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Evaluating Shoulder Stiffness Following Post-Mastectomy Breast Reconstruction
e66 5 lasertherapy vs 5 placebo. 5 combined. 30 day intervention. Main Outcome Measure(s): FIQ scale. Results: Homeopathy and laser resulted effective vs placebo ( p 0,001) ANOVA. Reduction of the dosage of SOC treatment (50% average) Cortisone,Duloxetine, Pregabalin. The combined one provided better results (p 0,000). No reported side effects or interactions with SOC. Conclusion/Discussion: Given the results an Integrative approach should be considered in the rehabilitation of chronic diseases like Fibromyalgia studies with a bigger N and other modalities should be considered in the future. Key Words: Physical Rehabilitation Medicine, Fibromyalgia, Lasertherapy, Integrative Medicine, Homeopathy Disclosures: The authors declare no conflict of interest. Research Poster 313685 Evaluating Shoulder Stiffness Following PostMastectomy Breast Reconstruction David Lipps (University of Michigan), Joshua Leonardis, Brian Diefenbach, Daniel Lyons, Thomas Olinger, Adeyiza Momoh Research Objectives: To identify how three post-mastectomy breast reconstruction techniques impact the integrity of the shoulder joint. Design: Cross-sectional study. Setting: University-based research laboratory. Participants: 27 post-mastectomy breast cancer patients were examined at least 18 months post-reconstructive surgery. Patients whose surgery disinserted a shoulder muscle (9 implant only (IMP) and 10 latissimus dorsi flaps (LAT)) were compared to 8 patients whose deep inferior epigastric perforator (DIEP) flap surgery did not impact the shoulder. Interventions: Robot-assisted biomechanical measures of shoulder stiffness were acquired. A single-axis rotary motor applied small, stochastic perturbations over several 60 second trials while measuring resultant multidimensional shoulder torques. Patients were examined with their arm elevated 90 degrees while relaxed or actively producing torques scaled to 10% of their isometric strength. Measurements were repeated in the horizontal and vertical adduction directions. Joint impedance, the dynamic relationship between joint angle and torque, was fitted with a 2nd order model to estimate shoulder stiffness. Main Outcome Measure(s): Multi-dimensional shoulder strength and stiffness. Results: A linear mixed model analyzed between-groups differences. The LAT group exhibited reduced shoulder strength than the DIEP flap group in vertical adduction (p Z 0.05) and horizontal abduction (p Z 0.03). No strength differences existed between the IMP and DIEP groups. Shoulder stiffness was compromised in the horizontal plane, where the LATand IMP groups exhibited significantly lower shoulder stiffness than the DIEP group during passive, adduction, and abduction tasks (all p < 0.05). Shoulder stiffness in the vertical plane was similar between the groups except the LAT group exhibited lower shoulder stiffness than the DIEP group during adduction (p Z 0.02). Conclusion/Discussion: Passive and active integrity of the shoulder in the horizontal plane is compromised in IMP and LAT breast reconstruction patients. Key Words: Reconstructive Surgical Procedures, Breast Cancer, Shoulder Joint, Biomechanical Phenomena Disclosures: None.
Research Poster 324245 Evidence-Based Evaluation of Practice and Innovation in Rehabilitation Using the IDEALPhysio Framework Arsenio Paez (University of Oxford, Oxford, Northeastern University), David Hamilton, Loretta Davies, Jonathan Cook, Allison Hirst, Peter McCulloch, David Beard
Research Posters Research Objectives: To present and outline the application of the IDEAL framework as an established method of formalising the evaluation of innovation in complex interventions such as Surgery, Physical Therapy, and Rehabilitation. IDEAL-Physio proposes that innovation and evaluation in clinical practice should evolve together in an ordered manner, from conception to validation by appropriate clinical trials. Design: IDEAL describes a five-stage process for introducing innovation in complex. Interventions: Idea, Development, Exploration, Assessment, and Longterm study. Setting: Physical Therapy and Rehabilitation Medicine. Participants: IDEAL lends itself to complex, non-pharmacological interventions. Interventions: Ideal-Physio has five stages; Stage-1, the idea phase where formal data collection should begin. Stage-2a, for iterative improvement and adjustment with thorough data recording. Stage-2b, the onset of formal evaluation using systematically collected group or cohort data. Stage-3, the formal comparative assessment phase of treatment usually involving randomised studies. Stage- 4; long-term follow-up. Main Outcome Measure(s): IDEAL-Physio is recommended as a method of guiding and evaluating innovation in Physical Therapy and Rehabilitation Medicine, and guiding the evaluation of practice with the overall strategy of providing better evidence-based care and foster innovation in Physical Therapy and Rehabilitation, and the varied populations they serve. Results: IDEAL has been shown to be a feasible method for documenting the development and implementation of new procedures in patient care and is now successfully embedded in the surgical sciences at a global level and has been adapted for evaluating and regulating the use of medical devices. Conclusion/Discussion: Ideal-Physio can guide major gains in Rehabilitation and PT innovation through the development of reporting systems (Stage-1), protocol registries (Stage-2a), comprehensive, disease-specific research databases (Stages-2b, 3) and population registries (Stage-4). Physical Therapy and Rehabilitation can be improved, and safe and efficient innovation in practice fostered, by IDEAL-Physio. Key Words: Rehabilitation, Physical Therapy, Innovation, Evaluation, Evidence-Based Practice Disclosures: None. Research Poster 308115 Examining the Effect of Receiving Strategy Training Intervention on Usual Care Practice Stephanie Harleman (University of Pittsburgh), Elizabeth Skidmore Research Objectives: Compared to directed cues, guided cues are associated with favorable outcomes for individuals with stroke-related cognitive impairments. We examined the frequencies of directed and guided cues in usual rehabilitation care (occupational therapy and physical therapy) and in strategy training sessions (where guided cues are emphasized). Design: Secondary analysis of randomized controlled trial. Setting: Participants were recruited upon admission to inpatient rehabilitation at an academic health center. Participants: Participants had a diagnosis of acute stroke and cognitive impairment (Executive Interview 3). Individuals with severe aphasia, dementia, or current psychiatric conditions were excluded. Interventions: All participants engaged in usual rehabilitation care; in addition, participants were randomized to receive an extra session of reflective listening (a non-active control, nZ20) or strategy training (nZ20). Randomly selected usual rehabilitation care sessions (20% of total sessions for all 40 participants) and strategy training sessions (20% of sessions for 20 participants receiving strategy training) were videotaped and analyzed. Main Outcome Measure(s): Using a standardized coding scheme, trained research staff blinded to group assignment coded the number of therapist cues per minute and the proportions of cues that were directed and guided cues during training activities for usual rehabilitation care and strategy training sessions.
