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WOS:000569098300002 PubMed: 33089080 Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

OBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p

Objective : To determine if the incidence of pressure injuries (PIs) upon admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early COVID-19 pandemic period. Design : Retrospective survey chart review of consecutive cohorts. Admissions to four acute IRHs within one system of care over the first consecutive 6-week period of admitting COVID-19 positive patients during the initial peak of the COVID-19 pandemic, April 1 to May 9, 2020. A comparison was made with the pre-COVID-19 period of 2020, January 1 to February 19, 2020. Setting : Four acute IRHs with admissions on a referral basis from acute care hospitals. Participants : A consecutive sample of pre-COVID-19 admissions (n = 768) and COVID-19 period admissions (n = 357); including persons who were COVID positive (n = 161) and COVID negative (n = 196). Main Outcome Measure(s) : Incidence of PIs on admission to IRH. Results : Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared to the pre-COVID-19 period by 14.9% (p < 0.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19 positive and COVID-19 negative (35.4% to 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient present with, worsened during the COVID-19 period in comparison to pre-COVID-19 (chi-squared 32.04%, p < 0.001). The length of stay in the acute care hospital prior to transfer to the IRH during COVID-19 was greater than in pre-COVID-19 by 10.9 % (p < 0.001). Conclusions : During the early part of the COVID-19 pandemic timeframe, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues, and potential future pandemics that place strain on medical resources.

Evaluation of long-term experience cardiac rehabilitation in a rehabilitation center "Chyornaya rechka" allowed to formulate general technology rehabilitation of cardiac patients in different categories. The key points of technology at the 2nd stage of rehabilitation are the risk stratification, evaluation classes severity of patients in a rehabilitation center, multidisciplinary rehabilitation. In practice cardiorehabilitation used notion of rehabilitation potential and prognosis of rehabilitation. Suggested modular design personalized rehabilitation programs. The modular structure allows individual programs to achieve optimum results of rehabilitation, facilitating current and final control effectiveness.

The article discusses the procedure for organizing speech therapy rehabilitation of preschoolers in the environment of a rehabilitation center; its tasks are revealed and substantiated; specific organizational principles characteristic of this process in the atmosphere of a rehabilita- tion center; the content of speech therapy influence; the role of methods in working with preschool children, their choice and use in individual, sub- group and frontal classes; an important role is assigned to diagnostics, as one of the most important components of this process.

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Research purposes: The hierarchical rehabilitation system model of Yunnan Province is built to provide a reference for the establishment of a standardized three-level rehabilitation system so as to meet the patient demands for different functional rehabilitation at different stages during the whole treatment. Research methods: 1. The General System Theory model is adopted as a guidance for the organizational structure construction of the hierarchical rehabilitation system model in rehabilitation centers, rehabilitation sub-centers, and rehabilitation stations in Yunnan Province. Standardized hierarchical rehabilitation hardware construction for these rehabilitation institutions of different levels helps form an exemplary structural model of a three-level standardized rehabilitation system. 2. The Learning Cycle Theory model is adopted as a guidance for the unified standardized training for patient rehabilitation management in the exemplary rehabilitation institutions of the three-level system. The researchers regularly guide, supervise, and summarize the standard implementation situations of patient rehabilitation management in these institutions and assess the operational quality and management efficiency of the hierarchical rehabilitation system model in Yunnan Province, finally forming the exemplary and standardized three-level rehabilitation system model. 3. The researchers analyze the operating parameters of the medical institutions at all levels in the three-level standardization rehabilitation system and evaluate the structural process and operational efficiency of the three-level standardized rehabilitation system model based on the analysis results. O modelo do sistema de reabilitação hierárquico da Província Yunnanfoi concebido comoumreferencial para a implementação de um sistema de reabilitação estruturado em três níveis, de modo a responder às necessidades dos doentes nas diferentes fases da sua reabilitação funcional. Como guias metodológicos foram adotadosa Teoria Geral dos Sistemas e o LearningCycleTheory, entre outros contributos teóricos considerados relevantes. Os investigadores participantes supervisionaram a operacionalização do sistema e avaliaram as instituições de cada um dos três níveis, quanto àestrutura, ao processo e à eficiência operacional. Quanto aos resultados houve uma clara perceção dos ganhos obtidos em várias dimensões. Pelo lado das instituições governamentais, pela redução dos recursos utilizados e pela maior mobilização e empenhamento dos profissionais e por parte dos doentes, pela maior rapidez de resposta às suas necessidades e a uma redução do tempo da sua reintegração no mercado de trabalho. A reputação deste sistema implicoutambém ganhos significativos nas receitas obtidas, que aumentaram em mais de 10% em dois anos, tendo mesmo algumas serviços atingido incrementos de 89,6%. A mudança de cultura organizacional das instituições envolvidas,no sentido da inovação e da proatividadeé também um facto a reter com particular relevância. Como conclusão, poderemos referir que este modelorespondeu as expectativas de todos os stakeholders, desde o governo, aos doentes e ao público em geral, bem assim como às das instituições de saúde implicadas e os seus profissionais. Deste modo, este modelo pode fornecer contributos sustentados de aprendizagem para a conceção e implementação de sistemas de reabilitação regional de um modo rápido e estruturado.

