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Deschepper M, Colpaert K. Creating awareness of the heterogeneity of the intensive care unit population and its impact on generalizability of results and transportability of models. Intensive Crit Care Nurs 2024; 80:103565. [PMID: 37875048 DOI: 10.1016/j.iccn.2023.103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Mieke Deschepper
- Data Science Institute, Ghent University Hospital, Ghent, Belgium.
| | - Kirsten Colpaert
- Data Science Institute, Ghent University Hospital, Ghent, Belgium; Department of Intensive Care, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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2
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Arippa F, Scribante A, Rocca B, Monticone M. Robot-assisted rehabilitation of people with breast cancer developing upper limb lymphedema: protocol of a randomized controlled trial with a 6-month follow‑up. Trials 2023; 24:731. [PMID: 37964287 PMCID: PMC10647105 DOI: 10.1186/s13063-023-07778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
Upper limb lymphedema (ULLy) is an external (and/or internal) manifestation of lymphatic system insufficiency and deranged lymph transport for more than 3 months and frequently affects people as a consequence of breast cancer (BC). ULLy is often underestimated despite diminished motor skills, mood, and cognitive-behavioral complaints negatively condition the health-related quality of life (HRQoL) of persons. BC can also metastasize to the jawbone, further impacting on the HRQoL. In time, the implementation of robot-assisted rehabilitation (RR) for neurological diseases has grown to improve HRQoL and pain. This study aims to evaluate the effectiveness of a RR program in the treatment of individuals who develop an ULLy; as a further analysis, the study will assess the effectiveness of the same program in people with jawbone metastases from BC who will also develop ULLy. A randomized, parallel-group superiority-controlled trial will be conducted. 44 participants will be randomly allocated to either the experimental (receiving a RR program) or the control group (regular rehabilitation). Both groups will follow individual-based programs three times a week for 10 weeks. The main outcome measure will be the Lymphedema Quality of Life Questionnaire. Secondary outcomes will be a pain intensity numerical rating scale and the Cranio-Facial Pain Disability Inventory. Evaluations are before and after training and 6 months later. Findings may provide evidence on the effectiveness of a RR program on inducing improvements in the HRQoL and pain of individuals with ULLy due to BC. People with ULLy and jawbone metastases from BC are expected for similar or higher improvements as per the same comparisons above. This trial might contribute towards defining guidelines for good clinical rehabilitation routines and might be used as a basis for health authorities' endorsements.Trial registration OSF REGISTRIES, osf-registrations-jz7ax-v1 . Registered on 26 June 2023.
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Affiliation(s)
- Federico Arippa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
| | - Andrea Scribante
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Barbara Rocca
- Department of Clinical Psychology, International Institute of Behavioral Medicines, Sevilla, Spain
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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3
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Muroi D, Saito Y, Koyake A, Hiroi Y, Higuchi T. Training for walking through an opening improves collision avoidance behavior in subacute patients with stroke: a randomized controlled trial. Disabil Rehabil 2023:1-9. [PMID: 36815267 DOI: 10.1080/09638288.2023.2181412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Paretic side collisions frequently occur in stroke patients, especially while walking through narrow spaces. We determined whether training for walking through an opening (T-WTO) while entering from the paretic side would improve collision avoidance behavior and prevent falls after 6 months. MATERIALS AND METHODS Thirty-eight adults with moderate-to-mild hemiparetic gait after stroke who were hospitalized in a rehabilitation setting were randomly allocated to the T-WTO (n = 20) or regular rehabilitation (R-Control; n = 18) program. Both groups received five sessions of 40 min per week, for three weeks total. T-WTO included walking through openings of various widths while rotating with the paretic side in front, and R-Control involved normal walking without body rotation. Obstacle avoidance ability, 10-m walking test, timed Up and Go test, Berg Balance Scale, Activities-specific Balance Confidence, the perceptual judgment of passability, and fall incidence were assessed. RESULTS Collision rate and time to passage of the opening in obstacle avoidance task significantly improved in the T-WTO group compared with those in the R-Control group. Contrast, T-WTO did not lead to significant improvements in other outcomes. CONCLUSIONS T-WTO improved efficiency and safety in managing subacute stroke patients. Such training could improve patient outcomes/safety because of the paretic body side during walking. CLINICAL TRIAL REGISTRATION NO. R000038375 UMIN000033926.
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Affiliation(s)
- Daisuke Muroi
- Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yutaro Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Aki Koyake
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yasuhiro Hiroi
- Department of Rehabilitation, Sarashina Rehabilitation Hospital, Chiba, Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
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4
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Finnanger Garshol B, Knardahl S, Emberland JS, Skare Ø, Johannessen HA. Effects of the Labour Inspectorate Authority's regulatory tools on psychosocial and biomechanical work factors in Norwegian home care services: a cluster randomised controlled trial. Occup Environ Med 2022; 79:807-815. [PMID: 36167785 DOI: 10.1136/oemed-2022-108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to determine the effects of the Labour Inspectorate Authority's (LIA's) regulatory tools on psychosocial and biomechanical work factors in the Norwegian municipal home care services. METHODS A cluster-randomised controlled trial conducted in the home care services with employee questionnaire data on work factors at baseline, and 6 and 12 months after the interventions. In total, 96 eligible municipalities were randomly assigned to either the control group or one of two interventions: (1) labour inspection visits, based on the LIA's standard inspections; and (2) guidance-through-workshops, where the participating services highlighted issues and trained labour inspectors provided guidance based on existing labour laws and regulations. RESULTS No favourable intervention effect was observed for the inspection intervention. No effects were observed for most of the variables in the guidance intervention, although an effect was observed for the following psychosocial factors: decision control, control over work intensity and empowering leadership. However, after adjusting for multiple testing, none of the observed effects were statistically significant. CONCLUSION Labour inspections did not affect psychosocial and biomechanical work factors in the home care services. A favourable effect of the guidance intervention on psychosocial work factors was observed. However, this was not evident after adjusting for multiple testing. Further research is needed to elaborate on how labour inspections and other regulatory tools can impact psychosocial and biomechanical work factors. TRIAL REGISTRATION NUMBER NCT03855163.
