Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain-A Practical Review.

This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development.

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification.

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50-69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.

The Use of Samsung Health and ECG M-Trace Base II Applications for the Assessment of Exercise Tolerance in the Secondary Prevention in Patients after Ischemic Stroke.

Background and objectives: The aim of the study was to use the mobile application Samsung Health for the assessment of parameters of exercise tolerance and the ECG (electrocardiogram) M-Trace Base II for the assessment of cardiological parameters. Materials and Methods: The measurements were conducted during rest and after performing SMWT (Six Minute Walk Test) and SCT (Stair Climb Test) in 26 patients after ischemic stroke (IS) and 26 healthy individuals. Results: In the SMWT, the post-stroke group (SG) walked a shorter distance (p < 0.001), achieving lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p = 0.002). In the SCT, SG achieved a lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p < 0.001) when compared to the control group (CG). In SG, myocardial ischemia in ECG was noted in four patients after SMWT and in three patients following SCT. Both in SG and in CG the increase in SBP (systolic blood pressure) value measured after SMWT and SCT compared to at rest (p < 0.001) was observed. In SG, in the compared ratios rest to SMWT and SCT as well as SMWT to SCT, there was an increase in HR (heart rate) (p < 0.001). Conclusions: ECG M-Trace Base II and Samsung Health are mobile applications that can assess cardiological parameters and exercise tolerance parameters in patients after IS, so they can be used to plan the intensity of exercise in rehabilitation programs.

Does Regular Dancing Improve Static Balance?

The aim of the study was to compare the static balance of dancers and non-dancers in a bipedal and unipedal stance. Twenty-three female dancers (mean age: 21.3 ± 1.7) and 24 age and sex-matched subjects (mean age 22.3 ± 1.0) participated in this study. A force platform was used to assess balance. The tests on the balance platform were performed in several positions with different foot placement, such as normal standing (NS) eyes open and eyes closed positions, semi-tandem position (ST), tandem position (TP), and one-leg standing (1L) eyes open and eyes closed position. Significant differences in balance between the dancers and the control group, especially in the tandem position and one-leg standing position with eyes closed were found. We observed higher results for the velocity of the COP in the frontal plane in the TP with a dominant limb in front (p = 0.04) and higher results for the velocity of the COP in the frontal plane (p = 0.01) and in the sagittal plane (p < 0.01) in the TP with a dominant limb in front in the control group. We also observed significant differences between groups in the mean velocity of COP sway in the sagittal plane in the 1 L position with eyes closed (p = 0.04). We concluded that dancing regularly for several years improves static balance.

The ICF Classification as a Simple Tool to Aid in the Assessment of Healthcare Services in a Non-COVID-19 Hospital during the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on the operation of medical facilities. In this period, they have seen increased absence of medical staff from work, a decrease in the number of hospitalizations and in the value of healthcare services provided. We assess the impact of this pandemic on the operation of a non-COVID-19 orthopedic and rehabilitation hospital using International Classification of Functioning, Disability and Health (ICF) categories. The authors analyzed these parameters in relation to the operation of a non-COVID-19 orthopedic, rehabilitation and rheumatological hospital in Q1 2020 compared to Q1 2019. For the analysis, the categories and qualifiers of the ICF were used, allowing for a simple and easily readable data analysis. In March 2020, in comparison to March 2019, the average working time of medical workers (p < 0.001) and the number of hospitalizations (p < 0.034) decreased significantly. In April 2020, compared to April 2019, the average working time of medical workers (<0.001) and the number of hospitalizations (0.002) also decreased significantly. In addition, in April 2020, the percentage value of the contracted services provided decreased significantly (p = 0.017), which was not observed in March of that year. The COVID-19 pandemic has affected the operation of a non-COVID-19 hospital, causing an increase in staff absences from work, a decrease in the number of hospitalizations and a decrease in the value of the revenue generated from health services provided. The ICF is a useful tool for the evaluation of a hospital's healthcare services.

The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage.

