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ObjectiveTo evaluate the Chinese guidelines and consensus of rehabilitation medicine published in the medical journals in 2022 using Scientific, Transparent and Applicable Rankings (STAR). MethodsGuidelines and consensus which were developed by Chinese institutions or led by Chinese scholars were retrieved in databases of CNKI, Wanfang Data, CBM, Chinese Medical Journal Network, PubMed and Web of Science, in 2022, followed by screening for rehabilitation medicine field. The literature were rated with STAR. ResultsSeven guidelines and eleven consensuses were included. The STAR scores ranged from 11.7 to 69.6, with a median score of 25.9 and mean score of 28.3. There was a significant difference in the total score between guidelines and consensus (U = 12.000, P = 0.014). The score ratio was high in the domains of recommendations (73.6%), evidence (39.5%) and others (33.3%), while it was low in the domains of protocol (1.4%), clinical questions (12.5%) and conflicts of interest (13.9%). The score ratio was high in the items of listing the institutional affiliations of all individuals involved in developing the guideline (94.4%), identifying the references for evidence supporting the main recommendations (94.4%), indicating the considerations (e.g., adverse effects) in clinical practice when implementing the recommendations (88.9%), and making the recommendations clearly identifiable, e.g., in a table, or using enlarged or bold fonts (75%); and it was low in the items of describing the role of funder(s) in the guideline development (0), indicating information about the evaluation and management of conflicts of interest (0), providing tailored editions of the guidelines for different groups of target users (0), presenting the guideline or recommendations visually, such as with figures or videos (0), providing details of the guideline protocol (2.8%), assessing the risk of bias or methodological quality of the included studies (2.8%), describing the responsibilities of all individuals or sub-groups involved in developing the guideline (5.6%), indicating how the clinical questions were selected and sorted (5.6%), formating clinical questions in PICO or other formats (5.6%), making the guideline accessible through multiple platforms (5.6%), and declaring that the funder(s) did not influence the guideline's recommendations (8.3%). ConclusionThe quality of current clinical practice guidelines and consensus of rehabilitation medicine is poor, which should be developed in accordance with the relevant standards.
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ObjectiveTo investigate rehabilitation competence among trainers and trainees whom participated in the training program entitled National Training Program of Shortage Rehabilitation Physicians (NTPSRP) using World Health Organization rehabilitation competency framework (RCF). MethodsBased on RCF, a questionnaire was developed and administrated through network using Questionnaire Star. All the trainers and trainees who participated in NTPSRP were investigated in September, 2023. ResultsA total of 911 subjects were collected from 27 provinces, including 426 trainers (teachers) and 485 trainees (students). The average age of the teachers was older, with more years of work experience and professional experience in rehabilitation medicine. The degree and professional title of the teachers was also higher. The overall internal consistency reliability of the questionnaire was good (Cronbach's α = 0.988), and all the internal consistency reliability in five fields was good (Cronbach's α > 0.9). The five dimensional structure of RCF in the results was consistent with the prior model established by RCF theory. The self-ratings of all physicians in the five fields were higher than the median level, and was higher in the teachers than in the students [(3.42±0.68) vs. (2.73±0.80), P < 0.001]. Gender and years of experience in rehabilitation medicine were independent factors for the total score of the questionnaire. The total self-rating of female students was 9.65 points lower than that of the male (95%CI 4.386 to 14.914); and one more year in rehabilitation medicine would increase 1.78 points in self-rating (95%CI 1.140 to 2.419). ConclusionThe structure and content of RCF can be used to evaluate the competence of rehabilitation physicians. The teachers and students of NTPSRP are eligible to RCF. RCF-based evaluation can be used to guide the development of continuing education courses for rehabilitation professionals.