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Research Poster 324245 Evidence-Based Evaluation of Practice and Innovation in Rehabilitation Using the IDEALPhysio Framework Arsenio Paez (University of Oxford, Oxford, Northeastern University), David Hamilton, Loretta Davies, Jonathan Cook, Allison Hirst, Peter McCulloch, David Beard
Research Posters Research Objectives: To present and outline the application of the IDEAL framework as an established method of formalising the evaluation of innovation in complex interventions such as Surgery, Physical Therapy, and Rehabilitation. IDEAL-Physio proposes that innovation and evaluation in clinical practice should evolve together in an ordered manner, from conception to validation by appropriate clinical trials. Design: IDEAL describes a five-stage process for introducing innovation in complex. Interventions: Idea, Development, Exploration, Assessment, and Longterm study. Setting: Physical Therapy and Rehabilitation Medicine. Participants: IDEAL lends itself to complex, non-pharmacological interventions. Interventions: Ideal-Physio has five stages; Stage-1, the idea phase where formal data collection should begin. Stage-2a, for iterative improvement and adjustment with thorough data recording. Stage-2b, the onset of formal evaluation using systematically collected group or cohort data. Stage-3, the formal comparative assessment phase of treatment usually involving randomised studies. Stage- 4; long-term follow-up. Main Outcome Measure(s): IDEAL-Physio is recommended as a method of guiding and evaluating innovation in Physical Therapy and Rehabilitation Medicine, and guiding the evaluation of practice with the overall strategy of providing better evidence-based care and foster innovation in Physical Therapy and Rehabilitation, and the varied populations they serve. Results: IDEAL has been shown to be a feasible method for documenting the development and implementation of new procedures in patient care and is now successfully embedded in the surgical sciences at a global level and has been adapted for evaluating and regulating the use of medical devices. Conclusion/Discussion: Ideal-Physio can guide major gains in Rehabilitation and PT innovation through the development of reporting systems (Stage-1), protocol registries (Stage-2a), comprehensive, disease-specific research databases (Stages-2b, 3) and population registries (Stage-4). Physical Therapy and Rehabilitation can be improved, and safe and efficient innovation in practice fostered, by IDEAL-Physio. Key Words: Rehabilitation, Physical Therapy, Innovation, Evaluation, Evidence-Based Practice Disclosures: None. Research Poster 308115 Examining the Effect of Receiving Strategy Training Intervention on Usual Care Practice Stephanie Harleman (University of Pittsburgh), Elizabeth Skidmore Research Objectives: Compared to directed cues, guided cues are associated with favorable outcomes for individuals with stroke-related cognitive impairments. We examined the frequencies of directed and guided cues in usual rehabilitation care (occupational therapy and physical therapy) and in strategy training sessions (where guided cues are emphasized). Design: Secondary analysis of randomized controlled trial. Setting: Participants were recruited upon admission to inpatient rehabilitation at an academic health center. Participants: Participants had a diagnosis of acute stroke and cognitive impairment (Executive Interview 3). Individuals with severe aphasia, dementia, or current psychiatric conditions were excluded. Interventions: All participants engaged in usual rehabilitation care; in addition, participants were randomized to receive an extra session of reflective listening (a non-active control, nZ20) or strategy training (nZ20). Randomly selected usual rehabilitation care sessions (20% of total sessions for all 40 participants) and strategy training sessions (20% of sessions for 20 participants receiving strategy training) were videotaped and analyzed. Main Outcome Measure(s): Using a standardized coding scheme, trained research staff blinded to group assignment coded the number of therapist cues per minute and the proportions of cues that were directed and guided cues during training activities for usual rehabilitation care and strategy training sessions.
www.archives-pmr.org