12-week Rehabilitation Program Research Articles

#5764 STUDY OF THE INFLUENCE OF PHYSICAL ACTIVITY ON THE FUNCTION OF EXTERNAL RESPIRATION IN PATIENTS WITH CKD IN THE PROCESS OF REHABILITATION

Abstract Background and Aims Chronic kidney disease is a global health problem in which patients performance decreases as renal dysfunction progresses. The aim was to study of the function of external respiration in patients with CKD in the dynamics of a 12-week rehabilitation program. Method The study included 130 patients with CKD stages 2-3, aged 45 to 65 years, whose average age was 58.7 ± 0.73 years, and the proportion of women in the sample was 47.7%. All patients were examined of urea, serum creatinine, hemoglobin level. To determine exercise tolerance, a cardiorespiratory exercise test and spirogram were performed. Patients of the main group, depending on the initial CRET parameters, were divided into 2 subgroups: 1 subgroup - 67 patients who performed light intensity exercises; 2 subgroups - 33 patients who performed medium-intensity exercises for 12 weeks 3 times a week. The choice of training intensity was made according to the level of individual or subjective perception of the load and was calculated using the approximate heart rate. The control group consisted of patients with CKD stages 2-3 who did not perform physical training. Results An analysis of the spinographic parameters of patients with CKD revealed that the FEV1 and FVC indicators are of great importance in assessing the results of rehabilitation measures. There were positive results of 12 weeks of physical training with a more pronounced increase in FEV1. Patients in the light intensity training group achieved 35-45% of maximum heart rate or 40% of peakO2 consumption, and in the moderate intensity training group, 45-55% of maximum heart rate and 50-60% of peakO2 were achieved. The index (FEV1/FVC, in %) showed significant differences both in the initial indicators and in the dynamics. Conclusion In patients with pre-dialysis stages of CKD, a significant effect was revealed with the combined use of standard therapy and physical activity of light and moderate intensity, which ensures the preservation of positive dynamics in terms of the degree of increase in diastolic blood pressure at the time of exercise and respiratory parameters (FEV-1 and FVC, p<0.05).

Evaluation of the MOVE online exercise programme for young people aged 13–30

PurposeTo evaluate the MOVE exercise programme in supporting the recovery of young people affected by cancer.MethodsParticipants in an 8-week exercise rehabilitation programme delivered online by cancer rehabilitation specialists completed self-reported questionnaires at baseline and after programme completion. Assessments included cancer-related fatigue (FACIT fatigue scale) and health-related quality of life (EORTC-QLC-30). Qualitative data were provided through written accounts of participant experiences and underwent content analysis.ResultsSeventy-one participants commenced the exercise rehabilitation programme and 57 completed the programme and provided data for analysis (63% female; median age 22 years). Statistically significant improvements were observed in post-programme scores for all measured outcomes (cancer-related fatigue, quality of life, physical functioning, role functioning, emotional functioning). Content analysis of written experiences generated ten unique codes. The highest frequency codes were enjoyment (n = 34), motivation (n = 14) and fitness (n = 13).ConclusionsThese findings indicate feasibility of delivery, acceptability to patients and physical and psychological benefits of a personalised online exercise rehabilitation programme for young people living with and beyond cancer. Further research involving a control arm and long-term follow-up would be beneficial.Implications for cancer survivorsThese results support the inclusion of a personalised exercise programme as part of cancer rehabilitation for young people living with and beyond cancer.

Heart Failure Rehabilitation Impacts Quality of Life and Readmissions: Breathlessness Rehabilitation Classes Integrating Heart Failure and Pulmonary Rehabilitation Made Positive Impact on Quality of Life, Health Literacy, and Readmissions

