The Effects of Interdisciplinary Team Assessment and a Rehabilitation Program for Patients With Chronic Pain.

The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain.

Filed under: Rehab Centers

Am J Phys Med Rehabil. 2013 Jan; 92(1): 77-83
Pietilä Holmner E, Fahlström M, Nordström A

The aim of this study was to evaluate the effects of interdisciplinary team assessment and a 4-wk rehabilitation program in chronic pain patients.This was a longitudinal cohort study evaluating interdisciplinary pain rehabilitation measures in a specialist care setting. A total of 93 women (42.2 ± 9.5 yrs) with chronic musculoskeletal pain (median pain duration, 8 yrs) were evaluated at assessment and at the start and end of the rehabilitation program. Pain intensity measured with a visual analog scale, pain dimensions measured with the Multidimensional Pain Inventory, and anxiety and depression measured with the Hospital Anxiety and Depression Scale were registered.The participants exhibited significantly improved results of pain and pain-related measures. The results were seen both after the short-term intervention in the form of the interdisciplinary assessment and after the 4-wk rehabilitation program. The improvements seen after the assessment were not related to specific interventions, such as change of medication, and therefore seem to be a result of the interdisciplinary assessment concept as such.Both interdisciplinary assessment and rehabilitation program seem to be effective in chronic pain rehabilitation, at least for women. Further studies are needed to investigate potential sex differences, as well as content and duration for optimal pain rehabilitation programs.
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Use of a squatting movement as a clinical marker of function after total knee arthroplasty.

Filed under: Rehab Centers

Am J Phys Med Rehabil. 2013 Jan; 92(1): 53-60
Rossi MD, Eberle T, Roche M, Brunt D, Wong M, Waggoner M, Blake R, Burwell B, Baxter A

The aims of this study were to evaluate weight bearing during standing and 30- and 60-degree squats approximately 1 wk and 2 mos after surgery and determine whether weight bearing during squatting could be a better clinical marker than standing for identifying perceived functional limitation approximately 1 wk after surgery. A further objective was to determine whether age, body mass index, and number of outpatient visits over the course of rehabilitation predicted weight bearing during a squat approximately 2 mos after surgery.The percentage of body weight placed over both limbs during stand and 30- and 60-degree squats in 38 patients (25 women and 13 men) who had primary unilateral knee arthroplasty was determined. An asymmetry index would be used as a marker that could discriminate between those who perceived at least moderate difficulty with functional tasks and those who perceived only slight or no difficulty with functional activities based on the physical function dimension of the Western Ontario McMaster Universities Osteoarthritis index approximately 1 wk after surgery. Stepwise regression was conducted to determine whether clinical characteristics predicted weight-bearing asymmetry at discharge.At initial visit (first observation), and compared with the uninvolved side, individuals placed significantly less body weight over the involved or operated limb for stand and 30- and 60-degree squats (P < 0.0001). Results were similar at last rehabilitation visit (second observation). Identifying at least moderate self-reported difficulty with functional tasks based on the receiver operator characteristic curve for the asymmetry index for the stand position was 0.64, whereas for the 30- and 60-degree squats, the area under the curve was 0.81 and 0.89, respectively. At discharge from rehabilitation, there was a moderate to good direct relationship (r = 0.70) between the number of rehabilitation visits completed and the weight-bearing asymmetry index for the 60-degree squat.On the first outpatient visit, individuals who had primary unilateral knee arthroplasty placed more body weight over the uninvolved side for the three weight-bearing positions. With high probability, the asymmetry index for both squatting angles identified perceived functional difficulty. As rehabilitation visits increased, there was a direct association to improved interlimb weight-bearing symmetry when squatting to 60 degrees. HubMed – rehab


Effects of acute joint effusion on balance in patients with knee osteoarthritis.

Filed under: Rehab Centers

Am J Phys Med Rehabil. 2013 Jan; 92(1): 45-52
Hong BY, Lim SH, Im SA, Lee JI

The purpose of this study was to assess the effects of acute joint effusion on balance in patients with knee osteoarthritis.Forty-four female subjects with painful knee osteoarthritis participated in this single-blind, randomized, controlled clinical trial. All subjects were randomly assigned to either the injection or the control group. A volume of 20 ml of normal saline was injected into the knee joint cavity of the test subjects, who performed static and dynamic balance tests twice before and after joint infusion. The subjects in the control group performed the same tests without joint infusion. The outcome variables for static measurement were the mean speeds (millimeter per second) of the movement of the center of pressure in the mediolateral and anteroposterior directions and the mean velocity moment (square millimeter per second) with both eyes opened and eyes closed conditions. For dynamic measurement, time (second) and distance (millimeter) of the center of pressure were used.Significant interaction of the balance-test variables (mean speeds, velocity moment, time, and distance) between the groups and time (P > 0.05) was not found. There were no significant differences between the groups in any of the balance-test variables (P > 0.05).This study showed that acute joint effusion has no effect on static or dynamic postural sway in patients with knee osteoarthritis.
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