Статья посвящена исследованию правовых и институциональных механизмов реабилитации жертв пыток, сформированных в Республике Казахстан в результате имплементации Конвенции Организации Объединенных Наций против пыток и других видов жестокого или унижающего достоинство обращения и наказания. По результатам защиты третьего периодического доклада Казахстана по имплементации Конвенции против пыток и других жестоких бесчеловечных или унижающих достоинство видов обращения и наказания в 2014 г. Комитетом Организации Объединенных Наций против пыток был дан ряд рекомендаций, в числе которых обеспечивать более полную реабилитацию всем жертвам пыток. Следует отметить, что сегодня для Казахстана проблема реабилитации жертв пыток имеет научную новизну и актуализируется рекомендациями Комитета Организации Объединенных Наций против пыток. До настоящего времени юридическим сообществом не предпринимались шаги по оценке существующей системы предоставления реабилитационных услуг жертвам пыток. В статье проводится анализ зарубежного опыта реабилитации жертв пыток, задействованных механизмов и ресурсов проведения реабилитационных программ, а также системы реабилитации. Проведенный анализ позволил автору статьи выработать предложения и рекомендации по экстраполяции зарубежного опыта в правовом пространстве Республики Казахстан. Их реализация позволит сформировать в Республике Казахстан систему реабилитации жертв пыток в соответствии с международными стандартами и в свете рекомендаций Комитета Организации Объединенных Наций против пыток. В качестве основного результата проведенного в статье исследования автором предложена теоретическая модель создания более полного механизма реабилитации жертв пыток и жестокого обращения., This article is devoted to the study of legal and institutional mechanisms for the rehabilitation of torture victims, formed in the Republic of Kazakhstan as a result of the implementation of the Convention and the OSCE against Torture and Other Cruel or Degrading Treatment or Punishment. Following the results of the protection of Kazakhstan's third periodic report on the implementation of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, a number of recommendations were issued by the UN Committee against Torture in 2014, including recommending that all victims of torture provide fuller rehabilitation. It should be recognized that for modern Kazakhstan the problem of rehabilitation of victims of torture has a scientific novelty and is actualized by the recommendations of the UN Committee Against Torture. To date, no attempt has been made to assess the existing system for providing rehabilitation services to victims of torture. The article analyzes the foreign experience of rehabilitation of victims of torture, the mechanisms involved and the resources for carrying out rehabilitation programs, as well as the rehabilitation system. The analysis allowed the author of the article to develop proposals and recommendations on extrapolation of foreign experience in the legal space of the Republic of Kazakhstan. Realization of these proposals will allow to form a system of rehabilitation of victims of torture in the Republic of Kazakhstan in accordance with international standards and in the light of the recommendations of the UN Committee Against Torture. As the main result of the research conducted in the article, the author proposed a variant of a pilot project for the rehabilitation of victims of torture and ill-treatment., №2(45) (2018)

Objective: To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. Design: Randomized controlled trial. Subjects: A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental (n = 26) and control group (n = 26). Interventions: The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. Outcome measures: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. Results: Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). Conclusion: An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.

The article deals with the organization of cardiac rehabilitation in a rehabilitation center. Post stationary rehabilitation of various categories of cardiac patients should be performed on a single technology, but with taking into account the features of the rehabilitated contingents. Manufacturability of rehabilitation is ensured through risk stratification with the release of homogeneous groups of patients. Cardiorehabilitation success ensured its multidisciplinary character with the construction of personalized programs. A modular method for constructing individual rehabilitation programs is suggested.

