Rationale for hospital-based rehabilitation in obesity with comorbidities.

PubMed

Capodaglio, P; Lafortuna, C; Petroni, M L; Salvadori, A; Gondoni, L; Castelnuovo, G; Brunani, A

2013-06-01

Severely obese patients affected by two or more chronic conditions which could mutually influence their outcome and disability can be defined as "complex" patients. The presence of multiple comorbidities often represents an obstacle for being admitted to clinical settings for the treatment of metabolic diseases. On the other hand, clinical Units with optimal standards for the treatment of pathological conditions in normal-weight patients are often structurally and technologically inadequate for the care of patients with extreme obesity. The aims of this review paper were to review the intrinsic (anthropometrics, body composition) and extrinsic (comorbidities) determinants of disability in obese patients and to provide an up-to-date definition of hospital-based multidisciplinary rehabilitation programs for severely obese patients with comorbidities. Rehabilitation of such patients require a here-and-now multidimensional, comprehensive approach, where the intensity of rehabilitative treatments depends on the disability level and severity of comorbidities and consists of the simultaneous provision of physiotherapy, diet and nutritional support, psychological counselling, adapted physical activity, specific nursing in hospitals with appropriate organizational and structural competences.

Understanding the Models of Community Hospital rehabilitation Activity (MoCHA): a mixed-methods study

PubMed Central

Gladman, John; Buckell, John; Young, John; Smith, Andrew; Hulme, Clare; Saggu, Satti; Godfrey, Mary; Enderby, Pam; Teale, Elizabeth; Longo, Roberto; Gannon, Brenda; Holditch, Claire; Eardley, Heather; Tucker, Helen

2017-01-01

Introduction To understand the variation in performance between community hospitals, our objectives are: to measure the relative performance (cost efficiency) of rehabilitation services in community hospitals; to identify the characteristics of community hospital rehabilitation that optimise performance; to investigate the current impact of community hospital inpatient rehabilitation for older people on secondary care and the potential impact if community hospital rehabilitation was optimised to best practice nationally; to examine the relationship between the configuration of intermediate care and secondary care bed use; and to develop toolkits for commissioners and community hospital providers to optimise performance. Methods and analysis 4 linked studies will be performed. Study 1: cost efficiency modelling will apply econometric techniques to data sets from the National Health Service (NHS) Benchmarking Network surveys of community hospital and intermediate care. This will identify community hospitals' performance and estimate the gap between high and low performers. Analyses will determine the potential impact if the performance of all community hospitals nationally was optimised to best performance, and examine the association between community hospital configuration and secondary care bed use. Study 2: a national community hospital survey gathering detailed cost data and efficiency variables will be performed. Study 3: in-depth case studies of 3 community hospitals, 2 high and 1 low performing, will be undertaken. Case studies will gather routine hospital and local health economy data. Ward culture will be surveyed. Content and delivery of treatment will be observed. Patients and staff will be interviewed. Study 4: co-designed web-based quality improvement toolkits for commissioners and providers will be developed, including indicators of performance and the gap between local and best community hospitals performance. Ethics and dissemination Publications

Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review.

PubMed

Vieira, Edgar Ramos; Freund-Heritage, Rosalie; da Costa, Bruno R

2011-09-01

To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Eligible studies were systematically searched on 16 databases from inception to December 2010. The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.

Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis.

PubMed

Anderson, Craig; Ni Mhurchu, Cliona; Brown, Paul M; Carter, Kristie

2002-01-01

Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services. To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke. A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care. Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350] ($US11 390)] compared with standard care. A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

Humanistic psychology and rehabilitation programs in mental hospitals.

PubMed

Steele, R L

1976-07-01

A humanistic growth-oriented theory, specifically Maslow's need-satisfaction theory, was used as a basis for examining the contributions work and employment make toward rehabilitation of the state mental hospital patient. Research literature reviewed indicated that if the rehabilitation program is to be viable and optimally effective, satisfying the belongingness and esteem needs of the patient is important. Research that stresses the therapeutic benefit of work, as well as research that raises the issue of workshops inhibiting independence and fostering dependence are presented. Modifications of rehabilitation programs that resulted in reports of increased program effectiveness are discussed. Fundamental features of these alternative or ancillary programs were: 1. a definite structure that allows various levels of advancement; 2. group participation; 3. patient initiative; 4. an orientation that reflects the competitive nature of employment; and 5. early community involvement. The importance of evaluating each client's needs and planning for growth before his/her job placement is considered vital to the program and to the individual.

Functional outcomes of adult patients with West Nile virus admitted to a rehabilitation hospital.

PubMed

Hoffman, Julie E; Paschal, Karen A

2013-01-01

The clinical manifestation of West Nile Virus (WNV) varies in individuals from mild flu-like symptoms to acute flaccid paralysis. Advanced age is the most significant risk factor for developing severe neurological disease and for death. The broad range of neurologic symptoms associated with WNV infection leads to varied body structure and function limitations and participation restrictions that may require rehabilitation. The purpose of this study is to describe the functional impairments upon admission and the functional outcomes at discharge of 48 adult patients admitted with WNV to a rehabilitation facility in the Midwest from 2002 to 2009. A retrospective chart review was completed on 48 patients (29 male, 19 female) with mean age 67.8 (SD = 16.6, range = 24-91) years and median age 72.5 years, admitted to inpatient rehabilitation with a diagnosis of WNV after January 1, 2002, and discharged prior to December 31, 2009. General information (sex, age, social history, employment, and living environment), past medical history, and information specific to the current hospitalization (medical conditions, functional status and activity level on admission and discharge as measured by the Functional Independence Measure [FIM], lengths of stay [LOSs] in the acute care and rehabilitation hospital, physical therapy care, discharge destination, and follow-up care provisions) were gathered. The standardized response mean (SRM) was calculated for total, motor, and cognitive FIM scores to provide insight into the effect size and the responsiveness of the FIM for the patients with WNV in this study. All patients were admitted to the rehabilitation hospital from acute care hospitals following LOSs ranging from 1 to 62 days. The rehabilitation hospital LOS ranged from 2 to 304 days. These patients had significant comorbidities including hypertension (43.75%), diabetes mellitus (41.67%), acute respiratory failure (37.5%), ventilator dependency/tracheostomy (33.33%), and pneumonia

Functional Independence, Diagnostic Groups, Hospital Stay, and Modality of Payment in Three Croatian Seaside Inpatient Rehabilitation Centers

PubMed Central

Mrčela, Nada Tomasović; Massari, Dražen; Vlak, Tonko

2010-01-01

Aim To determine patients’ functional independence, diagnostic groups, duration of hospital stay, and modality of payment of rehabilitation in major special hospitals for rheumatology and medical rehabilitation on the Croatian seaside. Methods In a cross-sectional study conducted from October 2006 until January 2009, we surveyed 400 patients treated at 3 special hospitals for medical rehabilitation. Their functional independence was assessed by modified Barthel index and they self-evaluated their health using the first item from the 36-Item Short-Form Health Survey questionnaire. Results On admission, almost half of the patients (46%) were fully functionally independent, 33% were slightly dependent, while 21% were moderately or severely dependent. At the end of the hospitalization, significant predictors for the increase in Barthel index were longer hospital stay (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06-1.22), diagnosis of post-procedural musculoskeletal disorders (OR, 4.84; 95% CI, 1.90-10.57), diagnosis of conditions following acute ischemic heart disease (OR, 9.71; 95% CI, 3.40-27.75), and lower Barthel index at admission (OR, 0.96; 95% CI, 0.94-0.97). Of the 97 patients with dorsopathy, 73 (75%) were fully functionally independent and 57 (59%) paid for the treatment either themselves or contributed substantially to the total cost. Conclusion Assessment of patients’ functional status is important for the organization of inpatient rehabilitation. Patients with dorsopathy could be targeted as a population for medical tourism in rehabilitation medicine in order to maximize the use of rehabilitation hospitals. PMID:21162166

Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

PubMed

Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

2017-04-01

Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

Prediction of destination at discharge from a comprehensive rehabilitation hospital using the home care score

PubMed Central

Matsugi, Akiyoshi; Tani, Keisuke; Yoshioka, Nami; Yamashita, Akira; Mori, Nobuhiko; Oku, Kosuke; Murakami, Yoshikazu; Nomura, Shohei; Tamaru, Yoshiki; Nagano, Kiyoshi

2016-01-01

[Purpose] This study investigated whether it is possible to predict return to home at discharge from a rehabilitation hospital in Japan using the home care score of patients with cerebrovascular or osteoarticular disease and low activities of daily living at admission. [Subjects and Methods] The home care score and functional independent measurement were determined for 226 patients at admission and at discharge from five hospitals, and receiver operating characteristic analyses were conducted. [Results] The home care score cutoff point for the prediction of return to home at admission and at discharge was 11, and the area under the curve was more than 0.8. The area under the curve of the home care score was 0.77 for patients with low activities of daily living and within this group, the probability of return to home was approximately 50%, as predicted by the functional independent measurement. The home care score increased after receiving intervention at a rehabilitation hospital. [Conclusion] The home care score is useful for the prediction of return to home from a rehabilitation hospital, although prediction using the functional independent measurement is difficult for patients with low activities of daily living. Moreover, comprehensive interventions provided by the rehabilitation hospitals improve the ability to provide home care of the patient’s family, which is assessed by the home care score. PMID:27821925

Family Type as a Prognostic Indicator of Rehabilitation Outcome with Post-Hospitalized Male Schizophrenics

ERIC Educational Resources Information Center

Beres, Barbara Oliver; Frumkin, Robert M.

1973-01-01

A study of 65 male schizophrenic patients at the Bureau of Vocational Rehabilitation Unit, Cleveland Psychiatric Institute, Cleveland, Ohio revealed that family type (conjugal settings, parental settings, living alone) is found to to be a valuable prognosticator of rehabilitation outcome among post-hospitalized schizophrenics. (EA)

The rehabilitation team: staff perceptions of the hospital environment, the interdisciplinary team environment, and interprofessional relations.

PubMed

Strasser, D C; Falconer, J A; Martino-Saltzmann, D

1994-02-01

Although inpatient rehabilitation is an interdisciplinary activity organized around a treatment team, there is a limited understanding of the workings of the interdisciplinary process. To elucidate staff perceptions of key aspects of the rehabilitation treatment process, we surveyed staff (n = 113) from selected inpatient teams. The staff completed social psychological instruments that measure perceptions of the hospital environment (The Ward Atmosphere Scale [WAS]), the team's environment (the Group Environment Scale [GES]), and interprofessional relations (Interprofessional Perception Scale [IPS]). Rehabilitation staff generally endorse the team approach, but express concerns over professional boundaries. Interprofessional difficulties seemed to be independent of team membership or professional training. Compared with published data from other settings, rehabilitation teams resembled task-oriented groups, but showed significant differences across teams in their perceptions of the team and hospital environments. The task-oriented character of rehabilitation teams, team-specific characteristics, and discord in interprofessional relationships may need to be considered in studies of rehabilitation teams effectiveness.

Risk factors for discharge to an acute care hospital from inpatient rehabilitation among stroke patients.

PubMed

Roberts, Pamela S; DiVita, Margaret A; Riggs, Richard V; Niewczyk, Paulette; Bergquist, Brittany; Granger, Carl V

2014-01-01

To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. Retrospective cohort study. Academic medical center. A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. Logistic regression analysis. Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

[Rehabilitation of chronic obstructive pulmonary diseases at the lung hospital (author's transl)].

PubMed

Meister, W

1979-12-01

The modern lung hospital offers favorable conditions for the rehabilitation of patients suffering from chronic obstructive pulmonary diseases. In the years from 1972 to 1976 2398 patients suffering from chronic bronchitis, bronchial asthma and pulmonary emphysema were subjected to a rehabilitation process at the central hospital for heart and lung diseases Bad Berka. A long-term therapy plan based on a most accurate investigation possible of all the factors which trigger off the complaint in each case was used as baseline. An account is given of the resulting diagnostic and therapeutic program carried out. In the case of chronic obstructive pulmonary diseases it is particularly difficult to assess the effectiveness of rehabilitation measures. One aspect dealt with is the restoration of working capacity. 56.7% of the men and 56.8% of the women were capable of working when they were dismissed. 31.6% of male and 26.4% of female patients were invalids, 11.7% and 16.8% respectively were old age pensioners. Rehabilitation success depended on variables such as age, degree of cardio-pulmonary limitation in performance, as well as on certain concomitant diseases and the patient's cooperation. A decisive factor in some cases was also whether suitable employment could be found for these patients whose age ranges between 40 and 60.

Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital.

PubMed

Nip, W F R; Perry, L; McLaren, S; Mackenzie, A

2011-10-01

Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001). Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

ERIC Educational Resources Information Center

Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2012-01-01

The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

Perceptions of Yoga Therapy Embedded in Two Inpatient Rehabilitation Hospitals: Agency Perspectives

PubMed Central

Van Puymbroeck, Marieke; Miller, Kristine K.; Dickes, Lori A.; Schmid, Arlene A.

2015-01-01

Inpatient medical rehabilitation has maintained a typical medical-model focus and structure for many years. However, as integrative therapies, such as yoga therapy, emerge as treatments which can enhance the physical and mental health of its participants, it is important to determine if they can be easily implemented into the traditional rehabilitation structure and milieu. Therefore, the purpose of this study was to examine the perceptions of key agency personnel on the feasibility and utility of yoga therapy implemented in inpatient rehabilitation. This study reports the results of focus groups and an individual interview with key stakeholders (administrators and rehabilitation therapists) from two rehabilitation hospitals following the implementation of yoga therapy. Results focused on several key themes: feasibility from the therapist and administrator perspectives, challenges to implementation, and utility and benefit. Overall, the implementation and integration of yoga therapy were positive; however, some programmatic and policy and organizational considerations remain. Implications for practice and future research are provided. PMID:26491457

Postoperated hip fracture rehabilitation effectiveness and efficiency in a community hospital.

PubMed

Tan, Adrian K H; Taiju, Rangpa; Menon, Edward B; Koh, Gerald C H

2014-04-01

This study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later. A retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy. The mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later. CH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.

A randomised controlled trial of domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital.

PubMed Central

Gladman, J R; Lincoln, N B; Barer, D H

1993-01-01

This study compared the functional ability and perceived health status of stroke patients treated by a domiciliary rehabilitation team or by routine hospital-based services after discharge from hospital. Patients discharged from two acute and three rehabilitation hospitals in Nottingham were randomly allocated in three strata (Health Care of the Elderly, General Medical and Stroke Unit) to receive domiciliary or hospital-based care after discharge. Functional recovery was assessed by the Extended Activities of Daily Living (ADL) scale three and six months after discharge and perceived health at six months was measured by the Nottingham Health Profile. A total of 327 eligible patients of 1119 on a register of acute stroke admissions were recruited over 16 months. Overall there were no differences between the groups in their Extended ADL scores at three or six months, or their Nottingham Health Profile scores at six months. In the Stroke Unit stratum, patients treated by the domiciliary team had higher household (p = 0.02) and leisure activity (p = 0.04) scores at six months than those receiving routine care. In the Health Care of the Elderly stratum, death or a move into long-term institutional care at six months occurred less frequently in patients allocated to the routine service, about half of whom attended a geriatric day hospital. Overall there was no difference in the effectiveness of the domiciliary and hospital-based services, although younger stroke unit patients appeared to do better with home therapy while some frail elderly patients might have benefited from day hospital attendance. PMID:8410035

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway

Use and Distribution of Rehabilitation Services: A Register Linkage Study in One Hospital District Area in Finland

ERIC Educational Resources Information Center

Pulkki, Jutta Maarit; Rissanen, Pekka; Raitanen, Jani A.; Viitanen, Elina A.

2011-01-01

This study focuses on a large set of rehabilitation services used between 2004 and 2005 in one hospital district area in Finland. The rehabilitation system consists of several subsystems. This complex system is suggested to produce arbitrary rehabilitation services. Despite the criticisms against the system during decades, no attempts have been…

[Efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model].

PubMed

Ding, R J; Gao, L M; Chu, L; Xie, W L; Wang, X R; Tang, Q; Wang, H L; Hu, D Y

2017-03-24

Objective: To explore the efficacy and safety of tertiary hospital guided and community-driven family self-help cardiac rehabilitation model. Methods: This study was a prospective randomized controlled study, 80 patients from Beijing Electrical Power Hospital and Beijing Jingmei Group General Hospital with acute coronary syndrome were included from June to December 2015 and divided into 2 groups. Patients in rehabilitation group ( n =52) received tertiary hospital(Peiking University Peoples' Hospital) guided and community-driven family self-help cardiac rehabilitation for 3 months, and patients in control group ( n =28) received routine secondary treatment for 3 months. Following parameters including 6 minutes walk distance, score of life quality (evaluated by Short Form-12), score of anxiety (evaluated by Generalized Anxiety Disorder-7), score of depression (evaluated by Perceived Health Questionnaire-9), self-management competency (evaluated by questionnaire) were collected at baseline and after treatment for 3 months. Results: Compared with control group, 6 minutes walk distance was longer in rehabilitation group((60.2±6.8) meters vs. (24.9±10.5)meters, P <0.01). The difference values between after and before intervention of life quality scores((0.14±3.90)scores vs.(-7.44±5.85)scores, P >0.05), anxiety scores((-0.16±2.12 ) scores vs.(0.70±1.13)scores, P >0.05) and depression scores((-1.17±2.79) scores vs.(0.60±0.36)scores, P >0.05) were similar between the 2 groups. The amplification of patients with regular exercise (50.26% vs. 0, P <0.05), limit sugary foods usually and always (53.22% vs. 3.98%, P <0.05), eat 200-400 g fruits usually and always (78.61 % vs. 0, P <0.05), eat 300-500 g vegetables usually and always (9.74% vs. 0, P <0.05), and answering very confident to questions such as let the physicians know about your diseases (40.17% vs. 5.00%, P <0.05), know how to take medicines (44.52% vs. 5.00%, P <0.05), know how much exercise was right for

Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma.

PubMed

Kimmel, Lara A; Holland, Anne E; Lannin, Natasha; Edwards, Elton R; Page, Richard S; Bucknill, Andrew; Hau, Raphael; Gabbe, Belinda J

2017-05-01

Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital

Depression following traumatic brain injury: Impact on post-hospital residential rehabilitation outcomes.

PubMed

Lewis, Frank D; Horn, Gordon J

2017-01-01

A need exists to better understand the impact of depression on functional outcomes following TBI. To evaluate the prevalence and severity of depression among a large group of chronic TBI adults; to determine the impact of depression on outcomes of post-hospital residential rehabilitation programs; and to assess effectiveness of post-hospital residential rehabilitation programs in treating depression. 820 adults with moderate to severe traumatic brain injury (TBI) were assigned to one of four groups based on MPAI- 4 depression ratings: (1) Not Depressed, (2) Mildly Depressed, (3) Moderately Depressed, and (4) Severely Depressed. Functional status was assessed at admission and discharge with the MPAI-4 Participation Index. Differences among groups were evaluated using conventional parametric tests. Rasch analysis established reliability and validity of MPAI-4 data. Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability = 0.89-0.92, Item reliability = 0.99). Of the 820 subjects, 39% presented with moderate to severe depressive symptoms at admission, These subjects demonstrated significantly higher MPAI-4 Participation scores than the mild and not depressed groups. Depressed groups realized significant improvement in symptoms, but, those remaining depressed at discharge had significantly greater disability than those who improved. Depressive symptoms had a deleterious impact on outcome. Remediation of symptoms during rehabilitation significantly improved outcomes.

Horticultural therapy: the 'healing garden'and gardening in rehabilitation measures at Danderyd Hospital Rehabilitation Clinic, Sweden.

PubMed

Söderback, Ingrid; Söderström, Marianne; Schälander, Elisabeth

2004-01-01

Objectives were to review the literature on horticultural therapy and describe the Danderyd Hospital Horticultural Therapy Garden and its associated horticultural therapy programme. The literature review is based on the search words 'gardening', 'healing garden' and 'horticultural therapy'. The description is based on the second author's personal knowledge and popular-scientific articles initiated by her. The material has been integrated with acknowledged occupational therapy literature. The setting was the Danderyd Hospital Rehabilitation Clinic, Sweden, Horticultural Therapy Garden. Forty-six patients with brain damage participated in group horticultural therapy. Horticulture therapy included the following forms: imagining nature, viewing nature, visiting a hospital healing garden and, most important, actual gardening. It was expected to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental or physical illness. The Horticultural Therapy Garden was described regarding the design of the outdoor environment, adaptations of garden tools, cultivation methods and plant material. This therapy programme for mediating mental healing, recreation, social interaction, sensory stimulation, cognitive re-organization and training of sensory motor function is outlined and pre-vocational skills and the teaching of ergonomical body positions are assessed. This study gives a broad historic survey and a systematic description of horticultural therapy with emphasis on its use in rehabilitation following brain damage. Horticulture therapy mediates emotional, cognitive and/or sensory motor functional improvement, increased social participation, health, well-being and life satisfaction. However, the effectiveness, especially of the interacting and acting forms, needs investigation.

Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial

PubMed Central

Ramsay, Pam; Huby, Guro; Merriweather, Judith; Salisbury, Lisa; Rattray, Janice; Griffith, David; Walsh, Timothy

2016-01-01

Objectives To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting Two university-affiliated hospitals in Scotland. Participants 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated

Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury.

PubMed

Hammond, Flora M; Horn, Susan D; Smout, Randall J; Beaulieu, Cynthia L; Barrett, Ryan S; Ryser, David K; Sommerfeld, Teri

2015-08-01

To assess the incidence of, causes for, and factors associated with readmission to an acute care hospital (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Prospective observational cohort. Inpatient rehabilitation. Individuals with TBI admitted consecutively for inpatient rehabilitation (N=2130). Not applicable. RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location. A total of 183 participants (9%) experienced RTAC for a total of 210 episodes. Of 183 participants, 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. The mean time from rehabilitation admission to first RTAC was 22±22 days. The mean duration in acute care during RTAC was 7±8 days. Eighty-four participants (46%) had ≥1 RTAC episodes for medical reasons, 102 (56%) had ≥1 RTAC episodes for surgical reasons, and 6 (3%) participants had RTAC episodes for unknown reasons. Most common surgical RTAC reasons were neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurological (23%), and cardiac (12%). Any RTAC was predicted as more likely for patients with older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission. RTAC was less likely for patients with higher admission FIM motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home. Approximately 9% of patients with TBI experienced RTAC episodes during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation for RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting. Copyright �

Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan.

PubMed

Asahi, Yoshinao; Omichi, Shiro; Ono, Takahiro

2015-09-01

Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

The Validity of Goal Achievement as an Outcome Measure in Physical Rehabilitation Day Hospitals for Older People

ERIC Educational Resources Information Center

Kneebone, Ian I.; Hurn, Jane S.; Raisbeck, Elizabeth; Cropley, Mark; Khoshnaw, Hiro; Milton, Jane E.

2010-01-01

Physical rehabilitation day hospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored…

Evaluation of super-link system theory for spinal cord injury patients using participatory action research in a rehabilitation hospital.

PubMed

Chen, Hsiao-Yu; Wu, Tzu-Jung; Cheng, Mei-Li; Sung, Hsi-Hui

2012-01-01

The purpose of this study was to integrate and evaluate the spinal cord injury rehabilitation nursing theory named Super-Link System Theory using participatory action research. Data were collected from October 2007 to September 2008 in a rehabilitation hospital by means of interviews, participant observations, documentary resources, case conferences and reports, and participants' self-reflective inquiries. The Super-Link System Theory was introduced to 31 rehabilitation nurses. The nurses selected a key reference group including the researcher to facilitate the participatory action research process to implement and evaluate the theory. Data were analyzed using content analysis. The findings shows that several key concepts were clarified and specific nursing interventions were identified. Furthermore, an integrated link system from the hospital to the community through both rehabilitation nurses and discharge planners was established. The study demonstrated an evidence base for an evolving theory of care, and empowered nurses to make sustainable changes to their practice. © 2012 Association of Rehabilitation Nurses.

Moral distress in rehabilitation professionals: results from a hospital ethics survey.

PubMed

Mukherjee, Debjani; Brashler, Rebecca; Savage, Teresa A; Kirschner, Kristi L

2009-05-01

Moral distress in the rehabilitation setting was examined in a follow-up survey. The survey had 3 goals: (1) to systematically and anonymously gather data about the ethical issues that employees struggle with in their daily work; (2) to raise the visibility of the hospital-based ethics program and resources available to employees; and (3) to prioritize and focus the direction of the program's educational seminars, quality improvement projects, and ethics consultation. Online survey of employees. Urban rehabilitation system of care. The survey was open to all employees; 207 completed the survey. N/A MAIN OUTCOME MEASUREMENTS: N/A CONCLUSIONS: Three broad categories of moral distress were identified: institutional ethics, professional practice, and clinical decision-making. Institutional ethics issues related to the health care environment, such as health care reimbursement pressures and corporate culture. Professional practice issues involved codes of behavior and concepts of professionalism, including patient confidentiality/privacy. Clinical decision-making included such practical dilemmas as conflicts around goal-setting, discharge planning, and assessment of decision-making capacity. An anonymous survey of staff members allowed the hospital ethics program to identify sources of moral distress and prioritize strategies to address them.

The new look in rehabilitation.

PubMed

Eazell, D E

1987-01-01

In the 1990s, operational strategies to assure survival will be crucial for all healthcare providers. All will face an accelerating rate of change, and the paramount change will be an intensified competitive marketplace. How does this impact rehabilitation? Like acute care hospitals, rehabilitation facilities will diversify into alternative delivery systems. This paper examines the course one provider--Casa Colina, Inc.--has taken, the pitfalls and problems along the way, and the implications for other rehabilitation providers. Strategies used to strengthen various areas of rehabilitation are considered, including ambulatory care, skilled nursing, traumatic brain injury, medical and vocational rehabilitation, residential programs, joint ventures, rehabilitation hospitals and outpatient services. A strong consensus exists today among healthcare experts concerning where we are headed and operational strategies for survival in 1990. How does this consensus impact rehabilitation? Before dealing with rehabilitation, let us review essential agreements. For HOSPITALS, the experts agree that: multi-hospital systems will continue to grow and will be best positioned to implement and take advantage of the strategies of choice in the new competitive market; money spent nationally on healthcare services will continue to grow; new types of providers will erode acute care inpatient hospitals' share of healthcare expenditures; emphasis in healthcare will shift to ambulatory services and delivery systems; and hospitals may be at a disadvantage in attracting capital financing and many will have to create new corporate structures and business ventures to compete in the capital market.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland.

PubMed

Meehan, Tom; Stedman, Terry; Parker, Stephen; Curtis, Bretine; Jones, Donna

2017-05-01

Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community

Examining the Hospital Elder Life Program in a rehabilitation setting: a pilot feasibility study.

PubMed

Huson, Kelsey; Stolee, Paul; Pearce, Nancy; Bradfield, Corrie; Heckman, George A

2016-07-18

The Hospital Elder Life Program (HELP) has been shown to effectively prevent delirium and functional decline in older patients in acute care, but has not been examined in a rehabilitation setting. This pilot study examined potential successes and implementation factors of the HELP in a post-acute rehabilitation hospital setting. A mixed methods (quantitative and qualitative) evaluation, incorporating a repeated measures design, was used. A total of 100 patients were enrolled; 58 on the pilot intervention unit and 42 on a usual care unit. Group comparisons were made using change scores (pre-post intervention) on outcome measures between pilot unit patients and usual care patients (separate analyses compared usual care patients with pilot unit patients who did or did not receive the HELP). Qualitative data were collected using focus group and individual interviews, and analyzed using emergent coding procedures. Delirium prevalence reduced from 10.9 % (n = 6) to 2.5 % (n = 1) in the intervention group, while remaining the same in the usual care group (2.5 % at both measurement points). Those who received the HELP showed greater improvement on cognitive and functional outcomes, particularly short-term memory and recall, and a shorter average length of stay than patients who did not. Participant groups discussed perceived barriers, benefits, and recommendations for further implementation of the HELP in a rehabilitation setting. This study adds to the limited research on delirium and the effectiveness of the HELP in post-acute rehabilitation settings. The HELP was found to be feasible and have potential benefits for reduced delirium and improved outcomes among rehabilitation patients.

Post-acute rehabilitation care for older people in community hospitals and general hospitals--philosophies of care and patients' and caregivers' reported experiences: a qualitative study.

PubMed

Small, Neil; Green, John; Spink, Joanna; Forster, Anne; Young, John

2009-01-01

This article contrasts community hospital and general hospital philosophies of care and examines how they relate to patients' and caregivers' experiences. Semi-structured interviews with 42 staff were used to produce care setting vignettes in six community hospitals and four general hospitals in the midlands and north of England. The vignettes were used with 26 patients and 10 caregivers in semi-structured interviews. Community hospital and general hospital staff identified shared understandings of requirements for post-acute rehabilitation care for older people. Distinctive features were: general hospital--medical efficiency, helping patients get better, high standard of care, need for stimulation; community hospital--home-like setting, quiet, calm ambience, good views, orientated to elderly people, encouragement of social interaction, involvement of relatives in care. In the main there was symmetry between staff aspirations and patients' experience. However some concepts used and assumptions made by staff were not recognised by patients. These were characteristically reframed in patients' answers as if they were discussing subjective dimensions of care. There was patient and caregiver preference for the home-like environment of community hospitals. In care of older people, where the focus is rehabilitation, patient preferences are particularly pertinent and should be considered alongside clinical outcomes and cost-effectiveness.

Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.

PubMed

Aizen, Efraim; Lutsyk, Galina; Wainer, Lea; Carmeli, Sarit

2015-10-01

There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.

Observations of mealtimes in hospital aged care rehabilitation wards.

PubMed

Walton, Karen; Williams, Peter; Tapsell, Linda; Hoyle, Matthew; Shen, Zhi Wei; Gladman, Lauren; Nurka, Martin

2013-08-01

Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over 2days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance given at meals; negative and positive interruptions. The time taken to eat meals averaged 22min, ranging from 3 to 55min. Food intakes appeared to be better when meals were consumed communally in a dining room. There were many occasions when patients needed more assistance to eat than was available. The most common factors negatively affecting meal consumption were medication rounds, inappropriate placement of trays, packaging being hard to open, and patient showering. The presence of visitors, dietitians and nutrition assistants appeared to improve dietary intakes. Trials of protected mealtimes in Australian hospitals are certainly important and timely. Copyright © 2013 Elsevier Ltd. All rights reserved.

Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

PubMed

Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

2017-11-01

Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001). An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

In-hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists.

PubMed

De Kleijn, P; Fischer, K; Vogely, H Ch; Hendriks, C; Lindeman, E

2011-11-01

This project aimed to develop guidelines for use during in-hospital rehabilitation after combinations of multiple joint procedures (MJP) of the lower extremities in persons with haemophilia (PWH). MJP are defined as surgical procedures on the ankles, knees and hips, performed in any combination, staged, or during a single session. MJP that we studied included total knee arthroplasty, total hip arthroplasty and ankle arthrodesis. Literature on rheumatoid arthritis demonstrated promising functional results, fewer hospitalization days and days lost from work. However, the complication rate is higher and rehabilitation needs optimal conditions. Since 1995, at the Van Creveldkliniek, 54 PWH have undergone MJP. During the rehabilitation in our hospital performed by experienced physical therapists, regular guidelines seemed useless. Guidelines will guarantee an optimal physical recovery and maximum benefit from this enormous investment. This will lead to an optimal functional capability and optimal quality of life for this elderly group of PWH. There are no existing guidelines for MJP, in haemophilia, revealed through a review of the literature. Therefore, a working group was formed to develop and implement such guidelines and the procedure is explained. The total group of PWH who underwent MJP is described, subdivided into combinations of joints. For these subgroups, the number of days in hospital, complications and profile at discharge, as well as a guideline on the clinical rehabilitation, are given. It contains a general part and a part for each specific subgroup. © 2011 Blackwell Publishing Ltd.

An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital.

PubMed

Healy, Stan; Manganelli, Joe; Rosopa, Patrick J; Brooks, Johnell O

2015-01-01

This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table. This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand. The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand. Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized. © The Author(s) 2015.

Antibiotic prescription evaluation in the rehabilitation ward of a geriatric hospital.

PubMed

Afekouh, H; Baune, P; Abbas, R; De Falvelly, D; Guermah, F; Haber, N

2015-01-01

We aimed to identify the indications for antibiotic prescriptions made to patients hospitalized in the rehabilitation ward of a geriatric hospital. Our final objective was to assess those prescriptions. Medical experts performed a prospective study of all antibiotic treatments prescribed in the rehabilitation ward over a 4-month period based on Gyssens' algorithm and on the local guidelines for anti-infective drugs. Treatments were considered appropriate when the indication, choice of agent, duration, and dose were approved by the experts. They were however considered unnecessary when the indication was incorrect, and they were deemed inappropriate when the experts approved the indication but considered that treatment modalities were not optimal. We also reviewed the prescription re-evaluation made 48 to 72hours after treatment initiation. We reviewed 142 prescriptions. Treatments had mainly been prescribed for respiratory tract infections (81 infections), urinary tract infections (41), skin infections (15), or abdominal infections (8). A total of 27 prescriptions (19%) were considered unnecessary mainly because a urinary tract infection diagnosis had been wrongly made (21 prescriptions). Half of the prescriptions were considered inappropriate: 38 prescriptions had an inappropriate spectrum of activity and 32 had an inadequate treatment duration. A total of 67 prescriptions (47.2%) had been reassessed 48-72hours after treatment initiation. Overall, 25 prescriptions (17.6%) were considered appropriate and were reassessed 48-72hours after treatment initiation. We now have a better understanding of antibiotic prescription in a rehabilitation ward context. We identified several points that need to be improved: update and improvement of the local guidelines, better training for prescribers, and creation of a supporting document for the reassessment of the prescriptions 48-72hours after treatment initiation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[In-patient (early) rehabilitation].

PubMed

Wallesch, Claus-W; Lautenschläger, Sindy

2017-04-01

It is difficult to develop the financing and hospital provision of interventions for early rehabilitation within the diagnosis-related group (DRG) system. In addition to a range of partially rehabilitative complex interventions, the system recognizes three main forms of early rehabilitative interventions: geriatric, neurological/neurosurgical, and interdisciplinary and others. In this article, the appropriate definitions and cost-effectiveness of these procedures are analyzed and compared. The early rehabilitative interventions are characterized by constant cooperation in the therapeutic team, especially neurological early rehabilitation through the incorporation of nursing as a therapeutic profession. Whereas geriatric and neurological early rehabilitation are reflected in the DRG system, the former provided in many general hospitals and the latter mainly in specialized institutions, interdisciplinary early rehabilitation has only occasionally been represented in the DRG system so far. If all acute in-patients who require early rehabilitation should receive such an intervention, an additional fee must be implemented for this this interdisciplinary service.

The correlation between organizational justice and trust among employees of rehabilitation clinics in hospitals of Ahvaz, Iran

PubMed Central

Khiavi, Farzad Faraji; Shakhi, Kamal; Dehghani, Roohallah; Zahiri, Mansour

2016-01-01

Introduction Organizational justice is an intricate concept that refers to fair and ethical conduct of individuals within organizations. No research has been conducted on the variables associated with organizational justice in rehabilitation clinics. Thus, the aim of this research was to determine the correlation between organizational justice and organizational trust among the employees of rehabilitation clinics in hospitals of Ahvaz, Iran. Methods This was a cross-sectional research, and it was conducted on 140 rehabilitation staff members of hospital clinics in Ahvaz. The data were gathered using organizational justice and trust questionnaires. The data were analyzed using the independent-samples t-test, ANOVA, and Pearson’s product-moment correlation SPSS software. Results Significant correlations between procedure and interaction justice and organizational trust were identified (p < 0.001). Distributive justice showed small correlation with trust (r = 0.25, p < 0.021). Organizational justice was significantly associated with organizational trust (r = 0.42, p < 0.001). Organizational justice was not significantly related to any demographic variable (p > 0.05). Conclusion There was a positive, medium, and significant correlation between organizational justice and trust. It is suggested that rehabilitation clinics’ managers develop plans to increase their organizational justice subscales in order to develop organizational trust among their employees. PMID:27053997

Patients undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence.

PubMed

McPhail, Steven M; Varghese, Paul N; Kuys, Suzanne S

2014-01-01

This study investigated cognitive functioning among older adults with physical debility not attributable to an acute injury or neurological condition who were receiving subacute inpatient physical rehabilitation. A cohort investigation with assessments at admission and discharge. Three geriatric rehabilitation hospital wards. Consecutive rehabilitation admissions (n = 814) following acute hospitalization (study criteria excluded orthopaedic, neurological, or amputation admissions). Usual rehabilitation care. The Functional Independence Measure (FIM) Cognitive and Motor items. A total of 704 (86.5%) participants (mean age = 76.5 years) completed both assessments. Significant improvement in FIM Cognitive items (Z-score range 3.93-8.74, all P < 0.001) and FIM Cognitive total score (Z-score = 9.12, P < 0.001) occurred, in addition to improvement in FIM Motor performance. A moderate positive correlation existed between change in Motor and Cognitive scores (Spearman's rho = 0.41). Generalized linear modelling indicated that better cognition at admission (coefficient = 0.398, P < 0.001) and younger age (coefficient = -0.280, P < 0.001) were predictive of improvement in Motor performance. Younger age (coefficient = -0.049, P < 0.001) was predictive of improvement in FIM Cognitive score. Improvement in cognitive functioning was observed in addition to motor function improvement among this population. Causal links cannot be drawn without further research.

[Rehabilitation outcomes of terror victims with multiple trauma: the experience in Hadassah University Hospital 2000-2004].

PubMed

Meiner, Zeev; Tuchner, Maya; Shiri, Shimon; Tsenter, Jeanna; Shochina, Mara; Shoshan, Yigal; Katz-Leurer, Michal; Schwartz, Isabella

2008-11-01

From late September 2000 until 2005, the State of Israel was attacked by continuing acts of terrorism known as the Al Aqsa Intifada. During this period the number of terror victims treated in rehabilitation facilities has escalated significantly. The city of Jerusalem has a unique place in the heart of the Israel-Palestinian conflict and, therefore, almost 20% of national atrocities have been carried out in Jerusalem. Between September.2000 and September 2004, 72 terror victims were treated in the department of rehabilitation in Hadassah University Hospital. Among them, 47 (65%) suffered from multiple trauma without CNS involvment, 19 (26%) suffered from traumatic brain injury and 6 (8%) suffered from spinal cord injury. The rehabilitation outcomes of terror victims was compared to the rehabilitation outcomes of non-terror multiple trauma patients treated in the same rehabilitation facility over the same period. The rehabilitation outcomes were evaluted using the following parameters: length of hospitalization (LOH) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (Functional Independence Measurement, FIM), occupational outcome (returning to previous occupation) and psychological outcome (Salomon PTSD questionnaire). The mean LOH of terror victims was 218 +/- 131 days as opposed to 152 +/- 114 days for the non-terror group (p < 0.01). The difference between FIM value at entry and discharge (delta FIM) was significantlly higher in terror victims as compared to controls (41.1 +/- 21.6 vs. 30.8 +/- 21.8, p = 0.002). The rate of PTSD was higher among terror victims than non-terror control (40.9% vs. 24.2%, p = 0.04). The rate of returning to previous occupation was similar between terror and non-terror victims (53% vs. 46.9% respectively). Long term study showed that terror victims still suffer from lower quality of life and life satisfaction 2 years after the insult. In summary, terror victims spent longer periods in

"Go home, sit less: The impact of home versus hospital rehabilitation environment on activity levels of stroke survivors".

PubMed

Simpson, Dawn B; Breslin, Monique; Cumming, Toby; de Zoete, Sam; Gall, Seana L; Schmidt, Matthew; English, Coralie; Callisaya, Michele L

2018-05-08

To examine whether change in rehabilitation environment (hospital or home) and other factors, influence time spent sitting, upright and walking after stroke. Observational study. Two inpatient rehabilitation units, and community residences following discharge. Thirty-four participants with stroke were recruited. An activity monitor was worn continuously for 7 days during the final week in hospital, and first week home. Other covariates included mood, fatigue, physical function, pain and cognition. Linear mixed models were performed to examine the associations between the environment (exposure) and physical activity levels (outcome) in hospital and at home. Interaction terms between the exposure and other covariates were added to the model to determine whether they modified activity with change in environment. The mean age of participants was 68 [SD 13] years and 53% were male. At home, participants spent 45 fewer minutes sitting (95% CI -84.8, -6.1; p=0.02), 45 more minutes upright (95% CI 6.1, 84.8; p=0.02), 12 more minutes walking (95% CI 5, 19; p=0.001) and completed 724 additional steps (95% CI 199, 1250; p=0.01) each day compared to in hospital. Depression at discharge predicted greater sitting time and less upright time (p=0.03 respectively) at home. Environmental change from hospital to home was associated with reduced sitting time and increased the time spent physically active, though depression modified this change. The rehabilitation environment may be a target to reduce sitting and promote physical activity. Copyright © 2018. Published by Elsevier Inc.

Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults.

PubMed

Liu, Stephen K; Montgomery, Justin; Yan, Yu; Mecchella, John N; Bartels, Stephen J; Masutani, Rebecca; Batsis, John A

2016-10-01

To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge after an acute hospitalization. Retrospective cohort study. Inpatient unit of a rural academic medical center. Hospitalized individuals aged 70 and older from October 1, 2013 to June 1, 2014. Participant age at the time of admission, modified Folstein Mini-Mental State Examination score, and self-reported instrumental activities of daily living 2 weeks before admission were used to calculate HARP score. The primary predictor was HARP score, and the primary outcome was discharge disposition (home, facility, deceased). Multivariate analysis was used to evaluate the association between HARP score and discharge disposition, adjusting for age, sex, comorbidities, and length of stay. Four hundred twenty-eight individuals admitted from home were screened and their HARP scores were categorized as low (n = 162, 37.8%), intermediate (n = 157, 36.7%), or high (n = 109, 25.5%). Participants with high HARP scores were significantly more likely to be discharged to a facility (55%) than those with low HARP scores (20%) (P < .001). After adjustment, participants with high HARP scores were more than four times as likely as those with low scores to be discharged to a facility (odds ratio = 4.58, 95% confidence interval = 2.42-8.66). In a population of older hospitalized adults, HARP score (using readily available admission information) identifies individuals at greater risk of skilled nursing or acute rehabilitation facility discharge. Early identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A pilot study to explore the effectiveness of "early" rehabilitation after a hospital admission for chronic heart failure.

PubMed

Houchen, Linzy; Watt, Amye; Boyce, Sally; Singh, Sally

2012-07-01

People with chronic heart failure (CHF) experience acute exacerbations of their symptoms. These episodes are costly to patients and the health service. The study was a single group, pretest and posttest design. Seventeen patients with left ventricular systolic dysfunction (LVSD) started rehabilitation within 4 weeks of hospital discharge. The 6 week rehabilitation programme included exercise and self-management education. The hospital anxiety and depression scale (HADS), the incremental and endurance shuttle walking tests (ISWT/ESWT) were assessed at baseline and after rehabilitation. The number and duration of any CHF admissions in the year before and the year after rehabilitation were also recorded. Improvements in the ISWT, ESWT, and depression were, mean (95% confidence interval [CI]) 60.6 (36.0-85.2) metres, 356.0 (173.0-539.0) seconds (both p≤0.001) and (-)1.0 ((-)1.8-(-)0.2) points (p<0.05), respectively. HADS anxiety improvements failed to reach significance. At 1 year, there was a significant decrease in CHF-related hospitalisations, mean change (95% CI) (-)0.8 ((-)1.1-(-)0.4), p≤0.001 and CHF bed days (-)13.0 ((-)24.4-(-)1.6), p<0.05. Early rehabilitation significantly improved exercise capacity and depression and reduced CHF-associated health care utilisation in patients who had recently been hospitalised. The intervention was safe. However, the sample size was small and results were not compared to a control group. Therefore, the effects of natural recovery are unknown.

Health Care Costs of Spontaneous Aneurysmal Subarachnoid Hemorrhage for Rehabilitation, Home Care, and In-Hospital Treatment for the First Year.

PubMed

Ridwan, Sami; Urbach, Horst; Greschus, Susanne; von Hagen, Johanna; Esche, Jonas; Boström, Azize

2017-01-01

Given the young age of onset and high probability of long-term disability after subarachnoid hemorrhage (SAH), the financial impact is expected to be substantial. Our primary objective was to highlight subsequent treatment costs after the acute in-hospital stay, including rehabilitation and home care, compared with costs for ischemic stroke. The study included 101 patients (median age 52 years, 70 women) with aneurysmal SAH treated from July 2007 to April 2009. In-hospital costs were calculated using German diagnosis related groups. Rehabilitation costs depended on rehabilitation phase/grade and daily rate. Level of severity of care requirements determined the costs for home care. Of patients, 54% received coiling and 46% received clipping. The clipping group included more poor-grade patients than the coiling group (P = 0.039); 23 patients died. Of 78 surviving patients, 70 received rehabilitation treatment (68 in Germany). Mean rehabilitation costs were €16,030 per patient. Patients in the clipping group generated higher rehabilitation costs and longer treatment periods in rehabilitation facilities (P = 0.001 for costs [€20,290 vs. €11,771] and P = 0.011 for duration (54.4 days vs. 40.5 days). Of surviving patients, 32% needed home care, of whom 52% required constant care. Multivariate regression analysis identified longer intensive care unit stay and poor Hunt and Hess grade as independent predictors of higher costs. Aneurysmal SAH prevalently affects working individuals with long-term occupational disability necessitating long-term medical rehabilitation for most patients and subsequent nursing care in one third of survivors. Overall, SAH treatment generates far higher costs than reported for ischemic stroke. Copyright © 2016 Elsevier Inc. All rights reserved.

Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

PubMed

Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

2014-01-01

To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return

Clinical validation of an anxiety and depression screening test for intensive in-hospital rehabilitation.

PubMed

Vedana, L; Baiardi, P; Sommaruga, M; Gallì, M; Neri, M; Pedretti, R F E; Tramarin, R; Bertolotti, G

2002-09-01

Routine hospital psychological care must necessarily make use of a clinically reliable screening instrument for the identification of the patients to be referred for a clinical interview with a psychologist. This study compared two tests for the evaluation of anxiety and depression that are widely used in the hospital setting: the Hospital Anxiety and Depression Scale (HADS) and Form A-D, consisting of the State-Trait Anxiety Inventory (STAI-X1) for the evaluation of anxiety, and the Depression Questionnaire (DQ) for measuring depression. The aim of the study was to identify which of these instruments is the most suitable for screening a population admitted at in-hospital intensive rehabilitation using the clinical interview-based psychological evaluation as the gold standard. Both of the tests showed a concordance with the clinical opinion expressed by the psychologist, whose judgement was guided by the use of the validation study evaluation form. The analyses confirmed the good correlation of the two instruments in measuring anxiety and depression. The sensitivity of the STAI-X1 (52%) was less than that of HADS section A (72%), but its specificity (99%) was greater than that observed with the application of the HADS Anxiety subscale (84%). Analysis of the ROC curves showed that the STAI-X1 percentages of sensitivity and specificity tended to balance at higher level with a cut-off point equal to the 80th percentile. The results of the analysis of the DQ demonstrated equivalence with the results obtained using HADS section D, with a cut-off point of the 90th percentile. On the basis of these results, and given that both the STAI-X1 and the DQ have a broadly based Italian normative population, we feel that they can be recommended for psychological screening of patients in an in-hospital intensive rehabilitation.

Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial.

PubMed

Walsh, Timothy S; Salisbury, Lisa G; Merriweather, Judith L; Boyd, Julia A; Griffith, David M; Huby, Guro; Kean, Susanne; Mackenzie, Simon J; Krishan, Ashma; Lewis, Stephanie C; Murray, Gordon D; Forbes, John F; Smith, Joel; Rattray, Janice E; Hull, Alastair M; Ramsay, Pamela

2015-06-01

Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score

Feasibility of Delivering a Dance Intervention for SubAcute Stroke in a Rehabilitation Hospital Setting

PubMed Central

Demers, Marika; McKinley, Patricia

2015-01-01

Dance can be a promising treatment intervention used in rehabilitation for individuals with disabilities to address physical, cognitive and psychological impairments. The aim of this pilot study was to determine the feasibility of a modified dance intervention as an adjunct therapy designed for people with subacute stroke, in a rehabilitation setting. Using a descriptive qualitative study design, a biweekly 45-min dance intervention was offered to individuals with a subacute stroke followed in a rehabilitation hospital, over 4 weeks. The dance intervention followed the structure of an usual dance class, but the exercises were modified and progressed to meet each individual’s needs. The dance intervention, delivered in a group format, was feasible in a rehabilitation setting. A 45-min dance class of moderate intensity was of appropriate duration and intensity for individuals with subacute stroke to avoid excessive fatigue and to deliver the appropriate level of challenge. The overall satisfaction of the participants towards the dance class, the availability of space and equipment, and the low level of risks contributed to the feasibility of a dance intervention designed for individuals in the subacute stage of post-stroke recovery. PMID:25785497

Cognitive and academic achievement changes associated with day hospital rehabilitation in children with acquired brain injury.

PubMed

Goldstein, Gerald; Mayfield, Joan; Thaler, Nicholas S; Walker, Jon; Allen, Daniel N

2018-01-01

An evaluation was made of the outcome of a day hospital rehabilitation program for children who experienced an acquired neurological illness, mainly traumatic brain injury. Participants were administered neuropsychological and academic evaluations upon entry to the program, immediately upon discharge and several months after discharge Repeated measures ANOVA results for variables selected from the Reynolds Intellectual Assessment and the Delis-Kaplan Executive Function System found that comparisons showed significant (≥p < .01) improvement occurred between the first and second assessment, generally with large effect sizes. There were some nonsignificant decrements in performance between the discharge and follow-up assessments. A correlational analysis showed that while the association between cognitive function and academic achievement was robust, correlation coefficients did not differ in strength before and following rehabilitation. The study demonstrates significant improvement in children with acquired neurological disorders following rehabilitation.

Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

PubMed

Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

2017-10-01

Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients?

PubMed

Hershkovitz, Avital; Beloosesky, Yichayaou; Brill, Shai; Gottlieb, Daniel

2004-05-01

(1) To assess whether a rehabilitation day hospital programme is associated with a reduced handicap level of stroke patients. (2) To estimate the relationship between the London Handicap Scale (LHS) and other outcome measures. (3) To examine the effect of demographic parameters (age, gender, family status, education) on LHS scores. A prospective longitudinal survey. An urban geriatric rehabilitation day hospital. Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001. London Handicap Scale (LHS), Functional Independent Measure (FIM), Nottingham Extended ADL Index, timed get up and go test. LHS scores at discharge changed significantly (p < 0.008) for mobility, physical independence and occupation. The overall change in LHS score was 2.3 points (20%); effect size 0.43. A significant relationship was found between discharge score of LHS and admission score of FIM, Nottingham Index, timed get up and go and age. Multiple linear regressions did not identify a good predictor for the discharge score of LHS. Higher education was associated with higher LHS scores on admission (p = 0.016) but with less success in correcting handicap (p = 0.046). A day hospital programme is associated with reduced level of handicap in stroke patients. The LHS is a useful and simple scale for measuring change in these patients. LHS in stroke patients correlates with other outcome measures, yet they cannot be used interchangeably. A significant relationship between education and level of handicap exists.

[Judicial psychiatric hospital closings. Workers' expectations in rehabilitation facilities: A pilot study from the Province of Taranto (Italy)].

PubMed

Grattagliano, I; Scialpi, C; Pierri, G; Pastore, A; Ragusa, M; Margari, F

2014-01-01

The aim of this study is to gain a clear understanding of the level of knowledge and training of staff members from psychiatric rehabilitation services in the Province of Taranto (Italy), where patients released from judicial psychiatric hospitals will be admitted. A questionnaire taken from an earlier study on judicial psychiatric hospitals, conducted by The Ministry of Justice of the Department Penitentiary Administration - Superior Institute of Penitentiary Studies, was used in this study. Were contacted in advance of Directors 8 Community Rehabilitation and Psychiatric Care and Day Care Centres 7 present the province of Taranto, who has sought membership survey. Many requests for information and training regarding the problems and challenges related to the management of individuals who are mentally ill, perpetrators of crimes, and persons who are held in protective custody are made by those who work in these institutions. Hospital workers are highly apprehensive with regard to working with a patient population quite different from that which they are normally accustomed to. In order to confront these challenges, they, together with other colleagues from both the private and public services sector, have turned toward the concept of teamwork. One element of contradiction seems to be a low level of knowledge regarding what will be required of them when their work will be connected to the world of criminal justice in the future. The workers who were interviewed who have experience in working with patients from Judicial Psychiatric Hospitals seem to be up to the task of meeting the complex needs of the mentally ill and perpetrators of crimes within psychiatric rehabilitation facilities, as these patients must be kept under security.

Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

PubMed Central

Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

2014-01-01

Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and

Association Between Facility Type During Pediatric Inpatient Rehabilitation and Functional Outcomes

PubMed Central

Fuentes, Molly M.; Apkon, Susan; Jimenez, Nathalia; Rivara, Frederick P.

2017-01-01

Objective To compare functional outcomes between children receiving inpatient rehabilitation at children’s hospitals and those at other facilities. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities. Participants Children (N=28,793) aged 6 months to 18 years who received initial inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Total, cognitive, and motor developmental functional quotients (DFQs; which is the WeeFIM score divided by age-adjusted norms and multiplied by 100) at discharge from inpatient rehabilitation and WeeFIM efficiency (the change in WeeFIM score from admission to discharge divided by the length of the rehabilitation stay), adjusting for age, sex, race, insurance, region, admission function, impairment type, discharge year, and length of stay. Results A total of 12,732 children received rehabilitation at 25 children’s hospitals and 16,061 at 36 other facilities (general hospitals or freestanding rehabilitation hospitals). Adjusting for clustering by facility, patients at children’s hospitals had a lower cognitive DFQ at admission (difference between children’s hospitals and other facility types, −3.8; 95% confidence interval [CI], −7.7 to −0.1), a shorter length of stay (median, 16d vs 22d; P<.001), and a higher WeeFIM efficiency (difference, 0.63; 95% CI, 0.25–1.00) than did children at other facility types. Rehabilitation in a children’s hospital was independently associated with a higher discharge cognitive DFQ (regression coefficient, 2.3; 95% CI, 0.3–4.2) and more efficient rehabilitation admissions (regression coefficient, 0.3; 95% CI, 0.1–0.6). Conclusions Children who receive inpatient rehabilitation at children’s hospitals have more efficient inpatient rehabilitation admissions, a shorter median length of stay, and a slight improvement in cognitive function than do children at other facility types. PMID:27026580

From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

PubMed

Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W

2013-01-01

The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

Transitions of care and rehabilitation after fragility fractures.

PubMed

Eslami, Michelle; Tran, Hong-Phuc

2014-05-01

Transitions in care are a vulnerable time period for patients during which unintended errors may occur. This article discusses potential risks that could occur during care transitions, suggested improvements, and the transition from hospital to skilled nursing facilities for patients needing rehabilitation after their discharge from the hospital. Different rehabilitation settings and their reimbursement are reviewed. Common potential medical conditions arising in patients undergoing rehabilitation, rehabilitation goals, and secondary prevention also are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

[Acute Care Rehabilitation is the First Link in a Chain of Rehabilitation Interventions].

PubMed

Beyer, Joachim; Seidel, Egbert J

2017-08-01

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established. © Georg Thieme Verlag KG Stuttgart · New York.

Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries.

PubMed

Middleton, Addie; Graham, James E; Ottenbacher, Kenneth J

2018-06-01

To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions. Retrospective cohort study. Inpatient rehabilitation facilities submitting claims to Medicare. National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1±7.6 years. Most were women (59.7%) and white (84.5%). Not applicable. (1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions. The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3-3.5) versus 6.9% (95% CI, 6.7-7.1), mobility: 3.3% (95% CI, 3.2-3.4) versus 7.2% (95% CI, 7.0-7.4), and cognition: 3.5% (95% CI, 3.4-3.6) versus 6.2% (95% CI, 6.0-6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67-.74), mobility: .64 (95% CI, .61-.68), and cognition: .84 (95% CI, .80-.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%). Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at

Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors.

PubMed

Handberg, Charlotte; Midtgaard, Julie; Nielsen, Claus Vinther; Thorne, Sally; Lomborg, Kirsten

The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation. Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs. Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation. Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct. These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.

[Psychosocial rehabilitation at the dawn of the 21st century: II: Therapeutic or rehabilitative modalities and institutional disposition].

PubMed

Gasset, François; Orita, Alina; Spagnoli, Dany; Pomini, Valentino; Rabia, Sophie; Ducret, Michel; Veillon, Henri; Cucchia, Anne-Therèse

2004-04-01

The main goal of psychosocial rehabilitation is to compensate the vulnerability underlying psychiatric disorders through intermediate institutions when the persistence and recurrence of these disorders have led to social and professional exclusion. Intermediate institutions refer to services which allow transition between the state of dependence on the hospital to the state of relative autonomy in social community. Psychosocial rehabilitation is a comprehensive approach which link the type of interventions: treatment, rehabilitation and support integrated in multimodal and individualized programs. A study of the out-patients followed by the rehabilitation unit of the psychiatric department in Lausanne has shown that provision of services is divided into 60% for rehabilitation, 20% for treatment and 20% for support independently of the psychiatric disorders. The implementation of these programs necessitates institutional support from psychiatric hospital to outpatient clinics through different types of facilities in order to offer a medical and psychosocial device of rehabilitation into the community.

The impact of patient's weight on post-stroke rehabilitation.

PubMed

Kalichman, Leonid; Alperovitch-Najenson, Deborah; Treger, Iuly

2016-08-01

Purpose To evaluate the influence of patient's weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission - FIM at discharge) were evaluated. The Kruskal-Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho = -0.20, p = 0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients' BMI. Implications for Rehabilitation In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients' BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.

COPD online-rehabilitation versus conventional COPD rehabilitation - rationale and design for a multicenter randomized controlled trial study protocol (CORe trial).

PubMed

Hansen, Henrik; Bieler, Theresa; Beyer, Nina; Godtfredsen, Nina; Kallemose, Thomas; Frølich, Anne

2017-11-16

Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program and 30-50% drop-out before completion. The main reasons are severe symptoms, inflexible accessibility and necessity for transportation. Currently there are no well-established and evident rehabilitation alternatives. Supervised online screen rehabilitation could be a useful approach to increase accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). This study is a randomized assessor- and statistician blinded superiority multicenter trial with two parallel groups, employing 1:1 allocation to the intervention and the comparison group.On the basis of a sample size calculation, 134 patients with severe or very severe COPD and eligible to conventional hospital based outpatient COPD rehabilitation will be included and randomized from eight different hospitals. The CORe intervention group receives group supervised resistance- and endurance training and patient education, 60 min, three times/week for 10 weeks at home via online-screen. The CCRe comparison group receives group based supervised resistance- and endurance training and patient education, 90 min, two times/week for 10 weeks (two hospitals) or 12 weeks (six hospitals) in groups at the local hospital. The primary outcome is change in the 6-min walking distance after 10/12 weeks; the secondary outcomes are changes in 30 s sit-to-stand chair test, physical activity level, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline

Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial.

PubMed

Gassaway, Julie; Jones, Michael L; Sweatman, W Mark; Hong, Minna; Anziano, Peter; DeVault, Karen

2017-08-01

To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. Randomized controlled trial. Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes

Time to inpatient rehabilitation hospital admission and functional outcomes of stroke patients.

PubMed

Wang, Hua; Camicia, Michelle; Terdiman, Joe; Hung, Yun-Yi; Sandel, M Elizabeth

2011-04-01

To study the association of time to inpatient rehabilitation hospital (IRH) admission and functional outcomes of patients who have had a stroke. A retrospective cohort study. A regional IRH. Moderately (n = 614) and severely (n = 1294) impaired patients who had a stroke who were admitted to the facility between 2002 and 2006. Not applicable. Change in total, motor, and cognitive Functional Independence Measure (FIM) scores between IRH admission and discharge. After controlling for patient demographics and initial medical conditions and functional status, shorter periods from stroke onset to IRH admission were significantly associated with greater functional gains for these patients during IRH hospitalization. Moderately impaired patients achieved a greater total FIM gain when admitted to an IRH within 21 days of stroke. Severely impaired patients showed a gradient relationship between time to IRH admission and total FIM gain, with significantly different functional gain if admitted to an IRH within 30 and 60 days after stroke diagnosis. Results of multiple regression analysis also showed that age, race/ethnicity, side of stroke, history of a previous stroke, functional measures at IRH admission, IRH length of stay, and selected medications were associated with total, motor, and cognitive FIM score changes. In addition, certain factors such as older age, diagnosis of a hemorrhagic stroke or a previous history of stroke, and initial functional status were associated with longer periods between diagnosis and admission to an IRH after the stroke occurred. Our findings are consistent with the hypothesis that earlier transfer to an IRH may lead to better functional improvement after stroke. However, certain factors such as age, race/ethnicity, initial medical conditions and functional status, and length of stay at an IRH contributed to functional gain. Factors affecting the time to IRH admission also were addressed. Copyright © 2011 American Academy of Physical Medicine

[Rehabilitation of patients with acquired brain injury].

PubMed

Rasmussen, Anne Almskou; Jørgensen, Henrik Stig; Nielsen, Jørgen Feldbæk

2014-05-12

In Denmark the development of rehabilitation of patients with acquired brain injury (ABI) has differed from most parts of Europe. Denmark has no medical rehabilitation specialty. In 2000 two specialized hospital units were established to serve the population of 5.7 million inhabitants. They cover the needs of patients with the most severe ABIs. Only recently rehabilitation of patients with ABI has been anchored in the medical specialty of neurology. Since then the development has taken an up-going curve. This process has been supported by The Danish Health and Medicines Authority publishing several papers that highlights evidence-based organization and interventions. Current development aim to define: 1) skills of the medical doctor engaged in the rehabilitation of patients with ABI, 2) stratification to different levels of specialization at hospital and in the community, and 3) national guidelines that specify skills and collaboration between groups of professionals working with ABI rehabilitation.

Gait outcomes of older adults receiving subacute hospital rehabilitation following orthopaedic trauma: a longitudinal cohort study.

PubMed

Mathew, Saira A; Varghese, Paul; Kuys, Suzanne S; Heesch, Kristiann C; McPhail, Steven M

2017-07-20

This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination. A longitudinal cohort study was conducted. Australian tertiary hospital subacute rehabilitation wards. Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion. Usual care (multidisciplinary inpatient hospital rehabilitation). Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility. At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92). Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events. © Article author(s) (or

Comparative cost analysis of outpatient and inpatient rehabilitation for musculoskeletal diseases in Germany.

PubMed

Zeidler, J; Mittendorf, T; Vahldiek, G; Zeidler, H; Merkesdal, S

2008-10-01

To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of euro2047 and euro1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were euro2067 (euro1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

Early intensive rehabilitation after oral cancer treatment.

PubMed

Bschorer, Maximilian; Schneider, Daniel; Hennig, Matthias; Frank, Bernd; Schön, Gerhard; Heiland, Max; Bschorer, Reinhard

2018-06-01

The treatment of oral cancer requires an effective rehabilitation strategy such as an early intensive rehabilitation (EIR) program. The medical records and data of 41 patients who participated in an EIR program and 20 control group patients were analyzed. These patients all underwent surgical resection of the primary tumor followed by microsurgical reconstruction using free flaps. The length of stay (LOS) at the acute care hospital was compared between the two groups. Four indexes were used to evaluate the effectiveness of the EIR program. EIR patients stayed an average of 11.6 fewer days at the acute care hospital. All indexes showed significant improvements (p < 0.001). The Barthel Index (BI) and the Early Intensive Rehabilitation Barthel Index (EIR-BI) improved by 36.0 and 103.6 points, respectively. At discharge, the Bogenhausener Dysphagia Score (BODS) had improved to a score of 11.0 compared to the 13.9 at admission. EIR patients had a Work Ability Index (WAI) score of 25.7. Length of stay at the acute care hospital can be reduced using early intensive rehabilitation if patients are transferred to an intensive rehabilitation clinic early. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[The development of the rehabilitation medicine concept in Israel (1948-1974)].

PubMed

Paran, Geula; Rozenberg-Friedman, Lilach; Ohry, Avi

2015-07-01

The field of physical medicine and rehabilitation in Israel was developed in different ways. Some services were developed as a part of comprehensive rehabilitation centers like the Loewenstein Hospital and others were developed as a part of specific disciplines, like the Polio-Rehabilitation Center at Assaf Harofeh hospital. Moreover, the various fields of rehabilitation medicine were developed at different rates. The origin of each stemmed from different circumstances. Sometimes they were developed with a direct connection to a national event and sometimes separately. Occasionally, the field was developed as a result of one person's initiation and others as a result of the establishment's recognition of the value and the essentiality of the field. This essay will focus, in a chronological manner, on the development of the medical rehabilitation fields, that took place in the two leading rehabilitation centers in Israel, the Loewenstein Hospital and at Tel Hashomer. These rehabilitation centers were established in Israel close to the establishment of the State of Israel and their activity will be discussed until 1974, the year in which the Israeli society had to deal with the results of the Yom Kippur war, which had drastic implications on rehabilitation medicine.

DAY-CARE REHABILITATION CENTER FOR EMOTIONALLY DISTURBED ADOLESCENTS. FINAL REPORT.

ERIC Educational Resources Information Center

CRAWFORD, HUGH A.; VAN DUYNE, WILLIAM V.

IN THIS FIVE YEAR DEMONSTRATION PROJECT, EMOTIONALLY DISTURBED ADULTS AND ADOLESCENTS RECEIVED TREATMENT AT A DAY CARE REHABILITATION CENTER SPONSORED BY THE RHODE ISLAND DIVISION OF VOCATIONAL REHABILITATION (DVR) LOCATED IN A PRIVATE PSYCHIATRIC HOSPITAL (BUTLER HOSPITAL). THE MAJOR TREATMENT GOALS WERE PRESERVATION AND RESTORATION OF…

The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation.

PubMed

Landi, F; Calvani, R; Ortolani, E; Salini, S; Martone, A M; Santoro, L; Santoliquido, A; Sisto, A; Picca, A; Marzetti, E

2017-05-01

This study evaluates the prevalence of sarcopenia among older people admitted to a rehabilitation unit after hip fracture and the association between sarcopenia and functional outcomes. The results show that sarcopenia had a negative impact on functional recovery. The assessment of sarcopenia among older adults receiving rehabilitation programs is crucial. Sarcopenia is a highly prevalent geriatric syndrome associated with adverse outcomes, including falls, disability, institutionalization, and mortality. Few studies assessed sarcopenia among older adults receiving rehabilitation programs. Patients aged 70 years or more consecutively admitted to in-hospital rehabilitation programs that had suffered from hip fracture entered the study. Sarcopenia was defined according to the Foundation for National Institutes of Health (FNIH) criteria. Multivariable linear regression models were used to analyze the association between the sarcopenia and functional recovery. The recruited population was composed of 127 patients, with a mean age of 81.3 ± 4.8 years, predominantly females (64.6%). Using the criteria proposed by the FNIH, patients with a diagnosis of sarcopenia were 43 (33.9%). After adjustment for potential confounders, participants with sarcopenia had a significant increased risk of incomplete functional recovery compared with non-sarcopenic patients (OR 3.07, 95% CI 1.07-8.75). Compared with participants without sarcopenia, those with sarcopenia showed lower Barthel index scores at the time of discharge from the rehabilitation unit (69.2 versus 58.9, respectively; p < 0.001) and after 3 months of follow-up (90.9 versus 80.5, respectively; p = 0.02). These findings support the systematic assessment of sarcopenia among older adults receiving rehabilitation programs to assist in the development of personalized treatment plans aimed at improving functional outcomes.

Clinical and psychosocial predictors of exceeding target length of stay during inpatient stroke rehabilitation.

PubMed

Lai, Wesley; Buttineau, Mackenzie; Harvey, Jennifer K; Pucci, Rebecca A; Wong, Anna P M; Dell'Erario, Linda; Bosnyak, Stephanie; Reid, Shannon; Salbach, Nancy M

2017-10-01

In Ontario, Canada, patients admitted to inpatient rehabilitation hospitals post-stroke are classified into rehabilitation patient groups based on age and functional level. Clinical practice guidelines, called quality-based procedures, recommend a target length of stay (LOS) for each group. The study objective was to evaluate the extent to which patients post-stroke at an inpatient rehabilitation hospital are meeting LOS targets and to identify patient characteristics that predict exceeding target LOS. A quantitative, longitudinal study from an inpatient rehabilitation hospital was conducted. Participants included adult patients (≥18 years) with stroke, admitted to an inpatient rehabilitation hospital between 2014 and 2015. The percentage of patients exceeding the recommended target LOS was determined. Logistic regression was performed to identify clinical and psychosocial patient characteristics associated with exceeding target LOS after adjusting for stroke severity. Of 165 patients, 38.8% exceeded their target LOS. Presence of ataxia, recurrent stroke, living alone, absence of a caregiver at admission, and acquiring a caregiver during hospital LOS was each associated with significantly higher odds of exceeding target LOS in comparison to patients without these characteristics after adjusting for stroke severity (p < 0.05). Findings suggest that social and stroke-specific factors may be helpful to adjust LOS expectations and promote efficient resource allocation. This exploratory study was limited to findings from one inpatient rehabilitation hospital. Cross-validation of results using data-sets from multiple rehabilitation hospitals across Ontario is recommended.

Duckneglect: video-games based neglect rehabilitation.

PubMed

Mainetti, R; Sedda, A; Ronchetti, M; Bottini, G; Borghese, N A

2013-01-01

Video-games are becoming a common tool to guide patients through rehabilitation because of their power of motivating and engaging their users. Video-games may also be integrated into an infrastructure that allows patients, discharged from the hospital, to continue intensive rehabilitation at home under remote monitoring by the hospital itself, as suggested by the recently funded Rewire project. Goal of this work is to describe a novel low cost platform, based on video-games, targeted to neglect rehabilitation. The patient is guided to explore his neglected hemispace by a set of specifically designed games that ask him to reach targets, with an increasing level of difficulties. Visual and auditory cues helped the patient in the task and are progressively removed. A controlled randomization of scenarios, targets and distractors, a balanced reward system and music played in the background, all contribute to make rehabilitation more attractive, thus enabling intensive prolonged treatment. Results from our first patient, who underwent rehabilitation for half an hour, for five days a week for one month, showed on one side a very positive attitude of the patient towards the platform for the whole period, on the other side a significant improvement was obtained. Importantly, this amelioration was confirmed at a follow up evaluation five months after the last rehabilitation session and generalized to everyday life activities. Such a system could well be integrated into a home based rehabilitation system.

The Benefit of Modified Rehabilitation and Minimally Invasive Techniques in Total Hip Replacement

PubMed Central

Lilikakis, Anastasios K; Gillespie, Beryl; Villar, Richard N

2008-01-01

INTRODUCTION We wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement. PATIENTS AND METHODS We compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery. RESULTS We found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant. CONCLUSIONS The data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The combination of modified anaesthetic and minimally invasive surgical techniques with the new rehabilitation regimen can further improve short-term outcome after total hip replacement. PMID:18634739

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

PubMed

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care

Exercise therapy in oncology rehabilitation in Australia: A mixed-methods study.

PubMed

Dennett, Amy M; Peiris, Casey L; Shields, Nora; Morgan, Delwyn; Taylor, Nicholas F

2017-10-01

Oncology rehabilitation improves outcomes for cancer survivors but little is known about program availability in Australia. The aims of this study were: to describe oncology rehabilitation programs in Australia: determine whether the exercise component of programs is consistent with guidelines: and to explore barriers and facilitators to program implementation. A sequential, explanatory mixed-methods study was completed in two phases: (1) a survey of Australian oncology rehabilitation programs; and (2) purposively sampled follow-up semistructured interviews with senior clinicians working in oncology rehabilitation who were involved with exercise prescription. Hospitals and/or cancer centers from 42 public hospital health networks (representing 163 hospitals) and 39 private hospitals were contacted to identify 31 oncology rehabilitation programs. All 31 surveys were returned (100% response rate). Programs were typically multidisciplinary, ran twice weekly, provided education and exercise and included self-management strategies. Exercise prescription and progression was patient centered and included a combination of resistance and aerobic training supplemented by balance, pelvic floor, and core stability exercises. Challenges to implementation included a lack of awareness of programs in the community and organizational barriers such as funding. Strong links with oncologists facilitated program referrals. Despite evidence to support oncology rehabilitation, there are few programs in Australia and there are challenges that limit it becoming part of standard practice. Programs that exist are multidisciplinary with a focus on exercise with the majority of programs following a cardiac rehabilitation model of care. © 2016 John Wiley & Sons Australia, Ltd.

Inpatient rehabilitation diabetes consult service: a rehabilitation psychology approach to assessment and intervention.

PubMed

Schumann, Kristina P; Touradji, Pegah; Hill-Briggs, Felicia

2010-11-01

Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Readmission to Acute Care Hospital during Inpatient Rehabilitation for Traumatic Brain Injury

PubMed Central

Hammond, Flora M.; Horn, Susan D.; Smout, Randall J.; Beaulieu, Cynthia L.; Barrett, Ryan S.; Ryser, David K.; Sommerfeld, Teri

2015-01-01

Objective To investigate frequency, reasons, and factors associated with readmission to acute care (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Design Prospective observational cohort. Setting Inpatient rehabilitation. Participants 2,130 consecutive admissions for TBI rehabilitation. Interventions Not applicable. Main Outcome Measure(s) RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location. Results 183 participants (9%) experienced RTAC for a total 210 episodes. 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. Mean days from rehabilitation admission to first RTAC was 22 days (SD 22). Mean duration in acute care during RTAC was 7 days (SD 8). 84 participants (46%) had >1 RTAC episode for medical reasons, 102 (56%) had >1 RTAC for surgical reasons, and RTAC reason was unknown for 6 (3%) participants. Most common surgical RTAC reasons were: neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurologic (23%), and cardiac (12%). Older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission predicted patients with RTAC. RTAC was less likely for patients with higher admission Functional Independence Measure Motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home. Conclusion(s) Approximately 9% of patients with TBI experience RTAC during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation due to RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting. PMID:26212405

Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay, in-hospital mortality, and functional rehabilitation indexes.

PubMed

Sánchez-Rodríguez, Dolores; Marco, Ester; Annweiler, Cédric; Ronquillo-Moreno, Natalia; Tortosa, Andrea; Vázquez-Ibar, Olga; Escalada, Ferran; Duran, Xavier; Muniesa, Josep M

2017-11-01

To determine the relationships between malnutrition and nutrition-related conditions according to the European Society of Clinical Nutrition and Metabolism (ESPEN) consensus and guidelines and clinical outcomes in postacute rehabilitation. Of 102 eligible inpatients, 95 (84.5 years old, 63.2% women) fulfilled inclusion criteria: aged ≥70 years, body mass index <30kg/m 2 , admission for rehabilitation. Mini-Nutritional Assessment-Short Form (MNA-SF≤11) identified patients "at risk" and ESPEN basic and etiology based definitions were applied. Nutrition-related conditions (sarcopenia, frailty, overweight/obesity, micronutrient abnormalities) were determined. We assessed the relationship between these conditions and the clinical and rehabilitation outcomes (relative functional gain, rehabilitation efficiency) during hospitalization. All patients were "at risk" by MNA-SF criteria and 31 reported unintentional weight loss >5% in the last year or 2-3kg in the last 6 months. Nineteen fulfilled the ESPEN basic definition, of which 10 had disease-related malnutrition with inflammation and 9 without inflammation, and 20 had cachexia. Sarcopenia (n=44), frailty (n=94), overweight/obesity (n=59), and micronutrient abnormalities (n=70) were frequent. Unintentional weight loss impaired all functional outcomes and increased length of stay [OR=6.04 (2.87-9.22); p<0.001]. In multivariate analysis, relationships between rehabilitation impact indices and the ESPEN basic and etiology-based definitions observed in univariate analysis persisted only (and marginally) for relative functional gain [OR=13.24 (0.96-181.95); p=0.005]. Infrequent in-hospital mortality prevented meaningful analysis of this outcome. ESPEN basic and etiology-based definitions and nutrition related disorders were determined in postacute care. Malnutrition was associated with poor rehabilitation outcomes, mainly due to unintentional weight loss. Copyright © 2017 Elsevier B.V. All rights reserved.

Listening to patients: choice in cardiac rehabilitation.

PubMed

Wingham, Jenny; Dalal, Hasnain M; Sweeney, Kieran G; Evans, Philip H

2006-12-01

The benefits of cardiac rehabilitation (CR) after myocardial infarction (MI) are increasingly recognised and is recommended in national guidelines. To explore patients' experience of MI and to identify the factors which influence the choice patients make given the option of hospital or home-based CR after MI. Qualitative study using semi-structured interviews and interpretive phenomenological analysis (IPA). This study was embedded within a randomised trial with preference arms. Seventeen participants were interviewed before their rehabilitation programme. Ten expressed a preference for home-based and seven for hospital-based rehabilitation. Common to both groups was shock and disbelief, which led to a loss of confidence. They expressed a strong desire to make lifestyle changes and looked for specific advice, guidance and support from knowledgeable experts. The hospital-based group had an emphasis on supervision during exercise, needed the camaraderie of a group, were willing to make travel arrangements and believed they lacked self-discipline. The home-based group believed that their CR should fit in with their lives rather than their lives fitting in with the rehabilitation programme and were self-disciplined. They disliked groups and expressed practical concerns. Understanding the factors that influence patient's choices may help professionals guide them to the most appropriate CR method and hence improve uptake.

Factors Associated With Late Specialized Rehabilitation among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

PubMed Central

Kurichi, Jibby E.; Xie, Dawei; Kwong, Pui L.; Bates, Barbara E.; Vogel, W. Bruce; Stineman, Margaret G.

2011-01-01

Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units. PMID:21389847

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

PubMed Central

FREITAS, José Alberto de Souza; GARIB, Daniela Gamba; OLIVEIRA, Thais Marchini; LAURIS, Rita de Cássia Moura Carvalho; de ALMEIDA, Ana Lúcia Pompéia Fraga; NEVES, Lucimara Teixeira; TRINDADE-SUEDAM, Ivy Kiemle; YAEDÚ, Renato Yassutaka Faria; SOARES, Simone; PINTO, João Henrique Nogueira

2012-01-01

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics. PMID:22666849

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center.

PubMed

Rice, Danielle B; McIntyre, Amanda; Mirkowski, Magdalena; Janzen, Shannon; Viana, Ricardo; Britt, Eileen; Teasell, Robert

2017-09-01

Goal-setting can have a positive impact on stroke recovery during rehabilitation. Patient participation in goal formulation can ensure that personally relevant goals are set, and can result in greater satisfaction with the rehabilitation experience, along with improved recovery of stroke deficits. This, however, not yet been studied in a stroke outpatient rehabilitation setting. To assess patient satisfaction of meeting self-selected goals during outpatient rehabilitation following a stroke. Retrospective chart review. Stroke patients enrolled in a multidisciplinary outpatient rehabilitation program, who set at least 1 goal during rehabilitation. Patients recovering from a stroke received therapy through the outpatient rehabilitation program between January 2010 and December 2013. Upon admission and discharge from rehabilitation, patients rated their satisfaction with their ability to perform goals that they wanted to achieve. Researchers independently sorted and labeled recurrent themes of goals. Goals were further sorted into International Classification of Functioning, Disability and Health (ICF) categories. To compare the perception of patients' goal satisfaction, repeated-measures analysis of variance was conducted across the 3 ICF goal categorizations. Goal satisfaction scores. A total of 286 patients were included in the analysis. Patient goals concentrated on themes of improving hand function, mobility, and cognition. Goals were also sorted into ICF categories in which impairment-based and activity limitation-based goals were predominant. Compared to activity-based and participation-based goals, patients with impairment-based goals perceived greater satisfaction with meeting their goals at admission and discharge (P < .001). Patient satisfaction in meeting their first-, second-, and third-listed goals each significantly improved by discharge from the rehabilitation program (P < .001). Within an outpatient stroke rehabilitation setting, patients set

Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial.

PubMed

Buhagiar, Mark A; Naylor, Justine M; Harris, Ian A; Xuan, Wei; Kohler, Friedbert; Wright, Rachael J; Fortunato, Renee

2013-12-17

Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%.The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together with any baseline differences in

Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (The HIHO study): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Formal rehabilitation programs are often assumed to be required after total knee arthroplasty to optimize patient recovery. Inpatient rehabilitation is a costly rehabilitation option after total knee arthroplasty and, in Australia, is utilized most frequently for privately insured patients. With the exception of comparisons with domiciliary services, no randomized trial has compared inpatient rehabilitation to any outpatient based program. The Hospital Inpatient versus HOme (HIHO) study primarily aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a hybrid home program provides superior recovery of functional mobility on the 6-minute walk test (6MWT) compared to a hybrid home program alone following total knee arthroplasty. Secondarily, the trial aims to determine whether inpatient rehabilitation yields superior recovery in patient-reported function. Methods/Design This is a two-arm parallel randomized controlled trial (RCT), with a third, non-randomized, observational group. One hundred and forty eligible, consenting participants who have undergone a primary total knee arthroplasty at a high-volume joint replacement center will be randomly allocated when cleared for discharge from acute care to either 10 days of inpatient rehabilitation followed by usual care (a 6-week hybrid home program) or to usual care. Seventy participants in each group (140 in total) will provide 80% power at a significance level of 5% to detect an increase in walking capacity from 400 m to 460 m between the Home and Inpatient groups, respectively, in the 6MWT at 6 months post-surgery, assuming a SD of 120 m and a drop-out rate of <10%. The outcome assessor will assess participants at 10, 26 and 52 weeks post-operatively, and will remain blind to group allocation for the duration of the study, as will the statistician. Participant preference for rehabilitation mode stated prior to randomization will be accounted for in the analysis together

Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review.

PubMed

Sarkies, Mitchell N; White, Jennifer; Henderson, Kate; Haas, Romi; Bowles, John

2018-06-18

Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35days (95% CI 0.45 to 4.24, I 2 =0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI -0.01 to 0.19, I 2 =0%), and health-related quality of life (SMD 0.10, 95% CI -0.01 to 0.20, I 2 =0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 4: Oral Rehabilitation

PubMed Central

FREITAS, José Alberto de Souza; de ALMEIDA, Ana Lúcia Pompéia Fraga; SOARES, Simone; NEVES, Lucimara Teixeira das; GARIB, Daniela Gamba; TRINDADE-SUEDAM, Ivy Kiemle; YAEDÚ, Renato Yassutaka Faria; LAURIS, Rita de Cássia Moura Carvalho; OLIVEIRA, Thais Marchini; PINTO, João Henrique Nogueira

2013-01-01

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients. PMID:23857655

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 4: oral rehabilitation.

PubMed

Freitas, José Alberto de Souza; Almeida, Ana Lúcia Pompéia Fraga de; Soares, Simone; Neves, Lucimara Teixeira das; Garib, Daniela Gamba; Trindade-Suedam, Ivy Kiemle; Yaedú, Renato Yassutaka Faria; Lauris, Rita de Cássia Moura Carvalho; Oliveira, Thais Marchini; Pinto, João Henrique Nogueira

2013-01-01

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Multidisciplinary rehabilitation program in recently hospitalized patients with heart failure and preserved ejection fraction: rationale and design of a randomized controlled trial.

PubMed

Koifman, Edward; Grossman, Ehud; Elis, Avishay; Dicker, Dror; Koifman, Bella; Mosseri, Morris; Kuperstein, Rafael; Goldenberg, Ilan; Kamerman, Tamir; Levine-Tiefenbrun, Nava; Klempfner, Robert

2014-12-01

Heart failure with preserved ejection fraction (HFpEF) comprises a large portion of heart failure patients and portends poor prognosis with similar outcome to heart failure with reduced ejection fraction (HFrEF). Thus far, no medical therapy has been shown to improve clinical outcome in this common condition. The study is a randomized-controlled, multicenter clinical trial aimed to determine whether early posthospitalization comprehensive cardiac rehabilitation (CR) including exercise training (ET) in recently hospitalized HFpEF patients reduces the composite end point of all-cause mortality and hospitalizations in comparison with usual care (UC). After undergoing baseline evaluation, patients are randomized to either UC or to ambulatory comprehensive CR program. Patients in the CR arm will participate in a 6-month biweekly ET program according to a predefined protocol, in addition to a complementary home exercise prescribed by a specialist in CR. Exercise training will include endurance and low-intensity resistance training. Patients in the UC arm will be followed up at the outpatient clinic, with management according to current heart failure guidelines. Physician follow-up visits will be conducted at 3, 6, and 12 months for assessment of adherence to therapy and ET, functional status, quality of life, and clinical events. Secondary end points will include quality-of-life questionnaire, economic end points, blood pressure, and hemoglobin A1C levels. Cardiac rehabilitation and ET are relatively inexpensive and accessible and can be beneficial in HFpEF patients. Our trial is designed to evaluate the impact of early posthospitalization comprehensive rehabilitation program on clinical end points of mortality, hospitalization, and quality of life in HFpEF patients. Copyright © 2014 Elsevier Inc. All rights reserved.

The Danish Cardiac Rehabilitation Database.

PubMed

Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne; Foghmar, Sussie; Eichhorst, Regina; Prescott, Eva; Cerqueira, Charlotte; Soja, Anne Merete Boas; Gislason, Gunnar H; Larsen, Mogens Lytken; Andersen, Ulla Overgaard; Gustafsson, Ida; Thomsen, Kristian K; Boye Hansen, Lene; Hammer, Signe; Viggers, Lone; Christensen, Bo; Kvist, Birgitte; Lindström Egholm, Cecilie; May, Ole

2016-01-01

The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients.

Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients

PubMed Central

Chang, Won Hyuk; Shin, Yong-Il; Lee, Sam-Gyu; Oh, Gyung-Jae; Lim, Young Shil

2015-01-01

Purpose The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients. Materials and Methods This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge. Results A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management. Conclusion Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke. PMID:25510773

Day of Surgery Impacts Outcome: Rehabilitation Utilization on Hospital Length of Stay in Patients Undergoing Elective Meningioma Resection.

PubMed

Sarkiss, Christopher A; Papin, Joseph A; Yao, Amy; Lee, James; Sefcik, Roberta K; Oermann, Eric K; Gordon, Errol L; Post, Kalmon D; Bederson, Joshua B; Shrivastava, Raj K

2016-09-01

Meningiomas account for approximately one third of all brain tumors in the United States. In high-volume medical centers, the average length of stay (LOS) for a patient is 6.8 days compared with 8.8 days in low-volume centers with median total admission charges equaling approximately $55,000. To our knowledge, few studies have evaluated day of surgery and its effect on hospital LOS. Our primary goal was to analyze patient outcome as a direct result of surgical date, as well as to characterize the individual variables that may impact their hospital course, early access to rehabilitation, and long-term functional status. A retrospective database was generated for cranial meningioma patients who underwent elective surgical resection at our institution over a 3-year study period (2011-2014). Inclusion criteria included any patient who underwent elective meningioma resection and was discharged either home or to a rehabilitation facility with at least 6 months of follow-up. Exclusion criteria included any patient who was not discharged after resection (i.e., expired). Each patient's medical record was evaluated for a subset of demographics and clinical variables. Given that patients who undergo surgical resection of meningiomas have a national median LOS of 6 days, we subdivided the patients into 2 cohorts: early discharge (LOS < 3) and late discharge (LOS ≥ 3). Statistical analysis was performed using SPSS 21.0 to assess the significance of the results. We identified 139 (25 male, 114 female) meningioma patients who underwent surgical resection. Seventy of these patients had surgery during the early week (defined as Monday-Wednesday), and 69 had surgery in the later week (Thursday-Friday). The median age for both early and late groups was 58, and the median diameter of the tumor was 3.1 cm and 3.3 cm, respectively. Overall, 55% of the patients had public insurance and 43% had private insurance, with no significant variation between the early and late groups. The

Costs after hip fracture in independently living patients: a randomised comparison of three rehabilitation modalities.

PubMed

Lahtinen, A; Leppilahti, J; Vähänikkilä, H; Harmainen, S; Koistinen, P; Rissanen, P; Jalovaara, P

2017-05-01

To evaluate costs and cost-effectiveness of physical and geriatric rehabilitation after hip fracture. Prospective randomised study (mean age 78 years, 105 male, 433 female) in different rehabilitation settings: physically oriented (187 patients), geriatrically oriented (171 patients), and healthcare centre hospital (control, 180 patients). At 12 months post-fracture, we collected data regarding days in rehabilitation, post-rehabilitation hospital treatment, other healthcare service use, number of re-operations, taxi use by patient or relative, and help from relatives. Control rehabilitation (4945,2€) was significantly less expensive than physical (6609.0€, p=0.002) and geriatric rehabilitation (7034.7€ p<0.001). Total institutional care costs (primary treatment, rehabilitation, and post-rehabilitation hospital care) were lower for control (13,438.4€) than geriatric rehabilitation (17,201.7€, p<0.001), but did not differ between control and physical rehabilitation (15659.1€, p=0.055) or between physical and geriatric rehabilitation ( p=0.252). Costs of help from relatives (estimated as 30%, 50% and 100% of a home aid's salary) with physical rehabilitation were lower than control ( p=0.016) but higher than geriatric rehabilitation ( p=0.041). Total hip fracture treatment costs were lower with physical (36,356€, 51,018€) than control rehabilitation (38,018€, 57,031€) at 50% and 100% of salary ( p=0.032, p=0.014, respectively). At one year post-fracture, 15D-score was significantly higher in physical rehabilitation group (0.697) than geriatric rehabilitation group (0.586, p=0.008) and control group (0.594, p=0.009). Considering total costs one year after hip fracture the treatment including physical rehabilitation is significantly more cost-effective than routine treatment. This effect could not be seen between routine treatment and treatment including geriatric rehabilitation.

[Present situation of terminal care and home rehabilitation at Karuizawa Hospital].

PubMed

Komiyama, Emi; Nakamura, Takashi; Sakakiyama, Sakura; Miyao, Yoichi; Yoda, Misa

2002-12-01

Rehabilitation is usually considered to have the connotation of regaining function or reintegration into society, and no direction or achievement regarding the time of involvement or details of request has been suggested for the terminal rehabilitation in the patients with cancer who can't expect to have any improvement. Dieatz defines four phases for the goal of rehabilitation in the patients with cancer; Preventive Phase, Recovering Phase, Supportive Phase and Alleviative Phase. This time, we encountered a couple of cases in patients with cancer: patients who gained QOL through developing environment and setting goals that enable them to maintain the active daily life (ADL) at the supportive phase; and patients who realized us when relieving the pain while losing self-consciousness due to psychosomatic changes at the alleviative phase. In this report, we discuss what care can be provided at the phase when trust of the patient/family members is established, at the phase when care providers can grasp needs, and at the phase when the needs can be satisfied. We also report on how the patient and family member reacted to the direct hand massage provided by the physical therapist at the terminal stage. The rehabilitation system for home care at each phase is discussed in association with practical side and problems of the rehabilitation in the future terminal care.

Effects of Out-of-hospital Continuing Nursing on Schizophrenia Patients’ Rehabilitation and Quality of Life

PubMed Central

Ye, Maoting; Guo, Jia; Song, Caiping; Zheng, Feiyu

2017-01-01

Abstract Objective This paper aims to explore specific effects of out-of-hospital continuing nursing on schizophrenia patients’ health rehabilitation and quality of life, and further improve application and popularization of out-of-hospital continuing nursing. Methods The 180 schizophrenia patients discharged from our hospital from March 2014 to March 2016 were selected as the subjects. The patients were divided into two groups according to the randomized double-blind method. Both groups received routine discharge guidance, and the observation group received out-of-hospital continuing nursing on this basis. Questionnaires and scales were used to compare differences of the two groups after discharge from hospital, such as medication compliance, recurrence rate of schizophrenia, awareness of health knowledge and quality of life. Results After 6 months of nursing for the observation group, complete medication compliance rate was 71.11% (64/90), awareness rate of schizophrenia-related health knowledge was 96.67% (87/90), and recurrence rate was 8.89% (8/90). For the control group, complete medication compliance rate was 45.56% (41/90), awareness rate of schizophrenia-related knowledge was 46.67% (42/90) and the recurrence rate of disease was 26.67% (24/90). Hence, the observation group enjoys significant advantages compared with the control group. Statistical analysis (P <0.05) showed statistical significance; In addition, life quality scores showed that the quality of life of the observation group was obviously better than the control group; the difference was statistically significant (P <0.05). Conclusion Out-of-hospital continuing nursing for schizophrenia patients after discharge can effectively improve medication compliance, awareness rate of health knowledge, effectively reduce incidence of schizophrenia and improve the quality of life of patients. Thus, the nursing concept and related methods are worthy of publicity and application in a wider range. PMID

Korean Brain Rehabilitation Registry for Rehabilitation of Persons with Brain Disorders: Annual Report in 2009

PubMed Central

Yang, Seung Nam; Park, Si-Woon; Jung, Han Young; Rah, Ueon Woo; Kim, Yun-Hee; Chun, Min Ho; Paik, Nam-Jong; Yoo, Seung Don; Pyun, Sung-Bom; Kim, Min Wook; Lee, Sam-Gyu; Park, Byung Kyu; Shin, Heesuk; Shin, Yong Il; Lee, Heeyeon

2012-01-01

This first annual report provides a description of patients discharged from rehabilitation facilities in Korea based on secondary data analysis of Korean Brain Rehabilitation Registry V1.0 subscribed in 2009. The analysis included 1,697 records of patients with brain disorders including stroke, traumatic brain injury, brain tumor and other disorders from 24 rehabilitation facilities across Korea. The data comprised 1,380 cases of stroke, 104 cases of brain injury, 55 cases of brain tumor, and 58 cases of other brain diseases. The functional status of each patient was measured using the Korean version of the Modified Barthel Index (KMBI). The average change in the KMBI score was 15.9 for all patients in the inpatient rehabilitation facility. The average length of stay for inpatient rehabilitation was 36.9 days. The transfer rates to other hospitals were high, being 62.4% when all patients were considered. Patients with brain disorders of Korea in 2009 and measurable functional improvement was observed in patients. However, relatively high percentages of patients were not discharged to the community after inpatient rehabilitation. Based on the results of this study, consecutive reports of the status of rehabilitation need to be conducted in order to provide useful information to many practitioners. PMID:22690103

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture

PubMed Central

Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

2016-01-01

Abstract The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery. We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey. At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group. In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate. PMID:27537579

Ambivalence in rehabilitation: thematic analysis of the experiences of lower limb amputated veterans.

