Rehabilitation Care Research Articles

Descriptive retrospective cross-sectional study of rehabilitation care for poststroke users in Québec during the COVID-19 pandemic

ObjectivesDuring the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This...

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial

ObjectiveTo investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.DesignA feasibility randomised controlled trial with a parallel process evaluation.SettingAcute Stroke Unit...

Effectiveness of a New Device for Hand, Wrist, and Forearm Rehabilitation: Feasibility Randomized Controlled Trial.

Forearm, wrist, and hand impairments affect many individuals and impose a significant economic burden on health care systems. The FEPSim (flexion, extension, pronation, and supination) is designed for hand and wrist rehabilitation. It could become part of the standard care for upper extremity rehabilitation, aiming to improve range of motion, dexterity, and strength during therapeutic activities. However, the FEPSim has not yet been tested in a health care setting, highlighting the need for a trial to assess its effectiveness in upper extremity rehabilitation. We aim to assess the feasibility of conducting a definitive trial investigating the effectiveness of adding a new device for hand therapy exercises, the FEPSim, to standard care for patients with impairments of the hand, wrist, and forearm. Thirty-eight patients with impairments of distal upper extremities were randomly assigned either to the intervention group (FEPSim and standard care, n=19) or to the control group (standard care, n=19). Therapeutic activities to increase strength, range of motion, resistance, and dexterity were delivered by treating hand therapists using the FEPSim device for the intervention group. Outcome measures included wrist passive and active range of motion, grip strength, pinch grip force, and the Patient-Rated Wrist Evaluation. The trial retention rate (36/38, 95%) and compliance (control group: 100%; intervention group: 89%) were high. The comparisons of the change-from-baseline between groups revealed that in 63.2% (12/19) of the outcome variables, the change was in favor of the FEPSim, with statistically significant improvements in passive wrist flexion (t34=-0.335, P=.008) and grip strength (t34=-1.841, P=.04). The FEPSim was accepted as part of standard care by therapists and patients at 2 hospitals. The trial design was feasible for hand intervention using the FEPSim device. The FEPSim positively affected grip strength, an objective measure of hand functioning.

The Johns Hopkins Hope at Hopkins Clinic: supporting the comprehensive needs of individuals with metastatic breast cancer.

Individuals with metastatic breast cancer (MBC) may live with their disease for many years. We initiated the Johns Hopkins Hope at Hopkins Clinic to assess the needs and optimize the care of these patients. Patients with MBC who agreed to participate in the Clinic in addition to usual care completed patient-reported outcome (PRO) surveys. They met with a navigator and underwent core consults (cancer rehabilitation, integrative medicine, supportive and palliative care, social work, and nutrition), clinical trial eligibility assessment, and optional services based on PRO responses and selection from a Clinic Menu. A medical oncologist provided a Care Plan during a final consult. Participants were asked to complete 3- and 6-month follow-up PRO surveys. We report on initial Clinic implementation, participant characteristics, and baseline PROs. From 11/2020 to 6/2022, 45 patients completed baseline surveys and participated in the Clinic. Median age was 58 (32-86); the majority (71%) were white and had estrogen receptor-positive (84%) tumors. Baseline physical and mental health were not good for ≥ 14days of the past month for 22 and 10%, respectively. PROMIS measure scores were > 1 standard deviation worse than average for 32% for Physical Health, 16% for Mental Health, and 23% for Physical Function. PHQ-8 and GAD-7 scores suggested depression and anxiety for 22 and 7%, respectively. More than 80% of participants received specific recommendations from the core consultants. Only 20% of participants completed follow-up surveys. Patients living with MBC have multiple needs. We used our results to implement routine PRO assessments and to expand services for patients with MBC. Our experience can serve as a model for coordinated care in other systems.