Background: Disability can involve many by diseases, injuries, or aging, and thus access to rehabilitation services has a key role in improving these patients' social life. Since 2008, Iran has improved the access to rehabilitation facilities along with the global convention. Yet, nationwide studies are required to evaluate the fair distribution of centres in each province. Thus, the present study aimed to evaluate the distribution of outpatient rehabilitation services in 32 provinces of Iran to help policymakers make more appropriate decisions. Methods: In this cross sectional study, which was conducted between April and October 2017, a master facilities list (MFL) of rehabilitation services that was developed in Iran was used to identify health facilities. Data were collected from the statistics of the Deputy for Rehabilitation of Social Welfare Organization offices and Red Crescent Organization in 32 provinces of Iran. Descriptive data were analysed by SPSS version 22 and reported by percentage and number in 1 000 000 population; distribution was drawn on Iran's map by the GIS software. Results: According to the MFL, outpatient rehabilitation services include physical medicine & rehabilitation, physiotherapy, occupational therapy, speech therapy, audiometry, and orthotics & prosthetics (90%); other rehabilitation centres include general rehabilitation centres, day care centres, and vocational centres (10%). The largest number of occupational therapy, physiotherapy, and audiology offices were found in Tehran, where general rehabilitation centres, day care centres, and vocational centres were less than 3 per 1 000 000 population. There were no rehabilitation centers in 14 provinces, and there were very few physical medicine and rehabilitation centres in most of the provinces. Conclusion: There was significant difference in the distribution of outpatient rehabilitation facilities in different provinces of Iran and some provinces required urgent attention of policymakers, as they had the least number or no rehabilitation facilities.

This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren’s syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management. © 2016, International League of Associations for Rheumatology (ILAR).

Severe obesity is a chronic disease associated with medical and psychosocial comorbidity causing disability and poor quality of life that represents a social and economic burden for the National Health Systems worldwide. The Italian Society of Physical and Rehabilitation Medicine (SIMFER), the Italian Society of Obesity (SIO) and the Italian Society of Eating Disorders (SISDCA) have joined in a panel of experts to discuss a consensus document on the requisites of rehabilitation units devoted to patients affected by severe obesity with comorbidities. The main recommendations of the consensus document are the following: (1) the management of severe obesity should be characterized by the integration of nutritional, physical/functional rehabilitation, psycho-educational, and rehabilitative nursing interventions; (2) the intensity of the rehabilitative interventions should depend on the level of severity and comorbidities, frailty of the psychic status, degree of disability and quality of life of the patient; (3) the rehabilitative approach should be multidisciplinary and integrated in relation to the clinical complexity of obesity; (4) the estimated need for multidimensional rehabilitation of severe obesity is 1 bed per every 1,000 patients and of 4 beds in rehabilitative day-care ward every 1,000 patients suffering from severe obesity with comorbidities. © 2014 Springer International Publishing.

Severely obese patients affected by two or more chronic conditions which could mutually influence their outcome and disability can be defined as "complex" patients. The presence of multiple comorbidities often represents an obstacle for being admitted to clinical settings for the treatment of metabolic diseases. On the other hand, clinical Units with optimal standards for the treatment of pathological conditions in normal-weight patients are often structurally and technologically inadequate for the care of patients with extreme obesity. The aims of this review paper were to review the intrinsic (anthropometrics, body composition) and extrinsic (comorbidities) determinants of disability in obese patients and to provide an up-to-date definition of hospital-based multidisciplinary rehabilitation programs for severely obese patients with comorbidities. Rehabilitation of such patients require a here-and-now multidimensional, comprehensive approach, where the intensity of rehabilitative treatments depends on the disability level and severity of comorbidities and consists of the simultaneous provision of physiotherapy, diet and nutritional support, psychological counselling, adapted physical activity, specific nursing in hospitals with appropriate organizational and structural competences.