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Affiliation(s)
- Bjørnar Finnanger Garshol
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Stein Knardahl
- Research Director, National Institute of Occupational Health, Oslo, Norway
| | - Jan Shahid Emberland
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Øivind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Håkon A Johannessen
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
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5
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Monticone M, Simone Vullo S, Lecca LI, Meloni F, Portoghese I, Campagna M. Effectiveness of multimodal exercises integrated with cognitive-behavioral therapy in working patients with chronic neck pain: protocol of a randomized controlled trial with 1-year follow-up. Trials 2022; 23:425. [PMID: 35597965 PMCID: PMC9123712 DOI: 10.1186/s13063-022-06340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The etiology of neck pain is multifactorial and includes personal and work-related factors such as age, sex, wrong postures, and repeated strains. Studies based on bio-psychosocial model also link chronic neck pain to psychological factors. Over time, the use of multidisciplinary interventions for chronic neck pain has grown in order to improve disability, pain, and adaptive cognitions and behaviors towards patients’ problems. The objective is to evaluate the effectiveness of an individual-based multidisciplinary rehabilitation program that integrates cognitive-behavioral therapy focused on kinesiophobia with specific exercises in the treatment of patients with chronic neck pain, employed in different working activities. Methods A randomized, parallel-group superiority-controlled trial will be conducted with 1-year follow-up. One hundred seventy patients engaged in several working activities (blue collar and white collar workers) will be randomly allocated to either the experimental (receiving a multidisciplinary rehabilitation program combining multimodal exercises with psychologist-lead cognitive-behavioral therapy sessions) or the control group (receiving general care physiotherapy). Both groups will follow individual-based programs once a week for 10 weeks. The main outcome measures will be the Neck Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, the Short-Form Health Survey, and the Work Ability Index. Participants will be evaluated before, after training, and after 12 months. Discussion Findings may provide empirical evidence on the effectiveness of an individual-based multidisciplinary rehabilitation program on inducing clinically significant and long-term improvements in the disability, pain, psychological factors, and quality of life of workers with chronic neck pain and that these would be maintained in the long term. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities’ recommendations. Trial registration ClinicalTrials.gov NCT04768790. Registered on 24 February 2021
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Affiliation(s)
- M Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - S Simone Vullo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. .,Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - L I Lecca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Doctoral Programme in Clinical Sciences, University of Florence, Florence, Italy
| | - F Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - I Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - M Campagna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Inoue M, Amimoto K, Shida K, Sekine D, Hasegawa D, Fukata K, Fujino Y, Makita S, Takahashi H. Effects of Dynamic Sitting Exercise with Delayed Visual Feedback in the Early Post-Stroke Phase: A Pilot Double-Blinded Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12050670. [PMID: 35625055 PMCID: PMC9139189 DOI: 10.3390/brainsci12050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Sitting ability in the early post-stroke phase affects functional balance ability and other prognoses. We investigated whether dynamic sitting exercise with delayed visual feedback in the mediolateral and anteroposterior directions affected postural control in the early post-stroke phase. In this pilot randomized controlled trial, 27 hemiparetic stroke patients were randomized to experimental (n = 13) and control (n = 14) groups. Dynamic sitting exercise (30 times/day, 5 days/week) in the mediolateral and anteroposterior directions, with 500-ms-delayed (experimental group) or real-time (control group) visual feedback on a computer, was added to usual physical therapy. We evaluated the postural assessment scale for stroke (PASS), static and dynamic sitting balance tasks, the five-times sit-to-stand test, trunk impairment scale, functional ambulation category, and functional independence measure−motor items. In intention-to-treat analysis, the experimental group demonstrated a significant intervention effect on the PASS score (p < 0.05). The mean percentage of body weight on the moving side in the lateral sitting task and the number of successes in the five-times sit-to-stand test were significantly higher in the experimental group than those in the control group (p < 0.05). Thus, the proposed exercise improves postural control, dynamic sitting balance, and sit-to-stand ability in early post-stroke patients.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-1211
| | - Kohei Shida
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Daichi Hasegawa
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
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Inoue M, Amimoto K, Chiba Y, Sekine D, Fukata K, Fujino Y, Takahashi H, Makita S. Effect of Exercise Involving Standing Weight Shifting to the Nonparetic Side on an Inclined Surface in the Early Phase After a Stroke: A Randomized Controlled Trial. Phys Ther 2021; 101:6254128. [PMID: 33909896 DOI: 10.1093/ptj/pzab114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/24/2021] [Accepted: 03/18/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed to clarify whether an exercise involving weight shifting to the nonparetic side while standing on an inclined surface improves standing balance in the early phase after stroke. METHODS This assessor-blinded, randomized controlled trial included people undergoing inpatient rehabilitation at a university hospital. Participants (N = 52) with hemiparesis caused by a stroke were randomly assigned to an experimental group (n = 26) or control group (n = 26). Participants performed a weight-shifting exercise to the nonparetic side using a goal-directed reaching strategy while standing on an inclined surface that was elevated 5 degrees to the nonparetic side in the experimental group or a flat surface in the control group. The reaching exercise was conducted 30 times per day for 5 days. Primary outcome was the Berg Balance Scale. Secondary outcomes were the posturographic examination (static standing and lateral weight shifting to the nonparetic and paretic sides), Trunk Control Test, Trunk Impairment Scale, Functional Ambulation Category, and Functional Independent Measure motor item scores. RESULTS Through intention-to-treat analysis, no significant intervention effects were observed between groups on the Berg Balance Scale. A significant intervention effect was observed, however, with the experimental group on the lateral weight shifting to the nonparetic side in the mean percentage bodyweight values and center-of-pressure moving distance and to the paretic side in center-of-pressure moving distance and Functional Ambulation Category. There were no significant interaction effects concerning other outcomes. CONCLUSION These results suggest that standing reaching exercises to the nonparetic side while standing on an inclined surface could improve lateral weight-shifting capacity and gait ability in participants in the early poststroke phase. IMPACT This intervention should be incorporated into standard treatment programs focusing on the paretic side during early stroke rehabilitation.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Higashiogu, Arakawa-ku, Tokyo, Japan
| | - Yuya Chiba
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
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Monticone M, Ambrosini E, Portoghese I, Rocca B. Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up. Eur J Phys Rehabil Med 2021; 57:959-967. [PMID: 33947827 DOI: 10.23736/s1973-9087.21.06696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials. AIM To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent. DESIGN Randomised parallel-group superiority-controlled trial. SETTING Outpatient rehabilitation hospital. POPULATION 150 patients with subacute LBP. METHODS Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p<0.001), time (p=0.002), and time-by-group interaction (p<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up. CONCLUSIONS The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year. CLINICAL REHABILITATION IMPACT Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioural and motor lasting changes.