Background and objectives: Patients with a history of prior stroke have a high risk for subsequent cardiovascular events (CVD). Therefore, the implementation of an effective strategy to reduce risk factors and thereby improve secondary prevention outcomes is crucial in this patient population. The aim of this study was to determine differences in the incidence of risk factors for recurrent CVD events based on clinical type of prior stroke and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 109 patients with a history of ischemic stroke (IS) and 80 patients with a history of intracerebral hemorrhage (ICH) within 14 days poststroke. Results: Atrial fibrillation/flutter (p = 0.031), >70% carotid artery stenosis (p = 0.004), blood pressure >140/90 mmHg (p = 0.025), blood HbA1c levels >7% (p = 0.002), smoking (p = 0.026) and NSAID (nonsteroidal anti-inflammatory drug) use (p < 0.001) were significantly more common in patients with a history of ischemic stroke. However, liver function test abnormalities were observed more commonly in patients with a history of hemorrhagic stroke (p = 0.025). Conclusions: The incidence and type of risk factors for recurrent CVD events vary according to the clinical type of prior stroke. The ICF classification system is a useful tool for evaluating these risk factors. This may help reduce the risk of subsequent CVD events.

Wireless Motion Sensors-Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis-Preliminary Report.

Osteoarthritis of the knee (OAK) is characterized by pain, limitation of joint mobility, and significant deterioration of proprioception resulting in functional decline. This study assessed proprioception in OAK patients following two ten-day rehabilitation programs using the Orthyo® system. Fifty-four study participants with clinical symptoms and radiological signs of OAK were randomly divided into an exercise group (n = 27) or a manual therapy group (n = 27). The control group consisted of 27 volunteers with radiological signs of OAK, but with no clinical symptoms or prior history of rehabilitation. The following parameters were assessed: knee proprioception using inertial sensors and a mobile application, patients' function using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and pain intensity using the visual analog scale (VAS). Following rehabilitation, knee proprioception tests did not improve in either study group. Both study groups showed significant improvement of the WOMAC-assessed function (exercise group: p < 0.01, manual therapy group: p = 0.01) and a significant decrease (p < 0.01) of VAS-assessed pain following rehabilitation, but the post-therapy results did not differ significantly between the aforementioned groups. The Orthyo® system provided a quick and accurate assessment of the knee joint position sense. There was no direct relationship between functionality, pain, and proprioception threshold in the knee joint.

Body balance a few years after total hip replacement.

PURPOSE: These aim of the study was to conduct a long-term evaluation of whether total hip replacement permanently affects the dynamic body balance. METHODS: Twenty-five patients after the unilateral total hip replacement (mean age: 69.9 ± 6.2) and 25 subjects without the total hip replacement (mean age: 68.4 ± 4.8) who matched the age and overall health participated in this study. The force platform and functional tests such as Timed Up and Go, 3m walk test, Functional Reach Test, 30s Chair Stand Test, Step Test and Berg Balance Scale were used to assess dynamic balance. The results obtained in individual trials were compared using the Student's t-test for independent variables, the Welch test or the non-parametric Mann-Whitney U-test. RESULTS: Subjects from the THR group exhibited significantly increased time and distance in the tests performed on the force platform, compared to the control group. We also observed worse balance and functional test scores in the THR group: Timed Up and Go test ( p < 0.001), 3 m walk test ( p < 0.001), Functional Reach Test ( p < 0.001), 30 s Chair Stand Test ( p = 0.001) and Step Test (operated leg: p < 0.001, non-operated leg: p < 0.001). The results obtained in the Berg Balance Scale tests were not significantly different between the groups ( p = 0.218). CONCLUSIONS: We observed significant differences in postural stability and dynamic balance between patients after THR and subjects in the same age without endoprosthesis. Our research shows that total hip replacement permanently impairs patients' dynamic balance and their functionality in certain lower-extremity activities.

Mobile Applications in Evaluations of Knee Joint Kinematics: A Pilot Study.

Because medical professionals lack the means to monitor exercises performed by patients in their home environment directly, there is a strong case for introducing technological solutions into this domain. They include methods that use wireless inertial sensors, which emit signals recorded and processed by special applications that work with mobile devices. This paper's aim is (a) to evaluate whether such sensors are suitable for qualitative and quantitative motion analysis, and (b) to determine the repeatability of results over a few recordings. Knee joint activity was analysed using a system of inertial sensors connected through a Wi-Fi network to mobile devices. The tested individuals did eight different activities, all of which engaged the knee joint. Each excercise was repeated three times. Study results did not reveal any statistically significant differences between the three measurements for most of the studied parameters. Furthermore, in almost every case, there were no statistically significant differences between the results of the right and left lower limb (p > 0.05). This study shows that easy use and repeatability of results combined with the feature of quantitative and qualitative analysis make the examined method useful for functional evaluations of the knee joint.

