Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument

BACKGROUND

Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation. Thus, patients with diabetes should be screened for this disorder according to local guidelines. An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.

AIM

To validate both sections (A and B) of the Michigan Neuropathy Screening Instrument (MNSI) in Polish (PL) patients with diabetes.

METHODS

A cross-sectional study using a test (A1, B1) and re-test (A2, B2) formula was performed in 80 patients with diabetes. The gold standard used for neuropathy detection was a nerve conduction study (NCS) which was performed in all participants. Reliability of the MNSI-PL was assessed using the Cronbach’s alpha, Kuder-Richardson formula 20 (KR-20), split-half reliability, the Gottman split-half tests, and correlation between first and second half was accessed. Stability was assessed using an intraclass correlation coefficient (ICC). For external validation, we used simple linear correlation, binomial regression, and agreement between two different tools using a Bland-Altman plot analysis.

RESULTS

The scale was internally consistent (Cronbach’s alpha for the full scale: 0.81 for A and 0.87 for B). MNSI-PL scores in test/retest showed high stability (ICC = 0.73 for A and ICC = 0.97 for B). The statistically important correlations between MNSI-PL and NCS were found for B1, B2, and A1 (P < 0.005). The cut-off points of ≥ 3 for section A (sensitivity of 90%-100%; specificity of 33%-40%) and ≥ 2 for section B (sensitivity of 81%-84%; specificity of 60%-70%) were obtained during neuropathy detection.

CONCLUSION

The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.

The impact of lockdown caused by the COVID-19 pandemic on glycemic control in patients with diabetes

PURPOSE

The aim the study was to assess the impact of the lockdown due to COVID-19 on diabetes control.

METHODS

The HbA1c value from a pre-lockdown visit (V1) from patients with diabetes was compared to the lockdown visit one (V2) after 3-5 months of its duration. Additional information on how the HbA1c changed and which variables can modify HbA1c during lockdown was also studied.

RESULTS

Records from 65 patients (type 2 diabetes -96,9%) were eligible and revealed that: HbA1c was at the target in 60% of the patients at V2 compared to 40% at V1; HbA1c decreased and normalized in 19, but worsened in 4 participants during the lockdown. No impact on HbA1c of: sex, age, diabetes duration, therapy type and modification before the pandemic, abandonment of the treatment, previous problems with glycemic control, or change in body weight and physical activity during the lockdown, was found. The previous macrovascular complications were the only variable that affected the increase in HbA1c (p = 0.0072), OR = 5.33.

CONCLUSIONS

The COVID-19 pandemic has not revealed worsened glycemic control in patients with type 2 diabetes, in general. The patients with macrovascular complications turned out to be at risk of the harmful impact of the restrictions on the HbA1c.

COVID-19 Vaccine Acceptance in Pregnant and Lactating Women and Mothers of Young Children in Poland

Purpose

The World Health Organization indicated vaccine hesitancy as one of the top 10 threats to global health. The success of a vaccine depends not only on its efficacy but also on its acceptance. Our study aims to define COVID-19 vaccine acceptance in a sample of pregnant and lactating women in Poland. Since mothers are often key decision-makers for whether their children will receive vaccination, it is vital to measure vaccine confidence among this group.

Patients and Methods

An anonymous online survey was distributed to assess the level of acceptance of COVID-19 vaccination among pregnant and lactating women for themselves and their children in Poland.

Results

The trust of pregnant and breastfeeding women and women who have offspring in government, in healthcare professionals, in scientific authorities, and sound scientific data is strongly associated with vaccine acceptance and may influence an individual's decision to perceive recommended actions as beneficial to the society as a whole.

Conclusion

Acceptance and confidence in receiving the COVID-19 vaccination among pregnant and lactating women and mothers with young children is strongly associated with feelings of trust in government, health professionals, scientific authorities, and sound scientific data. The dissemination of professional and reliable information regarding the safety and efficacy of COVID-19 vaccine uptake by qualified health care personnel can significantly increase the level of trust and public awareness regarding the safety and efficacy of COVID-19 vaccine uptake in pregnancy, while breastfeeding, and mothers with young children.

Factors affecting rehabilitation of infants with Central Coordination Disorders during a three-month-long observation

Background

Central coordination disorders (CCD) encompass various abnormalities observed in infants but early therapy may have an impact on their condition. The aim was to seek factors that may affect the early results of therapy of infants with CCD.