Heart Failure (HF) patients often have limited exercise capacity due to dyspnoea and fatigue. Despite the availability of effective treatment, HF is associated with poor quality of life (QOL), high morbidity and mortality. Māori are twice as likely to die and four times as likely to be hospitalised for HF. Heart failure hospitalisations cost an estimated 2% to the New Zealand health system. Until the late 1980s, exercise was considered unsafe for HF; since then, considerable research evidence has suggested that exercise is safe and provides substantial physiological and psychological benefits. Whilst potential benefits are clear, there were no guidelines or resources available for HF patients in Hawkes Bay. With aim of improving functional capacity and QOL for HF patients and reduce readmissions, rehabilitation space was explored. Fiscal budgets and need of a multidisciplinary team were barriers to idealistic HF rehabilitation. The HF rehabilitation was integrated into pulmonary rehabilitation, with modification as per HF guidelines on exercise, content, and training of all staff regarding cardiology. The HF rehabilitation classes commenced in rural and urban regions (four regions in total). Patients were selected as per referral criteria and the first assessment was completed by the cardiologist/nurse practitioner/clinical nurse specialist and referred to an 8-week rehabilitation program. QOL tools were used to measure the before and after outcomes. More than 200 patients were referred and evaluated for results. Twenty-five HF patients were interviewed to understand enablers and barriers to rehabilitation. The HF patients who attended the program were almost 50% less likely to be readmitted, had reduced breathlessness, and improved fitness. Self-management skills and health literacy were also improved. Heart failure rehabilitation has proven to be a low-cost, high-value intervention, but is generally underused.

Additive benefit of rehabilitation on physical status, symptoms and mental health after hospitalisation for severe COVID-19 pneumonia

IntroductionThe potential additive benefits of rehabilitation beyond spontaneous recovery post-COVID-19 currently remain unknown.MethodsIn this prospective, interventional, non-randomised parallel assignment two-arm study, we investigated the effects of an 8-week rehabilitation programme...

The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study.

determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight. Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test. according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed. our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.

Non-inferiority of a hybrid outpatient rehabilitation: a randomized controlled trial (HIRE, DRKS00028770)

BackgroundPhysiotherapeutic telerehabilitation in various musculoskeletal and internal diseases, including back pain, might be comparable to face-to-face rehabilitation or better than non-rehabilitation. In Germany, a standardized back school for patients with chronic back pain is provided in outpatient rehabilitation centers. The effectiveness of this standardized back school was shown in a randomized controlled trial in face-to-face rehabilitation. This study examines non-inferiority of a hybrid rehabilitation applying a digital version of the standardized back school against a rehabilitation applying the face-to-face back school.Methods/designWe recruit 320 patients in eight German outpatient rehabilitation centers. Patients are randomized equally to the intervention and control groups. Patients aged 18 to 65 years with back pain are included. Patients lacking a suitable private electronic device and German language skills are excluded. Both groups receive the standardized back school as part of the 3-week rehabilitation program. The control group receives the back school conventionally in face-to-face meetings within the outpatient rehabilitation center. The intervention group receives the back school online using a private electronic device. Besides the back school, the patients participate in rehabilitation programs according to the German rehabilitation guideline for patients with chronic back pain. Hence, the term “hybrid” rehabilitation for the intervention group is used. The back school consists of seven modules. We assess data at four time points: start of rehabilitation, end of rehabilitation, 3 months after the end of rehabilitation and, 12 months after the end of rehabilitation. The primary outcome is pain self-efficacy. Secondary outcomes are, amongst others, motivational self-efficacy, cognitive and behavioral pain management, and disorder and treatment knowledge. Guided interviews with patients, physicians, physiotherapists and other health experts supplement our study with qualitative data.Discussion/aimOur randomized controlled trial aims to demonstrate non-inferiority of the online back school, compared to conventional implementation of the back school.Trial registrationGerman Clinical Trials Register (DRKS00028770, April 05, 2022).

Peak Quadriceps Muscle Torque and Electromyographic Output in Patients With Chronic Respiratory Disorders: Effects of Pulmonary Rehabilitation

