Acute Rehabilitation Program Research Articles

ACUTE MYOCARDIAL INFARCTION WITH “ST” SEGMENT ELEVATION IN SOUTHERN MARCHE: INTRA AND POST–HOSPITAL PROCESS INDICATORS IN THE APPLICATION OF THE UNIFIED PDTA “RETE STEMI” AST OF ASCOLI PICENO AND FERMO. LONGITUDINAL OBSERVATIONAL CLINICAL STUDY

Abstract Background SCAs (Acute Coronary Syndromes) are one of the most frequent cardiovascular diseases, among which STEMI is certainly the most relevant in terms of short and long–term prognosis. The latest ESC Guidelines about ACS–STEMI indicate some key elements in terms of diagnosis and treatment, from first contact to cardiological rehabilitation. Objective Detect the number of SCA–STEMIs managed in the AST of Ascoli Piceno, along with intra and post–hospital process indicators provided in the PDTA of the “RETE STEMI” issued by the Marche Region specifically in AST of Ascoli Piceno. MATERIALS & METHODS An observational, longitudinal, monocentric, not–for–profit clinical study without diagnostic–therapeutic interventions was designed. The data collection started on 01/11/2022 and ended on 30/06/2023, at “Madonna del Soccorso” Hospital of San Benedetto del Tronto and “Mazzoni” Hospital of Ascoli Piceno in Cardiological Intensive Care Units (UTIC). Useful data for this study were acquired every month, consulting the folders of each patient diagnosed with “SCA–STEMI”, and then, reported in an Excel sheet, they were processed with different mathematical and statistical functions, including frequency, percentage, arithmetic average and standard deviation, and later used to design tables and graphs. All the data have been aggregated in full compliance with current legislation on the protection of patient privacy. Results The most significant results are related to the time between the first medical contact and the’ starting of the PPCI procedure, with an average time detected of 110 minutes. Another very important result is the number of patients sent to a post–acute cardiological rehabilitation program (PCRP): from the present study it appears that only the 1% of the entire sample was sent to a PCRP. Finally, other indicators considered in relation to the PDTA appear to be in line with the current Guidelines. Conclusions The present study highlights the aspects of the STEMI PDTA of the Marche Region which could be improved, namely reducing FCM–Wire crossing time and sending patients to a cardiological rehabilitation program, also by implementing the figure of the nurse specialized in the critical and cardiological area.

Clinical Profile of the Stroke Recovering Patients in the Acute Rehabilitation Setting in Peshawar

All stroke patients across the stroke spectrum frequently experience functional deficits of varying degrees. Despite the idea of post-stroke functional advancement, there is a lack of information regarding post-acute stroke recovery. Objective: To track the progress of acute stroke patients admitted to acute stroke rehabilitation centers in terms of functional recovery. Methods: A cohort study was designed and extracted the data of ninety-five (N=95) acute stroke patients admitted to the center for the acute rehabilitation program (ARP). Ninety-five (N=95) post-stroke patients with the mRS 3-4 (Modified ranking scale) admitted to the centers were enrolled for this retrospective cohort study. All enrolled patients for the study went through functional, neurophysiological and quality of life assessment/evaluation was taken at the time of admission to the center and before the discharge from the center. The score at the discharge were the functional outcomes and were used to compare them with the score taken at the time of admission (baseline score). Results: The results of the retrospective cohort showed that the average length of stay was 56.40 days. After the intervention of the intensive ARP significant improvement were observed in all test score. The removal rate for foley catheter (p=0.003), Nasogastric tubes (p=0.00) was found for all patients at the time of discharge. Conclusions: The study's findings demonstrated that ARP can help acute stroke patients who have functional deficits improve their functional status. To find more efficient forms of intervention in the acute-stroke rehabilitation, this study advises future research

The Inclusion of a Complementary Running Progression Program in the Rehabilitation of Acute Hamstring Injuries: A Critically Appraised Topic

