Ambrogi Vincenzo, Mineo Tommaso Claudio
From the Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University, Rome, Italy.
Am J Phys Med Rehabil. 2017 Feb;96(2):77-83. doi: 10.1097/PHM.0000000000000538.
To demonstrate the effectiveness of a comprehensive program of rehabilitation therapy in patients undergoing thymectomy for myasthenia gravis (MG).
From 2005 to 2010, 46 consecutive patients affected by MG underwent a rehabilitation program both before and after thymectomy. We matched each patient with a "control patient" who underwent thymectomy within the period 1999 to 2004 with no preoperative rehabilitation, who had the closest propensity score matching.
All patients but 2 were able to complete the intended program. Eighteen patients (41%) experienced mild fatigue (>25 at MG quantitative score). Propensity score selected a group of 17 patients for the matching process. The group of patients who underwent the rehabilitation program showed significant preoperative improvement associated with a reduced operative risk, a decreased early postoperative morbidity, a lower rate of postoperative intensive care unit needed (12% vs 35%; P = 0.01) and a shorter hospital stay (3 vs 5 days; P = 0.04). After the expected perioperative decline, all major myasthenic outcomes demonstrated a significant faster recovery at 3 months. Complete stable remission did not reveal significant differences.
Exercise is not necessarily a contraindication in MG, and rehabilitation can be safely performed before and after thymectomy, reducing operative risks and decreasing recovery time.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME OBJECTIVES: Upon completion of this article, the reader should be able to do the following: (1) appreciate the benefits of physical therapy in individuals with myasthenia gravis; (2) describe the benefits of physical therapy on postoperative morbidity in myasthenia gravis patients who undergo thymectomy; and (3) incorporate appropriate rehabilitation into the treatment plan of patient with myasthenia gravis.
AdvancedACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
证明综合康复治疗方案对接受重症肌无力（MG）胸腺切除术患者的有效性。
2005年至2010年，46例连续的MG患者在胸腺切除术前后均接受了康复计划。我们将每位患者与一名“对照患者”匹配，该对照患者在1999年至2004年期间接受了胸腺切除术，且术前未进行康复治疗，其倾向评分匹配最为接近。
除2例患者外，所有患者均能够完成预定计划。18例患者（41%）经历了轻度疲劳（MG定量评分>25）。倾向评分选择了17例患者进行匹配过程。接受康复计划的患者组术前有显著改善，手术风险降低，术后早期发病率降低，术后入住重症监护病房的比例较低（12%对35%；P = 0.01），住院时间较短（3天对5天；P = 0.04）。在预期的围手术期病情恶化后，所有主要的重症肌无力结局在3个月时均显示出明显更快的恢复。完全稳定缓解未显示出显著差异。
运动不一定是MG的禁忌症，康复治疗可在胸腺切除术前后安全进行，降低手术风险并缩短恢复时间。
高级
学术物理治疗师协会经继续医学教育认证委员会认证，可为医生提供继续医学教育。学术物理治疗师协会将此活动指定为最多1.5个美国医学协会医师认可奖第1类学分™。医生应仅根据其参与活动的程度申请相应学分。
