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Post-COVID Syndrome (PCS) is characterized by physical, psychological and cognitive symptoms with a negative impact on daily activities. This study tested the responsiveness and construct validity of the original version of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) in a cohort of Italian hospitalized COVID-19 patients. This longitudinal study involved 79 hospitalized COVID-19 patients with rehabilitation needs, assessed after 12 and 26 weeks post-infection. Functional and patient-reported outcome measures were correlated with 10 items of the C19-YRS to test the construct validity, whereas distribution-based methods were used for the responsiveness over time. After 12 weeks since infection, 88.5% of patients reported fatigue, 83.3% breathlessness, 69.4% anxiety, 55.6% depression, and 44.9% pain. Moreover, 84.6% experienced reduced mobility, 75.7% had difficulties with usual activities, and 47.4% with personal care. Single items for each symptom had significant correlation (rho 0.25–0.60) with well-established scales for these symptoms. At 26 weeks, except for anxiety, all the PCS symptoms were still present but significantly reduced. The C19-YRS had moderate responsiveness for the most represented deficit reported. The C19-YRS was a valuable patient-reported outcome for screening, assessing severity, and monitoring the persistence of symptoms after 12 and 26 weeks from SARS-CoV2 infection in a cohort of Italian hospitalized patients.

The relationship between Long Covid (LC) symptoms and physical activity (PA) levels are unclear. In this cross-sectional study, we examined this association, and the advice that individuals with LC received on PA. Adults with LC were recruited via social media. The New Zealand physical activity questionnaire short form (NZPAQ-SF) was adapted to capture current and pre-COVID-19 PA levels and activities of daily living (ADLs). Participants reported how PA affected their symptoms, and what PA recommendations they had received from healthcare professionals and other resources; 477 participants completed the survey. Mean age (SD) was 45.69 (10.02) years, 89.1% female, 92.7% white, and median LC duration was 383.5 days (IQR: 168.25,427). Participants were less active than pre-COVID-19 (26.88 ± 74.85 vs. 361.68 ± 396.29 min per week, p < 0.001) and required more assistance with ADLs in a 7-day period compared to pre-COVID-19 (2.23 ± 2.83 vs. 0.11 ± 0.74 days requiring assistance, p < 0.001). No differences were found between the number of days of assistance required with ADLs, or the amount of PA, and the different durations of LC illness (p > 0.05). Participants reported the effect of PA on LC symptoms as: worsened (74.84%), improved (0.84%), mixed effect (20.96%), or no effect (28.72%). Participants received contradictory advice on whether to be physically active in LC. LC is associated with a reduction in PA and a loss of independence, with most participants reporting PA worsened LC symptoms. PA level reduction is independent of duration of LC. Research is needed to understand how to safely return to PA without worsening LC symptoms.

BackgroundAs our understanding of the nature and prevalence of Post-COVID-19 syndrome (PCS) is increasing, a measure of the impact of COVID-19 could provide valuable insights into patients’ perceptions in clinical trials and epidemiological studies, as well as routine clinical practice.ObjectiveTo evaluate the clinical usefulness and psychometric properties of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) in patients with PCS.DesignA prospective, observational study of 187 consecutive patients attending a post-COVID-19 rehabilitation clinic. The C19-YRS was used to record patients’ symptoms, functioning and disability. A global health question was used to measure the overall impact of PCS on health. Classical psychometric methods (data quality, scaling assumptions, targeting, reliability and validity) were used to assess the C19-YRS.ResultsFor the overall scale, missing data were low, scaling and targeting assumptions were satisfied, and internal consistency was high (Cronbach’s alpha = 0.891). Relationships between perception of health and patients’ reports of symptoms, functioning and disability demonstrated good concordance.ConclusionsThis is the first study to examine the psychometric properties of an outcome measure in patients with PCS. In this sample of patients, the C19-YRS was clinically useful and satisfied standard psychometric criteria, providing preliminary evidence of its suitability as a measure of PCS.

