title: Intensive physiotherapy for vegetative and minimally conscious state patients: a retrospective audit and analysis of therapy intervention.
abstract: OBJECTIVE
  To analyse physiotherapy interventions and evaluate their effectiveness in the prevention and management of contracture with patients admitted in either vegetative or minimally conscious state in a UK Inpatient Regional Acquired Brain Injury Rehabilitation Service.
  
  
  METHODS
  Retrospective audit of dependency levels and physiotherapy interventions in ten vegetative or minimally conscious state patients admitted over a 3-year period (2006-2009). Admission and discharge patient dependency status, Wessex Head Injury Matrix data and passive range of movement measurements on admission and discharge from physiotherapy were recorded.
  
  
  RESULTS
  All patients presented with hypertonicity including contractures and all initially received a manual stretching/passive movement programme. Casting/splinting was employed in 8 cases and 7 received botulinum toxin injections. Standing regimes were initiated for 8 patients. No patient emerged out of either vegetative or minimally conscious state. Although they remained fully dependent for care needs, carer burden was reduced and all patients were able sustain a seating regimen. No minimal clinically important difference was observed in 85 out of 120 joint ranges measured (70.8%). Positive outcomes were observed in only 14 joints (11.7%) and negative outcomes in 21 joints (17.5%).
  
  
  CONCLUSIONS
  At present, there is a paucity of evidence regarding physiotherapy efficacy to inform the management of patients in vegetative or minimally conscious state. Clearer agreed definitions of clinically important difference in passive range of movement are required to allow better interpretation of outcomes. Interventions should be aimed at minimising carer burden and developing individualised disability management programmes. Further research documenting the long-term outcomes in such patients is warranted.
authors.affiliation: Regional Acquired Brain Injury Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Wheatley-Smith
authors.forename: Siobhan
authors.initials: S
authors.lastname: McGuinness
authors.forename: F
authors.initials: F
authors.lastname: Colin Wilson
authors.forename: Gareth
authors.initials: G
authors.lastname: Scott
authors.forename: John
authors.initials: J
authors.lastname: McCann
authors.forename: Sheena
authors.initials: S
authors.lastname: Caldwell
mesh_terms: D000328:Adult; D003286:Contracture / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000628:therapy*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome