No Difference in Muscle Basal Oxygenation in a Bedridden Population Pre and Post Rehabilitation.

Long periods of bed rest for elderly population, due to a femur fracture event, can cause a deterioration in the muscular capacity. Therefore, monitoring of the muscle oxidative capacity in this fragile population is necessary to define the muscular oxidative metabolism state before and after a rehabilitation period. The time-domain near-infrared spectroscopy (TD-NIRS) technique enables the absolute values to be calculated for hemodynamic parameters such as oxy- (O2Hb), deoxy- (HHb), total- (tHb) haemoglobin, and tissue oxygen saturation (SO2) of the muscular tissue. In this work, we have characterized vastus lateralis muscle hemodynamics during a baseline period at two different time points: after the surgery (PRE) and after 15 days of rehabilitation (POST). The mean values for the absolute values of the hemodynamic parameters were: O2Hb_PRE = 49.1 ± 14.1 µM; O2Hb_POST = 47.1 ± 13.4 µM; HHb_PRE = 28.3 ± 10.3 µM; HHb_POST = 26.7 ± 9.9 µM; tHb_PRE = 77.3 ± 23.6 µM; tHb_POST = 73.8 ± 21.4 µM; SO2_PRE = 63.9 ± 4.0% and SO2_POST = 64.9 ± 5.6%. The hemodynamic parameters did not show significant differences at both group and single subject level. These results suggest that for this kind of population, the baseline of the hemodynamic parameters is not the best one to consider to assess the rehabilitation progresses in terms of muscular oxidative metabolism.

A bio-psycho-social approach in elderly population: outcome of adapted physical activity in patients with osteoarthritis.

BACKGROUND: The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. OBJECTIVE: The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. METHODS: The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). RESULTS: A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. CONCLUSIONS: These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.

Anaesthesia management in patients with multiple chemical sensitivity syndrome.

Multiple Chemical Sensitivity (MCS) is characterised by the appearance of numerous and sometimes severe symptoms, when subjects are in contact with various chemicals and medicinal substances. Currently there are no useful guidelines for managing clinical issues and, specifically, anaesthesia for patients with MCS. This case report describes anaesthesia management in a patient affected by clinically documented MCS and a latex allergy, a candidate for a laparoscopic cholecystectomy operation.

Predicting the need for institutional care shortly after admission to rehabilitation: Rasch analysis and predictive validity of the BRASS Index.

BACKGROUND: Effective discharge planning is increasingly recognised as a critical component of hospital-based Rehabilitation. The BRASS index is a risk screening tool for identification, shortly after hospital admission, of patients who are at risk of post-discharge problems. AIM: To evaluate the internal construct validity and reliability of the Blaylock Risk Assessment Screening Score (BRASS) within the rehabilitation setting. DESIGN: Observational prospective study. SETTING: Rehabilitation ward of an Italian district hospital. POPULATION: One hundred and four consecutively admitted patients. METHODS: Using classical psychometric methods and Rasch analysis (RA), the internal construct validity and reliability of the BRASS were examined. Also, external and predictive validity of the Rasch-modified BRASS (RMB) score were determined. RESULTS: Reliability of the original BRASS was low (Cronbach's alpha=0.595) and factor analyses showed that it was clearly multidimensional. A RA, based on a reduced 7-BRASS item set (RMB), satisfied model's expectations. Reliability was 0.777. The RMB scores strongly correlated with the original BRASS (rho=0.952; P<0.000) and with FIM™ admission scores (rho=-0.853; P<0.000). A RMB score of 12 was associated with an increased risk of nursing home admission (RR=2.1, 95%CI=1.7-2.5), whereas a score of 17 was associated to a higher risk of length of stay >28 days (RR=7.6, 95%CI=1.8-31.9). CONCLUSION: This study demonstrated that the original BRASS was multidimensional and unreliable. However, the RMB holds adequate internal construct validity and is sufficiently reliable as a predictor of discharge problems for group, but not individual use. CLINICAL REHABILITATION IMPACT: The application of tools and methods (such as the BRASS Index) developed under the biomedical paradigm in a Physical and Rehabilitation Medicine setting may have limitations. Further research is needed to develop, within the rehabilitation setting, a valid measuring tool of risk of post-discharge problems at the individual level.

