Amount Of Rehabilitation Research Articles

Beyond Discharge Disposition: A Scoping Review on Sociodemographic Disparities in Rehabilitation Use after Hip and Knee Arthroplasty.

The aims of this scoping review were to summarize the evidence regarding sex, racial, ethnic, geographic, and socioeconomic disparities in post-acute rehabilitation following total hip arthroplasty (THA) and knee arthroplasty (TKA). Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and PEDro. Studies were included if they were original research articles published 1993 or later; used data from the US; included patients after THA and/or TKA; presented results according to relevant sociodemographic variables, including sex, race, ethnicity, geography, or socioeconomic status; and studied utilization of post-acute rehabilitation as an outcome. Twelve studies met the inclusion criteria. Five examined disparities in inpatient rehabilitation and found that Black patients and women experience longer lengths of stay after arthroplasty, and women are less likely than men to be discharged home after inpatient THA rehabilitation. Four studies examined data from skilled nursing facilities and found that insurance type and dual eligibility impact length of stay and rates of community discharge but found conflicting results regarding racial disparities in skilled nursing facility utilization after TKA. Five studies examined home health data and noted that rural agencies provide less care after TKA. Results regarding racial disparities in home health utilization after arthroplasty were conflicting. Six studies of outpatient rehabilitation noted geographic differences in timing of outpatient rehabilitation but mixed results regarding race differences in outpatient rehabilitation. Current evidence indicates that sex, race, ethnicity, geography, and socioeconomic status are associated with disparities in post-acute rehabilitation use after arthroplasty. Rehabilitation providers across the post-acute continuum should be aware of disparities in the population of patients after arthroplasty and regularly assess social determinants of health and other factors that may contribute to disparities. Customized care plans should ensure optimal timing and amount of rehabilitation is provided, and advocate for patients who need additional care to achieve the desired functional outcome.

Contributors to self-report motor function after anterior cruciate ligament reconstruction

Numerous functional factors may interactively contribute to the course of self-report functional abilities after anterior cruciate ligament (ACL)-reconstruction. This study purposes to identify these predictors using exploratory moderation-mediation models in a cohort study design. Adults with post unilateral ACL reconstruction (hamstring graft) status and who were aiming to return to their pre-injury type and level of sport were included. Our dependent variables were self-reported function, as assessed by the the KOOS subscales sport (SPORT), and activities of daily living (ADL). The independent variables assessed were the KOOS subscale pain and the time since reconstruction [days]. All other variables (sociodemographic, injury-, surgery-, rehabilitation-specific, kinesiophobia (Tampa Scale of Kinesiophobia), and the presence or absence of COVID-19-associated restrictions) were further considered as moderators, mediators, or co-variates. Data from 203 participants (mean 26 years, SD 5 years) were finally modelled. Total variance explanation was 59% (KOOS-SPORT) and 47% (KOOS-ADL). In the initial rehabilitation phase (< 2 weeks after reconstruction), pain was the strongest contributor to self-report function (KOOS-SPORT: coefficient: 0.89; 95%-confidence-interval: 0.51 to 1.2 / KOOS-ADL: 1.1; 0.95 to 1.3). In the early phase (2–6 weeks after reconstruction), time since reconstruction [days] was the major contributor (KOOS-SPORT: 1.1; 0.14 to 2.1 / KOOS-ADL: 1.2; 0.43 to 2.0). Starting with the mid-phases of the rehabilitation, self-report function was no longer explicitly impacted by one or more contributors. The amount of rehabilitation [minutes] is affected by COVID-19-associated restrictions (pre-versus-post: − 672; − 1264 to − 80 for SPORT / − 633; − 1222 to − 45 for ADL) and by the pre-injury activity scale (280; 103 to 455 / 264; 90 to 438). Other hypothesised contributors such as sex/gender or age were not found to mediate the time or pain, rehabilitation dose and self-report function triangle. When self-report function is rated after an ACL reconstruction, the rehabilitation phases (early, mid, late), the potentially COVID-19-associated rehabilitation limitations, and pain intensity should also be considered. As, for example, pain is the strongest contributor to function in the early rehabilitation phase, focussing on the value of the self-report function only may, consequently, not be sufficient to rate bias-free function.

REHABILITATION OUTCOMES IN PATIENTS WITH LOWER LIMB AMPUTATION RECEIVING HAEMODIALYSIS: A RETROSPECTIVE COHORT STUDY.