Aside from its prompt use in musculoskeletal injuries (sports lesions, degenerative/inflammatory joint disorders, and peripheral nerve pathologies), ultrasonographic imaging can be used quite conveniently in various types of rehabilitation conditions as well. If used in a rehabilitation setting, ultrasound can significantly contribute to the diagnostic/therapeutic algorithm of rehabilitation patients. Accordingly, in this article, the authors focus on the diagnostic/interventional utility of ultrasound particularly for shoulder problems, overuse injuries of wheelchair users, heterotopic ossification, amputee follow-up, peripheral nerve and botulinum toxin injections, and diaphragm imaging/electromyography. Copyright © 2012 by Lippincott Williams & Wilkins.

To measure the functional outcome we analyzed 723 consecutive patients with multiple injuries (Abbreviated Injury Scale (AIS)/Injury Severity Score (ISS) greater than or equal to 16, mean ISS 30.1) treated at the University Hospital Groningen, the Netherlands, between 1985 and 1989. Age, sex, type of accident, AIS/ISS, discharge destination, length of hospital stay and functional outcome (measured by the Glasgow Outcome Scale) are described. The patients were young (mean age 33.4 years) and 186 died (25.7%) mainly because of severe head injuries. Half of the survivors could be discharged home and 29% were transferred to a rehabilitation center. Rehabilitation centers predominantly treat patients with severe injuries of the head or neck and extremities. These injuries, together with spinal cord injuries, appeared to be responsible for the majority of permanent disabilities.Although the functional outcome deteriorated linearly with increasing AIS/ISS, the final functional result was good: in the first half year after injury there was considerable recovery; after that there was further slight recuperation. Two years after injury, 68% had mild or no disabilities, 19% were moderately disabled, and 7% severely disabled.

Objective: The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD).Methods: The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56±17.59) group or center-based rehabilitation (28 cases; mean age: 28.57±14.74 years). The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD.Results: Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p, Amaç: Çalışmamızın amacı 1 ila 3. evre arası tibialis posterior tendon disfonksiyonu (TPTD) olan hastalarda, ev egzersiz programı ile fizyoterapist denetiminde uygulanan rehabilitasyon programının etkinliğini karşılaştırmaktı. Çalışma planı: Çalışmaya TPTD tanısı konarak ortopedi uzmanı tarafından fizyoterapi departmanına yönlendirilmiş 49 olgu katıldı. Olgular rastgele ev egzersiz programı (21 olgu; ortalama yaş: 33.56±17.59) ve fizyoterapist denetiminde rehabilitasyon (28 olgu; ortalama yaş: 28.57±14.74) gruplarına alındı. Ev egzersizi grubuna soğuk uygulaması, tibialis posterior ve intrinsik kaslar için kuvvetlendirme egzersizleri ve subtalar nötralde germe egzersizi içeren bir ev programı verildi. Fizyoterapist denetimindeki gruba, ev programına ek olarak, fonksiyonel olmayan tibialis posterior kasının yeniden eğitimini içeren teknikler kapsamında, proprioseptif nöromusküler fasilitasyon yöntemleri, elektrik stimülasyonu, eklem mobilizasyonu ve bantlama tekniklerini içeren tedavi protokolü uygulandı. Her iki gruptaki olgulara da problemlerine uygun spesifik ortezler verildi. Olguların tümü, tedavi öncesi ve sonrası ağrı, kas kuvvetleri, ayak fonksiyon indeksi (AFİ) ve TPTD’ye özel testler açısından değerlendirildi. Bulgular: İstatistiksel analizler sonucunda, fizyoterapist denetimli grupta, olguların ağrı, 1. metatarsofalangeal açı, ön ayak abdüksiyon açısı, AFİ skoru ve tüm kasların kuvveti gibi göstergeler açısından ve ev egzersizi grubunda da tibialis posterior kas kuvveti açısından, tedavi öncesi ve sonraki ölçümleri istatistiksel olarak anlamlı fark göstermekteydi (p0.05).Çıkarımlar: 1 ila 3. evre arası TPTD tanısı alan hastalar için, ev programı olarak uygulanan ve fizyoterapist denetimindeki iki yaklaşımın da ağrının azaltılması ve fonksiyonelliğin geliştirilmesi konusunda eşit derecede tatmin edici olduğu görülmüştür. Hastanın spesifik gereksinimleri gözetilerek hazırlanmış, fizyoterapist denetimindeki bir program, tibialis posterior gücü açısından, evde gerçekleştirilecek bir rehabilitasyondan daha etkili olabilir.