PubMed

Christensen, Jan; Langberg, Henning; Doherty, Patrick; Egerod, Ingrid

2017-06-20

Knowledge about the organization and factors of importance to rehabilitation of veterans with lower limb amputation is sparse. The aim of this study was, therefore, to improve understanding of the influences of "military identity" on the organization of rehabilitation services and to investigate those factors influential in achieving successful rehabilitation, including interprofessional collaboration between different sectors involved in the rehabilitation of veterans with lower limb amputations. We used a qualitative exploratory design, triangulating interviews and participant observation. Data were generated using in-depth semi-structured interviews (n = 6) exploring in-hospital and post-hospital rehabilitation in Danish veterans after unilateral lower limb amputation due to trauma. We conducted four sessions of participant observation, during weekly post-hospitalization rehabilitation and included field notes in the dataset. Two main themes emerged: "experiencing different identities" and "experiencing discontinuity in rehabilitation." The first theme illustrated how veterans actively shift between the identities of disabled person, wounded veteran and athlete according to the context. The second theme illustrated the frustration of negotiating military versus civilian mindsets during rehabilitation and lack of coordination between the public healthcare system, municipal services and the military. Veterans live with shifting identities after returning to civilian life, increasing their awareness of the transition from active service to a new life as a civilian. During rehabilitation, it is important to acknowledge the disparities between the military and civilian mindsets and to integrate the different sets of values, such as structure versus autonomy. IMPLICATIONS FOR REHABILITATION Recommendations for the improvement of rehabilitation of amputated veterans include: Rehabilitation professionals working with veterans should focus on abilities instead of

Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.

PubMed

English, Coralie; Shields, Nora; Brusco, Natasha K; Taylor, Nicholas F; Watts, Jennifer J; Peiris, Casey; Bernhardt, Julie; Crotty, Maria; Esterman, Adrian; Segal, Leonie; Hillier, Susan

2016-07-01

Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression. People with stroke admitted to inpatient rehabilitation facilities. Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. Modest evidence indicates that additional weekend therapy might reduce

[Impulsivity: What are the consequences on compliance to rehabilitation?].

PubMed

Cancel, A; Naudet, F; Rousseau, P F; Millet, B; Drapier, D

2016-08-01

Impulsivity is a transnosographical dimension with major consequences on medical care with which psychiatrists are frequently confronted. Furthermore, compliance is a major variable that can affect the efficiency of therapeutics and hospitalizations in psychiatry. A study was carried out in three drug and alcohol rehabilitation hospitalization units to find out if impulsivity can have consequences on compliance. The studied population was composed of 85 patients aged from 18 to 70, hospitalized for one or more addiction disorders in a psychometric hospital in Vannes (France). Impulsivity was measured for all patients with the BIS-11 at the beginning of the rehabilitation program. Because no tool to evaluate a total rehab program compliance existed, a scale, used at the end of the hospitalization, was created to measure patient compliance. This score was composed of two simple numeric scales (one used by the nurses and one used by the patient's psychiatrist) and a coefficient of hospitalization duration that was the ratio of completed to planned days of hospitalization. Correlations were made between the different dimensions: impulsivity and compliance, impulsivity and hospitalization conditions, compliance and hospitalization conditions (voluntary or involuntary, planned by a psychiatrist or not, etc.). The main statistically significant result of the study was a negative correlation existing between the motor dimension of impulsivity and compliance (r=-0.37 and P=0.001). The other dimensions of impulsivity showed no significant correlation with compliance score. The study revealed that the different hospitalization conditions showed no link with compliance or impulsivity. These original results show that motor impulsive patients need an adaptation of the rehabilitation programs. Shorter programs might be more efficient. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

An advanced rehabilitation robotic system for augmenting healthcare.

PubMed

Hu, John; Lim, Yi-Je; Ding, Ye; Paluska, Daniel; Solochek, Aaron; Laffery, David; Bonato, Paolo; Marchessault, Ronald

2011-01-01

Emerging technologies such as rehabilitation robots (RehaBot) for retraining upper and lower limb functions have shown to carry tremendous potential to improve rehabilitation outcomes. Hstar Technologies is developing a revolutionary rehabilitation robot system enhancing healthcare quality for patients with neurological and muscular injuries or functional impairments. The design of RehaBot is a safe and robust system that can be run at a rehabilitation hospital under the direct monitoring and interactive supervision control and at a remote site via telepresence operation control. RehaBot has a wearable robotic structure design like exoskeleton, which employs a unique robotic actuation--Series Elastic Actuator. These electric actuators provide robotic structural compliance, safety, flexibility, and required strength for upper extremity dexterous manipulation rehabilitation training. RehaBot also features a novel non-treadmill paddle platform capable of haptics feedback locomotion rehabilitation training. In this paper, we concern mainly about the motor incomplete patient and rehabilitation applications.

Allocation and preference of patients for domiciliary or institutional rehabilitation after a stroke.

PubMed

Weiss, Zwi; Snir, David; Zohar, Ruth; Klein, Bracha; Eyal, Pnina; Dynia, Aida; Eldar, Reuben

2004-06-01

On discharge from an acute-care hospital after a stroke, 191 patients were told that they needed rehabilitation and were offered the option of receiving care in an institution or in their homes. One hundred and one (52.4%) patients chose an institution and 91 (47.6%) preferred rehabilitation in their own home. A higher number of women than men chose to be rehabilitated at home. Multivariate logistic regression showed that odds for being included in the home rehabilitation group were higher for women and for those who had a stroke in the past. Odds for being included in the institutional rehabilitation group were individuals with diabetes and difficulty in ambulating and those who had a longer stay in the acute-care hospital. Findings of the study suggest that in Israel there is a sub-population of acute stroke survivors who may be appropriate for rehabilitation at home and accept the option when they are offered it.

Fight like a ferret: a novel approach of using art therapy to reduce anxiety in stroke patients undergoing hospital rehabilitation.

PubMed

Ali, Khalid; Gammidge, Tony; Waller, Diane

2014-06-01

The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with more emphasis placed on physical recovery despite anxiety and depression being common poststroke. From the limited amount of current literature, it seems that creative strategies such as art therapy (AT) can be beneficial in reducing isolation and anxiety among stroke patients. Stroke patients (able to consent) in a hospital rehabilitation unit were invited to participate in two weekly AT sessions for 6 weeks, facilitated by an art psychotherapist using paints, crayons, clay, a camera and an iPad. Hospital anxiety and depression scales (HAD) and therapy outcome measures (TOM) were measured at the beginning and end of the study. Six male patients were recruited, average age 69 years (38-85). Group discussions allowed patients to express openly feelings of frustration as well as hope for physical and emotional recovery: 'fight like a ferret', an expression used by a group member. The group produced several art objects and photographic images that were collated using stop-frame animation to produce a 10 min film. Median HAD score for the group was eight points upon entering the study and six points on finishing the study. There is little attention to the emotional needs of stroke patients in rehabilitation. Properly designed research studies exploring the role of AT in addressing anxiety and depression poststroke are needed. Our study showed that AT was a feasible intervention that helped patients explore the sequel of stroke in an open supportive environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation.

PubMed

Meyer, Fiorenza Angela; von Känel, Roland; Saner, Hugo; Schmid, Jean-Paul; Stauber, Stefanie

2015-10-01

Little is known as to whether negative emotions adversely impact the prognosis of patients who undergo cardiac rehabilitation. We prospectively investigated the predictive value of state negative affect (NA) assessed at discharge from cardiac rehabilitation for prognosis and the moderating role of positive affect (PA) on the effect of NA on outcomes. A total of 564 cardiac patients (62.49 ± 11.51) completed a comprehensive three-month outpatient cardiac rehabilitation program, filling in the Global Mood Scale (GMS) at discharge. The combined endpoint was cardiovascular disease (CVD)-related hospitalizations plus all-cause mortality at follow-up. Cox regression models estimated the predictive value of NA, as well as the moderating influence of PA on outcomes. Survival models were adjusted for sociodemographic factors, traditional cardiovascular risk factors, and severity of disease. During a mean follow-up period of 3.4 years, 71 patients were hospitalized for a CVD-related event and 15 patients died. NA score (range 0-20) was a significant and independent predictor (hazard ratio (HR) 1.091, 95% confidence interval (CI) 1.012-1.175; p = 0.023) with a three-point higher level in NA increasing the relative risk by 9.1%. Furthermore, PA interacted significantly with NA (p < 0.001). The relative risk of poor prognosis with NA was increased in patients with low PA (p = 0.012) but remained unchanged in combination with high PA (p = 0.12). The combination of NA with low PA was particularly predictive of poor prognosis. Whether reduction of NA and increase of PA, particularly in those with high NA, improves outcome needs to be tested. © The European Society of Cardiology 2014.

Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery: Data From the Clinical Outcomes Assessment Program.

PubMed

Beatty, Alexis L; Bradley, Steven M; Maynard, Charles; McCabe, James M

2017-06-01

Despite guideline recommendations that patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass surgery, or valve surgery be referred to cardiac rehabilitation, cardiac rehabilitation is underused. The objective of this study was to examine hospital-level variation in cardiac rehabilitation referral after PCI, coronary artery bypass surgery, and valve surgery. We analyzed data from the Clinical Outcomes Assessment Program, a registry of all nonfederal hospitals performing PCI and cardiac surgery in Washington State. We included eligible PCI, coronary artery bypass surgery, and valve surgery patients from 2010 to 2015. We analyzed PCI and cardiac surgery separately by performing multivariable hierarchical logistic regression for the outcome of cardiac rehabilitation referral at discharge, clustered by hospital. Patient-level covariates included age, sex, race/ethnicity, comorbidities, and procedure indication/status. Cardiac rehabilitation referral was reported in 48% (34 047/71 556) of PCI patients and 91% (21 831/23 972) of cardiac surgery patients. The hospital performing the procedure was a stronger predictor of referral than any individual patient characteristic for PCI (hospital referral range 3%-97%; median odds ratio, 5.94; 95% confidence interval, 4.10-9.49) and cardiac surgery (range 54%-100%; median odds ratio, 7.09; 95% confidence interval, 3.79-17.80). Hospitals having an outpatient cardiac rehabilitation program explained only 10% of PCI variation and 0% of cardiac surgery variation. Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was the hospital performing the procedure. Efforts to improve cardiac rehabilitation referral should focus on increasing referral after PCI, especially in low referral hospitals. © 2017 American Heart Association, Inc.

Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

PubMed

Rasekaba, T M; Williams, E; Hsu-Hage, B

2009-01-01

Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P < 0.001) 12 months after the introduction of the CDM Program; in contrast, changes in the cumulative indicators were statistically insignificant for the Opt-out Cohort (emergency department presentations decreased by 5%, inpatient admissions decreased by 12%, length of stay increased by 30%; effect size = 0.14-0.40, P > 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

Efficiency and effectiveness of stroke rehabilitation after first stroke.

PubMed

Lin, J H; Chang, C M; Liu, C K; Huang, M H; Lin, Y T

2000-06-01

To investigate predictive variables of rehabilitation efficiency and achievement of rehabilitation potential following stroke rehabilitation. We prospectively studied 110 first-stroke patients consecutively admitted to the inpatient rehabilitation department of our university hospital from 1 January to 31 December 1997. Functional recovery was measured as improvement in the ability to perform the Functional Independence Measure (FIM) instrument. Major medical (side of paralysis, stroke etiology, risk factors, Brunnstrom motor recovery stage, etc.), rehabilitative (initial FIM subscore, interval from stroke onset to rehabilitation commencement, rehabilitation stay, etc.), and demographic (age, years of education, occupation, marital and living status, care-giver, etc.) variables were examined. The mean FIM score was 57.7 +/- 24.5 at admission and 77.3 +/- 26.3 at discharge. The mean rehabilitation efficiency (0.7 +/- 0.7) and effectiveness (30.6 +/- 24.0%) of stroke rehabilitation were determined. Rehabilitation efficiency and rehabilitation effectiveness were significantly predicted by length of stay and arm motor recovery stage, and by age and arm motor recovery stage, respectively. The variance explained only 21% of the rehabilitation efficiency and 24% of the achievement of rehabilitation potential. The results of this study suggest that the large proportion of the unexplained variance in rehabilitation efficiency and effectiveness is due to nonmedical factors influencing the selection of patients for rehabilitation.

Cognitive problems in patients in a cardiac rehabilitation program after an out-of-hospital cardiac arrest.

PubMed

Boyce-van der Wal, L W; Volker, W G; Vliet Vlieland, T P M; van den Heuvel, D M J; van Exel, H J; Goossens, P H

2015-08-01

Estimate prevalence of cognitive problems due to hypoxic brain injury in out-of-hospital cardiac arrest (OHCA) survivors referred for cardiac rehabilitation and association with quality of life as well as autonomy and participation. Prospective cohort study. Consecutive OHCA patients. The Mini-Mental State Examination (MMSE), Cognitive Failures Questionnaire (CFQ) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were administered 4 weeks after the OHCA. Cognitive problems were defined if MMSE <28, CFQ >32 or IQCODE >3.6. The Impact on Participation and Autonomy Questionnaire (IPAQ) (participation/autonomy), the SF-36 Health Survey (SF-36) (quality of life) and the Hospital Anxiety Depression Scale (HADS) (anxiety/depression) were administered. Correlations between cognitive problems and participation/autonomy and quality of life were calculated. 63 of 77 patients were male (82%), median age 59 years (range 15-84). MMSE median 29 (interquartile range 28-30), CFQ mean 20.9 (SD 9.4) and IQCODE mean 3.1 (SD 0.2). Eighteen patients (23%) scored positive for cognitive problems. Significant correlations were found between MMSE and IPAQ: autonomy inside (r = -0.38), family role (r = -0.26), autonomy outside (r = -0.32), social relations (r = -0.38) and social functioning (r = 0.32). MMSE was related to SF-36: social functioning (r = 0.32). The CFQ was related to IPAQ: autonomy outdoors (r = 0.29) and SF-36: bodily pain (r = -0.37), vitality (r = -0.25), mental health (r = -0.35) and role emotional (r = -0.40). The IQCODE was related to IPAQ: autonomy indoors (r = 0.26) and to SF-36: vitality (r = -0.33) and social functioning (r = -0.41). Twenty-three percent of the patients referred for cardiac rehabilitation showed cognitive problems. Associations were found between cognitive problems and several aspects of participation/autonomy and perceived quality of life. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Do patients have any special medical or rehabilitation difficulties after a craniectomy for malignant cerebral infarction during their hospitalization in a physical medicine and rehabilitation department?

PubMed

Mandon, L; Bradaï, N; Guettard, E; Bonan, I; Vahedi, K; Bousser, M G; Yelnik, A

2010-03-01

To observe whether medical complications, the evolution of neurological disorders and dependence and/or the discharge destinations are different for patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery compared to patients treated medically for severe or malignant cerebral infarction in the same cerebral territory, during their hospitalization in a physical medicine and rehabilitation department. This retrospective study compared patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery and patients treated medically for severe or malignant cerebral infarction in the same cerebral territory. Patients were paired according to age, lesion side and hospitalization period. Twelve patients treated by craniectomy (age 43+/-10.44) were paired with 12 patients treated medically (age 49+/-7.66). The two groups were comparable in terms of general undesirable medical events. The medical events related to craniectomy are described. The evolution of patient deficiencies, the length of the hospital stay (194+/-118.93 days vs 152+/-94.64 days), the Functional Independence Measure at discharge (87+/-21.28 vs 95+/-22.19) and the number of direct home discharges (7 vs 9) did not significantly differ between groups. No more medical problems were observed in the patients treated by craniectomy than in the patients treated medically, except for the medical events specifically related to craniectomy, which extended the hospital stay but had no major repercussions. 2010 Elsevier Masson SAS. All rights reserved.

[Characteristics of art therapists in rehabilitative therapy].

PubMed

Oster, Jörg

2017-09-01

Characteristics of art therapists in rehabilitative therapy Objectives: This study examines the sociodemographic, qualification- and activity-related characteristics of art therapists working in the field of rehabilitation. In 2013, an analysis of occupational groups was carried out in Germany, with the objective of describing the art therapists working there.A total of 2,303 complete datasets were submitted. From this group, those therapists mainly working in the field of rehabilitation/follow-up care/participation of disabled persons (according to Social Security Code VI and IX, n = 302) were selected and described. Most art therapists are female (average age 45 years) and largelywork part-time. Music and art therapy are the most common venues.More than 80% have a graduate degree. Methods of quality management are used.More than half of the therapists working in rehabilitation hospitals are employed in the field of psychosomatic medicine. Both individual and group therapy (each patient attending 1-2 times a week) are common. The results provide an overview of art therapy in the field of rehabilitation and show the spread in rehabilitation. Further research is indicated.

Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.

PubMed

McWilliams, David; Weblin, Jonathan; Atkins, Gemma; Bion, Julian; Williams, Jenny; Elliott, Catherine; Whitehouse, Tony; Snelson, Catherine

2015-02-01

Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU). A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality. The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P < .05), total hospital LOS (35.3 vs 30.1 days, P < .001), and in-hospital mortality (39% vs 28%, P < .05). A quality improvement strategy to promote early and enhanced rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.

PubMed

Chen, Chien-Min; Ke, Yen-Liang

2016-02-01

One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.

Defining Rehabilitation Success in Older Adults with Dementia--Results from an Inpatient Geriatric Rehabilitation Unit.

PubMed

Muir-Hunter, S W; Fat, G Lim; Mackenzie, R; Wells, J; Montero-Odasso, M

2016-04-01

To quantify the magnitude of functional recovery in older adults with and without dementia admitted to an inpatient geriatric rehabilitation program by measuring change in measures of global physical function and physical therapy treatment outcomes. Retrospective cohort study. Rehabilitation academic hospital. Consecutive subjects, with (N=65, age 81.9±6.0 y) and without (N=157, age 82.8±7.2 y) a dementia diagnosis, had assessment data at admission and discharge from inpatient geriatric rehabilitation unit. Not applicable. The Functional Independence Measure (FIM) was used to estimate level of independence on activities of daily living. The Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and 2 Minute Walk Test (2MWT) were used to estimate functional mobility and endurance. The FIM (total, motor subscale, cognitive subscale scores) were used to calculate rehabilitation efficacy and efficiency scores. After controlling for confounding, there was no group difference for gains on the BBS, TUG, 2MWT; there was no group difference on rehabilitation efficacy and efficiency values based on the FIM motor subscale. The magnitude of the rehabilitation gain using the total FIM score was statistically different between groups, people with dementia having smaller gains. Older adults with a diagnosis of dementia are capable of making motor function recovery during inpatient sub-acute rehabilitation comparable to their peers without a dementia diagnosis. The metric used to evaluate functional recovery influences the determination of rehabilitation success between groups. Rehabilitation success should be defined among people with a dementia diagnosis by a change in the motor subscale of the FIM, rather than the total FIM score or the gain relative to the maximal FIM score.

Behavioral Contributions to Rehabilitation and Childhood Asthma

ERIC Educational Resources Information Center

Creer, Thomas L.; And Others

1976-01-01

Described is the 12- to 18-month residential treatment program at the Children's Asthma Research Institute and Hospital, a behaviorally oriented rehabilitation program for children who suffer from chronic bronchial asthma. (IM)

Casemix and rehabilitation: evaluation of an early discharge scheme.

PubMed

Brandis, S

2000-01-01

This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitations of a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. The POSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period. Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6% drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patient satisfaction, improved carer support and increased continuity of care. The challenge under the Australian interpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acute care, and community and home settings.

Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan.

PubMed

Murata, Kyoko; Hinotsu, Shiro; Sadamasa, Nobutake; Yoshida, Kazumichi; Yamagata, Sen; Asari, Shoji; Miyamoto, Susumu; Kawakami, Koji

2017-02-01

To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Retrospective cohort study. One acute and one rehabilitation hospital in Japan. Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Impact of Rehabilitation on Outcomes in Patients With Ischemic Stroke: A Nationwide Retrospective Cohort Study in Japan.

PubMed

Yagi, Maiko; Yasunaga, Hideo; Matsui, Hiroki; Morita, Kojiro; Fushimi, Kiyohide; Fujimoto, Masashi; Koyama, Teruyuki; Fujitani, Junko

2017-03-01

We aimed to examine the concurrent effects of timing and intensity of rehabilitation on improving activities of daily living (ADL) among patients with ischemic stroke. Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively analyzed consecutive patients with ischemic stroke at admission who received rehabilitation (n=100 719) from April 2012 to March 2014. Early rehabilitation was defined as that starting within 3 days after admission. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. A multivariable logistic regression analysis with multiple imputation and an instrumental variable analysis were performed to examine the association of early and intensive rehabilitation with the proportion of improved ADL score. The proportion of improved ADL score was higher in the early and intensive rehabilitation group. The multivariable logistic regression analysis showed that significant improvements in ADL were observed for early rehabilitation (odds ratio: 1.08; 95% confidence interval: 1.04-1.13; P <0.01) and intensive rehabilitation of >5.0 U/d (odds ratio: 1.87; 95% confidence interval: 1.69-2.07; P <0.01). The instrumental variable analysis showed that an increased proportion of improved ADL was associated with early rehabilitation (risk difference: 2.8%; 95% confidence interval: 2.0-3.4%; P <0.001) and intensive rehabilitation (risk difference: 5.6%; 95% confidence interval: 4.6-6.6%; P <0.001). The present results suggested that early and intensive rehabilitation improved ADL during hospitalization in patients with ischemic stroke. © 2017 American Heart Association, Inc.

Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation.

PubMed

Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko

2017-06-01

For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (<10 mg/dL) is predictive of a poor outcome in stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

The costs and benefits of technology-enabled, home-based cardiac rehabilitation measured in a randomised controlled trial.

PubMed

Whittaker, Frank; Wade, Victoria

2014-10-01

We conducted a cost benefit analysis of a home telehealth-based cardiac rehabilitation programme compared to the standard hospital-based programme. A total of 120 participants were enrolled in a trial, with 60 randomised to the telehealth group and 60 randomised to usual care. Participants in the telehealth group received a mobile phone, Wellness Diary and a Wellness web portal, with daily text messaging. Participants in the usual care group received the standard 6-week hospital-based outpatient cardiac rehabilitation programme, including gym sessions. The cost of delivery by telehealth was slightly lower than for patients attending a rehabilitation service in person. From the provider's perspective, the telehealth intervention could be delivered for $1633 per patient, compared to $1845 for the usual care group. From the participant's perspective, patient travel costs for home rehabilitation were substantially less than for hospital attendance ($80 vs $400). Cardiac rehabilitation by telehealth offers obvious advantages and the option should be available to all patients who are eligible for cardiac rehabilitation. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

Rehabilitation in Madagascar: Challenges in implementing the World Health Organization Disability Action Plan.

PubMed

Khan, Fary; Amatya, Bhasker; Mannan, Hasheem; Burkle, Frederick M; Galea, Mary P

2015-09-01

To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach, new partnerships, strategic collaboration, provision of technical assistance, future policy directions, and research and development. Other challenges for many basic policies included: access to rehabilitation services, geographical coverage, shortage of skilled work-force, limited info-technology systems; lack of care-models and facility/staff accreditation standards; limited health services infrastructure and "disconnect" between acute and community-based rehabilitation. The DAP summary actions were useful planning tools to improve access, strengthen rehabilitation services and community-based rehabilitation, and collate data for outcome research.

Outcomes in a Community-Based Intensive Cardiac Rehabilitation Program: Comparison with Hospital-Based and Academic Programs.

PubMed

Katzenberg, Charles; Silva, Edna; Young, M Jean; Gilles, Greg

2018-04-13

The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population. Participants seeking either primary or secondary coronary artery disease prevention voluntarily enrolled in the 12-week intensive cardiac rehabilitation program. Data were obtained at baseline and 6-12 months after completion of the program. A total of 142 individuals, mean age 69 years, completed the Heart Series between 2012 and 2016. Follow-up data were available in 105 participants (74%). Participants showed statistically significant improvements in mean weight (165 to 162 lbs, P = .0005), body mass index (26 to 25 kg/m 2 , P = .001), systolic blood pressure (126 to 122 mm Hg, P = .01), diastolic blood pressure (73 to 70 mm Hg, P = .0005), total cholesterol (175 to 168 mg/dL, P = .03), low-density lipoprotein cholesterol (LDL-C) (100 to 93 mg/dL, P = .005), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (1.8 to 1.6, P = .005), and cholesterol/HDL-C ratio (3.2 to 3.0, P = .003). Changes in HDL-C, triglycerides, and fasting blood glucose did not reach statistical significance, but all trended in favorable directions. Adverse cardiovascular disease outcomes were rare (one stent placement, no deaths). A total of 105 participants completed our 12-week community-based intensive cardiac rehabilitation program and showed significant positive changes in several measures of cardiac risk, with only 1 adverse event. These results compare favorably with those of hospital-based and academic institutional programs. Copyright © 2018 Elsevier Inc. All rights reserved.

Cardiac rehabilitation after myocardial infarction.

PubMed

Contractor, Aashish S

2011-12-01

Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease (CHD), and as such are recommended as useful and effective (Class I) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD. The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. Cardiac rehabilitation, aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient. The program involves education, exercise, risk factor modification and counselling. A meta-analysis based on a review of 48 randomized trials that compared outcomes of exercise-based rehabilitation with usual medical care, showed a reduction of 20% in total mortality and 26% in cardiac mortality rates, with exercise-based rehabilitation compared with usual medical care. Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants. During exercise, the patients' ECG is continuously monitored through telemetry, which serves to optimize the exercise prescription and enhance safety. The safety of cardiac rehabilitation exercise programs is well established, and the occurrence of major cardiovascular events during supervised exercise is extremely low. As hospital stays decrease, cardiac rehabilitation is assuming an increasingly important role in secondary prevention. In contrast with its growing importance internationally, there are very few

Using RFID Positioning Technology to Construct an Automatic Rehabilitation Scheduling Mechanism.

PubMed

Wang, Ching-Sheng; Hung, Lun-Ping; Yen, Neil Y

2016-01-01

Accurately and efficiently identifying the location of patients during the course of rehabilitation is an important issue. Wireless transmission technology can reach this goal. Tracking technologies such as RFID (Radio frequency identification) can support process improvement and improve efficiencies of rehabilitation. There are few published models or methods to solve the problem of positioning and apply this technology in the rehabilitation center. We propose a mechanism to enhance the accuracy of positioning technology and provide information about turns and obstacles on the path; and user-centered services based on location-aware to enhanced quality care in rehabilitation environment. This paper outlines the requirements and the role of RFID in assisting rehabilitation environment. A prototype RFID hospital support tool is established. It is designed to provide assistance for monitoring rehabilitation patients. It can simultaneously calculate the rehabilitant's location and the duration of treatment, and automatically record the rehabilitation course of the rehabilitant, so as to improve the management efficiency of the rehabilitation program.

Rehabilitation of Critical Illness Polyneuropathy and Myopathy Patients: An Observational Study

ERIC Educational Resources Information Center

Novak, Primoz; Vidmar, Gaj; Kuret, Zala; Bizovicar, Natasa

2011-01-01

Critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in intensive care units. The number of patients with CIPNM admitted to inpatient rehabilitation is increasing. The aim of this study was to comprehensively evaluate the outcome of their rehabilitation. Twenty-seven patients with CIPNM were included in…

Educated parent as a key member of rehabilitation team.

PubMed

Mikelić, Valentina Matijević; Bartolović, Jelena; Kosicek, Tena; Crnković, Maja

2011-12-01

Involvement of children with minor motor impairments in early intervention programs is becoming a positive trend. Rehabilitation of young children is usually performed in family environment with continuous monitoring by a team of experts including a physiatrist, speech therapist, psychologist, and rehabilitator. For this reason, it is important to educate parents in proper procedures designed to encourage the child's global and language development. Parental competence in encouraging the child's language development and providing home learning environment is associated with the level of parental education. We performed a retrospective analysis of data on 50 children aged 1-3 years, hospitalized during 2010 at Department of Pediatric Rehabilitation, University Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center in Zagreb. The aim was to determine the percentage of children included in an early intervention program according to the level of parental education and to assess the impact of the program on the children's language development. The results showed a higher percentage of parents to have high school education and a smaller percentage of parents to have university degree. These data indicated the need of educational programs for parents on the procedures of encouraging child development, including language development.

Admission of people with dementia to psychiatric hospitals in Japan: factors that can shorten their hospitalizations.

PubMed

Morikawa, Takako; Maeda, Kiyoshi; Osaki, Tohmi; Kajita, Hiroyuki; Yotsumoto, Kayano; Kawamata, Toshio

2017-11-01

People exhibiting serious behavioural and psychological symptoms of dementia are usually voluntarily or involuntarily committed to psychiatric hospitals for treatment. In Japan, the average hospital stay for individuals with dementia is about 2 years. Ideally, individuals should be discharged once their symptoms have subsided. However, we see cases in Japan where individuals remain institutionalized long after behavioural and psychological symptoms of dementia are no longer apparent. This study will attempt to identify factors contributing to shorter stays in psychiatric hospitals for dementia patients. Questionnaires consisting of 17 items were mailed to 121 psychiatric hospitals with dementia treatment wards in western Japan. Out of 121 hospitals that received the questionnaires, 45 hospitals returned them. The total number of new patient admissions at all 45 hospitals during the month of August 2014 was 1428, including 384 dementia patients (26.9%). The average length of stay in the dementia wards in August 2014 was 482.7 days. Our findings revealed that the rate of discharge after 2 months was 35.4% for the dementia wards. In addition, we found that the average stay in hospitals charging or planning to charge the rehabilitation fee to dementia patients was significantly shorter than in hospitals not charging the rehabilitation fee. In Japan, dementia patients account for over 25% of new admissions to psychiatric hospitals with dementia wards. The average length of stay in a psychiatric hospital dementia ward is more than 1 year. A discharge after fewer than 2 months is exceedingly rare for those in a dementia ward compared with dementia patients in other wards. If institutions focus on rehabilitation, it may be possible to shorten the stay of dementia patients in psychiatric hospitals. © 2017 Japanese Psychogeriatric Society.

Current therapeutic techniques and rehabilitation from neurological disorders

NASA Technical Reports Server (NTRS)

Nickel, V. L.; Hsu, J. D.

1974-01-01

Rancho Los Amigos Hospital is a 1100-bed teaching hospital that is primarily oriented toward rehabilitation. The individual services that deal with neuromuscular disorders are categorically disease entity oriented: They are directed toward the major problems, such as spinal cord injuries, amputations, stroke, cerebral palsy, and rheumatoid arthritis. The services at Rancho cross many traditional medical specialty barriers.

Pulmonary rehabilitation in lung transplant candidates.

PubMed

Li, Melinda; Mathur, Sunita; Chowdhury, Noori A; Helm, Denise; Singer, Lianne G

2013-06-01

While awaiting lung transplantation, candidates may participate in pulmonary rehabilitation to improve their fitness for surgery. However, pulmonary rehabilitation outcomes have not been systematically evaluated in lung transplant candidates. This investigation was a retrospective cohort study of 345 pre-transplant pulmonary rehabilitation participants who received a lung transplant between January 2004 and June 2009 and had available pre-transplant exercise data. Data extracted included: 6-minute walk tests at standard intervals; exercise training details; health-related quality-of-life (HRQL) measures; and early post-transplant outcomes. Paired t-tests were used to examine changes in the 6MW distance (6MWD), exercise training volume and HRQL during the pre-transplant period. We evaluated the association between pre-transplant 6MWD and transplant hospitalization outcomes. The final 6MWD prior to transplantation was only 15 m less than the listing 6MWD (n = 200; p = 0.002). Exercise training volumes increased slightly from the start of the pulmonary rehabilitation program until transplant: treadmill, increase 0.69 ml/kg/min (n = 238; p < 0.0001); biceps resistance training, 18 lbs. × reps (n = 286; p < 0.0001); and quadriceps resistance training, 15 lbs. × reps (n = 278; p < 0.0001). HRQL measures declined. A greater final 6MWD prior to transplant correlated with a shorter length of stay in the hospital (n = 207; p = 0.003). Exercise capacity and training volumes are well preserved among lung transplant candidates participating in pulmonary rehabilitation, even in the setting of severe, progressive lung disease. Participants with greater exercise capacity prior to transplantation have more favorable early post-transplant outcomes. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

PubMed

Lin, Heui-Fen; Wu, Ying-Tai; Tsauo, Jau-Yih

2012-08-16

Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database

PubMed Central

2012-01-01

Background Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients’ functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Methods Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. Results The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). Conclusions In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual

Medication errors versus time of admission in a subpopulation of stroke patients undergoing inpatient rehabilitation complications and considerations.

PubMed

Pitts, Eric P

2011-01-01

This study looked at the medication ordering error frequency and the length of inpatient hospital stay in a subpopulation of stroke patients (n-60) as a function of time of patient admission to an inpatient rehabilitation hospital service. A total of 60 inpatient rehabilitation patients, 30 arriving before 4 pm, and 30 arriving after 4 pm, with as admitting diagnosis of stroke were randomly selected from a larger sample (N=426). There was a statistically significant increase in medication ordering errors and the number of inpatient rehabilitation hospital days in the group of patients who arrived after 4 pm.

Long Sick Leave after Orthopaedic Inpatient Rehabilitation: Treatment Failure or Relapse?

ERIC Educational Resources Information Center

Mangels, Marija; Schwarz, Susanne; Worringen, Ulrike; Holme, Martin; Rief, Winfried

2011-01-01

We investigated whether short-term versus long-term sick leave after orthopaedic inpatient rehabilitation can be predicted by initial assessment information, the clinical status at discharge, or whether the follow-up interval is crucial for later sick leave. We examined 214 patients from an orthopaedic rehabilitation hospital at admission,…

Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients.

PubMed

Burrus, Cyrille; Ballabeni, Pierluigi; Deriaz, Olivier; Gobelet, Charles; Luthi, François

2009-09-01

To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest. Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points. Rehabilitation clinic. Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years. Not applicable. Nonresponse to the questionnaires was the binary dependent variable. Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse. We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.

Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital.

PubMed

Sakai, Kotomi; Nakayama, Enri; Tohara, Haruka; Maeda, Tomomi; Sugimoto, Motonobu; Takehisa, Takahiro; Takehisa, Yozo; Ueda, Koichiro

2017-04-01

The aim of this cross-sectional study was to investigate whether tongue strength observed in older adult inpatients of a rehabilitation hospital is associated with muscle function, nutritional status, and dysphagia. A total of 174 older adult inpatients aged 65 years and older in rehabilitation (64 men, 110 women; median age, 84 years; interquartile range, 80-89 years) who were suspected of having reduced tongue strength due to sarcopenia were included in this study. Isometric tongue strength was measured using a device fitted with a disposable oral balloon probe. We evaluated age, muscle function as assessed by the Barthel index and grip strength, nutritional status as measured by the Mini Nutritional Assessment-short form (MNA-SF), body mass index, serum albumin, controlling nutritional status, and calf circumference and arm muscle area to assess muscle mass. In addition, the functional oral intake scale (FOIS) was used as an index of dysphagia. Multivariate linear regression analysis revealed that isometric tongue strength was independently associated with grip strength (coefficient = 0.33, 95 % confidence interval (CI) 0.12-0.54, p = 0.002), MNA-SF (coefficient = 0.74, 95 % CI 0.12-1.35, p = 0.019), and FOIS (coefficient = 0.02, 95 % CI 0.00-0.15, p = 0.047). To maintain and improve tongue strength in association with sarcopenic dysphagia, exercise therapy and nutritional therapy interventions, as well as direct interventions to address tongue strength, may be effective in dysphagia rehabilitation in older adult inpatients.

Rehabilitation Risk Management: Enabling Data Analytics with Quantified Self and Smart Home Data.

PubMed

Hamper, Andreas; Eigner, Isabella; Wickramasinghe, Nilmini; Bodendorf, Freimut

2017-01-01

A variety of acute and chronic diseases require rehabilitation at home after treatment. Outpatient rehabilitation is crucial for the quality of the medical outcome but is mainly performed without medical supervision. Non-Compliance can lead to severe health risks and readmission to the hospital. While the patient is closely monitored in the hospital, methods and technologies to identify risks at home have to be developed. We analyze state-of-the-art monitoring systems and technologies and show possibilities to transfer these technologies into rehabilitation monitoring. For this purpose, we analyze sensor technology from the field of Quantified Self and Smart Homes. The available sensor data from this consumer grade technology is summarized to give an overview of the possibilities for medical data analytics. Subsequently, we show a conceptual roadmap to transfer data analytics methods to sensor based rehabilitation risk management.

Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.

PubMed

Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

2014-11-01

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working

Psychological benefits of virtual reality for patients in rehabilitation therapy.

PubMed

Chen, Chih-Hung; Jeng, Ming-Chang; Fung, Chin-Ping; Doong, Ji-Liang; Chuang, Tien-Yow

2009-05-01

Whether virtual rehabilitation is beneficial has not been determined. To investigate the psychological benefits of virtual reality in rehabilitation. An experimental group underwent therapy with a virtual-reality-based exercise bike, and a control group underwent the therapy without virtual-reality equipment. Hospital laboratory. 30 patients suffering from spinal-cord injury. A designed rehabilitation therapy. Endurance, Borg's rating-of-perceived-exertion scale, the Activation-Deactivation Adjective Check List (AD-ACL), and the Simulator Sickness Questionnaire. The differences between the experimental and control groups were significant for AD-ACL calmness and tension. A virtual-reality-based rehabilitation program can ease patients' tension and induce calm.

Ethical and policy issues in rehabilitation medicine.

PubMed

Caplan, Arthur L; Callahan, Daniel; Haas, Janet

1987-08-01

The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive issues of rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia....

Managerial and professional collaboration in the provision of home care rehabilitation.

PubMed

Hollis, Vivien; May, Laura

2005-01-01

Demand for home care rehabilitation continues to grow in response to faster hospital discharges. One solution is to expand rehabilitation services using therapist assistants. Professionals voice concerns regarding many instances of assistants providing interventions outside their expertise and practicing without therapist supervision. This paper provides principles elicited from practitioners' experiences of an effective management culture and collaboration in one home care organization that effectively assimilated assistants, with reports of consequent improvements to rehabilitation service and client outcomes.

Rehabilitation outcomes of children with cerebral palsy.

PubMed

Yalcinkaya, Ebru Yilmaz; Caglar, Nil Sayıner; Tugcu, Betul; Tonbaklar, Aysegul

2014-02-01

[Purpose] To evaluate the results of Bobath-based rehabilitation performed at a pediatric cerebral palsy (CP) inpatient clinic. [Subjects and Methods] The study subjects were 28 children with CP who were inpatients at a pediatric service. Inclusion criteria were: being an inpatient of our hospital aged 2-12 with a diagnosis of CP; having one permanent primary caregiver; and the caregiver having no medical or psychotic problems. All of the patients received Bobath treatment for 1 hour per day, 5 days a week. The locomotor system, neurologic and orthopedic examination, Gross Motor Function Measure (GMFM) of the patients, and Short Form-36 (SF-36) of permanent caregivers were evaluated at the time of admission to hospital, discharge from hospital, and at 1 and 3 months after discharge. [Results] Post-admission scores of GMFM at discharge, and 1 and 3 months later showed significant increase. Social function and emotional role subscores of SF-36 had increased significantly at discharge. [Conclusion] Bobath treatment is promising and randomized controlled further studies are needed for rehabilitation technics.

Rehabilitation Outcomes of Children with Cerebral Palsy

PubMed Central

Yalcinkaya, Ebru Yilmaz; Caglar, Nil Sayıner; Tugcu, Betul; Tonbaklar, Aysegul

2014-01-01

[Purpose] To evaluate the results of Bobath-based rehabilitation performed at a pediatric cerebral palsy (CP) inpatient clinic. [Subjects and Methods] The study subjects were 28 children with CP who were inpatients at a pediatric service. Inclusion criteria were: being an inpatient of our hospital aged 2–12 with a diagnosis of CP; having one permanent primary caregiver; and the caregiver having no medical or psychotic problems. All of the patients received Bobath treatment for 1 hour per day, 5 days a week. The locomotor system, neurologic and orthopedic examination, Gross Motor Function Measure (GMFM) of the patients, and Short Form-36 (SF-36) of permanent caregivers were evaluated at the time of admission to hospital, discharge from hospital, and at 1 and 3 months after discharge. [Results] Post-admission scores of GMFM at discharge, and 1 and 3 months later showed significant increase. Social function and emotional role subscores of SF-36 had increased significantly at discharge. [Conclusion] Bobath treatment is promising and randomized controlled further studies are needed for rehabilitation technics. PMID:24648650

Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States.

PubMed

Aragam, Krishna G; Dai, Dadi; Neely, Megan L; Bhatt, Deepak L; Roe, Matthew T; Rumsfeld, John S; Gurm, Hitinder S

2015-05-19

Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns. Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction. Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non-ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring <20% of patients. Approximately 60% of patients undergoing PCI in the United States are referred for cardiac rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

[Early interdisciplinary geriatric rehabilitation after hip fracture : Effective concept or just transfer of costs?].

PubMed

Lögters, T; Hakimi, M; Linhart, W; Kaiser, T; Briem, D; Rueger, J; Windolf, J

2008-09-01

Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion. This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86+/-8 (65-110) years. All patients were treated operatively. After a mean of 12+/-9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27+/-13 (4-103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index. With discharge from the acute care hospital, the Barthel index was 42+/-20 points and it increased during rehabilitation to 65+/-26 points. One year later the Barthel index was 67+/-28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75+/-24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52+/-27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome. Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

PubMed

Yang, Si-Dong; Ning, Sheng-Hua; Zhang, Li-Hong; Zhang, Ying-Ze; Ding, Wen-Yuan; Yang, Da-Long

2016-08-01

The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

Client and family engagement in rehabilitation research: a framework for health care organizations.

PubMed

Anderson, James; Williams, Laura; Karmali, Amir; Beesley, Lori; Tanel, Nadia; Doyle-Thomas, Krissy; Sheps, Gideon; Chau, Tom

2018-04-01

To describe the development and implementation of an organizational framework for client and family-centered research. Case report. While patient-centered care is now well established, patient-centered research remains underdeveloped. This is particularly true at the organizational level (e.g., hospital based research institutes). In this paper we describe the development of an organizational framework for client and family centered research at Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada. It is our hope that, by sharing our framework other research institutions can learn from our experience and develop their own research patient/client/family engagement programs. Implications for rehabilitation Family engagement in rehabilitation research •Rehabilitation research is crucial to the development and improvement of rehabilitative care. •The relevance, appropriateness, and accountability of research to patients, clients and families could be improved. •Engaging clients and families as partners in all aspects of the research process is one way to address this problem. •In this paper, we describe a framework for engaging clients and families in research at the organizational level.

Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital.

PubMed

Hirano, Yoshitake; Nitta, Osamu; Hayashi, Takeshi; Takahashi, Hidetoshi; Miyazaki, Yasuhiro; Kigawa, Hiroshi

2017-07-01

For patients with severe hemiplegia in a rehabilitation hospital, early prediction of the functional prognosis and outcomes is challenging. The purpose of this study was to create and verify a prognostic scale in severely hemiplegic stroke patients and allowing for prediction of (1) the ability to walk at the time of hospital discharge, (2) the ability to carry out activities of daily living (ADL), and (3) feasibility of home discharge. The study was conducted on 80 severely hemiplegic stroke patients. A prognostic scale was created as an analysis method using the following items: mini-mental state examination (MMSE) at the time of admission, modified NIH stroke scale (m-NIHSS); trunk control test (TCT); and the ratio of the knee extensor strength on the non-paralyzed side to the body weight (KES/BW-US). We verified the reliability and validity of this scale. We established a prognostic scale using the MMSE, m-NIHSS, TCT, and KES/BW-US. A score of 56.8 or higher on the prognostic scale suggested that the patient would be able to walk and that assistance with ADL would be unnecessary at the time of hospital discharge. In addition, a score of 41.3 points indicated that the patient's return home was feasible. The reliability and the results were in good agreement. These findings showed that the ability or inability to walk was predictable in 85%, the need of assistance with ADL in 82.5%, and the feasibility of home return in 76.3% of cases. At the time of admission, four evaluation items permitted the prediction of three outcomes at time of discharge. Our formula predicts three outcomes with an accuracy of more than 76%. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient perspectives on navigating the field of traumatic brain injury rehabilitation: a qualitative thematic analysis.

PubMed

Graff, Heidi J; Christensen, Ulla; Poulsen, Ingrid; Egerod, Ingrid

2018-04-01

This study aimed to provide an understanding of the lived experience of rehabilitation in adults with traumatic brain injury (TBI) from hospital discharge up to four years post-injury. We used a qualitative explorative design with semi-structured in-depth interviews. Twenty participants with TBI were included from a level I Trauma Center in Denmark at 1-4 years post-injury. Qualitative thematic analysis was applied for data analysis. Three main themes emerged during analysis: A new life, Family involvement, and Rehabilitation impediments. These themes and their sub-themes described the patient perspective of TBI and rehabilitation post hospitalization. Participants reassessed their values and found a new life after TBI. Family caregivers negotiated rehabilitation services and helped the participant to overcome barriers to rehabilitation. Although participants were entitled to TBI rehabilitation, they had to fight for the services they were entitled to. Individuals with TBI found ways of coping after injury and created a meaningful life. Barriers to TBI rehabilitation were overcome with help from family caregivers rather than health care professionals. Future studies need to find ways to ease the burden on family caregivers and pave the way for more accessible rehabilitation in this vulnerable group of patients. Implications for rehabilitation TBI rehabilitation might benefit from:    • Increased transparency in rehabilitation options    • More systematic follow-up programs    • Age-appropriate rehabilitation facilities    • Inclusion of patient and family in the planning of long-term rehabilitation.