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Objective:To measure the change in Young′s modulus of the biceps brachii during passive stretching and to assess the potential of shear wave elastography (SWE) as an auxiliary quantitative technique for assessing muscle tone.Methods:Forty-nine stroke survivors and 30 healthy subjects were evaluated using the modified Ashworth scale (MAS). According to their MAS scores they were divided into a healthy group, a healthy elbow group, an MAS class-0 group, an MAS class-1 group, an MAS class-1 + group and an MAS class-2 group. During passive extension of the subjects′ elbows, shear wave elastography was used to image the biceps brachii. Six points of the elbow were selected to record the instantaneous Young′s modulus ( EX) and calculate its change during the movement (Δ E). Those data were correlated with the MAS scores and compared among the groups. Results:Persons with higher MAS scores tended to have a higher Young′s modulus of the biceps brachii, and the modulus was likely to increase more with increases in the angle of elbow extension. From half of the range of motion to full extension there were significant differences in EX and Δ E between MAS class-0 and class-1 groups, as well as between the class-0 and class-1 + groups. There were, however, no significant differences between MAS class-1 and MAS class-1 + . Conclusions:MAS scores can usefully predict biceps brachii stiffness during passive elbow flexion. Shear wave elastography can quantify that stiffness and also muscle tone.
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Most literature defines knee extension lag as the failure of the knee joint to achieve the passive extension angle, and some literature defines the inability of the knee to complete the last 15° extension as knee extension lag. Extension lag is one of the common complications after knee surgery, which seriously affects the postoperative knee joint function of patients. Disuse atrophy due to prolonged postoperative bed rest, arthrogenic muscle inhibition due to pain and (or) swelling, direct injury to the knee extensor mechanism during surgery and nerve dysfunction of the quadriceps muscle can all contribute to extension lag. While rehabilitation exercises, physical therapy and medication can significantly improve the patient's symptoms, extension lag due to the knee extension device injury requires surgery if necessary to regain normal knee function. As surgical techniques continue to be refined and rehabilitation interventions advance, the prevention of extension lag and the minimization of angle of knee extension lag need to be given adequate attention by patients, physicians, and researchers. This article reviews clinical studies related to extension lag after knee surgery, focusing on etiology, treatment, prevention and prognosis, with the aim of providing a basis and guidance for the current clinical management.
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Objective:To investigate the relationship between bone metabolism biochemical markers and clinic features (course,AIS,etc.)in spinal cord injury patients.Method:Totally 73 patients aged from 13 to 89 years with SCI were enrolled.The injury time was recorded,and patients' AIS was assessed.25-hydroxyvitamin D [25(OH)D],collagen type Ⅰ C-terminal telopeptide (CTX)and N-terminal propeptide of type 1 precollagen(P1NP) were measured.Result:In our observation of patients with spinal cord injury,the ratio of 25(OH)D deficience was 98.6％.Correlation between 25(OH)D and clinic features was not found.P1NP showed positive correlation with course (R=-0.235,P＜0.05)and negative correlation with AIS (R=0.442,P＜0.01).CTX showed negative correlation with AIS and age(R was-0.232 and-0.296,P＜0.05).There is no difference between tetraplegia and paraplegia (AIS C and D) in 25(OH)D、P1NP and CTX.CTX is higher in traumatic spinal cord injury patients,(Z=-.2.086,P ＜ 0.05)Conclusion:In patients with spinal cord injury,a lack of vitamin D has a high proportion.The lower AIS was,the higher P1NP and CTX was,which meant severe bone loss.Bone loss may be faster in younger SCI patients and traumatic spinal cord injury patients.
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Objective:Using sonography to clarify the shoulder lesion and injury and to evaluate the relationship between sonographic findings and muscle strength of stroke patients with shoulder pain.Method:One hundred and forty three patients with shoulder pain were divided into two groups according to muscle strength of hemiplegic shoulder.Of which,76 patients were in the muscle strength of hemiplegic shoulder below MMT grade 3 group and 67 patients were in the muscle strength of hemiplegic shoulder equal or above MMT grade 3 group.All the patients received ultrasound examination of their hemiplegic shoulders.Result:The total occurrence rate of shoulder lesion and injury was 74.8％(n=107).The occurrence rate of subacromial-subdeltoid bursal hydrops or bursitis was 41.3％(n=59).The occurrence rate of hydrops or inflammation of long head of biceps tendon sheath was 24.5％(n =35).The occurrence rate of tendinitis of rotator cuff was 22.4％(n=32).The occurrence rate of partial or complete tear of rotator cuff was 20.3％(n=29).There was no statistical correlation between muscle strength of hemiplegic shoulder and severity of shoulder lesion and injury(P＞0.05).Conclusion:The occurrence rate of shoulder lesion and injury after stroke was very high.There was no correlation between the severity of shoulder lesion and injury and the muscle strength of hemiplegic shoulder.For the function rehabilitation of upper extremity of stroke hemiplegic patients it is beneficial to find the shoulder lesion and injury earlier and administer effective therapy.
