Impact of anti-gravity treadmill rehabilitation therapy on the clinical outcomes after fixation of lower limb fractures: A randomized clinical trial

A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage

This study was conducted to investigate the effects of anti-gravity treadmill (AGT) training, which provides visual feedback and Biorescue training on proprioception, muscle strength, balance, and gait, in stroke patients. A total of 45 people diagnosed with post-stroke were included as study subjects; they were randomized to an AGT training group provided with visual feedback (Group A), a Biorescue training group provided with visual feedback (Group B), and an AGT/Biorescue group that subsequently received AGT training and Biorescue training (Group C). A muscle strength-measuring device was used to evaluate muscle strength. Timed Up and Go and Bug Balance Scale assessment sheets were used to evaluate balance ability. Dartfish software was used to evaluate gait ability. The results of the study showed that Groups A and C had a significant increase in muscle strength compared with Group B; in terms of balance and gait abilities, Group C showed a significant increase in balance ability and gait speed and a significant change in knee joint angle compared with Groups A and B. In conclusion, this study suggests that including a method that applies multiple therapeutic interventions is desirable in the rehabilitation of stroke patients to improve their independence.

Effect of the Holistic Nursing Model of Responsibility System on the Mental State of Elderly Patients with Limb Fractures Fixed by Splints in the Emergency Department

Objective

To explore the effect of the overall nursing mode of responsibility system on the psychological state of elderly patients with limb fractures fixed by splints.

Methods

This study selected 150 elderly patients who received emergency treatment of a limb fracture fixed by a traditional Chinese medicine splint in our hospital from May 2018 to June 2021 as the research subjects. They were divided into a control group and an observation group, with 75 cases in each group. The control group was intervened by traditional nursing mode, and the research group was intervened by responsible overall nursing mode. The quality of nursing work was observed and compared with the nursing staff's work quality and satisfaction, patients' psychological states and satisfaction, and the risk of clinical adverse events.

Results

After management, the quality of nursing work in the two groups was significantly improved. Compared with before management, the scores of basic nursing measures, nursing of critical patients, ward environment management, disinfection and isolation, rescue drugs and instruments, and nursing document management in the observation group were significantly higher than those in the control group (P < 0.05). After management, the work quality and satisfaction of nurses in the two groups were significantly higher than those before management. The SERVQUAL scale score and satisfaction score in the observation group were significantly higher than those in the control group (P < 0.05). The scores of HAMA and HAMD in the observation group were significantly lower than those in the control group (P < 0.05). The overall satisfaction of nursing in the observation group was 96.00%, which was significantly higher than the 80.00% in the control group (P < 0.05). The incidence of adverse events in the observation group was 8.00%, which was significantly lower than 17.33% in the control group (P < 0.05).

Conclusion

Giving elderly patients with limb fracture emergencies treated with splint fixation using traditional Chinese medicine the overall nursing mode management and responsibility system can give the elderly patients comprehensive and systematic clinical nursing, increase their trust and compliance with nursing work, improve the patient's psychological state, improve clinical satisfaction, and achieve the ideal doctor-patient relationship, which is worthy of clinical application.

Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review

OBJECTIVES

To explore the characteristics and to report on the effectiveness of postoperative rehabilitation strategies for people with an ankle fracture.

DATA SOURCES

PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL were searched to identify studies published from January 2010 to November 2021.

STUDY SELECTION

Studies that described or evaluated postoperative rehabilitation strategies for surgically repaired ankle fractures were included.

DATA EXTRACTION

Data on postoperative rehabilitation were extracted in accordance with the Template for Intervention Description and Replication guide. Quality was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tools.

DATA SYNTHESIS

Meta-analysis was planned to look at the effectiveness of postoperative rehabilitation strategies. Forty studies described postoperative rehabilitation strategies without evaluating effectiveness, whereas 15 studies focused on evaluating effectiveness. Because of the large variety in postoperative strategies and outcomes, narrative synthesis was deemed most suitable to answer our aims. Characteristics of postoperative rehabilitation strategies varied widely and were poorly described in a way that could not be replicated. Most of the studies (48%) used a late weight-bearing approach, although definitions and details around weight-bearing were unclear.

