Week 3 Y. Wooten EBP Article

Alajbegovic, A., Alajbegovic, S., Djelilovic-Vranic, J., Nskicevic, A., Todorovic, L. (2014). Post stroke depression. Medical Archives; 68(1): 47-50 

Post stroke depression is one of the most frequent and important psychiatric consequence of stroke.  It has been shown to effect cognitive function, functional recovery and survival.  This study investigated prevalence of this depression after different types of strokes as well as gender, age, and severity comparisons.  This study included 210 stroke patients who were followed through the acute phase (first 2 weeks) of the disease.  Patients were equal numbers of male and female. All patients were evaluated using the Beck Depression Inventory which contains 21 items rated on 4 point scale.  Results show that post stroke depression was significantly more common in women than men. It was also more prevalent among younger patients (52-60) and patients experiencing a more severe stroke. Finally this study also found that post stroke depression was more frequent in patients with stroke legions in the left hemisphere of the brain.  However insufficient evidence is available to determine whether LCVA increases the risk for post stroke depression.  Past research has been contradicting in terms of lesion location. Some of this research wasn't clear as to phase post stroke or whether patients have experience single stroke versus recurring stroke or have had past history of depression.

It is important for clinicians to understand this condition for stroke patients.  Post stroke depression has been shown to have adverse effects on the rehabilitation process. It can also increase fatigue, a major symptom of both stroke and depression which can make it difficult for patients to participate in therapy session.  This suggests that occupational therapy practitioners should put great focus on increasing of ADL and functional independence when treating stroke patients which may help to combat their depression.

Article

Suliman Week 1 EBP: Low vs. Medium Frequency Electrical Currents

This is Sam's week one EBP: Low vs. Medium Electrical Currents in the context of short vs. long term pain reduction. I've noted a trend between the students with the unanimous interest in physical agent modalities, so perhaps we should set up some time to really go over all of the modalities!

Now, here's Sam:
The article reviewed: Application of Low Frequency and Medium Frequency Currents in the Management of Acute and Chronic Pain-A Narrative Review focused on the pain management physical modality of TENS treatment. TENS which stands for transcutaneous electrical nerve stimulation is a physical modality which uses electrical pulses to relieve pain. The concept of electrical pulses to relieve pain is a fairly dated concept which dates as far back as 2500 B.C. There have been cave drawings depicting species of catfish with organs producing electrical charges to treat pain. (S.Samuels, 2015). Electrical impulses or TENS units work in reference to pain management by inhibiting pain-related potentials acting like as a gate control for nerve synapses. Low frequency currents or LF TENS takes longer to achieve relief in pain whereas HF TENS or high frequency currents relieves pain more quick but loses that effect more rapidly than LF TENS. This article supports the use of TENS in treating chronic, neuropathic, fibromyalgia, as well as musculoskeletal pain, as more than adequate. In fact, this study recommended TENS be used as a primary treatment for pain relief.

Thanks, Sam!

Suliman Week 2 EBP: Dry Needling and Adhesive Capsulitis

Hey guys! This is Sam's second week article about Dry Needling and Adhesive Capsulitis - he has seen me do quite a bit of needling in the pain management environment, which has been an excellent way to demonstrate many clinical aspects of anatomy, muscle pathology and how muscle pain can (and usually is) a primary limitor of ADL function. He had asked me a question about the current literature on frozen shoulder treatment in regards to multiple modalities based upon this article, which I was very pleased with! He, along with the other students, appear to be very interested in the physical agent and manual therapy side of OT (which makes me personally very happy). This is his summary on his recent find:

Sam:

