Molassiotis A.,University of Manchester |
Molassiotis A.,Hong Kong Polytechnic University |
Bardy J.,University of Manchester |
Finnegan-John J.,King's College London |
And 6 more authors.
Annals of Oncology | Year: 2013
Background: Maintenance acupuncture is advocated by clinicians after successful clinic-based acupuncture. We aimed to assess the effectiveness of maintenance acupuncture in the management of cancer-related fatigue (CRF); treatment delivered by therapists or self-acupuncture/self-needling was compared with no maintenance treatment. Methods: Breast cancer patients who participated in a randomized trial of acupuncture for CRF management (reported elsewhere) were re-randomized to receive an additional four acupuncturist-delivered weekly sessions; four self-administered weekly acupuncture sessions (self-needling); or no acupuncture. Primary outcome was general fatigue (Multidimensional Fatigue Inventory). Mood, quality of life and safety were also assessed. Results: In total, 197 patients were re-randomized, with 65 to therapist-delivered sessions, 67 to self-acupuncture/ self-needling and 65 to no further acupuncture. Primary outcome scores were equivalent between the therapistdelivered acupuncture and self-acupuncture (P > 0.05). A non-significant trend in improving fatigue was observed at the end of 4 weeks in the combined acupuncture arms (P = 0.07). There was no impact on mood or quality of life of the further acupuncture sessions at 18 weeks beyond the improvement observed in initial trial. Conclusion: Self-acupuncture is an acceptable, feasible and safe maintenance treatment for patients with CRF. However, overall, maintenance acupuncture did not yield important improvements beyond those observed after an initial clinic-based course of acupuncture. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Saverino A.,Rehabilitation Unit
Clinical Journal of Pain | Year: 2012
INTRODUCTION: Pain is a common symptom in patients with multiple sclerosis (MS) and it is thought to be the result of a mixture of neuropathic and nociceptive pain. Different elements of pain need to be recognized and treated differently, but a clinical tool to classify these components still remains to be defined. AIM: The aim of our study was to evaluate subjective feeling of pain in people with MS, including pain quality description and pain impact in daily functioning. We also investigated which descriptors are related to nociceptive pain and which to neuropathic pain. Finally, we explored if there are differences between the descriptors spontaneously used by individuals with MS and the ones included in the McGill Pain Questionnaire (MGPQ). METHODS: We used focus group (FG) of discussion to collect participants' opinion about their pain. We organized 2 FGs for persons with MS. We also gathered 2 FGs of individuals who had a recent knee arthroplasty, suffering a pure nociceptive pain, and 2 FGs of individuals with post-herpetic neuralgia, suffering a pure neuropathic pain, to compare their experience with the one of the people with MS. RESULTS: Original spontaneous descriptors emerged in all the groups. People with MS in particular used various symbolic descriptors to express their pain's quality and underlined the high impact of pain on their lives. The use of specific descriptors for neuropathic and nociceptive pain in the different groups did not appear easily definable. Finally, pain descriptors used during FG appeared to be different than the ones included in the MGPQ. CONCLUSIONS: Original spontaneous descriptors, possibly pathology-specific, emerged in all groups not included in the MGPQ and pointed out the need to use assessment tools based on people experience. © 2012 Lippincott Williams & Wilkins, Inc.
Welin L.,Lidkoping Hospital |
Bjalkefur K.,Rehabilitation Unit |
Roland I.,Lidkoping Hospital
Stroke | Year: 2010
Background and purpose: Although care in stroke units has improved outcome in stroke patients, it is less clear whether specialized outpatient care after stroke can further improve the prognosis. We therefore conducted a pilot study comparing specialized long-term care with usual care after a first stroke. Methods: During a 2-year period, 549 patients were discharged alive from our stroke unit. Eighty-one patients were randomized to follow-up care at the stroke outpatient clinic (intervention group), and 82 patients were randomized to follow-up care with their general practitioner (control group). Results: No differences in baseline variables were noted between the 2 groups. At the 12-month visit, there were no significant differences between the groups with respect to handicap, depression, and perceived health. During 3.5 years of follow-up, no differences in mortality, stroke recurrence rate, and unplanned hospitalizations were observed between the groups. Conclusions: In this small pilot study, specialized follow-up service for stroke patients was not superior to "usual care.". Copyright © 2010 American Heart Association. All rights reserved.