Conception of a mobile health application targeting early postoperative physiotherapeutic care after total knee replacement, a qualitative study

IntroductionMobile applications targeting physiotherapeutic care after total joint replacements are increasing in popularity among end-users. However, these applications were primarily conceived out of financial interest and lack an evidence-based programs tailored to the specific needs of the target population. The primary objective of this study is to describe the conception of an evidence-based mobile health application that targets early postoperative physiotherapeutic care after total knee replacement (TKR).MethodsA literature search of eHealth applications targeting physical therapy after TKR was carried out. Articles were then screened and suggestions as well as recommendations were extracted to inform the design of a new application. The beta version of the application was then passed onto experts for evaluation. Final changes were then undertaken to account for the expert's opinions.ResultsSeveral reviews with recommendations for the design of applications targeting patients after total joint replacement were identified. Primarily, mobile applications targeting rehabilitative care after TKR need to be tailored to the needs of the elderly population. Additionally, no unified rehabilitative physiotherapeutic (PT) program was found reflecting a discrepancy regarding what exercises are most useful. A comparison of different programs yielded no significant difference favoring one single exercise regimen.DiscussionAs the elderly population was shown to be less proficient regarding the use of new technologies, the application at hand was explicitly made simple. Elements of different PT programs were incorporated and quadriceps strengthening exercises were included. application was composed based on the findings of the reviewed literature and then subsequently modified to incorporate the expert's suggestions. Experts mainly expressed concerns regarding the safety of patients during unsupervised physical therapy as well as the safety of the recorded data. Thus, password protection and a split between the physician's and the patient's interface was created.

Mechanism evaluation of a digitally enabled rehabilitation intervention for people in aged care and neurological rehabilitation: mediation analysis of the AMOUNT trial

Purpose To investigate potential mechanisms of a digital rehabilitation intervention associated with improved mobility among adults undertaking rehabilitation. Materials and methods Causal mediation analysis of the AMOUNT trial (ACTRN12614000936628). Participants were randomised to digitally-enabled rehabilitation (virtual reality video games, activity monitors, and handheld computer devices prescribed by a physiotherapist) and usual care or usual care alone. Outcomes were mobility (Short Physical Performance Battery; continuous version; range 0–3), physical activity (average steps per day), and quality of life (EQ-5D-5L; utility score; range 0–1) measured at 6-months post-randomisation. Hypothesised mediators included mobility, physical activity, cognition, balance confidence, pain, activity and participation, and computer self-efficacy, assessed at 3-weeks post-randomisation. Results 216 participants with complete data were included. Three-week sit-to-stand ability mediated 6-month mobility (indirect effect 0.09 points, 95%CI 0.03–0.16), explaining 48% of the intervention’s effect. Dynamic single-leg-stance balance mediated physical activity (indirect effect 345 steps per day, 95%CI 63–678) and composite mobility mediated quality of life (indirect effect 0.03 points, 95%CI 0.00–0.05). Conclusion Digital rehabilitation outcomes appear to be mediated through sit-to-stand ability, dynamic single-leg-stance balance, and overall mobility. While future research is required to better understand these mediators, our findings recommend sit-to-stand training as a core element of digital rehabilitation interventions targeting mobility.

Self-regulation in eHealth: definition, contributing factors, and experiences from blended rehabilitation care

Purpose eHealth might contribute to changes in roles and responsibilities of patients and healthcare professionals (HCPs), including the patient’s potential to enhance self-regulation. The aim of this study was to identify important aspects and experiences of self-regulation and factors that may support self-regulation in blended rehabilitation care. Materials and methods Semi-structured interviews were conducted among HCPs and patients regarding perceptions and experiences with self-regulation in relation to a telerehabilitation portal. Thematic analysis was used to identify themes. Results According to HCPs (n = 18), aspects of self-regulation are: an active role of patients, a facilitating role for HCPs, and collaboration. Patients and parents (n = 24) experienced self-regulation by: having an active role and having a voice. Aspects of eHealth that support self-regulation are: at home usage, flexible scheduling, easily accessible communication, using it as a reference work, using it to stimulate motivation, and adapting usage to different phases of treatment. Conclusion Patients and HCPs agree that patients having an active role is important for experiencing self-regulation. A telerehabilitation portal that can be flexibly used at home, with a communication and log module, can support self-regulation. Optimising eHealth design to stimulate self-regulation, and measuring the impact of eHealth on self-regulation should be further studied.

Gender-Specific Patterns of Injury in Older Adults After a Fall from a Four-Wheeled Walker (Rollator): Retrospective Study from a Swiss Level 1 Trauma Centre

Aim: As the population is aging, falls by older people, in particular falls from four-wheeled walkers (“rollators”), are a growing problem. These falls must be examined by targeted research and interventions that incorporate gender differences. Therefore, this study examined the injury patterns of elderly patients admitted to a tertiary trauma centre in Switzerland after falls from rollators and focussed on gender differences. Methods: This was a retrospective single-centre study for the period from May 2012 to December 2019 which included elderly patients (≥65 years) who had suffered a fall from a rollator. Injury history, patient data, demographic information, and patient outcomes were compared between males and females, with the data sourced from the Ecare patient database, which contains all information related to patient visits and treatment procedures. Results: A total of 152 eligible patients were included in the analysis, with 56.6% hospitalised at our facility and 14.5% transferred to another hospital. The cohort comprised 50 (32.9%) males and 102 (67.1%) females. Males were more prevalent in the 75–84 age group, while females predominated in the 85 and older group, and this difference was statistically significant (p = 0.043). Osteoporosis was significantly more common in females (37.3% vs. 10%, p ≤ 0.001). Consequently, treatment with vitamin D and/or calcium was also significantly more prevalent among women (29.4% vs. 8%, p = 0.003). Most falls occurred at home (22.4%) or in nursing care facilities and rehabilitation centres (22.4%), without gender-based differences (p = 0.570). Men were six times more likely than women to sustain injuries when under the influence of alcohol (p = 0.002). Fractures to the lower extremities were the most common injuries, accounting for 34.2% of all injuries, with no statistically significant differences between groups (p = 0.063). Head injuries occurred in 34.9% of patients, with a trend towards more injuries in males (44% vs. 30.4%, p = 0.098). The cumulative rates of fractures to the pelvis, upper extremities, and lower extremities were significantly higher in females (59.8%) than in males (38%), p = 0.011. In-hospital mortality was significantly higher in men than in women (12.9% vs. 2.9%, p = 0.026). Operative procedures were significantly more common in women (33% vs. 16.3%; p < 0.001). Conclusion: Women were more frequently affected by falls related to rollators than men. Most falls occurred at home, in nursing care facilities, or rehabilitation centres, with no significant gender-based differences. There was a trend toward more head injuries in males, while the cumulative fracture rate of the pelvis, upper extremities, and lower extremities was significantly higher in females. In-hospital mortality was more than four times higher in men. These findings may guide the development of gender-specific interventions to reduce rollator-related injuries in the vulnerable elderly population.

Integration of neuromuscular control for multidirectional horizontal planar reaching movements in a portable upper limb exoskeleton for enhanced stroke rehabilitation.

Globally, the prevalence of stroke is significant and increasing annually. This growth has led to a demand for rehabilitation services that far exceeds the supply, leaving many stroke survivors without adequate rehabilitative care. In response to this challenge, this study introduces a portable exoskeleton system that integrates neural control mechanisms governing human arm movements. This design leverages neuroplasticity principles to simulate natural movements, aiming to reactivate and strengthen neuromuscular connections and thus enhance rehabilitation outcomes. A tailored musculoskeletal model of the human arm and an associated cost function were developed to accurately replicate the planar motion trajectories of a healthy human arm across 32 directions. The application of a Proportional-Derivative (PD) controller enables precise tracking of these trajectories by the exoskeleton. Individual testing has demonstrated high consistency between the exoskeleton-driven motion paths and the simulated trajectories, especially in trajectory accuracy along the X and Y axes. These findings support the efficacy of integrating advanced neural control strategies with practical exoskeleton designs in stroke rehabilitation.

