Community-based Rehabilitation Centre Research Articles

Return to Work in Breast Cancer Patients following an Interdisciplinary Rehabilitation Program in a Community-Based Cancer Rehabilitation Center: A Pilot Study.

Despite curative treatment and discharge from acute hospital settings, breast cancer patients often have cancer- and treatment-related morbidity which impairs them from returning to work. Hence, the role of community-based return to work rehabilitation programs is important to help these patients transition back to work. This was a retrospective cohort study involving patients with breast cancer conducted at a community-based cancer rehabilitation center. Patients were involved in an interdisciplinary vocational rehabilitation program involving physiatrists, occupational therapists, physiotherapists and social workers. We recruited 63 patients for this study cohort, with 46 (73.0%) patients ≤ 60 years old. After undergoing the rehabilitation program, there were 37 (58.7%) participants who successfully returned to work. These participants returned to work at either within 6 months (27.0%), 12 months (29.7%) or 24 months (43.2%) after enrollment into the program, with a majority enrolling in white collar jobs. Multivariate regression analysis revealed that significant negative factors for return to work were advanced stage of cancer (p = 0.004), along with clinically significant fatigue, measured on the Brief Fatigue Inventory (p < 0.001). However, perceived work ability (p = 0.020) was found to be a positive factor.

Effectiveness of Community-Based Rehabilitation (CBR) Centers for Improving Physical Fitness for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

To synthesise the best available evidence for the effectiveness of interventions delivered in community-based rehabilitation (CBR) centers on physical fitness, for community-dwelling older adults living in Asian countries. This study is a systematic review and meta-analysis. Seven English and two Chinese electronic databases were searched for randomised controlled trials (RCTs) and quasi-experimental studies that were conducted by centers providing CBR. Independent reviewers screened, quality-appraised and extracted data. The primary outcome was physical fitness measured by validated assessment tools, including the Timed Up and Go Test (TUG), gait speed, hand grip strength, Functional Reach Test (FRT), and one-leg standing test. Assessments of activity of daily living and quality of life using tools including the Barthel Index, Short Form (SF)-12, and SF-36 were secondary outcomes. After screening 5,272 studies, 29 studies were included (16 RCTs, 13 quasi-experimental studies) from four countries. Meta-analyses found that CBR programs significantly decreased TUG time (mean difference [MD], -1.89 seconds; 95% confidence interval [95% CI], -2.84 to -0.94; I2=0%; Z=3.90, p<0.0001), improved gait speed (MD, 0.10 m/s; 95% CI, 0.01-0.18; I2=0%; Z=2.26, p=0.02), and increased one-leg standing time (MD, 2.81 seconds; 95% CI, 0.41-5.22; I2=0%; Z=2.29, p=0.02). Handgrip strength and FRT showed no statistically significant improvement in the meta-analyses. CBR may improve aspects of physical fitness for older adults in Asian countries. However, variability in intervention components and measurement tools reduced the ability to pool individual studies. Further trials are required with robust designs including standardised measures of physical fitness.

Identifying Stroke Caregivers’ Coping Strategies: The Smile that has Struggled through the Tears-A Mixed-Method Research Approach

Background: Sudden stroke had caused the caregivers minimal time to prepare for their role as carers. Some stroke caregivers were overwhelmed to adjust and accept new responsibilities. They need to reorganise their functions and establish new daily life routines in response to the chronic illness that happens with stroke survivors.&#x0D; Objective: This study aimed to determine and explore coping strategies employed by stroke caregivers.&#x0D; Methods: This mixed-method study involved 32 stroke caregivers from a community-based stroke rehabilitation centre in Kuching, Sarawak. Results: From quantitative analysis, most stroke caregivers employed problem-focused coping strategies (mean=56.66, SD=10.79), followed by emotion-focused coping strategies (mean=55.63, SD=10.29) in confronting the challenges of caring for stroke survivors. Data from qualitative findings revealed eight themes of coping strategies: adjustment to daily life, selfmotivation, sharing with other people, acceptance, avoiding thinking about the problem, hoping stroke survivors will get better, emotion suppression and self-blame.&#x0D; Conclusion: This study’s outcomes provide crucial information about the burdens held by stroke caregivers when taking care of stroke survivors. Stroke caregivers need to adapt better and suitable coping strategies. This will prevent them from becoming overwhelmed by the accumulated stress from caring burdens. The long-term effect of coping strategies should positively assist stroke caregivers in managing the burdens effectively and fostering satisfaction in their life.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 130-140