As I continue my fieldwork and develop better understandings of treatment, one treatment in particular has stuck out. I was unaware largely of the treatment option and effects behind dry needling but was assured by patients of how helpful dry needling has been for them. The article reviewed is based from a view point of dry needling as a primary modality for adhesive capsulitis, better known as frozen shoulder. There are too many factors that can lead to frozen shoulder to pinpoint a singular cause but in general, frozen shoulder occurs from lack of use of the shoulder. In general, this lack of use comes primarily from pain, injury, or physiological ailments such as diabetes. These physical and physiological ailments can lead to stiffness of the glenohumeral joint which is termed frozen shoulder. It is recommended that stretching as well as heat modalities be used to loosen the joint and if results are not achieved, move to surgery. I was interested in this article to find other options to resolve frozen shoulder other than surgery. Dry needling is where that inquisition leads me. In this article, dry needling was used as a primary modality to relieve the symptoms of frozen shoulder. Since currently majority of occupational therapist cannot achieve licensure to needle, I was interested to find out if this option was viable to achieve greater range of motion to assist patients in ADLS/IADLS as it relates. This article concluded that dry needling was a useful option and viable modality to be used to achieve greater range of motion for frozen shoulder. 

Thanks, Sam!

References:

TREATMENT OF NONSPECIFIC THORACIC SPINE PAIN WITH TRIGGER POINT DRY NEEDLING AND INTRAMUSCULAR ELECTRICAL STIMULATION: A CASE SERIES

Jodie M. Rock, Charles E. Rainey. Int J Sports Phys Ther. 2014 October; 9(5): 699–711. PMCID: PMC4196334

Trigger point dry needling as an adjunct treatment for a patient with adhesive capsulitis of the shoulder. Derek Clewley, Timothy W. Flynn, Shane Koppenhaver, J Orthop Sports Phys Ther. 2014 February; 44(2): 92–101. Published online 2013 November 21. doi: 10.2519/jospt.2014.4915

Week 2 Y. Wooten EBP Article

Mikotajewska, E. (2013). Changes in Barthel Index outcomes as result of poststroke rehabilitation using NDT-Bobath method. International Journal of Disability and Human Development, 12(3): 363-367

       This article describes a study conducted to determine the effectiveness of NDT in patients after an ischemic stroke.  Patients after having a stroke often have many limitations in completing ADLs and IADLs will need adequate rehab to do so. NDT (Neurodevelopmental Treatment) is method and concept of assessment and analysis of functional deficits to promote normal movement and integration of affected and unaffected sides of the body.  This is done through direct patient handling while inhibiting abnormal movement patterns.  Past research has suggested that NDT though widely used in some manner by therapists, is not superior to any other method of treatment of adults.  However these studies offered very little discussion in terms of the use of NDT for specific diagnosis.  The question still remains whether NDT in itself is an effective treatment still worth using to improve ADL performance particularly for CVA patients.  Another big question is how much of past research was conducted by therapists with extended or deep knowledge of the NDT method and how does this affect results?

       This study included 60 post CVA patients (ischemic CVA) equal numbers men and women and equal numbers LCVA and RCVA.  All patients were over 18 with mean age of 67. These patients received 30 minute sessions of NDT for 2 weeks (10 sessions).  Therapy was carried out by certified and experienced NDT therapist.  Results were measured using the following selected part of the Barthel Index: Transfers ( bed to chair), mobility (on level surface), and walking up stairs.  Result showed that overall NDT is an effective method for the increase of ADL function.  The favorable results were for patient 2-3 years poststroke, women, patients with Left sided paralysis/paresis and those aged 78-87.  Further studies are needed to look at effectiveness at various ranges poststroke and for more functional ADLs such as self-feeding, bathing, or dressing.  Such studies should also have a control group for comparison which this one did not.

Atricle:

Changes in Barthel Index outcomes as result of poststroke rehabilitation using NDT-Bobath method

Author: Mikolajewska, Emilia

ProQuest document link

Abstract:

Background: Poststroke patients need effective rehabilitation because of limitations in activities of daily living (ADLs). The aim of the study was to assess the results of ADL rehabilitation of patients after ischemic stroke who underwent NDT-Bobath therapy for adults method using selected items of the Barthel Index.

Methods: The investigated group consisted of 60 patients after ischemic stroke who participated in the program of rehabilitation: 10 sessions of the NDT-Bobath therapy for 2 weeks (10 days of the therapy). The measurement of the ADLs using selected items of the Barthel Index were performed in every patient on admission (before the therapy) and after the last session of the therapy to assess rehabilitation effects.

Results: Results among patients involved in the research were as follows: recovery, 30 cases (50%); no measurable changes, two cases (3.33%); relapse, not stated.

