Comprehensive Rehabilitation Intervention Research Articles

Early comprehensive pulmonary rehabilitation for hospitalized patients with acute ex-acerbation of chronic obstructive pulmonary disease: a randomized controlled trial.

To investigate whether an early comprehensive pulmonary rehabilitation intervention initiated during hospital admission is safe and effective for patients with acute exacerbation of chronic obstructive pulmonary disease. Prospective randomized controlled study. Patients with acute exacerbation of chronic obstructive pulmonary disease. In total, 108 patients were randomized to the early comprehensive pulmonary rehabilitation and usual care groups within 48 hours. The 6-min walking distance, quality of life, breathlessness, and inspiratory muscle strength were measured on admission and discharge. Any adverse events of pulmonary rehabilitation were recorded. On discharge, the patients in the early comprehensive pulmonary rehabilitation group had a more significant improvement in the 6-min walking distance (47.5 vs 23.0, p = 0.04). There was no significant difference in quality of life and breathlessness between the 2 groups. In the early comprehensive pulmonary rehabilitation group, inspiratory muscle strength and peak inspiratory flow were significantly improved, and the changes were much more pronounced than in the usual care group. There were no adverse events. Early comprehensive pulmonary rehabilitation is safe and effective for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease, and should be performed during the early stage of hospitalization.

Impact of Combined Exercise Rehabilitation and Continuous Health Education on the Quality of Life and Mental Health of Patients Post-Coronary Stent Implantation

Objective: To evaluate the impact of patient-centered exercise rehabilitation combined with continuous health education on the quality of life and mental health of patients after coronary stent implantation to provide effective rehabilitation intervention strategies and scientific evidence for clinical practice. Methods: This retrospective cohort investigation involved patients who underwent coronary stent implantation at our hospital between January 2021 to December 2022. The control group (n = 81) received routine post-operative follow-up and health education, while the observation group (n = 68) additionally received personalized exercise rehabilitation and continuous health education. The short form-36 (SF-36) scale was used to assess quality of life, while the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate mental health. The Exercise of Self-Care Agency Scale (ESCA) was used to assess self-care ability. Results: At 6 months post-operation, the observation group showed significantly higher scores than the control group across all dimensions of the SF-36 scale, SAS, SDS, and ESCA (p < 0.05). The observation group exhibited significantly improved quality of life, mental health, and enhanced self-care ability. Conclusion: Patient-centered exercise rehabilitation combined with continuous health education significantly positively impacts the quality of life and mental health of patients after coronary stent implantation. This comprehensive rehabilitation intervention strategy should be adopted in clinical practice to improve patient prognosis and quality of life.

The clinical effects of Orff music therapy on children with autism spectrum disorder: a comprehensive evaluation.

This study aimed to investigate the clinical effects of Orff music therapy on children with Autism Spectrum Disorder (ASD) from the perspectives of parents, evaluators, and therapists. 93 children with ASD aged 3-6 years participated in the study. They were divided into an observation group (n = 48) receiving comprehensive rehabilitation intervention including Orff music therapy, and a control group (n = 45) receiving only comprehensive rehabilitation intervention. The Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), and Psycho-educational Profile-3rd edition (PEP-3) were used for assessments before and after the intervention. There were no significant demographic differences between the two groups. Both groups showed significant improvements in Sensory, Relating, Language, CVP, EL, RL, VMI, AE, SR, and CARS scores at T1, T2, and T3 (T1 vs. T2, T2 vs. T3, T1 vs. T3) (all p < 0.05). The observation group demonstrated significant changes in Body and Object use and FM, while the control group showed some changes in these domains. Social and self-help, GM, CMB, and CVB also significantly improved in both groups after 6 months of intervention (all p < 0.05). In terms of different time intervals, the observation group showed greater improvements in Sensory, Relating, Language, CARS scores, EL, RL, and SR compared to the control group (all p < 0.05). The improvement levels in Body and Object use, CVP, FM, VMI, and AE did not differ significantly between the two groups in the T1-T2 interval, but were significantly higher in the observation group in the T2-T3 and T1-T3 intervals (all p < 0.05). The magnitude of changes in Social and self-help, GM, CMB, and CVB did not differ significantly between the groups. Orff music therapy showed significant improvements in language expression, language comprehension, social skills, cognitive abilities, imitation abilities, emotional expression and fine motor in children with ASD. These findings provide support for the use of Orff music therapy as an effective intervention for children with ASD.

