Physical Medicine & Rehabilitation (all articles)

RCT: Lower oxygenation target improves days alive without life support in severe COVID-19 hypoxemia

21 Mar, 2024 | 13:46h | UTC

Study Design and Population: This multicenter randomized clinical trial investigated the impact of different oxygenation targets on the survival of adult patients with COVID-19 and severe hypoxemia in the ICU. Conducted across 11 European ICUs from August 2020 to March 2023, the study involved 726 patients requiring at least 10 L/min of oxygen or mechanical ventilation. Participants were randomly assigned to receive an oxygenation target of either 60 mm Hg (lower oxygenation group, n=365) or 90 mm Hg (higher oxygenation group, n=361) for up to 90 days.

Main Findings: The primary outcome was the number of days alive without life support at 90 days post-intervention. Patients in the lower oxygenation group achieved a median of 80.0 days alive without life support compared to 72.0 days in the higher oxygenation group, a difference that was statistically significant (P=0.009). Although there was a slight reduction in mortality at 90 days in the lower oxygenation group (30.2% vs 34.7% in the higher group), this was not statistically significant. No significant differences were observed in the proportion of patients with serious adverse events or the number of days alive and out of hospital.

Implications for Practice: Targeting a lower Pao2 of 60 mm Hg in ICU patients with COVID-19 and severe hypoxemia appears to increase the days alive without life support compared to a higher target of 90 mm Hg, without increasing serious adverse events. This finding suggests that a lower oxygenation target could be more beneficial for this patient population, potentially guiding clinical practice in managing oxygen therapy for severe COVID-19 cases.

Reference

Reference: Nielsen FM et al. (2024). Randomized Clinical Trial: Effect of Oxygenation Targets on Survival Without Life Support in COVID-19 Patients with Severe Hypoxemia. JAMA, Published online March 19, 2024. DOI: 10.1001/jama.2024.2934. Access the study here: [Link]

Meta-Analysis: Efficacy of exercise modalities in major depressive disorder treatment

20 Mar, 2024 | 17:54h | UTC

Study Design and Population: This article presents a systematic review and network meta-analysis of randomized controlled trials to assess the optimal dose and modality of exercise for treating major depressive disorder, comparing its effects to psychotherapy, antidepressants, and control conditions such as usual care or placebo. The review included 218 unique studies encompassing 495 arms with a total of 14,170 participants who met the clinical cutoffs for major depression.

Main Findings: The findings revealed moderate reductions in depression symptoms for several exercise modalities when compared to active controls. Notably, walking or jogging, yoga, and strength training demonstrated the most significant effects. The effectiveness of exercise was found to be proportional to the intensity of the activity prescribed. Among these, yoga and strength training were identified as the most acceptable modalities for participants. However, the overall confidence in these results is low due to the high risk of bias in the included studies, with only one study meeting the criteria for a low risk of bias.

Implications for Practice: The study concludes that exercise, particularly walking or jogging, yoga, and strength training at sufficient intensities, can be an effective treatment for major depressive disorder. These modalities could be recommended alongside traditional treatments such as psychotherapy and antidepressants. Future research should focus on blinding participants and staff to mitigate expectancy effects and improve the reliability of findings. The inclusivity of exercise as a core treatment for depression could significantly impact treatment strategies and patient outcomes.

Reference: Noetel, M., et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. DOI: https://doi.org/10.1136/bmj-2023-075847. Access the study here: [Link]

RCT – 2ry analysis | Aerobic exercise intervention shows potential to reduce chemotherapy-induced peripheral neuropathy

11 Aug, 2023 | 15:17h | UTC

Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer: A Secondary Analysis of a Randomized Clinical Trial – JAMA Network Open

See also: Visual Abstract

Commentary: Aerobic Exercise Cuts Chemotherapy-Induced Peripheral Neuropathy Symptoms – HealthDay

Commentary on Twitter

Aerobic exercise improves chemotherapy-induced peripheral neuropathy (CIPN) in women who were treated for ovarian cancer. Incorporating referral to exercise programs as a part of standard of oncology care is recommended. https://t.co/lp9C9seyM6 @anlan_cao

— JAMA Network Open (@JAMANetworkOpen) August 1, 2023

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials – British Journal of Sports Medicine (free for a limited period)

USPSTF Draft Statement | Insufficient evidence for screening children under 5 years for speech and language delay

2 Aug, 2023 | 14:13h | UTC

Speech and Language Delay and Disorders in Children: Screening – U.S. Preventive Services Task Force

Commentary:

USPSTF issues statement on speech, language disorder screenings for all children up to 5 years – Contemporary Pediatrics

USPSTF: Evidence Lacking for Screening for Speech Delays in Young Children – HealthDay

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

2 Aug, 2023 | 14:04h | UTC

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome – Critical Care

Commentary from the author on Twitter

Very proud to announce our new publication:

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

Incl. 1 statement, 12 recommendations, and 4 therapy options for prevention & rehab of patients with PICShttps://t.co/NbjIx7zcwR pic.twitter.com/X63epI7ec7