Methods

We analyzed the outcomes of a three-month period of rehabilitation of infants living with CCD. Children were treated at Non-public Specialist Healthcare Institution Medi-Reh in Kalisz in the period from 1 Jan 2014 to 31 Nov 2019. In our retrospective study results of three-month therapy of infants, aged 1 to 6 months, with CCD were analysed regards to the effectiveness and the potential impact of different factors. Therapy and assessment of children were conducted with the use of the Vojta method, which was performed during the first visit (WW) and the follow-up visit (after 3 months- 1WK). The analysis of the influence of various factors on the effect of therapy included: mother's age at the time of delivery, duration of breastfeeding, child APGAR, gestational age in which the child was born, sex of the child, birth weight, age of the child at WW, type of delivery, craniosacral therapy as an additive treatment.

Results

Based on the examination results from 66 medical records it was demonstrated that after active period of the therapy, improvement was observed in 54 (81.81%) (p=0.48) children (condition during WW versus 1WK among the group). The sole factor impacting improvement after 3 months was the age of the child at WW, when the child started therapy. This factor significantly (p=0.002) increased the chance of achieving improvement - by 3.2 times (OR= 3,2; CI= 95). No statistically significant differences were shown for the other studied factors.

Conclusions

Prompt implementation of rehabilitation in children with CCD provides a better chance of improving their motor function. The rehabilitation should be started as soon as possible after the diagnosis is constituted.

Assessment of the level of anxiety and pain in women who do and do not attend childbirth classes during the SARS-CoV-2 pandemic

INTRODUCTION

Participation in childbirth classes is aimed at learning to cope with the anxiety that accompanies a woman during her pregnancy and childbirth. The aim of the study was to answer the question whether the lack of access to childbirth classes affected anxiety and perinatal pain in pregnant women who gave birth during the pandemic period.

MATERIALS AND METHODS

This cross-sectional survey-based study involved women who were pregnant during the lockdown period. The respondents were asked to fill in the following questionnaires: a personal questionnaire, the Polish version of the Delivery Fear Scale and the Numeric Rating Scale for the assessment of average and maximum pain experienced during the labour. The survey was completed within 24-72 hours after the birth of the child. The obtained questionnaires were divided into 2 groups based on the information concerning attending or not attending childbirth classes (divided into subgroups): group A - patients participated in childbirth classes, and group B - patients did not participate in childbirth classes.

RESULTS

Groups were homogeneous in terms of age, weight, height, body mass index and week of gestation. Perception of anxiety did not differ between groups. There was a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there were no significant differences between groups in terms of mean and maximum pain during labour.

CONCLUSION

The level of anxiety and pain associated with childbirth is not modulated by childbirth classes during the pandemic period. There is s a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there are no significant differences between groups in terms of mean and maximum pain during labour.

Myoelectrical activity of muscles stabilizing the sacroiliac joints before and after the use of elastic tapes in women suffering from Pregnancy-related Pelvic Girdle Pain

OBJECTIVES

The aim of this study was the analysis of activity of selected muscles stabilizing the sacroiliac joints in pregnant women suffering from pelvic pain and changes in the pattern in response to the implementation of Kinesio Taping (elastic tape).

MATERIAL AND METHODS

Seventeen women with Pregnancy-related Pelvic Girdle Pain and 20 pregnant women without pain in the lumbar-pelvic complex were enrolled into the study. In patients with pelvic pain, the parameters describing the action of the muscles were assessed: before the tape was applied, immediately after application, 3 days into application and 5 days after the cessation of taping. In the control group, the test was carried out one time. The activity of the muscles was measured during extension of the hip from a four-point kneeling position.

RESULTS

The gluteus maximus muscle shows higher resting activity values than in the control group, before and after application of the tape as well as five days after the removal of the tape. Before application, the gluteus maximus activates quicker than in the control group while the ipsilateral extensor spinae had a delayed activation when compared to the control group.

CONCLUSIONS

The patterns of activation of tested muscles and their action potential values are different in the group of women with pelvic pain compared to the group without pelvic pain. The application of KT in the lumbar region appears to alter the activation of the GM muscle as well as improve activation of IES muscle during hip extension from the four-point-kneeling position.

