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Zampolini M, Oral A, Barotsis N, Aguiar Branco C, Burger H, Capodaglio P, Dincer F, Giustini A, Hu X, Irgens I, Negrini S, Tederko P, Treger I, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2024; 60:165-181. [PMID: 38477069 DOI: 10.23736/s1973-9087.24.08396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.
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Affiliation(s)
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | | | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Hospital of Entre o Douro e Vouga E.P.E., Porto, Portugal
- Faculty of Dentistry, University of Porto, Porto, Portugal
| | - Helena Burger
- University Rehabilitation Institute of the Republic of Slovenia, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Paolo Capodaglio
- Orthopedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | | | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ingebjorg Irgens
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Piotr Tederko
- Department of Rehabilitation, Center of Postgraduate Medical Education, Otwock, Poland
| | - Iuly Treger
- Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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2
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Frontera WR, Cordani C, Décary S, DE Groote W, Del Furia MJ, Feys P, Jette AM, Kiekens C, Negrini S, Oral A, Resnik L, Røe C, Sabariego C. Relevance and use of health policy, health systems and health services research for strengthening rehabilitation in real-life settings: methodological considerations. Eur J Phys Rehabil Med 2024; 60:154-163. [PMID: 38252128 PMCID: PMC10938940 DOI: 10.23736/s1973-9087.24.08386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Research on health policy, systems, and services (HPSSR) has seen significant growth in recent decades and received increasing attention in the field of rehabilitation. This growth is driven by the imperative to effectively address real-life challenges in complex healthcare settings. A recent resolution on 'Strengthening rehabilitation in health systems' adopted by the World Health Assembly emphasizes the need to support societal health goals related to rehabilitation, particularly to promote high-quality rehabilitation research, including HPSSR. This conceptual paper, discussed with the participants in the 5th Cochrane Rehabilitation Methodological Meeting held in Milan on September 2023, outlines study designs at diverse levels at which HPSSR studies can be conducted: the macro, meso, and micro levels. It categorizes research questions into four types: those framed from the perspective of policies, healthcare delivery organizations or systems, defined patient or provider populations, and important data sources or research methods. Illustrative examples of appropriate methodologies are provided for each type of research question, demonstrating the potential of HPSSR in shaping policies, improving healthcare delivery, and addressing patient and provider perspectives. The paper concludes by discussing the applicability, usefulness, and implementation of HPSSR findings, and the importance of knowledge translation strategies, drawing insights from implementation science. The goal is to facilitate the integration of research findings into everyday clinical practice to bridge the gap between research and practice in rehabilitation.
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Affiliation(s)
- Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wouter DE Groote
- Rehabilitation Programme, Department for Noncommunicable Diseases, Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Matteo J Del Furia
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy -
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Peter Feys
- Faculty of Rehabilitation Sciences, University of Hasselt, REVAL Rehabilitation Research Center, Diepenbeek, Belgium
| | - Alan M Jette
- Boston University's Sargent College of Health & Rehabilitation Sciences, Boston, MA, USA
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Linda Resnik
- Department of Health Services, Policy and Practice, Brown University and Research Career Scientist VA Medical Center, Providence, RI, USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Faculty of Health Sciences and Medicine and Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
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Arienti C, Armijo-Olivo S, Ferriero G, Feys P, Hoogeboom T, Kiekens C, Lazzarini SG, Minozzi S, Negrini S, Oral A, Pollini E, Puljak L, Todhunter-Brown A, Walshe M. The influence of bias in randomized controlled trials on rehabilitation intervention effect estimates: what we have learned from meta-epidemiological studies. Eur J Phys Rehabil Med 2024; 60:135-144. [PMID: 38088137 PMCID: PMC10938941 DOI: 10.23736/s1973-9087.23.08310-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
This study aimed to synthesize evidence from studies that addressed the influence of bias domains in randomized controlled trials on rehabilitation intervention effect estimates and discuss how these findings can maximize the trustworthiness of an RCT in rehabilitation. We screened studies about the influence of bias on rehabilitation intervention effect estimates published until June 2023. The characteristics and results of the included studies were categorized based on methodological characteristics and summarized narratively. We included seven studies with data on 227,806 RCT participants. Our findings showed that rehabilitation intervention effect estimates are likely exaggerated in trials with inadequate/unclear sequence generation and allocation concealment when using continuous outcomes. The influence of blinding was inconsistent and different from the rest of medical science, as meta-epidemiological studies showed overestimation, underestimation, or neutral associations for different types of blinding on rehabilitation treatment effect estimates. Still, it showed a more consistent pattern when looking at patient-reported outcomes. The impact of attrition bias and intention to treat has been analyzed only in two studies with inconsistent results. The risk of reporting bias seems to be associated with overestimation of treatment effects. Bias domains can influence rehabilitation treatment effects in different directions. The evidence is mixed and inconclusive due to the poor methodological quality of RCTs and the limited number and quality of studies looking at the influence of bias and treatment effects in rehabilitation. Further studies about the influence of bias in RCTs on rehabilitation intervention effect estimates are needed.
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Affiliation(s)
| | - Susan Armijo-Olivo
- Faculty of Economics and Social Sciences, University of Applied Sciences of Osnabrück, Osnabrück, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Giorgio Ferriero
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Physical Rehabilitation Medicine Unit, Scientific Institute of Tradate IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy
| | - Peter Feys
- Uhasselt, Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt, Belgium
| | - Thomas Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
- Laboratory of Methodology of Systematic Reviews and Guidelines Production, Mario Negri Pharmacological Research Institute IRCCS, Milan, Italy
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Türkiye
| | | | - Livia Puljak
- Center for Evidence-Based Medicine and Healthcare, Catholic University of Croatia, Zagreb, Croatia
| | | | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
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Côté P, Negrini S, Donzelli S, Kiekens C, Arienti C, Ceravolo MG, Gross DP, Battel I, Ferriero G, Lazzarini SG, Dan B, Shearer HM, Wong JJ. Introduction to target trial emulation in rehabilitation: a systematic approach to emulate a randomized controlled trial using observational data. Eur J Phys Rehabil Med 2024; 60:145-153. [PMID: 38420907 PMCID: PMC10938938 DOI: 10.23736/s1973-9087.24.08435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
Rehabilitation providers and policymakers need valid evidence to make informed decisions about the healthcare needs of the population. Whenever possible, these decisions should be informed by randomized controlled trials (RCTs). However, there are circumstances when evidence needs to be generated rapidly, or when RCTs are not ethical or feasible. These situations apply to studying the effects of complex interventions, including rehabilitation as defined by Cochrane Rehabilitation. Therefore, we explore using the target trial emulation framework by Hernán and colleagues to obtain valid estimates of the causal effects of rehabilitation when RCTs cannot be conducted. Target trial emulation is a framework guiding the design and analysis of non-randomized comparative effectiveness studies using observational data, by emulating a hypothetical RCT. In the context of rehabilitation, we outline steps for applying the target trial emulation framework using real world data, highlighting methodological considerations, limitations, potential mitigating strategies, and causal inference and counterfactual theory as foundational principles to estimating causal effects. Overall, we aim to strengthen methodological approaches used to estimate causal effects of rehabilitation when RCTs cannot be conducted.
