International journal of rehabilitation research. Internationale Zeitschrift für Rehabilitationsforschung. Revue internationale de recherches de réadaptation
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Review Meta Analysis Comparative Study
Lumbar fusion compared with conservative treatment in patients with chronic low back pain: a meta-analysis.
We assess the effect of lumbar fusion (LF) in reducing disability among patients with chronic low back pain (CLBP) compared with conservative treatment and to weigh the clinical significance of this effect. We conducted a random-effect meta-analysis on the basis of a systematic review with research quality grading according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The studies included were retrieved from MEDLINE and Cochrane CENTRAL databases from 1990 till January 2013. ⋯ Test for heterogeneity indicated that study imputation would favor LF but the imputed result would still be clinically insignificant with an estimated corrected reduction of ODI score of -5.51 (95% confidence interval -5.78 to -5.24). There is strong evidence that LF is not more effective than conservative treatment in reducing perceived disability because of CLBP among patients with degenerative spinal diseases. It is unlikely that further research on the subject would considerably affect this conclusion.
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Comparative Study
Measuring functional health among the elderly: development of the Japanese version of the World Health Organization Disability Assessment Schedule II.
The Japanese version of the World Health Organization Disability Assessment Schedule II (WHODAS II-J) was developed and its psychometric properties were evaluated, and then used to determine the influence of disability on quality of life among the elderly in Japan. The study included three phases: qualitative, preliminary and field. For the qualitative portion of the study, six key informants were interviewed before the translation/back-translation procedure. ⋯ A significant correlation was observed between the results of the WHODAS II-J and the degree of disability (P<0.01), and a negative correlation was observed between WHOQOL-BREF and WHODAS II-J scores (P<0.01). A significant difference was found between healthy elderly individuals and those with disabilities in three domains: getting around, self-care, and life activities (P<0.01). In conclusion, the WHODAS II-J is a reliable and valid instrument for assessment of function in the elderly population in Japan.
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Randomized Controlled Trial Comparative Study
Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial.
To compare the efficacy of electromyography (EMG)-triggered (active) neuromuscular electrical stimulation (NMES) and passive NMES in enhancing the upper extremity (UE) motor and functional recovery of subacute and chronic stage stroke patients. Thirty-one hemiplegic patients were randomly assigned to active NMES (n=11), passive NMES (n=10), and control (sham stimulation) (n=10) groups. Each treatment regimen was applied five times per week for 45 min for 3 weeks. ⋯ The active wrist extension ROM and FMA scores were significantly improved in the passive NMES group compared with the controls (P<0.05). There were no statistically significant differences between active and passive NMES groups in any of the parameters evaluated at the end of the treatment (P>0.05). Both active and passive NMES as adjuvant therapy in the neurophysiologic exercise program effectively enhanced the UE motor and functional recovery of stroke survivors.
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The severity of traumatic brain injury (TBI) is determined by many variables, the complexity of which has made prediction of functional outcome an elusive target. To evaluate whether the three components of the Glasgow Coma Scale (GCS) and their alterations over time can serve as predictors of functional outcome after a severe TBI at 12 months after the TBI insult, we carried out a prospective study of patients with severe TBI. Seventy patients were initially enrolled. ⋯ A higher motor and verbal response on day 15 was strongly associated with a patient's functional independence, whereby the motor response was a better predictor. The GCS motor score 2 weeks after injury was statistically significantly associated with the 12-month functional outcome in TBI survivors. Motor response was the most useful predictor among the GCS components with respect to the long-term functional outcome in patients with severe TBI.
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Randomized Controlled Trial
Organization of functional postural responses following perturbations in multiple directions in elderly fallers standing quietly.
The objective of the study was to assess functional postural responses by analyzing the center-of-pressure trajectories resulting from perturbations delivered in multiple directions to elderly fallers. Ten elderly individuals were standing quietly on two force platforms while an apparatus delivered controlled perturbations at the level of pelvis in eight directions: 'forward (FW)' and 'backward (BW)' [anterioposterior plane (AP)], 'left (LT)' and 'right (RT)' [mediolateral plane (ML)] and four combinations of these principal directions: forward-left (FL), forward-right (FR), backward-left (BL) and backward-right (BR). Perturbations were repeated randomly four times in each direction. ⋯ The comparison of the group averaged PARAP and TPAR-AP in all 'forward' directions (FW, FL, FR) as well in all 'backward' directions (BW, BL, BR) have not shown statistically significant differences. The comparison of the group averaged PARML and TPAR-ML in all 'left' directions (LT, FL, BL) as well in all 'right' directions (RT, FR, BR) have not shown statistically significant differences. These results suggest that a principle of decoupled control may to a large extent be preserved also in elderly with clearly diminished balancing abilities, which implies that the accuracy in the assessment of perturbation direction may be well preserved also in very old age.