Physical Medicine & Rehabilitation (all articles)
Meta-Analysis: ERAS Protocols Improve Recovery and Reduce Complications After Emergency Laparotomy – Am J Surg
18 Aug, 2024 | 19:32h | UTCStudy Design and Population: This systematic review and meta-analysis assessed the effects of Enhanced Recovery After Surgery (ERAS) protocols compared to standard care (SC) in patients undergoing emergency laparotomy. The analysis included six randomized clinical trials (RCTs) with a total of 509 patients.
Main Findings: The ERAS group showed a reduction in length of hospital stay (mean difference: -2.92 days) and quicker recovery milestones, such as time to ambulation (mean difference: -1.67 days) and first bowel opening (mean difference: -1.26 days). The ERAS protocols were also associated with lower rates of pulmonary complications (odds ratio [OR]: 0.43) and surgical site infections (OR: 0.33). Mortality rates were similar between the ERAS and SC groups.
Implications for Practice: These findings suggest that ERAS protocols may enhance recovery and reduce complications in patients undergoing emergency laparotomy. Implementation of these protocols could be beneficial in emergency surgical settings, where feasible.
Meta-Analysis: Daily Sedation Interruption Shortens PICU Stay Without Impacting Mortality or Ventilation Duration in Pediatric MV Patients – JAMA Netw Open
11 Aug, 2024 | 13:19h | UTCStudy Design and Population: This systematic review and meta-analysis included six randomized clinical trials (RCTs) involving 2,810 pediatric patients receiving mechanical ventilation (MV) in the pediatric intensive care unit (PICU). The trials compared the effects of daily sedation interruption (DSI) with continuous intravenous (IV) sedation on clinical outcomes such as MV duration and PICU length of stay.
Main Findings: The analysis found that DSI was associated with a significant reduction in the length of PICU stay (mean difference of -1.45 days, p = 0.03). However, there was no significant difference in the duration of MV between DSI and continuous sedation (mean difference of -0.93 days, p = 0.06). Additionally, there were no significant differences in total sedative doses, adverse events, or mortality between the two groups.
Implications for Practice: The findings suggest that DSI may reduce the length of PICU stay without increasing the risk of adverse events, making it a potentially valuable strategy in managing sedation for pediatric patients on MV. However, further research is needed to explore the long-term neurodevelopmental outcomes associated with DSI.
Cohort Study: Thick liquids not linked to better outcomes in hospitalized patients with dementia—further studies required – JAMA Intern Med
25 May, 2024 | 19:41h | UTC– This matched cohort study evaluated the impact of thick vs. thin liquids on clinical outcomes in 8916 hospitalized patients aged 65 and older with Alzheimer Disease and Related Dementias (ADRD) and oropharyngeal dysphagia. Conducted across 11 diverse hospitals in New York from January 2017 to September 2022, the study utilized propensity score matching to ensure comparability between the two diet groups based on demographic and clinical characteristics.
– The study found no significant difference in mortality rates between the thick and thin liquid groups (hazard ratio, 0.92; 95% CI, 0.75-1.14; P = .46). Patients on a thick liquid diet were less likely to require intubation (odds ratio [OR], 0.66; 95% CI, 0.54-0.80) but exhibited a higher incidence of respiratory complications such as pneumonia (OR, 1.73; 95% CI, 1.56-1.91).
– The findings suggest that while thick liquids may reduce the need for intubation, they may increase the risk of respiratory complications. These results underscore the necessity for future prospective studies to more definitively ascertain the effectiveness of thick liquids in improving clinical outcomes for this patient population.
Reference (link to abstract – $ for full-text):
Makhnevich, A. et al. (2024). Thick Liquids and Clinical Outcomes in Hospitalized Patients With Alzheimer Disease and Related Dementias and Dysphagia. JAMA Intern Med. Published online May 6, 2024. doi:10.1001/jamainternmed.2024.0736
RCT: Lower oxygenation target improves days alive without life support in severe COVID-19 hypoxemia
21 Mar, 2024 | 13:46h | UTCStudy 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 | UTCStudy 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 | UTCSee 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
Survival ≠ Recovery | A narrative review of post-intensive care syndrome
11 Aug, 2023 | 15:11h | UTCSurvival ≠ Recovery: A Narrative Review of Post-Intensive Care Syndrome – CHEST Critical Care
Podcast | Knee pain pearls
9 Aug, 2023 | 15:08h | UTC#406 Kneedful Things: Knee Pain 201 with Dr. Ted Parks – The Curbsiders
M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders
8 Aug, 2023 | 13:35h | UTC
USPSTF Draft Statement | Insufficient evidence for screening children under 5 years for speech and language delay
2 Aug, 2023 | 14:13h | UTCSpeech and Language Delay and Disorders in Children: Screening – U.S. Preventive Services Task Force
Commentary:
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
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
RCT | Dysphagia-optimized intensity-modulated radiotherapy better preserves swallowing function in pharyngeal cancer patients
25 Jul, 2023 | 13:52h | UTCCommentaries:
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.#hncsmhttps://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
RCT | Swallowing and oral-care program enhances oral-feeding resumption and reduces pneumonia post-extubation
14 Jul, 2023 | 12:44h | UTC
RCT| Exercise during hemodialysis improves physical function in chronic kidney failure patients
13 Jul, 2023 | 13:01h | UTCExercise during Hemodialysis in Patients with Chronic Kidney Failure – NEJM Evidence
M-A | Cognitive rehabilitation may improve everyday activities in mild to moderate dementia
12 Jul, 2023 | 13:34h | UTCCognitive rehabilitation for people with mild to moderate dementia – Cochrane Library
Podcast | Overuse injuries in pediatrics
11 Jul, 2023 | 13:52h | UTC#86: Overuse Injuries – The Leg Bone’s Connected to the Foot Bone! – The Cribsiders
RCT | Semont-plus maneuver yields faster recovery than Epley maneuver in posterior canal BPPV
7 Jul, 2023 | 16:26h | UTCThe Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study – JAMA Neurology (link to abstract – $ for full-text)
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 | UTCAuthor 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 | UTCArthroscopic 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)
M-A | Effectiveness of physical therapy in axillary web syndrome after breast cancer
27 Jun, 2023 | 13:28h | UTC
M-A | Effect of resistance exercise dose components for tendinopathy management
26 Jun, 2023 | 00:22h | UTC
Editorial | Who should judge treatment effects as unimportant?
22 Jun, 2023 | 15:05h | UTCWho should judge treatment effects as unimportant? – Journal of Physiotherapy
Review | Pulmonary rehabilitation and physical interventions
21 Jun, 2023 | 13:11h | UTCPulmonary rehabilitation and physical interventions – European Respiratory Review
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