Introduction/Clinical Scenario: As many hamstring injuries occur when the hamstrings are in a lengthened state during the deceleration phase of running when the muscle is eccentrically contracting to slow the body down this functional aspect needs to be addressed. Thus, a rehabilitation program with a focus on progressive targeted eccentric hamstring exercises by gradually placing and exposing the muscle to eccentric force in a lengthened state supplemented with progressive running drills should be evaluated. Focused Clinical Question: Does the inclusion of a complementary running progression program for the rehabilitation of an acute hamstring injury reduce the time to safe return to sport with less hamstring reinjury occurrence for an athletic population? Summary of Key Findings: Three studies assessed the inclusion of a progressive running program with several types of running progression parameters addressed. Progressive running drills will load the hamstring in a functional manner, with a gradual increase in velocity of movement and lengthening of the muscle. Clinical Bottom Line: It appears that a complementary progressive running program within an acute hamstring rehabilitation program should be included as it caused no further harm and does not tend to increase hamstring reinjury occurrence. Strength of Recommendation: There is grade B evidence to include a complementary running progression program within an acute hamstring rehabilitation program.

The role of acute rehabilitation in COVID-19 patients.

In the published literature there is scarce data on the importance of acute rehabilitation in patients suffering from COVID-19 disease. Evaluation of the feasibility of respiratory and neuromuscular rehabilitation treatment in stable acute COVID-19 inpatients. The study was designed as an observational prospective investigation of two cohorts respectively identified as Mild/Moderate and Stable Severe COVID-19 disease. All patients received a rehabilitation treatment consisting of breathing exercises, range of motion exercises and strengthening exercises, with the main difference in intensity and progression of treatment, depending on individual capacity of patient. Inpatients with diagnosed mild to moderate, or stable severe COVID-19 infection were included in the study. Acute COVID-19 inpatients. Patients were divided into two groups depending on the severity of disease: "mild to moderate group" (MMG) and "stable severe group" (SSG). Functional outcomes included the Barthel Index (BI), Six Minute Walk Test (6MWT), Borg Scale for dyspnea, "Time Up and Go" Test (TUG), "Sit To Stand" test (STS), "One Leg Stance Test" (OLST) and Beck Depression Inventory (BDI) were evaluated at baseline and after rehabilitative treatment, on discharge. We included 147 acute COVID-19 inpatients (75 male and 72 female), mean aged 63.90±13.76 years. There were noticeable statistically significant improvements in all observed measurements in both groups. Comparison between groups showed significant difference in MMG compared to SSG in all functional outcomes: TUG (P<0.001), STS (P<0.001), OLST (P<0.001), BDI (P=0.008), BI (P<0.001), and Borg scale for dyspnea (P<0.001). Despite the significant improvements of BI in SSG, the obtained values showed that the patients were still not functionally independent. Acute respiratory and neuromuscular rehabilitation program is a feasibile, but also effective and safe method for improving functional status in patients with COVID-19 infection. Results of the present study implicate that a supervised early rehabilitation program, implemented in the treatment of patients with COVID-19 disease in the acute phasis a feasible way for significant improvement of patient's functional outcomes. Early rehabilitation should be included into clinical protocols for the treatment of patients with COVID-19.

Patients' perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer.

This study aimed to examine challenges, competencies, and supportive care needs (SCN) of women with breast or gynecological cancer during acute cancer treatment and associations to other health-related variables. We surveyed 120 patients with breast or gynecological cancer at the end of acute cancer treatment, either directly after surgery or during adjuvant chemotherapy. We assessed challenges, subjective competencies, and SCN using a self-developed measure comprising 25 items referring to coping tasks assigned to six domains. In addition, patients' competencies and health literacy (HL) were assessed. Most patients felt at least moderately challenged by coping tasks concerning psychological distress (e.g., dealing with fears and insecurities, 70.2%; coping with cancer diagnosis, 69.6%) and physical complaints (e.g., dealing with a reduced physical capacity, 56.6%). About 42.5%-71.4% of patients who evaluated coping tasks as highly challenging felt competent to deal with these challenges themselves. Less than half of patients reported SCN, mainly regarding psychological concerns. The extent of challenging coping tasks, patients' perceived ability to overcome challenges themselves, and SCN showed associations to patient competencies and HL. SCN regarding psychological concerns and health behavior should be addressed in acute cancer care and rehabilitation programs. In addition, promoting HL might be essential in strengthening patients' subjective competencies related to various coping tasks.

Continuity of Care Advocate Model (CCAM): Healthcare Workers' Perspectives on Quality Stroke Care at an Acute Unit, Rehabilitation Center and Community Rehabilitation Program in Singapore.