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Affiliation(s)
- Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy - .,Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy -
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research, Lissone, Monza Brianza, Italy
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Monticone M, Portoghese I, Cazzaniga D, Liquori V, Marongiu G, Capone A, Campagna M, Zatti G. Task-oriented exercises improve disability of working patients with surgically-treated proximal humeral fractures. A randomized controlled trial with one-year follow-up. BMC Musculoskelet Disord 2021; 22:293. [PMID: 33743670 PMCID: PMC7981858 DOI: 10.1186/s12891-021-04140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 02/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND General physiotherapy is a common means of rehabilitation after surgery for proximal humeral fracture (PHF). Better-targeted exercises seem worthy of investigation and the aim of this study was to assess the efficacy of a rehabilitation program including task-oriented exercises in improving disability, pain, and quality of life in patients after a PHF. METHODS By means of a randomized controlled trial with one-year follow-up, 70 working patients (mean age of 49 ± 11 years; 41 females), who were selected for open reduction and internal fixation with plates caused by PHF, were randomized to be included in an experimental (n = 35) or control group (n = 35). There was a permuted-block randomization plan, and a list of program codes was previously created; subsequently, an automatic assignment system was used to conceal the allocation. The first group underwent a supervised rehabilitation program of task-oriented exercises based on patients' specific job activities, and occupational therapy. The second group underwent general physiotherapy, including supervised mobility, strengthening and stretching exercises. Both groups individually followed programs of 60-min session three times per week for 12 weeks in the outpatient setting. The Disability Arm Shoulder Hand questionnaire (DASH; scores range from 0 to 100; primary outcome), a Pain intensity Numerical Rating Scale (scores range 0 to 10; secondary outcomes), and the Short-Form Health Survey (scores range from 0 to 100; secondary outcomes) assessed the interventions. Participants were evaluated before surgery, before and after rehabilitation (primary endpoint), and at the one-year follow-up (secondary endpoint). A linear mixed model analysis for repeated measures was carried out for each outcome measure (p < 0.05). RESULTS Time, group and time by group showed significant effects for all outcome measures in favour of the experimental group. The DASH and the DASH work achieved clinically important between-group differences of 16.0 points (95% confidence interval [C.I.] 7.3 to 24.7) and 19.7 (95% C.I. 9.0 to 30.5) at follow-up, respectively. The NRS achieved a between-group difference of 2.9 (95% C.I. 1.0 to 3.9) at follow-up. As for SF-36, there were between-group differences ranging from 17.9 to 37.0 at follow-up. CONCLUSIONS A rehabilitation program based on task-oriented exercises was useful in improving disability, pain, and quality of life in working patients after PHFs. Improvements lasted for at least 12 months. TRIAL REGISTRATION On 16/12/2019, the trial was retrospectively registered in the ISRCTN registry with the ID number 17996552 .
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Affiliation(s)
- Marco Monticone
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy
- Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Igor Portoghese
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy
| | | | | | - Giuseppe Marongiu
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio Capone
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Marcello Campagna
- Department Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria, Strada Statale, 554 - Monserrato, Cagliari, Italy.
| | - Giovanni Zatti
- Bicocca University of Milan, Milan, Italy
- Orthopaedics Unit, San Gerardo Hospital, Brianza, Monza, Italy
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10
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The Art of Remediating Age-Related Cognitive Decline: Art Therapy Enhances Cognition and Increases Cortical Thickness in Mild Cognitive Impairment. J Int Neuropsychol Soc 2021; 27:79-88. [PMID: 32762792 DOI: 10.1017/s1355617720000697] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well. The current intervention examined the effects of an AT intervention on cognitive outcomes and cortical thickness (CT) among participants with mild cognitive impairment. METHOD Participants were assigned to AT (n = 22) and an active control group (n = 27). In both, weekly 45-min sessions were carried out across 3 months. Cognitive assessments and structural magnetic resonance imaging scans were carried out at baseline and 3-month follow-up. Whole brain analyses on CT were carried out. Cognitive outcomes were analyzed using hierarchical linear models. RESULTS Significant gains in immediate memory and working memory span were observed in the AT group, relative to the control group. Significantly increased CT in the AT group, relative to controls, was observed in a right middle frontal gyrus (MFG) cluster. Furthermore, CT changes in this cluster were significantly and positively correlated with changes in immediate memory. CONCLUSION These findings highlighted the role of MFG neuroplasticity in enhancing certain cognitive functions in AT. AT is a neuroplastic intervention capable of engendering significant cognitive gains and associated cortical changes in the context of age-related cognitive decline, even when executed as a low-intensity intervention across 3 months. Given the preliminary nature of these findings, future larger sampled studies are needed.
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11
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Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Lovi A, Brayda-Bruno M. Multimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up. Disabil Rehabil 2020; 44:3422-3429. [PMID: 33356640 DOI: 10.1080/09638288.2020.1863480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term. METHODS By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p < 0.001), time (p < 0.001), and time-by-group interaction (p < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively. CONCLUSION The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation, Department of Medical Sciences and Public Health, University of Cagliari.,Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Daniele Cazzaniga
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Valentina Liquori
- Physical Medicine and Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lissone, Italy
| | - Alessio Lovi
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
| | - Marco Brayda-Bruno
- Unit of Spinal Orthopaedics Surgery, Galeazzi Hospital, IRRCS, Milan, Italy
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12
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Coens C, Pe M, Dueck AC, Sloan J, Basch E, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Devlin N, Dorme L, Flechtner HH, Gotay C, Griebsch I, Groenvold M, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Musoro JZ, O'Connor D, Oliver K, Piault-Louis E, Piccart M, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Taphoorn MJB, Velikova G, Bottomley A. International standards for the analysis of quality-of-life and patient-reported outcome endpoints in cancer randomised controlled trials: recommendations of the SISAQOL Consortium. Lancet Oncol 2020; 21:e83-e96. [PMID: 32007209 DOI: 10.1016/s1470-2045(19)30790-9] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Patient-reported outcomes (PROs), such as symptoms, function, and other health-related quality-of-life aspects, are increasingly evaluated in cancer randomised controlled trials (RCTs) to provide information about treatment risks, benefits, and tolerability. However, expert opinion and critical review of the literature showed no consensus on optimal methods of PRO analysis in cancer RCTs, hindering interpretation of results. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data Consortium was formed to establish PRO analysis recommendations. Four issues were prioritised: developing a taxonomy of research objectives that can be matched with appropriate statistical methods, identifying appropriate statistical methods for PRO analysis, standardising statistical terminology related to missing data, and determining appropriate ways to manage missing data. This Policy Review presents recommendations for PRO analysis developed through critical literature reviews and a structured collaborative process with diverse international stakeholders, which provides a foundation for endorsement; ongoing developments of these recommendations are also discussed.
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Affiliation(s)
- Corneel Coens
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Madeline Pe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research and National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Nancy Devlin
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lien Dorme
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Mogens Groenvold
- Department of Public Health, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Paul G Kluetz
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Daniel O'Connor
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Epidemiological Methods Section, Stockholm, Sweden
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK; International Society for Quality of Life Research, Milwaukee, WI, USA
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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13
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Dissanayake A, Vandal AC, Boyle V, Park D, Milne B, Grech R, Ng A. Does intensive glycaemic control promote healing in diabetic foot ulcers? - a feasibility study. BMJ Open 2020; 10:e029009. [PMID: 31964660 PMCID: PMC7044945 DOI: 10.1136/bmjopen-2019-029009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION One in four diabetes patients will develop a foot ulcer over their lifetime. The role of glycaemic control in the healing of foot ulcers in diabetes patients is not supported by randomised controlled trial (RCT) data. OBJECTIVES To determine the feasibility of an RCT of glycaemic control with intensive insulin therapy in diabetic foot ulcer, by assessing: entry criteria, fasting capillary blood glucose (FCBG) medication satisfaction and sensitivity of different ulcer-healing endpoints to glycaemic control. DESIGN Two substudies: one cross-sectional and one single-arm prospective. SETTING Single-centre secondary care diabetic foot clinic in New Zealand. PARTICIPANTS Substudy 1: 78 participants consisting of all people ≥18 years with a diabetic foot ulcer presenting to the clinic over 35 weeks in 2015.Substudy 2: 15 participants from Substudy 1 consenting to intensive insulin therapy. INTERVENTION Substudy 1: None.Substudy 2: Intensive insulin therapy with standard podiatry care over 24 weeks. OUTCOME Substudy 1: Proportion of participants satisfying potential RCT entry criteria; medication satisfaction (Diabetes Medication Satisfaction).Substudy 2: FCBG, index ulcer healing time, index ulcer size, health-related quality of life (HRQoL; EuroQol 5 Dimensions 5 Levels and Diabetic Foot Ulcer Scale-Short Form). RESULTS Proportion in Substudy 1 satisfying all entry criteria was 31% (95% CI 21 to 42). FCBG values decreased between baseline and study end (difference -3.7 mmol/L, 95% CI -6.5 to -0.8); 83% (95% CI 44 to 95) of ulcers healed by 24 weeks. FCBG correlated negatively with medication satisfaction. Ulcer area logarithm was most sensitive to FCBG changes, displaying significant negative correlation with HRQoL outcomes. Detecting a 30% between-group difference in this outcome (80% power, α=5%) requires 220 participants per arm, achievable within 1 year with 15 centres similar to study setting. CONCLUSIONS An adequately powered RCT requires cooperation between a large number of centres. Ulcer area logarithm should be primary endpoint. TRIAL REGISTRATION NUMBER ANZCTR ACTRN12617001414303.