Does total hip replacement impact on postural stability?

BACKGROUND: Total hip replacement (THR) is a procedure which can improve the quality of life in patients with osteoarthritis. However, deficits in static stability and impairment of lower limb efficiency can be observed even several months after the procedure. The aim of this study was to investigate the static balance of the standing position in patients treated by THR. METHODS: The study included 30 THR patients and 30 healthy subjects. The subjects were examined once. A Metitur balance platform and a one-leg standing (OLS) test were used to assess the static balance. The tests on the balance platform were performed in several positions with different foot placement, such as normal standing, eyes open (NS EO) and eyes closed (NS EC) positions, tandem position (TP), the second form of tandem position (2TP) and one-leg standing position (1 L). RESULTS: Significant imbalance in the sagittal plane during normal standing EO and EC positions were found in the THR group. No significant differences in the measured parameters were found during tests in tandem, the second form of tandem and one-leg standing positions in the groups. The mean time of standing on the operated limb in the THR group during the OLS test was significantly shorter than that in the control group. CONCLUSIONS: Deficits in static balance may occur in THR patients even a long time after the procedure. The test performed in the NS position is sufficient to assess the balance. The rehabilitation protocols currently used after THR should include postural stability exercises. TRIAL REGISTRATION NUMBER: Trial registry: NCT03218267 . 12 July 2017 (retrospectively registered).

The usefulness of isometric protocol for foot flexors and extensors in assessing the effects of 16-week rehabilitation regiment in poststroke patients.

BACKGROUND: Ankle joint function in a paretic limb has a fundamental impact on mobility. Return of joint function is a measure of early poststroke physical rehabilitation. This study aims to assess the suitability of using the isometric protocol for objective evaluation of flexor and extensor muscle strength in the paretic limb of poststroke patients. METHODS: 34 patients (F: 9, M: 25) aged 51-79 years with hemiparesis following an acute ischemic stroke and 34 healthy controls were examined using the isometric protocol measured on the Biodex System®. The following parameters were analyzed: peak torque [PT], average torque [AVGT], average torque/body weight [AVGT/BW] for flexors and extensors, and AVGT flexor/AVGT extensor [agonist/antagonist ratio] of the paretic foot, the nonparetic foot and foot of healthy controls using three foot-shank positions (15°, 0°, and - 15°) prior to rehabilitation commencement and at its completion 16 weeks later. RESULTS: Prior to rehabilitation commencement, nonparetic foot differed significantly (p < 0.05) from healthy foot controls in all parameters and all positions for flexors and in all positions for foot-shank positions of 0° and - 15° for extensors. At rehabilitation program completion the following parameters increased significantly for the paretic foot: PT, AVGT, and AVGT/BW for foot extensors in all tested positions, and PT for foot flexors in foot-shank position of - 15°. The nonparetic foot however, showed no significant difference following rehabilitation regardless parameter or foot position tested for flexors and extensors alike. Prior to rehabilitation agonist/antagonist ratio in the paretic foot differed significantly from corresponding parameter in the control group for the foot-shank positions of 15° and 0°, whereas at rehabilitation completion, the two groups showed significant difference only in foot-shank position of 0°. CONCLUSIONS: In the early period following stroke, there is a significant strengthening of the paretic limb, but no improvement in the strength of nonparetic limb.

Importance of the functional examination in lower extremities in patients with rheumatoid arthritis.

This paper deals with evaluation of the lower extremity efficiency and balance in rheumatoid arthritis (RA) patients. The authors' own test (LLFT-lower extremities functional test) and balance tests during normal standing and tandem positions with eyes opened or closed were used. Twelve patients with RA and fifteen controls for comparison were examined. Center feet of pressure dislocation on platform in normal standing with eyes open, normal standing with eyes closed, tandem left foot in front and tandem right foot in front positions and further dynamic balance tests on three different boards were analyzed. Visual Analogue Scale monitored the level of pain after each LLFT task. There was found a relation between the intensity of pain and overloading of joints in particular tasks, resulting in lower extremities dysfunction. A significant disbalance in medio-lateral direction during normal standing with eyes closed and tandem right foot in front positions and also in anterior-posterior direction in tandem right foot in front position during static balance tests was found. Correlations showed that patient's age, disease duration and Steinbrocker Functional Classes have an influence on parameters of balance tests. Results indicate that complex dysfunction of lower extremities causes disbalance of posture in static conditions.