The COVID-19 pandemic has caused more than 5 million infections and 300,000 deaths worldwide. Many survivors of the illness are likely to have long-term symptoms and disability that will pose a significant burden to the healthcare systems and economies all over the world. Given the scale of the burden and lockdown measures in most countries, there is a need for a pragmatic tele-assessment tool to screen for needs and target rehabilitation interventions in time. A comprehensive multi-system telephone screening tool called COVID-19 Yorkshire Rehabilitation Screening (C19-YRS) tool has been developed by multi-disciplinary-rehabilitation teams from Leeds, Airedale and Hull NHS Trusts to assess and capture symptoms and guide rehabilitation interventions for these individuals. The tool has been shown to cover all the components of the WHO ICF Framework.

Background There is currently limited information on clinical severity phenotypes of symptoms and functional disability in Post-COVID Syndrome (PCS) METHODS: A purposive sample of 370 PCS patients from a dedicated community COVID-19 rehabilitation service were assessed using the C19-YRS (COVID-19 Yorkshire Rehabilitation Scale) where each symptom or functional difficulty was scored on a 0-10 Likert scale and also compared with before infection. Phenotypes based on symptom severity were extracted to identify any noticeable patterns. Correlation between symptom severity, functional disability and overall health was explored. Results Mean age was 47 years, with 237 (64%) female. Median duration of symptoms was 211 days (interquartile range 143 to 353). Symptoms and functional difficulties increased substantially when compared to before infection. Three distinct severity phenotypes of mild (n=90), moderate (n=186) and severe (n=94) were identified where severity of individual symptoms was of similar severity within each phenotype. Symptom scores were strongly positively correlated with functional difficulty scores (0.7, 0.6 to 0.7) and moderately negatively correlated with overall health (-0.4, -0.3 to -0.5). Conclusions This is the first study reporting on severity phenotypes in a largely non-hospitalised PCS cohort. Severity phenotypes might help stratify patients for targeted interventions and planning of care pathways. Word count: 199 This article is protected by copyright. All rights reserved.

Quantitative assessment of motor disorder is one of the main challenges in the field of stroke rehabilitation. This paper proposes a simplified kinematic model for human upper limb(UL) using seven main joints of both the dominant and non-dominant side. With this model, a deep neural network (DNN) is used to predict the 3D free reaching movement of UL of a healthy participant. The experimental results show that the prediction trajectories can achieve high similarities with trajectories of real movements, indicating the promising accuracy in 3D movement estimation of UL achieved by the DNN. With the capability of identifying specific reaching movements in realtime, the trajectories predicted by this data-driven model can be utilized to inform the rehabilitation assessment and training in the future studies as a personalized therapy approach.

The C19-YRS was the first scale reported in the literature for patient assessment and monitoring in Long Covid or Post-COVID syndrome. The scale has demonstrated content validity in a previous COVID-19 follow-up study. The growing number of patients with Post-COVID syndrome required the development of a self-report version (and a digital format) so that the scale can be completed by patients themselves. Individuals with Long Covid and clinicians providing care were involved in iterative changes to the scale. The self-report version of the scale captures symptom severity, functional disability and global health status. The C19-YRS digital format comprises a smartphone application for the patient and a web portal for the clinician to assess, triage and monitor patients remotely. The items have been shown to span all the components of the WHO ICF Framework for health condition.

The National Institute for Health and Care Excellence (NICE) describe “ post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.

Objective COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. Methods A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. Results The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. Conclusion The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.

Background: There is currently very limited information on the nature and prevalence of post-COVID-19 symptoms after hospital discharge. Methods: A purposive sample of 100 survivors discharged from a large University hospital were assessed 4 to 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ-5D-5L telephone version was also completed. Results: Participants were between 29 and 71 days (mean 48 days) postdischarge from hospital. Thirty-two participants required treatment in intensive care unit (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group and 42.6% in ward group) and psychological distress (46.9% in ICU group and 23.5% in ward group). There was a clinically significant drop in EQ5D in 68.8% in ICU group and in 45.6% in ward group. Conclusions: This is the first study from the United Kingdom reporting on postdischarge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximize the functional return of COVID-19 survivors.

Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission.Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.Lay AbstractSevere acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are two previous viral infection outbreaks similar to the current COVID-19 pandemic. Studies that have looked at long-term health problems in survivors of these two outbreaks report reduced lung function and reduced ability to exercise in some survivors up to 6 months after discharge from hospital. Mental health problems including stress, an-xiety and depression were observed in up to one-third of survivors at 6 months and beyond. The quality of life was observed to be low even 12 months after discharge from the hospital. Rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19, investigate them accordingly and plan suit-able and timely treatments to enable best possible recovery and quality of life for them.

This review evaluates the effectiveness of robotic and virtual reality technologies used for neurological rehabilitation in stroke survivors. It examines each rehabilitation technology in turn before considering combinations of these technologies and the complexities of rehabilitation outcome assessment. There is high-quality evidence that upper-limb robotic rehabilitation technologies improve movement, strength and activities of daily living, whilst the evidence for robotic lower-limb rehabilitation is currently not as convincing. Virtual reality technologies also improve activities of daily living. Whilst the benefit of these technologies over dose-controlled conventional rehabilitation is likely to be small, there is a role for both technologies as part of a broader rehabilitation programme, where they may help to increase the intensity and amount of therapy delivered. Combining robotic and virtual reality technologies in a rehabilitation programme may further improve rehabilitation outcomes and we would advocate randomised controlled trials of these technologies in combination.

Objectives Hyper-Acute Rehabilitation Units (HA-RUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU. Methods Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period. Results A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale score at admission was 11 (range 5-15) and at discharge was 13 (range 8-15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy. Conclusion Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes. LAY ABSTRACT A Hyper-Acute Rehabilitation Unit (HARU) provides rehabilitation to patients with sudden neurological injury, such as traumatic brain injury or stroke. In order to maintain a safe airway some of these patients have an artificial tube inserted into the trachea through an opening in the neck. This procedure is called a tracheostomy.This study analysed outcomes in tracheostomy patients admitted to a HARU over a 2-year period. A total of 208 patients were admitted to the unit, of whom 99 had a brain injury and had had a tracheostomy, either at admission or during their stay in the HARU. Functional activity, measured using Functional Independence Measure and Functional Assessment Measure (FIM+FAM) scales, showed significant improvement in both physical and mental ability in these patients. The tracheostomy tubes were removed successfully in 79% of patients as they became more independent and able to maintain their airway. However, long-term tracheostomy was needed in 21% of patients. This study shows that patients who have a tracheostomy following an acute neurological injury can be managed appropriately in a HARU and improve in functional ability.

This chapter focuses on those situations where the effects of a critical illness can produce additional morbidity with the potential to affect later rehabilitation. In the context of critical illness, much of this additional morbidity takes the form of readily predictable complications resulting from the disease process or the consequences of its early management. In this sense, rehabilitation principles should be an essential and integrated part of management in the intensive care unit (ICU) setting. Even though it is occurring in ICU, the goals of rehabilitation are unchanged—to maximize the potential for the person to maximize their short- and long-term functional capacity and quality of life. This chapter also describes rehabilitation in specific critical illnesses.

In healthcare, rehabilitation has been defined as ‘a general health strategy with the aim of enabling persons with health conditions experiencing, or likely to experience, disability to achieve and maintain optimal functioning’. This chapter covers models of disability, including clinical, social, and biopsychosocial models; describes the use of correct terminology, and the importance of avoiding terminology that implies dependency or terminology which just categorizes all people with disabilities; and introduces approaches to rehabilitation, illustrated by a case study. Goal planning, habit forming, and outcome measurement are all described, and the benefits of rehabilitation are outlined. It summarizes the basic tasks of rehabilitation, and introduces the rationale for the rest of the book.

A patient’s perception of their journey through rehabilitation is based on their personal aspirations and expectations as filtered through the value and belief systems within which they live. From these internal constructs, the uniqueness of an individual’s lived experience emerges and explains how two individuals with the same health condition or health state may respond to their situation very differently. This chapter covers contextual factors within the International Classification of Functioning, Disability and Health model, personality factors, attitudes, skills, and behaviour patterns in the context of how an individual will react to rehabilitation.

