Clinical efficacy of ultrasound-guided adductor block with chloroprocaine combined with fentanyl for early rehabilitation training after total knee arthroplasty / 中国基层医药

Objective:To investigate the effects of ultrasound-guided adductor block with chloroprocaine combined with fentanyl on analgesia and early rehabilitation after total knee arthroplasty.Methods:Eighty-eight patients who underwent total knee arthroplasty in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between June 2018 and June 2020 were included in this study. They were randomly divided into control and study groups, with 44 patients per group. The control group was subjected to distal adductor block with ropivacaine. The study group received distal adductor block with ropivacaine combined with fentanyl. Before and after distal adductor block, resting pain response was evaluated using the Visual Analogue Scale. The success rate, onset time of block, and duration of block effect were recorded. The quadriceps femoris muscle strength, knee joint range of motion, and Hospital for Special Surgery knee score before and after block were measured. The time spent in stand-to-walk test and 10-meter walking test, and incidence of falls during rehabilitation training as well as drug-related adverse reactions were recorded.Results:There were no significant differences in resting-state and task-state Visual Analogue Scale scores post-block between the two groups ( t = 0.43, 0.46, P = 0.689, 0.644). The onset time of block and duration of block effect in the study group were (5.02 ± 0.94) minutes and (2.64 ± 0.39) minutes, respectively, which were significantly shorter than those in the control group [(7.49 ± 1.12) minutes, (7.08 ± 0.92) minutes, t = 5.73, 13.02, both P < 0.001]. There was no significant difference in block success rate between study and control groups (100.0% vs. 100.0%, χ 2 = 0.00, P = 1.000). The quadriceps femoris muscle strength, knee range of motion, and Hospital for Special Surgery knee score in the study group were (4.68 ± 0.44), (112.57 ± 9.96) o and (70.56 ± 6.84) points, which were superior to those in the control group [(4.19 ± 0.42), (101.30 ± 9.67) o,(62.47 ± 6.16) points, t = 3.42, 4.64, 6.58, all P < 0.001). The time spent in stand-to-walk test and 10-meter walking test were (7.95 ± 1.48) minutes and (4.67 ± 0.63) minutes, respectively, which were significantly shorter than those in the control group [(13.41 ± 2.05) minutes, (6.24 ± 0.77) minutes, t = 8.23, 6.74, both P < 0.001). The incidence of falls in the study group was significantly lower than that in the control group (11.3% vs. 29.5%, χ 2 = 4.47, P = 0.034). There was no significant difference in total incidence of drug-related adverse reactions between the two groups (9.1% vs. 13.6%, χ 2 = 0.45, P = 0.502). Conclusion:Distal adductor block with cloprocaine combined with fentanyl meets the requirement of short-term intensive analgesia after total knee arthroplasty, and achieves sufficient analgesia, maximum retention of motor function, rapid onset, and repaid recovery.

Integrated continuous care: collaborating with the elderly functionality / Cuidado contínuo integrado: colaborando para a funcionalidade do idoso

This study aimed to evaluate the influence of Integrated Continuous Care on the functional independence of the elderly. This cohort study included participants aged 60 years or older who had experienced a disabling event or disease, and were admitted to rehabilitation in a Brazilian Integrated Continuous Care Unit. The functional gain was evaluated by the Barthel index.Fifty-nine elderly individuals admitted due to a disabling event or disease at the ICCU were assisted from March 2014 to February 2015. Since twenty-two of these were excluded, only 37 participants were evaluated. The mean age of the elderly that were included was 70.41 years (± 1.40) and most of them presented an ischemic stroke diagnosis (64.9%). The total functional gain was 24.05 (± 3.84) points, with an average stay of 32.32 (± 2.18) days. When compared with the degree of dependence on the admission and at discharge, total or severe dependence was identified in 62.2% on admission and mild dependence or total independence was identified in 54.1% at discharge, with a significant decrease in the percentage of the elderly with total dependence between admission and discharge (McNemar test, p = 0.001). At hospital discharge, 70.3% of the elderly had better individual performance in their Activities of Daily Living than at hospital admission and none of them got worse. The multi-professional team-based approach in the Integrated Continuous Care assistance model favors the elderly with gain in functionality and independence. The social network involvement of the elderly lead to their empowerment and co-responsibility along with their family/caregiver in pursuit of the therapeutic goals established together.

