Effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) Based on ERAS in Improving the Physical Function Recovery for Patients Following Minimally Invasive Esophagectomy: A Prospective Randomized Controlled Trial

BackgroundPerioperative rehabilitation management is essential to enhanced recovery after surgery (ERAS). Few reports, however, focused on quantitative, detailed early activity plans for patients after minimally invasive esophagectomy (MIE). The purpose of this research was to estimate the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS inthe recovery of bowel function andphysical functionfor patients undergoingMIE. MethodsIn this single-blind, 2-arm, parallel-group, randomized pilot clinical trial, patients were selectedfrom June 2019 to February 2020 and assigned to the intervention group (IG) or the controlgroup(CG)randomly.The participants inIGreceived at-ECRPstrategy during theperioperative period, and the CG received routine care. The recovery of bowel andphysical function, readiness for hospital discharge (RHD) and postoperative hospital stay evaluated on the day of discharge. Results215 cases were enrolled and randomized to theIG (n=107)orCG (n=108). There was no significant difference between the two groups in terms of demographic and clinicalcharacteristics and baseline physical function.After the t-ECRP intervention,the IG group presented a significantly shorter time tofirst flatus(P<0.001) and to first bowel movement postoperative (P=0.024),and a better physical function recovery (P＜0.001), compared with theCG group.The analysis also showed thatparticipants in the IG have higherscores of RHD and shorter length of postoperative stay than the CG (P＜0.05).Conclusions The findings suggest that the t-ECRP can improve bowel andphysical functionrecovery,amelioratepatients'RHD, and shorten postoperative hospital stayfor patients undergoing MIE.Trial registrationClinicalTrials.gov (Identifier: NCT01998230)

Development and Feasibility of the Early Rehabilitation Program on Postoperative Enhanced Recovery Following Minimally Invasive Esophagectomy: A Prospective Randomized Controlled Trial

Background: Perioperative rehabilitation management is essential to enhanced recovery after surgery. Few reports, however, focused on quantitative, detailed early activity plans for patients after esophagectomy. Aim: The purpose of this research was to estimate the effect of the Early Rehabilitation Program (ERP) on the recovery of bowel function and physical function for patients undergoing esophagectomy. Method: In this single-blind, 2-arm, parallel-group, randomized pilot clinical trial, patients were selected from June 2019 to February 2020 and assigned to the intervention group (IG) or the control group(CG) randomly. The participants in IG received an ERP strategy during the perioperative period, and the CG received routine care. The recovery of bowel and physical function, readiness for hospital discharge (RHD) and postoperative hospital stay were evaluated on the day of discharge. Results: 215 cases were enrolled and randomized to the CG (n=108) or IG (n=107). There was no significant difference between the two groups in terms of demographic and clinical characteristics and baseline physical function. After the ERP intervention, the IG group presented a significantly shorter time to first flatus (P<0.001) and to first bowel movement postoperative (P=0.024), and a better physical function recovery (P＜0.001), compared with the CG group. The analysis also showed that participants in the IG have higher scores of RHD and shorter length of postoperative stay than the CG (P＜0.05). Conclusion: The findings suggest that the ERP can improve bowel and physical function recovery, ameliorate patients' RHD, and shorten postoperative hospital stay for patients undergoing MIE.Trial registration：ClinicalTrials.gov Identifier: NCT01998230

Changes in the Physical Function and Psychological Distress from Pre-Implant to 1, 6, and 12 Months Post-Implant in Patients Undergoing Implantable Cardioverter Defibrillator Therapy

Recipients of implantable cardioverter-defibrillator (ICD) therapy in Western countries often experience distressful physical and psychological adjustments. Sociocultural influences on post-implant recovery are likely; however, evidence from other ethnic/cultural backgrounds is lacking. This study aimed to examine the changes in physical function and psychological distress (anxiety and depressive symptoms) from pre-implant to one, six, and 12 months post-implant in Korean patients undergoing ICD therapy. A total of 34 patients underwent pre- to post-implant longitudinal assessments of physical and psychological function using mixed modeling procedures. Physical function significantly declined from pre-implant to one month post-implant (B = −10.05, p = 0.004) and then nearly returned to the pre-implant level at six months post-implant (B = 8.34, p = 0.028). This level of improvement continued through 12 months post-implant. In psychological distress, significant improvements were observed from pre-implant to one month (anxiety (B = −1.20, p = 0.020) and in depressive symptoms (B = −1.15, p = 0.037)), which then plateaued without significant changes from one to 12 months. We concluded that physical function recovery occurred six months post-implant, but function remained poor until 12 months post-implant. Psychological distress improved one month post-implant and it was maintained. Clinicians must provide more intensive interventions to improve long-term physical function after ICD therapy.

Efficacy Comparison of Five Different Acupuncture Methods on Pain, Stiffness, and Function in Osteoarthritis of the Knee: A Network Meta-Analysis

The principal objective of this present study was to compare the effects of different acupuncture methods on pain, stiffness, and physical function for osteoarthritis of the knee by the pairwise and network meta-analysis (NMA). A network meta-analysis of randomized controlled trials (RCTs) was searched from three English databases and one Chinese database until January 2018. A pairwise meta-analysis was performed with a random effects model. Then we carried out the NMA within a Bayesian framework. Mean difference (MD) and its 95% confidence interval (CI) were calculated by R 3.4.1, Stata 14.0, and RevMan 5.3 software to assess the relief of pain, the effectiveness for stiffness, and physical function recovery. Node-splitting method was used to calculate the inconsistency. Rank probabilities were assessed and clustered by the surface under the cumulative ranking curve (SUCRA). 16 trials mostly researched short-term effectiveness and showed that fire needle and electro-acupuncture were statistically significant to decrease WOMAC pain and physical function scores when compared with other treatments, but there was no significant difference in stiffness calculations. Our NMA demonstrated that acupuncture with heat pain or electrical stimulation might be suggested as the better choices in all acupuncture methods to osteoarthritis of the knee.