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Affiliation(s)
- Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dentals Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sabrina Donzelli
- Department of Orthopedics, University Medical Center, Utrecht, the Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche University, Ancona, Italy
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Irene Battel
- Department of Biomedical, Surgical and Dentals Sciences, University "La Statale", Milan, Italy -
| | - Giorgio Ferriero
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Physical Rehabilitation Medicine Unit, Scientific Institute of Tradate IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy
| | | | - Bernard Dan
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
- Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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5
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Negrini S, Kiekens C, Levack WM, Meyer-Feil T, Arienti C, Côté P. Improving the quality of evidence production in rehabilitation. Results of the 5th Cochrane Rehabilitation Methodological Meeting. Eur J Phys Rehabil Med 2024; 60:130-134. [PMID: 38112680 PMCID: PMC10938939 DOI: 10.23736/s1973-9087.23.08338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
The paper introduces the Special Sections of the European Journal of Physical and Rehabilitation Medicine dedicated to the 5th Methodological Meeting of Cochrane Rehabilitation. It introduces Cochrane Rehabilitation; its vision, mission and goals; discusses why the Methodological Meetings were created; and reports on their organisation and previous outcomes. The core content of this editorial is the 5th Methodological Meeting held in Milan in September 2023. The original title for this meeting was "The Rehabilitation Evidence Ecosystem: useful study designs." The focus of the Milan meeting was informed by the lessons learned by Cochrane Rehabilitation in the past few years, by the new rehabilitation definition for research purposes, by the collaboration with the World Health Organization (WHO), and by the REH-COVER (Rehabilitation COVID-19 Evidence-Based Response) action. During the Meeting, participants discussed the current methodological evidence on the following: RCTs in rehabilitation coming from meta-epidemiological studies; observational study designs - specifically the IDEAL Framework (Idea, Development, Exploration, Assessment, Long-term study) and its potential implementation in rehabilitation and the Target Trial Emulation framework: Single Case Experimental Designs; complex intervention studies: health services research studies, and studies using qualitative approaches. The Meeting culminated in the development of a first version of a "road map" to navigate the evidence production in rehabilitation according to the previous discussions. The Special Sections' papers present all topics discussed at the meeting, and a methodological paper about choosing the right research question, presenting final results and the "road map" for evidence production in rehabilitation.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - William M Levack
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Thorsten Meyer-Feil
- Institute for Rehabilitation Medicine, Medical School, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
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Pollini E, Lazzarini SG, Cordani C, Del Furia MJ, Kiekens C, Negrini S, Arienti C. Effectiveness of Rehabilitation Interventions on Adults With COVID-19 and Post-COVID-19 Condition. A Systematic Review With Meta-analysis. Arch Phys Med Rehabil 2024; 105:138-149. [PMID: 37802177 DOI: 10.1016/j.apmr.2023.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of rehabilitation interventions for adults with COVID-19 and post COVID-19 condition (PCC) in all settings. DATA SOURCES PubMed, EMBASE, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence Database were searched from inception to December 31st, 2021. PROSPERO registration number: CRD42021258553. STUDY SELECTION We included randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) according to the University of Alberta Evidence-based Practice Center. DATA EXTRACTION One author extracted data using a predetermined Excel form. DATA SYNTHESIS The meta-analysis indicates uncertain evidence about the effect of pulmonary rehabilitation and self-activities on exercise capacity (MD 65.06, 95% CI 42.87 to 87.25), respiratory function (forced expiratory volume in the first second [FEV1]: MD 0.16, 95% CI 0.05 to 0.28; FEV1/forced vital capacity [FVC]: MD 0.05, 95% CI 0.01 to 0.09; FVC: MD 0.19, 95% CI -0.03 to 0.42) and anxiety (MD -12.03, 95% CI -21.16 to -2.90) in mild COVID-19 and PCC patients. According to the narrative synthesis, including RCTs and NRSI, prone positioning seems to show improvements in vital parameters in severe COVID-19 post intensive care unit (ICU) discharge, pulmonary rehabilitation in activities of daily living, and qigong exercise and acupressure rehabilitation program, and "twist and raise" walking technique in reducing dyspnea and weakness in any degree of severity of COVID-19 and PCC. Functional electrical stimulation-cycling or early rehabilitation programs seem to support a faster recovery in patients with moderate COVID-19 after ICU discharge. Yoga and naturopathy, Mandala coloring, and respiratory exercise seem to reduce anxiety and depression in patients with moderate and mild COVID-19. Cognitive motor training seems to improve cognitive function in PCC patients. CONCLUSIONS There is very uncertain evidence about the effect of pulmonary rehabilitation on exercise capacity and respiratory function in patients with mild COVID-19 and PCC. Further high-quality research is required to improve the certainty of evidence available to support rehabilitation's crucial role in managing COVID-19.
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Affiliation(s)
| | | | - Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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7
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Ceravolo MG, Anwar F, Andrenelli E, Udensi C, Qureshi J, Sivan M, Kiekens C, Zampolini M. Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2023; 59:789-799. [PMID: 38214046 DOI: 10.23736/s1973-9087.23.08315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.
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Affiliation(s)
- Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy -
| | - Cynthia Udensi
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jawaria Qureshi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, University of Leeds, Leeds, UK
| | | | - Mauro Zampolini
- Department of Rehabilitation, Hospital of Foligno, USL Umbria2, Perugia, Italy
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Paglierani P, Marani M, Maietti E, Kiekens C, Negrini S, Baroncini I. Prognostic validity of trunk control scales for mobility in individuals with motor complete thoracic SCI: a prospective cohort study. Spinal Cord 2023; 61:529-535. [PMID: 37648753 DOI: 10.1038/s41393-023-00929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To investigate the sensitivity to change and prognostic validity of Trunk Control Test (TCT) and Thoracic-Lumbar Control Scale (TLC) in terms of mobility in persons with motor complete thoracic spinal cord injury (SCI). SETTING Participants were recruited at an Italian SCI rehabilitation facility from October 2015 to January 2020. METHODS Inclusion criteria were acute traumatic or non-traumatic event and T1-L1 neurological level. Trunk control and mobility were assessed at baseline, discharge, and at 6 and 18-month follow-ups. Mobility was measured using Spinal Cord Independence Measure III mobility subscale. Linear regression models were used to analyze changes in trunk control and mobility over time, and the relationship between these measures. RESULTS The 39 participants were predominantly male, with a mean age of 38 years. Trunk control improved during rehabilitation, at 6-month follow-up, and remained stable thereafter, according to TCT and TLC scales. A higher baseline TCT score was associated with improvements in mobility at discharge and at follow-ups. Baseline TLC score and its change during rehabilitation were unrelated with changes in mobility. CONCLUSIONS Results suggest that the TCT and TLC scales are useful to capture changes in trunk control during the acute and subacute phases. Improvements in functional mobility are however associated with TCT score only, suggesting the potential of this test as a useful prognostic indicator. Further research with larger sample sizes is warranted to determine whether these findings are consistent across neurological level strata.
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Affiliation(s)
| | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Liguori S, Young VM, Arienti C, Pollini E, Patrini M, Gimigliano F, Negrini S, Kiekens C. Overview of Cochrane systematic reviews for rehabilitation interventions in individuals with cerebral palsy: A mapping synthesis. Dev Med Child Neurol 2023; 65:1280-1291. [PMID: 36908077 DOI: 10.1111/dmcn.15572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/14/2023]
Abstract
AIM This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence. METHOD Following the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for individuals with CP were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs indicating the effect of rehabilitation interventions and the certainty of evidence. RESULTS A total of eight CSRs were included in the evidence map. The effect of interventions varied across comparisons and the certainty of evidence was inconsistent, ranging from high to very low. The best evidence was found for botulinum neurotoxin A (BoNT-A) combined with occupational therapy in the management of spasticity. However, the effect of BoNT-A on drooling and salivation remains unclear. A paucity of randomized controlled trials studying treatments for both dystonia and postural deformities was noted. INTERPRETATION This review emphasizes the need to further investigate the effectiveness and cost-benefit of rehabilitation interventions for individuals with CP. WHAT THIS PAPER ADDS The quality and quantity of evidence on rehabilitation interventions for cerebral palsy is limited worldwide. Botulinum neurotoxin A plus occupational therapy showed robust efficacy for the management of upper-limb spasticity. Evidence on sleep-positioning systems for hip migration and trihexyphenidyl for dystonia is scarce.
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Affiliation(s)
- Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vanessa M Young
- Arizona State University, School of Social and Behavioral Sciences, Phoenix, AZ, USA
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
| | - Chiara Arienti
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Michele Patrini
- Laboratory of Evidence-Based Rehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Negrini
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università La Statale, Milan, Italy
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10
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Seijas V, Kiekens C, Gimigliano F. Advancing the World Health Assembly's landmark Resolution on Strengthening Rehabilitation in Health Systems: unlocking the Future of Rehabilitation. Eur J Phys Rehabil Med 2023; 59:447-451. [PMID: 37695038 PMCID: PMC10548396 DOI: 10.23736/s1973-9087.23.08160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
In May 2023, the historic Resolution on Strengthening Rehabilitation in Health Systems was adopted unanimously by the 194 Member States of the World Health Assembly (WHA), the highest health policy-setting body. The resolution aims to scale up and integrate rehabilitation into health systems as part of Universal Health Coverage (UHC) to address the growing rehabilitation needs due to the global ageing population, the increasing prevalence of non-communicable diseases, and the emergence of new infectious diseases such as COVID-19. Globally, data extracted from the Global Burden of Disease Study in 2019 showed that one out of three people could benefit from rehabilitation, while more than half of the population in many countries is not receiving essential rehabilitation services. This special article highlights the global challenges in meeting rehabilitation needs and emphasizes the importance of affordable, accessible, and quality rehabilitation services for vulnerable populations. The resolution's path, which started in 2017 with the "Rehabilitation 2030: a Call for Action" initiative by the World Health Organization (WHO), is outlined. We summarize the key aspects of the WHA resolution, including its requests for Member States, international organizations, and the WHO Director-General. Finally, we discuss the way forward towards implementation, involving advocacy and concrete actions by all stakeholders, with the support of the newly established World Rehabilitation Alliance. The goal is to integrate rehabilitation into health systems worldwide, thus improving the well-being and socio-economic participation of those in need.
