Rehab Centers: Recommendations for Physical Activity, Recreation Sport, and Exercise Training in Paediatric Patients With Congenital Heart Disease: A Report From the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology.

Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology.

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Eur J Prev Cardiol. 2012 Oct; 19(5): 1034-65
Takken T, Giardini A, Reybrouck T, Gewillig M, Hövels-Gürich HH, Longmuir PE, McCrindle BW, Paridon SM, Hager A

All children have a natural need to move, play, and perform activities. Physical activity is necessary for optimal physical, emotional, and psychosocial development for healthy children as well as children with congenital heart disease (CHD). In this paper we provide recommendations for physical activity, recreational sport, and exercise training in children and adolescents with CHD. In general, children with CHD should be advised to comply with public health recommendations of daily participation in 60 min or more of moderate-to-vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities. While all patients with CHD can participate and benefit from physical activity and exercise, those with specific lesions or complications may require counselling regarding precautions and recommendations.
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Periarticular injection with bupivacaine for postoperative pain control in total knee replacement: a prospective randomized double-blind controlled trial.

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Adv Orthop. 2012; 2012: 107309
Yuenyongviwat V, Pornrattanamaneewong C, Chinachoti T, Chareancholvanich K

Background. Local periarticular injection with bupivacaine alone in TKA has not been studied. Thus, we aimed to examine the effectiveness of local periarticular injection with bupivacaine for post-operative pain control in TKA. Method. Sixty patients undergoing TKA by a single surgeon were randomly assigned into two groups in a double-blind, placebo-controlled study. In the injection group, patients received periarticular injections with 0.25% bupivacaine before wound closure; in the control group, patients received a 0.9% normal saline injection. Both groups received the same anesthetic procedure, post-operative pain control, and rehabilitation protocol. Results. There was a significant reduction in post-operative morphine consumption in the first six hours after the operation (mean 0.9?mg and 2.43?mg, P = 0.01), but there was no significant difference in post-operative morphine consumption between six hours and ninety-six hours after the operation, visual analogue scale (VAS) score, morphine side effects during the first 96 hours, length of hospital stay, or complications from morphine consumption. Conclusion. Local periarticular injection with bupivacaine alone before wound closer was shown to be an effective method to improve pain control after TKA with a few complications and ease of use.
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Participants’ Perspectives on the Feasibility of a Novel, Intensive, Task-Specific Intervention for Individuals With Chronic Stroke: A Qualitative Analysis.

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Phys Ther. 2012 Nov 2;
Merlo AR, Goodman A, McClenaghan BA, Fritz SL

BACKGROUND: Evidenced-based practice promotes patient centered care, yet the majority of rehabilitative research fails to take into consideration patient perspectives. Qualitative research provides a unique opportunity for patients to express opinions and provide valuable insight on intervention processes. OBJECTIVE: To assess the feasibility of a novel, intensive, task-specific intervention from the participant’s perspective. DESIGN: Qualitative inquiry using a phenomenological approach. METHOD: Eight individuals with chronic stroke participated in an intensive intervention, three hours per day for 10 consecutive days. Participants were interviewed twice regarding their impressions of the therapy and focus group was conducted with participants and family members. Data analysis included an analytical thematic approach using Nvivo 8 Software. RESULTS: Five major themes arose related to the feasibility of the intervention: a manageable amount of fatigue; a difficult, yet doable level of intensity; a disappointingly short therapy duration; enjoyment of the intervention; and muscle soreness. CONCLUSIONS: These findings suggest that participants perceive this novel and intensive, task-specific intervention as a feasible therapeutic option for individuals with chronic stroke. Despite the fatigue and muscle soreness associated with intensive rehabilitation, participants frequently reported enjoying the therapy and stated disappointment with the short duration (10 days). Future research should include a feasibility trial of longer duration, as well as a qualitative analysis of the benefits associated with the intervention.
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The STarT Back Screening Tool and Individual Psychological Measures: Evaluation of Prognostic Capabilities for Low Back Pain Clinical Outcomes in Outpatient Physical Therapy Settings.

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Phys Ther. 2012 Nov 2;
Beneciuk JM, Bishop MD, Fritz JM, Robinson ME, Asal NR, Nisenzon AN, George SZ

BACKGROUND: Psychologically informed practice emphasizes routine identification of modifiable psychological risk factors being highlighted. OBJECTIVE: The purpose of this study was to test the predictive validity of the STarT Back Screening Tool (SBT) in comparison to single-construct psychological measures for 6-month clinical outcomes. DESIGN: Observational, prospective cohort study. METHOD: Patients (n = 146) receiving physical therapy for LBP were administered the SBT and a battery of psychological measures (Fear-Avoidance Beliefs Questionnaire (physical activity scale – FABQ-PA; work scale – FABQ-W); Pain Catastrophizing Scale – PCS; Tampa Scale of Kinesiophobia – TSK-11; and Patient Health Questionnaire – PHQ-9) at initial evaluation and 4-weeks later. Treatment was at the physical therapist’s discretion. Clinical outcomes consisted of pain intensity and self-reported disability. Prediction of 6-month clinical outcomes was assessed for intake SBT and psychological measure scores using multiple regression models while controlling for other prognostic variables. In addition, we assessed the predictive capabilities of intake to 4-week changes in SBT and psychological measure scores for 6-month clinical outcomes. RESULTS: Intake pain intensity (? = .39 to .45) and disability (? = .47 to .60) scores were the strongest predictors in all final regression models explaining 22% and 24% and 43% and 48% of the variance for the respective clinical outcome at 6-months. Neither SBT nor psychological measure scores improved prediction of 6 month pain intensity. SBT overall (? = .22) and SBT psychosocial (? =.25) scores added to the prediction of disability at 6-months. Four-week changes in TSK-11 scores (? = -.18) were predictive of pain intensity at 6-months. Four-week changes in FABQ-PA (? = -.21), TSK-11 (? = -.20) and SBT overall (? = -.18) scores were predictive of disability at 6-months. LIMITATIONS: Physical therapy treatment was not standardized or accounted for in the analysis. CONCLUSIONS: Prediction of clinical outcomes by psychology-based measures was dependent on the clinical outcome domain of interest. Similar to studies from the primary care setting, initial screening with the SBT provided additional prognostic information for 6-month disability and changes in SBT overall scores may provide important clinical decision-making information for treatment monitoring. In comparison to the SBT, individual psychological measures (i.e., TSK-11 and FABQ-PA) may potentially be more appropriate for treatment monitoring.
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