To compare the functional outcomes of patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis. A retrospective cohort study. Patients with lower limb amputation who were admitted to a convalescent rehabilitation ward between January 2018 and December 2021. The primary outcome was the effectiveness of the Functional Independence Measure (FIM) during hospitalisation in the ward. Secondary outcomes included the total and subtotal (motor/cognitive) FIM scores at discharge, gain in the total and subtotal (motor/cognitive) FIM scores, K-level at discharge, length of hospital stay in the ward, rehabilitation time, and discharge destination. Outcomes were compared between the non-haemodialysis and haemodialysis groups. A total of 28 patients (mean [standard deviation] age, 67.0 [11.9] years; men, 20) were enrolled in this study. Among them, 11 patients underwent haemodialysis. The FIM effectiveness was significantly higher in the non-haemodialysis group than in the haemodialysis group (median [interquartile range], 0.78 [0.72 - 0.81] vs 0.65 [0.28 - 0.75], p = 0.038). The amount of rehabilitation and all secondary outcomes were not significantly different between the groups (p > 0.05). Patients with lower limb amputation who were receiving haemodialysis had poorer FIM effectiveness than those not receiving haemodialysis.

The central nervous system involvement in listeria monocytogenes infection (clinical case)

Introduction. This report of Listeria monocytogenes infection with the involvment of central nervous system is important due to the increased frequency either in adults or children as well as the usually severe course and high mortality in generalized forms, especially with the CNS involvement. The demonstration of this clinical case, especialy the features of structural changes in the CNS with MRI in the disease’s dynamics, reflects the complexity of differential diagnosis and the evaluation of therapy effectiveness.Purpose of the study. To present a clinical case of CNS lesion in a 7-year-old child, the causative factor of which was listeria infection, with a detailed description of structural changes in the CNS using MRI studies.Material and methods. There is a clinical observation of a patient (child) with a diagnosis of listeriosis, secondary generalized form, extremely severe clinical course, with lesions of the central nervous system (meningoencephalitis). A series of magnetic resonance imaging studies of the brain in dynamics against the background of treatment are analyzed. Structural changes were assessed using multiparameter MRI of the brain using the following modes: T1-weighted, T2-weighted, Flair, T1-weighted with contrast, diffusionweighted and diffusion tensor imaging (DWI / DTI), susceptibility weighted imaging (SWI), MR perfusion, MR angiography.Results. The revealed structural changes in the brain during dynamic MRI examination, as well as their correlation with the data of anamnesis and clinical and laboratory data, made it possible to confirm meningoencephalitis, as well as to evaluate and make adjustments to the treatment.Conclusion. The described clinical case, the features of the course of the disease and MRI changes, suggest that dynamic MRI research is of great importance in identifying and assessing (including dynamics) structural changes in the brain substance in patients with neurological disorders in infectious diseases. The obtained data can be used by the attending physicians to assess and correct the ongoing therapy, to determine the required amount of rehabilitation.

Quantifying the amount of physical rehabilitation received by individuals living with neurological conditions in the community: a scoping review

BackgroundPhysical rehabilitation is often prescribed immediately following a neurological event or a neurological diagnosis. However, many individuals require physical rehabilitation after hospital discharge. The purpose of this scoping review was to determine the amount of physical rehabilitation that individuals living in the community with neurological conditions receive to understand current global practices and assess gaps in research and service use.MethodsThis scoping review included observational studies that 1) involved adults living with a neurological condition, and 2) quantified the amount of rehabilitation being received in the community or outpatient hospital setting. Only literature published in English was considered. MEDLINE, EMBASE, AMED, CINAHL, Cochrane Library, and PEDro databases were searched from inception. Two independent reviewers screened titles and abstracts, followed by full texts, and data extraction. Mean annual hours of rehabilitation was estimated based on the amount of rehabilitation reported in the included studies.ResultsOverall, 18 studies were included after screen 14,698 articles. The estimated mean annual hours of rehabilitation varied greatly (4.9 to 155.1 h), with individuals with spinal cord injury and stroke receiving the greatest number of hours. Participants typically received more physical therapy than occupational therapy (difference range: 1 to 22 h/year). Lastly, only one study included individuals with progressive neurological conditions, highlighting a research gap.DiscussionThe amount of rehabilitation received by individuals with neurological conditions living in the community varies greatly. With such a wide range of time spent in rehabilitation, it is likely that the amount of rehabilitation being received by most individuals in the community is insufficient to improve function and quality of life. Future work should identify the barriers to accessing rehabilitation resources in the community and how much rehabilitation is needed to observe functional improvements.

