ObjectiveInvestigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities.DesignSystematic review of randomised controlled trials.Data sourcesSearches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO.Eligibility criteriaTrials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence.ResultsForty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: −0.4 to 0.1), physical function (95% CI: −0.2 to 0.2) and quality of life (95% CI: −0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: −0.1 to 0.5) and quality of life (95% CI: −0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term.ConclusionsExercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.

HighlightsThe surgical ankle presented lower stiffness values than the non-surgical ankle in the same subject.The surgical ankle presented lower stiffness than the non-surgical group.The SU group had greater absolute asymmetry of ankle stiffness.The SU group had greater absolute asymmetry of plantar flexor muscle work.

Background Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition. Methods This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual’s functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals’ homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system’s usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be a physical function (Timed Up and Go and 30-s Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system. Discussion The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid the implementation of similar proposals in other patient groups. Trial registration Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020.

Background: The ''6-clicks'' is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly. Objective: Cross-culturally adapt the ''6-clicks'' into Brazilian-Portuguese and verify its measurement properties. Methods: Cross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients' of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included. Results: Minor changes implemented to the original version. The three domains showed adequate internal consistency (˛ > 0.65). Inter-rater reliability (n = 50) and test-retest reliability, when administer to patients (n = 51) and to companions (n = 30), showed good for basic mobility domain (ICC 2.1 = 0.81, 0.83 and 0.82, respectively), good to moderate for daily activity

Objetivo: descrever o perfil sociodemográfico, clínico e funcional dos pacientes atendidos pela fisioterapia, internados nas enfermarias de hospitais universitários de grande porte de Belo Horizonte. Métodos: participaram 200 adultos, de ambos os sexos, internados nas enfermarias do Hospital das Clínicas da Universidade Federal de Minas Gerais e do Hospital Risoleta Tolentino Neves, em atendimento fisioterápico. As informações foram coletadas no prontuário e por meio de perguntas ao paciente/acompanhante. A funcionalidade nos domínios de mobilidade básica, atividade diária e cognição aplicada foram avaliadas pelo “6-clicks”, instrumento desenvolvido com o arcabouço teórico da Classificação Internacional da Funcionalidade, Incapacidade e Saúde que avalia especificamente pacientes hospitalizados. Para análise, utilizou-se medidas de tendência central, dispersão e frequência, e testes comparativos não paramétricos. Resultados: os pacientes tinham 59±17,13 anos e, renda e escolaridade baixas. Um pouco mais da metade (52%) era de outro município. Foi observado tempo prolongado de internação de 27,1±29,93 dias, presença de comorbidades e reinternações frequentes. Condições neurológicas e cardíacas foram predominantes. A média de atendimento fisioterápico foi de 23 sessões e 63,5% recebiam acompanhamento de nutricionistas. Em quase todos os setores dos hospitais, a mobilidade básica foi o domínio mais comprometido, seguido de atividade diária e cognição aplicada (p0,05). Os idosos apresentaram mais déficits em atividade diária bem como aqueles internados há pelo menos 30 dias (p0,05). Os mais jovens obtiveram melhores resultados em cognição aplicada enquanto os menos escolarizados, piores resultados (p0,05). Conclusão: esses resultados podem nortear gestores para alocação de recursos humanos e financeiros, além de fomentar a criação de programas para melhorar a mobilidade e diminuir a permanência hospitalar, reduzindo os impactos negativos da hospitalização e potencializando a assistência.

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Background: Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition.Methods: This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual’s functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals’ homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be physical function (Timed Up and Go and 30-second Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system.Discussion: The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid implementation of similar proposals in other patient groups. Trial registration: Brazilian Clinical Trials Registry, RBR-9243v7. Registered on 24 August 2020.

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