Physicians, nurses, social workers, and allied health professionals including physiotherapists and occupational therapists play important roles as they work closely with stroke survivors to improve functional independence in daily activities and quality of life. Yet, in Singapore little is known about their perspectives on what constitute quality stroke care based on their clinical experiences. In this project, our qualitative interviews with 15 healthcare workers at a major stroke center in the country yielded a Continuity of Care Advocate Model (CCAM) to help us better understand our participants' experience-based perspectives on quality stroke care. We found that CCAM, constructed based on the perspectives of HCWs across a stroke care continuum, is a holistic model of quality stroke care which prioritizes support for patients and their families throughout the patient's health trajectory. We conclude by discussing how this model is aligned with and differs from current research on definitions of care continuity.

Evaluation of the Use of Neuro Muscular Taping (NMT) in the Treatment of Postoperative Edema in Acute ACL Repair Surgery

Background: Surgical techniques for the treatment of Anterior Cruciate Ligament (ACL) injuries are exponentially improved in the past few decades. Nevertheless, edema and pain commonly accompany post-surgical procedures and when excessive, can adversely affect the healing course. In recent years, Neuro Muscular Taping (NMT) has been proposed as a new technique for the treatment of post-operative edema. Objective: In this study, we aimed to investigate the effects Neuro Muscular Taping (NMT) in the treatment of edema in the acute and post-acute postoperative phases of ACL repair surgery. Methods: Thirty patients (19 M, 11F; mean age: 27 y/o) with ACL injury were randomly assigned to two groups for the rehabilitation program: (1) An experimental group to receive a NMT treatment; or (2) A control group which underwent the standard-of-care rehabilitation protocols. Both groups where weekly monitored for 4 weeks after the surgery. Swelling was assessed through measurement of the limb circumference; post-operative pain was evaluated with VAS. After collection, data were processed by means of the Mann-Whitney and Wilcoxon statistical tests, through which we evaluated the percentage decrease in knee swelling of the operated limb. Results: In comparison to the control group, the experimental group showed significant improvements in swelling and pain. The circumference of the operated limb registered was: -2.4% ±0.1 in the NMT-treated group and + 0.3% ±0.2 in the control group in the first week (p = 0.030), -3.7% ±0.1 in the NMT-treated group and -0.63% ±0.3 in the control group in the second week (p = 0.038), -4.5% ±0.1 in the NMT-treated group and -1.2% ±0.3 in the control group in the third week (p = 0.019), -5.8% ±0.1 in the NMT-treated group and -2.4% ±0.3 in the control group in the fourth week (p = 0.019). VAS in the first week was 3.11 ±01.05 in NTM-treated group and 4.67 ±0.71 in the control group (p = 0.006). Our data showed a statistically significant reduction of the mean circumference of the lower limb at each time point and the reduction of mean VAS at the first week treated with NMT compared to the control group (p &lt; 0.05). Conclusion: Our results revealed that NMT technique applied in the acute rehabilitation program of ACL surgery is effective in the treatment of postoperative edema.

Impact of Frailty on Acute Rehabilitation Outcomes: An Observational Study in a Regional Australian Context

Aims To determine associations between frailty and patient outcomes for participants in an acute rehabilitation program. Methods Retrospective participant data (n = 987) was extracted, and correlations between the Clinical Frailty Scale (CFS) and patient outcomes (FIMTM, FIMTM Efficiency, LOS, Discharge Destination, Unexpected clinical complication) were examined through statistical analysis (Logistic regression, ANCOVA, Kendall’s Tau, odds ratios). Results The study cohort was 49.1% female and 50.9% male, averaging 82.3 years of age. FIMTM was weakly correlated with frailty, with both extent and efficiency declining with increasing frailty. This was statistically significant, despite being weak (p < 0.001). There was a similar correlation between increasing CFS and less favorable discharge destination. CFS was not a reliable indicator of LOS nor unexpected clinical complication. Conclusions More frail patients often benefited from rehabilitation, and frailty score alone should not be used to select acute rehabilitation inpatients.

Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants' demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group's time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6-20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.

Disuse-Induced Muscle Loss and Rehabilitation: The National Aeronautics and Space Administration Bed Rest Study.

