Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury

Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial

BACKGROUND

The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. ObjectivesTo compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in stroke.

OBJECTIVE

The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. The aim of this study was to compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in stroke.

METHODS

A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography.

RESULTS

Except for FVC (%pred%) (F = 4.432, p = 0.018, ηp  = 0.174), FEV1(%pred%) (F = 3.725, p = 0.032, ηp  = 0.151), and MEP (F = 3.861, p = 0.029, ηp  = 0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p > 0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred%), FEV1(%pred%) and MEP (p > 0.025).

CONCLUSIONS

The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.

A Comparison of Sensorimotor Integration and Motor Fitness Components between Collegiate Athletes with and without Long COVID: A Cross-Sectional Study with Pair-Matched Controls

Background: Long COVID presents a concern for collegiate athletes, potentially impacting sensorimotor processing and motor fitness. This study aimed to assess these effects. Methods: This cross-sectional study involved 60 athletes diagnosed with Long COVID and 60 controls. Sensorimotor processing and integration were evaluated using neurophysiological variables (N13, P14, N20, P27, and N30), while motor fitness was assessed through balance, agility, and vertical jump testing. T-tests compared groups, and Pearson's correlations explored relationships. Results: Significant differences (p < 0.001) were observed in neurophysiological variables and motor fitness between Long COVID and control groups. Fatigue correlated positively (p < 0.001) with neurophysiological variables in Long COVID cases but not with motor fitness (p = 0.08, p = 0.07, p = 0.09). Conclusions: Collegiate athletes with Long COVID exhibit abnormal sensorimotor processing, integration, and diminished motor fitness compared to uninfected peers. The fatigue severity of Long COVID correlates with neurophysiological changes, suggesting a link between sensorimotor deficits and fatigue. Targeted interventions for sensorimotor deficits and fatigue management are crucial for athletes recovering from Long COVID. This study underscores the importance of addressing these issues to optimize the recovery and performance of collegiate athletes affected by Long COVID.

Using the benefit-harm trade-off method to determine the smallest worthwhile effect of intensive motor training on strength for people with spinal cord injury

STUDY DESIGN

Interviews using the benefit-harm trade-off method and an online survey.

OBJECTIVES

To determine the smallest worthwhile effect (SWE) of motor training on strength for people with spinal cord injury (SCI).

SETTING

SCI units, Australia.

METHODS

Forty people with recent SCI who had participated in motor training as part of their rehabilitation program (patient participants) and 37 physiotherapists (physiotherapist participants) working in SCI were recruited. The patient participants underwent an iterative process using the benefit-harm trade-off method to determine the SWE of motor training on strength. The physiotherapist participants were given an online survey to determine the SWE for five different scenarios. Both groups considered the SWE of a physiotherapy intervention involving an additional 12 h of motor training for 10 weeks on top of usual care. They were required to estimate the smallest improvement in strength (points on the Total Motor Score of the International Standards for Neurological Classification of SCI) to justify the effort and associated costs, risks or inconveniences of the motor training.

RESULTS

The median (interquartile range) smallest improvement in strength that patient and physiotherapist participants deemed worth the effort and associated costs, risks or inconveniences of the motor training was 3 (1-5) points, and 9 (7-13) points, respectively.

CONCLUSIONS

People with recent SCI are willing to devote 12 h a week for 10 weeks to motor training in addition to their usual care to gain small changes in strength. Physiotherapists wanted to see greater improvements to justify the intervention.

Cough flows as a criterion for decannulation of autonomously breathing patients with tracheostomy tubes

BACKGROUND

Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation.

STUDY DESIGN

Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital.

METHODS

Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months.

RESULTS

A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months.

CONCLUSIONS

CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube.

TRIAL REGISTRATION

This observational study was not registered online.

Feasibility of Brief, Hypnotic Enhanced Cognitive Therapy for SCI-related Pain During Inpatient Rehabilitation

OBJECTIVES

(1) Adapt evidence-based hypnosis-enhanced cognitive therapy (HYP-CT) for inpatient rehabilitation setting; and (2) determine feasibility of a clinical trial evaluating the effectiveness of HYP-CT intervention for pain after spinal cord injury (SCI).

STUDY DESIGN

Pilot non-randomized controlled trial.

SETTING

Inpatient rehabilitation unit.

