Conventional versus neutral positioning in central neurological disease
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Conventional versus neutral positioning in central neurological disease : a multicenter randomized controlled trial. / Pickenbrock, Heidrun; Ludwig, Vera U; Zapf, Antonia; Dressler, Dirk.
In: DTSCH ARZTEBL INT, Vol. 112, No. 3, 16.01.2015, p. 35-42.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Conventional versus neutral positioning in central neurological disease
T2 - a multicenter randomized controlled trial
AU - Pickenbrock, Heidrun
AU - Ludwig, Vera U
AU - Zapf, Antonia
AU - Dressler, Dirk
PY - 2015/1/16
Y1 - 2015/1/16
N2 - BACKGROUND: Severe immobility due to lesions of the brain necessitates therapeutic positioning over the long term. There is little scientific evidence concerning the efficacy of different positioning methods. This clinical trial compares the effects of conventional positioning (CON) with those of positioning in neutral (LiN).METHODS: A prospective, multicenter, investigator-blinded, randomized, controlled trial was performed on a total of 218 non-ambulatory patients (underlying disease: stroke, 141 patients; hypoxic brain damage, 28; traumatic brain injury, 20; other, 29). The subjects were randomly assigned to either LiN (105 patients) or CON (113 patients) and stratified within each of these two positioning concepts to five different positions. They remained in the assigned positions for two hours. The primary endpoint was change in the passive range of motion (PROM) of the hip joints. Secondary endpoints were change in the PROM of the shoulder joints and patient comfort.RESULTS: Patients in the LiN group had a significantly better PROM of the hips after positioning than those in the CON group (difference, 12.84°; p<0.001; 95% confidence interval [CI], 5.72°-19.96°). The same was true for PROM of shoulder flexion (11.85°; p<0.001; 95% CI, 4.50°-19.19°) and external rotation (7.08°; p<0.001; 95% CI: 2.70°-11.47°). 81% of patients in the LiN group reported their comfort level as good, compared to only 38% in the CON group (p<0.001).CONCLUSION: Positioning severely immobilized patients in LiN for two hours improved passive hip and shoulder mobility and patient comfort compared to conventional positioning. Further studies are needed to determine whether prolonged LiN positioning might improve rehabilitation and quality of life, prevent pressure sores, or ease nursing care.
AB - BACKGROUND: Severe immobility due to lesions of the brain necessitates therapeutic positioning over the long term. There is little scientific evidence concerning the efficacy of different positioning methods. This clinical trial compares the effects of conventional positioning (CON) with those of positioning in neutral (LiN).METHODS: A prospective, multicenter, investigator-blinded, randomized, controlled trial was performed on a total of 218 non-ambulatory patients (underlying disease: stroke, 141 patients; hypoxic brain damage, 28; traumatic brain injury, 20; other, 29). The subjects were randomly assigned to either LiN (105 patients) or CON (113 patients) and stratified within each of these two positioning concepts to five different positions. They remained in the assigned positions for two hours. The primary endpoint was change in the passive range of motion (PROM) of the hip joints. Secondary endpoints were change in the PROM of the shoulder joints and patient comfort.RESULTS: Patients in the LiN group had a significantly better PROM of the hips after positioning than those in the CON group (difference, 12.84°; p<0.001; 95% confidence interval [CI], 5.72°-19.96°). The same was true for PROM of shoulder flexion (11.85°; p<0.001; 95% CI, 4.50°-19.19°) and external rotation (7.08°; p<0.001; 95% CI: 2.70°-11.47°). 81% of patients in the LiN group reported their comfort level as good, compared to only 38% in the CON group (p<0.001).CONCLUSION: Positioning severely immobilized patients in LiN for two hours improved passive hip and shoulder mobility and patient comfort compared to conventional positioning. Further studies are needed to determine whether prolonged LiN positioning might improve rehabilitation and quality of life, prevent pressure sores, or ease nursing care.
KW - Aged
KW - Austria
KW - Brain Injuries
KW - Female
KW - Germany
KW - Humans
KW - Male
KW - Paralysis
KW - Patient Positioning
KW - Pressure Ulcer
KW - Single-Blind Method
KW - Treatment Outcome
KW - Journal Article
KW - Multicenter Study
KW - Randomized Controlled Trial
U2 - 10.3238/arztebl.2015.0035
DO - 10.3238/arztebl.2015.0035
M3 - SCORING: Journal article
C2 - 25657075
VL - 112
SP - 35
EP - 42
JO - DTSCH ARZTEBL INT
JF - DTSCH ARZTEBL INT
SN - 1866-0452
IS - 3
ER -