The time course and magnitude of atrophic remodeling and the effects of an acute rehabilitation program on muscle atrophy are unclear. We sought to characterize bed rest-induced leg muscle atrophy and evaluate the safety and efficacy of an acute rehabilitation program. Prespecified analysis of a randomized controlled trial. Single-center urban hospital. Adults (24-55 yr) randomized to 70 days of sedentary bed rest. The 11-day post-bed rest rehabilitation program consisted of low intensity exercise and progressed to increased aerobic exercise duration, plyometric exercises, and higher intensity resistance exercise. Upper (rectus femoris, vastus lateralis, quadriceps, hamstrings, adductors) and lower leg (medial gastrocnemius, lateral gastrocnemius, and soleus) MRI scans were obtained once before, nine times during, and three times after bed rest to assess muscle cross-sectional area. The magnitude and rate of muscle atrophy and recovery were determined for each muscle. Nine participants completed 70 days of sedentary bed rest and an 11-day rehabilitation program. A total of 11,588 muscle cross-sectional area images were quantified. Across all muscles except the rectus femoris (no change), there was a linear decline during bed rest, with the highest atrophic rate occurring in the soleus (-0.33%/d). Following rehabilitation, there was rapid recovery in all muscles; however, the quadriceps (-3.74 cm2; 95% CI, -7.36 to -0.12; p = 0.04), hamstrings (-2.30 cm2; 95% CI, -4.07 to -0.54; p = 0.01), medial gastrocnemius (-0.62 cm2; 95% CI, -1.10 to -0.14; p = 0.01), and soleus (-1.85 cm2; 95% CI, -2.90 to -0.81; p < 0.01) remained significantly lower than baseline. Bed rest results in upper and lower leg muscle atrophy in a linear pattern, and an 11-day rehabilitation program was safe and effective in initiating a rapid trajectory of muscle recovery. These findings provide important information regarding the design and refinement of rehabilitation programs following bed rest.

Methodology and baseline characteristics of a randomized controlled trial testing a health care professional and peer-support program for patients with chronic obstructive pulmonary disease: The BREATHE2 study

BackgroundSelf-management support (SMS) for patients with COPD can improve health-related quality of life (HRQOL). However, it remains unclear what SMS strategies are most effective. Using peer support to advance self-management is promising, as peer supporters possess credibility and can serve as role models. MethodsWe conducted a single-blinded RCT comparing the effectiveness of two strategies to support patients with COPD. The strategies were ‘Health Care Professional (HCP)’ and ‘HCP Plus Peer’ support. Peer support was provided by patients with COPD who have stopped smoking, completed an acute pulmonary rehabilitation program, and met the requirements for becoming a peer supporter. We enrolled patients receiving treatment at inpatient and outpatient settings. Patients were encouraged to invite one family-caregiver to enroll with them. The primary outcome measure was the change in HRQOL at 6 months post enrollment. Secondary outcomes included COPD-related and all-cause hospitalizations and ED visits. Caregiver outcomes included preparedness for caregiving, caregiver stress, and coping. ResultsA total of 292 patients as well as 50 family-caregivers were enrolled. The average patient age was 67.3 yrs. (SD 9.4), 61% were female and 26% were African-Americans. The majority of caregivers were females (68%) and were a spouse/partner (58%). DiscussionThis study tested a dual strategy for providing support to patients with COPD that incorporates peer and health care professional support. The study had minimal exclusion criteria. If shown effective, the study offers a program of peer support that can be readily implemented in health care settings.

Psychotropics and Neuroprotection: Literature Review and Case Series Report

Agitation is a common manifestation of acute brain injury. When not addressed, agitation can lead to slower recovery rates, including delayed admission to acute rehabilitation programs. Antipsychotics are commonly used to control agitation in acute brain injury in the ICU. However, there is no current consensus on the most

Evaluating Effectiveness of an Acute Rehabilitation Program in Hospital-Associated Deconditioning.