— Peter Nydahl (@NydahlPeter) July 31, 2023

Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness

26 Jul, 2023 | 13:28h | UTC

Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness – The Lancet Respiratory Medicine

RCT | Dysphagia-optimized intensity-modulated radiotherapy better preserves swallowing function in pharyngeal cancer patients

25 Jul, 2023 | 13:52h | UTC

Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial – The Lancet Oncology

Commentaries:

Dysphagia-Optimized vs Standard IMRT in Newly Diagnosed Patients With Head and Neck Cancer – The ASCO Post

Radiation approach improves swallowing in head, neck cancer – MDedge

Commentary on Twitter

NOW OF: The (DARS) phase 3 RCT investigates if dysphagia-optimised intensity-modulated radiotherapy (IMRT) reduces radiation dose to the dysphagia and aspiration related structures and improves swallowing function compared with standard IMRT.#hncsm https://t.co/CzpxsNxx1N pic.twitter.com/xNgfm43tHE

— The Lancet Oncology (@TheLancetOncol) July 7, 2023

Global perspectives on heart disease rehabilitation and secondary prevention

24 Jul, 2023 | 12:45h | UTC

Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation – European Heart Journal

See also: Visual Abstract

Videos:

Demonstration of the Semont-Plus Self-maneuver for Right Posterior Canal Canalithiasis

Semont-Plus Maneuver for Right Posterior Canal Benign Paroxysmal Positional Vertigo

Demonstration of the Epley Self-maneuver for a Right Posterior Canal Canalithiasis

Commentary: Semont-plus Meneuver Offered Faster Recovery for Benign Paroxysmal Positional Vertigo – Neurology Today

M-A | Interventions using wearable activity trackers to improve patient physical activity in adults who are hospitalized

30 Jun, 2023 | 14:46h | UTC

Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized: A Systematic Review and Meta-analysis – JAMA Network Open

Author Interview: Wearable Activity Trackers to Improve Physical Activity and Outcomes – JAMA

News Release: Wearable activity trackers accelerate hospital patient recovery – University of South Australia

RCT | Arthroscopic capsular shift surgery shows no significant pain or functional improvement in atraumatic shoulder instability

29 Jun, 2023 | 13:45h | UTC

Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomised, placebo-controlled trial – British Journal of Sports Medicine (link to abstract – $ for full-text)

Commentary on Twitter

ERR: Pulmonary rehabilitation that includes individualised exercise training is effective in patients with stable COPD and those who have suffered an exacerbation. Remaining challenges are to increase uptake and access to and personalisation of programmes. https://t.co/NSoASus6TW pic.twitter.com/JRl7dCOZrm

— ERS publications (@ERSpublications) June 12, 2023

Commentary: Supervised Walking Program Benefits Veterans Admitted to Hospital – Physician’s Weekly

Commentary on Twitter

A supervised #WalkingProgram known as #STRIDE reduced skilled nursing facility admissions among older adults. https://t.co/nvkzcx5eVE pic.twitter.com/UJnJMtaxXG

— Annals of Int Med (@AnnalsofIM) June 8, 2023

RCT: Lower oxygenation target improves days alive without life support in severe COVID-19 hypoxemia

Reference

Meta-Analysis: Efficacy of exercise modalities in major depressive disorder treatment

RCT – 2ry analysis | Aerobic exercise intervention shows potential to reduce chemotherapy-induced peripheral neuropathy

Survival ≠ Recovery | A narrative review of post-intensive care syndrome

Podcast | Knee pain pearls

M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders

USPSTF Draft Statement | Insufficient evidence for screening children under 5 years for speech and language delay

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness

RCT | Dysphagia-optimized intensity-modulated radiotherapy better preserves swallowing function in pharyngeal cancer patients

Global perspectives on heart disease rehabilitation and secondary prevention

RCT | Swallowing and oral-care program enhances oral-feeding resumption and reduces pneumonia post-extubation

RCT| Exercise during hemodialysis improves physical function in chronic kidney failure patients

M-A | Cognitive rehabilitation may improve everyday activities in mild to moderate dementia

Podcast | Overuse injuries in pediatrics

RCT | Semont-plus maneuver yields faster recovery than Epley maneuver in posterior canal BPPV

M-A | Interventions using wearable activity trackers to improve patient physical activity in adults who are hospitalized

RCT | Arthroscopic capsular shift surgery shows no significant pain or functional improvement in atraumatic shoulder instability

M-A | Effectiveness of physical therapy in axillary web syndrome after breast cancer

M-A | Effect of resistance exercise dose components for tendinopathy management

Editorial | Who should judge treatment effects as unimportant?

Review | Pulmonary rehabilitation and physical interventions

ATS Report | Rehabilitation for people with respiratory disease and frailty

M-A | Post-surgery interventions for hip fracture

Cluster RCT | Effects of implementation of a supervised walking program in veterans affairs hospitals

Stay Updated in Your Specialty