomised controlled trial was conducted on 91 stroke survivors (mean age 58.9±10.6 years, median time post-onset 13.0 months, 76.5% males) who had completed individual rehabilitation. The control group received hospital-based group therapy delivered by physiotherapists as out-patients and the test group was assigned to a home-based carer-assisted therapy. Targeted primary outcomes were physical functions (mobility, balance, lower limb strength and gait speed). A secondary outcome index was health-related quality of life. An intention-to-treat analysis was used to evaluate outcomes at week 12 of intervention. RESULTS: Both therapy groups improved significantly in all the functional measures; mobility (p < 0.01), balance (p < 0.01), lower limb strength (p < 0.01), gait speed (p < 0.05), and in the quality of life score (p < 0.05) at trial completion. No statistical differences were found between the two groups in any outcome indices (all p > 0.05). CONCLUSIONS: The home-based carer-assisted therapy is as effective as the hospital-based therapist-delivered training in improving post-stroke functions and quality of life. [ABSTRACT FROM AUTHOR]

Background: Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services. Methods: A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached. Results: Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support. Conclusions: Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community. [ABSTRACT FROM AUTHOR]

Background Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. Methods In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. Results Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. Conclusion Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the provision of rehabilitation to and the functional recovery of stroke survivors receiving acute care in a tertiary hospital. Methods: Analyses of medical records of stroke patients who were admitted to a main teaching hospital between the years 2006-2009. Variables studied were the demographics, clinical profiles, rehabilitation profiles and the patients' functional recovery at discharge, as measured on a modified Rankin Scale (mRS). Findings: Records of 557 patients; mean age 64 years, 53.7% females were analysed. Mean length of stay was 6.8 days SD=5.8 during which, 62.7% received daily rehabilitation. Mean time from stroke diagnosis to rehabilitation was 3.0 days SD=2.0; 51.0% of cases were seen after 48 hours of hospital admission. Rehabilitation was provided mainly by physiotherapy services to 71.6%, 64.7% and 52.5% of severe, moderate and mild cases, respectively. Mean mRS was 3.5, SD=0.9 and 53.0% had not regained any level of walking ability prior to discharge. Age and severity level significantly predicted mRS at discharge (F6,536=12.26, P<0.001). Conclusions: Provision of rehabilitation to acute stroke survivors in a tertiary hospital was sub-optimal. Establishment of dedicated stroke rehabilitation services is recommended to enable better functional gain in post-stroke survivors. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the provision of rehabilitation to and the functional recovery of stroke survivors receiving acute care in a tertiary hospital. Methods: Analyses of medical records of stroke patients who were admitted to a main teaching hospital between the years 2006-2009. Variables studied were the demographics, clinical profiles, rehabilitation profiles and the patients' functional recovery at discharge, as measured on a modified Rankin Scale (mRS). Findings: Records of 557 patients; mean age 64 years, 53.7% females were analysed. Mean length of stay was 6.8 days SD=5.8 during which, 62.7% received daily rehabilitation. Mean time from stroke diagnosis to rehabilitation was 3.0 days SD=2.0; 51.0% of cases were seen after 48 hours of hospital admission. Rehabilitation was provided mainly by physiotherapy services to 71.6%, 64.7% and 52.5% of severe, moderate and mild cases, respectively. Mean mRS was 3.5, SD=0.9 and 53.0% had not regained any level of walking ability prior to discharge. Age and severity level significantly predicted mRS at discharge (F6,536=12.26, P<0.001). Conclusions: Provision of rehabilitation to acute stroke survivors in a tertiary hospital was sub-optimal. Establishment of dedicated stroke rehabilitation services is recommended to enable better functional gain in post-stroke survivors. [ABSTRACT FROM AUTHOR]

Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s) control, depression according to Patient Health Questionnaire (PHQ9), and level of independence using Barthel Index (BI). Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD) 10.9] years, mean stroke episodes were 1.30 (SD 0.5). The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0) months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007), while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06). Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2-100) to 90.5 (range: 27-100) (Z = 2.34, P = 0.01). Median PHQ9 scores decreased from 4.0 (range: 0-22) to 3.0 (range: 0-19) though the change was not significant (Z= -0.744, P = 0.457). Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level. [ABSTRACT FROM AUTHOR]