[The formation and developmental outlook of medical rehabilitation in the Armed Forces of the Russian Federation].

PubMed

Chizh, I M; Ivanov, V N; Golov, Iu S; Shchegol'kov, A M

2000-01-01

In medical service system of AF RF rehabilitation means combination of medical, military and professional, social and economic and pedagogical measures directed to recovery of health, fighting efficiency (ability to work) which were disturbed or lost by servicemen because of disease or trauma. In the article the main landmarks of rehabilitation development in Russian military medicine are pointed out, today's state of system on the whole and stages in particular is analyzed, perspectives of development are determined. The authors have noted considerable contribution made by Central Military Clinical Hospital N 6 to development of medical rehabilitation. Arsenal of modern rehabilitation and restorative measures is indicated. Methodological principles of rehabilitation conduction are shown. The main ways in further improvement of medical rehabilitation are development of its specialization, rise in economic and social efficiency of rehabilitation measures at the expense of significant unloading of hospital urgent beds and decrease in periods of patient return to military service who will be ready to perform their duties in whole volume. Introduction of modern methodological and organizational principles of medical rehabilitation into the practice of medical support of the Armed Forces' personnel will contribute to achievement of success in this area.

Implementation of Clinical Quality Management for Rehabilitation in Malaysia.

PubMed

Engkasan, Julia Patrick; Stucki, Gerold; Ali, Sadeeq; Yusof, Yusniza Mohd; Hussain, Hafez; Latif, Lydia Abdul

2018-04-18

In February 2017, the World Health Organization (WHO) launched its historic "Rehabilitation 2030: A Call for Action". Scaling up rehabilitation in health systems requires concerted action across all 6 components of WHO's Health Systems Framework. For rehabilitation, information about functioning is essential, as it is required for effective rehabilitation at all levels of the health system. What is missing is a countrywide demonstration project involving the implementation of a clinical quality management system for the continuous improvement of rehabilitation, both at the level of clinical care for individual patients and at the level of rehabilitation service provision. Consequently, the Department of Rehabilitation Medicine at the University of Malaya and University Malaya Medical Centre, together with the Cheras Rehabilitation Hospital of the Ministry of Health, and the Social Security Organisation (SOCSO) Rehabilitation Centre in Malacca, Malaysia, initiated a project to develop a Malaysian-wide clinical quality management system for rehabilitation (CQM-R Malaysia). The objective of this paper is to describe CQM-R Malaysia. First, a conceptual description of a CQM-R based on the International Classification of Functioning, Disability and Health (ICF) is set out. The methods, results and conclusions of a situation analysis conducted in January 2017 are then reported. Finally, the building blocks and implementation action plan developed for CQM-R Malaysia are presented.

Geriatric and physically oriented rehabilitation improves the ability of independent living and physical rehabilitation reduces mortality: a randomised comparison of 538 patients.

PubMed

Lahtinen, Antti; Leppilahti, Juhana; Harmainen, Samppa; Sipilä, Jaakko; Antikainen, Riitta; Seppänen, Maija-Liisa; Willig, Reeta; Vähänikkilä, Hannu; Ristiniemi, Jukka; Rissanen, Pekka; Jalovaara, Pekka

2015-09-01

To examine effects of physical and geriatric rehabilitation on institutionalisation and mortality after hip fracture. Prospective randomised study. Physically oriented (187 patients), geriatrically oriented (171 patients), and health centre hospital rehabilitation (180 patients, control group). A total of 538 consecutively, independently living patients with non-pathological hip fracture. Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living (ADL) and mortality. Mortality was significantly lower at 4 and 12 months in physical rehabilitation (3.2%, 8.6%) than in geriatric rehabilitation group (9.6%, 18.7%, P=0.026, P=0.005, respectively) or control group (10.6%, 19.4%, P=0.006, P=0.004, respectively). At 4 months more patients in physical (84.4%) and geriatric rehabilitation group (78.0%) were able to live at home or sheltered housing than in control group (71.9%, P=0.0012 and P<0.001, respectively). No significant difference was found between physical rehabilitation and geriatric rehabilitation (P=0.278). Analysis of femoral neck and trochanteric fractures showed that significant difference was true only for femoral neck fractures (physical rehabilitation vs geriatric rehabilitation P=0.308, physical rehabilitation vs control group P<0,001 and geriatric rehabilitation vs control group P<0.001). Effects of intensified rehabilitations disappeared at 12 months. No impact on walking ability or ADL functions was observed. Physical rehabilitation reduced mortality. Physical and geriatric rehabilitation significantly improved the ability of independent living after 4 months especially among the femoral neck fracture patients but this effect could not be seen after 12 months. © The Author(s) 2014.

New activity-based funding model for Australian private sector overnight rehabilitation cases: the rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model.

PubMed

Hanning, Brian; Predl, Nicolle

2015-09-01

Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Environment (ECLIPSE) and health reform generally.

Is acupuncture an acceptable option in stroke rehabilitation? A survey of stroke patients.

PubMed

Yam, Winnie; Wilkinson, Jenny M

2010-01-01

Stroke is a leading cause of morbidity and mortality and stroke survivors make up the largest group of patients in rehabilitation. These individuals also have one of the longest lengths of stay in rehabilitation. It has been suggested that acupuncture may be beneficial in post-stroke rehabilitation and in this study we examine how stroke patients value acupuncture and their perceptions of acupuncture as a rehabilitation treatment option. A questionnaire was distributed to individuals undergoing post-stroke rehabilitation at three rehabilitation centers attached to hospitals in Toronto, Canada. Two hundred and seventy-three individuals completed the questionnaire with the respondent group comprising mainly males (62%) over 65 years of age (68%). Overall 29% had used acupuncture with 16% receiving acupuncture treatment for stroke related conditions. Almost all respondents (98%) wanted to know more about acupuncture in stroke rehabilitation and 87% would consider acupuncture as a treatment option. Few (8%) reported that they had advanced level knowledge about acupuncture, with most reporting a basic (48%) or intermediate (33%) level which recognized that acupuncture used fine needles to produce a therapeutic response. Those with prior acupuncture experience expected to pay more for treatment. The main factors influencing decisions to use acupuncture were practitioner competency (84%), cost (65%) and sterilization concerns (40%). This study demonstrates that there is willingness by patients attending conventional hospital-based rehabilitation centers to consider acupuncture in stroke rehabilitation and that lack of knowledge about this treatment is not a barrier to use. Copyright 2010 Elsevier Ltd. All rights reserved.

Rehabilitation of Combat-Related Injuries in the Veterans Administration: A Web of Support.

PubMed

Howell, Paul; Capehart, Bruce P; Hoenig, Helen

2015-01-01

The Department of Veterans Affairs provides acute, subacute, and continuing rehabilitation for veterans using a hub-and-spoke system of hospitals and outpatient facilities. Using traumatic brain injury as an example, this commentary illustrates how this system provides interdisciplinary rehabilitative care to veterans throughout North Carolina.

Planning for a medical surge incident: Is rehabilitation the missing link?

PubMed

Vonderschmidt, Kay

2017-01-01

This mixed methods study explored surge planning for patients who will need rehabilitative care after a mass casualty incident. Planning for a patient surge incident typically considers only prehospital and hospital care. However, in many cases, disaster patients need rehabilitation for which planning is often overlooked. The purpose of this study was to explore this hidden dimension of patient rehabilitation for surge planning and preparedness and ask: 1. To what extent can an analysis of standard patient acuity assessment tools [Simple Triage and Rapid Treatment and Injury Severity Score] be used to project future demand for admission to rehabilitative care? 2. What improvements to medical disaster planning are needed to address patient surge related to rehabilitation? This study found that standard patient benchmarks can be used to project demand for rehabilitation following a mass casualty incident, and argues that a reconceptualization of surge planning to include rehabilitation would improve medical disaster planning.

[Optimal rehabilitation of patients with coronary heart disease in outpatient setting].

PubMed

Korzhenkov, N P; Kuzichkina, S F; Shcherbakova, N A; Kukhaleishvili, N R; Iarlykov, I I

2012-01-01

The problem of invalid rehabilitation in Russia is an important state task and dictates necessity of design of an effective state program of primary prevention of cardiovascular diseases. Common global practice of medico-social model is based on complex detailed medico-social aid. Rehabilitation of postmyocardial infarction patients consists of three phases (stages): hospital posthospital (readaptation) and postreconvalescent (supportive). The program includes physical, psychological and pharmacological rehabilitation. Departments of readaptation and medico-social rehabilitation provide effective conduction of all kinds of rehabilitation. The Moscow North-East Regional Administration has a rich experience in organization of departments of readaptation and medico-social rehabilitation. The departments practice an individual approach to the patients and work in a close contact with bureaus of medico-social commission of experts. Management of patients by cardiologist, rehabilitation specialist and outpatient clinic's physicians provides uninterrupted staged rehabilitation, timely correction of pharmacotherapy, early patient referral to invasive investigations and treatment of coronary heart disease. A course of rehabilitative measures lasts 2 months. Setting up departments of medico-social rehabilitation in outpatient clinics provides more effective use of money assigned by the state for social support of invalids.

Short- and long-term changes in perceived work ability after interdisciplinary rehabilitation of chronic musculoskeletal disorders: prospective cohort study among 854 rehabilitants.

PubMed

Saltychev, Mikhail; Laimi, Katri; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

2014-06-01

To investigate the changes in rehabilitants' perceived work ability after rehabilitation for chronic musculoskeletal disorders with respect to the baseline characteristics. Prospective cohort study based on register and repeated survey data. Public sector employees in ten towns and five hospital districts. A total of 854 employees who participated in the rehabilitation programme owing to common chronic musculoskeletal disorders between 1997 and 2009. Interdisciplinary, biopsychosocial, inpatient rehabilitation programme targeting people of working age with common chronic musculoskeletal disorders. The programme was executed in different rehabilitation centres across the country and funded by the Social Insurance Institution of Finland. Differences in perceived work ability level before and after rehabilitation. Data were derived from repeated surveys on average 2.1 years before rehabilitation, and 1.5 years (short-term follow-up) and 6.0 years (long-term follow-up) after rehabilitation. Before the rehabilitation, perceived work ability was 7.13 (SD 1.84) among the rehabilitants and 7.27 (SD 1.72) in the matched reference population. Among rehabilitants, this figure decreased by 0.82 (95% confidence interval -0.98 to -0.67) in the short-term and by 1.26 (95% confidence interval -1.45 to -1.07) in the long-term follow-up. Only slight differences in steepness of this deterioration were observed between subgroups, created based on the participants' baseline characteristics. Perceived work ability of participants, in an interdisciplinary biopsychosocial rehabilitation programme for common musculoskeletal disorders, deteriorated regardless of any studied pretreatment characteristics. The improvement of work ability may be an unrealistic goal for participants in this type of rehabilitation. © The Author(s) 2014.

[Rehabilitation after Traumatic Fracture of Thoracic and Lumbar Spine].

PubMed

Bork, Hartmut; Simmel, Stefan; Böhle, Eckhardt; Ernst, Ulrich; Fischer, Klaus; Fromm, Bernd; Glaesener, Jean-Jacques; Greitemann, Bernhard; Krause, P; Panning, S; Pullwitt, V; Schmidt, J; Veihelmann, Andreas; Vogt, Lutz

2018-05-18

On the basis of the S2-k guideline "Rehabilitation after traumatic fractures of the thoracic und lumbar spine without neurologic disorder", this article gives an overview of target-oriented rehabilitation of patients with minor fractures or those with column stability and unstable spinal fractures which are stabilised by surgery. To obtain early social and job related reintegration, outpatient or inpatient rehabilitation has to start immediately after treatment in hospital. Rehabilitation must be orientated towards the biopsychosocial model of ICF and has to be adapted for the patient. The overall goal of rehabilitation is functional restoration of patient health to enable participation in society, life and job. Individual goals may change during rehabilitation, because of differential progress in therapy. Pain management must be orientated towards individual requirements and mental health has to be tested early, especially in polytrauma patients. Disorders have to be treated by psychotherapy, because psychic stress supports chronification of pain. Generally early exercise and physiotherapy are recommended in the guideline, with patient education for health-seeking behavior. Otherwise an orthesis device is not really necessary for treatment of a stable fracture. To improve the outcome of rehabilitation aftercare, treatment has to be arranged during rehabilitation, especially for employed patients. Georg Thieme Verlag KG Stuttgart · New York.

Activity and heart rate-based measures for outpatient cardiac rehabilitation.

PubMed

Bidargaddi, N P; Sarela, A

2008-01-01

Derive activity and heart rate (HR) monitor-based clinically relevant measures for outpatient cardiac rehabilitation (CR). We are currently collecting activity/ECG data from patients undergoing cardiac rehabilitation over duration of six weeks. From these data sets, we a) derive various measures which can be used in assessing home-based CR patients remotely and b) investigate the usefulness of continuous ambulatory HR and heart rate variability (HRV) for various core components of CR. The information provided by these measures is interpreted according to the CR guidelines framework by American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), thus showing how these tools can be used in assessing the progress of patients' condition. The usefulness and significance of these measures from a health care professional perspective is also presented by evaluating them against the existing hospital-based measures through examples. Hospital-based CR programs, despite their clinical benefits are severely under-utilized and resource-demanding. Ambulatory monitoring technologies, which provide a means for continuous physiological monitoring of patients at home compared to hospital-based tools, can enable home-based CR. The clinically relevant measures derived from these tools not only reflect patients' condition in a similar way as conventional tools but also show the continuous status of functional capacity (FC).

Expanding the Haitian rehabilitation workforce: employment situation and perceptions of graduates from three rehabilitation technician training programs.

PubMed

Descôteaux, Nancy; Chagnon, Valérie; Di Dong, Xin; Ellemo, Eric; Hamelin, Alessandra; Juste, Evans; Laplante, Xavier; Miron, Allison; Morency, Philippe; Samuel, Katherine; Charles, David; Hunt, Matthew

2018-05-01

This article examines the employment situation and perceptions of graduates from three rehabilitation technician (RT) programs in Haiti. In this mixed method study, 74 of 93 recent graduates completed a questionnaire, and 20 graduates participated in an in-depth qualitative interview. We analyzed survey results using descriptive statistics. We used a qualitative description approach and analyzed the interviews using constant comparative techniques. Of the 48 survey respondents who had completed their training more than six months prior to completing the questionnaire, 30 had found work in the rehabilitation sector. Most of these technicians were working in hospitals in urban settings and the patient population they treated most frequently were patients with neurological conditions. Through the interviews, we explored the participants' motivations for becoming a RT, reflections on the training program, process of finding work, current employment, and plans for the future. An analysis of qualitative and quantitative findings provides insights regarding challenges, including availability of supervision for graduated RTs and the process of seeking remunerated work. This study highlights the need for stakeholders to further engage with issues related to formal recognition of RT training, expectations for supervision of RTs, concerns for the precariousness of their employment, and uncertainty about their professional futures. Implications for Rehabilitation The availability of human resources in the rehabilitation field in Haiti has increased with the implementation of three RT training programs over the past 10 years. RTs who found work in the rehabilitation sector were more likely to work in a hospital setting, in the province where their training had taken place, to treat a diverse patient clientele, and to be employed by a non-governmental organization. The study underlines challenges related to the long-term sustainability of RT training programs, as well as the

Characteristics and Outcomes of Children With Conversion Disorder Admitted to a Single Inpatient Rehabilitation Unit, A Retrospective Study.

PubMed

Bolger, Ashlee; Collins, Andrew; Michels, Michelle; Pruitt, David

2018-03-14

Conversion disorder (CD) can lead to impaired functioning. Few studies present demographic and outcome data for pediatric patients. Many have had success with rehabilitation; however, further details are not known. To identify characteristics and outcomes of children admitted to a pediatric inpatient rehabilitation program with CD symptoms. Retrospective study. Inpatient rehabilitation unit within a large children's hospital. All patients with diagnosis of CD or functional gait disorder (FGD) during designated time period. Data were obtained from chart review and United Data Systems for Medical Rehabilitation. Descriptive statistics and Wilcoxon signed rank tests were used to analyze data. A P value of <.05 was statistically significant. Average length of stay, Functional Independence Measure for Children (WeeFIM) scores, WeeFIM change, WeeFIM efficiency, recommended therapies, number of repeat admissions to the same hospital for conversion disorder symptoms in the 12 months following discharge, and school reentry characteristics. 30 admissions were identified that met criteria. Before diagnosis, duration of symptoms was 58 ± 145 days, physician visits averaged 1.9 ± 2.1, hospital admissions to the same hospital averaged 0.7 ± 0.9, and absence from school was 6 ± 12 weeks. Overall, 83% exhibited mixed symptoms. Length of inpatient rehabilitation stay was 8.4 ± 4.2 days with WeeFIM score change of 30 ± 11.9 (P <.001). WeeFIM efficiency was 4.8 ± 4.1 points/d. For patients with documented WeeFIM scores at 3 months, all were improved or maintained. More than three-fourths (80%) had no documented readmission to the same hospital for CD symptoms for one year after discharge from inpatient rehabilitation. Close to half (47%) returned to school within one week of discharge from inpatient rehabilitation (when school was in session). This study suggests that a multidisciplinary inpatient rehabilitation approach is a potentially effective and efficient treatment for

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

PubMed

Sutton, J P; DeJong, G; Song, H; Wilkerson, D

1997-12-01

To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. Financial performance, as measured by the ratio of reimbursement to average costs. Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement

A UK survey of rehabilitation following critical illness: implementation of NICE Clinical Guidance 83 (CG83) following hospital discharge.

PubMed

Connolly, Bronwen; Douiri, A; Steier, J; Moxham, J; Denehy, L; Hart, N

2014-05-15

To determine the implementation of National Institute for Health and Care Excellence guidance (NICE CG83) for posthospital discharge critical illness follow-up and rehabilitation programmes. Closed-question postal survey. Adult intensive care units (ICUs) across the UK, identified from national databases of organisations. Specialist-only and private ICUs were not included. Senior respiratory critical care physiotherapy clinicians. A representative sample of 182 surveys was returned from the 240 distributed (75.8% (95% CI 70.4 to 81.2)). Only 48 organisations (27.3% (95% CI 20.7 to 33.9)) offered a follow-up service 2-3 months following hospital discharge, the majority (n=39, 84.8%) in clinic format. 12 organisations reported posthospital discharge rehabilitation programmes (6.8% (95% CI 3.1 to 10.5)), albeit only 10 of these operated on a regular basis. Lack of funding was reported as the most frequent (n=149/164, 90%) and main barrier (n=99/156, 63.5%) to providing services. Insufficient resources (n=71/164, 43.3%) and lack of priority by the clinical management team (n=66/164, 40.2%) were also highly cited barriers to service delivery. NICE CG83 has been successful in profiling the importance of rehabilitation for survivors of critical illness. However, 4 years following publication of CG83 there has been limited development of this clinical service across the UK. Strategies to support delivery of such quality improvement programmes are urgently required to enhance patient care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Dysphagia rehabilitation in visiting home care].

PubMed

Tohara, Haruka; Iida, Takatoshi; Inoue, Motoharu; Sato, Mitsuyasu; Wada, Satoko; Sanpei, Ryuichi; Okada, Takeshi; Shimano, Takaya; Ebihara, Katsuko; Ueda, Koichiro

2010-12-01

Dysphagia can cause aspiration pneumonia. The condition of dysphagia is difficult to evaluate from outside. Therefore, a careful examination is necessary to grasp the state of swallowing of a patient accurately. However, it has been a difficult situation for a patient who cannot come to hospital for some reason to be examined by video fluoroscopy or video endoscopy. In recent years, a usefulness of video endoscopy in visiting home examination for dysphagia has been reported several times. And this video endoscopy examination is a valuable tool to detect a discrepancy between swallowing function and nutritional intake of the patient. Cooperative rehabilitation with such a careful examination is an important issue to be successful in dysphagia rehabilitation.

The Uniform Data System for Medical Rehabilitation Report of Patients with Traumatic Spinal Cord Injury Discharged from Rehabilitation Programs in 2002 – 2010

PubMed Central

Granger, Carl V.; Karmarkar, Amol M.; Graham, James E.; Deutsch, Anne; Niewczyk, Paulette; DiVita, Margaret A.; Ottenbacher, Kenneth J.

2012-01-01

Objective Provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation following a traumatic spinal cord injury. Design Analysis of secondary data from 891 inpatient medical rehabilitation facilities in the United States that contributed traumatic spinal cord injury data to the Uniform Data System for Medical Rehabilitation (UDSmr) during the period January 2002 through December 2010. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, pre-hospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, ICD-9 codes for admitting diagnosis, comorbidities), and functional status (FIM® instrument [“FIM”] ratings at admission and discharge, FIM efficiency, FIM gain). Results The final sample included 47,153 patients with traumatic spinal cord injury. Overall mean length of stay = 26.2 (±23.2) days: yearly means ranged from 29.7 (±25.4) in 2002 to 22.9 (±18.9) in 2009. FIM total admission and discharge ratings also declined over the 8-year study period: admission decreased from 60.5 (± 17.4) to 55.9 (±16.3); discharge decreased from 86.1 (±23.8) to 82.4 (±23.4). Rehabilitation efficiency (FIM gain per day) remained relatively stable over time (1.6 ±1.7 points per day). The percentage of all patients discharged to the community ranged from 75.8% to 71.5% per year. Wheelchair users stayed in rehabilitation longer than persons who could walk (34.6 ±217.4 vs. 17.4 ±14.1 days) and also experienced less functional improvement (21.6 ±15.8 vs. 29.6 ±16.3 FIM points). Conclusions National data from persons with traumatic spinal cord injury in 2002-2010 indicate that lengths of stay declined, but efficiency in functional independence was stable to slightly increased. Over seventy percent of patients were consistently discharged to community settings following inpatient

Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

PubMed Central

Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

2016-01-01

Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022). Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

Predictors for living at home after geriatric inpatient rehabilitation: A prospective cohort study.

PubMed

Kool, Jan; Oesch, Peter; Bachmann, Stefan

2017-01-31

To evaluate patient characteristics predicting living at home after geriatric rehabilitation. Prospective cohort study. A total of 210 patients aged 65 years or older receiving inpatient rehabilitation. Candidate predictors evaluated during rehabilitation were: age, vulnerability (Vulnerable Elders Survey), multimorbidity (Cumulative Illness Rating Scale), cognition (Mini-Mental State Examination), depression (Hospital Anxiety and Depression Scale), living alone, previous independence in activities of daily living, fall risk, and mobility at discharge (Timed Up and Go test). Multiple imputation data-sets, bivariate and multiple regression were used to build a predictive model for living at home, which was evaluated at 3-month follow-up. A total of 210 patients (mean age 76.0 years, 46.2% women) were included in the study. Of these, 87.6% had been admitted to geriatric rehabilitation directly from acute hospital care. Follow-up was complete in 75.2% of patients. The strongest predictor for living at home was better mobility at discharge (Timed Up and Go test < 20 s), followed by lower multimorbidity, better cognition, and not living alone. In bivariate regression, living at home was also associated with age, fall risk, vulnerability, depression, and previous independence in activities of daily living. Mobility is the most important predictive factor for living at home after geriatric rehabilitation. Assessment and training of mobility are therefore key aspects in geriatric rehabilitation.

Shriners Hospital Spinal Cord Injury Self Care Manual.

ERIC Educational Resources Information Center

Fox, Carol

This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…

Initial physical grades and cognitive stages after acute stroke: who receives comprehensive rehabilitation services?

PubMed

Stineman, Margaret G; Bates, Barbara E; Kurichi, Jibby E; Kwong, Pui L; Ripley, Diane Cowper; Vogel, W Bruce; Xie, Dawei

2013-12-01

To study the degree to which initial physical grades and cognitive stages of independence assessed by physical medicine and rehabilitation (PM&R) staff early after hospitalization for acute stroke relate to the decision to either provide rehabilitation in consultation or admission to a specialized rehabilitation unit (SRU) for comprehensive, high-intensity, multidisciplinary rehabilitation. An observational study. Early rehabilitation assessment by PM&R staff during patients' acute hospitalization for stroke in 112 Veterans Affairs facilities. The sample included 8,783 veterans who were assessed by PM&R staff. Shortly after hospital admission, functional status was determined according to 7 physical grades and 7 cognitive stages of increasing independence. Patients' physical grades and cognitive stages ranged at initial PM&R assessment from the lowest and most dependent "I" through intermediate "II, III, IV, V, or VI," and ended with the highest at total independence "VII." To assess the statistically independent effects of physical grade and cognitive stage, a multivariable generalized estimating equation was applied to account for within Veterans Affairs facilities correlation and to adjust for demographics, stroke type, comorbidities, clinical events before PM&R assessment, and facility-related factors. The decision to admit patients to an SRU for comprehensive rehabilitation. Only 11.2% of those patients assessed after stroke were admitted to an SRU after the acute management phase. After statistical adjustment, patients at the lowest physical grade (I) of independence had a 9-fold increased odds of admission to an SRU compared with those at the highest combined physical grades VI/VII (adjusted odds ratio 9.15, 95% confidence interval 4.31-19.39). In contrast, patients at intermediate cognitive stages of independence were the most likely to be admitted to an SRU. The presence of an SRU within the treating Veterans Affairs facility was strongly related to

[The application of electroacupuncture to postoperative rehabilitation of total knee replacement].

PubMed

Chen, Gang; Gu, Rui-Xin; Xu, Dan-Dan

2012-04-01

To explore the effect of electroacupuncture therapy for postoperative rehabilitation of total knee replacement of knee osteoarthritis. Seventy cases of total knee replacement of knee osteoarthritis were randomly divided into an acupuncture-rehabilitation group and a rehabilitation group, thirty five cases in each group. In acupuncture-rehabilitation group, routine rehabilitation therapy combined with electroacupuncture therapy was applied. The acupoints selection was mainly based on pathological location; Xuehai (SP 10), Liangqiu (ST 34), Dubi (ST 35), Neixiyan (EX-LE 4) and Yanglingquan (GB 34), etc. were selected. In rehabilitation group, routine rehabilitation therapy was applied. The functions of affected knee in both groups were evaluated by artificial total knee replacement scale of the New York Hospital for Special Surgery (HSS), range of motion (ROM) of affected knee, Visual Analogue Scale (VAS) of pain and Manual Muscle Test (MMT) before, and 2, 6 and 12 weeks after surgery. HSS scores in acupuncture-rehabilitation group were markedly higher than those in rehabilitation group in 2, 6 and 12 weeks after surgery (P < 0.05, P < 0.01); VAS scores in acupuncture-rehabilitation group were markedly lower than those in rehabilitation group (P < 0.05, P < 0.01); ROM and MMT in acupuncture-rehabilitation group were little superior to those in rehabilitation group, however, there was no significant difference (all P > 0.05). Rehabilitation therapy combined with electroacupuncture can obviously restrain the pain during rehabilitation process for total knee replacement patients, improve the endurance capacity of rehabilitation training and motivation, and obviously promote the recovery of total knee joint function.

A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture.

PubMed

Kuisma, Raija

2002-08-01

To compare ambulation outcomes between home and institutional rehabilitation of patients with hip fracture. Randomized controlled clinical equivalence trial. The Queen Elizabeth Hospital in Hong Kong. Eighty-one patients with hip fracture. Study group patients (40) were discharged directly home from the acute hospital and visited by a physiotherapist an average of 4.6 times. The control group subjects (41) were discharged to a rehabilitation centre for further treatment lasting on average 36.2 days (SD 14.6) and they received physiotherapy daily. Ambulation ability measured on a categorical scale. The mean age of the subjects was 75 years (SD 8.3 years). Females comprised 60% of all the subjects and majority were retired or home makers. Both groups of patients improved in their ambulation ability during their rehabilitation period but neither group achieved their pre-ambulatory status by the time of completion of the study. The study group achieved significantly higher ambulation scores (p < 0.05) for community and household ambulation compared with the control group by the end of the study, a year after operation. Five visits by a physiotherapist in the patient's home after discharge from an acute hospital after surgical treatment for hip fracture yielded better results in ambulation ability than one month of conventional institution-based rehabilitation.

Pilot clinical trial of a robot-aided neuro-rehabilitation workstation with stroke patients

NASA Astrophysics Data System (ADS)

Krebs, Hermano I.; Hogan, Neville; Aisen, Mindy L.; Volpe, Bruce T.

1996-12-01

This paper summarizes our efforts to apply robotics and automation technology to assist, enhance, quantify, and document neuro-rehabilitation. It reviews a pilot clinical trial involving twenty stroke patients with a prototype robot-aided rehabilitation facility developed at MIT and tested at Burke Rehabilitation Hospital. In particular, we present a few results: (a) on the patient's tolerance of the procedure, (b) whether peripheral manipulation of the impaired limb influences brain recovery, (c) on the development of a robot-aided assessment procedure.

42 CFR 412.23 - Excluded hospitals: Classifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... agreement under part 489 of this chapter to participate as a hospital. (2) Except in the case of a newly... whom at least 60 percent required intensive rehabilitation services for treatment of one or more of the... percentage if— (A) The patient is admitted for inpatient rehabilitation for a condition that is not one of...

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) Trial: Design and Rationale

PubMed Central

Reeves, Gordon R.; Whellan, David J.; Duncan, Pamela; O’Connor, Christopher M.; Pastva, Amy M.; Eggebeen, Joel D; Hewston, Leigh Ann; Morgan, Timothy M.; Reed, Shelby D.; Rejeski, W. Jack; Mentz, Robert J.; Rosenberg, Paul B.; Kitzman, Dalane W.

2017-01-01

Background Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. Hypothesis Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. Study Design Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) is a multi-center clinical trial in which 360 patients ≥ 60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. Conclusions REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities. PMID:28267466

Physiotherapy rehabilitation in the context of HIV and disability in KwaZulu-Natal, South Africa.

PubMed

Cobbing, Saul; Hanass-Hancock, Jill; Deane, Margaret

2014-01-01

The purpose of this study was to describe the experiences of people living with HIV (PLHIV) who had undergone a physiotherapy-led rehabilitation programme, with the aim of informing and improving future rehabilitation. The study population included patients living with HIV who were referred for physiotherapy rehabilitation at a public-funded KwaZulu-Natal hospital. Eight participants were considered for final analysis in the study. A qualitative research design was adopted using in-depth interviews to explore their experiences of their rehabilitation programme. Additionally all eligible participants were requested to complete the World Health Organisation Disability Assessment Schedule. Participants presented varying activity-related challenges with mobility, self-care and life activities being the most severely affected areas. Participants showed little understanding of their health conditions, prescribed medication and in some cases therapy. HIV and disability impacted their daily lives, adversely affecting work and domestic activities. Although participants reflected positively on the rehabilitation experience they faced a number of barriers to accessing continued rehabilitation. PLHIV who experience disability are affected in major life areas but the current model of delivering rehabilitation provides a number of barriers to patients. A more accessible approach of delivering HIV-care and rehabilitation needs to be developed. Implications for Rehabilitation Physiotherapists and other rehabilitation professionals, particularly those working in the South African public sector, need to consider developing and implementing home-based rehabilitation interventions for patients living with HIV and disability. This will counter some of the barriers these patients face in accessing hospital-based therapy. With the increasing incidence of HIV-related disabilities as PLHIV live longer lives, rehabilitation professionals working with this patient population should keep up

Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia.

PubMed

Khan, F; Turner-Stokes, L; Stevermuer, T; Simmonds, F

2009-07-01

To examine the outcomes of inpatient rehabilitation for persons with multiple sclerosis (pwMS), using the Australian Rehabilitation Outcomes Centre (AROC) database. Deidentified data from the AROC database were analyzed for all rehabilitation admissions during 2003-2007, using four classes for functional level. The outcomes included Functional Independence Measure (FIM) scores and efficiency, hospital length of stay (LOS), and discharge destination. Of 1010 case episodes, 70% were women, admitted from home (n = 851) and discharged into the community (n = 890), and 97% (n = 986) were in the higher three classes for functional level (classes 216, 217, and 218). Majority of the more disabled pwMS were treated in the public hospital system, with a longer LOS compared with private facilities (P < 0.001). The FIM for classes 216-218 showed significant functional improvement during the admission (P < 0.001), and those in higher classes showed less change (likely due to higher FIM admission scores). FIM efficiency was significantly higher in class 217 than other classes (P < 0.001). The year-on-year trend was toward reducing hospital LOS and FIM efficiency, but these did not reach significance (P = 0.107, P = 0.634). The AROC data set is useful for describing rehabilitation outcomes for pwMS. However, additional information needs to be collected to evaluate nature of services provided and service implications.

Rehabilitation outcomes of terror victims with multiple traumas.

PubMed

Schwartz, Isabella; Tsenter, Jeanna; Shochina, Mara; Shiri, Shimon; Kedary, Michal; Katz-Leurer, Michal; Meiner, Zeev

2007-04-01

To describe the rehabilitation outcomes of terror victims with multiple traumas, and to compare those outcomes with those of patients with nonterror-related multiple traumas treated in the same rehabilitation facility over the same time period. Retrospective chart reviews. Rehabilitation department in a university hospital in Jerusalem, Israel. Between September 2000 and September 2004, we treated 72 victims of terrorist attacks who had multiple traumas. Among them, 47 (65%) had multiple traumas without central nervous system involvement (MT subgroup), 19 (26%) had multiple traumas with traumatic brain injury (TBI subgroup), and 6 (8%) had multiple traumas with spinal cord injury (SCI subgroup). We matched, according to their types of injury and demographic data, each terror victim with a control patient treated in the same period in our rehabilitation department. Interdisciplinary inpatient and outpatient rehabilitation. Hospital length of stay (LOS) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (FIM instrument score), occupational outcome (returning to previous occupation), and psychologic outcome (Solomon PTSD [post-traumatic stress disorder] Inventory). The mean LOS of terror victims was 218+/-131 days; for the nonterror group it was 152+/-114 days (P<.01). In comparison with the control subgroups, the MT subgroup of terrorist victims had significantly longer LOS in the acute care and outpatient rehabilitation departments (P=.06) and the terror TBI subgroup had a longer LOS in outpatient department only (P<.05). The LOS of the SCI patients, both terror victims and control patients, was significantly longer than that of the other 2 subgroups. The difference between FIM value at entry and discharge (DeltaFIM) was significantly higher for terror victims than for the controls (41.1+/-21.6 vs 30.8+/-21.8, P=.002). This difference was mainly the result of the significantly higher DeltaFIM achieved by the terror MT

Managing and Rehabilitating the ‘Stroke’ Patient

PubMed Central

Sky, Ruth

1972-01-01

Strokes account for five out of every 1,000 general hospital admissions. Postoperative care can be frustrating, but with judicious use of allied health workers, and careful assessment of the patient's condition, most patients who survive can be rehabilitated to a considerable degree of self-care. The patient's family must be included in the team, and his preferences in activities must be considered. This article describes the results of a study done on 244 patient charts at a convalescent hospital in Toronto. PMID:20468858

Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge.

PubMed

Major, M E; Kwakman, R; Kho, M E; Connolly, B; McWilliams, D; Denehy, L; Hanekom, S; Patman, S; Gosselink, R; Jones, C; Nollet, F; Needham, D M; Engelbert, R H H; van der Schaaf, M

2016-10-29

The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5. Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed. A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.

Comparison of Two Post-Stroke Rehabilitation Programs: A Follow-Up Study among Primary versus Specialized Health Care

PubMed Central

Vega-Ramírez, Francisco Antonio; Rocamora-Pérez, Patricia; Aguilar-Parra, José Manuel; Padilla-Góngora, David

2016-01-01

Objective To compare home-based rehabilitation (RITH) and standard outpatient rehabilitation in a hospital setting, in terms of improving the functional recovery and quality of life of stroke patients. Study Design and Setting This was a prospective cohort study in Andalusia (Spain). Participants One hundred and forty-five patients completed the outcome data. Measures Daily activities were measured by the Barthel index, Canadian Neurological Scale (to assess mental state), Tinetti scale (balance and gait), and Short Form Health Survey-36 (SF-36 to compare the quality of life). Results No statistically significant differences were found between the two groups regarding the clinical characteristics of patients in the initial measurement, except for age and mental state (younger and with greater neurological impairment in the hospital group). After physical therapy, both groups showed statistically significant improvements from baseline in each of the measures. These improvements were better in RITH patients than in the hospital patients on all functionality scales with a smaller number of sessions. Conclusions Home rehabilitation is at least as effective as the outpatient rehabilitation programs in a hospital setting, in terms of recovery of functionality in post-stroke patients. Overall quality of life is severely impaired in both groups, as stroke is a very disabling disease that radically affects patients’ lives. PMID:27835673

Working the way up in neurological rehabilitation: the holistic approach of nursing care.

PubMed

Portillo, Mari Carmen; Cowley, Sarah

2011-06-01

To provide understanding of the nurses' role in neurological holistic rehabilitation and identify strategies for the enhancement of rehabilitation services. Although acute and chronic neurological patients and relatives experience emotional and social changes, most rehabilitation programmes do not deal with non-physical needs or involve nurses, leading to a poor definition and specialisation of the nursing role. Action research. The project took place in two neurological wards of a highly specialised hospital in Spain and lasted 30 months. An individualised nurse-led social rehabilitation programme was planned, implemented and evaluated. The nursing role and care in rehabilitation were explored with 37 nurses and 40 neurological patients and 40 relatives (convenience sampling). Semi-structured interviews and participant observations were developed. Content (QSR NUDIST Vivo v.2.0) and statistical (SPSS v. 13.0) analyses were run. The lack of time, knowledge and experience, the poor definition of the nursing role and ineffective communication with users limited holistic care in the wards. Some enhancing nursing strategies were proposed and explored: promotion of acceptance/adaptation of the disease through education, reinforcement of the discharge planning and planning of emotional and social choices based on the assessment of individual needs and resources at home. Nursing professionals are in a privileged position to deal with neurological patients' and carers' holistic needs. Several attributes of the advanced nursing role in rehabilitation teams have been proposed to deal with non-physical aspects of care. • Rehabilitation needs of neurological patients and carers at hospital have been described. • Nurses' perceptions of their work and role in rehabilitation have been presented. • Clinical strategies to develop the advanced nursing role in holistic neurological rehabilitation have been highlighted. © 2010 Blackwell Publishing Ltd.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil.

PubMed

Sousa, Kelienny de Meneses; Oliveira, Wagner Ivan Fonsêca de; Melo, Laiza Oliveira Mendes de; Alves, Emanuel Augusto; Piuvezam, Grasiela; Gama, Zenewton André da Silva

2017-03-01

Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the

Exercise-based cardiac rehabilitation for coronary heart disease

PubMed Central

Heran, Balraj S; Chen, Jenny MH; Ebrahim, Shah; Moxham, Tiffany; Oldridge, Neil; Rees, Karen; Thompson, David R; Taylor, Rod S

2014-01-01

Background The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health. Objectives To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD. Search methods RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009). Selection criteria Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography. Data collection and analysis Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information. Main results This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health

Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol.

PubMed

Edwards, Deborah; Carrier, Judith; Hopkinson, Jane

2015-11-01

The review question is: assistance at mealtimes for older adults in hospital settings and rehabilitation units: what goes on, what works and what do patients, families and healthcare professionals think about it?The specific objectives are:This mixed methods review seeks to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units in order to derive conclusions and recommendations useful for clinical practice and policy decision making. Worldwide, it is estimated that between 20% and 50% of all adult patients admitted to hospital wards are malnourished. Reported prevalence occurs, depending on the specific patient group of interest, type of healthcare setting, disease state and criteria used to assess malnutrition. For older adults in hospital (over 65 years) the prevalence of malnutrition has been reported as being as high as 60% and can continue to deteriorate during the hospital stay. This is an area of concern as it is associated with prolonged hospital stays and increased morbidity (pressure ulcers, infections and falls) and mortality, especially for those with chronic conditions.Malnutrition in adults in developed countries is frequently associated with disease and may occur because of reduced dietary intake, malabsorption, increased nutrient losses or altered metabolic demands, with reduced dietary intake being considered the single most important aetiological factor. For the hospitalized older adult patient with pre-existing malnutrition, further nutritional problems are often encountered due to a reduced dietary intake. Poor food intake for older patients in hospital may be due to the effects of acute illness, poor appetite, nausea or vomiting, "nil by mouth" orders, medication side effects, catering limitations, swallowing and/or oral problems, difficulty with vision and opening containers, the placement of food out of the patients' reach, limited access

Feasibility and effectiveness of circuit training in acute stroke rehabilitation.

PubMed

Rose, Dorian; Paris, Trevor; Crews, Erin; Wu, Samuel S; Sun, Anqi; Behrman, Andrea L; Duncan, Pamela

2011-02-01

Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation. To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient stroke unit. Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. The CTPT model was successfully implemented in an acute rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group (0.21 ± 0.25 m/sec vs. 0.13 ± 0.22 m/sec; p = 0.03). The difference between groups occurred primarily among those who were ambulatory upon admission. There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM, SF-36 and living location. Therapy focused on systematically progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program. This circuit-training model resulted in greater gains in gait velocity over the course of inpatient rehabilitation compared to the standard model of care. Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care.

Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research.

PubMed

Yu, Junhong; Tam, Helena M K; Lee, Tatia M C

2015-01-01

The rising public health concern regarding traumatic brain injury (TBI) implies a growing need for rehabilitation services for patients surviving TBI. To this end, this paper reviews the practices and research on TBI rehabilitation in Hong Kong so as to inform future developments in this area. This paper begins by introducing the general situation of TBI patients in Hong Kong and the need for rehabilitation. Next, the trauma system in Hong Kong is introduced. Following that is a detailed description of the rehabilitation services for TBI patients in Hong Kong, as exemplified by a rehabilitation hospital in Hong Kong. This paper will also review intervention studies on rehabilitating brain-injured populations in Hong Kong with respect to various rehabilitation goals. Lastly, the implications of culture-related issues will be discussed in relation to TBI. The intervention studies conducted in Hong Kong are generally successful in achieving various rehabilitative outcomes. Additionally, certain cultural-related issues, such as the stigma associated with TBI, may impede the rehabilitative process and lead to various psychosocial problems.

Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

PubMed

Martin, Ubaldo J; Hincapie, Luis; Nimchuk, Mark; Gaughan, John; Criner, Gerard J

2005-10-01

To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. Retrospective analysis of 49 consecutive patients. Multidisciplinary ventilatory rehabilitation unit in an academic medical center. Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit. None. Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p < .05) and were able to stand and ambulate. All weaned from mechanical ventilation, but three required subsequent intermittent support. Six patients died before hospital discharge. Upper extremity strength on admission inversely correlated with time to wean from mechanical ventilation (R = .72, p < .001). : Patients receiving chronic ventilation are weak and deconditioned but respond to aggressive whole-body and respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.

ICU early physical rehabilitation programs: financial modeling of cost savings.

PubMed

Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

2013-03-01

To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

Exercise-Based Oncology Rehabilitation: Leveraging the Cardiac Rehabilitation Model

PubMed Central

Dittus, Kim L.; Lakoski, Susan G.; Savage, Patrick D.; Kokinda, Nathan; Toth, Michael; Stevens, Diane; Woods, Kimberly; O’Brien, Patricia; Ades, Philip A.

2014-01-01

PURPOSE The value of exercise and rehabilitative interventions for cancer survivors is increasingly clear and oncology rehabilitation programs could provide these important interventions. However, a pathway to create oncology rehabilitation has not been delineated. Community-based cardiac rehabilitation (CR) programs staffed by health care professionals with experience in providing rehabilitation and secondary prevention services to individuals with coronary heart disease are widely available and provide a potential model and location for oncology rehabilitation programs. Our purpose is to outline the rehabilitative needs of cancer survivors and demonstrate how oncology rehabilitation can be created using a cardiac rehabilitation model. METHODS We identify the impairments associated with cancer and its therapy that respond to rehabilitative interventions. Components of the CR model that would benefit cancer survivors are described. An example of an oncology rehabilitation program using a CR model is presented. RESULTS Cancer survivors have impairments associated with cancer and its therapy that improve with rehabilitation. Our experience demonstrates that effective rehabilitation services can be provided utilizing an existing CR infrastructure. Few adjustments to current cardiac rehabilitation models would be needed to provide oncology rehabilitation. Preliminary evidence suggests that cancer survivors participating in an oncology rehabilitation program experience improvements in psychological and physiologic parameters. CONCLUSIONS Utilizing the CR model of rehabilitative services and disease management provides a much needed mechanism to bring oncology rehabilitation to larger numbers of cancer survivors. PMID:25407596

Endoparasites of Wild Mammals Sheltered in Wildlife Hospitals and Rehabilitation Centres in Greece

PubMed Central

Liatis, Theophanes K.; Monastiridis, Antonios A.; Birlis, Panagiotis; Prousali, Sophia; Diakou, Anastasia

2017-01-01

Wildlife parasitic diseases represent an important field of investigation as they may have a significant impact on wild animals’ health and fitness, and may also have zoonotic implications. This study aimed to investigate the occurrence of endoparasites in wild mammals admitted to wildlife hospitals and rehabilitation centres in Greece. Sixty-five animals belonging to 17 species and originated from various areas of continental and insular Greece were included in the survey. The most numerous animal species examined were hedgehogs (n = 19), red foxes (n = 16), and European roe deer (n = 6). Faecal samples were collected individually and examined by floatation and sedimentation method. Parasites were found in 46 (70.7%) of the animals. Most parasites found in canids, felids, and ruminants are of great relevance to the domestic animals’ health and some of them are also of zoonotic importance. To the best of the author’s knowledge, this is the first report of endoparasites in hedgehogs, roe deers, fallow deers, badgers, and bats, and the first report of the pulmonary nematode Troglostrongylus brevior in a wild cat in Greece. The significance of the parasites found in each animal species in regard to their health and their relevance to domestic animals and human health is discussed. PMID:29326954

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

PubMed

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current

On-site programmatic attendance to cardiac rehabilitation and the healthy-adherer effect.

PubMed

Alter, David A; Zagorski, Brandon; Marzolini, Susan; Forhan, Mary; Oh, Paul I

2015-10-01

On-site attendance to prescheduled cardiac rehabilitation visits has been shown to be associated with improved outcomes following cardiac rehabilitation. The extent to which on-site programmatic attendance represents a healthy-adherer effect remains unknown. This retrospective cohort study consisted of 17,000 consecutively referred patients to a cardiac rehabilitation program in Ontario, Canada. On-site attendance at prescheduled visits was our primary exposure variable. The primary outcome was all-cause death or hospitalization at two years following the expected program completion date, irrespective of drop-out. Secondary outcomes included adherence to statins, health-seeking preventative health visits, and changes in clinical risk-profiles. Cox proportional hazards adjusted for baseline sociodemographic, clinical and comorbid characteristics. Among the 12,440 patients who attended at least one prescheduled on-site visit, on-site attendance was inversely correlated with baseline smoking rates and body mass index at program entry. After adjustment for baseline factors, the risk of death or hospitalization progressively fell with incremental increases in on-site attendance (adjusted hazard ratio for each 10% increase in on-site attendance: 0.96; 95% confidence interval: 0.93-0.99, p = 0.007). Such associations were driven predominantly by differences in non-cardiovascular hospitalizations. Incremental increases in on-site attendance were associated with improvements in cardiopulmonary fitness and body mass index (both p < 0.001), better attendance of preventative care physician visits (p < 0.001) and higher medication adherence to statins (p = 0.007). Associations between on-site attendance at cardiac rehabilitation and outcomes may represent a healthy-adherer effect. Future research must evaluate the clinical utility of on-site attendance as a behavioral health-adherence metric for cardiac rehabilitation monitoring and surveillance. © The European

Inpatient rehabilitation performance of patients with paraneoplastic cerebellar degeneration.