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Affiliation(s)
- Ajith Dissanayake
- Endocrinology and Diabetes, Counties Manukau District Health Board, Auckland, New Zealand
| | - Alain C Vandal
- Department of Statistics, University of Auckland, Auckland, New Zealand
- Ko Awatea, Counties Manukau Health, Auckland, New Zealand
| | - Veronica Boyle
- Endocrinology and Diabetes, Counties Manukau District Health Board, Auckland, New Zealand
| | - Diane Park
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie Milne
- Middlemore Clinical Trials, Auckland, New Zealand
| | - Roger Grech
- Podiatry, Counties Manukau Health, Auckland, New Zealand
| | - Anthony Ng
- Podiatry, Counties Manukau Health, Auckland, New Zealand
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14
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Park JY, Ji GY, Lee SW, Park JK, Ha D, Park Y, Cho SS, Moon SH, Shin JW, Kim DJ, Shin DA, Choi SS. Relationship of Success Rate for Balloon Adhesiolysis with Clinical Outcomes in Chronic Intractable Lumbar Radicular Pain: A Multicenter Prospective Study. J Clin Med 2019; 8:jcm8050606. [PMID: 31058860 PMCID: PMC6572522 DOI: 10.3390/jcm8050606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/28/2019] [Indexed: 12/29/2022] Open
Abstract
Combined balloon decompression and epidural adhesiolysis has been reported to be effective in refractory lumbar spinal stenosis. Many cases of intractable stenosis have symptom-related multiple target sites for interventional treatment. In this situation it may not be possible to perform balloon adhesiolysis, or even only epidural adhesiolysis, for all target sites. Therefore, this multicenter prospective observational study aimed to evaluate the relationship of successful ballooning rate for multiple target sites with clinical outcome. Based on the ballooning success rate of multiple target sites, the patients were divided into three groups: below 50%, 50–85%, and above 85% ballooning. A greater ballooning success rate for multiple target sites provided a more decreased pain intensity and improved functional status in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 6 months. The estimated proportions of successful responders according to a multidimensional approach in the below 50%, 50–85%, and above 85% balloon success groups at 6 months after the procedure were 0.292, 0.468, and 0.507, respectively (p = 0.038). Our study suggests the more successful balloon adhesiolysis procedures for multiple target lesions are performed, the better clinical outcome can be expected at least 6 months after treatment.
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Affiliation(s)
- Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Gyu Yeul Ji
- Department of Neurosurgery, Spine and Joint Research Institute, Guro Cham Teun Teun Hospital, Seoul 08392, Korea.
| | - Sang Won Lee
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Jin Kyu Park
- Department of Neurosurgery, Himchan Hospital, Bupyeong 21399, Korea.
| | - Dongwon Ha
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Youngmok Park
- Department of Neurosurgery, Yonsei Barun Hospital, Seoul 07013, Korea.
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan 49201, Korea.
| | - Sang Ho Moon
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul 02488, Korea.
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
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15
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Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas 2018; 9:353-367. [PMID: 30464666 PMCID: PMC6219423 DOI: 10.2147/prom.s156279] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) can be included in clinical trials as primary or secondary endpoints and are increasingly recognized by regulators, clinicians, and patients as valuable tools to collect patient-centered data. PROs provide unique information on the impact of a medical condition and its treatment from the patient's perspective; therefore, PROs can be included in clinical trials to ensure the impact of a trial intervention is comprehensively assessed. This review first discusses examples of how PRO endpoints have added value to clinical trial interpretation. Second, it describes the problems with current practices in designing, implementing, and reporting PRO studies, and how these problems may be addressed by complying with guidance for protocol development, selecting appropriate PRO measures to match clinically motivated PRO hypotheses, minimizing the rates of avoidable missing PRO data, analyzing and interpreting PRO data, and transparently reporting PRO findings.