Rehabilitation, reablement, and restorative care approaches in the aged care sector: a scoping review of systematic reviews

BackgroundAgeing populations are set to drive up demand for aged care services, placing strain on economies funding social care systems. Rehabilitation, reablement, and restorative care approaches are essential to this demographic shift as they aim to support independent function and quality of life of older people. Understanding the impact of these approaches requires nuanced insights into their definitions, funding, and delivery within the aged care context. This scoping review mapped and compared systematic review-level research on rehabilitation, reablement, and restorative care approaches within aged care with the aim of determining definitional clarity, key themes, and the professional groups delivering each approach.MethodsNine databases were searched (2012 to September 2023) to identify English-language systematic reviews on aged care-based rehabilitation, reablement and/or restorative care. Two reviewers independently screened studies following predetermined eligibility criteria. Only reviews reporting quality appraisal findings were eligible. Data charting and synthesis followed the Arksey and O’Malley approach and are reported according to PRISMA-ScR guidelines.ResultsForty-one reviews met inclusion criteria. Most (68%) reported on rehabilitation in aged care, and eight (20%) combined the approaches. Only 14 reviews (34%) defined the approach they described. Reviews centred on services for older people in the home or community (n = 15), across a mix of settings including community, hospital, and residential care (n = 10). Ten distinct themes highlight the importance of multidisciplinary teams, allied health, risk of falls, hip fracture, reduced functional independence, and specific types of interventions including physical activity, technology, cognitive rehabilitation, goal setting, and transition care. Most reviews described the role of occupational therapists (n = 22), physiotherapists (n = 20) and nurses (n = 14) with wider support from the multidisciplinary team. The quality of primary studies within the reviews varied widely.ConclusionsThis scoping review summarises the evidence landscape for rehabilitation, reablement, and restorative care approaches in the context of aged care. Despite their role in enhancing independence and quality of life for older people, policy, funding, and terminology variation means the evidence lacks clarity. This fragmented evidence makes it challenging to argue the effectiveness of one approach over another for older people in receipt of aged care services.Clinical trial numberNot applicable.

Facilitators and barriers to interprofessional learning, collaboration, and identity development during interprofessional internship in rehabilitation care: A qualitative study

ABSTRACT The growing complexity of care and healthcare workforce shortages in the Netherlands necessitates exploring interprofessional collaboration (IPC). However, the predominant single-professional education may result in a professional identity (PI) among healthcare students, which may not support successful IPC. Internships in student-run interprofessional learning wards (SR-IPLW) could foster interprofessional identity (IPI) development. There is a need for a better understanding of the intricacies involved in learning to work collaboratively, particularly when undergraduates are still shaping their professional identities. Our aim, therefore, was to identify facilitators and barriers for interprofessional education (IPE), IPC, and identity development among 21 healthcare students during a 20-week clinical placement on a SR-IPLW in rehabilitation medicine. An action-based prospective study using grounded theory analysis of nine focus groups across three semesters identified 17 theoretical codes. These codes are elaborated in a conceptual model highlighting facilitators and barriers for IPC and identity development, emphasizing the importance of fostering feelings of relatedness, competence, and autonomy. There are indications that professional and interprofessional identities changed during the internship. Implications for preceptors are delineated, showing the importance of personal relationships and elements of a positive learning climate.

The effect of enhanced recovery protocols on postoperative rehabilitation in orthopedic surgery patients.

Orthopedics is a critical hospital department that has experienced shifts in the spectrum of orthopedic conditions due to societal advancements in recent years. While surgical interventions are effective in restoring fracture function, perioperative care remains a key factor in optimizing patient recovery. This study aims to assess the impact of orthopedic rehabilitation care based on the enhanced recovery after surgery (ERAS) protocol on postoperative rehabilitation. A total of 836 patients who underwent orthopedic surgery from June 2023 to June 2024 were included in the study. They were divided into a control group, which received standard care, and an observation group, which received care interventions based on ERAS principles. Recovery outcomes were assessed by measuring hospital stay duration, fracture healing time, joint function recovery time, and the incidence of complications in both groups. The observation group showed significantly shorter hospital stays, faster fracture healing times, and quicker joint function recovery compared with the control group. Furthermore, the incidence of complications was notably lower in the observation group. Postoperative joint function recovery scores and patient satisfaction were also higher in the observation group, with statistically significant differences between the 2 groups (P < .05). ERAS-based care enhances orthopedic recovery by reducing hospital stays, accelerating functional recovery, lowering complications, and improving patient satisfaction, proving its effectiveness in perioperative cares, and should be widely implemented in orthopedic rehabilitation.