Brock K.,Rehabilitation Unit |
Haase G.,Kliniken Schmieder Gailingen |
Rothacher G.,Kliniken Schmieder Gailingen |
Cotton S.,University of Melbourne
Clinical Rehabilitation | Year: 2011
Objective: To compare the short-term effects of two physiotherapy approaches for improving ability to walk in different environments following stroke: (i) interventions based on the Bobath concept, in conjunction with task practice, compared to (ii) structured task practice alone.Design: Randomized controlled trial.Setting: Two rehabilitation centresParticipants: Twenty-six participants between four and 20 weeks post-stroke, able to walk with supervision indoors.Interventions: Both groups received six one-hour physiotherapy sessions over a two-week period. One group received physiotherapy based on the Bobath concept, including one hour of structured task practice. The other group received six hours of structured task practice.Outcome measures: The primary outcome was an adapted six-minute walk test, incorporating a step, ramp and uneven surface. Secondary measures were gait velocity and the Berg Balance Scale. Measures were assessed before and after the intervention period.Results: Following the intervention, there was no significant difference in improvement between the two groups for the adapted six-minute walk test (89.9 (standard deviation (SD) 73.1) m Bobath versus 41 (40.7) m task practice, P=0.07). However, walking velocity showed significantly greater increases in the Bobath group (26.2 (SD 17.2) m/min versus 9.9 (SD=12.9) m/min, P=0.01). No significant differences between groups were recorded for the Berg Balance Scale (P=0.2).Conclusion: This pilot study indicates short-term benefit for using interventions based on the Bobath concept for improving walking velocity in people with stroke. A sample size of 32 participants per group is required for a definitive study. © The Author(s) 2011.
Takala J.H.,University of Helsinki |
Kautiainen H.,Central Finland Central Hospital |
Kautiainen H.,Rehabilitation Unit |
Leirisalo-Repo M.,University of Helsinki
Scandinavian Journal of Rheumatology | Year: 2010
Objective: To determine the survival of and contributing factors in patients diagnosed with Wegener's granulomatosis (WG) between 1981 and 2000 in Finland. Methods: A retrospective cohort study using hospital discharge registers with a review of hospital case records. Analysis of causes of death in Finland up to 30 July 2005. Results: A total of 492 patients received a verified diagnosis of WG between 1981 and 2000. Of these, 203 died before the end of June 2005. The overall 1-year survival rate was 83.3% and the 5-year survival rate was 74.2%. The standardized mortality ratio (SMR) for all WG patients was 3.43 [95% confidence interval (CI) 2.983.94], for women 4.38 (95% CI 3.595.61) and for men 2.80 (95% CI 2.283.41). The most frequent causes of death were WG or another connective tissue disease, cardiovascular events and neoplasms. The prognosis did not change markedly over the 20-year period. Older age and elevated creatinine level at presentation were associated with poorer prognosis, whereas primary ear, nose, and throat (ENT) involvement and prompt treatment with cyclophosphamide predicted longer survival. Conclusions: WG patients had increased mortality compared with the rest of the population. Older age and elevated creatinine level at diagnosis predicted poor prognosis, but ENT involvement initially and cyclophosphamide treatment resulted in a better outcome. © 2010 Informa UK Ltd.
Allen M.D.,Brigham Young University |
Owens T.E.,Brigham Young University |
Fong A.K.,Rehabilitation Unit |
Richards D.R.,Brigham Young University
Behavioural Neurology | Year: 2011
Recent progress has been made using fMRI as a clinical assessment tool, often employing analogues of traditional "paper and pencil" tests. The Trail Making Test (TMT), popular for years as a neuropsychological exam, has been largely ignored in the realm of neuroimaging, most likely because its physical format and administration does not lend itself to straightforward adaptation as an fMRI paradigm. Likewise, there is relatively more ambiguity about the neural systems associated with this test than many other tests of comparable clinical use. In this study, we describe an fMRI version of Trail Making Test-B (TMTB) that maintains the core functionality of the TMT while optimizing its use for both research and clinical settings. Subjects (N=32) were administered the Functional Trail Making Test-B (f-TMTB). Brain region activations elicited by the f-TMTB were consistent with expectations given by prior TMT neurophysiological studies, including significant activations in the ventral and dorsal visual pathways and the medial pre-supplementary motor area. The f-TMTB was further evaluated for concurrent validity with the traditional TMTB using an additional sample of control subjects (N=100). Together, these results support the f-TMTB as a viable neuroimaging adaptation of the TMT that is optimized to evoke maximally robust fMRI activation with minimal time and equipment requirements. © 2011 - IOS Press and the authors. All rights reserved.