Community-based Rehabilitation Service Excellence for Sustainability

People with disabilities require consistent and inclusive healthcare services from the related stakeholders to leverage their socio-economic well-being. Seven focus group discussions (participated by community-based rehabilitation centre managers, trainers, and parents) were conducted in Malaysia. Each group had 10-15 participants. The discussions were audio-recorded and analysed carefully to form meaningful themes. The findings suggested six important dimensions of rehabilitation service excellence culture: Trainee orientation, Competitor orientation, Inter-functional coordination, Excellence-driven, Long-term focus, and Employee orientation. These dimensions and their respective items would be used to operationalise the multi-item measures for the quantitative questionnaire survey.

First-Generation Palestinian Refugees in Jordan: Experiences of Occupational Disruption From an Occupational Justice Perspective.

Only a limited amount of research has investigated the impact of prolonged refugee status of Palestinian refugees who have been displaced for more than 70 yr. To explore lived experiences of Palestinian refugees in Jordan and understand their occupational disruption. Thematic analysis guided by descriptive phenomenology with one-on-one and group interviews. An AlBaqa'a community-based rehabilitation center or participants' homes. First-generation Palestinian refugees who fled Palestine and live in Jordan. Fifteen Palestinians, mainly widowed women in their 70s, participated in this study. Ten completed interviews, and five participated in two group interviews. Four themes emerged: (1) Palestinian pride, (2) trauma leaving one's home country, (3) challenges of living in a host country, and (4) internalized prejudice. After 70 yr, prolonged refugeeism has led to occupational disruption and negative implications for occupational justice, especially in the absence of social justice. The area most negatively affected was social participation; however, participants still had a great sense of pride about their homeland and their heritage. What This Article Adds: This foundational research explores the occupational injustices of the protracted refugee status of first-generation Palestinians in Jordan and identifies meaningful interventions to promote the alleviation of occupational disruption.

Defining a Treatment Model for Self-Management of Fatigue in Rehabilitation of Acquired Brain Injury Using the Rehabilitation Treatment Specification System.

Systematic treatment descriptions to standardize and evaluate management of fatigue after acquired brain injury (ABI) are lacking. The purpose of this multi-phase qualitative study was to formulate a treatment model for promoting self-management of fatigue in rehabilitation of ABI based on practice-based understandings and routines. The study was conducted in a community-based rehabilitation center in Denmark. The model was defined using the Rehabilitation Treatment Specification System. Phase 1 comprised co-production workshops with five service providers (occupational therapists, physiotherapists, and a neuropsychologist) to elicit preliminary treatment theories. In Phase 2, four case studies were conducted on management of fatigue in vocational rehabilitation. Interviews (n = 8) and treatment log entries (n = 76) were analyzed thematically to specify treatment targets and active ingredients. The treatment model comprised five main components: (i) Knowledge and understanding of fatigue, (ii) Interoceptive attention of fatigue, (iii) Acceptance of fatigue, (iv) Activity management, and (v) Self-management of fatigue. For each component, lists of targets and active ingredients are outlined. In conclusion, management of fatigue includes multiple treatment components addressing skills, habits, and mental representations such as knowledge and attitudes. The model articulates treatment theories, which may guide clinical reasoning and facilitate future theory-driven evaluation research.

Living the Process: Examining the Continuum of Coercion and Care in Tijuana's Community-Based Rehabilitation Centers.

In Mexico, community-based, non-biomedical treatment models for substance use are legally recognized in national drug policy, monitored by state-level Departments of Health, and in some cases publicly funded. Academic research on centers that utilize these forms of treatment have focused primarily on documenting their rapid spread and describing their institutional practices, particularly human rights abuses and lack of established biomedical efficacy. In Tijuana, these community-based therapeutic models are shaped by conceptions of health and illness from the local cultural context of the United States-Mexico border zone in ways that do not cleanly match western, biomedical notions of the illness "addiction." In this article, I examine treatment ethics by exploring the contextually understood need for coerced treatment (i.e., why centers are locked) along with experiences of compulsion in a women's 12 Step center. These discussions highlight the contested therapeutic value of coercion from multiple perspectives. Utilizing engaged listening around local care practices marks a path for global mental health researchers to understand and sit with difference in order to communicate across opposing viewpoints in the service of mental health equity and best care practices.