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Affiliation(s)
- Vanessa Seijas
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- University of Antioquia, Medellín, Colombia
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Osterthun R, Sunnerhagen K, Stam HJ, Kiekens C. End-of-life decisions and involvement of Physical and Rehabilitation Medicine Physicians in Europe. J Rehabil Med 2023; 55:jrm5575. [PMID: 37387681 DOI: 10.2340/jrm.v55.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/05/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries. DESIGN Exploratory cross-sectional survey. SUBJECTS Delegates of the Union of European Medical Specialists, Physical and Rehabilitation Medicine Section. METHODS In July 2020, a self-constructed survey was sent to 82 delegates from 38 European countries, who were asked to answer from the point of view of their country. Topics included the legal status of end-of-life decisions and the involvement of Physical and Rehabilitation Medicine physicians in these decisions. RESULTS Between July 2020 and December 2020, 32 delegates from 28 countries completed the survey (response rate country level of 74%). If legal frameworks allow for these specific end-of-life decisions, involvement of Physical and Rehabilitation Medicine physicians was reported in 2 of 3 countries in euthanasia cases, 10 of 17 countries in non-treatment decision cases, and 13 of 16 countries in cases of intensified symptom management by the administration of drugs using potentially life-shortening doses. CONCLUSION Estimated involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions varied between European countries, even when legal frameworks allow for these decisions.
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Affiliation(s)
- Rutger Osterthun
- Rijndam Rehabilitation Center, and Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Katharina Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, and the Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Oral A, Kiekens C, DE Vriendt P, Satink T, VAN DE Velde D, Grazio S, Moslavac S, Schnurrer-Luke-Vrbanić T, Vlak T, Kontaxakis A, Rapidi CA, Pyrgeli M, Stavrianou A, Kujawa J, Tederko P, Küçükdeveci AA, Sezgin M, Zampolini M, Stucki G, Selb M. Development of simple descriptions of the ICF Generic-30 Set in different languages: laying the foundation for an ICF-based clinical tool for Europe. Eur J Phys Rehabil Med 2023:S1973-9087.23.07932-7. [PMID: 37083101 DOI: 10.23736/s1973-9087.23.07932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Functioning is considered a third indicator of health and a key outcome in rehabilitation. A universal practical tool for collecting functioning information is essential. This tool would be ideally based on the International Classification of Functioning, Disability and Health. AIM To report the results of the development of country/language-specific versions of an ICF-based clinical tool in six European countries. DESIGN Consensus process. SETTING Expert conferences. POPULATION Multi-professional group of rehabilitation professionals in six European countries. METHODS 1) Developed an initial proposal by translating the published English-language version of the simple descriptions into the targeted language; 2) conducted a multi-stage consensus conference to finalize the descriptions; 3) employed a three-stage multi-professional expert panel translation back to English. The consensus conference model was modified for geographically large countries. RESULTS Croatian, Flemish/Dutch, Greek, Polish, and Turkish versions were produced. CONCLUSIONS The creation of the country/language-specific simple descriptions is a significant part of the "system-wide implementation of the ICF" initiative that will pave the way for the implementation of the ICF in national health systems. CLINICAL REHABILITATION IMPACT The practical ICF-based clinical tool with country/language specific versions for standardized reporting of functioning will serve as a means of integrating functioning information in national health systems and additionally for monitoring the effects of rehabilitation interventions.
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Affiliation(s)
- Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | | | - Patricia DE Vriendt
- Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing Research Group (MENT), Department of Gerontology, Vrije Universiteit, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Ton Satink
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Dominique VAN DE Velde
- Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing Research Group (MENT), Department of Gerontology, Vrije Universiteit, Brussels, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Simeon Grazio
- Department of Rheumatology, Physical and Rehabilitation Medicine, School of Medicine, University of Zagreb, Sestre Milosrdnice University Hospital, Zagreb, Croatia
| | - Sasa Moslavac
- Department Novi Marof, General Hospital Varaždin, Varaždin, Croatia
| | - Tea Schnurrer-Luke-Vrbanić
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rijeka, University Hospital Center Rijeka, Rijeka, Croatia
| | - Tonko Vlak
- Institute of Rehabilitation Medicine and Rheumatology, Clinical Hospital Center Split, Split, Croatia
| | | | | | - Maria Pyrgeli
- Department of Physical and Rehabilitation Medicine, G. Gennimatas General Hospital, Athens, Greece
| | - Aggeliki Stavrianou
- Department of Physical and Rehabilitation Medicine, ELEPAP "Rehabilitation for the disabled", Athens, Greece
| | - Jolanta Kujawa
- Physical and Rehabilitation Medicine Center, KEFIAP Amyntaio, Elena Dimitriou General Hospital of Florina, Amyntaio, Greece
| | - Piotr Tederko
- Medical Rehabilitation Clinic, Medical University of Lodz, Lodz, Poland
| | - Ayşe A Küçükdeveci
- Department of Rehabilitation, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Melek Sezgin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Mauro Zampolini
- Department of Physical Medicine and Rehabilitation, Mersin University Medical Faculty, Mersin, Türkiye
| | - Gerold Stucki
- Department of Rehabilitation, Foligno Hospital, USL Umbria2, Perugia, Italy
- Faculty of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Melissa Selb
- Department of Rehabilitation, Foligno Hospital, USL Umbria2, Perugia, Italy
- Faculty of Health Sciences and Medicine, University of Luzern, Luzern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Negrini S, Borg K, Cusick A, Ferriero G, Frontera WR, Gross DP, Heinemann A, Machalicek W, Moore AP, Nudo RJ, Pérennou D, Stam H, Kiekens C. Global Statements to Produce and Implement Evidence in the Post-COVID-19 Era Provide a Path Forward for Rehabilitation - A Joint Initiative of Cochrane Rehabilitation and the Leading Journals in the Field. Am J Phys Med Rehabil 2023; 102:e26-e31. [PMID: 36796420 PMCID: PMC9940826 DOI: 10.1097/phm.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Sgarzani R, Maietti E, Tedeschi S, Trapani FF, Battilana M, Landi S, Kiekens C, Negosanti L. Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study. Spinal Cord 2023; 61:204-210. [PMID: 36564552 DOI: 10.1038/s41393-022-00869-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol. SETTING Tertiary Rehabilitation Hospital for SCI/D in Italy. METHODS Retrospective analysis of the medical records of adult individuals with SCI/D, who developed a PI after the first discharge from a Spinal Unit, underwent flap surgery for PI between July 2011 and January 2018. The statistical unit of analysis was the surgical intervention. Logistic regression analysis with robust standard errors was performed to assess risk factors of post-surgical complications. RESULTS 434 surgical intervention records were included, for a total of 378 patients. The treated PIs were ischiatic in 56.2% of the cases, sacral in 32.5%, trochanteric in 15.7%, and 5.8% were in other sites. In 239 cases (55.1%) a histological diagnosis of osteomyelitis was confirmed. Minor complications occurred in 13.6% of interventions, while major complications were 3.9%. Sacral PI (OR = 2.55, 95%CI: 1.50-4.35) and muscular/musculocutaneous flap (OR = 2.12, 95%CI: 1.05-4.28) were significant factors associated with risk of post-surgical complications. After a mean follow-up of 21 months (range 12-36), six people (1.4%) had a recurrence. Patients with a recurrence had at least one comorbidity compared to 57% of people without recurrences (p = 0.036). CONCLUSION Our results demonstrate that complication and recurrence rates can be minimized when an established interdisciplinary and rehabilitation protocol is integrated in the clinical management.
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Affiliation(s)
- Rossella Sgarzani
- DIMES (Dipartimento di medicina specialistica, diagnostica e sperimentale), Università di Bologna, Bologna, Italy.
| | - Elisa Maietti
- DIBINEM (Dipartimento di Scienze Biomediche e Neuromotorie), Università di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio F Trapani
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
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Velez M, Lugo-Agudelo LH, Patiño Lugo DF, Glenton C, Posada AM, Mesa Franco LF, Negrini S, Kiekens C, Spir Brunal MA, Roberg ASB, Cruz Sarmiento KM. Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 2:CD014823. [PMID: 36780267 PMCID: PMC9918343 DOI: 10.1002/14651858.cd014823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. OBJECTIVES To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. SEARCH METHODS We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022. SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions. DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members. Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others. Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members. In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services. Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. AUTHORS' CONCLUSIONS This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.