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Affiliation(s)
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
| | - Michael Friedlander
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia,
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16
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Rombach I, Gray AM, Jenkinson C, Murray DW, Rivero-Arias O. Multiple imputation for patient reported outcome measures in randomised controlled trials: advantages and disadvantages of imputing at the item, subscale or composite score level. BMC Med Res Methodol 2018; 18:87. [PMID: 30153796 PMCID: PMC6114240 DOI: 10.1186/s12874-018-0542-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/19/2018] [Indexed: 01/11/2023] Open
Abstract
Background Missing data can introduce bias in the results of randomised controlled trials (RCTs), but are typically unavoidable in pragmatic clinical research, especially when patient reported outcome measures (PROMs) are used. Traditionally applied to the composite PROMs score of multi-item instruments, some recent research suggests that multiple imputation (MI) at the item level may be preferable under certain scenarios. This paper presents practical guidance on the choice of MI models for handling missing PROMs data based on the characteristics of the trial dataset. The comparative performance of complete cases analysis, which is commonly used in the analysis of RCTs, is also considered. Methods Realistic missing at random data were simulated using follow-up data from an RCT considering three different PROMs (Oxford Knee Score (OKS), EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L), 12-item Short Form Survey (SF-12)). Data were multiply imputed at the item (using ordinal logit and predicted mean matching models), sub-scale and score level; unadjusted mean outcomes, as well as treatment effects from linear regression models were obtained for 1000 simulations. Performance was assessed by root mean square errors (RMSE) and mean absolute errors (MAE). Results Convergence problems were observed for MI at the item level. Performance generally improved with increasing sample sizes and lower percentages of missing data. Imputation at the score and subscale level outperformed imputation at the item level in small sample sizes (n ≤ 200). Imputation at the item level is more accurate for high proportions of item-nonresponse. All methods provided similar results for large sample sizes (≥500) in this particular case study. Conclusions Many factors, including the prevalence of missing data in the study, sample size, the number of items within the PROM and numbers of levels within the individual items, and planned analyses need consideration when choosing an imputation model for missing PROMs data. Electronic supplementary material The online version of this article (10.1186/s12874-018-0542-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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17
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Rombach I, Jenkinson C, Gray AM, Murray DW, Rivero-Arias O. Comparison of statistical approaches for analyzing incomplete longitudinal patient-reported outcome data in randomized controlled trials. PATIENT-RELATED OUTCOME MEASURES 2018; 9:197-209. [PMID: 29950913 PMCID: PMC6016604 DOI: 10.2147/prom.s147790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose Missing data are a potential source of bias in the results of RCTs, but are often unavoidable in clinical research, particularly in patient-reported outcome measures (PROMs). Maximum likelihood (ML), multiple imputation (MI), and inverse probability weighting (IPW) can be used to handle incomplete longitudinal data. This paper compares their performance when analyzing PROMs, using a simulation study based on an RCT data set. Methods Realistic missing-at-random data were simulated based on patterns observed during the follow-up of the knee arthroscopy trial (ISRCTN45837371). Simulation scenarios covered different sample sizes, with missing PROM data in 10%–60% of participants. Monotone and nonmonotone missing data patterns were considered. Missing data were addressed by using ML, MI, and IPW and analyzed via multilevel mixed-effects linear regression models. Root mean square errors in the treatment effects were used as performance parameters across 1,000 simulations. Results Nonconvergence issues were observed for IPW at small sample sizes. The performance of all three approaches worsened with decreasing sample size and increasing proportions of missing data. MI and ML performed similarly when the MI model was restricted to baseline variables, but MI performed better when using postrandomization data in the imputation model and also in nonmonotone versus monotone missing data scenarios. IPW performed worse than ML and MI in all simulation scenarios. Conclusion When additional postrandomization information is available, MI can be beneficial over ML for handling incomplete longitudinal PROM data. IPW is not recommended for handling missing PROM data in the simulated scenarios.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Fragility of Results in Ophthalmology Randomized Controlled Trials. Ophthalmology 2018; 125:642-648. [DOI: 10.1016/j.ophtha.2017.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/16/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023] Open
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Wibault J, Öberg B, Dedering Å, Löfgren H, Zsigmond P, Peolsson A. Structured postoperative physiotherapy in patients with cervical radiculopathy: 6-month outcomes of a randomized clinical trial. J Neurosurg Spine 2017; 28:1-9. [PMID: 29087809 DOI: 10.3171/2017.5.spine16736] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Structured physiotherapy has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with cervical radiculopathy (CR), but randomized clinical trials to inform evidence-based clinical guidelines for the treatment of patients with CR after surgery are lacking. The aim of this study was to compare the results of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to a standard postoperative approach in patients who had undergone surgery for cervical disc disease with CR at 6 months after surgery. METHODS Patients with cervical disc disease and persistent CR who were scheduled for surgery were randomized preoperatively to structured postoperative physiotherapy (n = 101) or a standard postoperative approach (n = 100). The latter included pragmatic physiotherapy in accordance with the usual Swedish postoperative care. Outcome measures included patient-reported neck disability as measured with the Neck Disability Index (NDI), intensity and frequency of neck and arm pain, global outcome of treatment, and expectation fulfillment, as well as enablement. RESULTS Patients who received structured postoperative physiotherapy reported greater expectation fulfillment (p = 0.01), and those who attended at least 50% of the treatment sessions reported less neck pain frequency (p = 0.05), greater expectation fulfillment (p = 0.001), and greater enablement (p = 0.04) compared with patients who received the standard postoperative approach. No other difference between treatment groups was found (p > 0.15). The NDI and neck and arm pain intensity were improved in both groups at 6 months after surgery (p < 0.001). Additional use of postoperative physiotherapy was reported by 61% of the patients who received the standard postoperative approach. CONCLUSIONS The results from this first randomized clinical trial of postoperative physiotherapy showed only minor additional benefit of structured postoperative physiotherapy compared with standard postoperative approach 6 months postoperatively in patients who underwent surgery for cervical disc disease with CR. Patients who received structured postoperative physiotherapy reported higher expectation fulfillment, and many patients in the standard postoperative approach group perceived a need for additional treatments after surgery, suggesting that patients with CR are in need of further postoperative support. The results confirm that neck-specific exercises are tolerated postoperatively by patients with CR, but more studies of postoperative physiotherapy are needed to inform clinical guidelines for this patient group. Clinical trial registration no.: NCT01547611 (clinicaltrials.gov).
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Affiliation(s)
- Johanna Wibault
- 1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University
| | - Birgitta Öberg
- 1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University
| | - Åsa Dedering
- 2Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.,3Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm; and
| | - Håkan Löfgren
- 4Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden
| | - Peter Zsigmond
- 5Department of Neurosurgery, Linköping University Hospital, Linköping
| | - Anneli Peolsson
- 1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University
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Monticone M, Ambrosini E, Brunati R, Capone A, Pagliari G, Secci C, Zatti G, Ferrante S. How balance task-specific training contributes to improving physical function in older subjects undergoing rehabilitation following hip fracture: a randomized controlled trial. Clin Rehabil 2017; 32:340-351. [PMID: 28805094 DOI: 10.1177/0269215517724851] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. DESIGN Randomized controlled trial. SUBJECTS A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental ( n = 26) and control group ( n = 26). INTERVENTIONS The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. OUTCOME MEASURES The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. RESULTS Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). CONCLUSION An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.
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Affiliation(s)
- Marco Monticone
- 1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Emilia Ambrosini
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Roberto Brunati
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Antonio Capone
- 4 Orthopaedic Unit, Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Giulia Pagliari
- 2 Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research (IRCCS), Lissone, Italy
| | - Claudio Secci
- 5 Physical Medicine and Rehabilitation School, University of Cagliari, Cagliari, Italy
| | - Giovanni Zatti
- 6 University of Milano-Bicocca, Milan, Italy.,7 Orthopaedics Unit, San Gerardo Hospital, Monza, Italy
| | - Simona Ferrante
- 3 Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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21
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Verghese J, Ayers E, Mahoney JR, Ambrose A, Wang C, Holtzer R. Cognitive remediation to enhance mobility in older adults: the CREM study. Neurodegener Dis Manag 2016; 6:457-466. [PMID: 27813452 DOI: 10.2217/nmt-2016-0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mobility disabilities represent the most prevalent disability among seniors. Emerging evidence indicates that executive functions play an important role in maintaining mobility. However, the use of cognitive remediation programs to enhance mobility has not been investigated in a full-scale randomized control trial. The CREM study is a single-blind randomized control trial to examine the effect of computerized cognitive remediation versus computer-based health education training on mobility in 420 seniors. The primary outcome is change in gait speed during normal walking and walking-while-talking conditions from baseline to postintervention. Secondary outcomes are change in mobility, mobility-related cognitive processes and neuroplasticity. Results of this study will fill an important gap in the efficacy and feasibility of cognitive remediation to improve mobility in seniors.