Association of hemoglobin levels, acute hemoglobin decrease and age with Rehabilitation outcomes after total hip and knee replacement.

AIM: A previous retrospective study suggested that an anemia prevention may shorten hospitalization and improve recovery, stating the usefulness of a proper therapy for preventing anemization, in order to get a better functional recovery and reduce hospitalization length. The present study analyzed the association of preoperative and postoperative hemoglobin levels with rehabilitation outcomes to check these results in the Rehabilitation Unit. METHODS: The study enrolled 104 patients, 94 underwent hip replacement surgery and 10 knee replacement. Patients were functionally studied through the six-meter walking test (6MWT) at admittance and at discharge from the Rehabilitation Unit. RESULTS: Preoperative hemoglobin has no correlation either with the results of WT executed at discharge nor with the improvement of it compared to the WT executed at admittance, while there is a significant relationship with the results of the WT executed at admittance. Age impacts on the result of 6MWT at admittance, on the one at discharge and on the improvement as well. CONCLUSIONS: Despite movement weakening by anemization due to surgery, patients transferred to the Rehabilitation Unit after total hip- and knee replacement, are able to get a better movement performance independently on hemoglobin loss.

Planning the provision of outpatient services in a rehabilitation clinic.

OBJECTIVE: This study had two aims: (1) to plan the provision of outpatient services in a rehabilitation clinic and increase the efficiency of these services; (2) to identify and evaluate criteria of good clinical practice in outpatient rehabilitation activities in order to avoid transforming the therapy into an assembly line in which the number of services is considered more important than the quality of services delivered. DESIGN: The authors identified the sequence of activities carried out for each of the services requested and monitored the number of appointments and treatments performed in two four month periods. As part of the process of increasing delivery efficiency and recording services provided, the authors created a computerised database for processing hospital charges. MAIN MEASURES: Quantitative comparison of services delivered during the 4 month sample periods in 1998 and 1999 and evaluation of compliance with identified indicators of good practice related to a series of rehabilitation outpatient therapies, divided into instrumental therapies and manual therapies. RESULTS: There was an increase in the number of appointments and services without an increase in the number of staff or clinics. In particular, the database introduced in March 1999 contributed to a further improvement with 692 appointments and 7517 therapies. Overall quality of practice was good, although privacy needs to be increased. CONCLUSION: The use of quality control instruments improved staff awareness of good clinical practice and highlighted some aspects which could be improved. The efficiency of the outpatient rehabilitation clinic increased.

Measurement on Tinetti test: instrumentation and procedures.

A measurement system and associate signal processing procedures for quantifying subject's performance during the performance-oriented assessment of balance as defined in Tinetti test (TT) is described. It is based on two inclinometers measuring trunk inclination in two orthogonal planes. Signals from the transducers are acquired by a PC through A/DC board. Signal processing consists in computing morphological parameters describing the main features of subject movement during the different TT maneuvers. The system is simple, cheap, user friendly, causes no discomfort to the patient and can easily be modified to comply with either new requirements or the needs of other performance tests dealing with trunk movement. Preliminary results of measurements on both normals and patients suggest the viability of this approach and the possibility of discriminating normal from abnormal performance, based on the values of the morphological parameters.

Instrumental and metabolic evaluation of patients affected by peripheral arterial occlusive disease (PAOD) following surgical revascularization surgery.