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Affiliation(s)
- Marcela Velez
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | | | - Claire Glenton
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ana M Posada
- Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University La Statale , Milano, Italy
- Laboratory of Evidence Based Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Kiekens C, Duttine A, Mishra S, Sabariego C. Health systems, rehabilitation care and COVID-19: Challenges and opportunities. Front Rehabil Sci 2023; 4:1134461. [PMID: 36846198 PMCID: PMC9950811 DOI: 10.3389/fresc.2023.1134461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, IRCCS MultiMedica, Milan, Italy
| | - Antony Duttine
- Advisor, Disability and Rehabilitation, Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Satish Mishra
- Technical Officer, Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Carla Sabariego
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland,Swiss Paraplegic Research, Nottwil, Switzerland,Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
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Shahabi S, Kiekens C, Mojgani P, Arienti C, ShahAli S, Lankarani KB. The Deficits of the Methodological and Reporting Quality of Randomized Controlled Trials in the Field of Prosthetics and Orthotics in Iran: A Systematic Review. Rev Recent Clin Trials 2023; 18:92-111. [PMID: 36809948 DOI: 10.2174/1574887118666230221114201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/26/2022] [Accepted: 01/05/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Due to the development of the academic field of prosthetics and orthotics (P&O) in recent years, scientific studies in this domain have increased. However, relevant published studies, especially randomized controlled trials (RCTs), are not always of acceptable quality. Therefore, this study aimed to evaluate the methodological and reporting quality of RCTs in the field of P&O in Iran to recognize existing shortcomings. METHODS Six electronic databases, including PubMed, Scopus, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and the Physiotherapy Evidence Database, were searched from January 1, 2000, to July 15, 2022. The Cochrane risk of bias tool was applied to evaluate the methodological quality of the included studies. In addition, the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist was used to assess the reporting quality of the included studies. RESULTS 35 RCTs published from 2007 to 2021 were included in our final analysis. The methodological quality of 18 RCTs was poor, and the quality of the rest of the studies was good (n = 7) or fair (n = 10). In addition, the median score (IQR) of the reporting quality of RCTs in accordance with the CONSORT items was 18 (13-24.5) out of 35. The results of the relationship analysis indicated a moderate correlation between the CONSORT score and the publication year of the included RCTs. Nonetheless, there was a low correlation between the CONSORT scores and the journals' impact factors. CONCLUSION The overall methodological and reporting quality of RCTs in the field of P&O in Iran was not found to be optimal. To enhance the methodological quality, some items should be considered more strictly, such as blinding of outcome assessment, allocation concealment, and random sequence generation. Furthermore, the criteria of CONSORT, as reporting quality checklist, should be adopted in writing the papers, especially methods-related items.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | | | - Shabnam ShahAli
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Kiekens C, Cattadori G. Should we add antiplatelet agents to current deep venous thrombosis treatments? A Cochrane Review summary with commentary. NeuroRehabilitation 2023; 53:413-415. [PMID: 37899066 DOI: 10.3233/nre-236005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is an important complication in rehabilitation practice despite preventive measures. The management can be complicated because patients may have co-existing cardiovascular comorbidities. OBJECTIVE To assess the effects of antiplatelet agents in addition to current best medical practice (BMP) compared to current BMP (with or without placebo) for the treatment of deep venous thrombosis (DVT). METHODS A summary of the Cochrane Review by Flumignan et al. (2022), with comments from a rehabilitation perspective. RESULTS The review included six studies with 1625 eligible participants, with data up to 37.2 months of follow-up. When used after standard initial treatment with anticoagulants, antiplatelet agents such as aspirin in addition to BMP, may reduce recurrence of DVT or pulmonary embolism, when compared to BMP plus placebo in a chronic DVT setting and there may be a lower risk for post-thrombotic syndrome in patients with acute DVT. There is no clear difference in side effects, major bleeding, or pulmonary embolism (PE) with the use of antiplatelet agents. CONCLUSION Adding antiplatelet agents to standard anticoagulation treatment in patients with VTE could provide benefit without increasing risks in selected patient groups. However, high quality studies with a long-term follow up are needed, including patients in rehabilitation settings.
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Arienti C, Patrini M, Negrini S, Kiekens C. Overview of Cochrane Systematic Reviews for Rehabilitation Interventions in Persons With Spinal Cord Injury: A Mapping Synthesis. Arch Phys Med Rehabil 2023; 104:143-150. [PMID: 35905770 DOI: 10.1016/j.apmr.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This article aims to describe the evidence on rehabilitation interventions for persons with spinal cord injury (SCI) identified in Cochrane Systematic Reviews (CSRs) selected for inclusion in the World Health Organization Rehabilitation Programme-Package of Interventions for Rehabilitation. DATA SOURCES The CSRs search was led by the Cochrane Rehabilitation team, using the tagging process, using the terms "spinal cord injury" and "rehabilitation" in the Cochrane Library. STUDY SELECTION We performed an overview of all the CSRs according to the inclusion criteria defined with the World Health Organization: rehabilitation interventions in persons with SCI. DATA EXTRACTION The CSRs identified after the screening process were summarized using an evidence map, grouping outcomes, and comparisons of included CSRs indicating the effect and the quality of evidence to provide a comprehensive view of what is known. DATA SYNTHESIS Out of 248 CSRs from the past 10 years tagged in the Cochrane Rehabilitation database, 3 were related to SCI. They provide data on 13 outcomes analyzed within 11 comparisons for a total of 64 primary studies, including 2024 participants with SCI. Of these, 7 outcomes and 1 comparison focused on people with cervical SCI. Rehabilitation interventions might improve respiratory outcomes and pain relief in people with SCI. There is uncertainty whether bodyweight-supported treadmill training, robotic-assisted training, and functional electrostimulation affect walking speed and capacity. CONCLUSIONS The current evidence needs to be confirmed by better quality research. Therefore, future priorities are the improvement of methodological quality of the studies in people with SCI, particularly considering the complexity of this health condition. Further, there is a need for more CSRs in the field.
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Affiliation(s)
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan; IRCCS Istituto Ortopedico Galeazzi, Milan.
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Sivan M, Negrini S, Kiekens C, Khan F, Francisco GE, Gimigliano F. The INFORM (International Framework for Rehabilitation Medics) Project to Strengthen the Medical Specialty. Adv Rehabil Sci Pract 2023; 12:27536351231167482. [PMID: 37152355 PMCID: PMC10161326 DOI: 10.1177/27536351231167482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Manoj Sivan
- British Society of Physical and Rehabilitation Medicine, London, UK
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
- Manoj Sivan, Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK.
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University ‘La Statale’, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlotte Kiekens
- Physical and Rehabilitation Medicine, IRCCS MultiMedica, Milan, Italy
| | - Fary Khan
- Director Rehabilitation Royal Melbourne Hospital, Melbourne, Australia
| | - Gerard E. Francisco
- Department of Physical Medicine and Rehabilitation, UTHealth McGovern Medical School, and TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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Cordani C, Lazzarini SG, Zampogna E, Del Furia MJ, Arienti C, Negrini S, Kiekens C. Dyspnea: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:864-869. [PMID: 36511169 PMCID: PMC10077963 DOI: 10.23736/s1973-9087.22.07805-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" coming from interventions effective on the symptoms of PCC in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in their Guidelines. With this overview of reviews with mapping we aimed to synthesize in a map the Cochrane evidence relevant to rehabilitation for dyspnea due to PCC. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "dyspnea" and its synonyms in the Cochrane Library. We extracted and summarized all the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 371 CSRs published between 2016 and 2021 and included 15 in this overview. We found eight studies on chronic obstructive pulmonary disease, two on cancer, and one for bronchiectasis, chronic respiratory disease, cystic fibrosis, idiopathic pulmonary fibrosis and interstitial lung disease. Effective interventions included pulmonary rehabilitation, also in combination with exercise training, non-invasive ventilation, upper limb training and multicomponent integrated interventions, with very low- to moderate-quality evidence. CONCLUSIONS These results are the first step of indirect evidence to generate helpful hypotheses for clinical practice and future research on dyspnea in adults with PCC. They served as the basis for one recommendation on treatments for dyspnea as a PCC symptom published in the current WHO Guidelines for clinical practice.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Elisabetta Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Varese, Italy
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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22
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Zampolini M, Treger I, Nulle A, Kiekens C, Aguiar Branco C, Barotsis N, Frischknecht R, Tederko P, Janssen W, Christodoulou N, Oral A. Time to replace the inappropriate old name of Physiotherapy for the medical specialty of Physical and Rehabilitation Medicine in official EU documents. Eur J Phys Rehabil Med 2022; 58:799-801. [PMID: 36710642 PMCID: PMC10077879 DOI: 10.23736/s1973-9087.22.07814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Mauro Zampolini
- President of the Physical and Rehabilitation Medicine Section of the UEMS, Brussels, Belgium
| | - Iuly Treger
- Director Rehabilitation, Soroka Medical University Center, Beer Sheva, Israel.,President of Israeli PRM Association, Beer Sheva, Israel
| | - Anda Nulle
- Chairperson of the Clinical Affairs Committee, of the UEMS PMR Section, Brussels, Belgium
| | | | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Hospital of Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Nikolaos Barotsis
- President of the European Board of Physical and Rehabilitation Medicine, Brussels, Beglium
| | - Rolf Frischknecht
- Treasurer of the Physical and Rehabilitation Medicine Section of the UEMS, Brussels, Belgium
| | - Piotr Tederko
- Deputy Secretary of the European Board of Physical and Rehabilitation Medicine, Brussels, Belgium.,Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Wim Janssen
