Physical Medicine & Rehabilitation

Epidural injection for the treatment of lumbar discal cyst related-sciatica: a case report No abstract available

OUTCOMES OF ACUTE INPATIENT REHABILITATION AFTER VENTRICULAR ASSIST DEVICE PLACEMENT Objective To compare outcomes of inpatient rehabilitation after ventricular assist device (VAD) placement with outcomes for other cardiac diagnoses. Design This was a retrospective review of the electronic health records of 265 patients admitted to inpatient rehabilitation: 166 patients were admitted after VAD placement and 99 were admitted for other cardiac disease. Data collected included functional independence measure (FIM) score on admission and discharge, dates of admission and discharge, and disposition. Results Patients admitted after VAD placement had a mean FIM gain of 25.7 and length of stay (LOS) of 8.7 days. Patients admitted for other cardiac diagnoses had a mean FIM gain of 25.9 and LOS of 9.4 days. These differences were not statistically significant. Change in FIM from admission to discharge was statistically significant within each group (P<.001). Most patients were discharged home, and the proportions who returned to acute care or home were not different between groups. Conclusions Both the VAD and non-VAD groups had significant and equivalent improvements in functional outcomes after inpatient rehabilitation. This study found that VAD patients benefit from inpatient rehabilitation with similar disposition rates as patients with other cardiac diagnoses. Inpatient rehabilitation is the appropriate setting for this group. Please address correspondence to: Shelby E. Johnson, MD, Mayo Clinic, Department of Physical Medicine and Rehabilitation, 200 First St SW, Rochester, MN 55905. Phone: 507-266-8913. Fax: 507-284-3431. Email: Johnson.shelby@mayo.edu This material has been presented at the 2018 American Academy of Physical Medicine and Rehabilitation Annual Assembly held in Orlando, Florida from October 25th- 28th, 2018. No funding was required for this project. The authors have no competing interests or financial benefits to declare. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

The functional impact of the absence of a bulbocavernosus reflex in the postoperative period following a motor-complete traumatic spinal cord injury Objective To investigate the impact of the absence of a bulbocavernosus reflex (BCR) in the postoperative period on the neurological and functional recovery 6 to 12 months following a motor-complete traumatic spinal cord injury (TSCI). Design A retrospective review of a prospective database was completed among 66 patients. The functional and neurological statuses between individuals with and without a BCR were compared. A general linear model was used to investigate the association between the postoperative BCR status and the functional outcome, using the Spinal Cord Independence Measure (SCIM-III). Results 40% of the cohort had no BCR 5 days post-trauma. Individuals with a BCR showed a higher rate of AIS grade conversion, improvement of the level of injury and higher functional scores, however it did not reach a significant level. The BCR status in the postoperative period was not significantly associated with the functional status 6- to 12- months post-injury. Conclusion Late recovery of the BCR in the postoperative period may be associated with poorer neurological and functional outcome for individuals sustaining a motor-complete TSCI, for which the prognosis estimation is limited. A prospective study including a larger number of patients is necessary to confirm results of this study. Corresponding author: Andréane Richard-Denis, MD, MSc, Research center, Hopital du Sacré-Cœur de Montréal, Department of physical medicine and rehabilitation, 5400 Gouin ouest, Montréal, Qc, Canada, H4J 1C5. Tel : 514-338-2222 ext. 2050; Fax: 514-338-3661; email : andreane.rdenis@gmail.com Author disclosure: This research was funded by the Fonds de Recherche Québec-Santé (Traumatology Research Consortium), and part of the data was collected through the Rick Hansen Spinal Cord Injury Registry. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Short-Term Outcome Predictors in Patients with Primary Adhesive Capsulitis Treated with Ultrasound-Guided Hydrodilatation and Corticosteroids Objective Glenohumeral joint hydrodilatation with corticosteroids has been proposed as an effective secondary therapeutic procedure for primary adhesive capsulitis (AC). However, little is known about which subgroup of patients would benefit from this procedure. This study aimed to identify covariates associated with improved prognosis in patients receiving ultrasound-guided hydrodilatation with corticosteroid injection. Design This was a cohort study. Data on baseline demographic characteristics, disease status, past medical conditions, and initial ultrasonographic findings were collected. Linear and logistic regression analyses were performed to determine the prognostic factors associated with better clinical outcomes. Results Fifty-three patients (54 shoulders) were included. Linear regression analysis showed that coracohumeral