Efficacy of Daoyin combined with lower limb robot as a comprehensive rehabilitation intervention for stroke patients: a randomized controlled trial.

To assess the effectiveness of a comprehensive rehabilitation approach combining Traditional Chinese Medicine Daoyin with lower limb robotics during the recovery phase of stroke patients. Stroke patients meeting the specified criteria were randomly assigned to one of four groups using a random number table: Control group, Daoyin group, lower limb robot group (LLR group), and Daoyin and lower limb robot group (DLLR group). Each group received distinct treatments based on conventional rehabilitation training. The treatment duration spanned two weeks with two days of rest per week. Pre- and post-intervention assessments included various scales: Fugl-Meyer Assessment (FMA), Berg balance scale (BBS), Barthel index (BI), Fatigue Scale-14 (FS-14), Pittsburgh sleep quality index (PSQI), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). Statistically significant differences were observed in the lower limb function measured by FAM between the Control group (15 ± 5) and the DLLR group (18 ± 5) (P = 0.049). In the Barthel index, a statistically significant difference was noted between the Control group (54 ± 18) and the DLLR group (64 ± 11) (P = 0.041). Additionally, significant differences were found in the Berg balance scale between the Control group (21 ± 10) and the DLLR group (27 ± 8) (P = 0.024), as well as between the Control group (21 ± 10) and the LLR group (26 ± 10) (P = 0.048). The findings of this study suggest that the combined use of Daoyin and robotics not only enhances motor function in stroke patients but also has a positive impact on fatigue, sleep quality, and mood. This approach may offer a more effective rehabilitation strategy for stroke patients.

522 Testosterone Supplementation in Patients with Burn Hypermetabolism

Abstract Introduction After major burn injuries, patients experience a hypermetabolic response that leads to hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Many transdisciplinary approaches have been tested to mitigate this postburn hypermetabolic syndrome such as comprehensive burn rehabilitation, nutritional support, monitoring, and pharmacological interventions. Oxandrolone, a synthetic analog of testosterone, has been shown to have higher anabolic properties and minimal androgenic effects and studied intensely in burn care. In 2023, the FDA asked all manufacturers of oxandrolone to cease production and subsequently removed the drug from market on June 28, 2023. Our study examines the cost and operationalization of an intramuscular (IM) testosterone protocol as an alternative in male burn patients with ≥20% total body surface area (TBSA). Methods A cost analysis was conducted using the National Drug Codes (NDC) and commercially available benchmarking data. The cost of oxandrolone and testosterone were included in our analysis. Following a thorough literature review, a protocol was developed for adult male patients with &amp;gt;20% TBSA burn injuries. Patients undergoing gender affirming hormone therapy, untreated obstructive sleep apnea, or hormonal blockers for cancer were excluded from the protocol. Results The protocol begins with total serum testosterone levels at the time of admission and weekly thereafter for male patients with ≥20% TBSA injury. Once a testosterone level &amp;lt; 150 ng/dL is detected, supplementation of testosterone with 200 mg IM once weekly for two weeks is started. Weekly evaluations include total body weight, metabolic panels, and nutritional panels. Cost comparison between oxandrolone and testosterone show an equivalent unit cost of $8.62 versus $8.38, respectively. Conclusions Drug shortages and supply chain challenges are becoming more common in burn care. We hypothesize testosterone to be both a clinically effective and cost-effective alternative to oxandrolone in the setting of burn hypermetabolism in male patients with major burns. Currently, burn experts are working with endocrinologists to assess pharmacologic alternatives for female patients and have obtained IRB-approval to evaluate both safety and efficacy of testosterone supplementation in the setting of burn hypermetabolism. Applicability of Research to Practice This study evaluates the safety and efficacy of testosterone supplementation as an alternative to oxandrolone in the setting of burn hypermetabolism. This study helps provide guidance to other burn centers in filling the gap in therapy that now exists in the pharmacologic management of hypermetabolic syndrome in patients with severe burns.

Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM): protocol for a randomised feasibility trial

IntroductionPersonalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) is a research programme that seeks to develop and evaluate a comprehensive exercise-based rehabilitation intervention designed for people with multimorbidity, the...

The Roles and Duties of Physiotherapists on Women's Health During Disaster Period

The incidence of disasters is increasing in Turkey, and in addition to the great loss of life experienced as a result of these disasters, there is also a large increase in the number of individuals in need of rehabilitation. Today, disasters and the physical, mental and environmental damage caused by disasters affect the lives of women, especially. Considering the place of women in society, starting rehabilitation for women at an early age will play an important role in the recovery of society. Physiotherapists, especially those working on women's health, will become very important in the evaluation, treatment and adaptation of these problems to daily life, with the knowledge and capacity they have. The most common problems experienced by women in the post-disaster period are; deterioration of genital hygiene, menstrual problems, problems experienced during pregnancy and after birth, and pelvic floor dysfunctions. The practices that physiotherapists can do in these problems in accordance with environmental conditions are physiotherapy-related evaluations, manual applications, different exercise approaches and preventive approaches that can be recommended for these problems. However, these manual applications and exercises should be planned specifically for the individual and should be responsive to responses in a short time. Creating comprehensive rehabilitation interventions involving trained and experienced physiotherapists in disaster management programs will increase the functional status and quality of life of disaster victims

Recovery following discharge from intensive care: What do patients think is helpful and what services are missing?

Recovery following critical illness is complex due to the many challenges patients face which influence their long-term outcomes. We explored patients' views about facilitators of recovery after critical illness which could be used to inform the components and timing of specific rehabilitation interventions. To explore the views of patients after discharge from an intensive care unit (ICU) about their recovery and factors that facilitated recovery, and to determine additional services that patients felt were missing during their recovery. Qualitative study involving individual face-to-face semi-structured interviews at six months (n = 11) and twelve months (n = 10). Written, informed consent was obtained. [Ethics approval 17/NI/0115]. Interviews were audiotaped, transcribed and analysed using template analysis. Template analysis revealed four core themes: (1) Physical activity and function; (2) Recovery of cognitive and emotional function; (3) Facilitators to recovery; and (4) Gaps in healthcare services. Patient reported facilitators to recovery include support and guidance from others and self-motivation and goal setting, equipment for mobility and use of technology. Barriers include a lack of follow up services, exercise rehabilitation, peer support and personal feedback. Patients perceived that access to specific healthcare services was fragmented and where services were unavailable this contributed to slower or poorer quality of recovery. ICU patient recover could be facilitated by a comprehensive rehabilitation intervention that includes patient-directed strategies and health care services.

Early Gait Biomechanics Linked to Daily Steps Following Anterior Cruciate Ligament Reconstruction.