ObjectiveTo assess the change in relation of the peak quadriceps electromyographic signal to the peak torque produced during a train of 5 isokinetic knee extensions (from 90 degrees below horizontal at a constant speed of 60 degrees/s) at baseline, and at 4 and 8 weeks of pulmonary rehabilitation. DesignIn this prospective observational study, isokinetic contractions were recorded during the extensions from the knee bent at 90 degrees to the horizontal plane against graded resistance. Peak quadriceps torque signal (Tq) and peak electromyographic signal (Eq) were recorded by dynamometry and surface electrodes placed at designated locations over the muscle group, respectively. SettingPhysical therapy department in a tertiary care medical center. ParticipantsEighteen patients (9 restrictive lung disease, 6 chronic airflow limitation, 3 non-ILD restrictive; N=18) were compared with 11 healthy control subjects. InterventionsPatients underwent an 8-week pulmonary rehabilitation program. Main Outcome MeasuresComparisons of Tq, Eq, and Tq/Eq ratio among patients and controls were by analysis of variance. Associations between physiological variables were determined by multivariable Pearson's correlation. ResultsCompared with patients, controls exhibited a 22% higher baseline mean peak Eq (P<.05) and 76% higher mean peak Tq (P=.02) during knee extensions. Patients’ peak Eq/Tq was twice as high as in the controls (P=.02); at 4 weeks, Eq/Tq in patients decreased by 44% (P<.04) with no further decline at 8 weeks; changes in Eq/Tq of 5 of 6 patients paralleled changes in their respective St George's Respiratory Questionnaire scores. There was no change in Tq or Eq/Tq over time among the control cohort. ConclusionsEight weeks of pulmonary rehabilitation result in a decrease in Eq/Tq, indicating improvement in force generation of limb muscles, with the change occurring in the first 4 weeks.

Exercise training reduces circulating cytokines in male patients with coronary artery disease and type 2 diabetes: A pilot study.

Low-grade inflammation is central to coronary artery disease (CAD) and type 2 diabetes (T2D) and is reduced by exercise training. The objective of this study was to compare the anti-inflammatory potential of moderate-to-vigorous intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with CAD with or without T2D. The design and setting of this study is based on a secondary analysis of registered randomized clinical trial NCT02765568. Male patients with CAD were randomly assigned to either MICT or HIIT, with subgroups divided according to T2D status (non-T2D-HIIT n= 14 and non-T2D-MICT n= 13; T2D-HIIT n= 6 and T2D-MICT n= 5). The intervention was a 12-week cardiovascular rehabilitation program consisting of either MICT or HIIT (twice weekly sessions) and circulating cytokines measured pre- and post-training as inflammatory markers. The co-occurrence of CAD and T2D was associated with increased plasma IL-8 (p= 0.0331). There was an interaction between T2D and the effect of the training interventions on plasma FGF21 (p= 0.0368) and IL-6 (p= 0.0385), which were further reduced in the T2D groups. An interaction between T2D, training modalities, and the effect of time (p= 0.0415) was detected for SPARC, with HIIT increasing circulating concentrations in the control group, while lowering them in the T2D group, and the inverse occurring with MICT. The interventions also reduced plasma FGF21 (p= 0.0030), IL-6 (p= 0.0101), IL-8 (p= 0.0087), IL-10 (p< 0.0001), and IL-18 (p= 0.0009) irrespective of training modality or T2D status. HIIT and MICT resulted in similar reductions in circulating cytokines known to be increased in the context of low-grade inflammation in CAD patients, an effect more pronounced in patients with T2D for FGF21 and IL-6.

Deprescribing Strategies for Opioids and Benzodiazepines with Emphasis on Concurrent Use: A Scoping Review.

While the Food and Drug Administration's black-box warnings caution against concurrent opioid and benzodiazepine (OPI-BZD) use, there is little guidance on how to deprescribe these medications. This scoping review analyzes the available opioid and/or benzodiazepine deprescribing strategies from the PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases (01/1995-08/2020) and the gray literature. We identified 39 original research studies (opioids: n = 5, benzodiazepines: n = 31, concurrent use: n = 3) and 26 guidelines (opioids: n = 16, benzodiazepines: n = 11, concurrent use: n = 0). Among the three studies deprescribing concurrent use (success rates of 21-100%), two evaluated a 3-week rehabilitation program, and one assessed a 24-week primary care intervention for veterans. Initial opioid dose deprescribing rates ranged from (1) 10-20%/weekday followed by 2.5-10%/weekday over three weeks to (2) 10-25%/1-4 weeks. Initial benzodiazepine dose deprescribing rates ranged from (1) patient-specific reductions over three weeks to (2) 50% dose reduction for 2-4 weeks, followed by 2-8 weeks of dose maintenance and then a 25% reduction biweekly. Among the 26 guidelines identified, 22 highlighted the risks of co-prescribing OPI-BZD, and 4 provided conflicting recommendations on the OPI-BZD deprescribing sequence. Thirty-five states' websites provided resources for opioid deprescription and three states' websites had benzodiazepine deprescribing recommendations. Further studies are needed to better guide OPI-BZD deprescription.

Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial

We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity.

The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial

BackgroundTotal hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. ObjectiveThis study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. DesignRandomised controlled trial. SettingA teaching hospital in Shanghai, China. ParticipantsEighty-six patients who received a unilateral primary total hip or knee arthroplasty. MethodsThe participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. ResultsAt 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = −0.51, 95% CI −0.91 to −0.10, P = .015), and depression (adjusted mean difference = −0.37, 95% CI −0.66 to −0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. ConclusionMobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. Trial registrationRegistered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

The Effect of a Formal Nonoperative Management Program Combining a Hip Injection With Structured Adjunctive Exercise Rehabilitation in Patients With Symptomatic Femoroacetabular Impingement Syndrome

Background: Although the initial treatment recommendations for femoroacetabular impingement syndrome (FAIS) may include nonsurgical therapies such as injections and rehabilitation, many patients undergo isolated injections or a rudimentary exercise regimen. Purpose: To investigate the benefit of an intra-articular hip injection and concomitant structured exercise rehabilitation program in patients with symptomatic FAIS ≥6 months. Study Design: Case series; Level of evidence, 4. Methods: For this study we recruited 49 patients with a mean age of 32.8 years (range, 16-56 years) and symptoms ≥6 months (range, 6-250 months) associated with FAIS, as confirmed via magnetic resonance imaging and radiography. After a guided intra-articular injection of corticosteroid and local anesthetic, patients underwent a structured 12-week rehabilitation program. Patients were assessed before and after injection (8 weeks and 4, 6, 12, and 24 months) with a range of patient-reported outcome measures (PROMs), including the 33-item International Hip Outcome Tool, Hip Outcome Score, modified Harris Hip Score, the Tegner Activity Score, a visual analog scale assessing the frequency and severity of hip pain, and a Global Rating of Change scale. Range of motion, peak isometric hip strength, and hop tests were assessed. Absolute scores and limb symmetry indices were calculated. The percentage of patients transitioning toward surgery over the period was evaluated. Results: Of the 44 patients who underwent the injection and completed the initial 8-week rehabilitation component, 14 (31.8%) progressed toward surgical intervention over the 24-month postinjection period owing to dissatisfaction and/or symptom recurrence. Patients who progressed toward surgery, as compared with those who did not, reported significantly worse (P < .05) PROMs presurgery and more pain within the first 4 weeks after injection. In the nonoperative cohort, a significant improvement (P < .05) in all PROMs was observed, with 93% of these patients satisfied overall. The Global Rating of Change did not improve, although this was measured only after the injection, reflecting no further significant perceived global change from 8 weeks to 24 months. A significant increase (P < .05) in all hip range of motion and most isometric strength measures was observed at 8 weeks after injection, with these improvements largely sustained until 24 months. Bilateral improvements in hop capacity were observed, with hop test LSIs significantly improving for the single (p = 0.009), triple (p = 0.029) and triple crossover (p = 0.005) hop tests for distance. Conclusion: Although 32% of patients progressed toward surgery, significant improvement in hip pain, symptoms, and physical function was observed in the majority of patients with symptomatic FAIS as a result of a targeted nonoperative management pathway consisting of an intra-articular injection and a structured exercise program.