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Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P2.827, P0.05), and it increased in the control group six weeks after TKA (t>3.555, P0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P2.387, P0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.
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Objective To investigate the isokinetic strength of knee extensors and flexors in patients with knee osteoarthritis (KOA), and to establish the correlation between the isokinetic strength and function in patients with KOA. Methods 23 patients with bilateral KOA and 14 matched normal controls finished the isokinetic test of knee extensors and flexors, the Five Times Sit-to-Stand Test (FTSST), Gait analy-sis, and Balance test. The KOA patients were evaluated with Visual Analog Scale (VAS) for pain and Western Ontario and McMaster Univer-sity Osteoarthritis Index (WOMAC). Results It was less of the peak torque, average peak torque, average power, max rep total work, total work of knee extensors and flexors in the mainly involved limbs than the contralateral limbs (P0.05). Conclusion It is weak of the isokinetic strength of knee extensors and flexors in patients with KOA in the mainly involved limb, as well as the isokinetic strength of knee extensors compared with the normal controls. The changes in the ex-tensors and flexors are not equivalent. The peak torque of knee extensors significantly correlated with the pain and functions of the knee.
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@# Objective To compare the acceptance of 2 different teaching modes－physicians and therapists teaching together and separately in continuing education students of rehabilitation medicine. Methods A questionnaire was filled by the students who attended the lectures of both Rehabilitation of Elbow Injury and Rehabilitation of Wrist Injury in the 9th National Orthopedic Class. The former lecture was taught by the rehabilitation physician and physical therapist together (together mode), and the latter lecture was taught by the rehabilitation physician and physical therapist separately (separate mode). The questionnaire included the choices and text questions. Results There were 45 copies of effective questionnaire all together. The satisfaction of both lectures were above 90%. As to teaching modes, 77.8% students liked together mode better, and 22.2% students preferd the separate mode. 93.9% students would or maybe use together mode in their future work, and 88.9% in separate mode. Conclusion The mode of physician and therapist giving lectures together is well accepted by students.
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An investigation was made on the rehabilitation treatment for the injuries wounded in Wenchuan Earthquake offered in 30 hospitals of 8 provinces, including Beijing, Shanghai, Jiangsu, Shandong, Hubei, Guangdong, Cbongqing, and Sichuan. On the basis of data from this investigation, the paper made analysis and summary of the challenges and problems encountered in the said rehabilitation treatment, and raises such recommendations as relessing rehabilitation assessment principles and policies for the injuries to return to their home towns in Siehuan, clarifying the responsibilities of individual government authorities in the later-stage rehabilitation treatment of the injuries, and enhanced synergy among respective disciplines and authorities of both clinical practice and rehabilitation treatment. The goal of these recommendations is further development of the rehabilitation medicine discipline in China.
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Objective :To investigate a new method and its clinical results in the treatment of avascular necrosis of the femoral head in young adults. Method:The necrotic bone was removed and iliac periosteum and bone with vascular pedicle was transplanted in 25 cases (28 hips) ,age 12-42 years old in this group. Rehabilitation technique were applied after surgery. The time of follow up was 3-9.5 years. To evaluate the results, we used the standard score recommended by Society of Osteonecrosis in Chinese Medical Association. Result:16 cases were excellent,7 cases good, and 2 cases fair. The rate of excellent and good was 92%. Conclusion:Transplantation of iliac periosteum and bone with vascular pedicle has the effect on revascularization and new bone formation, which following with rehabilitation methods may promote the reconstruction of the necrotic femoral head and prevent it to collapse. Thus the pathogenesis process had been stopped.