PubMed

Fu, Jack B; Raj, Vishwa S; Asher, Arash; Lee, Jay; Guo, Ying; Konzen, Benedict S; Bruera, Eduardo

2014-12-01

To evaluate the functional improvement of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Retrospective review. Referral-based hospitals. Cancer rehabilitation inpatients (N=7) admitted to 3 different cancer centers with a diagnosis of paraneoplastic cerebellar degeneration. Medical records were retrospectively analyzed for demographic, laboratory, medical, and functional data. FIM. All 7 patients were white women (median age, 62y). Primary cancers included ovarian carcinoma (n=2), small cell lung cancer (n=2), uterine carcinoma (n=2), and invasive ductal breast carcinoma (n=1). Mean admission total FIM score was 61±23.97. Mean discharge total FIM score was 73.6±29.35. The mean change in total FIM score was 12.6 (P=.0018). The mean length of rehabilitation stay was 17.1 days. The mean total FIM efficiency was .73. Of the 7 patients, 5 (71%) were discharged home, 1 (14%) was discharged to a nursing home, and 1 (14%) was transferred to the primary acute care service. To our knowledge, this is the first study to demonstrate the functional performance of a group of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Despite the poor neurologic prognosis associated with this syndrome, these patients made significant functional improvements in inpatient rehabilitation. When appropriate, inpatient rehabilitation should be considered. Further studies with larger sample sizes are needed. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Intention to abstain from smoking among cardiac rehabilitation patients: the role of attitude, self-efficacy, and craving.

PubMed

Bakker, Esther C; Nijkamp, Marjan D; Sloot, Caroline; Berndt, Nadine C; Bolman, Catherine A W

2015-01-01

Smoking cessation after developing coronary heart disease improves disease prognosis more than any other treatment. However, many cardiac patients continue to smoke after hospital discharge. The aim of this study was to investigate factors associated with the intention to (permanently) abstain from smoking among cardiac rehabilitation patients 2 to 4 weeks after discharge from hospital. A cross-sectional survey was conducted among 149 cardiac rehabilitation patients recruited from 2 cardiac rehabilitation centers in The Netherlands 2 to 4 weeks after hospital discharge, at the start of the cardiac rehabilitation period. Psychosocial cognitions including attitude toward nonsmoking, social influence, and self-efficacy were measured with a standardized and validated Dutch questionnaire based on the Attitude-Social Influence-Self-efficacy model. Anxiety was measured using the shortened version of the State-Trait Anxiety Inventory. Craving for cigarettes was assessed with 6 items measuring the urge to smoke. Intention toward nonsmoking was assessed with 2 visual analog scales indicating the strength and probability of the intention to permanently refrain from smoking. Of all patients, 31% still smoked after hospital discharge. The smokers had a lower self-efficacy and intention to abstain from smoking and reported higher craving. Logistic regression analyses revealed that attitudes that embraced the advantages of not smoking, self-efficacy, and craving were significantly related to the intention to (permanently) abstain from smoking, whereas social influence and anxiety were not. Actual smoking behavior moderated the relation between self-efficacy and intention: only the quitters showed a significant positive relation. Anxiety did not moderate the relationship between psychosocial cognitive factors and intention. The intention to (permanently) abstain from smoking, measured 2 to 4 weeks after hospitalization for a cardiac event, predominantly depends on attitude, self

Effects of Prospective Payment Financing on Rehabilitation Income.

ERIC Educational Resources Information Center

Evans, Ron L.; And Others

1990-01-01

This study compared 187 patients discharged from a Veterans Administration hospital rehabilitation unit with 215 discharges that occurred following implementation of a prospective payment system. There were no significant differences in demographics, self-care ability, or readmissions. Length of stay and referrals for home health care decreased,…

Rehabilitation and social adjustment of people with burns in society.

PubMed

Din, Sirajud; Shah, Mussawar; Asadullah; Jamal, Humera; Bilal, Muhammad

2015-02-01

The present study was conducted on rehabilitation and social adjustment of people with burns in society with the main objective to determine the relationship between social adjustment of people with burns and their psychosocial rehabilitation. The study was limited to the Burn Unit, Khyber Teaching Hospital, Peshawar, Pakistan. At bi-variate level, the following were observed: the relationship of psychosocial rehabilitation was highly significant (P=0.000) considering that people with burns feel shame in the society, a highly significant relation (P=0.000) was found between psychosocial rehabilitation and burn as the hurdle to contact other members of the society, a highly significant (P=0.000) relation was found between psychosocial rehabilitation and perception that society provides social support to people with burns, a highly significant (P=0.000) relationship between psychosocial rehabilitation and people with burns feel alienated from the society, a significant association (P=0.024) was found between psychosocial rehabilitation and loss of social network, and a significant (P=0.002) association between psychosocial rehabilitation and society insult toward people with burns. Regular provision of treatment, quota in job allocation for people with burns, initiation of stipend through Benazir Income Support Program, and keeping and updating record of burns at the district level in census centers were suggested as recommendations in light of the study. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Early rehabilitation after elective total knee arthroplasty.

PubMed

Lisi, Claudio; Caspani, Patrick; Bruggi, Marco; Carlisi, Ettore; Scolè, Donatella; Benazzo, Francesco; Dalla Toffola, Elena

2017-10-18

Outcomes after TKA surgery are supposed to be related to the intensity and type of post-operative rehabilitation. Aim of this paper is to describe our early rehabilitation protocol following TKA with mini-invasive surgery in the immediate post-operative period and analyze functional recovery and changes in pain scores in these patients. in this observational study, data were collected on 215 total knee arthroplasty patients referred to Orthopedics and Traumatology inpatient ward from July 2012 to January 2014, treated with the same early start rehabilitation protocol. We recorded times to reach functional goals (sitting, standing and assisted ambulation) and pain after the treatment. length of hospital stay in TKA was 4.6±1.8 days, with a rehabilitation treatment lenght of 3.3±1.3 days. The mean time needed to achieve the sitting position was 2.3±0.7 days, to reach the standing position was 2.6±1.0 days to reach the walking functional goal was 2.9±1.0 days.  Pain NRS scores remained below 4 in the first and second post-operative day and below 3 from the third post-operative day. Our study confirms that rehabilitation started as soon as 24 hours after surgery with mini-invasive approach, enables early verticalization of patients and early recovery of walking with a good control of pain.

Kinect system in home-based cardiovascular rehabilitation.

PubMed

Vieira, Ágata; Gabriel, Joaquim; Melo, Cristina; Machado, Jorge

2017-01-01

Cardiovascular diseases lead to a high consumption of financial resources. An important part of the recovery process is the cardiovascular rehabilitation. This study aimed to present a new cardiovascular rehabilitation system to 11 outpatients with coronary artery disease from a Hospital in Porto, Portugal, later collecting their opinions. This system is based on a virtual reality game system, using the Kinect sensor while performing an exercise protocol which is integrated in a home-based cardiovascular rehabilitation programme, with a duration of 6 months and at the maintenance phase. The participants responded to a questionnaire asking for their opinion about the system. The results demonstrated that 91% of the participants (n = 10) enjoyed the artwork, while 100% (n = 11) agreed on the importance and usefulness of the automatic counting of the number of repetitions, moreover 64% (n = 7) reported motivation to continue performing the programme after the end of the study, and 100% (n = 11) recognized Kinect as an instrument with potential to be an asset in cardiovascular rehabilitation. Criticisms included limitations in motion capture and gesture recognition, 91% (n = 10), and the lack of home space, 27% (n = 3). According to the participants' opinions, the Kinect has the potential to be used in cardiovascular rehabilitation; however, several technical details require improvement, particularly regarding the motion capture and gesture recognition.

Early rehabilitation programs after laparoscopic colorectal surgery: Evidence and criticism

PubMed Central

Kim, Duck-Woo; Kang, Sung-Bum; Lee, Soo-Young; Oh, Heung-Kwon; In, Myung-Hoon

2013-01-01

During the past several decades, early rehabilitation programs for the care of patients with colorectal surgery have gained popularity. Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection. Patients cared for based on these protocols had a rapid recovery of bowel movement, shortened length of hospital stay, and fewer complications compared with traditional care programs. However, most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection, although this procedure seems to be associated with a higher morbidity than that reported with traditional care. In this article, we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery. We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies. We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery, focusing on laparoscopic resection. PMID:24379571

[Rehabilitation treatment of patients with uncomplicated fractures of the spine at a hospital rehabilitation center].

PubMed

Bagaturiia, G O; Chanov, V L; Kutushev, F Kh

1989-02-01

The authors make an analysis of treatment of 188 patients with noncomplicated compressive fractures of the vertebral column in the thoracolumbar part performed at the stationary rehabilitation center. The course of restorative treatment was as long as 31-40 days and included individual and group trainings of exercise therapy, massage, hydrokinesotherapy, thermo-, electro-, photo- and magnetotherapy. Results of the treatment were followed in 81 patients. Excellent and good results were obtained in 43 patients (53%), unsatisfactory--in 7 patients (8.6%). The period of follow-up observation was from 1 month to 1 year.

Rehabilitation of drug abusers: the roles of perceptions, relationships and family supports.

PubMed

Adejoh, Samuel Ojima; Temilola, Olusegun M; Adejuwon, Funmilayo F

2018-05-14

The increase in the use, abuse and misuse of psychoactive substances is not just of concern to national government of different countries but poses a big problem to the international community as well as of a global public health challenge. The study explored the perceived influence of perceptions, relationships and family support on rehabilitation of drug abusers undergoing rehabilitation in a rehabilitation centre. The non-experimental study design was used. The study population was that of drug abuse patients undergoing rehabilitation in the Neuropsychiatric Hospital in Lagos. Purposive sampling technique was used to select the respondents. Forty drug abusers who were met the criteria of not being a psychotic, had undergone detoxification, in the last stages of rehabilitation and consented to voluntarily participate were interviewed using In-depth Interview Guide to collect qualitative data based on the objectives of the study. The data were manually content analysed. The drug abusers viewed their condition as a mental disorder, an illness, a bad and dangerous habit that can be treated. They viewed their relationship with their rehabilitation officers as professional and cordial, which is essential for the rehabilitation process. Financial, material and moral supports given by the family were identified as important catalysts for quick rehabilitation. Rehabilitation officers and policy makers should consider on improving on the role of professional relationships and family support in the rehabilitation process of drug abusers undergoing rehabilitation.

Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

PubMed Central

Zanettini, Renzo; Gatto, Gemma; Mori, Ileana; Pozzoni, Maria Beatrice; Pelenghi, Stefano; Martinelli, Luigi; Klugmann, Silvio

2014-01-01

Background Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range: 192–738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up. PMID:25593575

Depression Predicts Functional Outcome in Geriatric Inpatient Rehabilitation.

PubMed

Shahab, Saba; Nicolici, Diana-Felicia; Tang, Alva; Katz, Paul; Mah, Linda

2017-03-01

To evaluate the effect of depression on functional recovery in geriatric patients who have completed an inpatient rehabilitation program. Prospective cohort study. Inpatient rehabilitation unit of a university-affiliated geriatric hospital. Convenience sample of patients (N=65; mean age, 81.6y; 25 men) admitted to rehabilitation over a 10-month period. Patients >60 years of age who were proficient in English and capable of providing informed consent were eligible to participate in the study. Depression was assessed using both the Geriatric Depression Scale-short form (GDS-15) and the Patient Health Questionnaire (9-item screen for depression) (PHQ-9). Measures of well-established predictors of rehabilitation outcome, which may interact with depression, were also obtained, and multiple regression linear modeling was used to evaluate the relation between depression and functional outcome over and above the contribution of these other factors. FIM (Functional Independence Measure) at discharge from the rehabilitation program. Depression, as assessed by the GDS-15, but not the PHQ-9, was predictive of functional outcome (standardized beta=-.151, P=.030) after controlling for other significant predictors, which included baseline disability, pain, cognition, and educational level. Participation in recreational, but not physio- or occupational, therapy additionally contributed to a small amount of variance in the functional outcome. Our findings suggest that self-report of depression is an independent predictor of functional outcome in high-tolerance, short-duration geriatric rehabilitation. Routine assessment of depressive symptoms in older adults using an instrument (eg, GDS-15) may help identify those at risk for poorer outcomes in rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Vertical integration strategies: revenue effects in hospital and Medicare markets.

PubMed

Cody, M

1996-01-01

The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.

Quality in rehabilitation after a working age person has sustained a fracture: partnership contributes to continuity.

PubMed

Lindahl, Marianne; Hvalsoe, Berit; Poulsen, Jeppe Rosengaard; Langberg, Henning

2013-01-01

Research in quality of rehabilitation has mostly concerned patients with chronic diseases, but the aim of the present study was to investigate what constitutes good quality in rehabilitation after a person has sustained a fracture at working age, from both patients' and therapists' perspectives. Seven patients with bone fracture, aged 32-60 years, and 23 occupational therapists and physiotherapists from hospitals, municipalities and private practices in Denmark. Qualitative study with in-depth semi-structured interviews. Data were analyzed according to grounded theory method. Partnership was a central theme that was constituted by continuity of rehabilitation and therapists' use of a patient-centred approach. Patients' experiences of continuity of rehabilitation was supported, not only by organizational factors, but depended also on values constituting the patient-centred approach. Therapists used their professional network to refine the transition process from hospital into the community, but there was no co-operation between departments in the municipalities about patients' return to work. The study suggests that patients with acute injuries need partnership, respect, and understanding through the rehabilitation course. Personal relations were important for continuity of rehabilitation (i.e. that organizational quality depended more on therapists' efforts to promote continuity for the patient than organizational tools).

[Efficiency of rehabilitation methods in the treatment of arm lymphedema after breast cancer surgery].

PubMed

Petruseviciene, Daiva; Krisciūnas, Aleksandras; Sameniene, Jūrate

2002-01-01

In this article we analyze influence of rehabilitation methods in treatment of arm lymphedema. In Kaunas oncological hospital were examined 60 women after surgery for breast cancer. The work objective was to evaluate efficiency of rehabilitation methods in treatment of arm lymphedema and in evaluate movement amplitude of shoulder joint. Two groups of women depending on rehabilitation start were evaluated. The same methods of rehabilitation were applied to both groups: physical therapy, electrostimulation, massage, lymphodrainage with apparate. Our study indicated that women, who were treated at early period of rehabilitation (3 months), showed statistically significantly (p < 0.01) better results in increase of movement amplitude of shoulder joint. However, results of treatment of arm lymphedema, comparing with women who started rehabilitation after 12 months, were equally successful--results were not statistically significantly better (p > 0.05).

Rehabilitative Learning: Education during Pscyhiatric Hospitalization

ERIC Educational Resources Information Center

Shaked, Haim

2014-01-01

This article presents a case study of a school designed for youth hospitalized for mental disorders, aiming to reveal the educational approach of such a school, a topic on which nothing has been written so far. The study, which lasted a year, employed qualitative techniques: observations, document collection and interviews. The study has found…

Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial.

PubMed

Holland, Anne E; Mahal, Ajay; Hill, Catherine J; Lee, Annemarie L; Burge, Angela T; Moore, Rosemary; Nicolson, Caroline; O'Halloran, Paul; Cox, Narelle S; Lahham, Aroub; Ndongo, Rebecca; Bell, Emily; McDonald, Christine F

2013-09-08

Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease (COPD) to improve exercise capacity, symptoms and quality of life, however only a minority of individuals with COPD are able to participate. Travel and transport are frequently cited as barriers to uptake of centre-based programs. Other models of pulmonary rehabilitation, including home-based programs, have been proposed in order to improve access to this important treatment. Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life, but not all elements of the program were conducted in the home environment. It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity, symptoms and quality of life as a hospital-based program. The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD. This randomised, controlled, equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD. Participants will be randomly allocated to hospital-based or home-based pulmonary rehabilitation. Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks. Home-based programs will involve one home visit followed by seven weekly telephone calls, using a motivational interviewing approach to enhance exercise participation and facilitate self management. The primary outcome is change in 6-minute walk distance immediately following intervention. Measurements of exercise capacity, physical activity, symptoms and quality of life will be taken at baseline, immediately following the intervention and at 12 months, by a blinded assessor. Completion rates will be compared between programs. Direct healthcare

Fast-track Rehabilitation Accelerates Recovery After Laparoscopic Colorectal Surgery

PubMed Central

Dakwar, Anthony; Sivkovits, Krina; Mahajna, Ahmad

2014-01-01

Background: Fast-track (FT) rehabilitation protocols have been shown to be successful in reducing both hospital stay and postoperative complications, as well as enhancing overall postoperative patient recovery. We are reporting the outcomes of our first group of patients undergoing colorectal surgery following the FT protocol. Patients and Methods: We performed a prospective study of patients, between January 1, 2007 and January 31, 2010, who underwent laparoscopic colorectal resections in accordance with the guidelines of FT rehabilitation protocol. Recovery parameters including time to removal of naso-gastric tube and urinary catheter, time to bowel function and to resume diet, and length of hospital stay were evaluated. Postoperative outcomes, that is, postoperative complications and mortality, reoperations, and readmissions were also studied. Results: A total of 71 patients, 30 women and 41 men, underwent FT rehabilitation for laparoscopic colorectal surgery. The mean age of the patients was 60 ± 16 years. The most common surgical procedures were right hemicolectomy 30% and anterior resection 27%. Liquid and regular diet were initiated on postoperative day 1.2 ± 0.4 and 2.1 ± 0.4, respectively. Overall postoperative morbidity was 8.5%. The mean length of stay was 4.4 ± 1.7 days, with only 3 readmissions. Forty-five patients fulfilled the FT care plan and were discharged on postoperative day 3. No reoperations or mortality were observed. Conclusions: FT rehabilitation results in favorable postoperative outcomes. Our data provides evidence and suggests that FT protocols should be implemented as a reliable method of preparation and recovery for laparoscopic colorectal surgery. PMID:25489207

[Documenting a rehabilitation program using a logic model: an advantage to the assessment process].

PubMed

Poncet, Frédérique; Swaine, Bonnie; Pradat-Diehl, Pascale

2017-03-06

The cognitive and behavioral disorders after brain injury can result in severe limitations of activities and restrictions of participation. An interdisciplinary rehabilitation program was developed in physical medicine and rehabilitation at the Pitié-Salpêtriere Hospital, Paris, France. Clinicians believe this program decreases activity limitations and improves participation in patients. However, the program’s effectiveness had never been assessed. To do this, we had to define/describe this program. However rehabilitation programs are holistic and thus complex making them difficult to describe. Therefore, to facilitate the evaluation of complex programs, including those for rehabilitation, we illustrate the use of a theoretical logic model, as proposed by Champagne, through the process of documentation of a specific complex and interdisciplinary rehabilitation program. Through participatory/collaborative research, the rehabilitation program was analyzed using three “submodels” of the logic model of intervention: causal model, intervention model and program theory model. This should facilitate the evaluation of programs, including those for rehabilitation.

The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study.

PubMed

Dambi, Jermaine M; Jelsma, Jennifer

2014-12-05

Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (p < .001) as compared to recipients of institution-based services. Long term caregiving

Validity of the stroke rehabilitation assessment of movement scale in acute rehabilitation: a comparison with the functional independence measure and stroke impact scale-16.

PubMed

Ward, Irene; Pivko, Susan; Brooks, Gary; Parkin, Kate

2011-11-01

To demonstrate sensitivity to change of the Stroke Rehabilitation Assessment of Movement (STREAM) as well as the concurrent and predictive validity of the STREAM in an acute rehabilitation setting. Prospective cohort study. Acute, in-patient rehabilitation department within a tertiary-care teaching hospital in the United States. Thirty adults with a newly diagnosed, first ischemic stroke. Clinical assessments were conducted on admission and then again on discharge from the rehabilitation hospital with the STREAM (total STREAM and upper extremity, lower extremity, and mobility subscales), Functional Independence Measure (FIM), and Stroke Impact Scale-16 (SIS-16). Sensitivity to change was determined with the Wilcoxon signed rank test and by the calculation of standardized response means. Spearman correlations were used to assess concurrent validity of the total STREAM and STREAM subscales with the FIM and SIS-16 on admission and discharge. We determined predictive validity for all instruments by correlating admission scores with actual and predicted length of stay and by testing associations between admission scores and discharge destination (home vs subacute facility). Not applicable. For all instruments, there was statistically significant improvement from admission to discharge. The standardized response means for the total STREAM and STREAM subscales were large. Spearman correlations between the total STREAM and STREAM subscales and the FIM and SIS-16 were moderate to excellent, both on admission and discharge. Among change scores, only the SIS-16 correlated with the total STREAM. All 3 instruments were significantly associated with discharge destination; however, the associations were strongest for the total STREAM and STREAM subscales. All instruments showed moderate-to-excellent correlations with predicted and actual length of stay. The STREAM is sensitive to change and demonstrates good concurrent and predictive validity as compared with the FIM and SIS-16

42 CFR 485.717 - Condition of participation: Rehabilitation program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Providers of Outpatient Physical Therapy and Speech-Language Pathology Services § 485.717 Condition of... (NFs) to which the agency furnishes services. The hospital, SNF, or NF is responsible for ensuring that qualified staff furnish services for which they arrange or contract for their patients. The rehabilitation...

Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation.

PubMed

Kucukboyaci, N Erkut; Long, Coralynn; Smith, Michelle; Rath, Joseph F; Bushnik, Tamara

2018-01-06

To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers. Cluster analysis of historical patient data obtained from inpatient visits. Inpatient rehabilitation unit in a large urban university hospital. Adult patients (N=148) receiving acute inpatient care, predominantly for closed head injury. Not applicable. We examined the membership of patients with traumatic brain injury in various "vulnerable group" clusters (eg, homeless, unemployed, racial/ethnic minority) and characterized the rehabilitation outcomes of patients (eg, duration of stay, changes in FIM scores between admission to inpatient stay and discharge). The cluster analysis revealed 4 major clusters (ie, clusters A-D) separated by vulnerable group memberships, with distinct durations of stay and FIM gains during their stay. Cluster B, the largest cluster and also consisting of mostly racial/ethnic minorities, had the shortest duration of hospital stay and one of the lowest FIM improvements among the 4 clusters despite higher FIM scores at admission. In cluster C, also consisting of mostly ethnic minorities with multiple socioeconomic status vulnerabilities, patients were characterized by low cognitive FIM scores at admission and the longest duration of stay, and they showed good improvement in FIM scores. Application of clustering techniques to inpatient data identified distinct clusters of patients who may experience differences in their rehabilitation outcome due to their membership in various "at-risk" groups. The results identified patients (ie, cluster B, with minority patients; and cluster D, with elderly patients) who attain below-average gains in brain injury rehabilitation. The results also suggested that systemic (eg, duration of stay) or clinical service improvements (eg, staff's language skills, ability to offer substance abuse therapy, provide appropriate referrals, liaise with intensive social work services, or plan

Enhanced Medical Rehabilitation increases therapy intensity and engagement and improves functional outcomes in post-acute rehabilitation of older adults: a randomized controlled trial

PubMed Central

Lenze, Eric J.; Host, Helen H.; Hildebrand, Mary W.; Morrow-Howell, Nancy; Carpenter, Brian; Freedland, Kenneth E.; Baum, Carolyn A.; Dixon, David; Doré, Peter; Wendleton, Leah; Binder, Ellen F.

2012-01-01

Objectives For millions of disabled older adults each year, post-acute care in skilled nursing facilities (SNFs) is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly due to therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in post-acute care rehabilitation. Design Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. Setting Post-acute care unit of a skilled nursing facility in St Louis, MO. Participants 26 older adults admitted from a hospital for post-acute rehabilitation. Intervention Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists (PT/OT) that increase patient engagement and intensity, with the goal of improving functional outcome, through: (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress. Measurements Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and six-minute walk. Results Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 meter/sec vs. 0.08 to 0.22 in standard of care,p=0.003) and six-minute walk (from 73 to 266 feet vs. 40 to 94 feet in standard of care, p=0.026), with a trend for better improvement of Barthel Index (+43 points vs. 26 points in standard of care, p=0.087), compared to participants randomized to standard

Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy.

PubMed

Chen, Kai; Ren, Yupeng; Gaebler-Spira, Deborah; Zhang, Li-Qun

2014-01-01

A portable rehabilitation robot incorporating intelligent stretching, robot-guided voluntary movement training with motivating games and tele-rehabilitation was developed to provide convenient and cost-effective rehabilitation to children with cerebral palsy (CP) and extend rehabilitation care beyond hospital. Clinicians interact with the patients remotely for periodic evaluations and updated guidance. The tele-assisted stretching and active movement training was done over 6-week 18 sessions on the impaired ankle of 23 children with CP in their home setting. Treatment effectiveness was evaluated using biomechanical measures and clinical outcome measures. After the tele-assisted home robotic rehabilitation intervention, there were significant increases in the ankle passive and active range of motion, muscle strength, a decrease in spasticity, and increases in balance and selective control assessment of lower-extremity.

Pulmonary Rehabilitation for Patients With Chronic Pulmonary Disease (COPD)

PubMed Central

2012-01-01

Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

Nursing Roles and Functions in the Acute and Subacute Rehabilitation of Patients With Stroke: Going All In for the Patient.

PubMed

Dreyer, Pia; Angel, Sanne; Langhorn, Leanne; Pedersen, Birgitte Blicher; Aadal, Lena

2016-04-01

The description of nursing roles and functions in rehabilitation of patients with stroke remains sparse. The aim of this study was to describe the experienced roles and functions of nurses during in-hospital rehabilitation of patients with stroke. Within a phenomenological hermeneutic approach, 19 nurses working with in-hospital rehabilitation of patients with stroke participated in three focus group interviews during 2013. The nurses' experiences were described in two themes: (a) the nurse's role and function in relation to the patient's needs 24/7 and (b) the nurse's role and function in the interdisciplinary team. Getting to know the patient as a person was essential to the nurses to care for the patient's basic needs; these must come first working with rehabilitation and always include the relatives. Recognition of the team members' individual skills with focus on the patient's needs must be the center of attention. An interdisciplinary rehabilitation program actively needs to include the patient by integrating the patient's perspective in the goals as well as in daily rehabilitation. In the team, nurses had the role of coordinator and the patient's voice.

Inpatient Rehabilitation Performance of Patients with Paraneoplastic Cerebellar Degeneration

PubMed Central

Fu, Jack B.; Raj, Vishwa S.; Asher, Arash; Lee, Jay; Guo, Ying; Konzen, Benedict S.; Bruera, Eduardo

2014-01-01

Objective To evaluate the functional improvement of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Design Retrospective Review Setting Three tertiary referral based hospitals. Interventions Medical records were retrospectively analyzed for demographic, laboratory, medical and functional data. Main Outcome Measure Functional Independence Measure (FIM) Participants Cancer rehabilitation inpatients admitted to three different cancer centers with a diagnosis of paraneoplastic cerebellar degeneration (n=7). Results All 7 patients were white females. Median age was 62. Primary cancers included ovarian carcinoma (2), small cell lung cancer (2), uterine carcinoma (2), and invasive ductal breast carcinoma. Mean admission total FIM score was 61.0 (SD=23.97). Mean discharge total FIM score was 73.6 (SD=29.35). The mean change in total FIM score was 12.6 (p=.0018). The mean length of rehabilitation stay was 17.1 days. The mean total FIM efficiency was 0.73. 5/7 (71%) patients were discharged home. 1/7 (14%) was discharged to a nursing home. 1/7 (14%) transferred to the primary acute care service. Conclusions This is the first study to demonstrate the functional performance of a group of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Despite the poor neurologic prognosis associated with this syndrome, these patients made significant functional improvements on inpatient rehabilitation. When appropriate, inpatient rehabilitation should be considered. Further studies with larger sample sizes are needed. PMID:25051460

75 FR 52960 - Medicare Program; Rural Community Hospital Demonstration Program: Solicitation of Additional...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... than 51 acute care inpatient beds (excluding beds in a distinct psychiatric or rehabilitation unit of... services furnished in a psychiatric or rehabilitation unit that is a distinct part of the hospital, using...

Hybrid Assistive Limb (HAL) Rehabilitation in Patients with Acute Hemorrhagic Stroke.

PubMed

Ogata, Toshiyasu; Abe, Hiroshi; Samura, Kazuhiro; Hamada, Omi; Nonaka, Masani; Iwaasa, Mitsutoshi; Higashi, Toshio; Fukuda, Hiroyuki; Shiota, Etsuji; Tsuboi, Yoshio; Inoue, Tooru

2015-01-01

The efficacy of hybrid assistive limb (HAL) rehabilitation in the acute phase of stroke remains unclear. The purpose of this study was to evaluate the outcomes of patients with acute intracranial hemorrhage (ICH) who were treated with or without HAL rehabilitation. Among 270 patients with acute ICH from 2009 to 2014, 91 patients with supratentorial ICH were included in this retrospective study. Of these, 14 patients (HAL group) received HAL rehabilitation at approximately 1 week after ICH occurrence, while the remaining 77 patients received usual rehabilitation without HAL (N-HAL group). We obtained various patient data from the hospitals where the patients were moved to for further rehabilitation. Statistical comparisons were performed for the characteristics of the ICH patients, and outcomes between the HAL and N-HAL groups. There were no differences in outcomes between the HAL and N-HAL groups. However, patients with right ICH in the HAL group exhibited a significant association with a functional independence measure (FIM) score of ≥ 110 compared with patients in the N-HAL group (HAL group: 81.8%, N-HAL group: 43.9%, P = 0.04). In patients with right ICH, HAL rehabilitation was associated with improved outcomes as evaluated by the FIM score. Thus, HAL rehabilitation may improve outcomes of acute ICH in appropriately selected patients.

Analyzing Sensor-Based Time Series Data to Track Changes in Physical Activity during Inpatient Rehabilitation.

PubMed

Sprint, Gina; Cook, Diane; Weeks, Douglas; Dahmen, Jordana; La Fleur, Alyssa

2017-09-27

Time series data collected from sensors can be analyzed to monitor changes in physical activity as an individual makes a substantial lifestyle change, such as recovering from an injury or illness. In an inpatient rehabilitation setting, approaches to detect and explain changes in longitudinal physical activity data collected from wearable sensors can provide value as a monitoring, research, and motivating tool. We adapt and expand our Physical Activity Change Detection (PACD) approach to analyze changes in patient activity in such a setting. We use Fitbit Charge Heart Rate devices with two separate populations to continuously record data to evaluate PACD, nine participants in a hospitalized inpatient rehabilitation group and eight in a healthy control group. We apply PACD to minute-by-minute Fitbit data to quantify changes within and between the groups. The inpatient rehabilitation group exhibited greater variability in change throughout inpatient rehabilitation for both step count and heart rate, with the greatest change occurring at the end of the inpatient hospital stay, which exceeded day-to-day changes of the control group. Our additions to PACD support effective change analysis of wearable sensor data collected in an inpatient rehabilitation setting and provide insight to patients, clinicians, and researchers.

[Domiciliary rehabilitation: an innovative form of outpatient medical rehabilitation].

PubMed

Schmidt-Ohlemann, M; Schweizer, C

2009-02-01

Domiciliary rehabilitation is an innovative form of outpatient medical rehabilitation. All components of service provision are delivered in the rehabilitant's home by a multidisciplinary team headed by a physician. The key context factors in the rehab process can be taken into account firsthand. The target group of domiciliary rehabilitation consists of multimorbid patients with severe functional limitations and complex assistance needs, whose rehabilitation options would be poor without this outreach service. Here, as suggested by the WHO concept of functional health, the interaction between health condition and environmental factors is kept in view much better than in other forms of rehabilitation. The positive effects and the efficiency of the rehabilitation measures provided can be assessed very well at a high descriptive level. This fact had been a precondition for legal establishment of domiciliary rehabilitation as a regular service. Domiciliary rehabilitation not only complies with key demands in the health and social policy fields, such as priority of outpatient over inpatient treatment or rehabilitation to precede and accompany long term care, it also constitutes an alternative concept challenging the traditional inpatient rehabilitation approach. The patient, hence, no longer is to fit into the institutional framework of outpatient or inpatient rehabilitation, but the team will fit into the specifics of the patient's unique social and material situation.

Characterizing speech and language pathology outcomes in stroke rehabilitation.

PubMed

Hatfield, Brooke; Millet, Deborah; Coles, Janice; Gassaway, Julie; Conroy, Brendan; Smout, Randall J

2005-12-01

Hatfield B, Millet D, Coles J, Gassaway J, Conroy B, Smout RJ. Characterizing speech and language pathology outcomes in stroke rehabilitation. To describe a subset of speech-language pathology (SLP) patients in the Post-Stroke Rehabilitation Outcomes Project and to examine outcomes for patients with low admission FIM levels of auditory comprehension and verbal expression. Observational cohort study. Five inpatient rehabilitation hospitals. Patients (N=397) receiving post-stroke SLP with admission FIM cognitive components at levels 1 through 5. Not applicable. Increase in comprehension and expression FIM scores from admission to discharge. Cognitively and linguistically complex SLP activities (problem-solving and executive functioning skills) were associated with greater likelihood of success in low- to mid-level functioning communicators in the acute post-stroke rehabilitation period. The results challenge common clinical practice by suggesting that use of high-level cognitively and linguistically complex SLP activities early in a patient's stay may result in more efficient practice and better outcomes regardless of the patient's functional communication severity level on admission.

Pulmonary rehabilitation in COPD - available resources and utilization in Swedish primary and secondary care.

PubMed

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

2017-01-01

Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD.

[REHABILITATION OF MOBILITY AND MOTOR FUNCTION IN NURSING HOME RESIDENTS WITH DEMENTIA].

PubMed

Aizen, Efraim; Lubosky, Enna; Sobeh, Saleh; Ibrahim, Rasha; Pressburger, Dina; Oliven, Roni

2018-04-01

Few clinical trials have evaluated exercise programs developed specifically for patients with dementia in nursing home settings. To determine if a training program tailored for demented patients, can be implemented in a nursing home setting in order to improve motor performances in patients with dementia who suffered functional decline. The present intervention was conducted in wards of patients suffering from dementia in three nursing homes. Patients suffering from dementia and hospitalized in a rehabilitation hospital were the control arm. Eligible patients in the wards assigned to the intervention group (NH; n = 24) received exercise training specifically designed for patients with dementia. Patients in the rehabilitation hospital were observed as a control group (RH; n = 50) and received usual care treatment. Primary endpoints were changes in Functional Independence Measure (FIM), 5X Sit-to-Stand Test, Timed up and go test and ADL. Basic parameters were examined as predictors of positive training response. Both the nursing home residents and rehabilitation hospital patients improved significantly in both primary endpoints (change: in Functional Independence Measure, NH: +119.2 ± 30.8 % versus RH: +83.3 ± 41.9%, p < 0.001; ADL, NH: +143.5 ± 102.6% versus RH: +59.0 ± 90.2%, p < 0.001). Age was found to be a predictor of positive training response. This functional training program tailored for demented patients can be implemented in a nursing home setting to improve motor performances in patients with dementia. Such interventions should be further evaluated in larger randomized controlled trials.

Economic burden of osteoporosis in women: data from the 2008 French hospital database (PMSI).

PubMed

Maravic, Milka; Jouaneton, Baptiste; Vainchtock, Alexandre; Tochon, Valerie

2012-01-01

To estimate the number and costs of hospitalisations associated with osteoporosis in France. Data for women aged 50 years and over were extracted from the 2008 French Hospital National Database. Criteria for acute care were established according to ICD-10 codes related to osteoporosis. As coding rules are not systematically used, an additional extraction which included surgical stays for hip fractures was performed in order to be more exhaustive. The two datasets were merged and duplicate stays excluded. Among women hospitalised in acute care during 2008, we selected those progressing to rehabilitation care within the year. We assessed the numbers of hospitalisations and women, proportion of surgical management, length of stay in acute care and numbers of rehabilitation days and costs. Hospital costs were calculated according to the National Hospital Tariff and National Scale of Costs, respectively, for acute and rehabilitation care based on 2009 tariffs. There were 67.807 hospitalisations (64.793 patients) associated with osteoporosis; 83% of total hospitalisations were in patients aged ≥75 years. A total of 80% of hospitalisations were associated with surgical management of fractures and 31.458 patients (49%) progressed from hospitalisation to rehabilitation. The mean ±SD length of stay was 12±8 days for hospitalisation and 43±31 days for rehabilitation care. The overall cost of hospitalisations was €415.4 million, of which 4.2% was related to medical devices. The overall cost of rehabilitation was €331.8 million. In 2008, postmenopausal osteoporosis was associated with a substantial economic burden at hospital in France.

A scoping review of video gaming in rehabilitation.

PubMed

Ravenek, Kelly E; Wolfe, Dalton L; Hitzig, Sander L

2016-08-01

To examine the scope of the peer-reviewed literature on the use of commercially available video gaming in rehabilitation. Five databases (SCOPUS, Cochrane, PsycINFO, PubMed and CINAHL) were searched for articles published between January 1990 and January 2014. The reference lists of selected articles were also reviewed to identify other relevant studies. Thirty articles met the inclusion criteria. Commercially available video gaming in rehabilitation was most commonly recommended by physiotherapists (50% or 15/30 studies) for populations at risk for falls or with decreased balance (67% or 19/30 studies). The most commonly used target outcomes were those assessing balance and/or fall prevention, with the Berg Balance Scale being the most frequently used (53% or 16/30 studies) outcome measure. The Nintendo Wii was the most prevalent gaming system (90% or 27/30 studies) used in the identified studies. Video gaming in rehabilitation is widely used by clinicians. Preliminary findings show that video gaming technology can be applied across a wide variety of rehabilitation populations, with some evidence showing clinical gains in physical functioning (e.g. gait and balance). There is a need for more robust clinical trials evaluating the efficacy of using video game systems as an adjunct to conventional rehabilitation. Implications for Rehabilitation Video gaming is a readily available technology that has been suggested as an enjoyable and motivating activity that engages patients in rehabilitation programming. Video gaming is becoming an increasingly popular adjunct to traditional therapy. Video gaming is most commonly used by physical therapists in a hospital setting for those with balance impairments. Video gaming has been shown to improve functional outcomes.

Rehabilitation needs of persons discharged from an African trauma center

PubMed Central

Christian, Asare; González-Fernández, Marlís; Mayer, Robert Samuel; Haig, Andrew J

2011-01-01

Background The study prospectively assessed the functional impairments and rehabilitation needs of Africans admitted to a regional trauma center. It also acts as a pilot study to demonstrate the practical use of the Language Independent Functional Evaluation (L.I.F.E.) software in an acute hospital setting. Methods A 5 page questionnaire was used to gather demographic data (age, sex, medical diagnosis, education, housing type, place of residency, occupation), cause of disability/injury, severity of disability or functional impairment, and rehabilitation treatment received (types of rehab, frequency of treatment, duration of therapy, follow up therapy, equipment). Functional status on discharge was evaluated with the L.I.F.E. scale. Results 84 consecutive consenting subjects were recorded. The predominant disability/injury of respondents involved the lower extremities (70%), followed by upper extremities (23%). The mechanisms of injury were largely related to auto accidents (69%). Falls made up 17% of these injuries and 14% were related to violence. Eleven subjects had disability measured using L.I.F.E and all were classified as having major disabilities. Only 14 patients (17%) received any rehabilitation therapy which consisted of only physical therapy provided at a frequency of once a day for less than one week duration. Conclusion This study found that most persons admitted to a sophisticated trauma unit in Ghana are discharged without adequate rehabilitation services, and that the level of disability experienced by these people can be measured, even while they are still sick and in the hospital, using L.I.F.E. The implications are clear: African trauma systems must measure the long term outcomes from their treatments and provide the inpatient medical rehabilitation services that are a standard of care for trauma victims elsewhere in the world. PMID:22187614

System flexibility in the rehabilitation process of mentally disabled persons in a hostel that bridges between the hospital and the community.

PubMed

Baloush-Kleinman, Vered; Schneidman, Michael

2003-01-01

Deinstitutionalization and community mental health services have become the focus of mental health care in the United States, Italy and England, and now in Israel. Tirat Carmel MHC developed an intervention model of organizational change implemented in a rehabilitation hostel. It is an interim service based on graduated transition from maintenance care to a transitional Half-way House, followed by a Transitional Living Skills Center oriented for independent community living. Of 205 rehabilitees who resided in the hostel since the beginning of the project, 138 were discharged to community residential settings: 67 patients were discharged to reinforced community hostels; 27 to sheltered housing and 23 to independent residential quarters; 7 patients were discharged to comprehensive hostels, 3 to old-age homes and 11 returned home to their families. In terms of employment, 79 were placed in sheltered employment facilities, 24 work in the open market and 3 returned to school; 22 work in therapeutic occupational settings and 10 patients discharged to comprehensive hostels and old-age homes are engaged in sheltered employment programs in those settings. The system flexibility model and the rehabilitation processes anchored in normalization supported the relocation of hospitalized psychiatric patients to community-based settings and enabled the rehabilitees to cope with readjustment to community life.

Preliminary Study on Prevalence and Associated Factors with Sarcopenia in a Geriatric Hospitalized Rehabilitation Setting.

PubMed

Pongpipatpaiboon, K; Kondo, I; Onogi, K; Mori, S; Ozaki, K; Osawa, A; Matsuo, H; Itoh, N; Tanimoto, M

2018-01-01

The reported prevalence of sarcopenia has shown a wide range, crucially based on the diagnostic criteria and setting. This cross-sectional study evaluated the prevalence of sarcopenia and sought to identify factors associated with sarcopenia on admission in a specialized geriatric rehabilitation setting based on the newly developed the Asian Working Group for Sarcopenia algorithm. Among 87 participants (mean age, 76.05 ± 7.57 years), 35 (40.2%) were classified as showing sarcopenia on admission. Prevalence was high, particularly among participants ≥80 years old, with tendencies toward lower body mass index, smoking habit, lower cognitive function, and greater functional impairment compared with the non-sarcopenic group. Identification of sarcopenia in elderly patients before rehabilitation and consideration of risk factors may prove helpful in achieving rehabilitation outcomes.

Preoperative nutritional status is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.

PubMed

Arai, Yasuhiro; Kimura, Toru; Takahashi, Yuki; Hashimoto, Takashi; Arakawa, Mamoru; Okamura, Homare

2018-06-23

Progression of cardiac rehabilitation after cardiovascular surgery can be affected by frailty. The nutritional status of the patient has been proposed as an indicator of frailty. In this study, we aimed to evaluate the influence of preoperative nutritional status on the progress of postoperative cardiac rehabilitation. This study included 146 patients (82 males, 64 females, average age 71.9 ± 12.0 years) who underwent elective cardiovascular surgery. In-hospital mortality cases were excluded to focus on postoperative cardiac rehabilitation. We classified patients with a Geriatric Nutritional Risk Index of 92 or higher as the good nutrition group and those with a Geriatric Nutritional Risk Index less than 92 as the malnutrition group. Preoperative patient characteristics and postoperative cardiac rehabilitation progress were compared between the good nutrition (n = 93) and malnutrition (n = 53) groups. The patients in the good nutrition group had an earlier progression to walking after postoperative rehabilitation (p = 0.002), a shorter postoperative hospital stay (p = 0.004), and a higher rate of discharge home (p = 0.028) than those in the malnutrition group. Multivariable analysis demonstrated preoperative malnutrition to be an independent predictor for the day to 100 m walking (p = 0.010). Preoperative nutritional status was associated with progression of postoperative cardiac rehabilitation.

Using Lean principles to manage throughput on an inpatient rehabilitation unit.

PubMed

Chiodo, Anthony; Wilke, Ruste; Bakshi, Rishi; Craig, Anita; Duwe, Doug; Hurvitz, Edward

2012-11-01

Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.

Post-deployment Multi-symptom Disorder rehabilitation: An integrated approach to rehabilitation.

PubMed

Bosco, Michelle A; Murphy, Jennifer; Peters, Walter E; Clark, Michael E

2015-01-01

Veterans and active duty service members returning from Operation New Dawn and those having returned from Operations Iraqi and Enduring Freedom frequently report the presence of overlapping, co-morbid symptom clusters consisting of chronic pain, mild cognitive complaints, and posttraumatic stress symptoms/disorder or mood disturbance. This presentation has been called Post-deployment Multi-symptom Disorder (PMD) and its implications not only impact various functional domains, but have also influenced a system/continuum of care to rise to meet the challenges of treating PMD. This continuum is based on innovation informed by evidence-based therapies, systemic limitations, and a focus on functional improvement rather than diagnostic classification. The purpose of this paper is to describe the symptomatic, functional and systemic challenges inherent to PMD conceptualization and treatment. The constituent clusters of PMD are defined and exemplified, its functional impact is illustrated, and a continuum of care at a large southeastern Veterans Affairs (VA) hospital offering an interdisciplinary approach to integrated rehabilitation is described. Three case examples are provided that that underscore the importance of vocation for improved behavioral health and quality of life. The case examples demonstrate how vocational rehabilitation services are an integral component of PMD treatment.}

Variations in Utilization of Inpatient Rehabilitation Services among Pediatric Trauma Patients.

PubMed

Nguyen, Huong T; Newton, Christopher; Pirrotta, Elizabeth A; Aguilar, Christine; Wang, N Ewen

2017-03-01

To assess clinical and nonclinical characteristics associated with the use of pediatric inpatient rehabilitation services among children with traumatic injuries. We hypothesized there would be no nonclinical variations in the use of pediatric inpatient rehabilitation services. Retrospective analysis of 1139 patients who were injured seriously (0-18 years of age) from our institutional trauma registry (2004-2014). Patients' nonclinical and clinical characteristics were analyzed. We used a full matching technique to compare characteristics between those admitted to rehabilitation (cases) to those discharged home (controls). We matched patients by age category, sex, maximum Abbreviated Injury Scale, and body region of maximum Abbreviated Injury Scale. We used survey-based multivariate logistic regression to identify characteristics associated with inpatient rehabilitation services, controlling for multiple injuries, distance from home to rehabilitation center, year of service, hospital length of stay, and clinically relevant interactions. Ninety-eight patients (8.6%) were admitted to inpatient rehabilitation and 968 (85.0%) were discharged home. Black and other minority patients had increased odds of receiving inpatient rehabilitation compared with white patients (OR, 7.6 [P< .001] and OR, 1.6 [P= .03], respectively). Patients with private compared with public insurance had increased odds of receiving inpatient rehabilitation (OR, 2.4; P< .001). Pediatric inpatient rehabilitation beds are a scarce resource that should be available to those with the greatest clinical need. The mechanism creating differences in the use of inpatient rehabilitation based on nonclinical characteristics such as race/ethnicity or insurance status must be understood to prevent disparities in access to inpatient rehabilitation services. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcome prediction in home- and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory.