Investigar a influência dos Cuidados Continuados Integrados na independência funcional de idosos. Este estudo de coorte incluiu participantes com 60 anos ou mais que sofreram algum evento ou doença incapacitante e que foram internados para reabilitação em Unidade Brasileira de Cuidados Continuados Integrados. O ganho funcional foi avaliado pelo índice de Barthel. Cinquenta e nove idosos admitidos por um evento ou doença incapacitante na UCCI foram atendidos de março de 2014 a fevereiro de 2015. Como vinte e dois deles foram excluídos, apenas 37 participantes foram avaliados. A média de idade dos pacientes incluídos foi de 70,41 anos (± 1,40) e a maioria apresentou AVC isquêmico como diagnóstico (64,9%). O ganho funcional total foi de 24,05 (± 3,84) pontos, com tempo médio de permanência de 32,32 (± 2,18) dias. Quando comparados o grau de dependência na admissão e na alta, a dependência total ou grave foi identificada em 62,2% na admissão e a dependência leve ou independência total foi identificada em 54,1% na alta, com uma diminuição significativa no percentual de pacientes com dependência total entre admissão e alta (teste de McNemar, p = 0,001). Na alta hospitalar, 70,3% dos pacientes apresentaram melhor desempenho individual em suas Atividades de Vida Diária do que no momento da admissão hospitalar e nenhum paciente piorou. A abordagem multiprofissional baseada em equipe no modelo assistencial do Cuidado Integrado Contínuo beneficia o idoso, com ganho de funcionalidade e independência. O envolvimento do paciente na rede social leva ao empoderamento e corresponsabilidade deste e da família/cuidador na busca dos objetivos terapêuticos estabelecidos em conjunto.

Establishing morphological database of lower limbs for providing appropriate clinical postoperative prosthesis socket / 中国组织工程研究

BACKGROUND: At present, the prosthesis is made by three steps: Taking, trimming and shaping. Because the process of trimming is manual, it is closely related to the experience and technology of clinical technicians. If the prosthesis is not beautiful, it is difficult to make full contact between the receiving cavity and the residual limb. OBJECTIVE: To collect MRI data of thigh in healthy volunteers, evaluate the anatomical symmetry of thigh amputation range (10-25 cm above knee joint space), and establish MRI data as a database so as to provide reference data for patients with lower limb amputation to match the appropriate prosthesis after operation. METHODS: Totally 40 healthy volunteers were recruited and basic information was collected, including age, height, weight, the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm. All volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Three-dimensional reconstruction was carried out in thigh amputation range. Taking the surface area and volume of the model as parameters, the thighs of each volunteer were anatomically measured. Three-dimensional reverse engineering software was used to analyze the three-dimensional deviation of the measurement results so as to conduct quantification and visualization of the thigh symmetry. RESULTS AND CONCLUSION: (1) Self symmetric analysis: Regarding the surface area, the maximal percent difference between the left and right thigh amputation was no more than 0.56% (P=0.109). Regarding the volume, the maximal percent difference between the left and right thigh amputation was no more than 1.19% (P=0.182). Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.47 mm, while the maximal mean positive deviation was 1.14 mm. Moreover, the three-dimensional deviation distribution of 40 subjects was within 2 mm (78.02%), between 2.1 and 3.0 mm (20.97%), and more than 3 mm (1.01%). (2) Allogeneic symmetric analysis: Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.97 mm, while the maximal mean positive deviation was 1.89 mm. (3) The results confirmed that adult bilateral thigh amputation range has a high degree of anatomical symmetry. When differences between two adults' right thighs are no more than 2 cm in the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm, their surface profiles of thigh amputation ranges are considered to be highly similar, but are not associated with gender, height and weight.

Estimulação cognitiva em idosos com demência: qual o impacto na saúde de seus cuidadores? / Cognitive stimulation in older adults with dementia: what is the impact on their caregivers' health?

OBJETIVOS: Identificar e avaliar o efeito das intervenções de estimulação cognitiva (EC) em idosos com demências na saúde dos cuidadores. MÉTODO: Revisão sistemática da literatura conduzida de acordo com as diretrizes do Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA). A busca foi realizada em maio de 2018, por dois pesquisadores independentes, nas bases de dados Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Escala da Base de Dados de Evidência em Fisioterapia (PEDro), PsycINFO e PubMed. Os descritores utilizados foram "dementia" AND "cognitive stimulation" e seus equivalentes em português e espanhol. Foram incluídos apenas artigos experimentais, publicados entre janeiro de 2007 e abril de 2018, que realizaram EC em idosos com demência, conduzida por profissional ou pelo próprio cuidador e cujo desfecho incidisse no cuidador. A qualidade dos estudos selecionados foi avaliada pela Escala PEDro. RESULTADOS: A amostra foi composta de 10 estudos, sendo que apenas dois verificaram benefícios da EC sobre a saúde do cuidador do idoso com demência. CONCLUSÃO: Este estudo não encontrou evidências consistentes sobre os reais benefícios da realização de EC no idoso com demência para a vida do seu cuidador.