- Deputy Treasurer of the Physical and Rehabilitation Medicine Section of the UEMS, Brussels, Belgium
| | | | - Aydan Oral
- Incoming President of the European Board of Physical and Rehabilitation Medicine, Brussels, Belgium - .,Department of PRM, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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23
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Cordani C, Lazzarini SG, Del Furia MJ, Kiekens C, Arienti C, Negrini S. Arthralgia: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:870-874. [PMID: 36472559 PMCID: PMC10153548 DOI: 10.23736/s1973-9087.22.07803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" coming from interventions effective on the symptoms of PCC in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in its Guidelines. With this overview of reviews with mapping we aimed to synthesize the Cochrane evidence relevant to rehabilitation for arthralgia due to PCC in a map. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "arthralgia," "joint pain," and "rehabilitation" and their synonyms in the Cochrane Library. We extracted and summarized all the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 200 CSRs published between 2016 and 2021, and included 11 in this overview. They provided data from 7 health conditions, with osteoarthritis (5 studies) being the most studied. Effective rehabilitation interventions included exercise training, transcranial magnetic stimulation, different types of electrical stimulation and Tai chi. The overall quality of evidence was mainly low to very low, and moderate in a few cases. CONCLUSIONS These results provided the requested information to the WHO and served as the basis for one recommendation on treatments for arthralgia due to PCC in the current Guidelines for clinical practice. These results should be interpreted as a first step of indirect evidence able to generate helpful hypotheses for future research.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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24
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Arienti C, Cordani C, Lazzarini SG, Del Furia MJ, Negrini S, Kiekens C. Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:857-863. [PMID: 36472558 PMCID: PMC10077961 DOI: 10.23736/s1973-9087.22.07802-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Rehabilitation focuses on impairments, activity limitations and participation restrictions being informed by the underlying health condition. In the current absence of direct "evidence on" rehabilitation interventions for people with post-COVID-19 condition (PCC), we can search and synthesize the indirect "evidence relevant to" coming from interventions effective for the symptoms of PCC in other health conditions. The World Health Organization (WHO) required this information to inform expert teams and provide specific recommendations in their Guidelines. With this overview of reviews with mapping, we aimed to synthesize in a map the Cochrane evidence relevant to rehabilitation for fatigue, post-exertional malaise and orthostatic intolerance due to PCC. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "fatigue," "orthostatic intolerance," "rehabilitation" and their synonyms in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS Out of 1397 CSRs published between 2016 and 2021, we included 32 for fatigue and 4 for exercise intolerance. They provided data from 13 health conditions, with cancer (11 studies), chronic obstructive pulmonary disease (7 studies), fibromyalgia (4 studies), and cystic fibrosis (3 studies) being the most studied. Effective interventions for fatigue included exercise training and physical activities, telerehabilitation and multicomponent and educational interventions. Effective interventions for exercise intolerance included combined aerobic/anaerobic training and integrated disease rehabilitation management. The overall quality of evidence was low to very low and moderate in very few cases. We did not identify CSRs that specifically addressed post-exertional malaise or orthostatic intolerance. CONCLUSIONS These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.
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Affiliation(s)
| | - Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy - .,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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25
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Negrini S, Kiekens C, Cordani C, Arienti C, DE Groote W. Cochrane "evidence relevant to" rehabilitation of people with post COVID-19 condition. What it is and how it has been mapped to inform the development of the World Health Organization recommendations. Eur J Phys Rehabil Med 2022; 58:853-856. [PMID: 36468825 PMCID: PMC10077960 DOI: 10.23736/s1973-9087.22.07793-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cochrane Rehabilitation developed a series of actions to provide the global rehabilitation community with the best available evidence to respond to the COVID-19 pandemic. These initiatives constituted the REH-COVER (Rehabilitation COVID-19 evidence-based response) action. In March 2020, the first initiative started in agreement with the European Journal of Physical and Rehabilitation Medicine (EJPRM): the rapid systematic review of all papers relevant to COVID-19 rehabilitation to inform rehabilitation health professionals rapidly. Currently, we are facing the long-term consequences of COVID-19, initially called "long Covid" and now named post COVID-19 condition (PCC), which led to the request by the WHO Rehabilitation Programme for evidence synthesis to support the development of specific recommendations. Cochrane Rehabilitation provided the best available evidence from the REH-COVER rapid living systematic review results, a systematic scoping review on the models of care and a summary of "evidence relevant to" the rehabilitation for adults with PCC. Based on this evidence, expert groups developed the 16 recommendations for the rehabilitation of adults with PCC recently published in Chapter 24 of the WHO "Clinical management of COVID-19 living guideline." This paper aims to introduce the Special Section of EJPRM reporting the work performed by Cochrane Rehabilitation to produce a summary of the existing "evidence relevant to" the rehabilitation of adults with PCC. The paper reports the methodology (overview of systematic reviews with mapping) and introduces the concept of "evidence relevant to" rehabilitation.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | | | | - Wouter DE Groote
- Rehabilitation Programme, Non-communicable Diseases Department, WHO, Geneva, Switzerland
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26
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Cordani C, Young VM, Arienti C, Lazzarini SG, Del Furia MJ, Negrini S, Kiekens C. Cognitive impairment, anxiety and depression: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition. Eur J Phys Rehabil Med 2022; 58:880-887. [PMID: 36534008 PMCID: PMC10153550 DOI: 10.23736/s1973-9087.22.07813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Currently, no evidence exists on specific treatments for post COVID-19 condition (PCC). However, rehabilitation interventions that are effective for similar symptoms in other health conditions could be applied to people with PCC. With this overview of systematic reviews with mapping, we aimed to describe the Cochrane evidence on rehabilitation interventions proposed for cognitive impairment, anxiety and depression in different health conditions that can be relevant for PCC. EVIDENCE ACQUISITION We searched the last five years' Cochrane Systematic Review (CSRs) using the terms "cognitive impairment," "depressive disorder," "anxiety disorder," their synonyms and variants, and "rehabilitation" in the Cochrane Library. We extracted and summarized the available evidence using a map. We grouped the included CSRs for health conditions and interventions, indicating the effect and the quality of evidence. EVIDENCE SYNTHESIS We found 3596 CSRs published between 2016 and 2021, and we included 17 on cognitive impairment and 37 on anxiety and depression. For cognitive impairment, we found 7 CSRs on participants with stroke, 3 with cancer, 2 with Parkinson's disease, and one each for five other health conditions. Each intervention improved a different domain, and included exercises, cognitive and attention-specific training, and computerized cognition-based training (from very low to high-quality evidence). For anxiety and depression, we found 10 CSRs including participants with cancer, 8 with stroke, 3 with chronic obstructive pulmonary disease, and 2 or 1 each in 11 other health conditions. Exercise training, physical activity and yoga resulted effective in several pathologies (very low- to moderate-quality evidence). In specific diseases, we found effective acupuncture, animal-assisted therapy, aromatherapy, educational programs, home-based multidimensional survivorship programs, manual acupressure massage, memory rehabilitation, non-invasive brain stimulation, pulmonary rehabilitation, and telerehabilitation (very low- to moderate-quality evidence). CONCLUSIONS These results are the first step of indirect evidence able to generate helpful hypotheses for clinical practice and future research. They served as the basis for the three recommendations on treatments for these PCC symptoms published in the current WHO Guidelines for clinical practice.
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Affiliation(s)
- Claudio Cordani
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Vanessa M Young
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA.,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
| | | | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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27
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Shahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res 2022; 22:1317. [PMCID: PMC9635163 DOI: 10.1186/s12913-022-08695-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that could facilitate the integration of rehabilitation services into Iran’s PHC network. Methods Semi-structured interviews were conducted with 38 participants, including health policymakers, rehabilitation managers, faculty members, and rehabilitation practitioners. Purposive and snowball sampling strategies were adopted to recruit participants. The WHO Health System building blocks framework analysis was applied to analyze the collected data. Results Participants’ perspectives and experiences outlined potential policy options including: (1) stewardship: increasing political support, strengthening the leadership of the rehabilitation sector, and promoting inter-sectoral collaborations; (2) service delivery: increasing the knowledge of healthcare professionals, using local volunteers, deploying mobile rehabilitation teams, using telerehabilitation, and improving referral pathways; (3) financing: increasing government funding, preparing a package of rehabilitation services, and using appropriate payment mechanisms; (4) human resources: expanding rehabilitation workforce, training rehabilitation assistants, and enhancing employment and social opportunities; (5) information systems: establishing a comprehensive information system and an effective surveillance system; and (6) technologies: facilitating access to a range of rehabilitation equipment and raw materials, especially for prosthetics and orthotics services. Conclusion Based on the WHO six building blocks framework, this study identified several policy options for integrating rehabilitation services into the Iranian PHC Network. Some of the policy options include increasing political support, promoting inter-sectoral collaborations, increasing the skills and knowledge of healthcare workers, establishing effective referral pathways, strengthening team-working, and increasing government funding.
