The use of technology in cancer prehabilitation: a systematic review.

Aim: This review aimed to evaluate the effectiveness and feasibility of cancer prehabilitation programs delivered through technological enablers compared to conventional face-to-face interventions. Methods: A systematic review was conducted, searching PubMed, Embase, and CINAHL for studies published from inception to February 6, 2024. Studies were included if they involved adult cancer patients in primary research, utilized technology for prehabilitation, and assessed functional, psychological, and quality of life outcomes. Results: Sixteen studies were included, encompassing wearables, apps, teleprehabilitation, and virtual reality. All studies reported feasibility, but challenges included technical issues, lack of supervision, and non-compliance. Effectiveness depended on intervention rigor and technology type. Wearables offered objective monitoring but faced compliance issues. Videoconferencing provided supervision and could mitigate compliance concerns. Multimodal programs and intervention-specific outcome measures were recommended. Conclusion: Technology-based prehabilitation programs seem feasible, but effectiveness depends on intervention design and technology employed. Future research should focus on developing robust evidence to guide clinical practice and explore the potential of integrated technological solutions. Systematic review registration: PROSPERO, identifier CRD42022376028.

Complete spinal cord injury from postoperative seroma following scoliosis surgery: A case report with favorable ambulatory outcomes after comprehensive rehabilitation.

CONTEXT: Postoperative seroma is a known complication following spine deformity surgery. However, complete spinal cord injury (SCI) due to postoperative seroma is rare. Rehabilitation strategies and outcomes of SCI associated with postoperative seroma have been inadequately described. FINDINGS: A 15-year-old female experienced inadvertent durotomy during pinal deformity correction surgery for idiopathic adolescent scoliosis. Despite immediate decompressive laminectomy, she developed complete loss of motor and sensory function with neurological level of injury at T10 immediately following the surgery. Urgent magnetic resonance imaging revealed cord compression due to seroma. Decompressive surgery was performed 48 h later and timely intensive rehabilitation was provided for 3 months, which included the use of robotic-assisted gait training (RAGT) to maximize neurological recovery. She demonstrated impressive improvement from grade A to D on the American Spinal Injury Association Impairment Scale and regained functional ambulation over the 3-month period. We describe a comprehensive rehabilitation program to manage SCI associated with postoperative seroma, entailing the use of a robotic gait device for locomotor training. The progression of the patient's neurological status and functional outcomes was documented accordingly. CONCLUSION/CLINICAL RELEVANCE: Complete SCI due to seroma, a surgical complication of corrective scoliosis surgery, is rare. However, prompt postoperative examination should be performed routinely in anticipation of neurological deterioration. Early rehabilitation comprising of gait re-training and the use of RAGT might enhance the lower-limb motor strength and functional recovery.

Ultrasound-guided Genicular Nerve Blockade With Pharmacological Agents for Chronic Knee Osteoarthritis: A Systematic Review.

BACKGROUND: Ultrasound-guided (ULSD-g) genicular nerve blocks (GNB) using pharmacological agents for pain control in chronic knee osteoarthritis (OA) are gaining in popularity. There lacks a systematic review to evaluate the ULSD techniques and pharmacological agents used during the intervention, and to assess the knee's function postintervention. OBJECTIVES: Our study aimed to determine the clinical characteristics of patients with chronic knee OA selected for ULSD-g GNB, describe the various ULSD-g techniques and pharmacological agents used to target the genicular nerves, and evaluate the primary outcomes of pain and function. STUDY DESIGN: Systematic review. METHODS: We looked at patients with chronic knee OA with symptoms or disease features of at least 3 months and the use of ULSD guidance for GNB using either local anesthetic agents and/or corticosteroids or alcohol. Two major electronic databases (Medline/PubMed and EMBASE) were searched from their inception through August 2021, without language restriction.After removing duplicates, 2 reviewers independently reviewed the abstracts of 340 records. Nine of the 10 full texts that were reviewed were selected for inclusion. A third reviewer was involved in resolving disagreements.Two reviewers extracted relevant information pertaining to study types, patient characteristics, intervention details, outcome measures, and adverse effects. This was followed by independent verification for accuracy. RESULTS: Data synthesis: Nine studies were included with a total of 280 patients who had symptoms or disease features of at least 3 months. The National Institute of Health's Study Quality Assessment Tools were used for quality appraisal, of which 8 studies were at least of fair quality. All studies involved targeted at least the superior medial, superior lateral, and inferior medial genicular nerves. ULSD techniques relied on bony, soft tissue, or periarterial landmarks; either local anesthetic agents and/or corticosteroids or alcohol were used in the injections. Follow-up intervals for pain and functional assessments were heterogeneous, ranging from one week to 6 months postprocedure. Sustained improvements in both pain and knee function were observed for up to 6 months regardless of the choice of pharmacological agents. Minimal adverse effects were reported. LIMITATIONS: Meta-analysis was not performed due to heterogeneity of study designs, ULSD techniques, pharmacological agents used, and dosages administered. Only one study targeted additional genicular nerves; conclusions regarding the therapeutic blockade of these nerves could not be made. CONCLUSIONS: There is fair evidence to at least target the superior medial genicular nerve, inferior medial genicular nerve, and Inferior medial genicular nerve using local anesthetics, corticosteroids, or alcohol to reduce pain and to improve knee function in patients with chronic knee OA under ULSD guidance. The procedure is safe but more research is needed to determine the optimal interventional approach.