OBJECTIVES: To identify and evaluate the effect of cognitive stimulation (CS) interventions for older adults with dementia on caregivers' health. METHOD: This systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) guidelines. A search was performed by two independent researchers in May 2018, using Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Science Literature Database (LILACS), Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed databases. The terms used were "dementia" AND "cognitive stimulation" and their equivalents in Portuguese and Spanish. For inclusion, articles should have been experimental, published from January 2007 to April 2018, with CS delivered to older adults with dementia by a professional or by a caregiver, and outcome measured in the caregiver. Quality of selected studies was assessed using the PEDro scale. RESULTS: The sample consisted of 10 studies, and only two reported CS benefits to the health of caregivers of older adults with dementia. CONCLUSION: This study found no consistent evidence of actual benefits of CS in older adults with dementia to their caregivers' health.

Características de patentes de dispositivos para rehabilitación física registradas en los Estados Unidos / Characteristics of patents of physical rehabilitation devices registered in the United States

Introducción: La rehabilitación física puede verse beneficiada con el uso de dispositivos, los cuales en su mayoría suelen ser patentados. La oficina de patentes y marcas de los Estados Unidos (USPTO) es una de las oficinas de patentes y marcas más grandes y reconocidas. Resulta de interés evaluar las características y la evolución de las patentes para la rehabilitación física; sin embargo, existen pocos estudios al respecto. Objetivo: Identificar las características de las patentes de dispositivos de rehabilitación física de extremidades, registradas en la oficina de patentes y marcas de los Estados Unidos. Material y métodos: Estudio descriptivo transversal. Se realizó una búsqueda en UPSTO usando una lista de palabras clave relacionadas con la rehabilitación. Se eligieron 10 grupos de patentes relacionados con la rehabilitación. Las variables estudiadas fueron: número de la patente, fecha de publicación, país, titular, área de la patente, extremidades para las cuales es útil la patente y portabilidad. Se realizó un análisis descriptivo usando STATA v.14. Resultados: Se analizaron 1971 patentes, de las cuales 16,2 por ciento fueron incluidas en los grupos de rehabilitación y 83,8 por ciento en ejercicio físico. El 36,6 por ciento de todas las patentes fueron patentadas por un titular corporativo, el 29,9 por ciento fueron portables, y el 46,3 por ciento tenían utilidad para ambas extremidades. Conclusiones: De las patentes encontradas las enfocadas para ejercicio físico fueron las predominantes. Existe una mayor cantidad de patentes útiles para ambas extremidades. Además, existe una tendencia ascendente en el tiempo, en el número de patentes del área de rehabilitación y de las invenciones portables(AU)

ABSTRACT Introduction: Physical rehabilitation can be benefitted from the use of devices, which are usually patented. The United States Patent and Trademark Office (USPTO) is one of the largest and most recognized patent and trademark offices. The characteristics and evolution of patents for physical rehabilitation is of great interest; however, there are few studies in this respect. Objective: To identify the characteristics of patents of physical rehabilitation devices for the physical rehabilitation of damaged limbs registered the United States Patent and Trademark Office. Material and methods: A cross-sectional descriptive study was conducted. A search was made at UPSTO using a list of keywords related to rehabilitation. Ten groups of patents related to rehabilitation were chosen. The variables studied were: patent number, publication date, country, holder, patent area, limbs for which the patent is useful, and portability. A descriptive analysis was performed by using STATA v.14. Results: A total of 1971 patents were analyzed, of which 16.2 percent were included in the rehabilitation groups and 83.8 percent in the physical exercise groups. The 36.6 percent of them were corporate-owned patents, 29.9 percent were portable, and 46.3 percent had usability which demonstrated to be useful for both extremities. Conclusions: Of the patents found, those focused on physical exercise were predominant. There is a greater number of useful patents for both extremities. In addition, there is an upward trend over time, the number of patents in the area of ​​rehabilitation, and portable inventions(AU)

Atuação do enfermeiro na reabilitação do paciente oncológico: revisão integrativa / The nurse's performance in the rehabilitation of the cancer patient: integrative review