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Affiliation(s)
- Saeed Shahabi
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manal Etemadi
- National Center for Health Insurance Research, Tehran, Iran
| | - Parviz Mojgani
- grid.444911.d0000 0004 0619 1231Iran-Helal Institute of Applied Science and Technology, Tehran, Iran ,Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouei
- grid.411746.10000 0004 4911 7066Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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28
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Negrini S, Borg K, Cusick A, Ferriero G, Frontera WR, Gross DP, Heinemann A, Machalicek W, Moore AP, Nudo RJ, Pérennou D, Stam H, Kiekens C. Global statements to produce and implement evidence in the post-COVID-era provide a path forward for rehabilitation - A joint initiative of Cochrane Rehabilitation and the leading journals in the field. J Rehabil Med 2022; 54:jrm00345. [PMID: 36317496 PMCID: PMC9639464 DOI: 10.2340/jrm.v54.4858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Indexed: 01/24/2023] Open
Abstract
This article is a simultaneous joint publication in Journal of Rehabilitation Medicine, Annals of Physical and Rehabilitation Medicine, American Journal of Physical Medicine & Rehabilitation, Developmental Neurorehabilitation, European Journal of Physical and Rehabilitation Medicine, Journal of Occupational Rehabilitation, Musculoskeletal Science & Practice and Neurorehabilitation and Neural Repair. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, Milan, Italy,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden,Chief Editor Journal Rehabilitation Medicine
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine and Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Allen Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine Northwestern University, Center for Rehabilitation Outcomes Research, Shirley Ryan Abilitylab, Chicago, IL, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA
| | - Ann Patricia Moore
- Editor in Chief Musculoskeletal Science and Practice an International Journal of Musculoskeletal Physiotherapy,Professor Emerita, University of Brighton, Brighton, UK
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Dominic Pérennou
- University Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, Department of Neurorehabilitation South Hospital, Cs 10217 - 38043 Grenoble cedex 9, France
| | - Henk Stam
- Chief Editor Journal Rehabilitation Medicine,Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carlotte Kiekens
- IRCCS MultiMedica, Milan, Italy,Corresponding author. E-mail address: (C. Kiekens)
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Décary S, De Groote W, Arienti C, Kiekens C, Boldrini P, Lazzarini SG, Dugas M, Stefan T, Langlois L, Daigle F, Naye F, LeBlanc A, Negrini S. Scoping review of rehabilitation care models for post COVID-19 condition. Bull World Health Organ 2022; 100:676-688. [PMID: 36324552 PMCID: PMC9589389 DOI: 10.2471/blt.22.288105] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To systematically map the current evidence about the characteristics of health systems, providers and patients to design rehabilitation care for post coronavirus disease 2019 (COVID-19) condition. Methods We conducted a scoping review by searching the databases: MEDLINE®, Embase®, Web of Science, Cochrane COVID-19 Registry and Cochrane Central Register of Controlled Trials, from inception to 22 April 2022. The search strategy included terms related to (i) post COVID-19 condition and other currently known terminologies; (ii) care models and pathways; and (iii) rehabilitation. We applied no language or study design restrictions. Two pairs of researchers independently screened title, abstracts and full-text articles and extracted data. We charted the evidence according to five topics: (i) care model components and functions; (ii) safe delivery of rehabilitation; (iii) referral principles; (iv) service delivery settings; and (v) health-care professionals. Findings We screened 13 753 titles and abstracts, read 154 full-text articles, and included 37 articles. The current evidence is conceptual and expert based. Care model components included multidisciplinary teams, continuity or coordination of care, people-centred care and shared decision-making between clinicians and patients. Care model functions included standardized symptoms assessment, telehealth and virtual care and follow-up system. Rehabilitation services were integrated at all levels of a health system from primary care to tertiary hospital-based care. Health-care workers delivering services within a multidisciplinary team included mostly physiotherapists, occupational therapists and psychologists. Conclusion Key policy messages include implementing a multilevel and multiprofessional model; leveraging country health systems' strengths and learning from other conditions; financing rehabilitation research providing standardized outcomes; and guidance to increase patient safety.
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Affiliation(s)
- Simon Décary
- Faculty of Medicine and Health Sciences, Research Centre of the CHUS, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Wouter De Groote
- Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine, Roma, Italy
| | | | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Québec, Canada
| | - Théo Stefan
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Québec, Canada
| | - Léa Langlois
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Québec, Canada
| | - Frédérique Daigle
- Faculty of Medicine and Health Sciences, Research Centre of the CHUS, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Florian Naye
- Faculty of Medicine and Health Sciences, Research Centre of the CHUS, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada
| | - Annie LeBlanc
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Québec, Canada
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, Milan, Italy
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30
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Kiekens C, Young VM. Can Walking Lower Blood Pressure in Adults?: A Cochrane Review Summary With Commentary. Am J Phys Med Rehabil 2022; 101:1083-1085. [PMID: 35583449 DOI: 10.1097/phm.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Carlotte Kiekens
- From the IRCCS MultiMedica, Milan, Italy (CK); and Arizona State University, School of Social and Behavioral Sciences, Phoenix, Arizona (VMY)
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31
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Negrini S, Borg K, Cusick A, Ferriero G, Frontera WR, Gross DP, Heinemann A, Machalicek W, Moore AP, Nudo RJ, Pérennou D, Stam H, Kiekens C. Global statements to produce and implement evidence in the post-COVID-19 era provide a path forward for rehabilitation. A joint initiative of Cochrane Rehabilitation and the leading journals in the field. Eur J Phys Rehabil Med 2022; 58:659-665. [PMID: 36217980 PMCID: PMC10019471 DOI: 10.23736/s1973-9087.22.07668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden.,Chief Editor Journal Rehabilitation Medicine
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine and Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Allen Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine Northwestern University, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA
| | - Ann P Moore
- Editor in Chief Musculoskeletal Science and Practice an International Journal of Musculoskeletal Physiotherapy.,Professor Emerita, University of Brighton, Brighton, UK
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Dominic Pérennou
- University Grenoble Alpes, UMR CNRS 5105 Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Department of NeuroRehabilitation South Hospital, Cs 10217 - 38043 Grenoble cedex 9, France
| | - Henk Stam
- Erasmus University Medical Center, Rotterdam, the Netherlands.,Chief Editor Journal Rehabilitation Medicine
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Uddin T, Siddiquee N, Rahman MA, Helal SU, Kiekens C. Rehabilitation of Persons with Spinal Cord Injury in Bangladesh. Mymensingh Med J 2022; 31:1093-1101. [PMID: 36189557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
There is a knowledge gap about the rehabilitation system for the persons with spinal cord injury (SCI). A rehabilitation scenario is necessary to conduct a national community survey in conjunction with the International Spinal Cord Injury Community Survey (InSCI) in order to gather data on the lived experiences of people with SCI, to map out the health and rehabilitation system of Bangladesh, it's demographic characteristics, accessible resources and rehabilitation challenges. Information for this narrative report was acquired through a structured questionnaire, which was supplemented by an online search of agencies, government websites, rehabilitation-related organizations and published papers during the period of March 2020 to April 2021. Bangladesh is a developing country with a vast population and a developing health care system. Representative government and non-government rehabilitative care settings a total of sixteen survey replies (n=16) were obtained. During the year 2019, a total of 1035 people with SCI were seen. The majority of patients with SCI were hospitalized by a non-government facility (38.65%), whereas the two main public general hospitals consulted roughly 30.0% of people with SCI. The rehabilitation team leader in the majority of the facilities (93.75%) was a physiatrist, but just a few had a full complement of rehabilitation professionals and only 12.5% of settings provide community care. Indoor rehabilitation facilities, equipment and a competent rehabilitation staff are not available at many of the tertiary care facilities including National Trauma Institute (NITOR), where most of the SCI report first after the trauma. A consistent and nationwide data source is unavailable and the majority of the available SCI research publications are hospital-based demographic studies in Bangladesh. SCI was commonly due to work-related trauma in young male manual laborers due to fall from height or road traffic accidents. The country faces multiple challenges in rehabilitation of people with SCI regarding triage, a referral system development, infrastructure and shortage of expert human resources in addition, currently there is no three-tier rehabilitation care continuum available. Keeping pace with the transition to a developed country by 2041, the Bangladesh health sector also has to be oriented to face the focused challenge of caring for people with SCI. As recommended by WHO Rehabilitation 2030 initiatives, establishment of an SCI dedicated national institute and escalation of number of related specialists such as trauma and orthopedic surgery, spinal neurosurgery and physical rehabilitation medicine, skilled professionals such as rehabilitation nurses, therapists, case managers and social workers to work in a team required for specialized care of SCI.