Using wearable devices in cardiac rehabilitation to increase uptake and intensity of physical activity: a pilot evaluation

Background/Aims Wearable devices to track exercise parameters have received increasing interest in the healthcare sector as a potential tool to help improve patient outcomes, particularly in cardiac rehabilitation. This pilot evaluation assessed the effectiveness of the Fitbit Inspire HR wearable device in increasing exercise intensity and step counts among patients undergoing cardiac rehabilitation. Methods A total of 39 patients (35 men, four women) undergoing an 8-week cardiac rehabilitation programme participated in the study. All participants were given a Fitbit Inspire HR device to wear both during and outside of sessions. Data regarding their step count, heart rate reserve and Borg scale score were collected at weeks 1, 5 and 8. The Statistical Package for Social Sciences version 27 was used to analyse the differences between the time points, with significance set at P≤0.05. Results Participants’ heart rate reserves and step counts increased significantly between weeks 1 and 5 (P=0.008), then the values were maintained up to week 8. There were no differences between Borg scale scores across the study. Conclusions Wearable devices, such as Fitbit Inspire HR, can help patients undergoing cardiac rehabilitation to track and improve their physical activity both in and outside of the clinical setting, but more research is needed to understand the role of positive feedback and the efficacy of these devices for older patients and women.

Effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with lumbar spinal stenosis with neurogenic claudication: a randomized controlled clinical trial protocol

BackgroundLumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is a leading cause of disability which is intimately related to a decrease in walking capacity. Walking limitation has negative physical and mental impacts on patients. Recent guidelines recommend the use of conservative treatment options such as exercises before considering surgery. Unfortunately, dedicated healthcare resources for the conservative management of patients with LSS causing NC are uncommon. Thus, it is important to develop accessible and specific rehabilitation programs aimed at improving patients’ self-management, especially with regard to walking capacity. The aim of this study is to evaluate the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC.Methods/designThis is a prospective randomized controlled parallel-group clinical trial. Sixty-six patients with LSS causing NC will be recruited from identified clinics and local advertisements. The intervention group will receive standardized education and specific exercises while the control group will only receive a standardized education. The program in both groups will last for 6 weeks with 5 evaluation time points (baseline, week 2, week 4, week 6, and week 12). The primary outcome will be walking capacity measured with the Self-Paced Walking Test, and the secondary outcomes will be back and leg pain intensity, LSS-related disability, self-efficacy, level of physical activity, anxiety, depression, gait pattern characteristics, balance, and global perceived change.DiscussionThis study will assess the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. By measuring objective gait pattern characteristics, the study will also provide new information about the impact of NC on gait pattern that could eventually improve the evaluation and the management of LSS.Trial registrationClinicalTrials.gov NCT05513326. Registered on August 22, 2022

Corrigendum: The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD.

Corrigendum: The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD.

Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study.

Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway, this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. This study aimed to assess the feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. A feasibility study with a mixed methods explanatory sequential design was implemented. The intervention was a 12-week group-based rehabilitation program comprising 5 components: goal setting, physical exercise, psychoeducation, individual follow-up consultations, and peer support. Feasibility was assessed through recruitment, retention, and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive, and qualitative data were transcribed and analyzed using framework analyses. Sixty participants started, and 55 completed the 12-week rehabilitation program. The majority were female (80%), and the mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as were adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. High retention, strong adherence, and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway "Home."

Psychiatric Rehabilitation Amidst COVID-19: Do Pandemic Restrictions Affect the Therapeutic Efficiency?

Community psychiatry is an effective and increasingly popular form of care for patients with mental disorders. Due to sanitary restrictions imposed by the COVID-19 pandemic, psychiatric rehabilitation programs had to adapt to the highly specific requirements and modify the offer of therapeutic activities for patients. Above all the activities focused on, social interactions were limited. The aim of the study was to assess the effectiveness of the modified rehabilitation program in light of the introduced sanitary restrictions due to COVID-19. This prospective observational single-centered study involved 41 patients diagnosed with organic mental disorders, psychotic disorders, affective disorders and anxiety disorders. The patients participated in a 6-week rehabilitation program which included varied forms of physical exercise, cognitive training, psychological training and Small Group Therapy. The quality-of-life assessment and the intensity of depression and anxiety symptoms were measured using standardized scales: Hospital Scale of Anxiety and Depression (HADS) and Short Form Health Survey (SF-36) at two time points before the initiation of the rehabilitation process and at the end of the program’s participation period. Median HADS D before admission to the rehabilitation center was 9 (IQR 6–12), and 5 (IQR 3–9) after 6-week participation (p &lt; 0.05). Median SF-36 at the beginning of rehabilitation was 93 (IQR 80–106) and 73 (IQR 53–95) at the end of the evaluation period (p &lt; 0.05), Median HADS-A at the start of rehabilitation was 11 (IQR 9–14) and 9 (IQR 6–12) after final assessment (p &gt; 0.05). The gender and age of the participants did not influence the results of the utilized standardized evaluation tools (p &gt; 0.05 for both). We observed an improvement in the participants’ subjective assessment of the intensity of the depression symptoms and the quality of life after partaking in the available activities. There was no clear benefit regarding the subjective assessment of the intensity of anxiety symptoms among the study participants resulting from the introduction to the program.