Measurement Properties of the Dutch Multifactor Fatigue Scale in Early and Late Rehabilitation of Acquired Brain Injury in Denmark.

Fatigue is a major issue in neurorehabilitation without a gold standard for assessment. The purpose of this study was to evaluate measurement properties of the five subscales of the self-report questionnaire the Dutch Multifactor Fatigue Scale (DMFS) among Danish adults with acquired brain injury. A multicenter study was conducted (N = 149, 92.6% with stroke), including a stroke unit and three community-based rehabilitation centers. Unidimensionality and measurement invariance across rehabilitation settings were tested using confirmatory factor analysis. External validity with Depression Anxiety Stress Scales (DASS-21) and the EQ-5D-5L was investigated using correlational analysis. Results were mixed. Unidimensionality and partial invariance were supported for the Impact of Fatigue, Mental Fatigue, and Signs and Direct Consequences of Fatigue, range: RMSEA = 0.07-0.08, CFI = 0.94-0.99, ω = 0.78-0.90. Coping with Fatigue provided poor model fit, RMSEA = 0.15, CFI = 0.81, ω = 0.46, and Physical Fatigue exhibited local dependence. Correlations among the DMFS, DASS-21, and EQ-5D-5L were in expected directions but in larger magnitudes compared to previous research. In conclusion, three subscales of the DMFS are recommended for assessing fatigue in early and late rehabilitation, and these may facilitate the targeting of interventions across transitions in neurorehabilitation. Subscales were strongly interrelated, and the factor solution needs evaluation.

Community-based psychosocial rehabilitation model for people with schizophrenia

Schizophrenia is a mental disorder that triggers the occurrence of impaired function in the human brain, behavior, cognitive, and emotional functions. This disorder has become a problem in the study of mental health, which must be treated comprehensively by using empirical treatment combined with rehabilitation. Hopefully, increasing the maximum level of healing and reducing recurrence rates can improve social function and quality of life. Thus, this review aims to narrate the model and effective community-based psychosocial rehabilitation center. The articles of the studies published from 2017-2021 were collected and analyzed in this literature review. The keywords used were community-based rehabilitation for schizophrenia. The results show that in addition to pharmacological therapy, six community-based psychosocial non-pharmacological therapy methods are considered effective for intervention in patients with schizophrenia. The methods are club methods in elderly schizophrenic patients, community-based methods, direct patient decision-making methods, case and club management methods, psychoeducational and social skills methods, and community care unit methods. All of the above methods analyzed showed significant effectiveness in community-based psychosocial rehabilitation treatment in developing countries.

Experiences of participating in group-based rehabilitation programmes: A qualitative study of community-dwelling adults with post-stroke aphasia.