Purpose: High Volume Distension Injection (HVDI) is a treatment adjunct in chronic mid-portion Achilles tendinopathy. This study analysed whether HVDI is safe and effective in an outpatient clinic setting. Methods: Retrospective service evaluation of 18 participants over 18 months. Ultrasound-guided saline, corticosteroid and bupivacaine was injected to disrupt vasculo-neural ingrowth, with post-procedure eccentric exercises. Mean follow-up was 8 weeks. Outcomes used were Numeric rating Scale (NRS) of pain, tendon thickness and Modified Ohberg score (MOS) of neovascularisation measured on Ultrasound and Doppler imaging. Results: Mean reduction in NRS was 5.30 ± 2.53 ( P < 0.001). Mean tendon thickness reduction was 0.21 ± 0.17 cm ( P < 0.001). Median MOS improved from 2.00 ± 2.00 to 1.00 ± 3.00 ( P = 0.009). No complications occurred. 11 participants had successful primary HVDI, 3 responded to a second injection. Two non-responders were referred for surgery and two referred for alternative therapy by patient preference. Conclusion: Significant reduction in pain, tendon thickness and neovascularity was observed in 78% of patients. Recurrence in 39%. HVDI with eccentric training is safe and effective intervention in outpatient clinic setting.

Adhesive capsulitis (AC) is a painful and debilitating condition of the glenohumeral joint and has been described as self-limiting. However, recent reports suggest that up to 40% of patients report persistent symptoms, therefore intervention strategies are needed to improve function and quality of life. One such intervention is the hydrodilatation of the glenohumeral joint with a high-volume injection, comprising of local anaesthetic, corticosteroid and normal saline, making a total volume of up to 40 ml. This service evaluation assessed the outcomes in 28 patients (23 females and 5 males; mean age 54.29 years) with AC who underwent ultrasound-guided (USG) hydrodilatation in a clinical outpatient setting. There was a statistically significant improvement in pain and all shoulder movements (all changes p value < 0.01). No adverse effects were encountered. Therefore, the USG glenohumeral joint hydrodilatation procedure in a clinical outpatient setting is a safe and effective intervention for AC.

A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge.

BACKGROUND:Rehabilitation following severe Traumatic Brain Injury (TBI) often involves the use of temporary tracheostomies. Tracheostomy weaning is influenced by physiological parameters, which are abnormal in the concomitant complication of Paroxysmal Sympathetic Hyperactivity (PSH). OBJECTIVE:To investigate the association between PSH and tracheostomy weaning in severe TBI. METHODS:This was a retrospective cohort study of consecutive patients with TBI and tracheostomy admitted to a Hyper-Acute Neurorehabilitation Unit over a 34-month period. Duration of tracheostomy wean and influencing characteristics were statistically compared between those with and without PSH. RESULTS:Fifty-one patients admitted with TBI required a tracheostomy. Of these, 10 patients were also diagnosed with PSH. The mean tracheostomy wean in the PSH group was longer compared to the non-PSH group (72.3, SD 61.0 versus 30.0 days, SD 16.2). This difference was statistically significant (p = 0.007, using Mann Whitney U test). The PSH group had more respiratory and oral secretions, but this was not statistically significant (p = 0.16 and 0.29). CONCLUSIONS:This is the first study to demonstrate that PSH is associated with prolonged tracheostomy weaning in severe TBI. Awareness of this association should enable those planning rehabilitation to set realistic goals for a patient’s tracheostomy weaning programme.

This study evaluates whether the International Classification of Functioning, Disability, and Health (ICF) framework provides a useful basis to ensure that key user needs are identified in the development of a home-based arm rehabilitation system for stroke patients. Using a qualitative approach, nine people with residual arm weakness after stroke and six healthcare professionals with expertise in stroke rehabilitation were enrolled in the user-centered design process. They were asked, through semi-structured interviews, to define the needs and specification for a potential home-based rehabilitation device to facilitate self-managed arm exercise. The topic list for the interviews was derived by brainstorming ideas within the clinical and engineering multidisciplinary research team based on previous experience and existing literature in user-centered design. Meaningful concepts were extracted from questions and responses of these interviews. These concepts obtained were matched to the categories within the ICF comprehensive core set for stroke using ICF linking rules. Most of the concepts extracted from the interviews matched to the existing ICF Core Set categories. Person factors like gender, age, interest, compliance, motivation, choice, and convenience that might determine device usability are yet to be categorized within the ICF comprehensive core set. The results suggest that the categories of the comprehensive ICF Core Set for stroke provide a useful basis for structuring interviews to identify most users needs. However some personal factors (related to end users and healthcare professionals) need to be considered in addition to the ICF categories.