PARTICIPANTS

English-speaking patients admitted to inpatient rehabilitation after SCI reporting current pain of at least 3 on a 0-10 scale. Persons with severe psychiatric illness, recent suicide attempt or elevated risk, or significant cognitive impairment were excluded. Consecutive sample of 53 patients with SCI-related pain enrolled, representing 82% of eligible patients.

INTERVENTION

Up to 4 sessions of HYP-CT Intervention, each 30-60 minutes long.

METHODS

Participants were assessed at baseline and given the choice to receive HYP-CT or Usual Care.

MAIN OUTCOME MEASURES

Participant enrollment and participation and acceptability of intervention. Exploratory analyses examined the effect of intervention on pain and cognitive appraisals of pain.

RESULTS

In the HYP-CT group, 71% completed at least 3 treatment sessions and reported treatment benefit and satisfaction with the treatment; no adverse events were reported. Exploratory analyses of effectiveness found pre-post treatment pain reductions after HYP-CT with large effect (P<.001; β=-1.64). While the study was not powered to detect significant between-group differences at discharge, effect sizes revealed decreases in average pain (Cohen's d=-0.13), pain interference (d=-0.10), and pain catastrophizing (d=-0.20) in the HYP-CT group relative to control and increases in self-efficacy (d=0.27) and pain acceptance (d=0.15).

CONCLUSIONS

It is feasible to provide HYP-CT to inpatients with SCI, and HYP-CT results in substantial reductions in SCI pain. The study is the first to show a psychological-based nonpharmacologic intervention that may reduce SCI pain during inpatient rehabilitation. A definitive efficacy trial is warranted.

A Case Study of Hypnosis Enhanced Cognitive Therapy for Pain in a Ventilator Dependent Patient during Inpatient Rehabilitation for Spinal Cord Injury

Early, acute pain following spinal cord injury (SCI) is common, can negatively impact SCI rehabilitation, and is frequently not responsive to biomedical treatment. Nonpharmacological interventions show promise in reducing pain for individuals with SCI. However, most psychological interventions rely heavily on verbal interaction between the individual being treated and the clinician, making them inaccessible for individuals with impaired verbal output due to mechanical ventilation. This case study aims to describe the adaptation and implementation of hypnotic cognitive therapy (HYP-CT) intervention for early SCI pain in the context of mechanical ventilation dependence and weaning. The participant was a 54-year-old male with C2 AIS A SCI requiring mechanical ventilation. Four sessions of HYP-CT were provided during inpatient rehabilitation with assessment prior to intervention, after the intervention sessions, and prior to discharge. The participant reported immediate reductions in pain intensity following each intervention session. Overall, he reported increases in self-efficacy and pain acceptance. He did not report any negative treatment effects and thought the intervention provided support during mechanical ventilation weaning. During treatment, he discontinued opioid pain medications and reported actively using intervention strategies. Our results support the potential for early, hypnotic cognitive therapy for individuals with SCI experiencing pain or distress while dependent on mechanical ventilation.

A prospective single-arm study on the efficacy and safety of short-course oral corticosteroids followed by topical corticosteroids in patients with severe chronic rhinosinusitis with nasal polyps

BACKGROUND

Little evidence exists regarding an integrated multidimensional evaluation methodology to analyze the within-patient effects of medical treatment for chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to use an integrated evaluation model to analyze the effects of short-course oral corticosteroid (OCS) followed by intranasal corticosteroid spray (INCS) therapy in patients with severe CRSwNP.

METHODS

In all, 32 patients with severe CRSwNP received oral methylprednisolone for three weeks followed by intranasal budesonide spray for nine weeks in this prospective single-arm study. An evaluation model integrating the concepts of the core outcome set (COS), clinical control and minimum clinically important difference (MCID) was longitudinally evaluated.

RESULTS

All uncontrolled patients at baseline showed similar progressive improvements from baseline and more than 1 MCID response across core outcomes during the OCS period, with severe CRSwNP being partly controlled in 31 (96.9%) patients and uncontrolled in 1 (3.1%) patient at 3 weeks. During the subsequent INCS period, 14 (43.8%) patients gradually deteriorated to an uncontrolled status at 12 weeks, whereas 18 (56.2%) exhibited partly controlled CRSwNP until 12 weeks.

CONCLUSIONS

In more than half of the patients, severe CRSwNP was partly controlled with the initial OCS followed by INCS therapy. An integrated evaluation model was used to facilitate the comprehensive evaluation of within-patient response, especially in patients with different responses to the same treatment.

TRIAL REGISTRATION

ChiCTR1900024287.

A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study

ABSTRACT

A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.