Intensive exercise and a patient in acute phase of polymyositis

Background and objective: Polymyositis (PM) is an idiopathic inflammatory myopathy manifested by proximal limb muscles weakness, elevated creatinin kinase, electromyography changes, and muscle inflammation in biopsy. We report an instance of intensive rehabilitation therapy in a patient with clinically active polymyositis. Case report: A 19-year-old female patient, diagnosed with 'electromyography and biopsy proven' polymyositis for 5 years, suffered from worsening limbs weakness and dysphagia. In her history, she had upper and lower limbs weakness accompanied by dysphagia which was further complicated by right bronchial aspiration 9 months ago. A four-week trial of intensive training and exercise rehabilitation, concurrently accompanied by medications was prescribed for this patient. At the end of therapy she achieved significant improvement in muscle strength, activities of daily living, and ambulation without any disease exacerbation. Conclusion: We concluded that short-term intensive training and exercise may lead to improvements in patients with PM, without causing a progress in the disease. Due to the rarity of PM and difficulty of conducting well-controlled studies to examine the risks and benefits of exercise in these patients, further research is necessary to investigate benefits of exercise training in active phase of disease

Functional Outcomes in Spinal Tuberculosis: A Review of the Literature

Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms “spinal tuberculosis,” “tuberculous spondylitis,” “tuberculous spondylodiscitis,” and “functional outcome” for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions

A Multicentre Analysis Of Employment Post-Spinal Cord Injury In Malaysia

OBJECTIVES: Employment outcome post-spinal cord injury (SCI) varies internationally due to different socioeconomic backgrounds. However, most previous studies were done in developed countries, with limited studies from developing countries like Malaysia. This research aims to study the employment rate, positive determinants of employment, and reasons for unemployment post-SCI in Malaysia. DESIGN: We conducted a cross-sectional multicentre survey study in Malaysia. This study included eight hospitals with inpatient rehabilitation services and one SCI organisation throughout Malaysia. 280 SCI individuals from 18 to 64 years old with more than one year of SCI duration participated in this study. We administered International Spinal Cord Injury (InSCI) Questionnaires to them. We extracted and analysed the relevant components like demographics, injury-related and work-related data. We identified significant positive determinants of employment by using logistic regression analyses with p-value <0.05 between categorical independent variables and employment status. We described reasons for unemployment post-SCI in frequencies of percentages. RESULTS: The employment rate post-SCI in Malaysia was 29%. Significant positive determinants of employment post-SCI in Malaysia identified from logistic regression analyses with higher odds of employment were female gender (OR [Odds Ratio]: 2.2, 95%, CI [Confidence Interval]: 1.1-4.2); being married (OR: 1.9, CI:1.1-3.4); and tertiary education (OR: 3.2, CI: 1.6-6.8. The five main reasons for unemployment post-SCI in Malaysia were health condition or disability (36.5%), inability to find suitable work (15.5%), not knowing how or where to seek work (11.5%), lack of accessibility to potential workplace (7.4%), and insufficient transportation services (6.2%) CONCLUSION: This study reported a low employment rate post-SCI in Malaysia. Tertiary education was a strong positive determinant of employment. Based on this study ’ s findings, suggested interventions focus on access to tertiary education, health condition optimisation, vocational guidance, exploration of telework options, creating a barrier-free environment, and provision of sufficient transportation services can raise the employment rate post-SCI

Impacts of bladder managements and urinary complications on quality of life: Cross-sectional perspectives of persons with spinal cord injury living in Malaysia, Indonesia, and Thailand

The impact of bladder care and urinary complications on quality of life (QoL) in persons with spinal cord injury (SCI) who have neurogenic lower urinary tract dysfunction has not been elucidated, especially in those living in low-resource countries. This multinational cross-sectional survey was conducted in rehabilitation facilities in Malaysia, Indonesia, and Thailand. Community-dwelling adults with traumatic or non-traumatic SCI participating in the International Spinal Cord Injury Community Survey (InSCI) from 2017 to 2018 were enrolled. Data regarding bladder management/care, presence of bladder dysfunction, urinary tract infection (UTI), and QoL score were extracted from the InSCI questionnaire. The impact of bladder care and urinary complications on QoL was determined using univariable and multivariable regression analysis. Questionnaires from 770 adults were recruited for analysis. After adjusting for all demographic and SCI-related data, secondary conditions, as well as activity and participation factors, UTI was an independent negative predictive factor of QoL score (p = 0.007, unstandardized coefficients = -4.563, multivariable linear regression analysis, enter method). Among bladder care and urinary complication factors, UTI is the only factor negatively impacting QoL. These results address the importance of proper bladder management and UTI prevention in persons with SCI to improve their QoL

A three-step formative assessment model for rehabilitation medicine postgraduate programme clinical skills training