PubMed

Malec, James F; Parrot, Devan; Altman, Irwin M; Swick, Shannon

2015-01-01

The objective of the study was to develop statistical formulas to predict levels of community participation on discharge from post-hospital brain injury rehabilitation using retrospective data analysis. Data were collected from seven geographically distinct programmes in a home- and community-based brain injury rehabilitation provider network. Participants were 642 individuals with post-traumatic brain injury. Interventions consisted of home- and community-based brain injury rehabilitation. The main outcome measure was the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index. Linear discriminant models using admission MPAI-4 Participation Index score and log chronicity correctly predicted excellent (no to minimal participation limitations), very good (very mild participation limitations), good (mild participation limitations), and limited (significant participation limitations) outcome levels at discharge. Predicting broad outcome categories for post-hospital rehabilitation programmes based on admission assessment data appears feasible and valid. Equations to provide patients and families with probability statements on admission about expected levels of outcome are provided. It is unknown to what degree these prediction equations can be reliably applied and valid in other settings.

The effects of the Norwegian Coordination Reform on the use of rehabilitation services: panel data analyses of service use, 2010 to 2013.

PubMed

Monkerud, Lars C; Tjerbo, Trond

2016-08-05

In 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. From 2012 to 2014, under the Municipal Co-Financing regime, municipalities were obliged to cover 20 % of the costs of health services provided at the specialist (hospital) level. Importantly, use of rehabilitation services in private institutions was not part of the cost-sharing mechanism of Municipal Co-Financing. Rehabilitation services may be seen as quite similar in nature whether they be provided by municipalities, hospitals or private institutions. Thus, with rehabilitation patients readily "transferrable" between levels, the question is whether the reform brought with it a sought after shift towards more municipal rehabilitation and less specialist rehabilitation. Data from the Norwegian Patient Register and from Statistics Norway/KOSTRA were utilized to gauge annual expenditures and inputs in specialist, municipal and private institution rehabilitation services respectively. Fixed effects and first difference regression analyses for the period 2010-2013 were carried out to account for certain time-invariant traits of municipalities and/or hospital regions, and results were adjusted for contemporaneous trends in local needs. Expenditures in specialist rehabilitation services declined sharply (typically by 8-10 %) from 2011 (pre-reform) to 2012 (post-reform), while expenditures in private rehabilitation services rose markedly in the same period (typically by 42-44 %). The results do not suggest any general expansion of municipal rehabilitation services. The results of the analyses suggest that municipalities shift away from the use of specialist rehabilitation services and towards the use of rehabilitation services in private institutions since the latter becomes relatively cheaper (free-of charge) than both municipal and specialist services in post-reform periods (as specialist services come at a cost

Reported use of evidence in clinical practice: a survey of rehabilitation practices in Norway.

PubMed

Moore, Jennifer L; Friis, Svein; Graham, Ian D; Gundersen, Elisabeth Troøyen; Nordvik, Jan E

2018-05-25

The South Eastern Health Region in Norway serves approximately 2.8 million people, which is more than half of Norway's population. Physical medicine and rehabilitation services are provided by 9 public hospital trusts and 30 private rehabilitation facilities. The purposes of this study were to conduct a psychometric analysis of the EBP Implementation Scale (EBPIS) and describe rehabilitation clinicians' self-reported 1) use of evidence-based practices (EBPs), 2) use of EBPs across hospitals, and 3) determine factors associated with use of EBPs in the South Eastern Health Region in Norway. A cross-sectional study using an online survey was conducted with public hospitals and private rehabilitation centers. The survey, which was distributed throughout the region, included the EBPIS, 8 questions related to EBP in the health region, and demographics. Response frequencies were calculated and described. Internal consistency and factor structure of the EBPIS and its subscales were determined. Associations and differences in groups with similar demographics, EBPIS scores, and use of EBPs were identified. A total of 316 individuals completed the survey, including allied health clinicians, nurses, psychologists, social workers, and physicians. The EBPIS mean score was 30/72. A factor analysis identified that the EBPIS can be divided into 3 subscales: literature search and critical appraisal (α = .80), knowledge sharing (α = .83), and practice evaluation (α = .74). EBP activities reported were primarily related to literature searches, critical appraisal, and discussing evidence. Approximately 65 and 75% of respondents agreed that the same OMs and evidence based interventions were used within the local clinic respectively. Fewer agreed that the same OMs (13%) and evidence-based interventions (39%) are used regionally. The EBPIS and its subscales demonstrated excellent internal consistency. Practice variability exists in rehabilitation throughout Southeastern

Rehabilitation of elderly patients in the community following surgery for hip fracture - utilization of personal and health care services.

PubMed

Eilat-Tsanani, Sophia; Tabenkin, Hava; Kaufman, Basil; Lavie, Idit; Weiss, Zvi; Apelbaum, Rakefet

2012-01-01

To assess the change in utilization of personal and health care services following surgery for hip fracture in elderly patients rehabilitated in the community. A descriptive study of patients hospitalized in the orthopedic surgery ward for traumatic hip fracture. The first interview took place after surgery and included functional and medical data, and details on utilization of personal and health care services in the month prior to surgery. The second interview took place at home three months after discharge from the hospital and documented corresponding data for the last month. The study included 91 elderly patients. The mean number of contacts with health care providers increased from 4.6/month before HF to 6.4/month during rehabilitation; in particular an increase in home visits by primary care nurses and physicians from 0.4 to 1.0 visit/month (p < 0.001). Personal care showed a greater increase from 32.5 to 95.0 weekly hours (p < 0.001). Multivariate analyses showed that the increase in primary care visits was associated with chronic co-morbidity and being single, while the increase in personal care was associated with medium dependence level and an ambulatory rehabilitation setting. During the rehabilitation period in the community there was an increase in non-rehabilitative services-medical and personal. Morbidity and functional data could predict the increase in use at time of discharge from hospital.

Rehabilitation Aspects of Human Sexuality

PubMed Central

Madorsky, Julie G. Botvin; Dixon, Thomas P.

1983-01-01

The PLISSIT model is a comprehensive program that combines educational strategies with behavioral intervention to integrate human sexuality into the initial rehabilitation of spinal cord-injured persons. Sexuality is treated as a health care issue as important as bowel and bladder care, skin care, psychosocial issues, mobility, self-care and vocational concerns. Patients admitted to the Spinal Cord Injury Program are surrounded by a supportive milieu and an interdisciplinary staff who comfortably incorporate sexuality into discussions about catheter care, positioning, communication styles, assistive devices and so forth. Patients are exposed to a behavioral training program that makes available didactic lectures, group and individual sessions, bibliotherapy, films and opportunities for directed overnight sexual exploration within the hospital. We advocate that sex therapy be integrated into comprehensive rehabilitation programs along with physical therapy occupational therapy, recreation therapy and psychotherapy as an integral and effective form of functional restoration for patients with major physical disabilities. PMID:6636728

Responding to the health and rehabilitation needs of people with disabilities post-Haiyan

PubMed Central

Kleinitz, Pauline; Calina, Liezel; Alcido, Ma Rowena; Gohy, Bérengère; Hall, Julie Lyn

2015-01-01

Introduction It is estimated that 15% of the world’s population has a disability, and disasters increase their risk and vulnerability. Rehabilitation services were limited in the area of the Philippines that was affected by Typhoon Haiyan. This study describes the initial rehabilitation needs assessment and activities to increase rehabilitation services conducted in Leyte province of Region 8 after Haiyan. Method A rehabilitation needs assessment for people with disabilities and injuries needing physical and functional rehabilitation care and assistive devices was conducted in health facilities, evacuation centres and selected municipalities in Leyte province between 9 November 2013 and 30 April 2014 by a consortium of agencies. Improvements to service delivery and referrals were documented. Results Rehabilitation services were reduced immediately after Haiyan, but they increased in the following months and peaked four months after Haiyan. There were 2998 individuals needing medicine and rehabilitation management, functional care and assistive devices. These included persons with pre-existing disabilities whose situations had worsened and people who had sustained injuries in the typhoon. Additional improvements included rehabilitation services with provision of assistive devices at the regional hospital, development of a directory of disability services in the region and advocacy through community-based rehabilitation. Discussion Information services and community knowledge for people with disabilities improved in Region 8 after Typhoon Haiyan, demonstrating that strengthening rehabilitation systems is a realistic goal after disasters. PMID:26767137

Responding to the health and rehabilitation needs of people with disabilities post-Haiyan.

PubMed

Benigno, Mylene Rose; Kleinitz, Pauline; Calina, Liezel; Alcido, Ma Rowena; Gohy, Bérengère; Hall, Julie Lyn

2015-01-01

It is estimated that 15% of the world's population has a disability, and disasters increase their risk and vulnerability. Rehabilitation services were limited in the area of the Philippines that was affected by Typhoon Haiyan. This study describes the initial rehabilitation needs assessment and activities to increase rehabilitation services conducted in Leyte province of Region 8 after Haiyan. A rehabilitation needs assessment for people with disabilities and injuries needing physical and functional rehabilitation care and assistive devices was conducted in health facilities, evacuation centres and selected municipalities in Leyte province between 9 November 2013 and 30 April 2014 by a consortium of agencies. Improvements to service delivery and referrals were documented. Rehabilitation services were reduced immediately after Haiyan, but they increased in the following months and peaked four months after Haiyan. There were 2998 individuals needing medicine and rehabilitation management, functional care and assistive devices. These included persons with pre-existing disabilities whose situations had worsened and people who had sustained injuries in the typhoon. Additional improvements included rehabilitation services with provision of assistive devices at the regional hospital, development of a directory of disability services in the region and advocacy through community-based rehabilitation. Information services and community knowledge for people with disabilities improved in Region 8 after Typhoon Haiyan, demonstrating that strengthening rehabilitation systems is a realistic goal after disasters.

Rehabilitation and transition after lung transplantation in children.

PubMed

Burton, J H; Marshall, J M; Munro, P; Moule, W; Snell, G I; Westall, G P

2009-01-01

We describe the key components of an outpatient pediatric recovery and rehabilitation program set up within the adult lung transplant service at the Alfred Hospital, Melbourne. Following discharge, pediatric lung transplant recipients and their families participated in an intensive 3-month outpatient rehabilitation program. Weekly sessions included education regarding transplant issues, physiotherapy, and occupational therapy sessions. The overall aim of the program was to comprehensively address physical rehabilitation and psychosocial and educational needs. Sessions tailored to meet the individual needs of the child were presented at an appropriate cognitive level. Education sessions for both the children and parents focused on medications, identification of infection and rejection, nutrition, physiotherapy/rehabilitation, occupational roles and stress management, donor issues, psychosocial readjustment, and transition issues. Physiotherapy included a progressive aerobic and strength training program, postural reeducation, and core stability. We incorporate Age-appropriate play activities: running, dancing, jumping, ball skills, and so on. Occupational therapy sessions addressed the primary roles of patient, students, and player. Transitions such as returning to school, friends, and the community were explored. Issues discussed included adjustment to new health status, strategies to manage side effects of medications, and altered body image issues. Weekly multidisciplinary team meetings were used to discuss and plan the rehabilitation progress. School liaison and visits occurred prior to school commencement with follow-up offered to review the ongoing transition process. Both patients and parents have reported a high level of satisfaction with the rehabilitation program. We plan to formally evaluate the program in the future.

Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated with 30-day Unplanned Hospital Readmission for Medicare Beneficiaries?

PubMed Central

Karmarkar, Amol; Lin, Yu-Li; Kuo, Yong-Fang; Ottenbacher, Kenneth J.; Graham, James E.

2017-01-01

Objective To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after Inpatient Rehabilitation Facilities (IRFs) discharge. Design We used the 100% Medicare claims data, covering 269,306 discharges from 1,094 IRFs between October 2010 and September 2011. We examined the association between hospital readmission and ten facility-level factors (number of discharges, disproportionate share percentage, profit status, teaching status, freestanding status, accreditation status, census region, stroke belt, location and median household income). Setting Discharge from IRFs. Participants Facilities (IRFs) serving Medicare fee-for-service beneficiaries. Intervention NA Main Outcome Measure(s) Risk Standardized Readmission Rate (RSRR) for 30-day hospital readmission. Results Profit status was the only IRF provider-level characteristic significantly associated with unplanned readmissions. For-profit IRFs had significantly higher RSRR (13.26 ± 0.51) as compared to non-profit IRFs (13.15 ± 0.47) (p<0.001). After controlling for all other facility characteristics (except for accreditation status due to collinearity), for-profit IRFs remained 0.1% point higher RSRR than non-profit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (p=0.005 for both, type III test). Conclusions Our findings support the inclusion of profit status on the IRF Compare website (a platform includes IRF comparators to indicate quality of services). For-profit IRFs had higher RSRR than non-profit IRFs for Medicare beneficiaries. The South had higher RSRR than other regions. The RSRR difference between for-profit and non-profit IRFs could be due to the combined effects of organizational and regional factors. PMID:28958606

Private Rehabilitation.

ERIC Educational Resources Information Center

McMahon, Brian T., Ed.

1983-01-01

Discusses the expanding role of the rehabilitation counselor into private sector rehabilitation in the seven articles of this special issue. Topics cover private rehabilitation in an insurance context including forensics issues, computer applications, recent trends, services in a multiprogram private clinic, and rehabilitation counselor training.…

Problems of Achieving Rehabilitation and Punishment in Special School Environments

ERIC Educational Resources Information Center

Wiles, David K.; Rockoff, Edward

1978-01-01

Explores the legal implications of inschool suspension practices through consideration of individual versus institutional rights within a punitive-rehabilitative setting. Discusses the applicability of the prison hospital model to schools and argues that future legal action may challenge the viability of inschool suspension practices. (Author/JG)

Trade-offs between effectiveness and efficiency in stroke rehabilitation.

PubMed

Koh, Gerald Choon-Huat; Chen, Cynthia; Cheong, Angela; Choo, Tai Bee; Pui, Choi Kwok; Phoon, Fong Ngan; Ming, Chan Kin; Yeow, Tan Boon; Petrella, Robert; Thind, Amardeep; Koh, David; Seng, Chia Kee

2012-12-01

Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation. To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency. Using a retrospective cohort study design, we studied all stroke patients (n = 2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period. Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β -4·7 (95% confidence interval -7·4 to -2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2-4·0) in effectiveness but a decrease of 0·04 (95% confidence interval -0·05 to -0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7-10·3) in effectiveness but a decrease of 0·82 (95% confidence interval -0·90 to -0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30-62 and length of stay was 37-41 days. There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional

Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel.

PubMed

Ben Natan, Merav; Heyman, Neomi; Ben Israel, Joshua

2016-01-01

To identify risk factors for elder falls in a geriatric rehabilitation center in Israel. Retrospective chart review study. Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not. Of elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition. The research findings single out patients who are allegedly at a lower risk of falls than more complex patients. Caregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular. © 2014 Association of Rehabilitation Nurses.

Hybrid Assistive Limb (HAL) Rehabilitation in Patients with Acute Hemorrhagic Stroke

PubMed Central

OGATA, Toshiyasu; ABE, Hiroshi; SAMURA, Kazuhiro; HAMADA, Omi; NONAKA, Masani; IWAASA, Mitsutoshi; HIGASHI, Toshio; FUKUDA, Hiroyuki; SHIOTA, Etsuji; TSUBOI, Yoshio; INOUE, Tooru

2015-01-01

The efficacy of hybrid assistive limb (HAL) rehabilitation in the acute phase of stroke remains unclear. The purpose of this study was to evaluate the outcomes of patients with acute intracranial hemorrhage (ICH) who were treated with or without HAL rehabilitation. Among 270 patients with acute ICH from 2009 to 2014, 91 patients with supratentorial ICH were included in this retrospective study. Of these, 14 patients (HAL group) received HAL rehabilitation at approximately 1 week after ICH occurrence, while the remaining 77 patients received usual rehabilitation without HAL (N-HAL group). We obtained various patient data from the hospitals where the patients were moved to for further rehabilitation. Statistical comparisons were performed for the characteristics of the ICH patients, and outcomes between the HAL and N-HAL groups. There were no differences in outcomes between the HAL and N-HAL groups. However, patients with right ICH in the HAL group exhibited a significant association with a functional independence measure (FIM) score of ≥ 110 compared with patients in the N-HAL group (HAL group: 81.8%, N-HAL group: 43.9%, P = 0.04). In patients with right ICH, HAL rehabilitation was associated with improved outcomes as evaluated by the FIM score. Thus, HAL rehabilitation may improve outcomes of acute ICH in appropriately selected patients. PMID:26511112

[Nonpharmacologic and rehabilitation aspects in inpatient settings].

PubMed

Gatterer, G; Rosenberger-Spitzy, A

1996-01-01

Dementia is one of the most psychic diseases of people over the age of 65 years and are often the reason or consequence of a hospitalization or need for commitment to rest homes. However, this disease should not lead to therapeutic nihilism, it should be a challenge for the development of new ideas and care concepts. The present publication shows the possibilities of non-pharmacological rehabilitative measures in the stationary field, whereby the priorities are on psychological and psychotherapeutical and also milieu therapeutical aspects. Additional well known intervention measures (e.g. physicotherapy, ergotherapy, logopedia, care) are summarized. Especially new concepts in stationary care can help to improve quality of life of geriatric patients with dementia in stationary fields: therefore they should be promoted and integrated to a greater amount into the total rehabilitative concept.

Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.

PubMed

Cowen, T D; Meythaler, J M; DeVivo, M J; Ivie, C S; Lebow, J; Novack, T A

1995-09-01

To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [CT] findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). Inception cohort. University tertiary care rehabilitation center. 91 patients with TBI. Inpatient rehabilitation. FIM, rehabilitation LOS, and rehabilitation charges. Patients in the severely impaired (GCS = 3 to 7) group showed significantly lower (p = .01) mean admission and discharge motor scores (21.26, 39.83) than patients in the mildly impaired (GCS = 13 to 15) group (38.86, 55.29). Cognitive scores were also significantly lower (p < .01) in the severely impaired group on admission (26.73 vs 54.14) and discharge (42.28 vs 66.48). These findings continued to be statistically significant (p < .01) after regression analysis accounted for the other early variables previously listed. Regression analysis also illustrated that longer acute hospitalization LOS was independently associated with significantly lower admission motor (p < .01) and cognitive (p = .05) scores, and significantly higher (p = .01) rehabilitation charges. Patients with CT findings of intracranial bleed with skull fracture had longer total LOS (70.88 vs 43.08 days; p < .05), rehabilitation LOS (30.01 vs 19.68 days; p < .10), and higher rehabilitation charges ($43,346 vs $25,780; p < .05). Paradoxically, those patients in a motor vehicle crash with an extremity bone fracture had significantly higher (p = .002; p = .04 after regression analysis) FIM cognitive scores on admission (48.30 vs 27.28) and discharge (64.74 vs 45.78) than those without a fracture. Finally, data available on rehabilitation admission were used to predict discharge outcomes. The percentage of explained variance for each outcome variable is as follows: discharge FIM motor

Improving brain injury cognitive rehabilitation by personalized telerehabilitation services: Guttmann neuropersonal trainer.

PubMed

Solana, Javier; Cáceres, César; García-Molina, Alberto; Opisso, Eloy; Roig, Teresa; Tormos, José M; Gómez, Enrique J

2015-01-01

Cognitive rehabilitation aims to remediate or alleviate the cognitive deficits appearing after an episode of acquired brain injury (ABI). The purpose of this work is to describe the telerehabilitation platform called Guttmann Neuropersonal Trainer (GNPT) which provides new strategies for cognitive rehabilitation, improving efficiency and access to treatments, and to increase knowledge generation from the process. A cognitive rehabilitation process has been modeled to design and develop the system, which allows neuropsychologists to configure and schedule rehabilitation sessions, consisting of set of personalized computerized cognitive exercises grounded on neuroscience and plasticity principles. It provides remote continuous monitoring of patient's performance, by an asynchronous communication strategy. An automatic knowledge extraction method has been used to implement a decision support system, improving treatment customization. GNPT has been implemented in 27 rehabilitation centers and in 83 patients' homes, facilitating the access to the treatment. In total, 1660 patients have been treated. Usability and cost analysis methodologies have been applied to measure the efficiency in real clinical environments. The usability evaluation reveals a system usability score higher than 70 for all target users. The cost efficiency study results show a relation of 1-20 compared to face-to-face rehabilitation. GNPT enables brain-damaged patients to continue and further extend rehabilitation beyond the hospital, improving the efficiency of the rehabilitation process. It allows customized therapeutic plans, providing information to further development of clinical practice guidelines.

Cognitive-communication disorder following right hemisphere stroke: exploring rehabilitation access and outcomes.

PubMed

Hewetson, Ronelle; Cornwell, Petrea; Shum, David

2017-07-01

Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined. To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment. A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge. The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge. People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment.

Pediatric rehabilitation psychology: Rehabilitating a moving target.

PubMed

Kaufman, Jacqueline N; Lahey, Sarah; Slomine, Beth S

2017-08-01

The current special section includes manuscripts focusing on four aspects of pediatric rehabilitation psychology that are unique to this practice area. The first domain addressed is natural developmental progression in the context of a disability (i.e., habilitation). The next domain addressed in this special section is pediatric rehabilitation; pediatric rehabilitation psychology addresses the reacquisition of previously attained skills and abilities within the context of the natural developmental milieu. This special section also highlights the inherently interdisciplinary and transdisciplinary nature of pediatric rehabilitation psychology given the complex environment in which children exist. Finally, the special section includes illustrations of the crucial role pediatric rehabilitation psychologists play in facilitating transitions through major milestones, particularly from pediatrics to adulthood when living with a disability. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

PubMed

Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

2011-08-01

Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

Rehabilitation-specific challenges and advantages in the integration of migrant physicians in Germany: a multiperspective qualitative interview study in rehabilitative settings.

PubMed

Jansen, E; Hänel, P; Klingler, C

2018-07-01

In Germany, rehabilitative healthcare institutions increasingly rely on migrant physicians to meet their staffing needs. Yet until now, research on the integration of migrant physicians has focussed entirely on the acute care setting. This study is the first to address the specific advantages and challenges to integration in the field of rehabilitative medicine where a high number of migrant physicians work. From the experiences of migrant physicians and their colleagues, we provide actionable suggestions to counteract potential sources of conflict and thereby improve the integration of migrant physicians in the German workforce. We conducted a qualitative interview study. We conducted 23 interviews with a total of 26 participants occupying a variety of roles in two different rehabilitation centres (maximum variation sampling). Interviews were recorded, transcribed verbatim and parsed through thematic analysis. Our research revealed advantages and challenges to integration in three distinct areas: rehabilitative care institutions, competencies of migrant professionals and interpersonal relations. The first set of issues hinges on the work processes within rehabilitative hospitals, professional prospects there and the location of the institutions themselves. Second, migrant physicians may encounter difficulties because of limited linguistic skills and country-specific knowledge. And finally, aspects of their interactions with care teams and patients may constitute barriers to integration. Some of the factors influencing the integration of migrant physicians are the same in both rehabilitative and acute medicine, but the rehabilitative setting presents distinct advantages and challenges that are worthy of study in their own right. We outline several measures which could help overcome challenges to the integration of migrant physicians, including those associated with professional relationships. Further research is needed to develop concrete support programmes

Interdisciplinary Rehabilitation Referrals in a Concussion Clinic Cohort: An Exploratory Analysis.

PubMed

Vargo, Mary M; Vargo, Kevin G; Gunzler, Douglas; Fox, Kermit W

2016-03-01

To assess the frequency and spectrum of referrals to rehabilitation disciplines in a concussion clinic population and factors associated with need for referral. Retrospective study. Concussion clinic within the Physical Medicine and Rehabilitation Department of an academic medical center. Patients receiving physiatric management for concussion care. Referral to physical therapy (PT), occupational therapy, speech therapy (ST), neuropsychology, or any referral (Any), and reasons for referral. Demographic and clinical variables were analyzed for possible association with referral to rehabilitation disciplines. These independent variables included mechanism of injury, referral source, age, gender, provider, days since injury, presenting Sports Concussion Assessment Tool 2 (SCAT2) symptom score, insurance type, clinical risk factors, whether the injury was work related and whether the patient had been hospitalized. Among 262 patients meeting inclusion criteria, the most commonly prescribed individual therapy was physical therapy (74 patients; 28%), followed by speech therapy (60 patients, 23%), neuropsychology (27 patients, 10.3%), and occupational therapy (19 patients, 7.2%). In all, 121 (46%) of patients were referred to one or more disciplines. The most common reasons for referral were cognitive strategies (54 patients, 21%), balance/vestibular therapy (50 patients,19%), and neck pain (32 patients, 12%). Per multivariate logistic regression analysis, covariates associated with PT: age, SCAT2 symptom score, gender, provider, and (inversely) cognitive/learning disorder; ST: time elapsed since injury, gender, and referral source of internal clinic; Any: SCAT2 symptom score. Referrals did not significantly vary by mechanism of injury (sports, fall, vehicular, etc), whether work-related, or whether the patient had been hospitalized. Insurance factors were significant for PT and Any on the univariate analysis but not logistic regression. Relatively little has been

Omission of Dysphagia Therapies in Hospital Discharge Communications

PubMed Central

Kind, Amy; Anderson, Paul; Hind, Jacqueline; Robbins, JoAnne; Smith, Maureen

2009-01-01

Background Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. Objective To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. Design Retrospective cohort study Subjects All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187). Measurements Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Results 45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Conclusions Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care. PMID:20098999

Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials.

PubMed

Legg, L; Langhorne, P

2004-01-31

Stroke-unit care can be valuable for stroke patients in hospital, but effectiveness of outpatient care is less certain. We aimed to assess the effects of therapy-based rehabilitation services targeted at stroke patients resident in the community within 1 year of stroke onset or discharge from hospital. We did a systematic review of randomised trials of outpatient services, including physiotherapy, occupational therapy, and multidisciplinary teams. We used Cochrane collaboration methodology. We identified a heterogeneous group of 14 trials (1617 patients). Therapy-based rehabilitation services for stroke patients living at home reduced the odds of deteriorating in personal activities of daily living (odds ratio 0.72 [95% CI 0.57-0.92], p=0.009) and increased ability of patients to do personal activities of daily living (standardised mean difference 0.14 [95% CI 0.02-0.25], p=0.02). For every 100 stroke patients resident in the community receiving therapy-based rehabilitation services, seven (95% CI 2-11) would not deteriorate. Therapy-based rehabilitation services targeted at selected patients resident in the community after stroke improve ability to undertake personal activities of daily living and reduce risk of deterioration in ability. These findings should be considered in future service planning.

Rollator use and functional outcome of geriatric rehabilitation.

PubMed

Vogt, Lutz; Lucki, Katrin; Bach, Matthias; Banzer, Winfried

2010-01-01

In a quasi-experimental pre- and postdesign, we examined the effect of rollator use on functional rehabilitation outcome in geriatric patients.From a sample of 458 geriatric inpatients, we matched 30 subjects who were not using assistive devices in their everyday lives but received a wheeled walker at the time of hospital admission (first-time user group) according to their admission scores on three motor performance tests (Timed Up-and-Go, Five-Times-Sit-to-Stand, and Performance-Oriented Mobility Assessment -Balance) with 30 patients who were actively using rollators as their primary walking aid for at least 3 months (long-term user group) and 30 control subjects without walking-aid assistance. Measurements were repeated after the inpatient rehabilitation regimen.The Kruskal-Wallis test did not reveal significant group differences in rehabilitation progress. Controls and device users, regardless of walking-aid experience, demonstrated nearly comparable mobility, strength, and balance improvements. More than half of each cohort (controls, n = 22; first-time, n = 17; long-term, n = 18) achieved functional gains in all three motor tests.The study showed that rollator assistance does not interfere with rehabilitation outcome and, to some extent, legitimates the prescription of assistive devices to improve confidence and restore or maintain motor ability at the highest possible level.

Which Factors Influence Functional Patients Improvements During Rehabilitation?

PubMed Central

Gabriele, Messina; Lorena, Rasimelli; Chiara, Bonavita; Emma, Ceriale; Cecilia, Quercioli; Nicola, Nante

2014-01-01

Background: Rehabilitation in patients with disabilities is an important aspect of tertiary prevention. Severity of disability, evaluated by global measures of autonomy, is essential for functional outcome evaluation. Aim: To determine the effectiveness of a rehabilitation programme in terms of percentage functional improvement (PFI); to verify the role of gender, age and length of stay (LOS), by motor and cognitive domains, on PFI. Design: Longitudinal study. Setting: An intensive rehabilitation hospital. Population: 305 inpatients. Methods: The disability has been investigated using the Functional Independence Measure (FIM). Percentage differences between discharge and admission were calculated for FIM score. Wilcoxon matched pair test for the six areas and the two domains of the FIM score were calculated. The effect of LOS, gender and age on PFI were studied with Robust regression. Results: Neurological and Orthopaedic patients had improvements on Motor and Cognitive domains. The greatest gains were in the Self Care, Sphintere Control, Transfer and Locomotion Areas (p=<0.001). LOS was associated (p<0.001) with PFI while age resulted borderline significant (p=0.049) in the cognitive domain in Neurological patients. Conclusion: The rehabilitation improved the overall conditions of neurological and orthopaedic patients. LOS emerged as the most important determinant in PFI. PMID:24762348

Shared care versus hospital-based cardiac rehabilitation: a cost-utility analysis based on a randomised controlled trial

PubMed Central

Dehbarez, Nasrin Tayyari; Refsgaard, Jens; Kanstrup, Helle; Johnsen, Søren P; Qvist, Ina; Christensen, Bo; Søgaard, Rikke; Christensen, Kent L

2018-01-01

Background Changes in the organisation of chronic healthcare, an increased awareness of costs and challenges of low adherence in cardiac rehabilitation (CR) call for the exploration of more flexible CR programmes as alternatives to hospital-based CR (H-CR). A model of shared care cardiac rehabilitation (SC-CR) that included general practitioners and the municipality was developed. The aim of this study was to analyse the cost utility of SC-CR versus H-CR. Methods The cost-utility analysis was based on a randomised controlled trial of 212 patients who were allocated to SC-CR or H-CR and followed up for 12 months. A societal cost perspective was applied that included the cost of intervention, informal time, healthcare and productivity loss. Costing was based on a microcosting approach for the intervention and on national administrative registries for the other cost categories. Quality-adjusted life years (QALYs) were based on the EuroQol 5-Dimensions measurements at baseline, after 4 months and after 12 months. Conventional cost-effectiveness methodology was employed to estimate the net benefit of SC-CR. Results The average cost of SC-CR was 165.5 kDKK and H-CR 163 kDKK. Productivity loss comprised 74.1kDKK and 65.9 kDKK. SC-CR cost was an additional 2.5 kDKK (95% CI −38.1 to 43.1) ≈ (0.33; −5.1 to 5.8 k€) and a QALY gain of 0.02 (95% CI −0.03 to 0.06). The probability that SC-CR would be cost-effective was 59% for a threshold value of willingness to pay of 300 kDKK (k€40.3). Conclusion CR after shared care model and H-CR are comparable and similar in socioeconomic terms. Trial registration number NCT01522001; Results. PMID:29531754

Rehabilitation of neglected Monteggia fracture: Dislocations in children.

PubMed

Yıldırım, Azad; Nas, Kemal

2017-11-06

There are limited studies related to the rehabilitation of neglected Monteggia fracture-dislocations. This study reports the results of the rehabilitation of neglected Monteggia fractures and dislocations and the best treatment options available. Thirteen children were rehabilitated between 2009 and 2012. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, time delay from symptom onset to fracture, Bado classification, Mayo Elbow Performance Index (MEPI) which includes pain, range of motion and daily life comfort, surgeries, length of hospitalization, location and pattern of fracture, length of follow-up and complications. The study group included thirteen children and adolescents; eleven males and two females with a mean age of 8.5 (range 2-15) years. According to the Bado classification, 11 patients had type 1, one had type 3 and one had type 4 fracture-dislocations. For Mayo Elbow Performance Index (MEPI) scales, patients that were less than ten years old had greater mean scores. Two patients had superficial infection, one had subluxation, one had osteoarthritis, one had delayed bone union and two had rigidity at the elbow. The goals of elbow rehabilitation following Neglected Monteggia cases include restoring function by restoring motion and muscle performance; influencing scar remodeling and preventing joint contracture; and restoring or maintaining joint stability. Patients aged younger than 10 years and intervals of less than one-year, between trauma and diagnosis, as well as early and effective rehabilitation were found as important parameters regarding favorable outcomes.

In-School Suspension Practices and the Prison Hospital Experience

ERIC Educational Resources Information Center

Wiles, David K.; Rockoff, Edward

1977-01-01

Explores the legal implications of in-school suspension practices through consideration of individual versus institutional rights within a special punitive-rehabilitative setting. Argues that the prison hospital model is applicable to in-school suspension programs and discusses a number of legal questions raised by the prison hospital model.…

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

PubMed Central

Li, Chao-jin-zi; Du, Xiao-xia; Yang, Kun; Song, Lu-ping; Li, Peng-kun; Wang, Qiang; Sun, Rong; Lin, Xiao-ling; Lu, Hong-yu; Zhang, Tong

2016-01-01

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small. PMID:28123417

Effect of Rehabilitation Intensity on Mortality Risk After Stroke.

PubMed

Hsieh, Cheng-Yang; Huang, Hsiu-Chen; Wu, Darren Philbert; Li, Chung-Yi; Chiu, Meng-Jun; Sung, Sheng-Feng

2018-06-01

To determine the relation between rehabilitation intensity and poststroke mortality. Retrospective cohort study. Nationwide claims data. From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled. The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions. Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates. Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63-.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84-1.06) compared with the low-intensity group. This association was not modified by stroke severity. Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Factors Influencing Institutional-Based Pediatric Rehabilitation Services among Caregivers of Children with Developmental Delay in Southwestern Rajasthan.

PubMed

Mishra, Kriti; Siddharth, V

2018-01-01

A limited number of caregivers of children with developmental delay access rehabilitation facilities in India. The study explored utilization of rehabilitation services at a tertiary care setup in southwestern Rajasthan and various factors influencing it. The aim of this study is to explore rehabilitation service utilization among children with developmental delay at a tertiary care setup and to ascertain factors that influence this pattern. This study was conducted at the department of physical medicine and rehabilitation at tertiary care setup. This was an observational study. Children with developmental delay who were advised institutional-based rehabilitation were identified over span of 1 year. Those who failed to return for rehabilitation after the first visit were interviewed telephonically. The interview had semi-structured open-ended questions about their reasons for inability to avail services. SPSS statistics 22 was used for descriptive analysis and correlation of variables. Of 230 children with developmental delay visiting department in 1-year duration, 48 took regular rehabilitation. Parents of 129 children with complete records were asked regarding discontinuation. Factors cited by majority were long distance from institute and service at hospital. Other reasons for discontinuation were related to belief system, family issues, time issues, socioeconomic factors, etc. Socioeconomic status was significantly associated with parental education (C = 0.488, P = 0.000) and financial issues. Location of family had significant association with long distance (C = 0.315, P = 0.000), parental education (C = 0.251, P = 0.003), and belief system (C = 0.265, P = 0.002). Distance from institute and quality of hospital service determined rehabilitation service use at a tertiary institute. Other factors such as socioeconomic status, family support, and social belief system must also be addressed while delivering institutional rehabilitation to children.

Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors: A randomized trial.

PubMed

Patsaki, Irini; Gerovasili, Vasiliki; Sidiras, Georgios; Karatzanos, Eleftherios; Mitsiou, Georgios; Papadopoulos, Emmanuel; Christakou, Anna; Routsi, Christina; Kotanidou, Anastasia; Nanas, Serafim

2017-08-01

Intensive Care Unit (ICU) survivors experience muscle weakness leading to restrictions in functional ability. Neuromuscular electrical stimulation (NMES) has been an alternative to exercise in critically ill patients. The aim of our study was to investigate its effects along with individualized rehabilitation on muscle strength of ICU survivors. Following ICU discharge, 128 patients (age: 53±16years) were randomly assigned to daily NMES sessions and individualized rehabilitation (NMES group) or to control group. Muscle strength was assessed by the Medical Research Council (MRC) score and hand grip at hospital discharge. Secondary outcomes were functional ability and hospital length of stay. MRC, handgrip, functional status and hospital length of stay did not differ at hospital discharge between groups (p>0.05). ΔMRC% one and two weeks after ICU discharge tended to be higher in NMES group, while it was significant higher in NMES group of patients with ICU-acquired weakness at two weeks (p=0.05). NMES and personalized physiotherapy in ICU survivors did not result in greater improvement of muscle strength and functional status at hospital discharge. However, in patients with ICU-aw NMES may be effective. The potential benefits of rehabilitation strategies should be explored in larger number of patients in future studies. www.Clinicaltrials.gov: NCT01717833. Copyright © 2017. Published by Elsevier Inc.

[Ten years of early complex geriatric rehabilitation therapy in the DRG system].

PubMed

Kolb, G; Breuninger, K; Gronemeyer, S; van den Heuvel, D; Lübke, N; Lüttje, D; Wittrich, A; Wolff, J

2014-01-01

Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients.

PubMed

Berger, Richard A; Sanders, Sheila A; Thill, Elizabeth S; Sporer, Scott M; Della Valle, Craig

2009-06-01

Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consecutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia and antiemetic therapy was implemented around a minimally invasive surgical technique. A rapid rehabilitation pathway was started immediately after surgery and patients had the option of being discharged to home the day of surgery if standard discharge criteria were met. All 150 patients were discharged to home the day of surgery, at which time 131 patients were able to walk without assistive devices. Thirty-eight patients required some additional intervention outside the pathway to resolve nausea, hypotension, or sedation prior to discharge. There were no readmissions for pain, nausea, or hypotension yet there was one readmission for fracture and nine emergency room evaluations in the three month perioperative period. This anesthetic and rehabilitation protocol allowed outpatient total hip arthroplasty to be routinely performed in these consecutive patients undergoing primary total hip arthroplasty. With current reimbursement approaches the modest savings to the hospital in length of stay may be outweighed by the additional costs of personnel, thereby making this outpatient system more expensive to implement. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Rehabilitation in the German statutory accident insurance. Guide to the new outpatient and inpatient structures].

PubMed

Simmel, S; Bühren, V

2015-02-01

The German statutory accident insurance (DGUV) has the statutory mandate to eliminate or to prevent an aggravation of the consequences of accidents by all appropriate means and is based on the principle of rehabilitation before pension. For this, special methods have been developed in recent decades, such as employer's mutual insurance inpatient further treatment (BGSW, Berufsgenossenschaftliche Stationäre Weiterbehandlung) and extended outpatient physiotherapy (EAP, Erweiterte Ambulante Physiotherapie). In 2012 the workplace-related musculoskeletal rehabilitation (ABMR, Arbeitsplatz-bezogene muskuloskelettale Rehabilitation) was added to these complex treatments. For complex injuries and delayed healing these methods approach their limits. The accident clinics of the Association of Clinics in Statutory Accident Insurance (KUV, Klinikverbund der gesetzlichen Unfallversicherung) provide a number of specialized rehabilitation measures in order to ensure an optimal seamless rehabilitation of the severely injured. In addition to complex inpatient rehabilitation (KSR, Komplexe Stationäre Rehabilitation) integrated special rehabilitation procedures, such as neurorehabilitation for severely traumatic brain injured patients and rehabilitation after spinal cord injury and other special rehabilitation methods, such as occupation-oriented rehabilitation (TOR, Tätigkeitsorientierte Rehabilitation) and pain rehabilitation, ensure that the German Society for Trauma Surgery (DGU) phase model of trauma rehabilitation is implemented. This provides an early start in the context of acute treatment as so-called early rehabilitation. After a specialized post-acute rehabilitation, additional therapeutic options are often required. An appropriate treatment of severely injured patients is important, for example through rehabilitation managers, which must not end with discharge from the rehabilitation hospital. The aim of all efforts is the reintegration into the working and social

[Challenges in geriatric rehabilitation: the development of an integrated care pathway].

PubMed

Everink, Irma Helga Johanna; van Haastregt, Jolanda C M; Kempen, Gertrudis I J M; Dielis, Leen M J; Maessen, José M C; Schols, Jos M G A

2015-04-01

Coordination and continuity of care within geriatric rehabilitation is challenging. To tackle these challenges, an integrated care pathway within geriatric rehabilitation care (hospital, geriatric rehabilitation and follow-up care in the home situation) has been developed. The aim of this article is to expound the process of developing the integrated care pathway, and to describe and discuss the results of this process (which is the integrated care pathway). Developing the integrated care pathway was done by the guidance of the first four steps of the theoretical framework for implementation of change from Grol and Wensing: (1) development of a specific proposal for change in practice; (2) analysis of current care practice; (3) analysis of the target group and setting; and (4) development and selection of interventions/strategies for change. The organizations involved in geriatric rehabilitation argued that the integrated care pathway should focus on improving the process of care, including transfer of patients, handovers and communication between care organizations. Current practice, barriers and incentives for change were analyzed through literature research, expert consultation, and interviews with the involved caregivers and by establishing working groups of health care professionals, patients and informal caregivers. This resulted in valuable proposals for improvement of the care process, which were gathered and combined in the integrated care pathway. The integrated care pathway entails agreements on (a) the triage process in the hospital; (b) active engagement of patients and informal caregivers in the care process; (c) timely and high quality handovers; and (d) improved communication between caregivers.

Barriers to participation in a phase II cardiac rehabilitation programme.

PubMed

Mak, Y M W; Chan, W K; Yue, C S S

2005-12-01

To identify barriers to participation in a phase II cardiac rehabilitation programme and measures that may enhance participation. Prospective study. Regional hospital, Hong Kong. Cardiac patients recruited for a phase I cardiac rehabilitation programme from July 2002 to January 2003. Reasons for not participating in a phase II cardiac rehabilitation programme. Of the 193 patients recruited for a phase I cardiac rehabilitation programme, 152 (79%) patients, with a mean age of 70.3 years (standard deviation, 11.9 years), did not proceed to phase II programme. Eleven (7%) deaths occurred before commencement of phase II and 74 (49%) patients were considered physically unfit. Reasons for the latter included fractures, pain, or degenerative changes in the lower limbs (24%), and co-morbidities such as cerebrovascular accident (19%), chronic renal failure (11%), congestive heart failure (9%), and unstable angina (8%). Phase II rehabilitation was postponed until after completion of scheduled cardiac interventions in 13% of patients. Failure of physicians to arrange the pre-phase II exercise stress test as per protocol was reported in 7% of patients. Other reasons were reported: work or time conflicts (16%), non-compliance with cardiac treatment (5%), financial constraints (4%), self-exercise (3%), fear after exercise stress testing (3%), and patients returning to their original cardiologists for treatment (3%). A significant (79%) proportion of patients did not proceed to a phase II cardiac rehabilitation programme for a variety of reasons. These included physical unfitness, work or time conflicts, and need to attend scheduled cardiac interventions. Further studies are required to determine how to overcome obstacles to cardiac rehabilitation.

Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial.

PubMed

Hill, Anne-Marie; McPhail, Steven M; Waldron, Nicholas; Etherton-Beer, Christopher; Ingram, Katharine; Flicker, Leon; Bulsara, Max; Haines, Terry P

2015-06-27

Falls are the most frequent adverse events that are reported in hospitals. We examined the effectiveness of individualised falls-prevention education for patients, supported by training and feedback for staff, delivered as a ward-level programme. Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge, cluster-randomised study, undertaken during a 50 week period. Units were randomly assigned to intervention or control groups by use of computer-generated, random allocation sequences. We included patients admitted to the unit during the study with a Mini-Mental State Examination (MMSE) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional, in addition to usual care. We provided information about patients' goals, feedback about the ward environment, and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients. The coprimary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers. All analyses were by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials registry, number ACTRN12612000877886). Between Jan 13, and Dec 27, 2013, 3606 patients were admitted to the eight units (n=1983 control period; n=1623 intervention period). There were fewer falls (n=196, 7·80/1000 patient-days vs n=380, 13·78/1000 patient-days, adjusted rate ratio 0·60 [robust 95% CI 0·42-0·94], p=0·003), injurious falls (n=66, 2·63/1000 patient-days vs 131, 4·75/1000 patient-days, 0·65 [robust 95% CI 0·42-0·88], p=0·006), and fallers (n=136 [8·38%] vs n=248 [12·51%] adjusted odds ratio 0·55 [robust 95% CI 0·38 to 0·81], p=0·003) in the intervention compared with the control group. There was no significant difference in length of stay (intervention median 11 days [IQR 7

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

PubMed Central

Sundh, Josefin; Lindgren, Helena; Hasselgren, Mikael; Montgomery, Scott; Janson, Christer; Ställberg, Björn; Lisspers, Karin

2017-01-01

Introduction Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Materials and methods Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. Results In primary care, nurse-based asthma/COPD clinics were common (87%), with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%). In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%), occupational therapists (3% vs 10%), nutritionists (5% vs 13%), and counselors (1% vs 4%). A higher COPD Assessment Test score and frequent exacerbations were associated with higher utilization of all rehabilitation professionals. Conclusion Pulmonary rehabilitation resources are available but underutilized, and receiving rehabilitation is more common in severe COPD. Treatment recommendations need to be better implemented, especially in mild and moderate COPD. PMID:28652722

Hydrocephalus during rehabilitation following severe TBI. Relation to recovery, outcome, and length of stay.

PubMed

Linnemann, Mia; Tibæk, Maiken; Kammersgaard, Lars Peter

2014-01-01

Post traumatic hydrocephalus (PTH) is a frequent complication during rehabilitation following severe TBI. However, the diagnosis of PTH is not straightforward and despite shunting recovery may be delayed. To study the influence of PTH on recovery and outcome during rehabilitation. We studied 417 patients with severe TBI admitted consecutively to a single hospital-based neurorehabilitation department serving Eastern Denmark between 2000 and 2010. Demographics (age and gender) and clinical characteristics (length of acute treatment, post traumatic amnesia (PTA), level of consciousness, injury severity (ISS), and admission FIM™), and PTH were related to recovery (discharge FIM™), outcome (GOS), and length of rehabilitation stay. Patients with PTH were older, brain injury more severe, and acute treatment was longer. At discharge they had more disability, longer rehabilitation stays, and unfavorable outcome. However, after adjusted multiple regression analyses PTH was not associated with disability at discharge or outcome. Instead, PTH was associated with longer stay for rehabilitation. Shunting for PTH does not affect recovery and outcome per se, but prolongs lengths of stay by almost 3 weeks. Therefore, patients treated for PTH are as likely to benefit from rehabilitation as patients without, but require longer rehabilitation stays.