Patients' and Health Care Providers' Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study.

Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86% of the patients). Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users.

Effects of Meditation on Cardiovascular and Muscular Responses in Patients during Cardiac Rehabilitation: A Randomized Pilot Study.

Background: Cardiovascular diseases are the world’s number one cause of death, with exceeding psychosocial stress load being considered a major risk factor. A stress management technique that has repeatedly shown positive effects on the cardiovascular system is the Transcendental Meditation (TM) technique. The present pilot study aimed to investigate the potential effect of TM on the recovery of cardiac patients. Objectives: We hypothesized that practicing TM in patients undergoing a 4-week cardiac rehabilitation program augments the recovery of cardiovascular parameters and reduces skeletal muscle tone after rehabilitation. Methods: Twenty cardiac patients were recruited and randomly assigned to either the control or the TM group. Cardiovascular parameters were assessed with the Task Force Monitor (TFM) and skeletal muscle contractile properties by Tensiomyography during a sit-stand test, performed at the beginning and end of a 4-week in-patient rehabilitation program. Results: Systolic blood pressure (SBP) was significantly lower after 4 weeks of cardiac rehabilitation, while the RR-interval (RRI) significantly increased. At the skeletal muscle level, the contraction time and maximal displacement increased, though only in the gastrocnemius medialis and biceps femoris muscles and not in vastus lateralis. Group interactions were not observed for hemodynamic parameters nor for muscle contractile properties. Discussion: Although significant improvements in hemodynamic and muscular parameters were observed after 4 weeks of rehabilitation, we could not provide evidence that TM improved rehabilitation after 4 weeks. TM may unfold its effects on the cardiovascular system in the longer term. Hence, future studies should comprise a long-term follow-up.

Responsiveness of the Post-Concussion Symptom Scale to Monitor Clinical Recovery After Concussion or Mild Traumatic Brain Injury.

Background:The Post-Concussion Symptom Scale (PCSS) is used to assess the number and intensity of symptoms after a concussion/mild traumatic brain injury. However, its responsiveness to monitor clinical recovery has yet to be determined.Purpose:To evaluate the responsiveness of the PCSS to change and longitudinal validity in patients with persistent postconcussive symptoms as well as to explore the responsiveness of other clinical outcome measures to monitor recovery of physical symptoms in patients with persistent postconcussive symptoms.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Patients with persistent symptoms after a concussion (N = 109) were evaluated using self-reported questionnaires at baseline and after a 6-week rehabilitation program. The program consisted of an individualized symptom-limited aerobic exercise program combined with education. Questionnaires included the PCSS, Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), and Numeric Pain Rating Scale (NPRS) related to 1) neck pain and 2) headache. Internal responsiveness was evaluated using the effect size (ES) and standardized response mean (SRM), and external responsiveness was determined with the minimal clinically important difference (MCID) calculated using a receiver operating characteristic curve. The global rating of change was used as the external criterion. Pearson correlations were used to determine the longitudinal validity.Results:The PCSS was highly responsive (ES and SRM, >1.3) and had an MCID of 26.5 points (of 132) for the total score and 5.5 (of 22) for the number of symptoms. For longitudinal validity, low to moderate correlations were found between changes in PCSS and changes in NDI, HDI, and DHI. The NDI, HDI, DHI, and NPRS were also highly responsive (ES and SRM, >0.8).Conclusion:All questionnaires including the PCSS were highly responsive and can be used with confidence by clinicians and researchers to evaluate change over time in a concussion population with persistent symptoms.