Abdominal muscles activity during abdominal bracing and posterior pelvic tilt in women after natural birth and after caesarean delivery

Purpose: Exercises after pregnancy can reduce the severity and risk of postnatal locomotor system disorders and muscular dysfunctions. The aim of the study was to evaluate electromyographic activity of abdominal muscles in women who gave birth naturally and via a caesarean section, and to compare it to a group of women who have never given birth. Methods: 27 women were included into the study after completing the personal questionnaire and functional examination. The surface electromyography during abdominal bracing and posterior pelvic tilt was used to test rectus abdominis muscles and internus oblique/ transversus abdominis muscles bilaterally. After normalization test, patients were asked to perform abdominal bracing and posterior pelvic tilt exercises. Results: Activity of rectus abdominis muscle is higher in posterior pelvic tilt compared to abdominal bracing. It should be noted that the internus oblique/transversus abdominis muscle activity in both exercises is similar. Conclusions: In women after natural birth and after a cesarean section who experienced no locomotor system symptoms, no statistically significant differences in abdominal muscle activity in both exercises were observed. In each group being studied, posterior pelvic tilt activated rectus abdominis muscles to a greater extent than just bracing.

Abdominal muscles activity during abdominal bracing and posterior pelvic tilt in women after natural birth and after caesarean delivery

PURPOSE

Exercises after pregnancy can reduce the severity and risk of postnatal locomotor system disorders and muscular dysfunctions. The aim of the study was to evaluate electromyographic activity of abdominal muscles in women who gave birth naturally and via a caesarean section, and to compare it to a group of women who have never given birth.

METHODS

27 women were included into the study after completing the personal questionnaire and functional examination. The surface electromyography during abdominal bracing and posterior pelvic tilt was used to test rectus abdominis muscles and internus oblique/ transversus abdominis muscles bilaterally. After normalization test, patients were asked to perform abdominal bracing and posterior pelvic tilt exercises.

RESULTS

Activity of rectus abdominis muscle is higher in posterior pelvic tilt compared to abdominal bracing. It should be noted that the internus oblique/transversus abdominis muscle activity in both exercises is similar.

CONCLUSIONS

In women after natural birth and after a cesarean section who experienced no locomotor system symptoms, no statistically significant differences in abdominal muscle activity in both exercises were observed. In each group being studied, posterior pelvic tilt activated rectus abdominis muscles to a greater extent than just bracing.

[The rehabilitation of a child with a sotos syndrome. case report]

OBJECTIVE

Introduction: Sotos syndrome is a rare genetic disease characterized by various physical and mental development disorders. The article proposes and discusses the developmental changes of a child with cerebral gigantism after 8 months improvement according to the proposed scheme.

PATIENTS AND METHODS

Material and methods: A six-months-old girl with Sotos syndrome was referred for rehabilitation due to a delay in development. After the neurokinesiological examination, the physiotherapy with use of the Vojta method was started, which after 5 months was supplemented with cranio-sacral and speech therapy. The effects of treatment were evaluated after 5 and 8 months using the Vojty method and 2 developmental profiles according to the Munich Functional Developmental Diagnostics.

RESULTS

Results: At the beginning of the therapy, in the neurokinesiological examination was found: 6 abnormal postural positions with asymmetry, spontaneous motor activity at the level below 3 months of age, abnormal primitive reflexes. After 8 months of therapy, 4 abnormal postural positions without asymmetry, spontaneous motor activity at the level of 7.5 months of age, primitive reflexes appropriate to age were found in a neurokinesiological examination. In addition, the child's development was rated the highest in terms of social functions - at 10 months of age, while the age of perception, sitting, crawling, walking and speech function respectively on: 8,7,6,5 and 4 months of age.

CONCLUSION

Conclusions: The proposed improvement procedure has contributed to the improvement of the quality of motor patterns and cognitive activation of the child.

The effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method

PURPOSE

Exerting axial pressure on the affected lower limb remains one of the most crucial elements of Ilizarov method. The objective was to determine the effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method.

METHODS

The study included 15 patients who underwent lower limb lengthening. The patients were tested on the third day after surgery using the pedobarographic platform. The tests were performed four times in the standing position: twice with the support of forearm crutches and twice without crutches. Patients were asked to either remain in the relaxed standing position (two tests) or use the lower limb equipped with Ilizarov apparatus to support the body weight (two tests).

RESULTS

In relaxed stance average pressure with forearm crutches was 24.1% for affected limb, as compared to 75.9% for the healthy limb. In test without forearm crutches average pressure for affected limb was 26.1%, as compared to 73.9% for the healthy limb. Patients shifted body weight to the affected limb with forearm crutches on average, at the rate of 53.6%. In test without forearm crutches the affected limb was supporting the body weight at the rate of 48.26%. None of the patients was able to fully support the body weight on the affected leg.

CONCLUSIONS

In spite of strict physiotherapy regimen, patients are neither able to equally distribute their body weight between the two lower limbs nor to shift their body weight to the limb equipped with Ilizarov apparatus.