Rehabilitation definition for research purposes. A global stakeholders’ initiative by Cochrane Rehabilitation

Negrini S, Selb M, Kiekens C, et al. Rehabilitation definition for research purposes. A global stakeholders initiative by Cochrane Rehabilitation. European Journal of Physical and Rehabilitation Medicine . 2022.Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a health care context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation

A noninterventional study evaluating the effectiveness of rotigotine and levodopa combination therapy in younger versus older patients with Parkinson\u27s disease

Background: PD0013 was a 6-month non-interventional study in clinical-practice comparing effectiveness and tolerability of rotigotine+levodopa in younger (<70years) vs. older (≥70years) Parkinson’s disease (PD) patients.Methods: Patients previously received levodopa for ≥6-months as monotherapy or in combination with another dopamine-agonist (DA). Primary variable: Unified PD Rating Scale (UPDRS) Part-II change from baseline to end-of-observation-period (EOP).Results: 91 younger/99 older patients started rotigotine; 68 younger/62 older patients completed the study. Most switched from levodopa+another DA. Addition of rotigotine as first DA was more common in older patients (20.2% vs.15.4%). Mean\ub1SD rotigotine-exposure: 6.1\ub13.4mg/24h younger vs. 4.9\ub12.4mg/24h older. Eleven patients changed levodopa dose during the study.At EOP, improvement in mean UPDRS-II was greater in younger patients (p=0.0289). UPDRS-II responder-rate (≥20% decrease in UPDRS-II score) was higher in younger patients (42.3% vs. 25.9%). Improvement across age-groups was similar on PD Sleep Scale-2 and Clinical Global Impressions-Improvement Scale. Adverse-drug-reactions (ADRs), and discontinuations because of ADRs, were more common among older patients. There were no new safety-signals.Conclusions: Despite low rotigotine doses, when added to levodopa or switched from levodopa+another DA, rotigotine led to greater improvement in UPDRS-II in younger patients (<70years). Assessment of individual patient data revealed clinically-meaningful improvements in UPDRS-II in both age-groups

La rieducazione della disfagia nella malattia di Parkinson.

Dysphagia frequently occurs in Parkinson’s Disease (PD) although patients may be unaware of swallow difficulties. The prevalence is about 40-82%. Several abnormalities in the various phases of swallowing have been described and include abnormal bolus formation, prolonged oropharyngeal transit time and oesophagus motility impairment. These troubles are not necessarily correlated with either severity of motor deficit or disease progression. Dysphagia can lead to ‘silent aspiration’ thus enhancing the risk of pneumonia which represents the main cause of mortality in PD patients. The management of dysphagic patients requires an accurate outlining of swallow phase alterations. Although videofluorography represents the diagnostic gold-standard, the collection of clinical history and the functional assessment are mandatory steps in the care pathway. Dopaminergic treatments may be effective at improving symptoms related to oral dysfunctions, but pharyngeal and oesophageal impairments are drug-resistant . Treatments such as behavioural interventions and diet modification are recommended for treatment of dysphagia in PD. Rehabilitation interventions, based on speech and language principles, are often applied, but no trial has so far considered the efficacy of these approaches for dysphagia management in PD

Malattie del motoneurone: riabilitazione

L’assistenza riabilitativa è attualmente ritenuta una componente imprescindibile dell’attività di Disease Management dedicata alla Malattia del Motoneurone (MM). Essa si integra nel complesso iter multidisciplinare che accompagna il soggetto dalla diagnosi all’exitus e si declina in azioni diverse in relazione alle fasi di malattia, alla tipologia e complessità della disabilità emergente e alle caratteristiche dell’individuo e dell’ambiente in cui vive. In definitiva, la finalità dell’intervento riabilitativo, nella MM come in ogni altro ambito di patologia, resta quello di favorire “….lo sviluppo del massimo potenziale fisico, psicologico, sociale, vocazionale ed educativo della persona, compatibilmente con le restrizioni fisiologiche o anatomiche e con i vincoli ambientali. Una realistica determinazione di obiettivi raggiungibili va condivisa tra il soggetto e coloro che sono destinati ad assisterlo. In tal modo si opera per ottimizzare la funzione a dispetto della disabilità anche in presenza di menomazioni inemendabili” (Bach, 2004). Concentrare l’attenzione sulle risorse disponibili al fine di garantire il massimo funzionamento possibile e desiderato dall’individuo, significa operare all’interno del paradigma dell’ICF

Action observation therapy in the subacute phase promotes dexterity recovery in right-hemisphere stroke patients.

The clinical impact of action observation (AO) on upper limb functional recovery in subacute stroke patients is recent evidence. We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one. Sixty-seven first-ever ischemic stroke subjects were randomly assigned to receive upper limb training coupled with AO tasks or standard rehabilitation. The groups were matched by age and gender, Bamford category, and interval from stroke and lesion side. Fugl-Meyer (FM) and Box and Block Test (BBT) were used to measure hand function recovery at the end (T1) and 4-5 months after the treatment (T2). At T1, FM was increased by 31% (± 26%), of maximum achievable recovery, whereas BBT was increased by 17% (± 18%); at T2, FM had reached 43% (± 45%) of maximum recovery, while BBT had reached 25% (± 22%). Combining the effects of treatment to those of lesion side revealed significantly higher gains, in both FM and BBT scores, in left hemiparetic subjects when exposed to AO as compared to standard rehabilitation alone (P < .01). The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patient