The effect of time spent in rehabilitation on activity limitation and impairment after stroke.

The effect of time spent in rehabilitation on activity limitation and impairment after stroke.

Influence of the amount of rehabilitation and the disease phase on recovering independence in patients with cerebral stroke

Objective ‒ to determine independent predictors and develop a prognostic model for asses-sing the likelihood of lack of a good outcome (dependence) in cerebral stroke patients with severe disabilities who were admitted to a comprehensive stroke unit in a subacute or chronic phase.Materials and methods. A retrospective observational study enrolled patients with a verified cerebral stroke, who were admitted to the Stroke Center (SC) over 2010‒2018 in the early subacute (from Day 8 to Day 90 from onset), the late subacute (from Day 91 to Day 180 from onset) or chronic (after 180 days from onset) phase of the disease and had severe disabilities upon admission (i.e. a modified Rankin scale (mRS) 4 or 5). There were included 290 patients (38.7 % of women) aged from 20.4 to 91.2 years (median ‒ 64.9 years, interquartile range ‒ 56.6‒74.6). Care in the SC was provided in accordance with guidelines and included active interdiscipli-nary rehabilitation. The restoration of independence in daily living at discharge was considered a good outcome (mRS 0‒2). We assessed the relationship of the risk of failure to achieve a good outcome with five clinical variables: age, sex, stroke period, and baseline mRS score and the amount (dose) of rehabilitation (total time of physical therapy, ergotherapy or mechanotherapy).Results. 81 (28.0 %) participant had intracerebral hemorrhage, whereas 209 (72.0 %) had cerebral infarction. The total National Institutes of Health stroke scale (NIHSS) score on admission ranged from 1 to 36 (median 14 points, interquartile range 10–20). While 188 (64.8 %) of the patients were hospitalized to the SC during the early subacute, 34 (11.8 %) and 68 (23.4 %) study participants were admitted only in the late subacute and chronic phase of stroke, respectively. In the analysis of generalized linear regression models, three features had a significant relationship with a decrease in the mRS score: sex, time from stroke onset to SC admission, and the total time of mechanotherapy. According to the multivariate analysis, four factors were significantly associated with a need for assistance in activities of daily living at SC discharge: the risk of dependence was significantly (p = 0.004) lower in men, was directly depended on the initial mRS score and the time elapsed from the estimated stroke onset to the SC admission, but was inversely related to the amount (dose) of certain rehabilitation interventions (the odds ratio of not achieving a good outcome was 0.93 (95 % CI 0.89‒0.97) for every additional 100 minutes of mechanotherapy). The logistic regression model based on the selected set of features turned out to be adequate (χ2 = 60.7 at 7 degrees of freedom, p &lt;0.001). The area under the curve of operational characteristics AUC = 0.82 (95 % CI 0.77‒0.86) indicates good internal prognostic model agreement, and its sensitivity and specificity were good with 76.1 % (95 % CI 70.1‒81.4 %) and 75.0 % (95 % CI 61.6‒85.6 %), respectively.Conclusions. In a cohort of patients with cerebral stroke, independent predictors of dependency after in-patient rehabilitation were identified and a predictive model was developed to assess the likelihood of a good treatment outcome. If its external validity is confirmed in other settings, the developed model may be useful for optimizing treatment strategies and providing patients and their families with prognostic evaluations.

The Quantity Of Rehabilitation Is Associated With Patient Reported Outcomes Following ACL Reconstruction

Athletes demonstrate impaired self-reported outcomes and reduced psychological readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). Formal physical therapy (PT), in conjunction with their home exercise program (HEP), ideally continues until an athlete is cleared to RTS. The quantity of total rehabilitation completed and its relationship to patient reported outcomes (PROs) remains unknown. PURPOSE: Determine the relationship between the amount of rehabilitation from 4-6 months post-ACLR to PROs at 9 months. METHODS: Fifteen athletes (8 M, 16.7 ± 2.9 yrs., 171.2 ± 8.4 cm, 63.9 ± 13.3 kgs) completed a weekly four-question survey between 4-6 months following an ACLR. Questions consisted of the number of times the athlete went to PT, completed their HEP, ran, and lifted leg weights with activity ranging from 0-7 days/week. The survey was sent via a secure web-based database. At the 9-month follow-up, the athletes completed both the International Knee Documentation Committee (IKDC) and the ACL-Return to Sport after Injury (ACL-RSI). Pearson correlations were calculated between activity quantity from 4-6 months and PROs at 9 months. RESULTS: The average bouts of running per week (2.1± 1.5 bouts) 4-6 months after surgery was significantly associated with the 9-month IKDC (72 ± 6.9, r = 0.74, p < 0.01). Bouts of running per week (r = 0.54, p = 0.04) and increased adherence to the HEP (3.5 ± 1.7 bouts, r = 0.56, p = 0.03) were significantly related to the 9-month ACL-RSI (55 ± 26). The average number of PT visits per week (0.96 ± 0.7) was not related to IKDC or ACL-RSI (p > 0.05). CONCLUSION: These data suggest that increased activity, including running and HEP, during the critical 4-6-month period after surgery may result in increased self-reported outcomes and psychological readiness to RTS. Increased activity may improve athletes’ comfort and confidence in their knee function. Those who were committed to running and their home exercises early after recovery may have continued to maintain this regimen through to their 9-month time point and thus felt better about their outcome. These data highlight the importance of athlete adherence to an early and consistent rehabilitation program, paired with clinician reinforcement of the HEP, for improved patient outcomes following ACLR.