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Affiliation(s)
- Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeannette R Mahoney
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anne Ambrose
- Burke Rehabilitation Hospital, White Plains, NY, USA
| | - Cuiling Wang
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roee Holtzer
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Ferkauf Graduate School of Psychology of Yeshiva University, Bronx, NY, USA
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22
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Richardson L, Laing A, Milloy MJ, Maynard R, Nosyk B, Marshall B, Grafstein E, Daly P, Wood E, Montaner J, Kerr T. Protocol of the impact of alternative social assistance disbursement on drug-related harm (TASA) study: a randomized controlled trial to evaluate changes to payment timing and frequency among people who use illicit drugs. BMC Public Health 2016; 16:668. [PMID: 27473400 PMCID: PMC4966816 DOI: 10.1186/s12889-016-3304-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 01/28/2023] Open
Abstract
Background Government social assistance payments seek to alleviate poverty and address survival needs, but their monthly disbursement may cue increases in illicit drug use. This cue may be magnified when assistance is disbursed simultaneously across the population. Synchronized payments have been linked to escalations in drug use and unintended but severe drug-related harms, including overdose, as well as spikes in demand for health, social, financial and police services. Methods/design The TASA study examines whether changing payment timing and frequency can mitigate drug-related harm associated with synchronized social assistance disbursement. The study is a parallel arm multi-group randomized controlled trial in which 273 participants are randomly allocated for six assistance cycles to a control or one of two intervention arms on a 1:1:1 basis. Intervention arm participants receive their payments: (1) monthly; or (2) semi-monthly, in each case on days that are not during the week when cheques are normally issued. The study partners with a community-based credit union that has developed a system to vary social assistance payment timing. The primary outcome is a 40 % increase in drug use during the 3 days beginning with cheque issue day compared to other days of the month. Bi-weekly follow-up interviews collect participant information on this and secondary outcomes of interest, including drug-related harm (e.g. non-fatal overdose), exposure to violence and health service utilization. Self-reported data will be supplemented with participant information from health, financial, police and government administrative databases. A longitudinal, nested, qualitative parallel process evaluation explores participant experiences, and a cost-effectiveness evaluation of different disbursement scenarios will be undertaken. Outcomes will be compared between control and intervention arms to identify the impacts of alternative disbursement schedules on drug-related harm resulting from synchronized income assistance. Discussion This structural RCT benefits from strong community partnerships, highly detailed outcome measurement, robust methods of randomization and data triangulation with third party administrative databases. The study will provide evidence regarding the potential importance of social assistance program design as a lever to support population health outcomes and service provision for populations with a high prevalence of substance use. Trial registration NCT02457949 Registered 13 May 2015.
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Affiliation(s)
- Lindsey Richardson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada
| | - Allison Laing
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 1Y6, BC, Canada
| | - Russ Maynard
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; PHS Community Services Society, 20 Hastings Street W, Vancouver V6B 1G6, BC, Canada
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A1S6, BC, Canada
| | - Brandon Marshall
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence 02912, RI, USA
| | - Eric Grafstein
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 910 West 10th Ave, Vancouver V5Z 1 M9, BC, Canada
| | - Patricia Daly
- Vancouver Coastal Health, 601 West Broadway, Vancouver V5Z 4C2, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 1Y6, BC, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada
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Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Pedrocchi A, Vernon H. Group-based multimodal exercises integrated with cognitive-behavioural therapy improve disability, pain and quality of life of subjects with chronic neck pain: a randomized controlled trial with one-year follow-up. Clin Rehabil 2016; 31:742-752. [DOI: 10.1177/0269215516651979] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Marco Monticone
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
| | - Emilia Ambrosini
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
- Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
| | - Daniele Cazzaniga
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
| | - Valentina Liquori
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Lissone, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Politecnico di Milano, Milan, Italy
| | - Howard Vernon
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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24
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Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Motta L, Cerri C, Brayda-Bruno M, Lovi A. Adults with idiopathic scoliosis improve disability after motor and cognitive rehabilitation: results of a randomised controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3120-3129. [DOI: 10.1007/s00586-016-4528-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
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Rombach I, Rivero-Arias O, Gray AM, Jenkinson C, Burke Ó. The current practice of handling and reporting missing outcome data in eight widely used PROMs in RCT publications: a review of the current literature. Qual Life Res 2016; 25:1613-23. [PMID: 26821918 PMCID: PMC4893363 DOI: 10.1007/s11136-015-1206-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 11/28/2022]
Abstract
Purpose Patient-reported outcome measures (PROMs) are designed to assess patients’ perceived health states or health-related quality of life. However, PROMs are susceptible to missing data, which can affect the validity of conclusions from randomised controlled trials (RCTs). This review aims to assess current practice in the handling, analysis and reporting of missing PROMs outcome data in RCTs compared to contemporary methodology and guidance. Methods This structured review of the literature includes RCTs with a minimum of 50 participants per arm. Studies using the EQ-5D-3L, EORTC QLQ-C30, SF-12 and SF-36 were included if published in 2013; those using the less commonly implemented HUI, OHS, OKS and PDQ were included if published between 2009 and 2013. Results The review included 237 records (4–76 per relevant PROM). Complete case analysis and single imputation were commonly used in 33 and 15 % of publications, respectively. Multiple imputation was reported for 9 % of the PROMs reviewed. The majority of publications (93 %) failed to describe the assumed missing data mechanism, while low numbers of papers reported methods to minimise missing data (23 %), performed sensitivity analyses (22 %) or discussed the potential influence of missing data on results (16 %). Conclusions Considerable discrepancy exists between approved methodology and current practice in handling, analysis and reporting of missing PROMs outcome data in RCTs. Greater awareness is needed for the potential biases introduced by inappropriate handling of missing data, as well as the importance of sensitivity analysis and clear reporting to enable appropriate assessments of treatment effects and conclusions from RCTs. Electronic supplementary material The online version of this article (doi:10.1007/s11136-015-1206-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,RCS Surgical Intervention Trials Unit (SITU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair M Gray
- Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Crispin Jenkinson
- Health Services Research Unit (HSRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Órlaith Burke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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26
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Bunce C, Quartilho A, Freemantle N, Doré CJ. Ophthalmic statistics note 8: missing data--exploring the unknown. Br J Ophthalmol 2015; 100:291-4. [PMID: 26719490 DOI: 10.1136/bjophthalmol-2015-307821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Catey Bunce
- Reserach & Development, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Quartilho
- Reserach & Development, NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline J Doré
- UCL Comprehensive Clinical Trials Unit, University College London, London, UK
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Choi SS, Lee JH, Kim D, Kim HK, Lee S, Song KJ, Park JK, Shim JH. Effectiveness and Factors Associated with Epidural Decompression and Adhesiolysis Using a Balloon-Inflatable Catheter in Chronic Lumbar Spinal Stenosis: 1-Year Follow-Up. PAIN MEDICINE 2015; 17:476-487. [PMID: 26814254 DOI: 10.1093/pm/pnv018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/20/2015] [Accepted: 09/05/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to investigate the efficacy of the combined balloon decompression with a balloon-inflatable catheter (ZiNeu) in addition to conventional epidural adhesiolysis, and to identify factors that predict patient responses. STUDY DESIGN An institutional single-armed prospective observational study. SUBJECTS Chronic refractory lumbar spinal stenosis. METHODS This study was performed in 61 patients with spinal stenosis who suffered from chronic (at least 3 months) lumbar radicular pain with or without lower back pain. Patients had failed to maintain improvement for more than 1 month with conventional epidural injection. The numeric rating scale (NRS) and Oswestry disability index (ODI) were each measured at 1, 3, 6, and 12 months after percutaneous epidural adhesiolysis and balloon decompression with a ZiNeu catheter. RESULTS The percentage of successful responders was 72.1%, 60.7%, 57.4%, and 36.1% of patients at 1, 3, 6, and 12 months, respectively. A single combined treatment of percutaneous epidural adhesiolysis and balloon decompression with a ZiNeu catheter provided sufficient pain relief and functional improvement in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 12 months (P < 0.001). Multivariate logistic regression analysis showed that absence of diabetes independently predicted successful response at 12 months after percutaneous epidural decompression and adhesiolysis with the balloon catheter (Odds ratio = 0.080; 95% confidence interval = 0.009-0.676; P = 0.020). CONCLUSIONS The combined epidural adhesiolysis and balloon decompression with a ZiNeu catheter led to significant pain relief and functional improvement in a subset of patients with refractory spinal stenosis.