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Affiliation(s)
- T Uddin
- Professor Md Taslim Uddin, Professor and Chairman, Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh; E-mail:
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Kiekens C, Tognonato C. Which screening tool should be used for identifying aspiration risk associated with dysphagia in acute stroke? A Cochrane Review summary with commentary. NeuroRehabilitation 2022; 51:533-535. [DOI: 10.3233/nre-228024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool. OBJECTIVE: To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke. METHODS: A summary of the Cochrane Review by Boaden et al. 2021, with comments from a rehabilitation perspective. RESULTS: The review included 25 studies with 3953 participants and 37 screening tests. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing swallow screening tools were the Bedside Aspiration test (combined water swallow and instrumental tool), the Gugging Swallowing Screen (GUSS, water plus other consistencies) and the Toronto Bedside Swallowing Screening Test (TOR-BSST, water only). However, these tests were based on single studies with small sample sizes. It was not possible to explore the influence of sources of heterogeneity. CONCLUSIONS: No single swallow screening tool with high accuracy as well as good quality evidence could be identified, but recommendations for further high-quality research are offered.
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Negrini S, Borg K, Cusick A, Ferriero G, Frontera WR, Gross DP, Heinemann A, Machalicek W, Moore AP, Nudo RJ, Pérennou D, Stam H, Kiekens C. Global statements to produce and implement evidence in the post-COVID-19 era provide a path forward for rehabilitation - A joint initiative of Cochrane Rehabilitation and the leading journals in the field. Ann Phys Rehabil Med 2022; 65:101688. [PMID: 35811074 PMCID: PMC9359696 DOI: 10.1016/j.rehab.2022.101688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden; Journal of Rehabilitation Medicine
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Italy; Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine and Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Allen Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA
| | - Ann Patricia Moore
- Musculoskeletal Science and Practice an International Journal of Musculoskeletal Physiotherapy; University of Brighton, East Sussex, UK
| | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dominic Pérennou
- Univ. Grenoble Alpes, UMR CNRS 5105, Neuropsychology and NeuroCognition, CHU Grenoble Alpes, Dept of NeuroRehabilitation, South Hospital, Cs 10217 - 38043, Grenoble cedex 9, France
| | - Henk Stam
- Erasmus University Medical Center Rotterdam, the Netherlands; Journal of Rehabilitation Medicine
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Negrini S, Borg K, Cusick A, Ferriero G, Frontera WR, Gross DP, Heinemann A, Machalicek W, Moore AP, Nudo RJ, Pérennou D, Stam H, Kiekens C. Global statements to produce and implement evidence in the post-COVID-19 era provide a path forward for rehabilitation - A joint initiative of Cochrane Rehabilitation and the leading journals in the field. J Occup Rehabil 2022; 32:330-336. [PMID: 36205804 PMCID: PMC9542461 DOI: 10.1007/s10926-022-10071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet Danderyd University Hospital, Stockholm, Sweden
| | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine and Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
| | - Allen Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, USA
| | | | - Randolph J Nudo
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dominic Pérennou
- Department of NeuroRehabilitation South Hospital, Université Grenoble Alpes, Grenoble, France
| | - Henk Stam
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Zampolini M, Selb M, Boldrini P, Branco CA, Golyk V, Hu X, Kiekens C, Negrini S, Nulle A, Oral A, Sgantzos M, Shmonin A, Treger I, Stucki G. The Individual Rehabilitation Project as the core of person-centered rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists Framework for Rehabilitation in Europe. Eur J Phys Rehabil Med 2022; 58:503-510. [PMID: 35148044 PMCID: PMC9980560 DOI: 10.23736/s1973-9087.22.07402-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.
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Affiliation(s)
| | - Melissa Selb
- ICF Research Branch, Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Treviso, Italy
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Volodymyr Golyk
- Department of Physical and Rehabilitation Medicine and Sports Medicine, Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine.,Department of Physical and Rehabilitation Medicine, City Municipal Teaching Hospital N.4, Dnipro, Ukraine
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, Università "La Statale, " Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Anda Nulle
- National Rehabilitation Center "Vaivari, " Jurmala, Latvia
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Markos Sgantzos
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Aleksei Shmonin
- First Saint-Petersburg I.P. Pavlov State Medical University, Saint-Petersburg, Russia
| | - Iuly Treger
- Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gerold Stucki
- ICF Research Branch, Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland.,Center for Rehabilitation in Global Health Systems, University of Lucerne, Lucerne, Switzerland
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Petronic Markovic I, Nikolic D, Stahl M, Tederko P, Hdyrya O, Negrini S, Zampolini M, Kiekens C. Evidence-based position paper of the UEMS PRM on the role of Physical and Rehabilitation Medicine (PRM) physician in the management of children and adults with spinal dysraphism. Eur J Phys Rehabil Med 2022; 58:511-519. [PMID: 35575455 PMCID: PMC9980507 DOI: 10.23736/s1973-9087.22.07536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PRM section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.
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Affiliation(s)
- Ivana Petronic Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - Minna Stahl
- National Center for Pediatric and Adolescent Pain Management and Research, New Children's Hospital, HUS, Helsinki, Finland
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Oksana Hdyrya
- Department of Rehabilitation and Alternative Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Stefano Negrini
- La Statale University, Milan, Italy.,IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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Negrini S, Selb M, Kiekens C, Todhunter-Brown A, Arienti C, Stucki G, Meyer T. Rehabilitation Definition for Research Purposes: A Global Stakeholders' Initiative by Cochrane Rehabilitation. Am J Phys Med Rehabil 2022; 101:e100-e107. [PMID: 35583514 PMCID: PMC9197136 DOI: 10.1097/phm.0000000000002031] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: (1) support the conduct of primary studies and systematic reviews and (2) identify relevant systematic reviews for knowledge translation purposes. DESIGN We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings, and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement and refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks, and 3 Cochrane Groups and included invited experts and representatives of low middle-income countries and consumers. RESULTS We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range, 5.5%-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a healthcare context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." CONCLUSIONS We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.
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Negrini S, Selb M, Kiekens C, Todhunter-Brown A, Arienti C, Stucki G, Meyer T. Rehabilitation definition for research purposes. A global stakeholders' initiative by Cochrane Rehabilitation. Eur J Phys Rehabil Med 2022; 58:333-341. [PMID: 35306803 PMCID: PMC9980575 DOI: 10.23736/s1973-9087.22.07509-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a health care context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale, " Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland
| | | | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Luzern, Switzerland
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Negrini S, Selb M, Kiekens C, Todhunter-Brown A, Arienti C, Stucki G, Meyer T. Rehabilitation Definition for Research Purposes. A Global Stakeholders' Initiative by Cochrane Rehabilitation. Neurorehabil Neural Repair 2022; 36:405-414. [PMID: 35574944 DOI: 10.1177/15459683221093587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: (1) support the conduct of primary studies and systematic reviews, and (2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings, and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks, and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a health care context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland
| | | | - Alex Todhunter-Brown
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, UK
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,ICF Research Branch, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Luzern, Switzerland
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- Members are listed at the end of the paper
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Kiekens C, Young VM. How effective and safe are current interventions for sexual dysfunction following stroke? A Cochrane Review summary with commentary. NeuroRehabilitation 2022; 50:343-345. [DOI: 10.3233/nre-228017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Sexual dysfunction (SD) is experienced by 50% of stroke survivors, and it is identified as critical in their rehabilitation management, but often remains unaddressed. OBJECTIVE: To evaluate the effectiveness and adverse events of currently available interventions for SD following stroke. METHODS: A summary of the Cochrane Review by Stratton et al. 2020, with comments from a rehabilitation perspective. RESULTS: Three randomized control trials with a total of 212 participants were included. Evidence quality was very low for all assessed interventions (pharmacological, psycho-educational and physical therapy). The efficacy of pelvic floor muscle training for lower urinary tract symptoms and erectile dysfunction remains uncertain. Pharmacological interventions may improve sexual functioning, while psychoeducation show little to no difference on sexual functioning outcomes. CONCLUSIONS: The effectiveness of current rehabilitation interventions for SD following stroke remains uncertain due to the low quality of evidence and limited sample size. Further studies with improved methodology should investigate rehabilitation interventions for SD in stroke survivors to improve their quality of life.
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Affiliation(s)
| | - Vanessa M. Young
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
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Sacco C, Olivi S, Visani J, Donati R, Veronesi V, Mencarani C, Capone C, Bizzocchi G, Kiekens C, De Bonis P, Scerrati A, Staffa G. Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report. Microsurgery 2022; 42:577-585. [PMID: 35484858 DOI: 10.1002/micr.30891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/13/2022] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. METHODS We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10 months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. RESULTS Thirteen PIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p = .005 and p = .008, respectively). SCIM self-care sub-score also statistically significant improved from 3 to 4 at 12 months (p = .016). No complication or donor morbidity occurred. CONCLUSIONS Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.