A Portable Soft Hand Exerciser With Variable Elastic Resistance for Rehabilitation and Strengthening of Finger, Wrist, and Hand1

Stroke is the leading cause of long term disability and has a major impact on societal and healthcare burden [1,2]. The recovery and rehabilitation process, if not well-managed, can lead to aftereffects which will impact on the quality of lives of the patients and their families. It was reported that early rehabilitation management after acute stroke leads to better outcomes and shorter hospitalization stays [3]. However, stroke rehabilitation is both manpower and resourceintensive. Hence, the shortage of skilled expertise and equipment is the primary limiting factor to the amount of rehabilitation each patient can receive. It is also observed that stroke patients spend a large part of their time resting in bed without any activity and this time could be better utilized for bedside therapy at their own convenience [4]. Existing hand exercisers, such as putty, elastic bands, grip strengtheners, soft balls and finger webs, are associated with disadvantages such as portability, durability, limited range of motion, and operational use on one hand only. Most devices also consist of only one elastic resistance in one unit, requiring the user to purchase multiple color-coded units as they progress in their rehabilitation or strength training. In this study, we aim to develop a portable, lightweight, and intuitively designed multifunctional soft hand exerciser with variable elastic resistances within one unit. The gradient feature of different resistance levels is expected to motivate and hasten user progress up the level of difficulty. This device should support a variety of finger, hand, wrist, and arm exercises in multiple planes of motion. Currently, this device is intended for use by outpatients suffering from hand injuries or disabilities, but with some residual strength in their fingers, hand, and wrist, and are in the stage of recovery toward regaining their strength. This portable and lightweight device is designed primarily for use at home to facilitate patient’s recovery outside of in-clinics therapy. Other user groups such as the elderly could also utilize this device for strength and flexibility training. Eventually, our goal is to make iterations to this device for use as a supplementary therapeutic intervention for stroke in-patients to self-manage a range of hand, finger, and wrist exercises by their bedside.

Стан соматичного здоров’я дітей раннього віку із синдромом Дауна

Із метою удосконалення медичного супроводження дітей раннього віку із синдромом Дауна проведено аналіз особливостей розвитку 35 дітей віком від одного місяця до трьох років із регулярною формою трисомії 21. Установлено високу частоту обтяженого перинатального анамнезу, відхилень показників фізичного розвитку. Відзначено, що в періоді раннього дитинства стан соматичного здоров’я дітей із синдромом Дауна визначають наявність уроджених аномалій серцево-судинної системи та інших органів, функціональні порушення органів травлення, щитоподібної залози. Оцінка особливостей соматичного здоров’я має важливе значення в обґрунтуванні обсягів реабілітаційних заходів при медичному спостереженні за такими дітьми.

What aspects of rehabilitation provision contribute to self‐reported met needs for rehabilitation one year after stroke – amount, place, operator or timing?

Background and ObjectiveTo a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self‐reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.MethodsThe participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self‐reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home‐based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.ResultsParticipants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd–4th quarters of the first year (OR 8.36, CI 1.40–49.88 P = 0.020) were more likely to report met rehabilitation needs.ConclusionFor people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self‐reported met needs for rehabilitation.

Handling of the tibial muscle envelope in tibial plateau levelling osteotomy - to elevate or not?