CONCLUSIONS

Late weight-bearing has been the most common postoperative approach reported in the past 10 years. The variety of definitions around weight-bearing and the lack of details of rehabilitation regimens limit replication and affect current clinical practice. The authors propose to adopt consistent definitions and terminology around postoperative practices such as weight-bearing to improve evidence for effectiveness and ultimately patient outcomes.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Role of Antigravity Training in Rehabilitation and Return to Sport After Running Injuries

Anti-gravity treadmill training is a therapeutic option to help recovering runners return to activity after injury. This current concept paper provides a synopsis of the latest evidence of the biomechanical and metabolic changes that occur with body weight support (BWS) treadmill training, effects of antigravity treadmill training on clinical outcomes and clinical case studies in injured runners. Literature searches identified studies with descriptive, experimental and interventional designs and case studies that examined acute and chronic use of antigravity treadmills in runners and relevant populations. Laboratory-based studies were included to provide technical considerations for rehabilitation programming. Antigravity treadmills use causes reductions in cadence, ground reaction forces (GRF), GRF impulses, knee and ankle range of motion, and vertical stiffness, with elevations in stride duration, flight time, ground contact time, and plantarflexion. Antigravity treadmills appear useful across a spectrum of injuries in runners, including postsurgical repair of osteochondral defect, stress reactions (medial tibia, pelvis), and lumbar disc herniation. Runners may preserve aerobic fitness, muscle activation patterns, and muscle mass during recovery compared to traditional rehabilitation protocols. Technical considerations for accurate loading include treadmill frame adjustment to appropriate height to ensure accuracy of level of BWS while running, and monitoring for fast cadence to ensure impact loading rates remain low. Speed or grade can be increased to maintain metabolic demand and fitness while minimizing bone and tissue loading. Monitoring for symptom provocation will guide protocol adjustments to BWS and prescriptions. Once able to run pain-free (sustained or interval) >95% BWS for >30 min, the runner is likely ready to safely transition to ground running. Antigravity treadmill training can be considered when available to facilitate smooth transition back to ground running in a conditioned state.

Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care

SUMMARY

In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non-weight-bearing while avoiding complications associated with premature return to full weight-bearing. This article describes a multicenter randomized controlled trial comparing outcomes after a 10-week antigravity treadmill therapy program versus standard of care in adult patients with periarticular fractures of the knee and distal tibia. The primary hypothesis is that, compared with patients receiving standard of care, patients receiving antigravity treadmill therapy will report better function 6 months after definitive treatment.

Anti-gravity treadmill rehabilitation improves gait and muscle atrophy in patients with surgically treated ankle and tibial plateau fractures after one year: A randomised clinical trial

OBJECTIVE

To compare the one-year postoperative outcomes of anti-gravity treadmill rehabilitation with those of standard rehabilitation in patients with ankle or tibial plateau fractures.

DESIGN

An open-label prospective randomised study.

SETTING

Three trauma centres.

SUBJECTS

Patients were randomised into the intervention (anti-gravity treadmill) or control (standard protocol) rehabilitation group.

MAIN MEASURES

The primary endpoint was changes in the Foot and Ankle Outcome Score for ankle fractures and Knee Injury and Osteoarthritis Outcome Score for tibial plateau fractures from baseline to 12 months after operation. Secondary endpoints were the subscores of these scores, muscle atrophy (leg circumference at 20 cm above and 10 cm below the knee joint) and the Dynamic Gait Index.

RESULTS

Initially, 73 patients (37 vs 36) underwent randomisation. After 12 months, 29 patients in the intervention group and 24 patients in the control group could be analysed. No significant difference was noted in the Foot and Ankle Outcome Score (80.8 ± 18.4 and 78.4 ± 21.1) and Knee Injury and Osteoarthritis Outcome Score (84.8 ± 15.2 and 81.7 ± 17.0). The change in the Dynamic Gait Index from 12 weeks to 12 months differed significantly between the groups (P = 0.04). Patients with tibial plateau fractures had a 3 cm wider thigh circumference in the intervention group than those in the control group (95% confidence interval: -0.2 to 6.3 cm, P = 0.08).

CONCLUSION

One year after surgery, patients who had undergone anti-gravity treadmill rehabilitation showed better gait than patients in the control group, and those with tibial plateau fractures had less muscle atrophy.