ligament (CHL) thickness <3 mm, use of analgesics before hydrodilatation, and female sex were associated with good improvement in the Shoulder Pain and Disability Index (SPADI) score. Multivariate logistic regression analysis showed that CHL thickness <3 mm on ultrasound was associated with a strong tendency (p=0.054) of reaching the minimal detectable change. Additionally, capsule rupture did not play a role in determining the clinical efficacy of hydrodilatation. Conclusion In patients with primary AC, CHL thickness <3 mm is correlated with greater short-term improvement in the SPADI score after ultrasound-guided hydrodilatation with steroid injection is performed. Corresponding Author: Jia-Chi Wang M.D., Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, E-mail: jcwang0726@gmail.com Phone number: +886 28712121 Author Disclosures: The study was funded by Taipei Veterans General Hospital (V106B-017), and the authors declare that there is no conflict of interest. This manuscript has not been published or presented elsewhere in part or in entirety and is not under consideration by another journal. All study participants provided informed consent, and the study design was approved by the appropriate ethics review board. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Correlation between D-dimer level and deep venous thrombosis in patients with acute spinal cord injuries Objective Venous thromboembolism is a serious life-threatening complication of spinal cord injury (SCI). Measurement of D-dimer levels is used as a screening test for deep vein thrombosis (DVT). However, trauma, surgery, and motor weakness are known as factors that affect D-dimer levels. Thus, the aim of this study was to examine the correlation between D-dimer levels and DVT in relation to the comorbidities in acute SCI. Design A retrospective observational study was conducted at a hospital’s rehabilitation department. Forty-five patients without pharmacologic thromboembolic thromboprophylaxis 5−90 days after the onset of injury were enrolled. Results Fourteen patients (31%) were diagnosed with DVT using duplex ultrasonography. The mean D-dimer levels were 2.15±2.74 and 6.98±7.46 μg/ml in the DVT-negative and DVT-positive groups, respectively. The lower extremity motor index scores significantly correlated with D-dimer levels regardless of the time between the onset of SCI and D-dimer testing. Patients with trauma had significantly increased D-dimer levels compared with patients without trauma. Conclusion Although D-dimer levels have limitations with regards to the positive prediction of acute SCI, it is a useful screening parameter for DVT. Trauma and lower extremity motor weakness should be considered when analyzing D-dimer levels. Corresponding author and reprint requests: Dong Gyu Lee, M.D., Ph.D., Correspondence address: Department of Rehabilitation Medicine and Spine Center, Yeungnam University, College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea. E-mail: painfree@yu.ac.kr, Office room: +82-53-620-3829, Fax: +82-53-624-8356 Funding sources This work was supported by the 2019 Yeungnam University research grant. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Increased muscle strength limits postural sway during daily living activities in total hip arthroplasty patients Objective To investigate the effect of maximal strength training (MST) on postural sway after total hip arthroplasty (THA), performed before and after a battery of physical performance tests that resemble daily living activities. Design This study is an exploratory study based on data from a 3-month randomized controlled trial involving 54 THA patients performing MST or conventional rehabilitation (CR). At 3, 6 and 12 months postoperatively, postural sway was evaluated in two gait tests; i.e. one test before (TB) and one test after (TA) conducting a battery of physical performance tests. Results At 3 months postoperatively, postural sway in the TA was significantly higher for the CR group than the MST group (p=0.045); however, there was no between-group difference at the TB (p=0.670). Postural sway was also significantly higher in the TA compared to the TB in the CR group (p<0.001). No difference was found between the TB and TA in the MST group (p=0.713). At 6 and 12 months postoperatively, there were no statistically significant within- or between-group differences in postural sway. Conclusion Increased muscular strength limits postural sway 3 months postoperatively in THA patients after a demanding battery of physical performance tests simulating daily living activities. Corresponding author: Siri B. Winther, Orthopedic Research Centre, Trondheim University Hospital HF, Postbox 3250 Sluppen, NO-7006 Trondheim, Norway. Phone number: +47 72573669, E-mail: siri.bjorgen@ntnu.no Disclosures: The authors certify that there is no financial conflict of interest regarding the material discussed in the manuscript. The study was supported by a grant from the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology. The funding source was not involved in any part of the study and provided no financial benefits to the authors. The present results have not been presented or published previously in any form. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Blinded or non-blinded randomized controlled trials in rehabilitation research – a conceptual analysis based on a systematic review Objective Some recent studies suggest that double blinding should not be considered a validity criterion in randomized controlled trials on real life circumstances. This study aims to assess whether blinding vs non-blinding have been analyzed conceptually in the rehabilitation literature. Propositions on the role of blinding in RCTs on rehabilitation are presented based on the conceptual analysis. Design Study questions, literature search strategy and inclusion and exclusion criteria for the original studies were formulated. A health science librarian carried out the literature search. Eligibility was assessed and data extraction performed by two independent researchers. Results The literature search identified a total of 1,052 citations, of which 13 studies fulfilled the inclusion criteria. None of the studies determined any of the study questions for the present study, and consequently neither produced results thereupon. Conclusions The ideas on blinding vs non-blinding in RCTs have not been considered in the rehabilitation research literature. This conceptual systematic review proposes that a physical therapy modality is a single core element and when the study question is on effectiveness of this single core element itself double blinding in a RCT is indicated. In all other RCTs in rehabilitation double blinding is not indicated and double blinding should not be considered a criterion for the assessment of risk of bias. Corresponding author: Antti Malmivaara, M.D., Ph.D., Chief Physician, Professor, Centre for Health and Social Economics, National Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland. E-mail: antti.malmivaara@thl.fi. Tel.: +358 40 554 5435 Acknowledgements: We acknowledge the International Society of Physical and Rehabilitation Medicine (ISPRM) for its financial support to facilitate the Cochrane Rehabilitation Methodology Meeting in Kobe, Japan. The following persons (in addition to the authors) have contributed to the paper during the discussions in the Kobe meeting: Chiara Arienti (Ita), Julia Patrick Engkasan (Mal), Walter Roura Frontera (Usa), Frane Grubisic (Cro), Carlotte Kiekens (Bel), William Levack (Nzl Wendy Machalicheck (Usa), Thorsten Meyer (Ger), Stefano Negrini (Ita),), Aydan Oral (Tur), Melissa Selb (Swi), Gerold Stucki (Swi), Will Taylor (Nzl). Contributors: AM has developed the idea for the paper. The study plan has been elaborated by AM, SAO and JA. LD has undertaken the literature search. AM has written the first draft of the manuscript. AM, SAO and JA have independently assessed the feasibility of the articles from the literature searches. AM and JA have independently extracted the data, and held a meeting for reaching a consensus. AM, SAO, AWH, SN and JA have edited the manuscript critically. All the authors have approved the final manuscript. Funding: No outside funding. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

THE MAGNITUDE AND DURATION OF THE EFFECT OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS ON PAIN SEVERITY IN KNEE OSTEOARTHRITIS – A SYSTEMATIC REVIEW AND META-ANALYSIS Objective To clarify the evidence on the magnitude and duration of treatment effect of intra-articular corticosteroid (IAC) injections for knee osteoarthritis (OA) compared to placebo, to evaluate a treatment effect by steroid type, and to describe the reported adverse effects. Design Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results The final sample included eight RCTs with follow-ups from 1 to 26 weeks. The risk of systematic bias was considered low in five and high in three studies. The pooled SMD was -0.58 (95% CI -0.88 to -0.27) and NNT 5.1 (95% CI 10.0 to 3.7). The heterogeneity was considerable. The pooled effect size approached the level of statistical insignificance at four months. The pooled risk ratio of adverse effects was insignificant 0.95 (95% CI 0.34 to 2.55). Conclusion The IAC had a mild to moderate effect on pain severity up to three months after the injection – much longer than it had previously been reported. The effect may vary substantially in different patient groups and appropriate patient selection is important. The risk of adverse effects was low. Address for correspondence:Mikhail Saltychev, Department of Physical and Rehabilitation Medicine, Turku University Hospital, PO Box 52, FI-20521, Turku, Finland. E-mail: mikhail.saltychev@gmail.com, Tel.: +358 50 438 1761, Fax: +358 2 313 3730 Review Statement of all funding sources: none Conflict of interest: None to declare PROSPERO registration number: CRD42019145117 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Evaluation of cognitive function in relation to progression of Parkinson's disease Objective Cognitive impairments are among the non-motor symptoms in patients with Parkinson’s disease (PD). Understanding the cognitive impairments in patients with PD may be critical