Acute hospitalization can result in significant decline in functional ability, known as hospital-associated deconditioning. Older adults are most vulnerable, with resultant functional difficulties and increased risk of institutionalization. This study evaluates the effectiveness of a multidisciplinary acute rehabilitation program in hospital-associated deconditioning on routinely collected outcome data to examine its impact to determine whether a controlled trial is warranted. We conducted a retrospective review of the hospital database for the national rehabilitation clinical registry for 2013 and 2014. We analyzed responses from patient feedback questionnaires over a 2-year period to assess patient experience of the rehabilitation program. The analysis included 289 patients referred to our acute rehabilitation program. Most patients were aged 81-90 years, representing 47% (n = 137) of all admissions. The main impairment group was deconditioning (54%). The median entry time to the acute rehabilitation program for this impairment group was 5 days from admission and length of stay in the rehabilitation program was 9 days. Many of these patients (57%) were directly discharged home, with only 21% needing transfer for inpatient rehabilitation. The average Functional Independence Measure score gain was 22 for the patients directly discharged home, with an average discharge Functional Independence Measure score of 94/126. Of the patient feedback responses received (response rate: 24%), 96% rated the program as very good or good. We observed improved functional outcomes among program participants, with the majority directly discharged home, reduced transfer to rehabilitation hospitals, and patient acceptance of this acute rehabilitation program. These promising results suggest that a more rigorous evaluation of this acute rehabilitation program in the management of hospital-associated deconditioning is warranted.

Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices and Subsequent Stroke.

The aim of the study was to examine the functional outcomes and medical complications of patients with left ventricular assist device implantation and subsequent stroke during comprehensive inpatient rehabilitation. Retrospective cohort study of 21 patients admitted to an inpatient rehabilitation facility between 2009 and 2015. Main outcome measurements include admission and discharge Functional Independence Measure, length of stay, and Functional Independence Measure efficiency. The study included 17 male and 4 female patients aged 32-75 yrs. Eleven patients (52%) required transfer to an acute care hospital for evaluation. Fifteen patients completed inpatient rehabilitation with median [interquartile range] length of stay 26 [13.5-34] days (range = 7-59 days), median [interquartile range] Functional Independence Measure gain of 18 [12.5-32], and median [interquartile range] Functional Independence Measure efficiency of 1.0 [0.6-1.44]. Patients who required transfer to acute care during their course but ultimately completed inpatient rehabilitation (n = 5) demonstrated larger median [interquartile range] Functional Independence Measure gain (40 [23-42]) and longer median [interquartile range] length of stay (35 [35-42]) compared with patients who completed inpatient rehabilitation without transfer (Functional Independence Measure gain = 15 [9.25-26.5]; length of stay = 14.5 [11.5-26.25]). Patients with left ventricular assist device implantation and subsequent stroke demonstrate functional gains during acute inpatient rehabilitation programs. A large percent of patients required transfer to acute care.

WeeFIM Completion for Outcome Tracking in an Acute Outpatient Rehabilitation Program

WeeFIM Completion for Outcome Tracking in an Acute Outpatient Rehabilitation Program

Kinesio taping as a treatment method in the acute phase of ACL reconstruction: A double-blind, placebo-controlled study

ObjectiveIn this study, we aimed on investigating the effects of Kinesio taping (KT) in acute postoperative rehabilitation phase of anterior cruciate ligament (ACL) reconstruction. MethodsThirty male patients (mean age: 28.1 years) with ACL reconstruction were randomly assigned to two groups: (1) an experimental group to receive a KT treatment through the muscle and lymphatic correction techniques; or (2) a control group for sham KT. Both interventions were applied twice during a 10-day period from the fourth postoperative day. All patients received the same rehabilitation program for three months. The groups were compared according to range of motion (ROM), pain, swelling and muscle strength before treatment and on the fifth and tenth treatment days. Subjective evaluations were made with the Lysholm, modified Cincinnati and Tegner scores on the first and third postoperative months. ResultsIntragroup comparisons showed significant improvements in both groups on the fifth and tenth day and first and third month evaluations (p < 0.05). In comparison to the control group, the experimental group showed significant improvements in swelling around the patella, all pain measurements and hamstring muscle strength on the fifth KT day and knee flexion range of motion (ROM), night pain, all swelling measurements and hamstring muscle strength on the tenth KT day (p < 0.05). ConclusionOur results revealed that KT techniques applied in addition to the acute rehabilitation program of ACL reconstruction are beneficial in treatment of pain, swelling, knee flexion ROM, and hamstring muscle strength. Level of evidenceLevel I, Therapeutic study.

