BackgroundThere is increasing evidence for the beneficial effects of exercise training in stroke survivors. In order to reach the desired training effects, exercise training principles must be considered as this ensures the prescription of adequate exercises at an adequate dose. Moreover, exercise training interventions must be designed in a way that maximizes patients’ adherence to the prescribed exercise regimen. The objectives of this systematic review were (1) to investigate whether training principles for physical exercise interventions are reported in RCTs for sub-acute and chronic stroke survivors, (2) to evaluate whether the RCTs reported the prescription of the FITT components of the exercise interventions as well as (3) patients’ adherence to this prescription, and (4) to assess the risk of bias of the included studies.MethodsWe performed a systematic review of RCTs with exercise training as the primary intervention and muscular strength and/or endurance as primary outcomes. The Cochrane library’s risk of bias (ROB) tool was used to judge the methodological quality of RCTs.ResultsThirty-seven RCTs were included in this systematic review. Eighteen studies (48.7%) focused on aerobic, 8 (21.6%) on resistance and 11 (29.7%) on combined interventions of aerobic and resistive strength exercise. Twenty-nine studies (78.4%) included only chronic stroke survivors, 5 studies (13.5%) only sub-acute stroke survivors whilst 3 studies (8.1%) included both. In terms of principle of exercise training, 89% reported specificity, 75.7% progression, 48.7% overload, 37.8% initial values, 32.4% reversibility and 13.5% diminishing returns. One RCT described all principles of physical exercise training and 19 (51.4%) all FITT components. Patients’ adherence to exercise prescription was accounted for in 3 studies (8.1%). Failure to report blinding in patients and participants and failure to report allocation concealment were the most prevalent methodological shortcomings.ConclusionsIncomplete and inconsistent reporting of (1) training components, (2) underlying exercise training principles and (3) patient adherence together with (4) a broad variation in the methodological quality of the included RCTs limit both the utility and reproducibility of physical exercise programs in stroke patients.

Introduction. Hand injuries commonly account for a fifth of all emergencies presenting to emergency departments of most hospitals in Europe. One-third of these injuries lead to chronic hand disability that entails economical, psychological, physical and social implications on the wellbeing of hand-injured adults with long-term consequences. However, knowledge about the impact of chronic hand disability on occupations in the long term is limited. Methods. The purpose of this narrative study was to understand how adults after a hand injury experience the impact of chronic hand disability on their occupations over time. Participants were selected through purposive sampling. Two narrative interviews were conducted with each participant and analysed using narrative and structural analysis. Results. All participants experienced the challenge of occupational disruption. They faced occupational limitations with the consequence of changed occupational patterns, and later strived for normality. In the end, all participants still needed to get accustomed to occupational changes. Conclusion. The findings indicate that this process of occupational adaptation continues on for at least one year after the hand injury. They further highlight the importance to support the clients through engagement in occupation during the therapy process.

The treatment of neuropathic pain challenges not only doctors but also hand therapists, since a majority of patients don't experience a significant pain relief despite systemic pain treatment. Early diagnosis of neuropathic pain and a therapeutic concept is crucial to meet the individual needs of the patient. The complexity of a pain syndrome calls for a multidisciplinary approach using patient education, pharmacological and non-pharmacological therapies, such as graded motor imagery or somatosensory rehabilitation, behavioral therapy and physical measures. The evidence of the above mentioned therapies with regards to neuropathic pain is not yet completely established. Possible reasons are the lack of complete understanding of the pain causing mechanisms and the fact of treating the symptoms rather than the cause.

No abstract