Johannesson E.,Gothenburg University |
Ringstrom G.,Rehabilitation Unit |
Abrahamsson H.,Gothenburg University |
Sadik R.,Rehabilitation Unit
World Journal of Gastroenterology | Year: 2015
AIM: To assess the long-term effects of physical activity on irritable bowel syndrome (IBS) symptoms and on quality of life, fatigue, depression and anxiety. METHODS: Seventy-six patients from a previous randomized controlled interventional study on increased physical activity in IBS were asked to participate in this long-term follow-up study. The included patients attended one visit in which they filled out questionnaires and they underwent a submaximal cycle ergometer test. The primary end point was the change in the IBS Severity Scoring System (IBS-SSS) at baseline, i.e. , before the intervention and at follow-up. The secondary endpoints were changes in quality of life, fatigue, depression and anxiety. RESULTS: A total of 39 [32 women, median age 45 (28-61) years] patients were included in this followup. Median follow-up time was 5.2 (range: 3.8-6.2) years. The IBS symptoms were improved compared with baseline [IBS-SSS: 276 (169-360) vs 218 (82-328), P = 0.001]. This was also true for the majority of the dimensions of psychological symptoms such as disease specific quality of life, fatigue, depression and anxiety. The reported time of physical activity during the week before the visit had increased from 3.2 (0.0-10.0) h at baseline to 5.2 (0.0-15.0) h at follow-up, P = 0.019. The most common activities reported were walking, aerobics and cycling. There was no significant difference in the oxygen uptake 31.8 (19.7-45.8) mL per min per kg at baseline vs 34.6 (19.0-54.6) mL/min per kg at follow-up. CONCLUSION: An intervention to increase physical activity has positive long-term effects on IBS symptoms and psychological symptoms.. © 2015 Baishideng Publishing Group Inc. All rights reserved.
Bianchi C.,Rehabilitation Unit |
Baiardi P.,Valutazioni Biologiche e Farmacologiche |
Khirani S.,Fondazione IRCCS caGranda Ospedale Maggiore Policlinico |
Cantarella G.,Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico
American Journal of Physical Medicine and Rehabilitation | Year: 2012
OBJECTIVE: The aim of this study was to ascertain whether an objective cough measure relates to the risk of pulmonary complications in dysphagic patients with persistent tracheobronchial aspiration. DESIGN: This is a retrospective observational study involving 55 dysphagic patients who underwent a modified barium swallow study and pulmonary function tests including cough peak flow measurement. The results were compared between subjects with and without pulmonary complications because of aspiration. RESULTS: The 18 patients (33%) with pulmonary complications had significantly lower mean cough peak flow values (202.2 ± 68.8 vs. 303.9 ± 80.7 liters/min; P < 0.001) than those without pulmonary complications. The finding of tracheobronchial coating in a modified barium swallow was not related to the occurrence of pulmonary morbidity. Receiver operating characteristic curve analysis showed that a CPF level lower than 242 liters/min predicted the development of pulmonary complications with a sensitivity of 77% and a specificity of 83%; the positive and negative predictive values were 65% and 90%, respectively. CONCLUSIONS: Our findings indicate that cough peak flow is a valuable predictor of respiratory prognosis in chronic aspiration. This finding suggests a new rehabilitation strategy aimed at improving cough flows for dysphagic patients. Copyright © 2012 Lippincott Williams & Wilkins.
Chiappedi M.,Rehabilitation Unit
Italian journal of pediatrics | Year: 2010
Corpus callosum agenesis is a relatively common brain malformation. It can be isolated or included in a complex alteration of brain (or sometimes even whole body) morphology. It has been associated with a number of neuropsychiatric disorders, from subtle neuropsychological deficits to Pervasive Developmental Disorders.Etiology and pathogenetic mechanisms have been better understood in recent years, due to the availability of more adequate animal models and the relevant progresses in developmental neurosciences. These recent findings are reviewed (through a MedLine search including papers published in the last 5 years and most relevant previously published papers) in view of the potential impact on children's global functioning and on the possible rehabilitative treatment, with an emphasis on the possibility to exploit brain plasticity and on the use of the ICF-CY framework.
Saverino A.,National Hospital of Neurology and Neurosurgery |
Saverino A.,Rehabilitation Unit |
Moriarty A.,National Hospital of Neurology and Neurosurgery |
Playford D.,National Hospital of Neurology and Neurosurgery
Disability and Rehabilitation | Year: 2014
Purpose: To review systematically the literature on fall risk factors for young patients affected by neurological disorders. Method: A systematic search of all primary research-based literature on risk factors for falls or fall characteristics in young adults (mean age <55 years) published prior to July 2012 was conducted using 11 databases. Studies that focused on fall risk screening tools, fear of falling or interventions for fall prevention were excluded. Two reviewers independently agreed on eligibility and methodological quality and extracted data. Results: Twenty-three final studies were selected, including 21 observational studies; one randomised controlled trial and one qualitative study. An average of 50.2% of the 2776 total participants experienced at least one fall. Among the multiple risk factors studied, a reduced performance in balance and gait was consistently associated with falls, while the contribution of single physical and cognitive impairments was variable in different populations. Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors. The heterogeneity of the assessment tools used to measure risk factors limited comparison across studies. Conclusion: Falling is a common problem among young patients affected by neurological disorders, although the risk of falling for a specific individual is difficult to predict and the risk of a severe fall-related injury has not yet been established.Implications for RehabilitationYoung patients with impaired gait and balance or medium to severe motor disability appear to be at increased risk of falling.Patients who are relatively independent and still participating in challenging activities have an increased exposure to fall-risk.Walking aids, wheelchair characteristics and environmental hazards are significant environmental risk factors.These risk factors should be monitored closely in the young neurological population to help prevent falls. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.