The purpose of this study was to evaluate the International Classification of Functioning, Disability and Health (ICF) as a framework to ensure that key aspects of user feedback are identified in the design and testing stages of development of a home-based upper limb rehabilitation system. Seventeen stroke survivors with residual upper limb weakness, and seven healthcare professionals with expertise in stroke rehabilitation, were enrolled in the user-centered design process. Through semi-structured interviews, they provided feedback on the hardware, software and impact of a home-based rehabilitation device to facilitate self-managed arm exercise. Members of the multidisciplinary clinical and engineering research team, based on previous experience and existing literature in user-centred design, developed the topic list for the interviews. Meaningful concepts were extracted from participants' interviews based on existing ICF linking rules and matched to categories within the ICF Comprehensive Core Set for stroke. Most of the interview concepts (except personal factors) matched the existing ICF Comprehensive Core Set categories. Personal factors that emerged from interviews e.g. gender, age, interest, compliance, motivation, choice and convenience that might determine device usability are yet to be categorised within the ICF framework and hence could not be matched to a specific Core Set category.

Background and objectiveThe curriculum for training in rehabilitation medicine (for doctors) in the United Kingdom requires 6 months of mandatory training in musculoskeletal (MSK) medicine. Current training content and scope vary considerably between different deaneries (regions) within the UK. They also differ significantly from MSK medicine training in other European countries. This national survey was designed to gather information on the MSK medicine training undergone by UK rehabilitation medicine trainees, their opinions as to how well it matched their perceived needs, and how it should be delivered in the future.MethodsAll trainees from the rehabilitation medicine trainee database were invited to participate in developing a questionnaire for the survey. A 13-item questionnaire was devised and sent to all trainees to respond.ResultsThirty-nine out of 48 (81%) trainees completed the questionnaire. Seventy-seven per cent of them felt that it was appropriate for rehabilitation physicians to be ...

Background and objective. One-stop clinics aim at assessment, investigation and initiating treatment in a single hospital visit. They have been proven to be cost-effective and to increase patient satisfaction in various specialties. The aim of this study was to describe the one-stop approach to managing soft tissue and degenerative musculoskeletal conditions using clinic-based musculoskeletal ultrasonography (MSUS). Methods. A retrospective case record review was carried out of patients assessed and managed in the musculoskeletal clinic by a musculoskeletal and sports physician over a 10-month period. Results. A total of 1,166 patients were assessed and managed in a total of 155 outpatient clinics. The age range of patients was 19 to 85 years (median age 45 years). The diagnoses included traumatic or overuse tendinopathy, degenerative arthritis, bursitis, acute/chronic sporting injuries and acute/chronic back pain. A total of 1,012 patients (87%) had conditions related to the appendicular system (shoulder girdle, upper limb, pelvic girdle and lower limb) and 154 patients were referred with spinal pain. All patients with appendicular system problems had a definite diagnosis and treatment initiated on the first visit to the clinic. In 658 (65%) patients, a diagnostic ultrasound was deemed an appropriate investigation to improve the accuracy of diagnosis and more than half of them (352 patients) needed ultrasound-guided injections as part of the management of their conditions. A portable GE Healthcare LOGIQe machine with a 10 MHz linear probe and colour Doppler flow imaging was used to perform all scans. No adverse incidents were reported. Conclusions. The use of clinic-based MSUS enables a one-stop approach, reduces repeated hospital appointments and improves quality of care in an outpatient musculoskeletal clinic. Copyright © 2010 John Wiley & Sons, Ltd.

Background Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. Methods hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Results Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. Conclusions The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-163) contains supplementary material, which is available to authorized users.