Objetivo: avaliar as evidências disponíveis na literatura sobre a atuação do enfermeiro na reabilitação do paciente oncológico. Método: trata-se de uma revisão integrativa seguindo as seguintes etapas: identificação do problema, busca na literatura, extração de dados dos estudos primários, avaliação dos estudos primários e apresentação da revisão integrativa. A busca dos estudos primários foi realizada nas bases de dados CINAHL, LILACS e PubMed publicados no período de 30 de junho de 2008 a 30 de junho de 2018. Resultados: a amostra foi composta de 32 estudos primários, agrupados em três categorias: (1) ações interacionais (n=8); (2) ações educacionais (n=10); e (3) ações assistenciais (n=14) do enfermeiro na reabilitação oncológica. Na categoria 1, os principais temas investigados foram comunicação, apoio espiritual e psicológico. Na categoria 2, apurou-se orientações prestadas ao paciente e elaboração de estratégias de ensino. Já na categoria 3, atenção domiciliar, processo de enfermagem, procedimentos técnicos e práticas alternativas foram os principais temas abordados. Constatouse que o enfermeiro inserido na reabilitação oncológica deve utilizar do diálogo e da escuta como recursos para atingir suas ações interacionais, e que suas habilidades permitem um relacionamento paciente-enfermeiro eficaz e terapêutico, resultando em uma melhor assistência biopsicossocial e espiritual. Além disso, suas ações educacionais mostraram-se importantes ao paciente no sentido de motivá-lo a ser responsável por seu cuidado, o que o auxiliará no enfrentamento de problemas e no alcance de sua autonomia. Já suas ações assistenciais se voltaram à promoção da saúde em todos os aspectos e pautaram-se na sistematização da assistência, que lhe proporciona recursos científicos e humanos; demonstraram, ainda, a importância da inserção das práticas alternativas no cuidado do paciente oncológico. Conclusão: todas as evidências forneceram subsídios para que o enfermeiro pudesse compreender sua atuação na reabilitação oncológica. A diversidade e complexidade do seu papel neste cenário demonstra claramente que suas ações são fundamentais, pois abordam todos os comprometimentos biopsicossociais impostos ao cliente pela doença, promovendo uma assistência de enfermagem individualizada, humanizada e holística

Objective: to evaluate the available evidences in the literature about the nurse's performance in the rehabilitation of the cancer patient. Method: it is an integrative review following the following steps: identification of the problem, research in the literature, extraction of data from the primary studies, evaluation of the primary studies and presentation of the integrative review. The search of the primary studies was performed in the databases CINAHL, LILACS and PubMed published in the period from June 30, 2008 to June 30, 2018. Results: the sample consisted of 32 primary studies, grouped into three categories: (1) interactional actions (n = 8); (2) educational actions (n = 10); and (3) care actions (n = 14) of the nurse in cancer rehabilitation. In category 1, the main subjects investigated were communication, spiritual and psychological support. In category 2, guidelines were found and given to the patient and elaboration of teaching strategies. In category 3, home care, nursing process, technical procedures and alternative practices were the main topics addressed. It was verified that the nurse involved in cancer rehabilitation should use dialogue and listening as resources to achieve his interactional actions, and that his skills allow an effective and therapeutic patient-nurse relationship, resulting in a better biopsychosocial and spiritual care. In addition, his educational actions have been proved important to the patient in order to motivate him to be responsible for his own care, which will help him in facing problems and reaching his autonomy. His care actions turned to health promotion in all aspects and were based on the systematization of care, which provides him scientific and human resources; they also demonstrated the importance of the insertion of alternative practices in the care of the cancer patient. Conclusion: all the evidences provided support to the nurse to understand his performance in cancer rehabilitation. The diversity and complexity of his role in this context clearly demonstrates that his actions are fundamental, as they address all the biopsychosocial commitments imposed on the client by the disease, promoting an individualized, humanized and holistic nursing care

Advance on Research of Treating Hemiplegia after Stroke with Acupuncture and Rehabilitation(review) / 中国康复理论与实践

@#This article systematic reviewed the recent ten years clinical research of acupuncture treatment and rehabilitation on hemiplegia after stroke.The curative effect of acupuncture treatment and rehabilitation on hemiplegia after stroke is certain,and also supported by subsequent clinical researches.At the same time,we found that there are some deficiencies.The author elaborated personal views of clinical research in the future.The main purpose is to review the clinical research progress and forecast of acupuncture treatment and rehabilitation on hemiplegia after stroke briefly.

Reliability and validity of Chinese Rehabilitation Research Center Standard Aphasia Examination / 中国康复理论与实践

@#ObjectiveTo investigate the reliability and validity of Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) among patients with aphasia after cerebral injury. Methods40 patients were measured using the CRRCAE. For reliability, interclass correlation coefficients were analyzed. For validity, the correlation coefficients of the aphasia quotients and 4 items of CRRCAE and Western Aphasia Battery (WAB) were analyzed.ResultsThe interclass correlation coefficients>0.9, while the Cronbach α of total scale was 0.9411, the scale of the comprehension was 0.8677,the scale of express was 0.8889. CRRCAE had positive relationship with WAB(with the aphasia quotients, r=0.948,P<0.01). The effect size statistics scale was 0.94.ConclusionCRRCAE shows a good retest reliability and good internal consistency. The total scale of CRRCAE can be correlated with serious level of aphasia effectively.

The Choice of the Research Topic and Research Design in Clinical Rehabilitation Setting / 中国康复理论与实践

@# The choice of the topic area and specific problem on which to conduct research is the mostimportant step in the research process.This paper focused on the development and execution of a clinical re-habilitation research study. The choice of the topic area. principle of research design. data collection and dataanalvsis of a research study have been discussed.