Hydrodissection for Carpal Tunnel Syndrome: A Systematic Review.

ABSTRACT: Hydrodissection is an ultrasound-guided technique that has received more attention recently for its role in nerve entrapment syndromes. The purposes of this systematic review were to evaluate the safety and effectiveness of hydrodissection in carpal tunnel syndrome and to investigate the ideal parameters for injectate type, dosage, volume, and frequency; injection approach and technique; as well as operator experience and training required. We searched the Embase, MEDLINE, and PubMed databases with supplemental searches in the CINAHL, Web of Science, and Google Scholar databases for relevant randomized controlled trials. Primary outcome measures were adverse outcomes and clinical effectiveness. Six randomized controlled trials involving 356 wrists were included. All studies used ultrasound guidance in their interventions. No safety-related adverse outcomes were found, although not all studies declared this. Only one study was placebo controlled and revealed symptomatic as well as functional improvements at 6 mos, whereas the rest investigated hydrodissection with different injectate types. We concluded that nerve hydrodissection for carpal tunnel syndrome can be safely performed under ultrasound guidance. However, it is unclear whether the hydrodissection mechanism truly causes improvements in clinical outcomes. We were also unable to draw conclusions regarding the ideal procedure-related parameters. We recommend that future work should not only investigate safety and clinical effectiveness but also attempt to clarify the ideal procedure-related parameters.

Effectiveness of Adjunct Robotic Therapy With a Patient-Guided Suspension System for Stroke Rehabilitation Using a 7-Days-a-Week Model of Care: A Comparison With Conventional Rehabilitation.

OBJECTIVE: To determine and compare the effectiveness of robotic therapy with a patient-guided suspension system for stroke rehabilitation using a 7-days-a-week model of care with that of conventional rehabilitation. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation unit of an acute general hospital. PARTICIPANTS: A total of 100 consecutive patients with stroke (N=100) admitted within a 7-month period who fulfilled the criteria to undergo robotic therapy with a patient-guided suspension system were enrolled in this study. INTERVENTIONS: Patients either underwent robotic therapy in addition to conventional therapy (robotic group) or conventional therapy only (control group). There were 50 patients in each cohort. MAIN OUTCOME MEASURES: FIM and its derivatives (FIM gain and FIM efficiency); Berg Balance Scale (BBS), functional ambulation category (FAC); modified Rankin Scale (mRS); and National Institutes of Health Stroke Scale. RESULTS: The average FIM gains in both groups were statistically significant (P<.01). The robotic group had greater improvement in FAC scores (1.24 vs 0.78, P=.007). However, other measurements such as FIM efficiency, BBS, and mRS were not significantly different between the 2 groups. The robotics group reported high patient satisfaction rates, with most patients finding the intervention both beneficial and desirable. CONCLUSIONS: Adjunct robotic therapy has the potential to increase the efficacy of stroke rehabilitation. However, further studies are needed to strengthen the evidence.

Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis.

OBJECTIVE: To summarize the evidence for dextrose prolotherapy in knee osteoarthritis. DATA SOURCES: The authors searched PubMed and Embase from inception to September 2020. All publications in the English language were included without demographic limits. STUDY SELECTION: Randomized clinical trials comparing the effects of any active interventions or placebo versus dextrose prolotherapy in patients with knee osteoarthritis were included. DATA EXTRACTION: Potential articles were screened for eligibility, and data was extracted independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was performed on clinical trials with similar parameters. The Strength of Recommendation Taxonomy (SORT) was used for evaluating the strength of recommendations. DATA SYNTHESIS: In total, eleven articles (n = 837 patients) met the search criteria and were included. The risk-of-bias analysis revealed two studies to be of low risk. The overall effectiveness was calculated using a meta-analysis method. Prolotherapy was no different from platelet-rich plasma on the pain subscale at the 6-month time point. Prolotherapy was inferior to platelet-rich plasma at 6 months (MD 0.45, 95% CI 0.06-0.85, p = 0.03) on the stiffness subscale. Prolotherapy was found to be safe with no major adverse effects. CONCLUSION: Prolotherapy in knee osteoarthritis confers potential benefits for pain but the studies are at high risk of bias. Based on two well-designed studies, dextrose prolotherapy may be considered in knee osteoarthritis (strength of recommendation B). This treatment is safe and may be considered in patients with limited alternative options (strength of recommendation C).