Objective: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy.Design: Randomized, prospective, controlled single-blind trial.Setting: Department of physical medicine and rehabilitation, university hospital.Subjects: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group.Interventions: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise.Main measures: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion–extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after.Results: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group ( P Conclusions: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Objective: The aim of this study was to present demographic and clinical features of lower limb amputee patients who consulted to our orthopedic rehabilitation out patient-clinic, and to explore the related variables with functional situation in respect of amputation reason. Material and Methods: Demographic data, and clinic data of patients related to amputation and prosthesis use were recorded. Related variables with functional situation and quality of life were explored with composing two groups according to vascular and traumatic amputation reasons. Functional situation was evaluated with walking-speed with prothesis (meters/second) and 6-minute-walk-test(meters). Beck-Depression-inventory, Amputee-body-image-scale, and Short-Form-36(SF-36) were asked for replying by the patients. Results: Seventy one patients with mean age of 54,2 ±17,5 years (15-85) were evaluated. Time elapsed since amputation was 113.4 ±49.8, and mean time of prosthesis use was 84.8 ±24.8 months. Sixty two patients (%87.3) were male, and nine patients (%12.7) were female. It was detected that there were vascular amputation in 42 (%59.2), and traumatic amputation in 29 patients (%40.8). Walking-speed was 0.3 ± 0.3 m/s in vascular group, 0.9 ± 0.5 m/s in traumatic group, 6-minute-walk-distance was 60m in vascular, 246m in traumatic group(p

Objectives To assess the impact of clinical instability (CI) and delirium on admission to a rehabilitation unit on clinical and functional outcomes (death, transfer to acute care, poor functional recovery) at discharge, in a population of elderly patients. Design Observational study. Setting Rehabilitation and Aged Care Unit (RACU). Participants Participants were 583 consecutively and firstly admitted elderly patients. Measurements On admission, all patients underwent a comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. CI was recorded for all patients on admission, assessing 5 vital signs (temperature, heart rate, systolic blood pressure, respiratory rate, and oxygen saturation). Delirium was assessed daily with the Confusion Assessment Method. Results Patients were on average old (mean age: 77.8 ± 9.8), predominantly female (68.6%), with mild cognitive deterioration (MMSE: 22.1 ± 6.3) and depressive symptoms (GDS: 5.9 ± 3.5). They had moderate comorbidity (means CIRS: 3.1 ± 1.9), and functional impairment both before (Barthel Index pre-admission: 84.5 ± 19.2; IADL: 3.3 ± 3.0) and on admission (Barthel Index: 55.8 ± 27.5). On admission, 136 (23.3%) patients were classified as clinically unstable: 76 (13%) had either CI or delirium, and 60 (10.3%) had CI associated to delirium. At discharge, 26 patients were transferred to acute care hospitals, and 14 died. Transfer to acute care occurred in more than 10% of patients with almost one altered condition (CI or delirium), and in one fifth of patients with the association of CI and delirium. In-RACU death was observed only in this latter group. Functional recovery at discharge was significantly higher in stable patients than in patients with CI and/or delirium. Conclusions CI and delirium are useful prognostic markers of adverse clinical and functional outcomes in a population of elderly subjects admitted to a rehabilitative unit.

Background The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self-) Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter. Conclusion Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation., GMS Health Technology Assessment; 6:Doc11; ISSN 1861-8863

Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts).In a prospective study, we considered all patients who visited in a Low Vision and Rehabilitation Center between September 2007 and January 2009. Distance best corrected VA (DBCVA) was evaluated with the ETDRS LogMAR 4-m chart and a customized ETDRS 1-m chart, while near best corrected VA (NBCVA) was measured with the LogMAR conversion of the Parinaud 30-cm chart.One hundred and sixteen eyes (58 patients; 34 males and 24 females with a mean age of 69+/-19.4 [19-94] years) were included in the study. Mean DBCVA was 0.97+/-0.58 LogMAR, mean NBCVA was 0.28+/-0.2 LogMAR. In 52 eyes (44.8%), distance VA was less than 1/20 (DBCVA 1.86+/-0.5 LogMAR, NBCVA 0.08+/-0.05 LogMAR). Among the 58 best seeing eyes, DBCVA was 0.87+/-0.6 LogMAR, while NBCVA was 0.34+/-0.2 LogMAR. In 18 of 58 cases (31%), distance VA was less than 1/20 (DBCVA 1.86+/-0.59 and NBCVA 1.51+/-0.42).In a center for low vision and visual rehabilitation, a customized chart was necessary in 31% of cases for evaluation of VA. A fine measurement of low VA is useful for baseline assessment and for evaluation of changes during rehabilitation.

