What Functional Aspects Explain Patients’ Impression of Change After Rehabilitation for Long-Lasting Low Back Pain?

What Functional Aspects Explain Patients’ Impression of Change after Rehabilitation for Long-lasting Low Back Pain?

Physiother Res Int. 2013 May 30;
Anderson B, Lygren H, Magnussen LH, Eide GE, Strand LI

BACKGROUND: Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies. PURPOSE: To examine whether the patients’ global impression of change (PGIC) after rehabilitation was explained by change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution primarily by the self-reported measures. METHODS: A test-retest design, within a prospective cohort study of patients with long-lasting low back pain. 96 patients were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5?weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. The study was approved by the Regional Committee for Medical Research Ethics and the National Data Inspectorate of Norway. RESULTS: In unadjusted analysis, change in pain, daily functioning and change in six physical tests contributed to the explained variance (R2: 6-24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5?weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training. CONCLUSION: Most measures demonstrated change that was of significance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients’ impression of change after controlling for change in pain and daily life functioning and may seem important to assess in addition to the self-report measures in intervention studies. Copyright © 2013 John Wiley & Sons, Ltd. HubMed – rehab


Disability Evaluation, Social Security, and the International Classification of Functioning, Disability and Health: The Time Is Now.

J Occup Environ Med. 2013 May 29;
Escorpizo R, Stucki G

OBJECTIVE:: To present the International Classification of Functioning, Disability and Health (ICF) as a standard in disability evaluation and to discuss the usefulness and challenges of the ICF when applied in disability evaluation. CONCLUSIONS:: Disability evaluation can be described and measured using the ICF and ICF-related tools such as the Generic Set, ICF Core Sets specific to health conditions or settings, and measurement instruments that have been linked to the ICF. Wide implementation of the ICF in disability evaluation, specifically in work disability and social security, is needed along with education on the ICF of those in occupational medicine, work rehabilitation, disability adjudication, policy and legislation, and government agencies. The ICF can be used to provide disability criteria in determining functional and work capacity and as a reference framework and a language of disability to help facilitate a common ground of understanding. HubMed – rehab


Adjustments to amputation and an artificial limb in lower limb amputees.

Prosthet Orthot Int. 2013 May 30;
Sinha R, van den Heuvel WJ, Arokiasamy P

Background:Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process.Objectives:To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and amputation-related factors that could potentially influence these adjustments.Study design:Cross-sectional.Methods:Adult unilateral and non-congenital lower limb amputees (n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient’s background, amputation and the Trinity Amputation and Prosthesis Experience Scales.Results:Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level.Conclusions:Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees.Clinical relevanceProper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment. HubMed – rehab


Forces and moments in knee-ankle-foot orthoses while walking on irregular surfaces: A case series study.

Prosthet Orthot Int. 2013 May 30;
Andrysek J, Klejman S, Kooy J

Background:Kinetic data provide important information about the mobility performance of individuals with lower limb impairments and their assistive devices; however, there is limited understanding of this in real-life environments.Objective:To evaluate the effect of real-life irregular surfaces on forces and moments in knee-ankle-foot orthoses.Methods:In this case series study, a load cell was used to measure the forces and moments at the knee joint of knee-ankle-foot orthoses of individuals with unilateral muscle weakness as a result of poliomyelitis while walking on different ground surfaces and at different speeds.Results:Significantly higher shear forces and external peak knee flexion moments were found when walking on irregular surfaces. In individual cases, certain irregular ground conditions elicited large increases in peak flexion moments (>50%) when compared to walking on smooth level ground. Forces and moments were significantly higher at faster walking speeds.Conclusions:Higher external peak knee flexion moments during the stance phase suggest that greater demands for support and stability are placed on individuals and their assistive devices when negotiating real-life ground surfaces.Clinical relevanceThis study demonstrates that walking on irregular surfaces alters the loads placed on knee-ankle-foot orthoses and that the requirements for knee stabilization increase. This has important clinical implications on the design, prescription, and use of such devices given the structural and functional demands placed on them. HubMed – rehab


Implant-Associated Anaplastic Large Cell Lymphoma: Beyond Breast Prostheses.

Ann Plast Surg. 2013 May 30;
Kellogg BC, Hiro ME, Payne WG

OBJECTIVE: Anaplastic large cell lymphoma (ALCL) is a rare form of non-Hodgkin T-cell lymphoma potentially associated with silicone-shelled breast implants. The low incidence of ALCL has prevented establishment of causality. Many implantable devices are constructed with biomaterials similar to those used in breast prostheses. The purpose of this paper is to identify reports of ALCL in association with other types of implantable devices. METHODS: A literature review was conducted using PubMed to identify reports of non-Hodgkin lymphoma in association with various implantable devices. RESULTS: One case of ALCL was identified in association with a stainless steel internal fixation plate. Diffuse large B-cell lymphoma was widely reported in association with various implantable biomaterials and chronic inflammation. CONCLUSION: The neoplastic response associated with breast prostheses appears substantively different from other implantable devices. Physicians caring for patients with silicone elastomer-containing implants should have increased suspicion for implant-associated ALCL and report all pertinent cases in the literature. HubMed – rehab