Simone Thomas

Electromechanical-Assisted Training for Walking After Stroke: A Major Update of the Evidence

Electromechanical-assisted gait training uses specialist machines to assist walking practice and might help to improve walking after stroke. This update of our Cochrane review examined the effects of electromechanical and robot-assisted gait training devices for improving walking after stroke and also assessed the acceptability and safety of this type of therapy. We searched the cochrane stroke group trials register (last searched, August 2016), the cochrane central register of controlled trials (Cochrane Library 2016; Issue 8), MEDLINE in Ovid (1950 to August 2016), Embase (1980 to August 2016), CINAHL (Cumulative Index to Nursing and Allied Health Literature; …

Recovery of sit-to-stand function in patients with intensive-care-unit-acquired muscle weakness: Results from the General Weakness Syndrome Therapy cohort study.

OBJECTIVES To describe the time course of recovery of sit-to-stand function in patients with intensive-care-unit-acquired muscle weakness and the impact of recovery. METHODS A cohort study in post-acute intensive care unit and rehabilitation units. Patients with chronic critical illness and intensive-care-unit-acquired muscle weakness were included. Sit-to-stand function was measured daily, using a standardized chair height, defined as 120% of the individuals knee height. RESULTS A total of 150 patients were recruited according to the selection criteria. The primary outcome of independent sit-to-stand function was achieved by a median of 56 days (interquartile range Q1-Q3 = 32-90 days) after rehabilitation onset and a median of 113 days (Q1-Q3=70-148 days) after onset of illness. The final multivariate model for recovery of sit-to-stand function included 3 variables: age (adjusted hazard ratio (HR) = 0.96 (95% CI 0.94-0.99), duration of ventilation (HR=0.99 (95% CI 0.98-1.00) and Functional Status Score for the Intensive Care Unit (FSS-ICU) (adjusted HR=1.12 (95% CI 1.08-1.16)). CONCLUSION Rapid recovery of sit-to-stand function for most patients with intensive-care-unit-acquired muscle weakness were seen. The variables older age and longer duration of ventilation decreased, and higher FSS-ICU increased the chance of regaining independent sit-to-stand function.

Regaining water swallowing function in the rehabilitation of critically ill patients with intensive-care-unit acquired muscle weakness

Abstract Purpose: Treatment in intensive care units (ICUs) often results in swallowing dysfunction. Recent longitudinal studies have described the recovery of critically ill people, but we are not aware of studies of the recovery of swallowing function in patients with ICU-acquired muscle weakness. This paper aims to describe the time course of regaining water swallowing function in patients with ICU-acquired weakness in the post-acute phase and to describe the risks of regaining water swallowing function and the risk factors involved. Methods: This cohort study included patients with ICU-acquired muscle weakness in our post-acute department, who were unable to swallow. We monitored the process of regaining water swallowing function using the 3-ounce water swallowing test. Results: We included 108 patients with ICU-acquired muscle weakness. Water swallowing function was regained after a median of 12 days (interquartile range =17) from inclusion in the study and after a median of 59 days (interquartile range= 36) from the onset of the primary illness. Our multivariate Cox Proportional Hazard model yielded two main risk factors for regaining water swallowing function: the number of medical tubes such as catheters at admission to the post-acute department (adjusted hazard ratio [HR] = 1.282; 95% confidence interval [CI]: 1.099–1.495) and the time until weaning from the respirator in days (adjusted HR =1.02 per day; 95%CI: 0.998 to 1.008). Conclusion: We describe a time course for regaining water swallowing function based on daily tests in the post-acute phase of critically ill patients. Risk factors associated with regaining water swallowing function in rehabilitation are the number of medical tubes and the duration of weaning from the respirator. Implications for rehabilitation Little guidance is available for the management of swallowing dysfunction in the rehabilitation of critically ill patients with intensive-care-units acquired muscle weakness. There is a time dependent pattern of recovery from swallowing dysfunction with daily water swallowing tests in the post-acute phase of critically ill patients. Daily water swallowing tests can be used to test swallowing dysfunction in the post-acute phase of critically ill patients The amount of medical tubes and the duration of weaning from respirator are associated risk factors for recovery of swallowing dysfunction.

Fitness and mobility training in patients with Intensive Care Unit-acquired muscle weakness (FITonICU): study protocol for a randomised controlled trial

