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Silvester L, Higo A, Kearney RS, McWilliams D, Palmer S. Key components of rehabilitation programmes for adults with complex fractures following traumatic injury: A scoping review. Injury 2024; 55:111801. [PMID: 39128165 PMCID: PMC11422290 DOI: 10.1016/j.injury.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/30/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Complex fractures are severe injuries that cause considerable disability, particularly in the working population. Effective rehabilitation is essential to achieve good outcomes, however, it is unclear what the best rehabilitation strategy is for adults with complex fractures, after their discharge from hospital. The aim of this scoping review was to identify and map the breadth of evidence available on this topic. METHODS A systematic search was completed on 24th July 2023 using a combination of subject and specialist databases. In addition, a secondary search assessed unpublished literature from trial registries. A citation search was completed on the selected studies. The template for intervention description and replication (TIDieR) checklist was used to extract consistent data on the interventions reported in the studies. The Joanna Briggs Institute methodology for scoping reviews was followed. RESULTS 19,253 studies were identified from the search strategy of which 25 studies met the eligibility criteria. Most interventions were exercise-based and delivered by physiotherapists. Some studies compared manual therapy treatments to other forms of physiotherapy or a placebo, whilst others investigated psychosocial interventions, such as cognitive behavioural therapy, in comparison to usual care. Two studies took a multidisciplinary team approach, incorporating components such as exercise, functional activities and self-management strategies. DISCUSSION The studies included were heterogenous in terms of population (fracture type, location and complexity), intervention content and therapeutic aims. However, commonalities were found with most interventions or comparators including range of movement, strengthening and task specific exercises; functional tasks; gait and balance training; and advice on return to activities as components. Value was attributed to components such as, a coordinated team approach, person-centred rehabilitation, supervised exercise and psychosocial support. CONCLUSION There is a broad and varied approach to the rehabilitation of complex fractures. The studies differed in population and approach, with a wide range of injuries, interventions and modes of delivery reported. Fidelity was poorly described, with only a third of studies reporting adherence or acceptability. There was inconclusive evidence to inform clinical practice and further research is advised. Qualitative, expert consensus, and coproduction approaches are recommended methods to develop complex interventions and best practice guidance.
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Affiliation(s)
- Lucy Silvester
- Institute for Applied & Translational Technologies in Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Anna Higo
- Research Centre for Healthcare & Communities, Coventry University, Priory Street, Coventry CV1 5FB, United Kingdom
| | - Rebecca S Kearney
- Bristol Trials Centre, University of Bristol, Whiteladies Road, Bristol BS8 1NU, United Kingdom
| | - David McWilliams
- Centre for Care Excellence, Coventry University, Priory Street, Coventry CV1 5FB, United Kingdom
| | - Shea Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff CF14 4YU, United Kingdom
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Lewis SR, Pritchard MW, Parker R, Searle HKC, Beckenkamp PR, Keene DJ, Bretherton C, Lin CWC. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2024; 9:CD005595. [PMID: 39312389 PMCID: PMC11418975 DOI: 10.1002/14651858.cd005595.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Ankle fracture is one of the most common lower limb fractures. Whilst immobilisation of the ankle can support and protect the fracture site during early healing, this also increases the risk of ankle weakness, stiffness, and residual pain. Rehabilitation aims to address the after-effects of this injury, to improve ankle function and quality of life. Approaches are wide-ranging and include strategies to improve ankle joint movement, muscle strength, or both. This is an update of a Cochrane review last published in 2012. OBJECTIVES To assess the effects of rehabilitation interventions following surgical or non-surgical management of ankle fractures in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two clinical trials registers in May 2022, and conducted additional searches of CENTRAL, MEDLINE, and Embase in March 2023. We also searched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing any rehabilitation intervention delivered to adults with ankle fracture. Interventions could have been given during or after the initial fracture management period (typically the first six weeks after injury), which may or may not have included surgical fixation. We excluded participants with multi-trauma, pathological fracture, or with established complications secondary to ankle fracture. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data for five outcomes: activity limitation (ankle function), health-related quality of life (HRQoL), participant satisfaction with treatment, pain, and adverse events (we focused on re-operation, defined as unplanned return to theatre). We report the findings up to six months after injury. MAIN RESULTS We included 53 studies (45 RCTs, 8 quasi-RCTs) with 4489 adults with ankle fracture. In most studies, orthopaedic management included surgical fixation but was non-surgical in five studies, and either surgical or non-surgical in six studies. Here, we summarise the findings for three common rehabilitation comparisons; these included the most data and were the most clinically relevant. Because of different intervention approaches, we sometimes included a study in more than one comparison. Data for other less common comparisons were also available but often included few participants and were imprecise. All studies were unavoidably at high risk of performance and detection bias. We downgraded the certainty of all evidence for this reason. We also downgraded for imprecision and when we noted inconsistencies between studies that precluded meta-analysis of data. Early (within 3 weeks of surgery) versus delayed weight-bearing (12 studies, 1403 participants) Early weight-bearing probably leads to better ankle function (mean difference (MD) 3.56, 95% confidence interval (CI) 1.35 to 5.78; 5 studies, 890 participants; moderate-certainty evidence); however, this does not include a clinically meaningful difference. Early weight-bearing may offer little or no difference to HRQoL compared to delayed weight-bearing (standardised mean difference (SMD) 0.15, 95% CI -0.01 to 0.30; 5 studies, 739 participants; low-certainty evidence); when translated to the EQ-5D scale (a commonly-used HRQoL questionnaire), any small difference was not clinically important. We were unsure whether there were any differences in participant satisfaction or pain because these outcomes had very low-certainty evidence. For adverse events, there may be little or no difference in re-operation (risk ratio (RR) 0.50, 95% CI 0.09 to 2.68; 7 studies, 1007 participants; low-certainty evidence). Removable versus non-removable ankle support (25 studies, 2206 participants) Following surgery, using a removable ankle support may lead to better ankle function (MD 6.39, 95% CI 1.69 to 11.09; 6 studies, 677 participants; low-certainty evidence). This effect included both a clinically important and unimportant difference. There is probably an improvement in HRQoL with a removable ankle support, although this difference included both a clinically important and unimportant difference when translated to the EQ-5D scale (SMD 0.30, 95% CI 0.11 to 0.50; 3 studies, 477 participants; moderate-certainty evidence). No studies reported participant satisfaction. We were unsure of the effects on pain because of very low-certainty evidence (1 study, 29 participants). There may be little or no difference in re-operations (RR 1.20, 95% CI 0.39 to 3.71; 6 studies, 624 participants; low-certainty evidence). Following non-surgical management, there may be little or no difference between removable and non-removable ankle supports in ankle function (MD 1.08, 95% CI -3.18 to 5.34; 3 studies, 399 participants), and HRQoL (SMD -0.04, 95% CI -0.24 to 0.15; 3 studies, 397 participants); low-certainty evidence. No studies reported participant satisfaction. We were unsure of the effects on pain (2 studies, 167 participants), or re-operation because of very low-certainty evidence (1 study, 305 participants). Physical therapy interventions versus usual care or other physical therapy interventions (9 studies, 857 participants) Types of interventions included the use of active controlled motion, a spring-loaded ankle trainer, an antigravity treadmill, and variations of enhanced physiotherapy (e.g. additional stretching, joint mobilisation, neuromuscular exercises), delivered during or after the initial fracture management period. We were unable to pool data because of the differences in the design of interventions and their usual care comparators. Studies often included very few participants. The certainty of the evidence for all outcomes in this comparison was very low, and therefore we were unsure of the effectiveness of these therapies. No studies in this comparison reported re-operation. AUTHORS' CONCLUSIONS Early weight-bearing may improve outcomes in the first six months after surgery for ankle fracture, but the difference is likely to be small and may not always be clinically important. A removable ankle support may also provide a better outcome, but again, the difference may not always be clinically important. It is likely that neither approach increases the re-operation risk. We assume that the findings for these comparisons are applicable to people with closed ankle fractures, and that satisfactory fracture stabilisation had been achieved with surgery. For people who have non-surgical treatment, there is no evidence that either a removable or non-removable ankle support may be superior. We were uncertain whether any physical therapy interventions were more effective than usual care or other physical therapy interventions. We encourage investigators of future studies on rehabilitation interventions for ankle fracture to use a core outcome set.
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Affiliation(s)
- Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michael W Pritchard
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Henry KC Searle
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Paula R Beckenkamp
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David J Keene
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Chris Bretherton
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Chung-Wei Christine Lin
- Musculoskeletal Health Sydney, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Lee JH, Lee DH. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage. Open Med (Wars) 2023; 18:20230828. [PMID: 37900962 PMCID: PMC10612527 DOI: 10.1515/med-2023-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/04/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
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.