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Affiliation(s)
- Seong-Soo Choi
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul;
| | - Jong-Hyuk Lee
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Doohwan Kim
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyun Kyu Kim
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sohee Lee
- *Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Kyo Joon Song
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul
| | - Jin Kyu Park
- Department of Neurosurgery, Himchan Hospital, Incheon
| | - Jae Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, School of Medicine, Hanyang University, Guri-si, Republic of Korea
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López-Navarro E, Del Canto C, Belber M, Mayol A, Fernández-Alonso O, Lluis J, Munar E, Chadwick P. Mindfulness improves psychological quality of life in community-based patients with severe mental health problems: A pilot randomized clinical trial. Schizophr Res 2015; 168:530-6. [PMID: 26298541 DOI: 10.1016/j.schres.2015.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effectiveness of group mindfulness-based intervention (MBI) in patients diagnosed with severe mental illness. The primary outcome was health-related psychological quality of life. Secondary measures were environmental, social and physical health related quality of life, frequency and intensity of psychotic symptoms and daily-life mindfulness. METHOD Forty-four patients from a public community rehabilitation center for people with severe mental illness were recruited, and randomly allocated to Integrated Rehabilitation Treatment (IRT) or IRT plus MBI. Measures included PANSS interview, WHOQOL-BREF, and Mindfulness Attention Awareness Scale. MBI comprised 26 one-hour weekly sessions. Intention-to-treat analysis was used. RESULTS One patient did not complete IRT+MBI and two did not complete IRT. At baseline there were no statistical group differences in demographic characteristics or primary and secondary outcomes. At post-treatment interaction between treatment and time in health-related psychological quality of life was statistically significant, and simple effect analysis showed significant differences for between and within subject factor in favor of MBI. Interaction was also significant in PANSS negative symptoms, simple effects showed a statistical trend in within subject factor. Time factor was significant in environmental and physical quality of life. CONCLUSIONS Data suggest mindfulness added to IRT may enhance psychological quality of life in people with severe mental illness from a public community center. Results also suggest that mindfulness may impact frequency and intensity of negative symptoms.
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Affiliation(s)
- Emilio López-Navarro
- Institut Universitari d´Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Ctra Valldemossa km 7,5, Balearic Islands, Spain.
| | - Cristina Del Canto
- Department of Clinical Psychology, Son Espases Hospital, Balearic Health Service, Ctra Valldemossa, 79, Palma de Mallorca, Balearic Islands, Spain
| | - Miriam Belber
- Department of Clinical Psychology, Son Espases Hospital, Balearic Health Service, Ctra Valldemossa, 79, Palma de Mallorca, Balearic Islands, Spain
| | - Antoni Mayol
- UCR Serralta Community Rehabilitation Center, Balearic Health Service, Balearic Islands, Spain
| | - Ovidio Fernández-Alonso
- UCR Serralta Community Rehabilitation Center, Balearic Health Service, Balearic Islands, Spain
| | - Josep Lluis
- EvoCog, UIB-IFISC, Associated Unit to CSIC, Spain
| | - Enric Munar
- EvoCog, UIB-IFISC, Associated Unit to CSIC, Spain
| | - Paul Chadwick
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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Monticone M, Ambrosini E, Rocca B, Cazzaniga D, Liquori V, Foti C. Group-based task-oriented exercises aimed at managing kinesiophobia improved disability in chronic low back pain. Eur J Pain 2015. [DOI: 10.1002/ejp.756] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Monticone
- Physical Medicine and Rehabilitation Unit; Scientific Institute of Lissone; Institute of Care and Research; Salvatore Maugeri Foundation IRCCS; Lissone Italy
| | - E. Ambrosini
- Physical Medicine and Rehabilitation Unit; Scientific Institute of Lissone; Institute of Care and Research; Salvatore Maugeri Foundation IRCCS; Lissone Italy
- Neuroengineering and Medical Robotics Laboratory; Department of Electronics; Information and Bioengineering; Politecnico di Milano; Milan Italy
| | - B. Rocca
- Physical Medicine and Rehabilitation Unit; Scientific Institute of Lissone; Institute of Care and Research; Salvatore Maugeri Foundation IRCCS; Lissone Italy
| | - D. Cazzaniga
- Physical Medicine and Rehabilitation Unit; Scientific Institute of Lissone; Institute of Care and Research; Salvatore Maugeri Foundation IRCCS; Lissone Italy
| | - V. Liquori
- Physical Medicine and Rehabilitation Unit; Scientific Institute of Lissone; Institute of Care and Research; Salvatore Maugeri Foundation IRCCS; Lissone Italy
| | - C. Foti
- Chair of Physical Medicine and Rehabilitation; University of Rome ‘Torvergata’; Rome Italy
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30
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A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2105-13. [DOI: 10.1007/s00586-014-3478-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
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31
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Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1204-14. [DOI: 10.1007/s00586-014-3241-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/26/2022]
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Hunger M, Kirchberger I, Holle R, Seidl H, Kuch B, Wende R, Meisinger C. Does nurse-based case management for aged myocardial infarction patients improve risk factors, physical functioning and mental health? The KORINNA trial. Eur J Prev Cardiol 2014; 22:442-50. [PMID: 24523431 DOI: 10.1177/2047487314524682] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older patients with acute myocardial infarction (MI) are often lacking optimal support to continue rehabilitation after discharge from hospital. The objective of the study was to examine whether a home-based case management programme led by nurses can improve atherogenic risk factors, physical functioning, and mental health in the first year following discharge. METHODS The KORINNA study is a randomized two-armed parallel group trial including 329 patients (aged 65-92 years) from the Augsburg Hospital in southern Germany. The intervention consisted of an individualized follow-up programme with a duration of 1 year, including home visits and telephone calls. The control group received usual care. Secondary outcome measures included clinical parameters (blood pressure, lipid parameters), functional status measures, cognitive status, depressive symptoms, and nutrition risk. RESULTS At 1-year follow up, patients in the intervention group (n = 116) had significantly better low-density lipoprotein cholesterol levels (-8.4 mg/dl, 95% CI -16.4 to -0.4), hand grip strength (+2.53 kg, 95% CI 0.56 to 4.50), and SCREEN-II nutrition risk scores (+2.03, 95% CI 0.58 to 3.48) than patients in the control group (n = 136). The intervention group also had better mean scores with regard to self-reported disability, activities in daily living, and mental health, but differences were not always significant and meaningful. CONCLUSIONS The results of the KORINNA study indicate that nurse-based case management can improve blood lipid levels, functional status, and nutrition risk of aged patients with MI.