Some lower limb amputees can present with alteration in phantom pain and sensation with visceral movement (micturition/defaecation). The authors specifically questioned 200 lower limb amputees from 2 amputee rehabilitation centers (150 recent lower limb amputees in the first center and 50 consecutive recent and established lower limb amputees in the second center) for such symptoms. Eight patients from the first center and 5 patients from the second center reported having the phenomenon. In this case series, the authors report the patient-described symptoms, estimate the prevalence, and discuss the likely pathophysiology of the phenomenon.

Twice-yearly meetings of The British Society of Rehabilitation Medicine (BSRM) take place at which posters and free papers are generated, as abstracts, to present novel research findings, audits and case reports. The aim of this study was to evaluate the academic value of these meetings, by determining the subsequent rate of publication in peer-reviewed journals of abstracts presented. This was compared to the publication rate of other European medical specialist society meetings.The authors used MEDLINE, PubMed and Google Scholar search engines to look for publication of abstracts presented at BSRM meetings within peer-reviewed journals over a 7-year period (2000-2006). The abstracts were categorised into sub-groups (original study, audit, review, case report and service description) to determine which type was more likely to be published. The above databases were used also to extract studies on publication rate of other medical specialties in Europe.In 7 years, a total of 251 abstracts (of which 152 are original studies) have been presented as free papers or posters in a total of 13 meetings. The publication rate for the described study categories were: total 34%, original study 52%, review 50%, case report 5%, audit 0% and service description 0%. Publication rates from other specialist meetings in Europe range from 10% to 70%.The average publication rate for an abstract submitted to a BSRM meeting is 34% for any abstract and 52% for an original study suggesting that the meeting is generating abstracts of comparable academic interest to other specialist societies.

Objective: To systematically review the effectiveness of medications used to improve attention in people with non-progressive acquired brain injury. Design: A systematic review. Methods: MEDLINE, EMBASE, CINALH, PUBMED and PsychINFO databases were used to identify studies published between 1987 and 2008 meeting the following criteria: studies with subjects older than 18 years; diagnosis of new onset or previous acquired brain injury; medication given to improve attention and use of outcome to measure attention. Studies involving subjects in low arousal states or with neurogenerative conditions were excluded. The studies were categorized into three evidence levels: I — Randomized controlled trials; II — Prospective studies, controlled trials with methodological limitations; and III — Retrospective studies, clinical case series. Results: Forty-seven articles were identified on initial search. Twenty-six met the pre-specified criteria. Five articles were assessed as meeting the level I evidence criteria, 12 were level II studies and 9 were level III studies. Methylphenidate can improve information processing speed but not all attention aspects in some people after traumatic brain injury. There is weak evidence for use of dopamine agonists to improve neglect/inattention after stroke. There is little evidence on the frequency of adverse effects and long-term functional benefits. Conclusion: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

To the Editor: I congratulate Hsieh et al on their well-conducted study comparing the responsiveness of some common outcomes used in stroke rehabilitation research.1 They report large responsiveness indices for Fugl Meyer (FM) and Action Research Arm test with FM being a more responsive measure than Action Research Arm test. Hsieh et al have used the standardized response mean (SRM), which is one of the best valid measures to estimate responsiveness. The authors have, however, used Cohen’s …

Professionals who work in the field of musculoskeletal (MSK) medicine—musculoskeletal physicians, sports physicians, rehabilitation physicians, rheumatologists, radiographers, physiotherapists, podiatrists, and general practitioners with a special interest in MSK medicine. We did the course while training in musculoskeletal and sports medicine. We use portable ultrasound regularly in outpatient clinics for diagnosis and guiding interventions. The use of portable ultrasound in outpatient clinics is gaining popularity among clinicians in this area. As ultrasound is highly dependent on the operator, a formal qualification is necessary to set standards comparable to those of radiologists and radiographers providing a similar service. The use of portable equipment in clinics enables on the spot diagnosis and helps explain findings to the patient. Using ultrasound to guide the injection during procedures increases the confidence of the clinician and the patient. Having seen the images on the screen, patients understand their condition better and are more likely to comply with the treatment plan. The …