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M. L. A. P. Schnackers et al.
description of the content of these activities was given.
In the other papers selected, no rehabilitation therapy
that focuses on the ICF activity level was provided.
ICF – Participation level. No explicit interventions that
focus on the ICF participation level were described in
either of the post-surgical rehabilitation programmes
selected.
Acetabulum fractures. The paper by Maurer et al.
(4) addressed the physiotherapeutic/occupational th-
erapeutic rehabilitation of acetabulum fractures after
surgical as well as conservative treatment, although
in the present paper we only outline the post-surgical
rehabilitation programme. Maurer et al. (4) described
the therapy in more detail compared with the papers
addressing the rehabilitation of proximal humerus
fractures. Furthermore, the rehabilitation programme
focussed not only on recovery of the affected region,
but also on maintaining the mobility and strength of
the contralateral side and on possible risks of the pa-
tients being bedridden, e.g. prevention of pneumonia
and thrombosis. The goal of the post-surgical therapy
was restoring painless functioning of the affected joint
towards pre-injury level with concomitant levels of
full weight-bearing associated with stance and gait.
ICF – Body Functions and Structures level. The pro-
tocol is subdivided into, what are termed 4 successive
“mobilization phases”, implying that the focus of the
therapy was mostly on the ICF Body Functions and
Structures level. In the first phase, only therapy related
to mobility, i.e. traction and stretching, and muscle
strength was provided. During this first phase, patients
were immobilized. Patients lay in bed in the supine
position with traction in the longitudinal direction of
the affected bone. Furthermore, treatment aimed to
preserve the mobility, muscle strength and coordination
of both lower limbs using the proprioceptive neuro-
muscular facilitation (PNF) technique (12). Therapy
dosage was not mentioned.
In the second phase, the therapy was expanded, but
still only targeting the mobility. It was stated that PNF
treatment was continued, although the therapy content
was not specified. The appliances for the positioning
in bed, such as foamed splints, were removed in or-
der to enlarge the mobility of the hip joint. The goal
was to: (i) mobilize the affected hip by using small
movements with little or no weight-bearing; and (ii)
improve muscle strength and coordination, according
to the functional kinetics of Klein-Vogelbach (13).
Furthermore, movements of single gait phases were
practiced passively in bed. The frequency and dura-
tion of the therapy and exercises were not mentioned.
Besides the hip joint of the affected limb the ipsilateral
knee joint was trained in this second phase.
www.medicaljournals.se/jrm
The third phase of the programme started in the third
week post-trauma. The traction in the longitudinal
direction of the affected bone was removed. Mobiliza-
tion of the affected limb was continued in this phase.
Previously trained PNF-related movement transitions
and patterns were now used during the training of sit-
ting, gait and stance. Patients could participate in group
hydrotherapy to train non-weight-bearing and group
remedial therapy focussing on stabilization and the
mobility of the knee joint. The content of both group
sessions was not specified. Due to a lack of information
about the therapy dosage, it was not possible to assess
whether the therapy in this phase improved endurance.
In the fourth and last phase, patients received treat-
ment in an outpatients’ department. Patients could be
discharged from the hospital when the muscles could
secure the mobility of the affected hip joint and the
gait pattern corresponded with the physiological gait
pattern. In this last phase, reaching full loading of the
affected joint at approximately 10 weeks post-trauma
was aimed for by gradually increasing the loading of
the injured limb. No information was provided about
the assessment of weight-bearing. Exercises and other
therapy components performed in this phase were not
specified. Furthermore, therapy frequency and duration
were not specified.
Similar to the protocols on proximal humerus frac-
tures, assessment rules based on patient characteristics
or on the progression of the fracture recovery were
missing in most phases of this protocol. In addition,
no methods to objectively monitor the rehabilitation
progress were mentioned. Patient-specific care cannot
be provided on the basis of this protocol. Although
care was provided for physical consequences of the
fracture, possible psychological consequences were
disregarded.
The authors did not provide scientific evidence on
which to base the rehabilitation programme described,
and did not scientifically examine the effectiveness of
their programme.
ICF – Activity level. In addition to the previously
described therapy in the third phase, the post-surgical
rehabilitation programme also provided therapy focus-
sing on the ICF activity level. In this phase, patients
were allowed to walk with the aid of elbow crutches
loading the affected limb to a maximum of 20 kg. How
this weight was controlled was not described. Therapy
focusing on the ICF activity level was not provided in
any of the other phases.
ICF – Participation level. No therapy aims on the ICF
level of participation were described. In Table II, the
content of the physiotherapy/occupational therapy
programmes selected, is summarized.