The stepwise formative assessment scheme was introduced into the Rehabilitation Medicine Postgraduate programme beginning from theory assessment to application of clinical skills on simulated and real patients to enable students or trainees to understand and competently apply theoretical knowledge to clinical practice. Formative assessment is intended to foster learning and assist students to develop under conditions that are nonthreatening. A key feature of formative assessment is to provide feedback and proper guidance to trainees on how to enhance performance. In this study, year 1 postgraduate students or trainees of Rehabilitation Medicine (n=9) were evaluated. The study was divided into three intervention phases. In Phase II, trainees were given educational materials on different specific clinical skills such as the Montreal Cognitive Assessment (MOCA), neurological examination of spinal cord injury based on ISNCSCl-motor examination, and GAIT assessment. Phase II was divided Into three steps, namely: 1) an applied pre-and post-theoretical quiz on which trainees must achieve 80% and above as a passing mark; 2) trainees conduct a clinical examination on a simulated patient after receiving the educational material; and 3) assessment of trainees using real patients after a month's assessment with the simulated patients. Phases I and II were conducted for approximately within three months of the intervention. All the assessments were conducted for 15 minutes, Including the debriefing session. In Phase 111, further evaluation will be conducted based on a focus group Interview (FGI). To date, Phases I and II of the clinical assessment have been completed. Results have shown that trainees had improvement In terms of the passing rate for both the theory and clinical assessment parts. The post- theoretical quiz assessment showed that 66.7% passed compared to 11.1 % in the pre-theory t est. Meanwhile, for the clinical assessments of ISNCSCI, MOCA and GAIT assessments, results show significant statistical differences of passes between the simulated and real patient (p<0.05). Overall, the result showed significant improvement in clinical competency for the trainees within three months of Phase land Phase II intervention. In addition, the results allow us to identify weak trainees for greater guidance during Year 1 to improve their clinical competency before their professional exams and able continue to Phase II postgraduate clinical training. The study also showed a feasible duration of formative assessment intervention to achieve satisfactory clinical competency which is perceived to be a practical approach towards structured clinical teaching and learning

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

Background: Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods: In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results: There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion: In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia

Mapping the primary outcomes reported in cochrane systematic reviews regarding stroke with the international Classification of Functioning, Disability and Health domains current trend and future recommendations

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) serves as a framework for defining and categorizing health and functioning. ICF could be used to classify research outcomes in a systematic manner. AIM: The aim of this study was to classify the primary outcomes used in Cochrane Systematic Reviews (CSRs) into the ICF domains of functioning; to describe the differences in primary outcomes in reviews related to rehabilitation intervention and non-rehabilitation intervention; and to describe the trend of outcome selections according year of publication. DESIGN: Methodological paper. POPULATION: Adult stroke population. METHODS: We analyzed the primary outcomes used in the CSRs published by the Cochrane Stroke Review Group up to December 2017. The primary outcomes were extracted and classified into the ICF domains of functioning (body functions, body structures and activity and participation). RESULTS: One hundred and seventy-four papers with 216 primary outcomes were included in this analysis. Less than half (102/216, 47.2%) of the outcomes could be classified into the ICF domains of functioning. For the outcomes that could be classified into the ICF domains, the majority (72/102, 70.5%) were in the activity and participation domain, followed by body functions (26/102, 25.5%) and body structures (4/102, 4.0%). Of the outcomes that could not be classified into the ICF domains (N.=114), death (81/114, 71.1%) and recurrent stroke (21/114,18.4%) formed the majority of the outcome. There were 75 CSRs on rehabilitation related interventions; the majority of the outcomes (75/97, 77.3%) used in rehabilitation related CSRs could be classified into the ICF framework with more than half (49/75, 65.3%) in the activity and participation domain. CONCLUSIONS: The majority of the primary outcomes selected by the Cochrane Stroke Review Group in their CSRs could not be classified into the ICF domains of functioning. Death and recurrence of vascular events remains the major outcome of interest. In rehabilitation related interventions, activity and participation domain is the functioning domain most commonly used. CLINICAL REHABILITATION IMPACT: The systematic use of patients-centered ICF-based outcomes in CSRs could help the application of evidence in clinical decision making

Effectiveness of home-based pulmonary rehabilitation:systematic review and meta-analysis

INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32–1.44; p=0.002) and HRQoL (SMD −0.62, 95% CI −0.88–−0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD −0.10, 95% CI −0.25–0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI −0.15–0.17; p=0.87). CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation

Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases:a systematic review protocol

INTRODUCTION: Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care. METHODS AND ANALYSIS: We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for ‘Chronic Respiratory Disease’ AND ‘Pulmonary Rehabilitation’ AND ‘Home-PR’, and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR? ETHICS AND DISSEMINATION: Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences. PROSPERO REGISTRATION NUMBER: CRD42020220137