Conclusions: Observed statistically significant and favorable changes in the health status of patients, described by Barthel Index outcomes, confirm the effectiveness of the NDT-Bobath method.

Links:Check for Full Text at CCBC

Full text:

Introduction
Stroke constitutes a huge medical, social, and financial problem. Fifteen million people experience stroke worldwide each year, with 5 million resulting to death. Of all stroke cases, 80%-85% constitutes ischemic stroke. The effect of the stroke depends mainly on area of the brain where it occurs and the extent of brain injury. About 50% of poststroke patients have limited independence, need the help of another person in accomplishing activities of daily living (ADLs), and/or are unable to participate fully in regular community life, learn, work, etc. [1, 2]. In poststroke patients, performance of ADLs is compromised, and one of the aims of poststroke rehabilitation is to restore the patients' best possible functioning in ADLs. Particular attention is directed to looking for more effective ways of doing the ADLs. The aim of this study was to assess the results of poststroke rehabilitation based on the neurodevelopmental treatment - Bobath (NDT-Bobath) method for adults in ADL restoration using selected items of the Barthel Index. The NDT-Bobath method for adults is one of the leading methods used in poststroke rehabilitation [3-11]. This method is not only a set of exercises but a whole concept that includes disability analysis and assessment of functional deficits and their causes. Particular attention is paid to "direct" stimulated use of the affected side. The uniqueness of the NDT-Bobath method lies in its attempts to integrate both the affected and unaffected sides of the body. Neuroplasticity plays the most important role. Patient-oriented therapy, problem-solving approach, and cause-to-goals analysis are used to plan the proper intervention. The main theoretical assumptions and therapy rules are not quite simple: the newest Polish book in the area of the NDT-Bobath method in the neurorehabilitation of adults has 232 pages and yet is considered basic [11].
Despite its wide use, there is lack of studies in the area of outcomes of poststroke rehabilitation using the NDT-Bobath method [10] including ADL rehabilitation (1, 2, 12-17). Almost every research in this area is considered valuable, as each increases knowledge and improves clinical practice in neurorehabilitation.
Patients and methods
Patients
The study was carried out in 60 patients after ischemic stroke. The study group was established based on the following inclusion criteria (confirmed by medical records): age, older than 18 years; time after cerebrovascular accident (CVA), from 6 weeks to 3 years; diagnosis, ischemic stroke. The size and anatomical involvement of infarct varied among patients, and the general extent of involvement of motor areas and tracts was not described. The patients' profiles are presented in Table 1 .
Patients' overall profile. (Table omitted, see PDF)
The study was accepted by the appropriate Bioethical Committee. The subjects gave written informed consent before entering the study in accordance with the recommendations of the Bioethical Committee, acting on the rules of good clinical practice and the Helsinki Declaration.
Methods
The patients underwent 10 sessions of NDT-Bobath therapy for 2 weeks (i.e., 5 days per week, for a total of 10 days). It will be easy to compare results of further studies and experiences of clinical practice. Each session lasted 30 min.
Patients were treated according to the NDT-Bobath method by an internationally certified and experienced therapist. The international certification in the NDT-Bobath method for adults was required to provide an easier comparison of professional qualifications in the NDT-Bobath method, as recommended by Paci [10], and includes the following: *International Bobath Instructors Training Association (IBITA)-recognized basic course, "Assessment and Treatment of Adults with Hemiplegia - The Bobath Concept" *IBITA-recognized advanced course, "Assessment and Treatment of Adults with Neurological Conditions - The Bobath Concept" *EBTA-recognized NDT-Bobath basic course, "Assessment and Treatment of Children"
The measurement of the ADLs, where available, was performed twice in every patient using selected items of the Barthel Index in the areas of transfers, mobility, and stairs ( Table 2 ), on admission (before the therapy) and after the last session of the therapy, to assess the effects of rehabilitation.
Barthel Index - part of the test [18]. (Table omitted, see PDF)
Guidelines: The assessment can be used to determine a baseline level of functioning and can be used to monitor improvement in ADLs over time. The items are weighted according to a scheme developed by the authors. The person receives a score based on whether they have received help while doing the task. The scores for each of the items are summed to create a total score. The higher the score the more "independent" the person. Independence means that the person needs no assistance at any part of the task. If a person does about 50% independently then the "middle" score would apply.
A selected part of the Barthel Index consists of three items measuring patients' daily functioning in the area of ADLs and mobility: moving from wheelchair to bed and back, walking on level surface, and going upstairs and downstairs. The reliability of the test is "valid" according to studies [19-21].
The possible results were generally defined as follows: *Recovery: After therapy, there was a measured significant difference (favorable change) compared with the result at the beginning of the therapy. *Relapse: There was a measured unfavorable change compared with the result at the beginning of the therapy. *Recovery: There was no measured significant difference compared with the result at the beginning of the therapy.
Statistical analysis
The results are expressed as mean, median, maximal value, minimal value, and standard deviation (SD). The results were statistically analyzed using the Wilcoxon's test. A probability p
Results
The results are presented in Tables 3 - 8 . This study has focused on the determination of changes in three areas of ADL (moving from wheelchair to bed and back, walking on level surface, going upstairs and downstairs) that were observed as a result of the therapy conducted according to the NDT-Bobath method in a group of patients after ischemic stroke. These elements are often impaired as a result of the stroke. There were observed statistically relevant changes reflecting recovery as the result of the therapy using the NDT-Bobath method. The observed changes reflect the recovery in the areas of ADL. The results found in the patients (n=60) involved in the study were as follows: recovery, 30 cases (50%); no measurable changes, 2 cases (3.33%); relapse, not stated.