for developing effective rehabilitation interventions. The purpose of this study is to assess cognitive function in patients with PD using the Wechsler Adult Intelligence Scale-third edition (WAIS-III) and the Wechsler Memory Scale-revised (WMS-R), and investigate how cognitive impairments relate to progression of disease in patients with PD according to the Hoehn and Yahr (HY) stages. Design Seventy-eight patients with PD participated in the present study. Our study consisted of patients in the following HY groups: I (no disability, n=11), II (mild, n=34), III (moderate, n=26), and IV-V (severe, n=7). Cognitive function was assessed using the WAIS-III and the WMS-R. Results The verbal memory was significantly higher in group I (106.4±12.0) than in the other groups (II: 90.5 ±14.0, III: 89.9±16.9, IV-V: 89.6 ±11.4). Visual memory and delayed recall were similar to the results seen with verbal memory, however, the differences between groups were not statistically significant. The full-scale IQ was not significantly different (I: 107.3±8.1, II: 96.9±18.2, III: 96.7±14.8, IV-V: 91.7±9.5). Conclusions These results suggest that a comprehensive assessment focused on memory impairments is important for applying the appropriate interventions in patients with early-stage PD. Rie Yamawaki and Manabu Nankaku should be considered joint first author Corresponding author: Rie Yamawaki, Rehabilitation Unit, Kyoto University Hospital, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan. TEL: +81-075-366-7729 FAX: +81-075-366-7725. E-mail: yamawaki@kuhp.kyoto-u.ac.jp Rie Yamawak (Ph.D.) e-mail: yamawaki@kuhp.kyoto-u.ac.jp Author. Study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. Manabu Nankaku (Ph.D.) e-mail: nankaku@kuhp.kyoto-u.ac.jp Author. Study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. Yusuke Kusano (BS) e-mail: kusano@kuhp.kyoto-u.ac.jp Author. Acquisition of data, analysis and interpretation. Ayumi Tajima (BS) e-mail: momoayu@kuhp.kyoto-u.ac.jp Author. Acquisition of data, analysis and interpretation. Ryosuke Ikeguchi (MD, Ph.D.) e-mail: ikeguchi@kuhp.kyoto-u.ac.jp Author. Approving the final version to be published. Shuichi Matsuda (MD, Ph.D.) e-mail: smat522@kuhp.kyoto-u.ac.jp Author. Approving the final version to be published. Author Disclosures All authors did not receive and will not receive any benefits including financial benefits from any commercial party related directly or indirectly to the subjects of this article. This study was supported by internal funds of the Rehabilitation Unit, Kyoto University Hospital. The authors further declare that the article is original, that it is not under consideration by another journal, and that this material has not been previously published. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Predictors of Exceeding Target Inpatient Rehabilitation Length of Stay after Hip Fracture Objective To identify factors associated with exceeding a target inpatient rehabilitation length of stay of 28 days or less for individuals with hip fracture. Design Retrospective cohort study of hip fracture patients admitted to an urban Canadian inpatient rehabilitation facility between January 1, 2013 and January 1, 2018. Patient characteristics previously shown to be associated with individual outcomes and / or length of stay following hip fracture were extracted from the institution’s data warehouse. Regression models were used to examine factors associated with exceeding target length of stay as well as overall length of stay. Results 493 subjects were included in the analysis. 345 (70%) met and 148 (30%) exceeded their target length of stay. Patients who exceeded their target were more likely to be elderly (OR 1.05, 95% CI 1.02-1.08), to live alone pre-fracture (OR 1.72, 95% CI 1.02-2.91), to have dementia (OR 2.79, 95% CI 1.12-6.97), and higher admission pain scores (severe pain OR 2.51, 95% CI 1.06-5.93). Higher admission motor FIM scores (OR 0.95, 95% CI 0.92-0.98) were protective. Conclusion Advancing age, having dementia, living alone pre-fracture, and reporting moderate or severe pain at the time of admission not only increased the odds of an individual exceeding their target length of stay, but was associated with an overall increase in length of stay. Conversely, having a higher admission motor FIM score was protective. Correspondence to: Shannon MacDonald, Bridgepoint Active Healthcare, Sinai Health System, Room G178, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5. Phone: (416) 461-8252, Email: shannon.macdonald@mail.utoronto.ca Disclosures: The authors have no competing interests. No grants, funding, or equipment were received by the authors to conduct this research. Shannon MacDonald receives funding from the Dr. Eliot A. Phillipson Department of Medicine Fellowship. Susan Jaglal holds the Toronto Rehabilitation Institute Chair at the University of Toronto. Initial results were presented at the University of Toronto Institute of Health Policy, Management and Evaluation Research Day. This manuscript has not been previously submitted for publication. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.