Cancer rehabilitation in Austria--aspects of Physical Medicine and Rehabilitation.

PubMed

Maehr, Bruno; Keilani, Mohammad; Wiltschke, Christoph; Hassler, Marco; Licht, Thomas; Marosi, Christine; Huetterer, Elisabeth; Cenik, Fadime; Crevenna, Richard

2016-02-01

In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.

A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty.

PubMed

Cheville, A; Chen, A; Oster, G; McGarry, L; Narcessian, E

2001-04-01

Reliance on "as-needed" analgesia following total knee arthroplasty may lead to inadequate control of pain and delayed recovery of function. Preemptive use of controlled-release opioids may improve pain control, accelerate recovery, and reduce the need for inpatient rehabilitative services. This study was designed to determine whether controlled-release opioids enhance post-arthroplasty pain control and facilitate functional recovery during rehabilitation. Fifty-nine patients admitted for inpatient rehabilitation following unilateral total knee arthroplasty were randomized to receive OxyContin (controlled-release oxycodone) (twenty-nine patients) or a placebo (thirty patients) every twelve hours. Both groups could receive on-request, immediate-release oxycodone (5 mg every four hours). The dose of study medication was increased on the basis of the frequency of requests for immediate-release oxycodone. Measures of interest included pain ratings as determined with a visual-analog scale, changes in the range of motion of the knee and quadriceps strength, and improvements in selected Functional Independence Measure scores during the first eight physical therapy sessions. The duration of the hospital stay for rehabilitation also was compared between the two groups. Baseline demographic, clinical, and functional characteristics were similar between the OxyContin and placebo groups. Compared with the placebo group, the patients who received OxyContin reported significantly less pain as well as significantly greater range of motion of the knee (passive motion, p = 0.036; active motion, p< 0.001) and quadriceps strength (p = 0.001) by the eighth physical therapy session. The patients who received OxyContin also were discharged from the rehabilitation hospital at an average of 2.3 days earlier than the patients in the placebo group (p = 0.013). Preemptive use of controlled-release oxycodone during rehabilitation following total knee arthroplasty leads to improved pain

A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit.

PubMed

Caruana, Erin L; Kuys, Suzanne S; Clarke, Jane; Bauer, Sandra G

2017-08-01

This study determined the impact of a pragmatic 6-day physiotherapy service on length of stay, functional independence, gait and balance in people undergoing inpatient rehabilitation, compared to a 5-day service. A prospective cohort study with historical comparison was undertaken in a mixed inpatient rehabilitation unit. Intervention period participants (2011) meeting inclusion criteria were eligible for a 6-day physiotherapy service. All other participants, including the historical cohort (2010) received usual care (5-day physiotherapy). Length of stay, functional independence, gait and balance performance were measured. A total of 536 individuals participated in this study; 270 in 2011 (60% received 6-day physiotherapy) and 266 in 2010. Participants in 2011 showed a trend for reduced length of stay (1.7 days, 95%CI -0.53 to 3.92) compared to 2010. Other measures showed no significant differences between cohorts. In 2011, those receiving 6-day physiotherapy were more dependent, but showed significantly improved functional independence and balance compared to those receiving 5-day physiotherapy (p < 0.040) without impacting length of stay. Implementing a 6-day physiotherapy service in a "real-world" rehabilitation setting demonstrated a trend towards reduced length of stay, and improved functional gains. This service could lead to cost-savings for hospitals and improved patient flow. Implications for Rehabilitation "Real-world" implementation of a 6-day physiotherapy service in rehabilitation shows a trend for reducing length of stay. This reduction in length of stay may lead to cost-savings for the hospital system, and improve patient flow into rehabilitation. Patients receiving 6-day physiotherapy made significant gains in balance and functional independence compared to patients receiving 5-day physiotherapy services in the rehabilitation setting.

Impact of vocational rehabilitation on social functioning, cognitive functioning, and psychopathology in patients with chronic schizophrenia

PubMed Central

Suresh Kumar, P. N.

2008-01-01

Aim: To assess the impact of vocational rehabilitation on psychopathology, social functioning and cognitive functioning in schizophrenia Materials and Methods: 34 patients with DSM IV diagnosis of chronic schizophrenia were compared 40 patients with same diagnosis but not attending vocational rehabilitation using PANSS, SCARF social functioning Index and MMSE. Results and Discussion: Basic psycho-socio-demographic data were comparable in both groups except more hospitalization in the no rehabilitation group. Comparison of social functioning, cognitive functioning and psychopathology showed significant improvement in rehabilitated patients. Cognitive functioning had positive correlation with occupational role in the rehabilitated group and negative correlation in the rehabilitated group. Social functioning had negative correlation with positive and negative symptoms, general psychopathology and total PANSS score and cognitive symptoms in patients without rehabilitation. Conclusion: The present concludes that there is a definite limitation in the domains of social functioning, cognitive functioning and psychopathology in chronic schizophrenia patients who had no rehabilitation. However vocational rehabilitation significantly improves these limitations, which in turn help these patients to integrate into the society so as to function efficiently in their roles as parents, home makers and social beings. PMID:19823610

Rehabilitation and future participation of youth following spinal cord injury: caregiver perspectives.

PubMed

House, L A; Russell, H F; Kelly, E H; Gerson, A; Vogel, L C

2009-12-01

Cross-sectional survey. To examine caregivers' perspectives on the effectiveness of rehabilitative support experienced by youth with spinal cord injury (SCI) during acute rehabilitation and after community reintegration in terms of their community participation. Data collection took place at the three Shriners SCI hospitals: Chicago, Philadelphia, and Northern California. A total of 132 primary caregivers of youth with SCI completed a survey on what their child had experienced during and after rehabilitation to enhance their community participation. Caregivers found technical support from staff (41%), motivation and encouragement from staff (25%), and education (17%) to be the most important factors during rehabilitation for encouraging their child's future participation in school or community activities. Caregivers found involvement in activities (30%), personal resilience (22%) and interactions with others with disabilities (13%) to be important experiences since rehabilitation in terms of their child's participation in school and community activities. Caregivers who responded that something they experienced during rehabilitation was helpful to participation had children who had been injured longer and who were older at time of injury. In addition, caregivers who reported that something they have experienced since their child's rehabilitation has been helpful in terms of participation also had children who were older at time of injury. Findings from this study can be used to help professionals tailor rehabilitation programs to better meet the needs of youth with SCI and their families, thereby increasing chances of successful reintegration back into their communities.

Enhancing Rehabilitation through Mutual Aid: Outreach to People with Recent Amputations.

ERIC Educational Resources Information Center

Wells, Lilian M.; And Others

1993-01-01

Describes outreach service in rehabilitation hospital through which volunteers with previous amputations visited patients with recent amputations, acting as role models and offering emotional support and information. Notes that patients who were visited had strong positive responses to the program, and identified critical components of the…

[Investigation of burn rehabilitation development of China in 2014].

PubMed

Ao, M; Wu, J; Chen, J

2017-05-20

treatment of 35 burn treatment units, the common problems were reflected in the authorized strength and professional technology level of rehabilitation treatment relating personnel, and the area and equipment for rehabilitation. There were also many problems in cooperation between burn surgeons and rehabilitation therapists and fund. The supports from hospital and department leaders were good. Conclusions: Through the development of several years, the general condition and the development of rehabilitation treatment of burn treatment units in China are improved; the beginning time of burn rehabilitation treatment is advanced; the number of rehabilitation treatment personnel is increased with their speciality improved; the burn rehabilitation work get great support from hospitals and departments.

Factors that predict acute hospitalization discharge disposition for adults with moderate to severe traumatic brain injury.

PubMed

Cuthbert, Jeffrey P; Corrigan, John D; Harrison-Felix, Cynthia; Coronado, Victor; Dijkers, Marcel P; Heinemann, Allen W; Whiteneck, Gale G

2011-05-01

To identify factors predicting acute hospital discharge disposition after moderate to severe traumatic brain injury (TBI). Secondary analysis of existing datasets. Acute care hospitals. Adults hospitalized with moderate to severe TBI included in 3 large sets of archival data: (1) Centers for Disease Control and Prevention Central Nervous System Injury Surveillance database (n=15,646); (2) the National Trauma Data Bank (n=52,012); and (3) the National Study on the Costs and Outcomes of Trauma (n=1286). None. Discharge disposition from acute hospitalization to 1 of 3 postacute settings: (1) home, (2) inpatient rehabilitation, or (3) subacute settings, including nursing homes and similar facilities. The Glasgow Coma Scale (GCS) score and length of acute hospital length of stay (LOS) accounted for 35% to 44% of the variance in discharges to home versus not home, while age and sex added from 5% to 8%, and race/ethnicity and hospitalization payment source added another 2% to 5%. When predicting discharge to rehabilitation versus subacute care for those not going home, GCS and LOS accounted for 2% to 4% of the variance, while age and sex added 7% to 31%, and race/ethnicity and payment source added 4% to 5%. Across the datasets, longer LOS, older age, and white race increased the likelihood of not being discharged home; the most consistent predictor of discharge to rehabilitation was younger age. The decision to discharge to home a person with moderate to severe TBI appears to be based primarily on severity-related factors. In contrast, the decision to discharge to rehabilitation rather than to subacute care appears to reflect sociobiologic and socioeconomic factors; however, generalizability of these results is limited by the restricted range of potentially important variables available for analysis. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Early rehabilitation outcome in patients with middle cerebral artery stroke.

PubMed

Balaban, Birol; Tok, Fatih; Yavuz, Ferdi; Yaşar, Evren; Alaca, Rıdvan

2011-07-12

Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation (P<0.05). Age was negatively correlated with both BI and FIM scores at admission and discharge. Length of stay was not correlated with improvement in BI or FIM scores during hospitalization. The patients that had ≤1 month of inpatient rehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation (P>0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Occupational rehabilitation in Hong Kong: current status and future needs.

PubMed

Kwok, H K H; Szeto, G P Y; Cheng, A S K; Siu, H; Chan, C C H

2011-03-01

development of the Occupational Medicine subspecialty in the public hospital system in Hong Kong is considered a facilitator to the future development of occupational rehabilitation in Hong Kong.

Intensive rehabilitative approach to eosinophilia myalgia syndrome associated with severe polyneuropathy.

PubMed

Draznin, E; Rosenberg, N L

1993-07-01

We report a case of the eosinophilia myalgia syndrome (EMS) with incapacitating myalgias, weakness secondary to a severe polyneuropathy, and contractures in all four extremities requiring aggressive rehabilitation treatment. A 55-year-old woman was admitted to a rehabilitation hospital 11 months after the onset of EMS. At that time, she had severe weakness secondary to peripheral neuropathy and painful contractures in all extremities and required high doses of narcotics for pain control. A continuous passive range of motion machine was used in order to maintain range of motion obtained during active exercise therapy. The patient showed functional improvement in basic mobility and ADL skills. She was withdrawn from narcotics and successfully learned pain management techniques. An aggressive rehabilitation approach in the treatment of EMS associated with peripheral neuropathy may improve functional outcome even when instituted late in the clinical course.

What factors determine therapists' acceptance of new technologies for rehabilitation – a study using the Unified Theory of Acceptance and Use of Technology (UTAUT).

PubMed

Liu, Lili; Miguel Cruz, Antonio; Rios Rincon, Adriana; Buttar, Vickie; Ranson, Quentin; Goertzen, Darrell

2015-01-01

The aim of this study was to examine what factors affect the acceptance behavior and use of new technologies for rehabilitation by therapists at a large rehabilitation hospital in Canada. A self-administrated paper-based survey was created by adapting scales with high levels of internal consistency in prior research using the Unified Theory of Acceptance and Use of Technology (UTAUT). Items were scored on a 7-point Likert scale, ranging from "strongly disagree (1)" to "strongly agree (7)". The target population was all occupational therapists (OT) and physical therapists (PT) involved with the provision of therapeutic interventions at the hospital. Our research model was tested using partial least squares (PLS) technique. Performance expectancy was the strongest salient construct for behavioral intention to use new technologies in rehabilitation, whereas neither effort expectancy nor social influence were salient constructs for behavioral intention to use new technologies; (4) facilitating condition and behavioral intention to use new technologies were salient constructs for current use of new technologies in rehabilitation, with facilitating condition the strongest salient for current use of new technologies in rehabilitation. In a large rehabilitation hospital where use of new technologies in rehabilitation is not mandatory, performance expectancy, or how the technology can help in therapists' work, was the most important factor in determining therapists' acceptance and use of technologies. However, effort expectancy and social influence constructs were not important, i.e. therapists were not influenced by the degree of difficulty or social pressures to use technologies. Behavioral intention and facilitating condition, or institutional support, are related to current use of new technologies in rehabilitation.

Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study.

PubMed

Alavi, Mousa; Irajpour, Alireza; Giles, Tracey; Rabiei, Katayoun; Sarrafzadegan, Nizal

2013-06-01

Cardiac rehabilitation programmes that include patient education aim to maximise physical, psychological and social functioning, and enable people with acute coronary syndrome to lead fulfilling and productive lives. Despite strong evidence for the benefits of patient education, various barriers exist that need to be addressed to ensure the effective delivery of care. This study explores patients/family members and health professionals' perceptions and experiences of the barriers to cardiac rehabilitation education in an Iranian context. A thematic analysis of in-depth interviews was undertaken using a constant comparative approach. Participants (10 health professionals, 15 patients/family members) were recruited from educational-medical centers and hospitals in Iran. Credibility and trustworthiness were grounded on four aspects: factual value, applicability, consistency and neutrality. Five major barriers to cardiac rehabilitation were identified relating to human resources, service provision, available educational services, unfavourable attitudes and collaboration gaps. Two main challenges exist to the provision of effective patient education; inadequate human resources in the hospital wards, specifically in terms of trained health care professionals and service users specific health related views and behaviours. Barriers to comprehensive patient education and cardiac rehabilitation in Iran must be addressed and urgent consideration should be given to the introduction and evaluation of education programmes to prepare health/support system professionals as well as service users, and cardiac rehabilitation services that employ a collaborative and individualised approach. This in turn may reduce the burden of CVD and improve the overall health and quality of life for people in Isfahan Iran.

Recruitment and Retention Challenges in a Technology-Based Study with Older Adults Discharged from a Geriatric Rehabilitation Unit.

PubMed

McCloskey, Rose; Jarrett, Pamela; Stewart, Connie; Keeping-Burke, Lisa

2015-01-01

Technology has the potential to offer support to older adults after being discharged from geriatric rehabilitation. This article highlights recruitment and retention challenges in a study examining an interactive voice response telephone system designed to monitor and support older adults and their informal caregivers following discharge from a geriatric rehabilitation unit. A prospective longitudinal study was planned to examine the feasibility of an interactive voice telephone system in facilitating the transition from rehabilitation to home for older adults and their family caregivers. Patient participants were required to make daily calls into the system. Using standardized instruments, data was to be collected at baseline and during home visits. Older adults and their caregivers may not be willing to learn how to use new technology at the time of hospital discharge. Poor recruitment and retention rates prevented analysis of findings. The importance of recruitment and retention in any study should never be underestimated. Target users of any intervention need to be included in both the design of the intervention and the study examining its benefit. Identifying the issues associated with introducing technology with a group of older rehabilitation patients should assist others who are interested in exploring the role of technology in facilitating hospital discharge. © 2014 Association of Rehabilitation Nurses.

Rehabilitation of patients with thoracic spine injury treated by spring alloplasty.

PubMed

Kiwerski, J

1983-12-01

Stabilization of the traumatic injured spine by means of springs, called spring alloplasty, was introduced into clinical practice by Professor M. Weiss in 1965 and has been applied in the Warsaw Medical Academy Rehabilitation Clinic ( Konstancin ) ever since. The springs here replace the damaged system of posterior ligaments of the spine, restoring its stability and alleviating the front (often damaged) part of the body. This method has been used in surgery on about 350 patients mainly with spinal injury in the thoracic and thoracolumbar levels. Spine stabilization by the method in question usually makes it possible to start an early verticalization and an active rehabilitation. The verticalization of the patient in a specially designed bed is introduced as early as a few days after the accident, and attempts at active verticalization are made in 2-3 weeks time after surgery, thus the rehabilitation process is substantially precipitated and the period of hospital treatment is significantly reduced. The methodology of rehabilitation of the patients in question has been presented and functional effects of the treatment have been discussed in the paper.

Change in inpatient rehabilitation admissions for individuals with traumatic brain injury after implementation of the Medicare inpatient rehabilitation facility prospective payment system.

PubMed

Hoffman, Jeanne M; Donoso Brown, Elena; Chan, Leighton; Dikmen, Sureyya; Temkin, Nancy; Bell, Kathleen R

2012-08-01

To evaluate the impact of Medicare's inpatient rehabilitation facility (IRF) prospective payment system (PPS) on use of inpatient rehabilitation for individuals with traumatic brain injury (TBI). Retrospective cohort study of patients with TBI. One hundred twenty-three level I and II trauma centers across the U.S. who contributed data to the National Trauma Data Bank. Patients (N=135,842) with TBI and an Abbreviated Injury Score of the head of 2 or greater admitted to trauma centers between 1995 and 2004. None. Discharge location: IRF, skilled nursing facility, home, and other hospitals. Compared with inpatient rehabilitation admissions before IRF PPS came into effect, demographic characteristics of admitted patients changed. Those admitted to acute care trauma centers after PPS was enacted (January 2002) were older and nonwhite. No differences were found in rates of injury between men and women. Over time, there was a significant drop in the percent of patients being discharged to inpatient rehabilitation, which varied by region, but was found across all insurance types. In a logistic regression, after controlling for patient characteristics (age, sex, race), injury characteristics (cause, severity), insurance type, and facility, the odds of being discharged to an IRF after a TBI decreased 16% after Medicare's IRF PPS system was enacted. The enactment of the Medicare PPS appears to be associated with a reduction in the chance that patients receive inpatient rehabilitation treatment after a TBI. The impact of these changes on the cost, quality of care, and patient outcome is unknown and should be addressed in future studies. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after stroke.

PubMed

Goljar, Nika; Globokar, Daniel; Puzić, Nataša; Kopitar, Natalija; Vrabič, Maja; Ivanovski, Matic; Vidmar, Gaj

2016-09-01

To evaluate effectiveness of fall-risk-assessment-based fall prevention for stroke rehabilitation inpatients. A consecutive series of 232 patients admitted for the first time to a subacute stroke-rehabilitation ward during 2010-2011 was studied in detail. The Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI by Nakagawa et al.) was used to assess fall-risk upon admission. Association of ASFPSI score and patient characteristics with actual falls was statistically tested. Yearly incidence of falls per 1000 hospital days (HD) was retrospectively audited for the 2006-2014 period to evaluate effectiveness of fall-risk reduction measures. The observed incidence of falls over the detailed-study-period was 3.0/1000 HD; 39% of the fallers fell during the first week after admission. ASFPSI score was not significantly associated with falls. Longer hospital stay, left body-side affected and non-extreme FIM score (55-101) were associated with higher odds of fall. Introduction of fall-risk reduction measures followed by compulsory fall-risk assessment lead to incidence of falls dropping from 7.1/1000 HD in 2006 to 2.8/1000 HD in 2011 and remaining at that level until 2014. The fall-risk-assessment-based measures appear to have led to decreasing falls risk among post-stroke rehabilitation inpatients classified as being at high risk of falls. The fall prevention programme as a whole was successful. Patients with non-extreme level of functional independence should receive enhanced fall prevention. Implications for Rehabilitation Recognising the fall risk upon the patient's admission is essential for preventing falls in rehabilitation wards. Assessing the fall risk is a team tasks and combines information from various sources. Assessing fall risk in stroke patients using the assessment sheet by Nakagawa et al. immediately upon admission systematically draws attention to the risk of falls in each individual patient.

Effectiveness of the second-stage rehabilitation in stroke patients with cognitive impairment.

PubMed

Milinavičienė, Eglė; Rastenytė, Daiva; Kriščiūnas, Aleksandras

2011-01-01

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status. During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no

Systematic review of multidisciplinary rehabilitation in patients with multiple trauma.

PubMed

Khan, F; Amatya, B; Hoffman, K

2012-01-01

Multiple trauma is a cause of significant disability in adults of working age. Despite the implementation of trauma systems for improved coordination and organization of care, rehabilitation services are not yet routinely considered integral to trauma care processes. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Physiotherapy Evidence Database, Latin American and Caribbean Literature on Health Sciences and Cochrane Library databases were searched up to May 2011 for randomized clinical trials, as well as observational studies, reporting outcomes of injured patients following multidisciplinary rehabilitation that addressed functional restoration and societal reintegration based on the International Classification of Functioning, Disability and Health. No randomized and/or controlled clinical trials were identified. Fifteen observational studies involving 2386 participants with injuries were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach assessed methodological quality as 'poor' in all studies, with selection and observer bias. Although patients with low functional scores showed improvement after rehabilitation, they were unable to resume their pretrauma level of activity. Their functional ability was significantly associated with motor independence on admission and early acute rehabilitation, which contributed to a shorter hospital stay. Injury location, age, co-morbidity and education predicted long-term functional consequences. Trauma care systems were associated with reduced mortality. The gaps in evidence include: rehabilitation settings, components, intensity, duration and types of therapy, and long-term outcomes for survivors of multiple trauma. Rehabilitation is an expensive resource and the evidence to support its justification is needed urgently. The issues in study design and research methodology in rehabilitation are challenging. Opportunities

Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD: A 5-year study.

PubMed

Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin

2016-10-01

Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022).Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation.

Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions.

PubMed

Jankowska, Agnieszka M; Klimkiewicz, Robert; Kubsik, Anna; Klimkiewicz, Paulina; Śmigielski, Janusz; Woldańska-Okońska, Marta

2017-08-01

Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning. The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke. Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT). Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke. Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

PubMed

Wei, Hongying; Sun, Dongxiu; Liu, Meiping

2017-12-01

Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Frequency and Reasons for Return to Acute Care in Leukemia Patients Undergoing Inpatient Rehabilitation

PubMed Central

Fu, Jack Brian; Lee, Jay; Smith, Dennis W.; Bruera, Eduardo

2012-01-01

Objective To assess the frequency and reasons for return to the primary acute care service among leukemia patients undergoing inpatient rehabilitation. Design Retrospective study of all patients with leukemia, myelodysplastic syndrome, aplastic anemia, or myelofibrosis admitted to inpatient rehabilitation at a tertiary referral-based cancer center between January 1, 2005, and April 10, 2012. Items analyzed from patient records included return to the primary acute care service with demographic information, leukemia characteristics, medications, hospital admission characteristics, and laboratory values. Results 225 patients were admitted a total of 255 times. 93/255 (37%) of leukemia inpatient rehabilitation admissions returned to the primary acute care service. 18/93 (19%) and 42/93 (45%) of these patients died in the hospital and were discharged home respectively. Statistically significant factors (p<.05) associated with return to the primary acute care service include peripheral blast percentage and the presence of an antifungal agent on the day of inpatient rehabilitation transfer. Using an additional two factors (platelet count and the presence of an antiviral agent both with a p<.11), a Return To Primary (RTP) - Leukemia index was formulated. Conclusions Leukemia patients with the presence of circulating peripheral blasts and/or antifungal agent may be at increased risk of return to the primary acute care service. The RTP-Leukemia index should be tested in prospective studies to determine its usefulness. PMID:23117267

77 FR 37022 - Disability and Rehabilitation Research Projects and Centers Program; Rehabilitation Engineering...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-20

...; Rehabilitation Engineering Research Centers AGENCY: Office of Special Education and Rehabilitative Services... Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers (RERC). SUMMARY... amended (Rehabilitation Act). Rehabilitation Engineering Research Centers Program (RERCs) The purpose of...

Impact of Early Inpatient Rehabilitation on Adult Burn Survivors' Functional Outcomes and Resource Utilization.

PubMed

Gomez, Manuel; Tushinski, Morris; Jeschke, Marc G

On July 2012, a rehabilitation hospital merged with a trauma center where the regional burn center is located. That rehabilitation center provides the only burn rehabilitation program in our region. The objective of this study was to determine if earlier initiation of inpatient rehabilitation after merger had an effect on burn survivors' functional outcomes and resource utilization. A retrospective review of electronic data of burn survivors' functional outcomes (functional independence measure [FIM] ratings on admission, at discharge, and percent change), and resource utilization (waiting time for rehab, burn center length of stay [LOS], rehab LOS, physiotherapy and occupational therapy rehabilitation workload [RehabWorkload], and discharge destination) was undertaken. Adult burn survivors who required inpatient rehabilitation and were transferred from the burn center to the inpatient rehabilitation service before the merger (July 2010-June 2012) were compared with those transferred after the merger (July 2012-June 2014). One hundred thirty-eight burn survivors were transferred from the burn center to the inpatient rehabilitation service during the study period. Sixty (43.5%) were transferred before and 78 (56.5%) were transferred after the merger. There were 97 (70.3%) men and 41 (29.7%) women with a mean age of 47.9 ± 17.9 years. TBSA burn was 24.2 ± 16.9%, and full thickness burn was 13.1 ± 16.4%. The etiology of these burns were flame (72.5%), scald (19.6%), electrical (5.1%), chemical (2.2%), and contact (0.7%). Patients in both groups had similar age, inhalation injury, TBSA, full thickness burn, FIM ratings, RehabWorkload, and burn etiology. Patients transferred before the merger had significantly more chemical burns (5% vs 0%, P = .046), and more work-related burns (26.7% vs 7.7%, P = .004). Patients transferred after the merger had significantly shorter burn center LOS (28.5 ± 20.9 days vs 38.8 ± 34.2 days, P = .043), and shorter

[Multidrug-Resistant Organisms (MDRO) in Rehabilitation Clinics in the Rhine-Main District, Germany, 2014: Risk Analysis and Hygiene Procedures].

PubMed

Heudorf, U; Färber, D; Mischler, D; Schade, M; Zinn, C; Nillius, D; Herrmann, M

2015-12-01

Many regional German MDRO-networks aim to improve the medical rehabilitation of patients with methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant pathogens. In 2014, the German Commission for Hospital Hygiene and Infection Control (KRINKO) released revised recommendations for the care of patients with MRSA. In particular, for rehabilitation facilities, these recommendations stipulated a medical risk analysis to establish necessary hygiene measures, and provide specific recommendations. Based on a large investigation carried out in 21 rehabilitation facilities covering different medical specialties, medical risk analyses according to KRINKO were performed, and the findings evaluated separately for orthopedic, cardiologic, oncologic, neurologic, or geriatric facilities, as well as for all institutions taken together. The overall colonization pressure, i. e. the point prevalence of MRSA and extended spectrum beta-lactamase-producing gram-negative pathogens (ESBL) among hospitalized rehabilitation patients was found to be 0.7% and 7.7%, respectively. Impairment of the intact skin (an established risk factor for persisting MRSA colonization and MRSA infection) was found in 7% of the patients, impaired mobility requiring enhanced level of care in 4.1%, and mental confusion and/or incontinence (potentially impairing the application of hygiene measures) in 11% of patients. Compared to the total study population, there was an increase in all risk factors in geriatric and neurologic rehabilitation patients: skin barrier breaches (in neurologic and in geriatric patients: 18.3 and 19.2%, respectively), impaired mobility (32.7 and 37.0%, respectively), and mental confusion/incontinence (24.5 and 28.0%, respectively). In addition, geriatric patients demonstrated an increased overall prevalence of multidrug-resistant organisms (MRSA: 9.4%; ESBL: 22.7%). Risk analysis according to KRINKO showed that in rehabilitation facilities with internal medicine

The innovative rehabilitation team: an experiment in team building.

PubMed

Halstead, L S; Rintala, D H; Kanellos, M; Griffin, B; Higgins, L; Rheinecker, S; Whiteside, W; Healy, J E

1986-06-01

This article describes an effort by one rehabilitation team to create innovative approaches to team care in a medical rehabilitation hospital. The major arena for implementing change was the weekly patient rounds. We worked to increase patient involvement, developed a rounds coordinator role, used a structured format, and tried to integrate research findings into team decision making. Other innovations included use of a preadmission questionnaire, a discharge check list, and a rounds evaluation questionnaire. The impact of these changes was evaluated using the Group Environment Scale and by analyzing participation in rounds based on verbatim transcripts obtained prior to and 20 months after formation of the Innovative Rehabilitation Team (IRT). The results showed decreased participation by medical personnel during rounds, and increased participation by patients. The rounds coordinator role increased participation rates of staff from all disciplines and the group environment improved within the IRT. These data are compared with similar evaluations made of two other groups, which served as control teams. The problems inherent in making effective, lasting changes in interdisciplinary rehabilitation teams are reviewed, and a plea is made for other teams to explore additional ways to use the collective creativity and resources latent in the team membership.

Effects of obesity on rehabilitation outcomes after orthopedic trauma.

PubMed

Vincent, Heather K; Seay, Amanda N; Vincent, Kevin R; Atchison, James W; Sadasivan, Kalia

2012-12-01

This study examined whether differences existed in inpatient rehabilitation outcomes and therapy participation in nonobese and obese patients with orthopedic trauma. This was a retrospective study of 294 consecutive patients admitted to an inpatient rehabilitation hospital. Main outcomes included participation in therapy sessions, Functional Independence Measure (FIM) ratings, walking distance and stair climb, length of stay, FIM efficiency (FIM score gain/length of stay), and discharge to home. Data were stratified by patient body mass index values (nonobese, <30 kg/m; or obese, ≥30 kg/m). There were no differences in therapy participation or length of stay between groups. Both total and motor FIM ratings at discharge were lower in obese patients compared with nonobese patients (P < 0.05). FIM efficiency was significantly lower in the obese than in the nonobese group (2.6 ± 1.5 vs. 3.1 ± 1.5 points gained per day; P = 0.05). Walking distance and stair climb ability were similar between groups by discharge. Even morbidly obese patients attained some improvement with independence in walking. Obese patients make significant functional improvement during rehabilitation, but at a lesser magnitude and rate as their nonobese counterparts. Even with morbid obesity, small but important functional gains can occur during rehabilitation for orthopedic trauma.

Advances in upper limb stroke rehabilitation: a technology push.

PubMed

Loureiro, Rui C V; Harwin, William S; Nagai, Kiyoshi; Johnson, Michelle

2011-10-01

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

[Costs of hospitalisation for exacerbations of COPD in patients receiving domiciliary rehabilitation].

PubMed

Romain, D; Bernady, A; Etchamendy, E; Barokas, T; Pignede, P

2011-09-01

The aim of this study was to estimate the costs related to hospitalisation for exacerbations of COPD in patients who received domiciliary rehabilitation. The hospital costs (obtained from the health insurance office of Bayonne) of 31 patients suffering from COPD of all stages, were analysed for the year of rehabilitation and for the preceding year. All the patients had access to the same management programme in a health care system: domiciliary bicycle ergometry, collective gymnastics, dietary advice, psychological support and education. The analysis of the costs of respiratory care revealed two populations: a minority in whom costs were increased (two end of life situations requiring palliative care and two severe episodes requiring intensive care), and a majority in whom domiciliary rehabilitation led to a reduction of over 60% in the costs related to hospitalisation. Respiratory rehabilitation reduces the costs of hospitalisation secondary to exacerbations in patients suffering from COPD but does not reduce the high costs related to severe episodes of respiratory failure or terminal care. It is important that rehabilitation is adapted to the needs of each patient until the end of his life. Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.

[Interdisciplinary cooperation in rehabilitation--problem solving following severe craniocerebral injury].

PubMed

Hackspacher, J; Dern, W; Jeschke, H A

1991-05-01

Therapy and rehabilitation of patients with craniocerebral trauma is particularly difficult to programme on account of the neuropsychological defects and personality changes found in this population. The Ulm rehabilitation hospital seeks to face up to this fact by intense interdisciplinary cooperation in the nursing and medical sector, the fields of logopaedics, Occupational Therapy, physiotherapy, immediate post-acute therapy including cerebral training, as well as the entire field of vocational rehabilitation. A dense time schedule has been established for graded introduction of the necessary therapeutic interventions in the sense of a therapy chain, with intense information flows among the therapists involved, thus ensuring a continuous process and joint adjustment of programming to the individual course, to new problems that may arise. The implementation of this concept is set out on the example of a young patient with craniocerebral injury, who had received treatment in various of our departments for a total of 12 months, finally bringing him up to the conclusion of his vocational education.

Rehabilitation Engineering Sourcebook [and] Rehabilitation Engineering Sourcebook Supplement I.

ERIC Educational Resources Information Center

Institute for Information Studies, Falls Church, VA.

Intended for use by rehabilitation counselors and work supervisors, the sourcebook contains 173 problems and solutions provided by rehabilitation engineering. A section titled "Guidelines for Formulating Problem Statements" is intended to summarize the most effective ways for either disabled individuals or rehabilitation practitioners to…

Identification of rehabilitation needs after a stroke: an exploratory study

PubMed Central

Talbot, Lise R; Viscogliosi, Chantal; Desrosiers, Johanne; Vincent, Claude; Rousseau, Jacqueline; Robichaud, Line

2004-01-01

Background Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community. Methods The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results. Results Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation. Conclusion Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations. PMID:15383147

Identification of rehabilitation needs after a stroke: an exploratory study.

PubMed

Talbot, Lise R; Viscogliosi, Chantal; Desrosiers, Johanne; Vincent, Claude; Rousseau, Jacqueline; Robichaud, Line

2004-09-21

Services to meet adequate rehabilitation needs of elderly stroke survivors are not always provided. Indeed, since 1995, in the wake of the Quebec shift to ambulatory care, home care services, mainly those related to rehabilitation of the elderly, are either unavailable or incomplete. The aim of this study was to examine the rehabilitation needs of this clientele from their hospitalization to their reintegration into the community. The "Handicap Production Process" conceptual approach was chosen to help identify the rehabilitation needs of persons affected by physical or cognitive disabilities due to the interactions between personal and environmental factors, and (activities of daily living, social roles). This qualitative exploratory study was performed in 2003. Data were collected among four groups of experts: patients, caregivers, health care providers and administrators. Data triangulation was used to ensure a rigorous analysis and validity of the results. Unfulfilled needs could be found in the categories of pertaining to residence, community living, psychological and emotional needs. Indeed, it appears that a psychological follow-up to discuss acceptance and consequences of non-acceptance would facilitate mid-to long-term rehabilitation. Improving accessibility to healthcare services, respecting priority parking spaces for the disabled as well as promoting public awareness would enable a better social reintegration and recovery of social roles, thus limiting the onset of handicap situations.

'Real-time' burden of community and healthcare-related infections in medical and rehabilitation patients in a public hospital in Auckland, New Zealand.

PubMed

Read, Kerry; Bhally, Hansan; Sapsford, Sabrina; Sapsford, Thomas

2015-12-04

To determine the prevalence and spectrum of infections on admission, or acquired during hospitalisation (HAI) at Waitakere Hospital, Auckland. A questionnaire was completed on two separate days for all adult in-patients admitted to medical and rehabilitation wards for greater than 24 hours. Information obtained included patient characteristics, the presence and type of infection on admission or acquired during hospitalisation, as well as information on indwelling devices. Infection was the admitting diagnosis in 81 (41%) of 195 patients reviewed, with lower respiratory tract infection (LRTI) diagnosed in 50%, urine infections in 22% and cellulitis 18%. Only 40% LRTIs were supported by radiology or microbiological criteria. Twenty-five HAIs occurred in 21 patients (cumulative and point prevalence of 10.7% and 5.0% respectively). Urinary tract infection (UTI) was the most common HAI in 13 patients (62%), including 4 catheter-related infections. Patients with HAI were older and appeared to have had longer hospital stays, and higher urinary catheter usage. This study highlights the ongoing high burden of infections contributing to hospitalisation of adult patients in a developed country. The prevalence of HAI, patient characteristics and risk factors are comparable to previous studies in similar settings.

The family experiences of in-hospital care questionnaire in severe traumatic brain injury (FECQ-TBI): a validation study.

PubMed

Anke, Audny; Manskow, Unn Sollid; Friborg, Oddgeir; Røe, Cecilie; Arntzen, Cathrine

2016-11-28

Family members are important for support and care of their close relative after severe traumas, and their experiences are vital health care quality indicators. The objective was to describe the development of the Family Experiences of in-hospital Care Questionnaire for family members of patients with severe Traumatic Brain Injury (FECQ-TBI), and to evaluate its psychometric properties and validity. The design of the study is a Norwegian multicentre study inviting 171 family members. The questionnaire developmental process included a literature review, use of an existing instrument (the parent experience of paediatric care questionnaire), focus group with close family members, as well as expert group judgments. Items asking for family care experiences related to acute wards and rehabilitation were included. Several items of the paediatric care questionnaire were removed or the wording of the items was changed to comply with the present purpose. Questions covering experiences with the inpatient rehabilitation period, the discharge phase, the family experiences with hospital facilities, the transfer between departments and the economic needs of the family were added. The developed questionnaire was mailed to the participants. Exploratory factor analyses were used to examine scale structure, in addition to screening for data quality, and analyses of internal consistency and validity. The questionnaire was returned by 122 (71%) of family members. Principal component analysis extracted six dimensions (eigenvalues > 1.0): acute organization and information (10 items), rehabilitation organization (13 items), rehabilitation information (6 items), discharge (4 items), hospital facilities-patients (4 items) and hospital facilities-family (2 items). Items related to the acute phase were comparable to items in the two dimensions of rehabilitation: organization and information. All six subscales had high Cronbach's alpha coefficients >0.80. The construct validity was

Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: A Convergent Mixed Methods study.

PubMed

Pedersen, Maria; Overgaard, Dorthe; Andersen, Ingelise; Baastrup, Marie; Egerod, Ingrid

2018-05-17

To explore the extent to which the qualitative and quantitative data converge and explain mechanisms and drivers of social inequality in cardiac rehabilitation attendance. Social inequality in cardiac rehabilitation attendance has been a recognized problem for many years. However, to date the mechanisms driving these inequalities are still not fully understood. The study was designed as a convergent mixed methods study. From March 2015 - March 2016, patients hospitalized with acute coronary syndrome to two Danish regional hospitals were included in a quantitative prospective observational study (N=302). Qualitative interview informants (N=24) were sampled from the quantitative study population and half brought a close relative (N=12) for dyadic interviews. Interviews were conducted from August 2015 to February 2016. Integrated analyses were conducted in joint displays by merging the quantitative and qualitative findings. Qualitative and quantitative findings primarily confirmed and expanded each other; however, discordant results were also evident. Integrated analyses identified socially differentiated lifestyles, health beliefs, travel barriers and self-efficacy as potential drivers of social inequality in cardiac rehabilitation. Our study adds empirical evidence regarding how a mixed methods study can be used to obtain an understanding of complex healthcare problems. The study provides new knowledge concerning the mechanisms driving social inequality in cardiac rehabilitation attendance. To prevent social inequality, cardiac rehabilitation should be accommodated to patients with a history of unhealthy behaviour and low self-efficacy. Additionally, the rehabilitation programme should be offered in locations not requiring a long commute. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy.

PubMed

Kristensen, Hanne Kaae; Præstegaard, Jeanette; Ytterberg, Charlotte

2017-02-01

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists' practice of stroke rehabilitation. Method The frame of reference is Fairclough's critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012-2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient's independence than to enabling the regaining of meaningful activities and participation. Implications for Rehabilitation Individualized rehabilitation must be organized with flexibility as it is a complex process Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality A broader range of stake holders, including patient organizations, are in demand within health policy making The discourses that

Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association.

PubMed

Le Grande, Michael R; Neubeck, Lis; Murphy, Barbara M; McIvor, Dawn; Lynch, Dianna; McLean, Helen; Jackson, Alun C

2016-09-01

Obstructive sleep apnoea is highly prevalent in acute coronary syndrome patients eligible for enrolment in cardiac rehabilitation programmes. This condition is an independent predictor of increased morbidity and comorbid conditions in the general population and can lead to an increase in major adverse cardiac events such as revascularization, heart failure and hospital readmission in cardiac patients. There is convincing evidence that treatments such as continuous positive airway pressure or mandibular advancement devices can successfully treat obstructive sleep apnoea and these conditions can be improved or negated resulting in improved cardiac rehabilitation outcomes and improved health related quality of life. Given the potential benefits of obstructive sleep apnoea treatment it would make sense to screen for this condition upon entry to out-patient cardiac rehabilitation programmes. A two-stage approach to screening is recommended, where patients are initially evaluated for the probability of having obstructive sleep apnoea using a brief questionnaire (The STOP-Bang) and then followed up with objective evaluation (portable home monitor or polysomnography) where necessary. Potential barriers to further referral and treatment could be partly mitigated by the training of cardiac rehabilitation staff in sleep disorders and screening. © The European Society of Cardiology 2016.

Acute brain injury and therapeutic hypothermia in the PICU: A rehabilitation perspective

PubMed Central

Fink, Ericka L.; Beers, Sue R.; Russell, Mary Louise; Bell, Michael J.

2011-01-01

Acquired brain injury from traumatic brain injury, cardiac arrest (CA), stroke, and central nervous system infection is a leading cause of morbidity and mortality in the pediatric population and admission to inpatient rehabilitation. Therapeutic hypothermia is the only intervention shown to have efficacy from bench to bedside in improving neurological outcome after birth asphyxia and adult arrhythmia-induced CA, thought to be due to its multiple mechanisms of action. Research to determine if therapeutic hypothermia should be applied to other causes of brain injury and how to best apply it is underway in children and adults. Changes in clinical practice in the hospitalized brain-injured child may have effects on rehabilitation referral practices, goals and strategies of therapies offered, and may increase the degree of complex medical problems seen in children referred to inpatient rehabilitation. PMID:21791822

Integrative medicine for subacute stroke rehabilitation: a study protocol for a multicentre, randomised, controlled trial.

PubMed

Fang, Jianqiao; Chen, Lifang; Chen, Luni; Wang, Chao; Keeler, Crystal Lynn; Ma, Ruijie; Xu, Shouyu; Shen, Laihua; Bao, Yehua; Ji, Conghua

2014-12-04

Many patients with stroke receive integrative medicine in China, which includes the basic treatment of Western medicine and routine rehabilitation, in conjunction with acupuncture and Chinese medicine. The question of whether integrative medicine is efficacious for stroke rehabilitation is still controversial and very little research currently exists on the integrated approach for this condition. Consequently, we will conduct a multicentre, randomised, controlled, assessor-blinded clinical trial to assess the effectiveness of integrative medicine on stroke rehabilitation. 360 participants recruited from three large Chinese medical hospitals in Zhejiang Province will be randomly divided into the integrative medicine rehabilitation (IMR) group and the conventional rehabilitation (CR) group in a 1:1 ratio. Participants in the IMR group will receive acupuncture and Chinese herbs in addition to basic Western medicine and rehabilitation treatment. The CR group will not receive acupuncture and Chinese herbal medicine. The assessment data will be collected at baseline, 4 and 8 weeks postrandomisation, and then at 12 weeks' follow-up. The primary outcome is measured by the Modified Barthel Index. The secondary outcomes are the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment, the mini-mental state examination and Montreal Cognitive, Hamilton's Depression Scale and Self-Rating Depression Scale, and the incidence of adverse events. Ethical approval was obtained from ethics committees of three hospitals. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients by telephone, during follow-up calls inquiring on patient's post-study health status. Chinese Clinical Trial Register: ChiCTR-TRC-12001972, http://www.chictr.org/en/proj/show.aspx?proj=2561. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico.

PubMed

Torres-Arreola, Laura del Pilar; Doubova Dubova, Svetlana Vladislavovna; Hernandez, Sergio F; Torres-Valdez, Laura E; Constantino-Casas, Norma P; Garcia-Contreras, Fernando; Torres-Castro, Sara

2009-11-01

Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care. A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003-May 2004. Stroke patients. Two rehabilitation strategies provided by nurses for stroke patients were compared: physiotherapy plus caregiver education in rehabilitation (strategy 1, S1) vs. education alone (strategy 2, S2). The main outcome variables were the basic (Barthel index) and social (Frenchay activities index) activities of daily living, of each patient. Age, sex, morbidity, stroke symptoms, complications, neurological damage (Canadian Scale), cognitive state (mini-mental state examination questionnaire) and duration of hospitalisation were defined as the control variables. Patients were evaluated at baseline and months one, three and six thereafter. One hundred and ten patients with ischaemic stroke were enrolled and randomised; 59 were assigned to S1 and 51 to S2. Comparison of the outcome variables showed that patients improved significantly over time, but no differences were observed between groups. We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living. Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone. Those countries that do not have integral rehabilitation programmes for stroke patients should understand their importance and budget resources for them. Meanwhile, both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these

Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity

PubMed Central

Vining, Robert D.; Gosselin, Donna M.; Thurmond, Jeb; Case, Kimberlee; Bruch, Frederick R.

2017-01-01

Abstract Rationale: This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. Patient concerns: The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3–C6). Diagnoses: Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. Interventions: The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Outcomes: Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2

Vestibular rehabilitation using video gaming in adults with dizziness: a pilot study.

PubMed

Phillips, J S; Fitzgerald, J; Phillis, D; Underwood, A; Nunney, I; Bath, A

2018-03-01

To determine the effectiveness of vestibular rehabilitation using the Wii Fit balance platform, in adults with dizziness. A single-site prospective clinical trial was conducted in a university hospital in the UK. Forty patients with dizziness, who would normally be candidates for vestibular rehabilitation, were identified and considered as potential participants. Participants were randomised into either the treatment group (the Wii Fit group) or the control group (standard customised vestibular rehabilitation protocol). Participants were assessed over a 16-week period using several balance and quality of life questionnaires. Both exercise regimes resulted in a reduction of dizziness and an improvement in quality of life scores over time, but no statistically significant difference between the two interventions was identified. This pilot study demonstrated that use of the Wii Fit balance platform resulted in a statistically significant improvement in balance function and quality of life. Furthermore, outcomes were comparable to a similar group of individuals following a standard customised vestibular rehabilitation protocol. The study provides useful information to inform the design and execution of a larger clinical trial.

78 FR 38840 - Final Priority-National Institute on Disability and Rehabilitation Research-Rehabilitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

... Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY: Office of Special Education and... Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation...

The uniform data system for medical rehabilitation: report of patients with traumatic spinal cord injury discharged from rehabilitation programs in 2002-2010.