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Affiliation(s)
- Carlo Sacco
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Silvia Olivi
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Jacopo Visani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy.,Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Roberto Donati
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Vanni Veronesi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Camilla Mencarani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Crescenzo Capone
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Gianluca Bizzocchi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | | | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Guido Staffa
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
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43
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Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, Kiekens C. Evidence-based position paper on Physical and Rehabilitation Medicine practice for people with amyotrophic lateral sclerosis. Eur J Phys Rehabil Med 2022; 58:271-279. [PMID: 34786907 PMCID: PMC9980500 DOI: 10.23736/s1973-9087.21.07120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.
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Affiliation(s)
- Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Institute for Rehabilitation, Belgrade, Serbia -
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - François C Boyer
- Department of Physical and Rehabilitation Medicine, Reims Champagne Ardenne University, Sebastopol Hospital, Reims, France
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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Lazovic M, Nikolic D, Boyer FC, Borg K, Ceravolo MG, Zampolini M, Kiekens C. Evidence based position paper on Physical and Rehabilitation Medicine practice for people with muscular dystrophies. Eur J Phys Rehabil Med 2021; 57:1036-1044. [PMID: 34823337 DOI: 10.23736/s1973-9087.21.07121-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.
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Affiliation(s)
- Milica Lazovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia - .,Institute for Rehabilitation, Belgrade, Serbia -
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Physical Medicine and Rehabilitation, University Children's Hospital, Belgrade, Serbia
| | - François C Boyer
- PRM Department, Sebastopol Hospital, Reims Champagne Ardenne University, Reims, France
| | - Kristian Borg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, Politecnica delle Marche University, Ancona, Italy
| | - Mauro Zampolini
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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45
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Linden E, Peers K, Kiekens C. Amputation for chronic pain and/or functional impairment of a limb. J Rehabil Med 2021; 53:jrm00237. [PMID: 34546378 PMCID: PMC8638726 DOI: 10.2340/16501977-2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the impact of a lower limb amputation for chronic pain and/or functional impairment on pain and participation in daily living activities and to assess the use of prostheses. To improve decision-making for this controversial treatment. Design Survey. Setting University hospital. Subjects Patients who had an amputation of a lower limb for chronic pain and/or functional impairment. Results Eighty-one percent of the patients were satisfied with the amputation and would decide to undergo an amputation again under the same conditions. Sixty-nine percent of the patients reported an improvement in pain, 69% an improvement in mobility, 75% in daily living activities, and 56% an improvement in sleep. Seventy-five percent of the patients used their prosthesis on a daily basis. Conclusion Most patients who underwent an amputation in our hospitals for chronic pain and/or functional impairment of a lower limb were satisfied and reported an improvement in function and pain.
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Affiliation(s)
- Evelyne Linden
- Department of Physical & Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
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Negrini S, Côté P, Kiekens C. Methodological quality of systematic reviews on interventions for children with cerebral palsy: the evidence pyramid paradox. Dev Med Child Neurol 2021; 63:1244-1245. [PMID: 34247397 PMCID: PMC8597080 DOI: 10.1111/dmcn.14988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This commentary is on the original article by Kolaski et al. on pages 1316–1326 of this issue.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental SciencesUniversity “La Statale”MilanItaly,IRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Pierre Côté
- Centre for Disability Prevention and Rehabilitation and Faculty of Health SciencesOntario Tech UniversityOshawazOntarioCanada
| | - Carlotte Kiekens
- Spinal UnitMontecatone Rehabilitation InstituteImola, BolognaItaly
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Abstract
PURPOSE Responding to a recent editorial arguing against defining rehabilitation, we discuss the reasons for developing a classification of rehabilitation for research purposes, its philosophical background and some of the possible risks. WHY DEFINE Science requires the definition and classification of phenomena to allow replication of experiments and studies, and to allow interpretation and use of the findings. As understanding increases, the definitions can be refined. Defining rehabilitation does run the risk of excluding some interventions or practices that are either considered rehabilitation (perhaps wrongly) or are rehabilitation interventions; when identified, these errors in definition can be remedied. Defining rehabilitation for research purposes should not inhibit but could (possibly) orient research. RISK OF NOT Without a definition, rehabilitation will remain in a permanent limbo. Experts will (apparently) know what it is, while others are left guessing or failing to comprehend or recognise it. This uncertainty may reassure some people, because all possible interventions are included; we argue that it downgrades the understanding of our field because interventions that are not rehabilitation are, nonetheless, called rehabilitation. In an era of international collaboration, and of undertaking systematic reviews with metanalysis, we need a shared definition. CONCLUSION Terminology is often controversial, but definition enables progress in understanding such that terms themselves can evolve over time.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University 'La Statale', Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Thorsten Meyer
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Bologna, Italy
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Arienti C, Lazzarini SG, Pollini E, Patrini M, Kiekens C, Negrini S. Effectiveness of rehabilitation interventions in adults with multi-organ dysfunction syndrome: A rapid review. J Rehabil Med 2021; 53:jrm00221. [PMID: 34037239 PMCID: PMC8638732 DOI: 10.2340/16501977-2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome, defined as altered organ function in critically ill patients, is a possible consequence of COVID-19. Investigating the current evidence is therefore crucial in this pandemic, as early rehabilitation could be effective for the functioning of patients with multiple organ failure. This rapid review assesses the effectiveness of rehabilitation interventions in adults with multiple organ dysfunction syndrome. METHODS A rapid review was conducted including only randomised control trials, published until 30 November 2020. All databases were investigated and the results synthesized narratively, evaluating the risk of bias and quality of evidence in all included studies. RESULTS A total of 404 records were identified through database searches. After removal of duplicates 346 articles remained. After screening, 3 studies (90 participants) met the inclusion criteria. All studies reported positive effects of neuromuscular electrical stimulation on muscle mass preservation compared with no treatment or standard physio-therapy. CONCLUSION The lack of evidence on the effectiveness of rehabilitation interventions does not allow any firm conclusion to be drawn. Neuromuscular electrical stimulation might be a possible rehabilitation intervention to prevent muscle volume loss and improve function in patients with multiple organ dysfunction syndrome. However, further studies are needed to support these preliminary findings.
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Skempes D, Kiekens C, Malmivaara A, Michail X, Bickenbach J, Stucki G. Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action. Health Policy 2021; 126:158-172. [PMID: 34281701 DOI: 10.1016/j.healthpol.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.
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Affiliation(s)
- Dimitrios Skempes
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy; Physical and Rehabilitation Medicine, University Hospitals Leuven - Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare and Orton Orthopedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Xanthi Michail
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Jerome Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, Department of Health Sciences and Medicine, University of Lucerne, Switzerland.
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50
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Bazzocchi G, Turroni S, Bulzamini MC, D'Amico F, Bava A, Castiglioni M, Cagnetta V, Losavio E, Cazzaniga M, Terenghi L, De Palma L, Frasca G, Aiachini B, Cremascoli S, Massone A, Oggerino C, Onesta MP, Rapisarda L, Pagliacci MC, Biscotto S, Scarazzato M, Giovannini T, Balloni M, Candela M, Brigidi P, Kiekens C. Changes in gut microbiota in the acute phase after spinal cord injury correlate with severity of the lesion. Sci Rep 2021; 11:12743. [PMID: 34140572 PMCID: PMC8211659 DOI: 10.1038/s41598-021-92027-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SCI patients, months after a traumatic injury. Here we characterized the gut microbiota in a large Italian SCI population, within a short time from a not only traumatic injury. Feces were collected within the first week at the rehabilitation center (no later than 60 days after SCI), and profiled by 16S rRNA gene-based next-generation sequencing. Microbial profiles were compared to those publicly available of healthy age- and gender-matched Italians, and correlated to patient metadata, including type of SCI, spinal unit location, nutrition and concomitant antibiotic therapies. The gut microbiota of SCI patients shows distinct dysbiotic signatures, i.e. increase in potentially pathogenic, pro-inflammatory and mucus-degrading bacteria, and depletion of short-chain fatty acid producers. While robust to most host variables, such dysbiosis varies by lesion level and completeness, with the most neurologically impaired patients showing an even more unbalanced microbial profile. The SCI-related gut microbiome dysbiosis is very likely secondary to injury and closely related to the degree of completeness and severity of the lesion, regardless of etiology and time interval. This microbial layout could variously contribute to increased gut permeability and inflammation, potentially predisposing patients to the onset of severe comorbidities.
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Affiliation(s)
- Gabriele Bazzocchi
- Neurogastroenterology Unit, Montecatone Rehabilitation Institute, via Montecatone 37, 40026, Imola, Bologna, Italy.
| | - Silvia Turroni
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | - Federica D'Amico
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mimosa Balloni
- Neurogastroenterology Unit, Montecatone Rehabilitation Institute, via Montecatone 37, 40026, Imola, Bologna, Italy
| | - Marco Candela
- Unit of Microbiome Science and Biotechnology, Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Brigidi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Bologna, Italy
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