To compare the outcome of the tibial plateau levelling osteotomy (TPLO) procedure, using a 6-hole 3.5 mm locking TPLO plate and performed with the muscle elevation technique (ET) and placement of sponges, to the TPLO without performing these steps (non-elevation-technique [NET]). Medical records and radiographs of dogs with ET (n = 21) or NET (n = 19) were retrospectively reviewed. Signalment, TPLO procedure side, meniscal treatment, surgery time, haemorrhage, pre- and postoperative tibial plateau angle, assistant, amount of rehabilitation, bone healing (cortical, osteotomy, combined healing scores), complications, limb function, recovery time and follow-up were recorded and analysed using multivariate analysis. A value of p <0.05 was considered significant. Surgery time was significantly shorter with the NET (68.5 min ± 3.4) than with the ET (87.8 min ± 3.4) (p <0.01). No significant differences were detected for all other evaluated factors. Soft tissue trauma was minimal and none of the dogs suffered severe haemorrhage. The bone healing scores with the NET and the ET were not significantly different (p = 0.1, p = 0.2, p = 0.1). Complications were rare, minor and not significantly different between groups (p = 0.73). The results of this in vivo study indicate that NET is a feasible technique that can be considered for the clinical setting.

Satisfaction with rehabilitation in relation to self‐perceived quality of life and function among patients with stroke – a 12 month follow‐up

Stroke causes complex disability and function, and perceived quality of life has been shown to correlate with satisfaction with care as well as with life in general among stroke patients. The aim of this study was to study the relation of satisfaction with how rehabilitation was provided with self-perceived quality of life, self-perceived function and rehabilitation received, 12 months after the incidence. The subjects were assessed 12 months after the onset of stroke. The Barthel index was used to measure function, and the EuroQol-5D to measure quality of life. To measure satisfaction with how rehabilitation was provided, a questionnaire from the Swedish Stroke Register was used. Two hundred and eighty-three patients participated in the follow-up, 137 women and 146 men, aged between 42 and 95 years (mean age 75.2, SD 11.8). For the majority of patients rehabilitation was initiated at in-hospital care (directly after onset). One hundred and sixty-eight patients considered that rehabilitation was well provided for. Sixty-six regarded that the rehabilitation was only partly provided for and 35 that it was not provided for at all. High value on Barthel Index was associated with satisfaction with how rehabilitation was provided for (OR 2.81). Also, rehabilitation on three or more levels was negatively associated with satisfaction with rehabilitation provision (OR 0.24) and so was being male (OR 0.49). In this study, patients with higher values on Barthel Index were more satisfied with how rehabilitation was provided for. However, male patients and patients who received rehabilitation on three or more levels of care were less satisfied. Given the assumption that patients with more severe dysfunction after stroke are being rehabilitated on more levels, this might imply that it is not the amount of rehabilitation that gives satisfaction but the patients self-perceived function after rehabilitation.

A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

BackgroundReducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.Methods/DesignA randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.DiscussionThis paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.Clinical trial registration numberAustralian and New Zealand Clinical Trials Registry ACTRN12609000973213

Effects of intensity of rehabilitation after stroke. A research synthesis.

A research synthesis was performed to (1) critically review controlled studies evaluating effects of different intensities of stroke rehabilitation in terms of disabilities and impairments and (2) quantify patterns by calculating summary effect sizes. The influences of organizational setting of rehabilitation management, blind recording, and amount of rehabilitation on the summary effect sizes were calculated. A Medline literature search was performed for a critical review of the literature. The internal and external validity of the studies was evaluated. In addition, a meta-analysis was performed by applying the fixed (Hedges's g) effects model. The effects of different intensities of rehabilitation were studied in nine controlled studies involving 1051 patients. Analysis of the methodological quality revealed scores varying from 14% to 47% of the maximum feasible score. Meta-analysis demonstrated a statistically significant summary effect size for activities of daily living (0.28 +/- 0.12). Lower summary effect sizes (0.19 +/- 0.17) were found for studies in which experimental and control groups were treated in the same setting compared with studies in which the two groups of patients were treated in different settings (0.40 +/- 0.19). Variables defined on a neuromuscular level (0.37 +/- 0.24) showed larger summary effect sizes than variables defined on a functional level (0.10 +/- 0.21). Weighting individual effect sizes for the difference in amount of rehabilitation between experimental and control groups resulted in larger summary effect sizes for activities of daily living and functional outcome parameters for studies that were not confounded by organizational setting. A small but statistically significant intensity-effect relationship in the rehabilitation of stroke patients was found. Insufficient contrast in the amount of rehabilitation between experimental and control conditions, organizational setting of rehabilitation management, lack of blinding procedures, and heterogeneity of patient characteristics were major confounding factors.