Objective: To test whether subcortical vascular lesions are associated with falls in elderly patients with gait disorder discharged from a rehabilitation ward. Design: Secondary 12-month follow-up analysis of an observational survey focusing on the prevalence of subcortical vascular lesions in a population of elderly patients discharged from rehabilitation hospitals. Setting: A rehabilitation and aged care unit. Participants: Consecutively admitted elderly patients (N=214) with gait disorder. Interventions: Not applicable. Main Outcome Measures: On admission, all patients underwent comprehensive geriatric assessment including sociodemographics, cognitive and depressive symptoms, nutritional status, physical health, and functional status. Subcortical vascular lesions were assessed on computed tomography films with a validated rating scale. All patients received a standardized rehabilitative program. Twelve months after discharge, all patients were interviewed by telephone, mainly focusing on the occurrence of falls during the follow-up period. Potential predictors of falls were assessed in univariate and multivariate analyses. Results: Univariate predictors of falls were age, sex, Mini-Mental State Examination, Barthel Index on admission, and subcortical vascular lesions. In multivariate analyses, subcortical vascular lesions were the only significant predictor of risk of falling; patients with moderate and severe subcortical vascular lesions scores had a greater risk of falling (odds ratio [OR]=3.0; 95% confidence interval [CI], 1.3-7.1; P=.012; OR=3.9; 95% CI, 1.6-9.2; P=.002, respectively) than those with no subcortical vascular lesions. Conclusions: Subcortical vascular lesions are associated with falls at 12 months in elderly patients with gait disorder discharged from a rehabilitative ward. Future research is needed to confirm our results. © 2008 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

"Der Beitrag präsentiert Zwischenergebnisse einer im Dezember 1995 angelaufenen Längsschnittstudie über die Wahmehmung und Verarbeitung von definierten chronischen Krankheiten (Herzinfarkt, Rückenschmerzen) bei 182 Patienten während ihres Aufenthaltes in einer Rehabilitationsklinik sowie im Anschluß an die stationäre Maßnahme. Die Auseinandersetzung mit einer chronischen Krankheit wird in diesem Beitrag als eine von den Individuen nichtintendierte Statuspassage im Lebenslauf angesehen, wobei nicht nur die psychophysische Integrität, sondern auch die soziale Verortung des Kranken in Frage gestellt wird. Das Ziel der Krankheitsverarbeitung besteht somit darin, über die Beschreibung der problematischen Aspekte hinaus, eine neue Sinnhaftigkeit herzustellen, d.h. ein Leben mit der Krankheit antizipierbar zu machen. Multidimensionale Konzepte von Gesundheit bzw. Lebensqualität als Handlungsergebnisse (Outcome) stellen Indikatoren dieser Verarbeitung dar. Als theoretischer Bezugsrahmen der Fragestellung wird die Ressourcentheorie Bourdieus nutzbar gemacht. In diesem Zusammenhang werden die drei Kapitalarten (sozial, ökonomisch, kulturell) als zur Verfügung stehende Handlungsressourcen erfaßt. Da Krankheitsverarbeitung nicht nur einen 'Vollzug sozial tradierter Wissensbestände' (Kohli) darstellt, sondern auch immer den 'Charakter des offenen Entwurfs' (Kohli) beinhaltet, gewinnt die zentrale Kategorie des Habitus als ein Produkt und Produzent von Praktiken zugleich seine Relevanz für diese Fragestellung. Der Habitus der Verarbeitung wird mit Hilfe des für Deutschland adaptierten 'Meaning-of-Illness'-Fragebogens erfaßt, welcher diesen inter-indiviuellen Konstruktionsunterschieden mit Hilfe von Appraisal-Prozessen Rechnung trägt. Die theoretische Herangehensweise erlaubt es, die Bedeutung von Handlungsressourcen und Wahrnehmungsunterschieden für die Verarbeitung des Lebensereignisses 'chronische Krankheit' anhand ausgewählter Parameter zu analysieren." (Autorenreferat)