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Affiliation(s)
- Jung-Ho Lee
- Physical therapy, Kyungdong University, Goseong-gun, Republic of Korea
| | - Dae-Hwan Lee
- Physical therapy, Kyungdong University, Goseong-gun, Republic of Korea
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Du S, Hao Y, Jiao Y. 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. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:1271606. [PMID: 37457496 PMCID: PMC10348845 DOI: 10.1155/2023/1271606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 07/18/2023]
Abstract
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.
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Affiliation(s)
- Shaolan Du
- Emergency Department, Baoji Central Hospital, Baoji, Shaanxi 721008, China
| | - Yanli Hao
- Department of Ophthalmology, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi 716000, China
| | - Yajuan Jiao
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi 721008, China
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Plinsinga M, Manzanero S, Johnston V, Andrews N, Barlas P, McCreanor V. Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review. J Orthop Trauma 2022; 36:e449-e457. [PMID: 36399682 DOI: 10.1097/bot.0000000000002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Melanie Plinsinga
- Jamieson Trauma Institute, Metro North Health, Herston, Australia
- RECOVER Injury Research Centre, the University of Queensland, Herston, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Silvia Manzanero
- Jamieson Trauma Institute, Metro North Health, Herston, Australia
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, the University of Queensland, Herston, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Australia
| | - Nicole Andrews
- RECOVER Injury Research Centre, the University of Queensland, Herston, Australia
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Herston, Australia
- Occupational Therapy Department, the Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia; and
| | - Panos Barlas
- Jamieson Trauma Institute, Metro North Health, Herston, Australia
| | - Victoria McCreanor
- Jamieson Trauma Institute, Metro North Health, Herston, Australia
- AusHSI, Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Australia
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Role of Antigravity Training in Rehabilitation and Return to Sport After Running Injuries. Arthrosc Sports Med Rehabil 2022; 4:e141-e149. [PMID: 35141546 PMCID: PMC8811491 DOI: 10.1016/j.asmr.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/29/2023] Open
Abstract
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.
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Stinner DJ, Rivera JC, Smith CS, Weiss DB, Hymes RA, Matuszewski PE, Gary JL, Morshed S, Schmidt AH, Wilken JM, Archer KR, Bailey L, Kleihege J, McLaughlin KH, Thompson RE, Chung S, Remenapp C, MacKenzie EJ, Reider L. Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care. J Orthop Trauma 2022; 36:S8-S13. [PMID: 34924513 DOI: 10.1097/bot.0000000000002285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Daniel J Stinner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica C Rivera
- U.S. Army Institute for Surgical Research, Brooke Army Medical Center, San Antonio, TX. Dr. Rivera is now with the Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans, LA
| | - Christopher S Smith
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - David B Weiss
- Department of Orthopaedic Surgery, University of Virginia Medical Center, Charlottesville, VA
| | - Robert A Hymes
- Department of Orthopaedic Surgery, Inova Fairfax Medical Campus, Falls Church, VA
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Joshua L Gary
- Department of Orthopaedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX (now at the Department of Orthopaedic Surgery, at the Keck School of Medicine, University of Southern California, Los Angeles, CA)
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Andrew H Schmidt
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research and Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lane Bailey
- Memorial Hermann IRONMAN Sports Medicine Institute, Houston, TX
| | | | - Kevin H McLaughlin
- Department of Physical Medicine and Rehabilitation, John Hopkins University, Baltimore, MD
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Suna Chung
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Craig Remenapp
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ellen J MacKenzie
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Waldrop NE, Kouk S. Rehabilitation and Return to Play Considerations. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Palke L, Schneider S, Karich B, Mende M, Josten C, Böhme J, Henkelmann R. 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. Clin Rehabil 2021; 36:87-98. [PMID: 34355605 DOI: 10.1177/02692155211037148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Lisa Palke
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Sebastian Schneider
- Hospital St. Georg GmbH, Clinic of Trauma, Orthopaedic and Septic Surgery, Leipzig, Germany; Ambulantes Reha Centrum Leipzig GmbH, Leipzig, Germany
| | - Bernhard Karich
- Department of Trauma and Physical Medicine, Heinrich-Braun-Klinikum GmbH, Zwickau, Germany
| | - Meinhard Mende
- Centre for Clinical Trials and Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Jörg Böhme
- Hospital St. Georg GmbH, Clinic of Trauma, Orthopaedic and Septic Surgery, Leipzig, Germany; Ambulantes Reha Centrum Leipzig GmbH, Leipzig, Germany
| | - Ralf Henkelmann
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
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