BackgroundCritical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of people with ICUAW is, therefore, of great importance at both an individual and a societal level. A recent systematic Cochrane review found no randomised controlled trials (RCT), and thus no supporting evidence, for physical rehabilitation interventions for people with defined CIP and CIM to improve activities of daily living. Therefore, the aim of our study is to compare the effects of an additional physiotherapy programme with systematically augmented levels of mobilisation with additional in-bed cycling (as the parallel group) on walking and other activities of daily living.Methods/designWe will conduct a prospective, rater-masked RCT of people with ICUAW with a defined diagnosis of CIM and/or CIP in our post-acute hospital. We will randomly assign patients to one of two parallel groups in a 1:1 ratio and will use a concealed allocation. One intervention group will receive, in addition to standard ICU treatment, physiotherapy with systematically augmented levels of mobilisation (five times per week, over 2 weeks; 20 min each session; with a total of 10 additional sessions). The other intervention group will receive, in addition to standard ICU treatment, in-bed cycle sessions (same number, frequency and treatment time as the intervention group).Standard ICU treatment includes sitting balance exercise, stretching, positioning, and sit-to-stand training, and transfer training to get out of bed, strengthening exercise (in and out of bed), and stepping and assistive standing exercises.Primary efficacy endpoints will be walking ability (defined as a Functional Ambulation Category (FAC) level of ≥3) and the sum score of the Functional Status Score for the Intensive Care Unit (FSS-ICU) (range 0–22 points) assessed by a blinded tester immediately after 2 weeks of additional therapy.Secondary outcomes will include assessment of sit-to-stand recovery, overall limb strength (Medical Research Council, MRC) and grip strength, the Physical Function for the Intensive Care Unit Test-Scored (PFIT-S), the EuroQol 5 Dimensions (EQ-5D) questionnaire and the Reintegration to Normal Living Index (RNL-Index) assessed by a blinded tester.We will measure primary and secondary outcomes with blinded assessors at baseline, immediately after 2 weeks of additional therapy, and at 3 weeks and 6 months and 12 months after the end of the additional therapy intervention.Based on our sample size calculation 108 patients will be recruited from our post-acute ICU in the next 3 to 4 years.DiscussionThis will be the first RCT comparing the effects of two physical rehabilitation interventions for people with ICUAW due to defined CIP and/or CIM to improve walking and other activities of daily living. The results of this trial will provide robust evidence for physical rehabilitation of people with CIP and/or CIP who often require long-term care.Trial registrationWe registered the study on 6 April 2016 before enrolling the first patient in the trial at the German Clinical Trials Register (www.germanctr.de) with the identifier DRKS00010269. This is the first version of the protocol (FITonICU study protocol).

Health-related quality of life, participation, and physical and cognitive function of patients with intensive care unit-acquired muscle weakness 1 year after rehabilitation in Germany: the GymNAST cohort study

Objective To describe predictors for health-related quality of life, participation, physical activity and cognitive function in patients with intensive care unit (ICU)-acquired muscle weakness 1 year after discharge from rehabilitation. Design This is a cohort study. Participants We included 150 chronic critically ill individuals with ICU-acquired muscle weakness. Setting Postacute ICU and rehabilitation units in Germany. Measures We measured health-related quality of life using the EQ-5D, participation using the Reintegration of Normal Living Index, physical activity using the Physical Activity Scale for Individuals With Physical Disabilities, and basal cognitive function using the Montreal Cognitive Assessment (MoCA) at 6 months, and the Clock Drawing Test 6 and 12 months after discharge from postacute treatment. We described the predictors of the results at 12 months. Results The best predictors for good health-related quality of life 1 year after discharge were the time until regaining walking ability (OR=0.96, OR per day, 95% CI 0.93 to 0.99) and the mean MoCA score on admission to our postacute ICU and rehabilitation units (OR=1.25,95% CI 1.02 to 1.52).The best predictor for good participation 1 year after discharge was the MoCA sum score on admission to our postacute ICU and rehabilitation units (OR=0.85,95% CI 0.72 to 1.00). The best predictor for good physical activity 1 year after discharge was the Apache sum score on admission to our postacute ICU and rehabilitation units (OR=1.68,95% CI 0.89 to 3.13). The best predictor for normal cognitive function 1 year after discharge was regaining walking function in rehabilitation (OR=8.0,95% CI 0.49 to 13.69). Conclusion Recovery of health-related quality of life, participation, physical activity and basal cognitive function was still not complete 12 months after discharge from postacute treatment. We described the predictors for these important outcomes in participants with ICU-acquired muscle weakness 1 year after discharge from rehabilitation. Trial registration number DRKS00007181.

Beurteilung von Assessments oder Testgütekriterien

Objektivitat, Reliabilitat und Validitat sind die bekanntesten klassischen Testgutekriterien. Was verbirgt sich dahinter, wie konnen sie praktisch angewandt werden und welche nicht klassischen Kriterien gibt es auserdem? Daruber gibt dieser Artikel Aufschluss.

Skalenniveau (Verarbeitung/Statistik) bei Assessment-Testergebnissen

Im Umgang mit Assessments tauchen die Fragen auf, wie sich die gewonnenen Daten verarbeiten lassen und wie Testgutekriterien berechnet werden konnen. Hierzu liefert der folgende Artikel wichtige Informationen mit Praxisbeispielen.

Erste Ergebnisse der GymNAST-Studie

Lang andauernde intensivmedizinische Behandlung verursacht haufig eine Schwache der Muskulatur. Betroffen sind sowohl die Extremitaten als auch die Atmung. Die Beatmungsentwohnung ist erschwert, die Mortalitat steigt. Eine Studie hat nun den Versuch unternommen, die Dauer der Intensivbehandlung zu bestimmen und Pradiktoren fur Alltagsbewegungen zu entwickeln, um Therapien entsprechend anpassen zu konnen.