People with post-stroke aphasia tend to have smaller social networks, a higher risk of depression and poorer health-related quality of life than those who do not have aphasia after stroke. Stroke-specific or general rehabilitation programmes offered by community-based organizations are commonly group-based and involve discussions among group members with or without stroke. Research has shown that people with post-stroke aphasia may be unable to participate fully in verbal sharing of experiences and exchange of thoughts. To explore the experiences of people with post-stroke aphasia in relation to participating in group-based rehabilitation programmes organized by community-based organizations. A qualitative design was adopted, including individual, semi-structured interviews with 20 adults with post-stroke aphasia recruited from community-based rehabilitation centres and support groups. The participants had a mean age of 68.86 ± 13.54 years and a mean post-stroke duration of 9.24 ± 7.72 years. They had participated in at least one group-based rehabilitation programme organized by community-based organizations in the past year. The participants were asked about their experiences of attending group-based programme(s), thoughts and feelings while interacting with the facilitators and group members, and satisfaction with their participation. The interview data were thematically analysed. Three themes were identified: (1) hurdles to active and fulfilling participation including the dominance of verbal sharing, short duration of the programme, being a minority in the group and accumulated negative experiences; (2) strategies adopted to improve participation including accepting a reduced speaking ability, having support from caregivers, and trying mobile apps to vocalize and supplement meanings; and (3) a preference for certain group conditions including receiving invitations by staff with whom they were familiar, groups that are led by experienced facilitators, a large or small group, the dominance of non-verbal activities, and inclusion of only people with post-stroke aphasia. The findings showed that people with post-stroke aphasia experience difficulties participating more actively in group-based rehabilitation programmes due to hurdles in terms of the structure and format of the programmes and accumulation of negative experiences. Facilitating positive group experiences for these people with innovative methods, such as using technology and providing professional and standby support, would be helpful. Longer sessions with smaller groups, exclusively including people with post-stroke aphasia and involving more non-verbal activities to help them express feelings, are suggested to optimize the benefits they derive from these group-based programmes. What is already known on the subject Stroke-specific or general group-based rehabilitation programmes are commonly offered by community-based organizations to support the recovery of people with or without stroke. However, some people with post-stroke aphasia may be unable to participate fully in verbal sharing of experiences and exchange of thoughts during these group-based programmes, which can limit the benefits they derive from these programmes. What this paper adds to existing knowledge This study explored the experiences of people with post-stroke aphasia in relation to participating in group-based rehabilitation programmes not specifically designed for people with stroke-induced aphasia organized by community-based organizations. The findings provide an insight into how these people participate in groups, their thoughts and feelings during interactions with the facilitators and group members, their satisfaction with their level of participation, and the characteristics of the groups they prefer to join. What are the potential or actual clinical implications of this work? People with post-stroke aphasia experience difficulties participating more actively in group-based programmes due to hurdles in terms of the structure and format of the group-based programmes and accumulation of negative experiences contributing to decreased motivation to participating in groups. More positive group experiences can be fostered by adopting longer sessions with smaller groups that exclusively include people with post-stroke aphasia and involve more non-verbal activities to help them express their feelings. Communication partner training for facilitators and the use of technology to support communication are suggested to promote active and fulfilling participation of the people with aphasia in group-based programmes.

VALIDITY AND RELIABILITY OF CIDDIE KIT©, A DIETARY ASSESSMENT TOOL FOR CHILDREN WITH INTELLECTUAL DISABILITY

Nutritional status of people with intellectual disability (PWID) is always at risk and developing a dietary assessment tool is important. This study aims to test reliability (inter-rater reliability and test-retest reliability) and comparable validity (limit of agreement against a multiple pass 24-hour diet recall recorded by a professional dietitian) of a recently developed dietary assessment kit, CIDDIE Kit©, that specialised for a more dependent group of PWID, focusing on preschool aged children. The CIDDIE Kit© was given to 26 parents or caretakers of children with intellectual disabilities (ID) registered with three selected Community Based Rehabilitation Centre in the Klang Valley area. Each subject was asked to complete two sets of CIDDIE Kit© in a two-week interval session. Meanwhile, a certified dietitian conducted a 24-Hour Diet Recall among the same 26 subjects. The validity and reliability of CIDDIE Kit© were analysed using Bland-Altman method, percentage of correctly classified quartile, Intra-class Correlation Coefficient (ICC) value and Pearson’s correlation coefficient. For comparable validity test, the estimated intake from CIDDIE Kit© and Multiple Pass 24-Hour Diet Recall were considerably in agreement to each other. The test-retest reliability analysis showed significant high similarity (p &lt; 0.001) between the estimated intake from both phases of CIDDIE Kit© where the ICC value ranged approximately 0.9 (R = 0.889 - 0.930). The inter-rater reliability analysis was significantly positive (p &lt; 0.001) and strong correlation (indicating internal consistency), r (0.706 – 0.853). The specially designed CIDDIE Kit© can provide a considerably valid and reliable assessment.