Experiments were performed on eight subjects affected by peripheral arterial occlusive disease (PAOD) of the lower limbs. Each patient was submitted to Ecodoppler, angiography and the "Treadmill test". Two bioptic muscle of these patients. A sample was used for the spectrophotometric and spectrophotofluorimetric determinations of: glycogen, pyruvate, lactate, citrate, alpha-ketoglutarate, malate, aspartate, glutamate, AMP, ADP, ATP and creatine phosphate (CP). The other bioptic sample was used to determine the following enzyme activities: hexokinase, phosphofructokinase, pyruvate kinase, lactate dehydrogenase, citrate synthase, succinate dehydrogenase, malate dehydrogenase, total NADH cytochrome c reductase, cytochrome oxidase, aspartate aminotransferase and alanine aminotransferase. Patients showed an increase in lactate dehydrogenase, total NADH cytochrome c reductase and succinate dehydrogenase activities, a decrease in glycogen, ATP and CP concentrations. Telethermographic data showed patient muscle thermic emission quantitatively different from control group. The telethermographic test can be used as an additional diagnostic tool to determine and monitor the efficiency of a muscle undergoing metabolic failure.

The effects of perioperative ketorolac infusion on postoperative pain and endocrine-metabolic response.

We designed a randomized, double-blind study to assess the analgesic efficacy and safety of perioperative ketorolac infusion in 95 patients undergoing cholecystectomy. The ketorolac group (n = 48) received premedication, combined with ketorolac 30 mg intramuscularly (IM), followed by a ketorolac continuous infusion (2 mg/h). The control group (n = 47) received an IM bolus of NaCl 0.9% (1 mL) followed by continuous saline infusion (2 mL/h) for 24 h. Operative blood losses, postoperative pain, sedation, and on-demand morphine consumption (patient-controlled analgesia [PCA]) were measured. The effects on plasma catecholamines, cortisol, potassium, creatinine, skin bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT) were also evaluated. Ketorolac improved pain scores (P < 0.05) and reduced plasma cortisol concentrations between 2 and 6 h (P < 0.05). No significant differences were observed concerning operative blood losses, glucose concentration, and renal and hemostatic functions. The ketorolac group required less morphine (not significant [NS]) than the control group and had less adverse effects (P = 0.002). Thus, perioperative ketorolac infusion improved the quality of postoperative pain relief, and had no major influence on endocrine-metabolic response and no negative influences on hemostatic and renal functions. This study suggests that preventive ketorolac administration, followed by a continuous infusion, is an easy, useful, and safe method for pain control after abdominal surgery.

Power output during knee extension/flexion movement performed in controlled mechanical conditions.

In order to investigate how exercise, performed under controlled mechanical conditions, might be influenced by variables such as fatigue and immobilization, a computerized transducer system was specially built. Quadriceps femoris and knee flexors were studied in healthy non-athlete and post-meniscal surgery subjects, by means of an isokinetic extension-flexion protocol. The protocol was applied before and after cycloergometer "fatiguing" effort in the healthy subjects and before and after re-training in the surgical ones. An original software was able to display the time course of dynamic parameters, particularly force, velocity and power output. Results obtained showed a 26.5% significant decrease in power output after the effort, owing to a concomitant decrease in velocity, while force increased, but over a longer time. As to the operated subjects, power output was higher following retraining, as a result of the combination of lower force and higher velocity. The transducer system proved reliable in detecting changes in power output, whatever the cause. The instantaneous control of variables which power is depending upon, such as force and velocity, may give a few hints on the efficacy of training and rehabilitation programs.

[Evaluation of force, velocity and power during muscular exercise]. / Valutazione dei parametri di forza, velocità e potenza in corso di esercizio muscolare.

Authors propose an original method for studying muscular hypotrophy considering mechanical output. Tests was performed on femoral quadriceps in order to have standardized parameters about work of normal, pathologic and retrained muscle.

[Fatigue during muscle work at variable traction angles]. / Affaticamento in corso di lavoro muscolare ad angoli di trazione variabili.

Using computerized surface EMG signal analysis, authors point out that muscle fatigue onset depends not only by exercise frequency and external load but also by mechanical arrangement of muscle insertions and this onset is faster if contraction is concentric. Therefore selective muscle training programs must contemplate this phenomenon.