Results for whole group of patients. (Table omitted, see PDF)
Statistical analysis of the results for whole group of patients. (Table omitted, see PDF)
In the whole group, the recovery was statistically significant (p
Results depend on the side of the paresis. (Table omitted, see PDF)
In the group of patients with right-sided paresis, recovery was statistically significant (p=0.001), with the mean recovery increasing from 32.0 (median, 35.0) in the first examination to 35.8 (median, 40.0) in the second examination. In the group of patients with left-sided paresis, recovery was statistically significant (p
Results depend on sex. (Table omitted, see PDF)
In the group of women, recovery was statistically significant (p
Results depend on age. (Table omitted, see PDF)
In the group of patients younger than 68 years, recovery was statistically significant (p=0.001), with the mean recovery increasing from 33.6 (median, 35.0) in the first examination to 37.5 (median, 40.0) in the second examination. In the group of patients older than 68 years, recovery was statistically significant (p=0.001), with the mean recovery increasing from 29.5 (median, 30.0) in the first examination to 34.1 (median, 40.0) in the second examination.
Results depend on time after CVA. (Table omitted, see PDF)
In the group of patients treated within 6 weeks to 6 months after CVA, recovery was statistically significant (p=0.005), the mean recovery increasing from 30.0 (median, 30.0) in the first examination to 35.0 (median, 40.0) in the second examination. In the group of patients treated within 6 months to 1 year after CVA, recovery was statistically significant (p=0.043), with the mean recovery increasing from 34.6 (median, 40.0) in the first examination to 37.9 (median, 40.0) in the second examination. In the group of patients treated within 1 year to 2 years after CVA, recovery was statistically significant (p=0.043), with the mean recovery increasing from 35.0 (median, 40.0) in the first examination to 37.4 (median, 40.0) in the second examination. In the group of patients treated within 2 to 3 years after CVA, recovery was statistically significant (p=0.008), with the mean recovery increasing from 27.1 (median, 30.0) in the first examination to 33.6 (median, 40.0) in the second examination.
For the purposes of statistical analysis, the whole group was divided into two groups using median age (68 years).
Discussion
The results of the therapy using the NDT-Bobath method showed statistically significant changes in the health status of patients in the selected items of the Barthel Index. These changes in three areas of ADL (moving from wheelchair to bed and back, walking on level surface, going upstairs and downstairs) were favorable. The results are very good, considering the short period of rehabilitation (2 weeks, with 10 sessions) and the mean age of patients (65.7 years).
The most favorable results of the therapy were achieved by patients with the following prognostic signs: *Therapy was started between 2 and 3 years after CVA, which suggests the effectivity of the method during the late period after CVA, especially in transfer activities. *Age between 78 and 87 years, which suggest the effectivity of the method in older patients, especially in transfer activities. *Women showed the biggest change in this group, as observed in mobility on level surface areas. *Left-side paresis.
The next stages of therapy should provide better results, but there is a need for longer rehabilitation. Unfortunately, there is lack of research on the use the NDT-Bobath method for adults to compare the outcomes of the study. A systematic literature review of 15 clinical trials performed by Paci [10] demonstrated that the results show no evidence of the effectiveness of the NDT-Bobath method, but this conclusion is widely discussed and needs additional studies. Paci [10] stated that it is necessary to perform further investigations to develop outcome measures concerning the goals of the Bobath approach (motor performance and others). One of criteria of the study is the therapist's deep knowledge of the NDT-Bobath method for adults, as confirmed by international certificates and several years of experience [10, 11]; this was required because only the outcomes of the NDT-Bobath method performed by certified and experience therapists can be objectively compared. The author has reviewed publications in the PubMed (US National Library of Medicine) database, but very little research is conducted in the aforementioned area. There was no review on the subject, and there were only six articles with the specified keywords "Bobath+adults+ADL" and one research in Chinese investigating the effects of early rehabilitation on ADLs within 1 month after the first stroke [22]. This was impossible to compare their results with the present study because of a different range of time after CVA.
The main limitation of this research is the lack of a control group. In most cases, a research without a control is insufficient. However, despite this study's lack of a control group, the results presented here is an important step toward a better understanding of ADL rehabilitation of adult stroke survivors using the NDT-Bobath method. Further studies should add a control group using another rehabilitation method or solely using the NDT-Bobath method to compare the results and examine the effectiveness of method.
No doubt, there is a need to provide further studies in the area, as independent sources of knowledge are necessary to estimate the effectiveness of the NDT-Bobath method for adults in the ADL recovery of poststroke patients. Based on this study, there is a need for further research using a control group and to provide better evidence.
In conclusion, the results showed that the NDT-Bobath method for adults is an effective in the ADL rehabilitation of adult patients after ischemic stroke. There were statistically significant and favorable changes in the health status of patients in terms of ADL outcomes measured using parts of the Barthel Index.
Conflict of interest statement
Authors' conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.