Parents’ Perspective of Sexuality among Down Syndrome Children

Introduction: Sexuality matters are always neglected, and are viewed as a taboo subject that is not discussed openly in Malaysia. Hence, sexuality issues among people with disabilities remain shrouded in prejudice and myths. Individual with Down syndrome have the same sexual experiences and needs as other typically developed children. The deficiency on cognitive ability among Down syndrome children is a major challenge for them to understand the concept of sexuality. The purpose of this preliminary qualitative study was to explore the perspectives on the topic of sexuality among Down syndrome children. Methods: The purposive sampling method was used to recruit respondents, based on the following criteria: i) Parents (father or mother) who have Down syndrome children aged from 8-17 years, and ii) able to communicate in the Malay or English language. A total of five respondents were included in this study. The respondents were the parents of Down syndrome children who were receiving occupational therapy interventions at three community-based rehabilitation centres in Kuala Selangor. The data were collected using semi-structured interviews, which were recorded using an audio recorder. The data were then transcribed and analysed using the Interpretative Phenomenological Analysis (IPA). Results: The study revealed the perspective of parents on sexuality issues among Down syndrome children in relation to readiness, puberty, sexual desires, cultural norms and vulnerable groups. Conclusion: Findings of this study could use as a baseline in developing a module to assist parents in managing their concerns.

Effectiveness of community-based rehabilitation (CBR) centres for improving physical fitness for community-dwelling older adults: a systematic review protocol

IntroductionThe increasing ageing population has become a substantial challenge for both healthcare and social services in many Asian countries. There is a high incidence of chronic diseases and comorbidities in...

EFFECTS OF THE COVID-19 PANDEMIC ON CARDIOPULMONARY FUNCTION IN CHILDREN WITH CEREBRAL PALSY: A PRELIMINARY STUDY

The purpose of this study was to examine what effects the coronavirus disease 2019 (COVID-19) pandemic has on the cardiopulmonary endurance, heart rate and oxygen saturation in children with cerebral palsy (CP) during a 6-min walk test (6[Formula: see text]MWT). This study had a laboratory design and tested a single group pre- and post-COVID-19. A convenience sample of 8 participants with CP (three females; mean [Formula: see text] years) that was recruited from a community-based rehabilitation center was enrolled in the current study. Due to COVID-19, no rehabilitation was provided by a physical therapist for two months as the participants stayed at home. The descriptive statistics and paired [Formula: see text]-test were derived by examining the participants’ cardiopulmonary function via the Borg scale, 6[Formula: see text]MWT, heart rate and oxygen saturation, while they underwent rehabilitation versus the two months without rehabilitation due to COVID-19. The participants’ walking distances, oxygen saturation and heart rates were measured, and the Borg scale was used to assess the participants’ perceptions of their fatigue, breathlessness, and effort and exertion during the 6[Formula: see text]MWT. The descriptive statistical analysis demonstrated the following effects when comparing the post-COVID-19 results to those before the pandemic: greater distance on the 6 MWT test (0.69%), minimal changes in oxygen saturation ([Formula: see text]0.3%) and increased heart rate (8.4%) and Borg scale values (19.4%). Paired [Formula: see text]-test suggested that a significant difference was shown on the Borg scale ([Formula: see text]) and heart rate ([Formula: see text]). The results of this study provide clinical, evidence-based insights into the impact of the COVID-19 pandemic on cardiopulmonary function in children with CP. The clinical case series study demonstrated that after the COVID-19 pandemic, the participants with CP experienced increased heart rates and decreased minimal oxygen saturation, cardiopulmonary endurance. Recent advances in communication and information technology allow physical therapists to train and refine individually through remote rehabilitation. Exercise and combining VR remote education can be a way to maintain cardiopulmonary functions that have fallen due to the pandemic.

The Effectiveness of Cerebral Palsy Support Intervention on Perceived Social Support Among Caregivers of Children with Cerebral Palsy in North-Eastern Region, Malaysia

Cerebral palsy (CP) is a lifelong disorder that requires a fulltime commitment from the caregivers. Due to the complexity of care and complications associated with CP, the caregivers of children with CP require a good social support. This study aimed to determine the impact of CP support intervention on caregivers perceived social support.This quasi-experimental study involved caregivers of children with CP from community-based rehabilitation (CBR) centers. The intervention group (n=21) were given CP Support intervention through provision of information and social support from a multidisciplinary team including governmental, non-governmental organizations (NGO) and parents. It contains information enrichment workshop (IEW), caregivers support group (CSG), and WhatsApp group. The control group (n=45) received only usual care. Factorial ANCOVA revealed that higher level of perceived social support was observed in the intervention group at the end of the study. The intervention effect was significant after six months post intervention when other variables were controlled (p = 0.031). Findings of this study highlighted the favorable outcome of the CP Support intervention program on the caregivers’ perceived social support through provision of information and social support.