A Generic Approach to Optimize a Blueprint Schedule for Multidisciplinary Group Therapy in Rehabilitation Care

This paper presents generic approach for tactical blueprint scheduling in multidisciplinary rehabilitation care. A blueprint prescribes both the timing of group therapy sessions and the allocation of therapist and treatment room capacity to these sessions and thus defines which appointment types can be booked on which time slots. The blueprint schedule was integrated in a decision support tool, and applied in the rehabilitation center of Sint Maartenskliniek in Nijmegen, the Netherlands.

Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis and neuromyelitis optica spectrum disorder - recommendations from ECTRIMS and the EBMT.

Autologous haematopoietic stem cell transplantation (AHSCT) is a treatment option for relapsing forms of multiple sclerosis (MS) that are refractory to disease-modifying therapy (DMT). AHSCT after failure of high-efficacy DMT in aggressive forms of relapsing-remitting MS is a generally accepted indication, yet the optimal placement of this approach in the treatment sequence is not universally agreed upon. Uncertainties also remain with respect to other indications, such as in rapidly evolving, severe, treatment-naive MS, progressive MS, and neuromyelitis optica spectrum disorder (NMOSD). Furthermore, treatment and monitoring protocols, rehabilitation and other supportive care before and after AHSCT need to be optimized. To address these issues, we convened a European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop in partnership with the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party, in which evidence and key questions were presented and discussed by experts in these diseases and in AHSCT. Based on the workshop output and subsequent written interactions, this Consensus Statement provides practical guidance and recommendations on the use of AHSCT in MS and NMOSD. Recommendations are based on the available evidence, or on consensus when evidence was insufficient. We summarize the key evidence, report the final recommendations, and identify areas for further research.

Evaluating the impact of Keep Your Move in the Tube (KYMITT) on patient AM-PAC scores and discharge disposition.

The Sarasota Memorial Health Care System (SMHCS) Acute Care Rehabilitation Team began implementing the Keep Your Move in the Tube (KYMITT) protocol in February 2023 to improve patient mobility and offer an alternative to traditional sternal precautions. The goal of KYMITT is for patients to remain within a safe zone (referred to as "the tube") rather than complying with time and weight restrictions, which are the cornerstone of traditional sternal precautions. In previous studies, KYMITT was associated with greater independence after surgery without placing patients at an increased risk of experiencing a surgical site infection. To test the hypothesis that KYMITT is associated with greater patient mobility and independence, without increasing the risk of surgical complications. Researchers at SMHCS analyzed records of 614 open-heart surgery patients (n = 293 in the traditional sternal precautions group and n = 321 in the KYMITT protocol group) to determine the differences in their Activity Measure for Post-Acute Care (AM-PAC) mobility scores. The average last-recorded AM-PAC score for the traditional sternal precautions group was significantly lower than for those receiving the KYMITT protocol (19.2 [95% CI: 18.86-19.62] vs. 20.0 [95% CI: 19.62-20.35], p = .006). For patients with at least two AM-PAC scores recorded, the difference was calculated for each patient's first to last AM-PAC score (AM-PAC delta). There was not a statistically significant difference between groups with an average improvement of 2.7 (95% CI: 2.30-3.09) for the traditional sternal precautions group compared to 3.1 (95% CI: 2.71-3.45) for the KYMITT protocol, p = .16 when comparing average AM-PAC delta. Overall, during the 7 months that KYMITT was conducted hospital-wide, a significant increase in average last-recorded AM-PAC scores was observed month to month (slope = 0.45, 95% CI: 0.27-0.62, p < .001).

