Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease

PurposeFree of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected.ParticipantsNinety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey.Findings to dateThe content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson’s disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered.Future plansThe current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.</jats:sec

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

GABA Levels Are Decreased After Stroke and GABA Changes During Rehabilitation Correlate With Motor Improvement.

Background and Objective. γ-Aminobutyric acid (GABA) is the dominant inhibitory neurotransmitter in the brain and is important in motor learning. We aimed to measure GABA content in primary motor cortex poststroke (using GABA-edited magnetic resonance spectroscopy [MRS]) and in relation to motor recovery during 2 weeks of constraint-induced movement therapy (CIMT). Methods. Twenty-one patients (3-12 months poststroke) and 20 healthy subjects were recruited. Magnetic resonance imaging structural T1 and GABA-edited MRS were performed at baseline and after CIMT, and once in healthy subjects. GABA:creatine (GABA:Cr) ratio was measured by GABA-edited MRS. Motor function was measured using Wolf Motor Function Test (WMFT). Results. Baseline comparison between stroke patients (n = 19) and healthy subjects showed a significantly lower GABA:Cr ratio in stroke patients (P < .001) even after correcting for gray matter content in the voxel (P < .01) and when expressing GABA relative to N-acetylaspartic acid (NAA; P = .03). After 2 weeks of CIMT patients improved significantly on WMFT, but no consistent change across the group was observed for the GABA:Cr ratio (n = 17). However, the extent of improvement on WMFT correlated significantly with the magnitude of GABA:Cr changes (P < .01), with decreases in GABA:Cr ratio being associated with better improvements in motor function. Conclusions. In patients 3 to 12 months poststroke, GABA levels are lower in the primary motor cortex than in healthy subjects. The observed association between GABA and recovery warrants further studies on the potential use of GABA MRS as a biomarker in poststroke recovery

GABA Levels Are Decreased After Stroke and GABA Changes During Rehabilitation Correlate With Motor Improvement.

Background and Objective. γ-Aminobutyric acid (GABA) is the dominant inhibitory neurotransmitter in the brain and is important in motor learning. We aimed to measure GABA content in primary motor cortex poststroke (using GABA-edited magnetic resonance spectroscopy [MRS]) and in relation to motor recovery during 2 weeks of constraint-induced movement therapy (CIMT). Methods. Twenty-one patients (3-12 months poststroke) and 20 healthy subjects were recruited. Magnetic resonance imaging structural T1 and GABA-edited MRS were performed at baseline and after CIMT, and once in healthy subjects. GABA:creatine (GABA:Cr) ratio was measured by GABA-edited MRS. Motor function was measured using Wolf Motor Function Test (WMFT). Results. Baseline comparison between stroke patients (n = 19) and healthy subjects showed a significantly lower GABA:Cr ratio in stroke patients (P &lt; .001) even after correcting for gray matter content in the voxel (P &lt; .01) and when expressing GABA relative to N-acetylaspartic acid (NAA; P = .03). After 2 weeks of CIMT patients improved significantly on WMFT, but no consistent change across the group was observed for the GABA:Cr ratio (n = 17). However, the extent of improvement on WMFT correlated significantly with the magnitude of GABA:Cr changes (P &lt; .01), with decreases in GABA:Cr ratio being associated with better improvements in motor function. Conclusions. In patients 3 to 12 months poststroke, GABA levels are lower in the primary motor cortex than in healthy subjects. The observed association between GABA and recovery warrants further studies on the potential use of GABA MRS as a biomarker in poststroke recovery