The Implementation of Vocational Skills in Teaching and Learning of People with Disabilities in the Community-Based Rehabilitation Center (CBRC): A Review from Ecological Environments Perspective

Vocational education for students with learning difficulties (SLD) emphasizes theoretical teachings and practical experiences among students, while teaching them the knowledge and skills required for an occupation. Studies on the teaching of vocational skills for SLD focus mainly on students in the mainstream educational system. The current study aims to explore the teaching and learning of vocational skills for SLD in a Community-Based Rehabilitation Center (CBRC), in Selangor, Malaysia from an ecological environment's perspective. Six teachers from the CBRC were interviewed and observed. Results show teachers focused mainly on microsystem and mesosytem environments through the various strategies to support TnL of vocational skills' education for SLD. Insufficient pedagogical skills and vocational training among teachers, and inadequate physical facilities and equipment compromised the execution of TnL in this context. We suggest CBRC teachers incorporate exsosystem and macrosystem environments in TnL of vocational skills among children with learning disabilities through a community-based or project-based approach involving corporate social responsibility (CSR) to improve vocational skills in both students and teachers. Implications to the current practice are also discussed.

Spatial accessibility to health care services among children with cerebral palsy in Johor, Peninsular Malaysia.

Cerebral palsy (CP) is one of the most common causes of disability in childhood, leading to functional limitations and poor nutritional status. Families with CP children face challenges in providing proper care. Thus, accessibility of CP patients to health facilities is important to ensure that they can maintain regular visits to health facilities for proper treatment and care. The current study aimed to map the spatial distribution of CP in Johor, Malaysia and measure the accessibility of CP patients to nearby hospitals, health clinics and community-based rehabilitation centres. The study is based on CP cases in 2017 obtained from the Department of Social Welfare, Malaysia and analysed using the average nearest neighbour, buffer analysis and Kernel Density Estimation. Results indicate that there is generally good access to health care services for many of the CP children in Johor, but for 25% of those living more than 10 km away from the health clinics or community-based rehabilitation centres, regular visits can be a problem. This information should be used for targeted intervention and planning for health care strategies. Furthermore, information on hospital accessibility of CP children would allow for planning of proper and regular treatment for these patients. The study has shown that it is possible to improve the understanding of the distribution of CP cases by integrating spatial analysis using geographical information systems without relying on official information about the density of populations.

Disability scores rate changes and predictors among road traffic injury victims admitted at Gondar specialized comprehensive hospital northwest Ethiopia: A prospective follow-up study

Objective Measuring the level of disability following trauma is a key step for secondary and tertiary level trauma prevention. It can give important evidence for decision-makers and program implementers on the need for establishing rehabilitation centers. Methods This is a longitudinal follow-up study on 235 road traffic injury survivors. Patients were followed for 12 months, and the outcome was ascertained using the brief WHODAS-II 12-item instrument at 1, 3, 6, and 12-months post-injury. The level of disability was divided into five groups from no disability to very severe based on their disability scores. Work status was assessed at each survey using a single question “are you back to work?” We employed a linear mixed model to identify disability scores changes over time and risk factors associated with disability. Statistically, a significant association was declared at p < 0.05. Results The overall mean disability score was 24.9 ± 11.3 at one month and 8.3 ± 6.4 after 12 months of injury. Disability score has decreased by 1.3 units over time during 12 months post-injury. Functional limitation persisted on 25–88% of participants at specific dimensions of disability at the end of the study. After a year of injury, 44% of participants didn’t return to work. Injury severity score (β = 0.47, p < 0.001, length of hospital stays (β = 0.88, p < 0.005) and discharge against medical advice (β = 2.18, p < 0.001) were found to be predictors of disability following road traffic injuries. Conclusion The current study demonstrated that, though there was a decrease in disability score over time, a significant number of participants were with some degree of limitation after one year of injury, and nearly half of them didn’t return to work. Shortening of long waiting times and counseling services need to be considered by the hospital. Community-based Rehabilitation centers (CBR) should be expanded. Further study should be conducted to uncover the reasons for preferring traditional bone fixers over medical management.

Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program

BackgroundPatients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery.MethodsThis cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS.ResultsThere were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12–11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36–31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS.ConclusionsA high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.

An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke.

Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation.Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis.Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known.Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.