The association between neighborhood social vulnerability and community-based rehabilitation after stroke

BackgroundTimely rehabilitative care is vital for functional recovery after stroke. Social determinants may influence access to and use of post-stroke care but have been inadequately explored. The study examined the relationship between the Social Vulnerability Index (SVI) and community-based rehabilitation utilization.MethodsWe included 6,843 adults (51.6% female; 75.1% White; mean age 70.1) discharged home after a stroke enrolled in the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 40 North Carolina hospitals from 2016–2019. Rehabilitation utilization was sourced from administrative claims. Geocoded addresses were linked to 2018 Census tract SVI. Associations between SVI and 90-day rehabilitation use, adjusted for patient’s clinical and socio-economic characteristics, were obtained from generalized estimating equations. We also examined the associations of SVI with therapy setting, types of therapy, intensity of visits, and time to first visit.ResultsThirty-five percent of patients had at least one physical (PT) or occupational therapy (OT) visit within 90 days, ranging from 32.4%-38.7% across SVI quintiles. In adjusted analysis, there was no dose-reponse relationship between higher summary SVI, nor most of its sub-domains, and 90-day rehabilitation use. Greater vulnerability in household composition and disability was modestly associated with -0.4% (95% CI -4.1% to 3.4%) to -4.3% (95% CI -0.8% to -7.7%) lower rehabilitation use across SVI quartiles. Greater summary and subdomain SVI was associated with higher odds of receiving therapy in the home versus outpatient clinic (OR = 1.88, 1.58 to 2.17 for Q5 vs Q1 summary SVI) and receiving both PT and OT versus a single-type therapy (1.72, 1.48 to 1.97 for Q5 vs. Q1 summary SVI). No differences were observed for therapy intensity or time to therapy.ConclusionUse of rehabilitation care was low, and largely similar across levels of SVI and most of its subdomains. Individuals residing in areas of high SVI were more likely to receive therapy in the home and to receive dual therapy, possibly reflecting greater need among these individuals. Future studies should evaluate potential mechanisms for these findings and further identify both patient and community factors that may inform strategies to improve rehabilitation use.Clinical Trial Numberhttps://www.clinicaltrials.gov/ NCT02588664 [registration date: 2015–10-23].

Early mobilization program with nonweight-bearing brace improves functional capacity after diabetic foot ulcer surgery: a randomized controlled trial

PurposeThis study aimed to evaluate the effectiveness of early mobilization program with nonweight-bearing braces in improving functional outcomes and clinical indicators after diabetic foot ulcer surgery.MethodsWe conducted a randomized trial involving patients with diabetic foot ulcers (DFUs) who underwent surgery at a tertiary university hospital. Participants were randomized to receive either early mobilization with nonweight-bearing braces or standard rehabilitation care. The primary outcome was the ability to walk a distance of three meters without human assistance upon hospital discharge. Secondary outcomes included activity of daily living (ADL), measured by the Barthel Index survey; reduction in lean body mass, assessed via thigh circumference on postoperative day 10 (POD 10); length of stay (LOS); and the incidence of postoperative complications such as deep venous thrombosis (DVT), pain, and wound dehiscence.ResultsA total of 46 patients were enrolled, with 23 assigned to the early mobilization program with nonweight-bearing braces (intervention group) and 23 to the standard rehabilitation care group (control group). The primary outcome was achieved in 16 patients (69.6%) in the intervention group and 6 patients (26.1%) in the control group [RD43.5%, 95%CI (17.5%,69.5%); P = 0.003]. The intervention group demonstrated improved outcomes in ADL. Additionally, the intervention facilitated earlier discharge with a LOS of 12 days in the intervention group compared to 18 days in the control group.ConclusionAn early postoperative mobilization program with nonweight-bearing brace is demonstrated to be feasible and effective in improving functional capacity in patients with diabetic foot ulcers undergoing surgery.

Impact of a Multi-Component Home-Based Physical Therapy Intervention on Cognitive Outcomes: Results From the CAP Randomized Controlled Trial.