Subject: Stroke; Methods; Therapy; Adults; Studies; Bioethics; Clinical medicine; Rehabilitation; Activities of daily living

Identifier / keyword: activities of daily living (ADLs), Barthel Index, ischemic stroke, NDT-Bobath, physical therapy, rehabilitation

Publication title: International Journal on Disability and Human Development

Volume: 12

Issue: 3

Pages: 363-367

Number of pages: 5

Publication year: 2013

Publication date: 2013

Year: 2013

Publisher: Walter de Gruyter GmbH

Place of publication: Berlin

Country of publication: Germany

Publication subject: Biology--Genetics, Medical Sciences--Endocrinology

ISSN: 21911231

Source type: Scholarly Journals

Language of publication: English

Document type: Journal Article

DOI: http://dx.doi.org/10.1515/ijdhd-2012-0110

ProQuest document ID: 1704337687

Document URL: http://ccbcmd.idm.oclc.org/login?url=http://search.proquest.com/docview/1704337687?accountid=3784

Copyright: Copyright Walter de Gruyter GmbH 2013

Last updated: 2015-08-21

Database: ProQuest Central

EBP Week 3 Erin Gaylor

A study published in 2015 in Manual Therapy evaluated the effectiveness of neck and aerobic training along with pain education vs. pain education alone on neck pain, muscle activity, and postural sway in patients with chronic neck pain.  The study was a single blind randomized controlled trial with a parallel group design.  Fifteen patients completed the study at a pain clinic.  8 patients were in the control group and 7 patients were in the intervention group.

 Effect on neck pain, function, and Global Perceived Effect (GPE) was measured before and after the intervention on both groups using the Cranio-Cervical Flexion Test and three postural control tests.  Surface electromyography was recorded from neck flexor and extensor muscles during the tests. 

