Objective: To develop a clinical prediction rule (CPR) that predicts treatment responses to mechanical lumbar traction (MLT) among patients with lumbar disc herniation (LDH). Method: This study was an uncontrolled prospective cohort study. The subjects included 103 patients diagnosed with LDH for which they underwent conservative therapy. The subjects received MLT for 2 weeks, and the application of any other medication was left at the discretion of the attending physician. The initial evaluation was performed prior to the initiation of treatment. The independent variables from the initial evaluation were imaging diagnosis, Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire score, visual analog scale, medical interview, physical examination. The patients whose ODI after 2 weeks of treatment improved by ≥50% of that at the initial evaluation were defined as responders. Results: Of the 103 subjects, 24 were responders, and the five predictors selected for the CPR were limited lumbar extension range of motion, low-level fear-avoidance beliefs regarding work, no segmental hypomobility in the lumbar spine, short duration of symptoms, and sudden onset of symptoms. For the patients with at least three of the five predictors, the probability of their ODI greatly improving increased from 23.3% to 48.7% compared with the patients without these predictors (positive likelihood ratio, 3.13). Conclusion: Five factors were selected for the CPR to predict whether patients with LDH would demonstrate short-term improvement following conservative therapy with MLT.
Objective: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. Methods: We enrolled 302 patients (mean age, 69±10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. Results: Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P =.01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P =.041) than in those without (OR: 2.22, P =.052). Conclusions: POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lower-extremity function during hospitalization.
Background: The 2-min walk test (2MWT) may be a simple and easy measurement of exercise tolerance for vertebral compression fracture (VCF) patients. But, the validity and reliability of the 2MWT in patients with VCFs have not been verified. The aim of this pilot study was to investigate the validity and reliability of the 2MWT in VCF patients. Methods: Ten patients with VCFs were selected from the inpatient convalescence rehabilitation ward. These patients were required to walk for a minimum of 6 minutes. The study was conducted over three test days. On the first and second test days, the participants completed one trial of the 2MWT each day. These data were used in the analyses for an intra-class correlation coefficient (ICC [1,1]). On the third test day, participants completed the 6-min walk test (6MWT). These data assessed the construct validity of the 2MWT. Participants completed testing on 3 days within a 5-day period. Results: A significant correlation was found between the 2MWT and the 6MWT (r=0.945; p<0.05), which suggested a high construct validity of the 2MWT. The intraclass correlation coefficient of the repeated 2MWTs was high (ICC=0.98; p<0.05), intimating that it had a high test-retest reliability. Conclusion: The 2MWT is a valid test for the assessment of exercise capacity in patients with VCFs. It is practical, simple, and well tolerated by patients with VCFs.