Differences in cognitive outcomes for two home-based 16-week interventions after usual rehabilitative care post-hip fracture were examined. Community Ambulation Project randomized controlled trial included 210 hip fracture participants. Interventions: Specific multi-component (PUSH) included strength-, balance-, function-, and endurance-based exercises; non-specific active control (PULSE) included seated range-of-motion exercises and sensory transcutaneous electrical neurostimulation. Cognitive measures: Modified Mini-Mental State Examination, plus Hooper Visual Organization Test and Trails A/B in an ancillary study (CAP-MP, n = 40), assessed pre-randomization and 16 and 40 weeks post-randomization. Over 16weeks, PUSH-assigned participants became faster on Trails A (Δ = -6.3, 95% CI: -16.7, 4.2); those in PULSE became slower (Δ = 9.3, 95% CI: -1.7, 20.3, p = .04). At 40 weeks, PUSH-assigned participants became faster on Trails B (Δ = -21.5, 95% CI: -46.2, 3.3) while those in PULSE became slower (Δ = 15.2, 95% CI: -11.9, 42.3, p = .04). No other significant differences were found. Results suggest that multi-component exercise interventions like PUSH may prevent/delay decline or improve attention and psychomotor speed in patients with recent hip fracture.

Transitioning to a virtual post-intensive care rehabilitation service in response to the COVID-19 pandemic: results of multidisciplinary focus-groups.

Telehealth has vastly expanded since the SARS-CoV-2 (COVID-19) pandemic and has been widely implemented as an efficient, cost-effective and accepted means of health care delivery, including rehabilitation. Although telerehabilitation is recommended across national guidelines, there is a lack of practical guidance to support clinicians with virtual adaptations. This study aimed to describe the key components of a safe and effective virtual post-intensive-care rehabilitation service, through qualitative exploration. This is a qualitative study using a focus-group design based upon grounded theory. This study is nested within a service development project, taking place during the COVID-19 pandemic. Focus groups were held after the first wave of the COVID-19 pandemic with key stakeholders from the physiotherapy and critical care departments of a large tertiary hospital in the United Kingdom. Semi-structured questions were used to guide discussions, led by a facilitator and scribe. Transcripts were thematically analysed using an exploratory inductive approach by two researchers then crosschecked. Three focus groups were attended by 12 multidisciplinary stakeholders, including six physiotherapists, two administration staff members, two critical-care follow-up nurses and two critical care consultants. Thematic analysis identified seven critical elements for virtual adaptations: (1) safety and risk assessment, (2) assessment and outcome measures, (3) virtual platform, (4) resources and equipment, (5) exercise programme adaptation, (6) exercise monitoring and safety, and (7) privacy and information governance. Our findings provide practical recommendations for virtual rehabilitation service development and delivery.

Integrated mental health care and vocational rehabilitation intervention to improve return to work rates for people on sick leave due to common mental and functional disorders (IBBIS-II) – results from a randomized clinical trial

Background More than 50% of people receiving long-term sickness benefits in Denmark have a common mental illness. At the same time, a significant treatment gap exists where less than 30% receive sufficient care for their mental illness. Methods The trial was designed as an investigator-initiated, randomized, two-group parallel superiority trial. Nine hundred participants with a common mental illness were randomly assigned into two groups: (1) IBBIS II, consisting of integrated mental health care and vocational rehabilitation, or (2) service as usual (SAU), at two sites in Denmark. The primary outcome was the difference between the two groups in time to return to work (RTW) at 12 months. Results There was no difference between the integrated IBBIS II intervention and SAU in time from baseline to RTW at the 12-month follow-up (Hazard ratio (HR) = 1.16 (95% CI 0.99–1.37), p = 0.07), but there was a tendency that the IBBIS II group had worse outcomes on several exploratory employment measures, including time to return to work at 6-month follow-up (HR = 1.36 (95% CI 1.03–1.55), p = 0.02), and number of weeks in work at 12-month follow-up (incidence rate ratio = 1.14 (95% CI 1.04–1.27), p = 0.008). Discussion The integrated employment and health intervention (IBBIS II) was not more effective than SAU in any of the included vocational outcomes and may even have been inferior to SAU on certain outcome measures. Based on these results, it is not recommended that the IBBIS II intervention is widely implemented in countries with service as usual comparable with Denmark. Trial registration ClinicalTrials.gov. Registered June 16, 2020, NCT04432129. https://clinicaltrials.gov/ct2/show/NCT04432129?term = IBBIS+II.