Both the intervention group and the control group received four 1.5 hour sessions of pain education.  The intervention group also received eight supervised .5 hour training sessions with instruction in progressive neck, shoulder and balance exercises, as well as aerobic training.  The patients were instructed to perform the exercises twice a day and the aerobic training every other day.

The intention-to-treat analysis revealed that both groups experienced a reduction in pain as measured by the Numeric Rating Scale for Pain, but the intervention group experienced a greater reduction as well as increased GPE.  The reduction in pain for the intervention group was larger than two points, which is considered clinically relevant.  This study provided evidence that both pain education and specific training exercises reduce neck pain more than pain education alone.

Article

Week 1 Y. Wooten EBP Article

Demery,J.,Giuffridaic,C., Haron, R., Lebowitts, B.,Reyes,L. (2009). Functional skill learning in men with traumatic brain injury. American Journal of Occupational Therapy, 63, 398-407.

       This article describes a study conducted to investigate the effects of different practice schedule on functional skill learning for men with TBI.  It is known that TBI is one of the leading causes of disability among adults and that it often adversely effects a person’s ability to perform functional task such as personal care.  Occupational therapists over the years have shown that teaching functional skills has a greater impact in the rehabilitation of TBI patients than therapeutic exercises.  Past research on non-brain injury patients have shown that random ordered practice schedule ( high contextual interference) greatly improves functional skill learning with retention and transfer of learning. This study aims to see if such practice condition could be appropriate neurologically impaired patients.

       In this study 6 men with at least 7 years post TBI were assign into one of two groups: blocked ordered practice and random ordered practice schedule.  Blocked ordered practice is a low contextual inference where skills are learned through repetition in the same way each time whereas random ordered practice involves repetition in multiple contexts (the same concept taught in more than one context.)  Patients were treated for 50 minutes a day for 13 consecutive days. Both groups completes the same 3 task: touch typing, using adding machine, and identifying subway stops. Patients were evaluated at the end of 13 days and again 2 weeks later to measure retention and carryover.  This study found that both groups made significant gains in functional skill level and retention from baseline.  However it was found that only the random ordered group was able to transfer skill learning to other task.

View/Download Article PDF here

EBP Week 2 Erin Gaylor- Yoga and Neck Pain Reduction

EBP Week 2 by Erin Gaylor

Lit Review Summary:

A study published in Pain Medicine in 2013 assessed the effects of a 9-week yoga group intervention for fifty-one patients with chronic, nonspecific neck pain.  The study was a randomized, controlled trial conducted in the Department of Internal and Integrative Medicine at an academic teaching hospital in Essen, Germany.   The patients were randomized to either a yoga group or a wait-list control group.  The treatment consisted of weekly 90-minute yoga classes over a 9-week period.  The classes were lead by a certified lyengar yoga instructor and physiotherapist and the program was specifically designed for patients with chronic neck pain without previous experience in yoga.  Patients were given a manual describing and depicting different postures and were asked to continue daily yoga practice at home.

The results were assessed three times during the trial.  One week after the first assessment, the yoga group began yoga classes, and the control group was given a manual for home-usage.  Both groups attended a second assessment after 10 weeks.  One week later, the control group began the yoga intervention.  The third assessment was completed 12 months after first assessment for the yoga group and 12 months after the second assessment for the control group. 

The results assessed pain intensity using the visual analogue scale.  From baseline to 12-month follow-up, pain intensity improved overall in the group by a mean of 31.16%.  Neck-related disability also decreased from a score of 25.26 to 19.49 as measured by the neck disability index.  A regression analysis revealed that improvements in pain intensity were predicted by higher baseline pain intensity and higher weekly minutes of yoga practice.  This study provided evidence that yoga can be used for both short-term and long-term pain relief of chronic, nonspecific neck pain.

References:

Cramer, H., Lauche, R., Hohmann, C., Langhorst, J., & Dobos, G. (2013). Yoga for chronic neck pain: a 12-month follow-up. Pain Medicine (Malden, Mass.), 14(4), 541-548. doi:10.1111/pme.12053

Again, I have the PDF article if anyone wants it or knows how to attach it to this post! Thanks! Enjoy :)

Link to article