PubMed

Granger, Carl V; Karmarkar, Amol M; Graham, James E; Deutsch, Anne; Niewczyk, Paulette; Divita, Margaret A; Ottenbacher, Kenneth J

2012-04-01

This study aimed to provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation after a traumatic spinal cord injury. This was an analysis of secondary data from 891 inpatient medical rehabilitation facilities in the United States that contributed traumatic spinal cord injury data to the Uniform Data System for Medical Rehabilitation from January 2002 to December 2010. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, International Classification of Diseases 9 codes for admitting diagnosis, co-morbidities), and functional status (Functional Independence Measure [FIM] instrument ratings at admission and discharge, FIM efficiency, FIM gain). The final sample included 47,153 patients with traumatic spinal cord injury. Overall, the mean length of stay was 26.2 ± 23.2 days: yearly means ranged from 29.7 ± 25.4 in 2002 to 22.9 ± 18.9 in 2009. FIM total admission and discharge ratings also declined during the 8-yr study period; admission decreased from 60.5 ± 17.4 to 55.9 ± 16.3; discharge decreased from 86.1 ± 23.8 to 82.4 ± 23.4. Rehabilitation efficiency (FIM gain per day) remained relatively stable over time (1.6 ± 1.7 points per day). The percentage of all patients discharged to the community ranged from 75.8% to 71.5% per year. Wheelchair users stayed in rehabilitation longer than did persons who could walk (34.6 ± 217.4 vs. 17.4 ± 14.1 days) and also experienced less functional improvement (21.6 ± 15.8 vs. 29.6 ± 16.3 FIM points). National data from persons with traumatic spinal cord injury in 2002-2010 indicate that lengths of stay declined, but efficiency in functional independence was stable to slightly increased. More than 70% of patients were consistently discharged to community settings

Young Adult Male Satisfaction with Drug & Alcohol Rehabilitation Facilities: Interior Design Implications.

ERIC Educational Resources Information Center

Potthoff, Joy K.

1991-01-01

Examined young adult male patient (n=18) satisfaction with interior environments of three different in-patient drug and alcohol rehabilitation facilities: renovated Elk's Club; hospital wing; and facility built for drug and alcohol treatment. Findings indicated satisfaction declined over four-week treatment period; familiar objects were missed;…

Rehabilitation

MedlinePlus

... help. A younger person who has had a heart attack may go through cardiac rehabilitation to try to return to work and normal activities. Someone with a lung disease may get pulmonary rehabilitation to be able to breathe better and improve their quality of life.

[Is rehabilitation worth it? : Review of economic evaluations of rehabilitation in Germany].

PubMed

Krauth, Christian; Bartling, Tim

2017-04-01

Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.

Impact of a Preemptive Multimodal Analgesia plus Femoral Nerve Blockade Protocol on Rehabilitation, Hospital Length of Stay, and Postoperative Analgesia after Primary Total Knee Arthroplasty: A Controlled Clinical Pilot Study

PubMed Central

Beaupre, Lauren A.; Johnston, D. Bill C.; Dieleman, Sherry; Tsui, Ban

2012-01-01

Purpose. To compare preemptive multimodal analgesia (PMMA) without femoral nerve blocks (FNB) to PMMA including FNB following total knee arthroplasty (TKA). Methods. In a prospective, controlled pilot study, subjects with noninflammatory arthritis undergoing TKA and a short postoperative stay received either PMMA + FNB (FNB group; n = 19) or PMMA only (PMMA group; n = 20). No preoperative group differences were noted. Evaluations occurred in hospital and at 2, 6, and 12 weeks postoperatively. The primary outcome (knee flexion) was measured on day two postoperatively. Rehabilitation indices, pain, analgesic use, and length of stay (LOS) were also measured. Results. All subjects completed the study. The only significant group differences were quadriceps motor blocks in the FNB group (P < 0.001). No significant differences were noted in ROM, pain levels, analgesic use, or hospital LOS. Conclusion. Other than the quadriceps motor block, no group differences were noted; both achieved satisfactory analgesia. Best postoperative pain management strategies when following a short hospital stay program are still unclear. PMID:22666096

Impact of a preemptive multimodal analgesia plus femoral nerve blockade protocol on rehabilitation, hospital length of stay, and postoperative analgesia after primary total knee arthroplasty: a controlled clinical pilot study.

PubMed

Beaupre, Lauren A; Johnston, D Bill C; Dieleman, Sherry; Tsui, Ban

2012-01-01

To compare preemptive multimodal analgesia (PMMA) without femoral nerve blocks (FNB) to PMMA including FNB following total knee arthroplasty (TKA). In a prospective, controlled pilot study, subjects with noninflammatory arthritis undergoing TKA and a short postoperative stay received either PMMA + FNB (FNB group; n = 19) or PMMA only (PMMA group; n = 20). No preoperative group differences were noted. Evaluations occurred in hospital and at 2, 6, and 12 weeks postoperatively. The primary outcome (knee flexion) was measured on day two postoperatively. Rehabilitation indices, pain, analgesic use, and length of stay (LOS) were also measured. All subjects completed the study. The only significant group differences were quadriceps motor blocks in the FNB group (P < 0.001). No significant differences were noted in ROM, pain levels, analgesic use, or hospital LOS. Other than the quadriceps motor block, no group differences were noted; both achieved satisfactory analgesia. Best postoperative pain management strategies when following a short hospital stay program are still unclear.

Impact of Spatial Neglect in Stroke Rehabilitation: Evidence from the Setting of an Inpatient Rehabilitation Facility

PubMed Central

Chen, Peii; Hreha, Kimberly; Kong, Yekyung; Barrett, A. M.

2015-01-01

Objective To examine the impact of spatial neglect on rehabilitation outcome, risk of falls, and discharge disposition in stroke survivors. Design Inception cohort Setting Inpatient rehabilitation facility (IRF) Participants 108 individuals with unilateral brain damage after their first stroke were assessed at the times of IRF admission and discharge. At admission, 74 of them (68.5%) demonstrated symptoms of spatial neglect, as measured with the Kessler Foundation Neglect Assessment Process (KF-NAP™). Interventions Usual and standard IRF care. Main Outcome Measures Functional Independence Measure (FIM™), Conley Scale, number of falls, length of stay (LOS), and discharge disposition. Results The greater severity of spatial neglect (higher KF-NAP scores) at IRF admission, the lower FIM scores at admission as well as at discharge. Higher KF-NAP scores also correlated with greater LOS and slower FIM improvement rate. The presence of spatial neglect (KF-NAP > 0), but not Conley Scale scores, predicted falls such that participants with spatial neglect fell 6.5 times more often than those without symptoms. More severe neglect, by KF-NAP scores at IRF admission, reduced the likelihood of returning home at discharge. A model that took spatial neglect and other demographic, socioeconomic, and clinical factors into account predicted home discharge. Rapid FIM improvement during IRF stay and lower annual income level were significant predictors of home discharge. Conclusions Spatial neglect following a stroke is a prevalent problem, and may negatively affect rehabilitation outcome, risk of falls, and length of hospital stay. PMID:25862254

Community reintegration in rehabilitated South Indian persons with spinal cord injury.

PubMed

Samuelkamaleshkumar, Selvaraj; Radhika, Somasundaram; Cherian, Binu; Elango, Aarumugam; Winrose, Windsor; Suhany, Baby T; Prakash, M Henry

2010-07-01

To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables. Survey. Rehabilitation center of a tertiary care university teaching hospital. Community-dwelling persons with SCI (N=104). Not applicable. Craig Handicap Assessment and Reporting Technique (CHART). The mean scores for each CHART domain were physical independence 98+/-5, social Integration 96+/-11, cognitive independence 92+/-17, occupation 70+/-34, mobility 65+/-18, and economic self sufficiency 53+/-40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration. Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the Functional Independence Measure.

PubMed

Ng, Yee Sien; Jung, Heeyoune; Tay, San San; Bok, Chek Wai; Chiong, Yi; Lim, Peter A C

2007-01-01

Rehabilitation improves functional outcomes, but there is little data on the profiles and outcomes of patients undergoing inpatient rehabilitation in Singapore. The aims of this paper were to document the clinical characteristics and functional outcomes, using the Functional Independence Measure (FIM), of all patients admitted to an inpatient rehabilitation unit in a tertiary teaching hospital, and to identify and analyse factors significantly associated with better discharge functional scores and higher functional gains. In this prospective cohort study over a 4-year period, clinical and functional data for 1502 patients admitted consecutively to the Singapore General Hospital inpatient rehabilitation unit were charted into a custom-designed rehabilitation database. The primary outcome measures were the discharge total FIM scores, FIM gain and FIM efficiency. Multiple linear regression analysis was used to identify independent variables associated with better discharge FIM scores and FIM gain. The mean age was 61.3 +/- 15.0 years and 57.2% of the patients were male. Stroke (57.9%) followed by spinal cord injury (9.7%) were the most common diagnoses. The average rehabilitation length of stay was 21.5 +/- 19.0 days. The mean admission total FIM score was 70.3 +/- 23.2 and the mean discharge total FIM score was 87.3 +/- 23.0, with this gain being highly significant (P <0.001). The mean FIM gain was 17.0 +/- 13.4 and FIM efficiency was 0.95 +/- 0.90 points/day. Factors associated with better functional outcomes were higher admission motor and cognitive FIM scores, male gender, a longer rehabilitation length of stay and the use of acupuncture. Factors associated with poorer functional outcomes were older age, clinical deconditioning, ischaemic heart disease, depression, pressure sores and the presence of a domestic worker as a caregiver. The FIM is an easy-to-use, standardised and robust general measure of functional disability. Multiple demographic, clinical and socio

Vestibular rehabilitation outcomes in chronic vertiginous patients through computerized dynamic visual acuity and Gaze stabilization test.

PubMed

Badaracco, Carlo; Labini, Francesca Sylos; Meli, Annalisa; De Angelis, Ezio; Tufarelli, Davide

2007-09-01

To evaluate the efficiency of the rehabilitative protocols in patients with labyrinthine hypofunction, focusing on computerized dynamic visual acuity test (DVAt) and Gaze stabilization test (GST) specifically evaluating the vestibulo-oculomotor reflex (VOR) changes due to vestibular rehabilitation. Consecutive sample study. Day hospital in Ears, Nose, and Throat Rehabilitation Unit. Thirty-two patients with chronic dizziness with a mean age of 60.74 years. Patients performed one cycle of 12 daily rehabilitation sessions (2 h each) consisting of exercises aimed at improving VOR gain. The rehabilitation program included substitutional and/or habitudinal exercises, exercises on a stability platform, and exercises on a moving footpath with rehabilitative software. Dizziness Handicap Inventory and Activities-specific Balance Confidence Scale. Computerized dynamic posturography, computerized DVAt, and GST. The patients significantly improved in all the tests. Vestibular rehabilitation improved the quality of life by reducing the handicap index and improving the ability in everyday tasks. The recovery of the vestibular-ocular reflex and vestibular-spinal reflex efficiency was objectively proven by instrumental testing. The DVAt and the GST allow to objectively quantify the fixation ability at higher frequencies and speeds (main VOR function). Moreover, these new parameters permit to completely evaluate vestibular rehabilitation outcomes, adding new information to the generally used tests that only assess vestibulospinal reflex.

Participation of children with neurodevelopmental risk factors in the early rehabilitation program in relation to the level of parental education.

PubMed

Mikelić, Valentina Matijević; Kosicek, Tena; Crnković, Maja; Radanović, Branko

2011-12-01

Many factors that have an adverse effect on fetal growth and development can manifest later in the child's development. Because of the biological basis, children born under the influence of these factors belong to the group of neurorisk children. They need special attention and prompt participation in the early rehabilitation program to encourage the use of brain plasticity. In addition to the biological influences, socioeconomic status affects a wide array of medical, cognitive and socio-emotional consequences in children, which begin before birth and continue into adulthood. This retrospective study included 50 children aged one to three years, hospitalized at Department of Pediatric Rehabilitation, University Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center in Zagreb. The aim was to determine the frequency of inclusion of children with neurodevelopmental risks in the early rehabilitation program according to the level of parental education. The results showed the highest percentage of parents of neurorisk children to have high school education, while the smallest number of parents had elementary school education. These data pointed to the lack of public awareness of the importance of the early period of life. However, they also indicated the lack of parental knowledge of their rights and opportunities for involvement of their neurorisk children in the early rehabilitation programs.

Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery.

PubMed

Smith, Toby O; Hameed, Yasir A; Cross, Jane L; Henderson, Catherine; Sahota, Opinder; Fox, Chris

2015-06-15

-led care in hospital to conventional care led by the orthopaedic team. All papers analysed subgroups of people with dementia/cognitive impairment from larger RCTs of older people following hip fracture. Trial follow-up periods ranged from acute hospital discharge to 24 months post-discharge.We considered all of the studies to be at high risk of bias in more than one domain. As subgroups of larger studies, the analyses lacked power to detect differences between the intervention groups. Further, there were some important differences in the baseline characteristics of the participants in experimental and control groups. Using the GRADE approach, we downgraded the quality of the evidence for all outcomes to 'low' or 'very low'.No study assessed our primary outcome (cognitive function) nor other important dementia-related outcomes including behaviour and quality of life. The effect estimates for most comparisons were very imprecise, so it was not possible to draw firm conclusions from the data. There was low-quality evidence that enhanced care and rehabilitation in hospital led to lower rates of some complications and that enhanced care provided across hospital and home settings reduced the chance of being in institutional care at three months post-discharge (Odds Ratio (OR) 0.46, 95% confidence interval (CI) 0.22 to 0.95, 2 trials, n = 184), but this effect was more uncertain at 12 months (OR 0.90, 95% CI 0.40 to 2.03, 2 trials, n = 177). The effect of enhanced care and rehabilitation in hospital and at home on functional outcomes was very uncertain because the quality of evidence was very low from one small trial. Results on functional outcomes from other trials were inconclusive. The effect of geriatrician-led compared to orthopaedic-led management on the cumulative incidence of delirium was very uncertain (OR 0.73, 95% CI 0.22 to 2.38, 1 trial, n = 126, very low-quality evidence). There is currently insufficient evidence to draw conclusions about how effective the models of

[Rehabilitation in the view of small and midsized enterprises: knowledge, appreciation and possibilities to cooperate - results of the KoRB-project].

PubMed

Hesse, B; Heuer, J; Gebauer, E

2008-12-01

The experiences of small and midsized enterprises (SME) with medical rehabilitation were investigated in the KoRB-Study (KoRB= KOoperation Rehabilitation und Betrieb) for the first time. Opportunities for a targeted cooperation between the statutory pension insurance and these enterprises were explored. Based on explorative interviews, Westphalian employers, members of the works council, occupational health practitioners and employees were interrogated about the image of and their appreciation of medical rehabilitation in the work setting. Experience with rehabilitation and the level of information on rehabilitation were recorded as well as the compatibility of rehabilitation with operative processes in the working site. In addition rehab hospitals were asked about their experience in cooperating with enterprises. 697 employers of small and midsized enterprises, 458 members of the works councils, 73 occupational health practitioners, 47 rehab hospitals and 3 509 employees, who are members of the German Pension Fund of Westphalia, took part in the survey. Especially employers perceived rehabilitation positively and reported good experiences. Among the employees, those who had taken part in rehabilitation showed the highest appreciation. Occupational health practitioners were more restrained in their appraisal. Some of them complained about a lack of sustainability. The different target groups of the survey felt differently well informed about rehabilitation - best ratings came from the occupational health practitioners, worst ratings from the employees. All groups would welcome more accessible information in case of need. Medical rehabilitation in its standard form of "3 weeks full-time" often causes severe logistic problems in SME (e. g., replacement of employee, loss of experience). However the financial burden is perceived as less problematic. Employers favour alternative rehab models, which allow part-time working. Many employees, who expressed a need for

The LIFEspan model of transitional rehabilitative care for youth with disabilities: healthcare professionals' perspectives on service delivery.

PubMed

Hamdani, Yani; Proulx, Meghann; Kingsnorth, Shauna; Lindsay, Sally; Maxwell, Joanne; Colantonio, Angela; Macarthur, Colin; Bayley, Mark

2014-01-01

LIFEspan is a service delivery model of continuous coordinated care developed and implemented by a cross-organization partnership between a pediatric and an adult rehabilitation hospital. Previous work explored enablers and barriers to establishing the partnership service. This paper examines healthcare professionals' (HCPs') experiences of 'real world' service delivery aimed at supporting transitional rehabilitative care for youth with disabilities. This qualitative study - part of an ongoing mixed method longitudinal study - elicited HCPs' perspectives on their experiences of LIFEspan service delivery through in-depth interviews. Data were categorized into themes of service delivery activities, then interpreted from the lens of a service integration/coordination framework. Five main service delivery themes were identified: 1) addressing youth's transition readiness and capacities; 2) shifting responsibility for healthcare management from parents to youth; 3) determining services based on organizational resources; 4) linking between pediatric and adult rehabilitation services; and, 5) linking with multi-sector services. LIFEspan contributed to service delivery activities that coordinated care for youth and families and integrated inter-hospital services. However, gaps in service integration with primary care, education, social, and community services limited coordinated care to the rehabilitation sector. Recommendations are made to enhance service delivery using a systems/sector-based approach.

Advances in rehabilitation medicine.

PubMed

Ng, Yee Sien; Chew, Effie; Samuel, Geoffrey S; Tan, Yeow Leng; Kong, Keng He

2013-10-01

Rehabilitation medicine is the medical specialty that integrates rehabilitation as its core therapeutic modality in disability management. More than a billion people worldwide are disabled, and the World Health Organization has developed the International Classification of Functioning, Disability and Health as a framework through which disability is addressed. Herein, we explore paradigm shifts in neurorehabilitation, with a focus on restoration, and provide overviews on developments in neuropharmacology, rehabilitation robotics, virtual reality, constraint-induced therapy and brain stimulation. We also discuss important issues in rehabilitation systems of care, including integrated care pathways, very early rehabilitation, early supported discharge and telerehabilitation. Finally, we highlight major new fields of rehabilitation such as spasticity management, frailty and geriatric rehabilitation, intensive care and cancer rehabilitation.

[Rehabilitation and Diagnosis Related Groups (REDIA Study): impact of DRG introduction in the acute sector on medical rehabilitation in Germany].

PubMed

von Eiff, W; Meyer, N; Klemann, A; Greitemann, B; Karoff, M

2007-04-01

As experiences from other countries show, introduction and use of Diagnosis Related Groups (DRG), as of January 2004 now also mandatory in Germany, may have a significant impact on associated rehabilitation. The Institute of Hospital Management (IKM) in a multi-centre study promoted by Deutsche Rentenversicherung Bund and Deutsche Rentenversicherung Westfalen is conducting a study regarding potential diversion of healthcare expenditures from acute care towards rehabilitation as a result of DRG introduction in Germany. For documentation of potential short-term changes in patient populations and patient streams, extensive data have been collected in the first two phases in 2003/04 and 2005/06 for a total of 1342 cardiologic and orthopaedic patients. Indication-specific comparison of the two phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in an intake of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversion of treatment efforts from the acute to the rehabilitative sector, regarding increased nursing effort and potential changes in the therapeutic and medical treatment to be provided, has not been proven as yet. The increase in wound problems expected by practitioners was confirmed in the orthopaedic area by an increasing number of wound healing disturbances and haematomas; in bypass-patients, an increasing number of pericardium and pleura bruises was found. The analyses performed on the data collected revealed no limitations in the patients' ability to participate in rehabilitative measures when the first and the second phase of the study are compared. To be able to depict the further course and interdependencies of changes, continuous systematic observation of developments would be desirable. To ascertain a lasting impact of DRG implementation at least a third study-phase will be necessary, which should be placed at the end of 2008, at the

Factors predicting rehabilitation outcomes of elderly patients with hip fracture.

PubMed

Chin, Raymond P H; Ng, Bobby H P; Cheung, Lydia P C

2008-06-01

To identify predictors of rehabilitation outcomes for the development of a case-mix system to rehabilitate patients suffering from hip fractures. Prospective cohort study. Two hospitals in Hong Kong. A cohort of hip fracture patients in 2005 (n=303) with a mean age of 82 years was studied. Rehabilitation outcomes were defined as: mortality, length of stay, placement, ambulation status, activity of daily living at the time of discharge and at 6-month follow-up. A comparison between groups and multivariate analysis was conducted to validate the best predictors. Potential predictors and rehabilitation outcomes. Two predictors, the Abbreviated Mental Test score of lower than 6 (odds ratio=0.19, P<0.05) and the Functional Independence Measures score of lower than 75 (odds ratio=38.0, P<0.05), at the time of admission to the rehabilitation setting were found to be related to outcomes. Our findings provided further support for a case-mix system based on these two factors, as they could correctly assign patients into three groups with different baseline characteristics and outcomes. A review of the possible limitations of the existing service with respect to each case-mix group was also conducted. A case-mix system utilising the cognition and activity of daily living function is recommended. Revisions of respective care plans are advocated with more realistic outcome expectations and specific actions for the respective case-mix groups. An evaluation study on the usefulness of this case-mix classification could then follow.

Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients.

PubMed

Härter, Martin; Woll, Sonja; Reuter, Katrin; Wunsch, Alexandra; Bengel, Jürgen

2004-07-01

To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs). Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews. Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany. More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed. Not applicable. Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians. The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians' diagnoses corresponded to the CIDI diagnoses. The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.

Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study.

PubMed

Campanini, Isabella; Mastrangelo, Stefano; Bargellini, Annalisa; Bassoli, Agnese; Bosi, Gabriele; Lombardi, Francesco; Tolomelli, Stefano; Lusuardi, Mirco; Merlo, Andrea

2018-01-11

Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. The HIIFRM showed satisfactory feasibility and predictive performances in

A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial.

PubMed

Braverman, S E; Spector, J; Warden, D L; Wilson, B C; Ellis, T E; Bamdad, M J; Salazar, A M

1999-06-01

To design and describe an effective rehabilitation programme for use in an ongoing trial on the efficacy of multidisciplinary brain injury rehabilitation for moderately head injury military service members. Treatment arm of a randomized control trial. US military tertiary care hospital inpatient rehabilitation programme. Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. Eight week rehabilitation programme combining group and individual therapies with an inpatient milieu-oriented neuropsychological focus. Group therapies included fitness, planning and organization, cognitive skills, work skills, medication, and milieu groups, and community re-entry outings. Individual therapy included neuropsychology, work therapy, occupational therapy, and speech and language pathology. Successful return to work and return to duty. At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. The described rehabilitation programme demonstrates one successful effort to rehabilitate active duty military service members with TBI who have the potential to return to duty.

Ergonomics diagnosis components in rehabilitation: statistical evaluation of an assessment instrument.

PubMed

Landau, K; Meschke, H; Brauchler, R; Kiesel, J; Knoerzer, J

2007-11-01

The current paper examines an assessment instrument used for combined medical and occupational rehabilitation (MOR) in a group of German hospitals. Patients with a history of musculo-skeletal disease make up a significant proportion of those undergoing rehabilitation. Scale and factor structures, discriminant factors and clustering procedures used in the Bavaria rehabilitation patient assessment method (BRPAM) are investigated in a cross-sectional study involving a sample of 800 patients. Although the results reveal good correlation between differences in the job demand/patient capability profiles and the typical stresses to which the relevant occupation is exposed, analyses also indicate that several factors and items are unstable. According to subjective assessment by the patients, the therapeutic objectives are fully attained in some 80% of cases. Discrepancies between job demands and patient capability revealed by the BRPAM yield pointers to choice of therapy and its chances of success, but these need to be examined in greater detail in long-term studies.

Severe to profound hearing impairment: quality of life, psychosocial consequences and audiological rehabilitation.

PubMed

Carlsson, Per-Inge; Hjaldahl, Jennie; Magnuson, Anders; Ternevall, Elisabeth; Edén, Margareta; Skagerstrand, Åsa; Jönsson, Radi

2015-01-01

To study the quality of life (QoL) and psychosocial consequences in terms of sick leave and audiological rehabilitation given to patients with severe to profound hearing impairment. A retrospective study of data on 2319 patients with severe to profound hearing impairment in The Swedish Quality Register of Otorhinolaryngology, followed by a posted questionnaire including The Hospital Anxiety and Depression Scale (HADS). The results indicate greater levels of anxiety and depression among patients with severe or profound hearing impairment than in the general population, and annoying tinnitus and vertigo had strong negative effects on QoL. The proportion of sick leave differed between the studied dimensions in the study. The proportion of patients who received extended audiological rehabilitation was 38% in the present study. Treatment focused on anxiety, depression, tinnitus and vertigo must be given early in the rehabilitation process in patients with severe or profound hearing impairment. Because sick leave differs greatly within this group of patients, collaboration with the regional Social Insurance Agency is crucial part of the rehabilitation. The study also shows that presently, only a small proportion of patients in Sweden with severe to profound hearing impairment receive extended audiological rehabilitation. Implications for Rehabilitation Greater levels of anxiety and depression have been found among patients with severe or profound hearing impairment than in the general population, and annoying tinnitus and vertigo have strong negative effects on QoL in this group of patients. Only a small proportion of patients with severe to profound hearing impairment receive extended audiological rehabilitation today, including medical, technical and psychosocial efforts. Extended audiological rehabilitation focused on anxiety, depression, tinnitus and vertigo must be given, together with technical rehabilitation, early in the rehabilitation process in patients with

Patients' Acceptance of the Use of Serious Games in Physical Rehabilitation in Morocco.

PubMed

Bonnechère, Bruno; Van Vooren, Mélissa; Jansen, Bart; Van Sint, Jan S; Rahmoun, Mohamed; Fourtassi, Maryam

2017-10-01

The aim of this study was to determine whether serious games especially customized for physical rehabilitation could be used in daily clinics with patients who are not familiar with informatics and/or new technologies and whether such a clinical approach would be culturally acceptable within a North African population to plan further clinical distribution if the hypothesis appears to be positive. Twenty-one patients participated in this study. Experiments were performed in the University Hospital Mohammed VI Oujda in Morocco. Patients were asked to perform physical rehabilitation exercises with dedicated serious games after their conventional therapy session. A questionnaire was used to evaluate patients' habits to rehabilitation exercises and satisfaction and expectation about the use of serious games for physical rehabilitation. The same problem of low participation in at-home exercises was found in Morocco compared to Europe and the United States: 60 (30)% of the exercises was performed by the patients in Morocco and 48 (28)% in Europe and the United States. Results of this study show that serious games are well accepted by the patients (100%) and that it can help during rehabilitation (90%). Most of the patients prefer exercises with games than conventional rehabilitation exercises. Even in a context of low education (participants in this study attended school until the age of 10 years old), and low access and knowledge about new technology and informatics, rehabilitation exercises within serious games seem to be an interesting option to motivate patients during rehabilitation with a physiotherapist. Such a system could be installed also at home to increase patient's participation.

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector.

PubMed

Buhagiar, Mark A; Naylor, Justine M; Simpson, Grahame; Harris, Ian A; Kohler, Friedbert

2017-06-19

To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. Mixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014-2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway. Interviews were in person or via the telephone. Qualitative analysis software was used to electronically manage qualitative data. An analytical approach guided data analysis. Pre-operative preferences strongly influenced the type of rehabilitation chosen by consumers. Key factors that influenced this were both intrinsic and extrinsic, including; the previous experience of self or known others, the perceived benefits of the chosen mode, a sense of entitlement, the role of orthopaedic surgeons and influence of patient preference, a patient's clinical status post-surgery, the private hospital business model and insurance provider involvement. The acceptability of rehabilitation modes varied between clinician groups. No one rehabilitation mode provided following arthroplasty is singularly preferred by stakeholders. Factors other than the belief that a particular mode was more effective than another appear to dominate the pathway followed by private arthroplasty consumers, indicating evidence-based policies around rehabilitation provision may have limited appeal in the private sector.

Relationship between nighttime vital sign assessments and acute care transfers in the rehabilitation inpatient.

PubMed

Pellicane, Anthony J

2014-01-01

To investigate the role of nighttime vital sign assessment in predicting acute care transfers (ACT) from inpatient rehabilitation. Retrospective chart review. Fifty patients unexpectedly discharged to acute care underwent chart review to determine details of each ACT. Seven of 50 ACT possessed new vital sign abnormalities at the 11 pm vital sign assessment the night before ACT. None of these seven underwent ACT during the night shift the abnormalities were detected. Two of 50 ACT were transferred between 11 pm and 6:59 am; both demonstrating normal vital sign at the 11 pm assessment. During study period, an estimated 5,607 11 pm vital sign assessments were performed. Nighttime vital sign assessments do not seem to be a good screening tool for clinical instability in the rehabilitation hospital. Eliminating sleep disturbance is important to the rehabilitation inpatient as inadequate sleep hinders physical performance. Tailoring vital sign monitoring to fit patents' clinical presentation may benefit this population. © 2014 Association of Rehabilitation Nurses.

Hospital-based versus hybrid cardiac rehabilitation program in coronary bypass surgery patients in western Iran: effects on exercise capacity, risk factors, psychological factors, and quality of life.

PubMed

Najafi, Farid; Nalini, Mahdi

2015-01-01

The efficacy of alternative delivery models for a cardiac rehabilitation program (CRP) in low- and middle-income countries is not well documented. This study compared the traditional hospital-based CRP with a hybrid CRP in western Iran. This observational study was conducted with postcoronary surgery patients in Imam-Ali Hospital in Kermanshah, Iran. Both program models included 2 phases: (1) a common preliminary phase (2-4 weeks) involving exercise training and a plan to control cardiac risk factors; and (2) a complementary phase (8 weeks) consisting of group educational classes and exercise training conducted 3 times a week in the hospital or once a week accompanied by phone calls in the hybrid program. Changes in exercise capacity, blood pressure, lipids, resting heart rate, body mass index, waist circumference, smoking, depression, anxiety, and quality of life as well as differences in attendance at hospital sessions were investigated. From a total of 887 patients, 780 (87.9%) completed the programs. There was no association between course completion and type of CRP. Mean age of patients completing the programs was 55.6 ± 8.7 years and 23.8% were female. The hospital-based (n = 585) and hybrid (n = 195) programs resulted in a significant increase in exercise capacity (P < .001 for both). Additional improvements in other outcomes were noted and attendance rates were similar in both CRPs. A well-designed hybrid CRP can be a viable alternative for hospital-based CRP in low- and middle-income countries where there are no appropriate health facilities in remote areas.

Severity of unilateral spatial neglect is an independent predictor of functional outcome after acute inpatient rehabilitation in individuals with right hemispheric stroke.

PubMed

Di Monaco, Marco; Schintu, Selene; Dotta, Manuela; Barba, Sonia; Tappero, Rosa; Gindri, Patrizia

2011-08-01

To investigate the relationship between severity of unilateral spatial neglect (USN) and functional recovery in activities of daily living after a right-hemisphere stroke. Observational study. Rehabilitation hospital in Italy. We investigated 107 of 131 inpatients with right-hemisphere stroke who were consecutively admitted to our rehabilitation hospital. Not applicable. To assess USN severity, conventional and nonconventional Behavioral Inattention Tests (BITs) were performed at admission to inpatient rehabilitation at a median of 19 days after stroke occurrence. FIM was performed both on admission to and discharge from inpatient rehabilitation to assess functional autonomy. FIM efficiency (improvement of FIM score per day of stay length) and FIM effectiveness (proportion of potential improvement achieved) were calculated. Fifty-four (50.5%) of the 107 patients were affected by USN. In these 54 patients, both conventional and nonconventional BIT scores were significantly correlated with FIM scores assessed at discharge from rehabilitation: ρ values were .385 (P=.004) and .396 (P=.003), respectively. After adjustment for 7 potential confounders, including FIM scores before rehabilitation, we found a significant positive association between either conventional or nonconventional BIT scores and FIM scores after rehabilitation (r=.276, P=.047 and r=.296, P=.033, respectively), FIM efficiency (r=.315, P=.022 and r=.307, P=.025, respectively), and FIM effectiveness (r=.371, P=.006 and r=.306, P=.026, respectively). Data support the independent prognostic role of USN severity assessed at admission to inpatient rehabilitation after a right-hemisphere stroke. Models aimed at predicting the functional outcome in stroke survivors may benefit from inclusion of USN severity. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Stroke Rehabilitation.

PubMed

Belagaje, Samir R

2017-02-01

Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

Rehabilitation robotics

PubMed Central

KREBS, H.I.; VOLPE, B.T.

2015-01-01

This chapter focuses on rehabilitation robotics which can be used to augment the clinician’s toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual’s functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We will provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we will then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We will present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. PMID:23312648

Rehabilitation robotics.

PubMed

Krebs, H I; Volpe, B T

2013-01-01

This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. Copyright © 2013 Elsevier B.V. All rights reserved.

Cancer surviving patients' rehabilitation – understanding failure through application of theoretical perspectives from Habermas

PubMed Central

Mikkelsen, Thorbjørn H; Soendergaard, Jens; Jensen, Anders B; Olesen, Frede

2008-01-01

This study aims to analyze whether the rehabilitation of cancer surviving patients (CSPs) can be better organized. The data for this paper consists of focus group interviews (FGIs) with CSPs, general practitioners (GPs) and hospital physicians. The analysis draws on the theoretical framework of Jürgen Habermas, utilizing his notions of 'the system and the life world' and 'communicative and strategic action'. In Habermas' terminology, the social security system and the healthcare system are subsystems that belong to what he calls the 'system', where actions are based on strategic actions activated by the means of media such as money and power which provide the basis for other actors' actions. The social life, on the other hand, in Habermas' terminology, belongs to what he calls the 'life world', where communicative action is based on consensual coordination among individuals. Our material suggests that, within the hospital world, the strategic actions related to diagnosis, treatment and cure in the biomedical discourse dominate. They function as inclusion/exclusion criteria for further treatment. However, the GPs appear to accept the CSPs' previous cancer diagnosis as a precondition sufficient for providing assistance. Although the GPs use the biomedical discourse and often give biomedical examples to exemplify rehabilitation needs, they find psychosocial aspects, so-called lifeworld aspects, to be an important component of their job when helping CSPs. In this way, they appear more open to communicative action in relation to the CSPs' lifeworld than do the hospital physicians. Our data also suggests that the CSPs' lifeworld can be partly colonized by the system during hospitalization, making it difficult for CSPs when they are discharged at the end of treatment. This situation seems to be crucial to our understanding of why CSPs often feel left in limbo after discharge. We conclude that the distinction between the system and the lifeworld and the implications of a

The association between patient participation and functional gain following inpatient rehabilitation.

PubMed

Morghen, Sara; Morandi, Alessandro; Guccione, Andrew A; Bozzini, Michela; Guerini, Fabio; Gatti, Roberto; Del Santo, Francesco; Gentile, Simona; Trabucchi, Marco; Bellelli, Giuseppe

2017-08-01

To evaluate patients' participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training. All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors. A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19-1.91). This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.

77 FR 8234 - National Institute on Disability and Rehabilitation Research-Disability and Rehabilitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

... DEPARTMENT OF EDUCATION National Institute on Disability and Rehabilitation Research-- Disability and Rehabilitation Research Projects and Centers Program, etc. AGENCY: Office of Special Education and...: National Institute on Disability and Rehabilitation Research-- Disability and Rehabilitation Research...

Voting pattern of mental patients in a community state hospital.

PubMed

Klein, M M; Grossman, S A

1967-06-01

The voting pattern of mental patients in a community-based state hospital was studied. Patients were polled on the New York City mayoralty race. A comparison to the vote of the general population revealed that the hospital sample vote resembled most closely the election results of the hospital district. The results highlight the advantage of community-centered mental health facilities, which undertake the treatment and rehabilitation of mental patients under conditions that maintain ties with family and community.

The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care.

PubMed

Hoekstra, Femke; Hettinga, Florentina J; Alingh, Rolinde A; Duijf, Marjo; Dekker, Rienk; van der Woude, Lucas H V; van der Schans, Cees P

2017-01-01

To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care. The current implementation status of a sports and physical activity stimulation programme in 12 rehabilitation centres and 5 hospitals with a rehabilitation department was described by scoring fidelity and satisfaction. Seventy-one rehabilitation professionals filled out a questionnaire on how sports and physical activity, including stimulation activities, were implemented into rehabilitation care. Total fidelity scores (in %) were calculated for each organization. Professionals' satisfaction was rated on a scale from 1 to 10. In most organizations sports and physical activity were to some extent integrated during and after rehabilitation (fidelity scores: median = 54%, IQR = 23%). Physical activity stimulation was not always embedded as standard component of a rehabilitation treatment. Professionals' satisfaction rated a median value of 8.0 (IQR = 0.0) indicating high satisfaction rates. The fidelity outcome showed that activities to stimulate sports and physical activity during and after rehabilitation were integrated into rehabilitation care, but not always delivered as standardized component. These findings have emphasized the importance to focus on integrating these activities into routines of organizations. Implications for Rehabilitation Components of an evidence-based programme to stimulate sports and physical activity during and after rehabilitation can be used to measure the current status of the integration of sports and physical activity in rehabilitation care in a structural and effective way. The method described in the current study can be used to compare the content of the rehabilitation care regarding the integration of sports and physical activity among organizations both on a national and international level

Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of Japan rehabilitation database.

PubMed

Kinoshita, Shoji; Kakuda, Wataru; Momosaki, Ryo; Yamada, Naoki; Sugawara, Hidekazu; Watanabe, Shu; Abo, Masahiro

2015-05-01

Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties. Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination. After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005). Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

LC-REHAB: randomised trial assessing the effect of a new patient education method--learning and coping strategies--in cardiac rehabilitation.

PubMed

Lynggaard, Vibeke; May, Ole; Beauchamp, Alison; Nielsen, Claus Vinther; Wittrup, Inge

2014-12-13

Due to improved treatments and ageing population, many countries now report increasing prevalence in rates of ischemic heart disease and heart failure. Cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete. In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program. The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called 'learning and coping' to that of standard care. Further, this paper aims to describe the theoretical basis and details of this intervention. Open parallel randomised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure. Patients are allocated to either the intervention group with learning and coping strategies incorporated into standard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program. Learning and coping consists of two individual clarifying interviews, participation of experienced patients as educators together with health professionals and theory based, situated and inductive teaching. Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units. In both groups, cardiac rehabilitation consists of training three times a week and education once a week over eight weeks. The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are quality of life (SF-12, Health education impact questionnaire and Major Depression Inventory) and lifestyle and risk factors (Body Mass Index, waist circumference, blood pressure, exercise work capacity, lipid profile and DXA-scan). Data collection occurs four times; at baseline, at immediate completion of cardiac

78 FR 42868 - Final Priority; National Institute on Disability and Rehabilitation Research-Rehabilitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-18

... Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY... for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority...

Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial.

PubMed

2017-08-05

Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training-including information provision, joint goal setting, carer training, and task-specific training-that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3-6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78-1·23, p=0·87). 72

Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes.

PubMed

Venkataraman, Kavita; Fong, Ngan Phoon; Chan, Kin Ming; Tan, Boon Yeow; Menon, Edward; Ee, Chye Hua; Lee, Kok Keng; Koh, Gerald Choon-Huat

2016-09-01

To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. Retrospective medical records review. All community hospitals. Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. Not applicable. Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home. Copyright © 2016

Pulmonary Rehabilitation

MedlinePlus

... as pulmonary hypertension and interstitial lung disease can benefit as well. What is Pulmonary Rehabilitation? Pulmonary rehabilitation is a program of education and exercise that helps you manage your breathing ...

A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

PubMed Central

Jackson, James C.; Girard, Timothy D.; Pandharipande, Pratik P.; Schiro, Elena; Work, Brittany; Pun, Brenda T.; Boehm, Leanne; Gill, Thomas M.; Ely, E. Wesley

2012-01-01

Background In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. Objective The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. Design This is a randomized controlled trial. Setting The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. Patients The participants will be patients who are critically ill with respiratory failure or shock. Intervention Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter

78 FR 28543 - Proposed Priority-National Institute on Disability and Rehabilitation Research-Rehabilitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY... priority under the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, this notice proposes a priority...

78 FR 26560 - Proposed Priority-National Institute on Disability and Rehabilitation Research-Rehabilitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-07

... Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY... priority for the Rehabilitation Research and Training Center (RRTC) Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, this notice proposes a priority...

Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury

PubMed Central

Majercik, Sarah; Bledsoe, Joseph; Ryser, David; Hopkins, Ramona O.; Fair, Joseph E.; Frost, R. Brock; MacDonald, Joel; Barrett, Ryan; Horn, Susan; Pisani, David; Bigler, Erin D.; Gardner, Scott; Stevens, Mark; Larson, Michael J.

2016-01-01

Introduction Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a Level One Trauma Center. Methods Patients with TBI who were admitted to our rehabilitation unit after the acute care trauma service from February 2009-July 2011 were eligible for the study. Demographic data and outcome variables including cognitive and motor FIM scores, length of stay (LOS) in the rehabilitation unit, and ability to return to home were obtained. DOI quantitative injury lesion volumes and degree of midline shift were obtained from day-of-injury (DOI) brain computed tomography (CT) scans. A multiple step-wise regression model including 13 independent variables was created. This model was used to predict post-rehabilitation outcomes, including FIM scores and ability to return to home. P<0.05 was considered significant. Results 96 patients were enrolled in the study. Mean age was 43±21 years, admission Glasgow Coma Score 8.4±4.8, Injury Severity Score 24.7±9.9, and head Abbreviated Injury Scale score 3.73±0.97. Acute hospital length of stay (LOS) was 12.3±8.9 days and rehabilitation LOS was 15.9±9.3 days. Day-of-injury TBI lesion volumes were inversely associated with cognitive FIM scores at rehabilitation admission (p=0.004) and discharge (p=0.004) and inversely associated with ability to be discharged to home after rehabilitation (p=0.006). Conclusion In a cohort of patients with moderate to severe TBI requiring a rehabilitation unit stay after the acute care hospital stay, DOI brain injury lesion volumes are associated with worse cognitive FIM scores at the time of rehabilitation admission and discharge. Smaller injury volumes were associated with eventual discharge to home. Volumetric neuroimaging in the acute injury phase may

Cardiac rehabilitation

MedlinePlus

... page: //medlineplus.gov/ency/patientinstructions/000791.htm Cardiac rehabilitation To use the sharing features on this page, please enable JavaScript. Cardiac rehabilitation (rehab) is a program that helps you live ...

Client Aggression toward Rehabilitation Counselors Employed by State Vocational Rehabilitation Agencies

ERIC Educational Resources Information Center

Trice, April Lynette

2011-01-01

Through a series of interviews this transcendental phenomenological study explored how rehabilitation counselors employed by state vocational rehabilitation agencies experienced client aggression. More specifically, it examined the circumstances involved when client aggression manifested in the work lives of rehabilitation counselors. This study…

Comparison of two different rehabilitation programmes for thrust plate prosthesis: a randomized controlled study.

PubMed

Unver, Bayram; Karatosun, Vasfi; Gunal, Izge; Angin, Salih

2004-02-01

Weight bearing after total hip arthroplasty is postponed in order to prevent early loosening, but this negatively affects the rehabilitation programme. For the force transfer characteristics of thrust plate prosthesis (TPP), a new type of hip prosthesis used without cement is similar to the normal hip. We evaluated the possibilities of early weight bearing after TPP by comparing early partial with early full weight bearing. Randomized controlled study. Department of orthopaedics and traumatology in a university hospital. Sixty hips of 51 patients who underwent total hip arthroplasty with TPP were randomly assigned into two groups. Both groups received accelerated rehabilitation programmes: group 1 with early partial weight bearing and group 2 with early full weight bearing. Patients were evaluated by a blind observer preoperatively, at three months after surgery by clinical (measurement of range of hip motion (universal goniometry), muscle strength (Manual Muscle Test), functional test (6-minute walk test), hip function (Harris Hip Scoring System)) and radiographical parameters and one year after surgery by clinical (Harris Hip Scoring System) and radiographical parameters. Group 2 performed transfer activities earlier, had more walking distance at the time of discharge and shorter hospital stay than group 1. At three months, Harris Hip Score, muscle strength, 6-minute walk test, and duration of crutch use were significantly (p < 0.05) in favour of group 2. None of the patients in either group showed signs of loosening one year after the operation. These results suggest that patients with TPP can tolerate an accelerated rehabilitation programme with early weight bearing and will gain the goals of rehabilitation earlier.

Position controlled Knee Rehabilitation Orthotic Device for Patients after Total Knee Replacement Arthroplasty

NASA Astrophysics Data System (ADS)

Wannaphan, Patsiri; Chanthasopeephan, Teeranoot

2016-11-01

Knee rehabilitation after total knee replacement arthroplasty is essential for patients during their post-surgery recovery period. This study is about designing one degree of freedom knee rehabilitation equipment to assist patients for their post-surgery exercise. The equipment is designed to be used in sitting position with flexion/extension of knee in sagittal plane. The range of knee joint motion is starting from 0 to 90 degrees angle for knee rehabilitation motion. The feature includes adjustable link for different human proportions and the torque feedback control at knee joint during rehabilitation and the control of flexion/extension speed. The motion of the rehabilitation equipment was set to move at low speed (18 degrees/sec) for knee rehabilitation. The rehabilitation link without additional load took one second to move from vertical hanging up to 90° while the corresponding torque increased from 0 Nm to 2 Nm at 90°. When extra load is added, the link took 1.5 seconds to move to 90° The torque is then increased from 0 Nm to 4 Nm. After a period of time, the speed of the motion can be varied. User can adjust the motion to 40 degrees/sec during recovery activity of the knee and users can increase the level of exercise or motion up to 60 degrees/sec to strengthen the muscles during throughout their rehabilitation program depends on each patient. Torque control is included to prevent injury. Patients can use the equipment for home exercise to help reduce the number of hospital visit while the patients can receive an appropriate therapy for their knee recovery program.

Rehabilitation - a new approach. Part four: a new paradigm, and its implications.

PubMed

Wade, Derick

2016-02-01

This editorial proposes changes in healthcare services that should greatly improve the health status of all patients with disability. The main premises are that: rehabilitation usually involves many actions delivered by many people from different organisations over a prolonged period; specific rehabilitation actions cover a wide range of professional activities, with face to face therapy only being one; and the primary patient activity that improves function is practice of personally relevant activities in a safe environment. This editorial argues that: rehabilitation should occur at all times and in all settings, in parallel with medical care in order to maximise recovery and to avoid loss of fitness, skills and confidence associated with rest and being cared for; hospitals and other healthcare settings should adapt the environment to encourage practice of activities at all times; and that measuring rehabilitation, whether in research or for re-imbursement, should not simply consider face-to-face 'therapy time' but must include: all the other important activities undertaken by the team; 'structures' such as the appropriateness of the environment; and a process measure of the time spent by patients undertaking activities. © The Author(s) 2016.

[Magnetic fields in physical therapy. Experience in orthopedics and traumatology rehabilitation].

PubMed

Borg, M J; Marcuccio, F; Poerio, A M; Vangone, A

1996-10-01

The present research is based on the premise that magnetic fields stimulate biological tissues, as many international works assert. They believe in the real aid of this therapeutical treatment in orthopedy and traumatology. The authors work in Rehabilitation Department of a traumatological hospital, so they have studied therapeutical results in ELF magnetotherapy on their patients for as long as six months.