Poster 457-C Towards Reducing Harms: Designing a Quality Improvement Project to Improve Pain Management and Outcomes Among Chronic Pain and Opioid Users in an Acute Rehabilitation Program

Poster 457-C Towards Reducing Harms: Designing a Quality Improvement Project to Improve Pain Management and Outcomes Among Chronic Pain and Opioid Users in an Acute Rehabilitation Program

RH-01 * THE SIGNIFICANCE OF ACUTE INPATIENT REHABILITATION FOR GLIOMA PATIENTS: IMPROVING THE PHYSICAL FUNCTION, QUALITY OF LIFE AND SURVIVAL

OBJECTIVE: To assess the effects of inpatient acute rehabilitation on overall function, quality of life and overall survival for glioma patients. DESIGN: A retrospective study of glioma patients treated at UCI Neuro-Oncology Program. PARTICIPANTS: We have identified 12 patients with glioma diagnosis who underwent inpatient acute rehabilitation program using our IRB approved neuro-oncology database. OUTCOME ASSESSMENT TOOLS: Functional status based upon Karnofsky performance scale (KPS), quality of life as assessed by Functional Assessment of Cancer Therapy Brain (FACT-Br) and overall survival. RESULTS: We identified on our study 3 patients with glioblastoma, 7 patients with anaplastic gliomas, and 2 patients with low grade gliomas. All of them had radiation and chemotherapy, except 2 patients with low grade gliomas who had radiation treatment only. The age range is from 26 to 77 and the mean age is 49-year-old. All the patients who underwent the acute inpatient rehabilitation program at our institution, not only improved their KPS scale significantly, but also enhanced their social and emotional well-being. The median KPS improvement is 30 points from a 3-6 weeks stay. Functional Assessment of Cancer Therapy Brain (FACT-Br) is obtained from 4 patients at this time (further information will be presented at SNO conference). The mean FACT-Br TOI is 60.8, and the total FACT0Br Score is 119.6. Survival data are still collected. CONCLUSIONS: The patients who underwent acute inpatient rehabilitation program, showed significant improvements in their functional status and quality of life. The observation from this pilot study warrants further research and demonstrates the acute inpatient rehabilitation may be beneficial to glioma patients with good physical functions and tolerance for 3 hours a day of physical, occupation and speech therapies.

Enhancing Health Promotion During Rehabilitation Through Information-Giving, Partnership-Building, and Teach-Back

This clinical article explores how Street, Gordon, and Millay's framework of evidence-based communication strategies of information-giving and partnership-building can be used by rehabilitation nurses and other rehabilitation team members in their practice to help patients with health promotion. This clinical article gives practical suggestions for using the information-giving strategies of control, description, instructions, options, outlook, rationale, recommendations, and risks; and the partnership-building strategies of agreement, decision-making, questions, and requests to assist patients. Combined with the teach-back method, these strategies have been shown to increase the likelihood that patients will lose weight, adopt a regular exercise program, and bring chronic illnesses such as hypertension and diabetes under control, which is also likely to increase patients' functional ability and independence. These strategies can be used by rehabilitation nurses and all members of the rehabilitation team in acute, sub-acute, out-patient, and in-home rehabilitation programs.

Medical Complications During Inpatient Rehabilitation Among Patients With Traumatic Disorders of Consciousness

ObjectiveTo assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs). DesignData on adverse events in a placebo controlled trial of amantadine hydrochloride revealed no group difference, which allowed these events to be reanalyzed descriptively as medical complications experienced by the 2 groups collectively. SettingEleven clinical facilities in the United States, Denmark, and Germany with specialty rehabilitation programs for patients with DOCs. ParticipantsPatients (N=184) with nonpenetrating traumatic brain injury enrolled from acute inpatient rehabilitation programs between 4 and 16 weeks postinjury. InterventionsParticipants were randomized to receive 200 to 400mg of amantadine hydrochloride or placebo daily for 4 weeks, and followed for an additional 2 weeks. Adverse events were recorded and categorized with respect to their nature, timing, and severity. Main Outcome MeasureNumber, type, and severity of medical complications occurring during the 6-week study interval. ResultsA total of 468 medical complications were documented among the patients (.40 events per week per patient). More than 80% of patients experienced at least 1 medical complication, and 41 of these were defined as serious adverse events. New medical complications declined over time in rehabilitation and were not dependent on time since injury. Hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance were the most commonly reported problems. Hydrocephalus, pneumonia, gastrointestinal problems, and paroxysmal sympathetic hyperactivity were the most likely to be severe. ConclusionsPatients with DOCs have a high rate of medical complications early after injury. Many of these complications require brain injury expertise for optimal management. Active medical management appears to contribute to the reduction in new complications. An optimal system of care for DOC patients must provide expert medical management in the early weeks after injury.