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Affiliation(s)
- Matthias Hunger
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Inge Kirchberger
- Helmholtz Zentrum München, Institute of Epidemiology II, Neuherberg, Germany KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Hildegard Seidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany Donau-Ries-Kliniken, Department for Internal Medicine/Cardiology, Nördlingen, Germany
| | - Rupert Wende
- Department of Internal Medicine I - Cardiology, Central Hospital of Augsburg, Augsburg, Germany
| | - Christine Meisinger
- Helmholtz Zentrum München, Institute of Epidemiology II, Neuherberg, Germany KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
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Monticone M, Ambrosini E, Rocca B, Lorenzon C, Ferrante S, Zatti G. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial. Clin Rehabil 2014; 28:658-68. [DOI: 10.1177/0269215513519342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 12/14/2013] [Indexed: 01/22/2023]
Abstract
Objective: To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement. Design: Randomized controlled trial. Setting: Specialised rehabilitation centre. Subjects: A total of 100 patients (mean age of 69 (8) years; 40 males, 60 females). Interventions: The experimental group underwent task-oriented exercises and was encouraged to abandon any walking aids by the end of their in-hospital stay. The control group underwent open chain kinetic exercises, and was recommended to use partial weight-bearing and walking aids until three months after surgery. Both groups individually followed programmes of 90-minute sessions five times a week for three weeks. Outcome measures: Western Ontario and McMaster Universities Osteoarthritis Index, Pain Numerical Rating Scale, Functional Independence Measure, and Short-Form Health Survey. The participants were evaluated before, after training, and after a further 12 months. Results: There were no significant between-group differences at baseline. After training, a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index – functional subscale, indicating a clinically tangible treatment effect on disability. The Functional Independence Measure increased by 31 and 15 points in the experimental and control group, respectively. A linear mixed model revealed significant effects of time, group, and time by group interaction on disability, pain, activities of daily living, and most of the physical quality of life domains. Conclusion: Task-oriented exercises associated with early full weight-bearing improve disability, pain, activities of daily living, and quality of life after total hip replacement.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Emilia Ambrosini
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Chiara Lorenzon
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone Salvatore Maugeri Foundation IRCCS, Monza Brianza, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering Politecnico di Milano, Milan, Italy
| | - Giovanni Zatti
- Bicocca University of Milan, Milan, Italy
- Orthopaedics Unit, San Gerardo Hospital, Monza Brianza, Italy
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Monticone M, Ferrante S, Teli M, Rocca B, Foti C, Lovi A, Brayda Bruno M. Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:87-95. [PMID: 23836299 DOI: 10.1007/s00586-013-2889-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 05/15/2013] [Accepted: 06/30/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the effect of a rehabilitation programme including the management of catastrophising and kinesiophobia on disability, dysfunctional thoughts, pain, and the quality of life in patients after lumbar fusion for degenerative spondylolisthesis and/or lumbar spinal stenosis. METHODS This was a parallel-group, randomised, superiority-controlled study in which 130 patients were randomly assigned to a programme consisting of exercises and cognitive-behavioural therapy (experimental group, 65 subjects) or exercises alone (control group, 65 subjects). Before treatment (T1), 4 weeks later (post-treatment analysis, T2) and 12 months after the end of treatment (follow-up, T3), all the patients completed a booklet containing the Oswestry Disability Index (ODI, primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain Numerical Rating Scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used for each outcome measure. RESULTS The ODI linear mixed model revealed significant main effects of group (F(1,122.8) = 95.78, p < 0.001) and time (F(2,120.1) = 432.02, p < 0.001) in favour of the experimental group. There was a significant group × time interaction effect (F(2,120.1) = 20.37, p < 0.001). The analyses of all of the secondary outcome measures revealed a significant effect of time, group and interaction in favour of the experimental group. CONCLUSION The rehabilitation programme, including the management of catastrophising and kinesiophobia, was superior to the exercise programme in reducing disability, dysfunctional thoughts, and pain, and enhancing the quality of life of patients after lumbar fusion for degenerative spondylolisthesis and/or LSS. The effects lasted for at least 1 year after the intervention ended.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research (IRCCS), Salvatore Maugeri Foundation IRCCS, Via Monsignor Bernasconi, 16, Lissone, 20851, Milan, Italy,
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Monticone M, Ambrosini E, Ferrante S, Colombo R. 'Regent Suit' training improves recovery of motor and daily living activities in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil 2013; 27:792-802. [PMID: 23503737 DOI: 10.1177/0269215513478228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an elastic element-based suit, called 'Regent Suit', in improving the recovery of motor and daily living activities in patients experiencing a subacute stroke. DESIGN Randomized controlled trial. SETTING Neurorehabilitation unit. SUBJECTS Sixty patients with subacute stroke who were capable of walking without direct assistance were randomized to an experimental and control group. INTERVENTIONS The experimental group attended 20 sessions of neuromotor exercises (e.g. sit-to-stand, balance, gait training) wearing the 'Regent Suit'; the control group performed the same exercises without the 'Regent Suit'. OUTCOME MEASURES 6-minute walking test, Berg Balance Scale, the Functional Independence Measure, and the Barthel Index. The participants were evaluated before and after training, and after a further six months. RESULTS There were no significant between-group differences at baseline. A repeated measure linear mixed model revealed a significant effect of time (p < 0.001), group (p = 0.019), and time-by-group interaction (p < 0.001) in the gait speed in favour of the experimental group. The Berg Balance Scale indicated a significant effect of time (p < 0.001) and time-by-group interaction (p < 0.001). The experimental group also showed greater improvement in Functional Independence Measure and Barthel Index. DISCUSSION The study findings showed that an intervention using the 'Regent Suit' is more effective than usual care in improving locomotion and daily living activities in patients with subacute stroke. Further studies might investigate the efficacy of this type of training in chronic stroke patients and the possibility of combining the suit with body weight-supported treadmill training.
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Affiliation(s)
- Marco Monticone
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Salvatore Maugeri Foundation IRCCS, Italy.
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Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013; 346:e7586. [PMID: 23303884 PMCID: PMC3541470 DOI: 10.1136/bmj.e7586] [Citation(s) in RCA: 3170] [Impact Index Per Article: 288.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 02/06/2023]
Abstract
High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.
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Affiliation(s)
- An-Wen Chan
- Women's College Research Institute at Women's College Hospital, Department of Medicine, University of Toronto, Toronto, Canada M5G 1N8
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