Gait biomechanics and daily steps are important aspects of knee joint loading that change following anterior cruciate ligament reconstruction (ACLR). Understanding their relationship during the first 6 months post-ACLR could help develop comprehensive rehabilitation interventions that promote optimal joint loading following injury, thereby improving long-term knee joint health. Our primary objective was to compare biomechanical gait waveforms throughout stance at early timepoints post-ACLR in individuals with different daily step behaviors at 6 months post-ACLR. The secondary aim was to examine how these gait waveforms compare to those of uninjured controls. Case-Control Study. Laboratory. Individuals with primary ACLR assigned to a low (LSG) (n=13) or high step group (HSG) (n=19) based on their average daily steps at 6 months post- ACLR, and uninjured matched controls (n=32). Gait biomechanics were collected at 2, 4, and 6 months post-ACLR in ACLR individuals and at a single session for controls. Knee adduction moment (KAM), knee extension moment (KEM), and knee flexion angle (KFA) waveforms were calculated during gait stance and then compared via functional waveform analyses. Mean differences and corresponding 95% confident intervals between groups were reported. Primary results demonstrated lesser KFA (1-45%, 79-92% of stance) and greater KEM (65-93% of stance) at 2 months and greater KAM (14-20%, 68-92% of stance) at 4 months post-ACLR for the HSG compared to the LSG. KEM, KAM, and KFA waveforms differed across various proportions of stance at all timepoints between step groups and controls. Differences in gait biomechanics are present at 2 and 4 months post-ACLR between step groups, with the LSG demonstrating an overall more flexed knee and more profound stepwise underloading throughout stance than the HSG. The results indicate a relation between early gait biomechanics and later daily steps behaviors following ACLR.

Clinical properties and rehabilitation needs of earthquake survivors in a subacute rehabilitation setting.

This descriptive analysis examines the victims of the February 6, 2023, earthquakes in Kahramanmaraş and Elbistan, Türkiye. It aims to detail the injury profiles related to neuro-musculoskeletal trauma, assess the rehabilitation needs of patients, and propose a comprehensive rehabilitation approach. The study included patients injured in the Kahramanmaraş-centered earthquake on February 6, 2023, who were transported to our hospital based on their rehabilitation needs. Data from patients treated at our hospital were recorded retrospectively. This included demographic information, accompanying pathologies, laboratory findings, rehabilitation programs, and treatments received during their hospital stay. Statistical analyses were conducted to examine the data. A total of 141 patients with musculoskeletal injuries were admitted due to injuries sustained from the earthquake. The mean age of the participants was 39.76 years, with a slight female predominance (56.7%). The majority of patients sustained injuries while trapped under debris (90.1%), with an average duration of 10 hours under rubble. Fractures were the most common form of injury (53.2%), predominantly affecting the lower extremities. Peripheral nerve injuries were present in 41.1% of patients, and amputations were observed in 30.5%. Complications included compartment syndrome (46.1%), crush syndrome (36.2%), and various infections. Pain was prevalent among patients, with somatic pain being the most reported type. Individualized rehabilitation programs were implemented, incorporating physical therapy, wound care, pain management, and psychosocial support. This study highlights the critical rehabilitation needs of earthquake survivors and emphasizes the importance of early and comprehensive rehabilitation interventions. Multidisciplinary rehabilitation programs were crucial in addressing medical issues, functional limitations, and psychological challenges faced by the survivors. The findings contribute to a deeper understanding of earthquake-related injuries and underscore the significance of well-coordinated rehabilitation strategies in disaster responses.

Clinical efficacy of comprehensive rehabilitation intervention and its effect on Quality of Life in patients with Advanced Liver Cancer after Ultrasound-guided Microwave Ablation.

To evaluate the clinical efficacy of comprehensive rehabilitation intervention and its effect on the quality of life (QoL) in patients with advanced liver cancer after ultrasound-guided microwave ablation (UMA). This is a retrospective study. Total 110 in-patients with advanced liver cancer who had received UMA in our hospital from January 2019 to January 2021 were included and randomly divided into two groups. Patients in the control group received the conventional intervention and those in the experimental group received comprehensive rehabilitation intervention. The incidence of postoperative complications as well as the differences in indicators, including emotional status, QoL score, and patient satisfaction before and after the intervention were analyzed and compared between the two groups. The differences in survival between the two groups were compared. The incidence of postoperative complications in the experimental group was significantly lower than that of the control group. SAS and SDS scores of the experimental group were significantly decreased after intervention, while the control group had no significant change before and after intervention. KPS and SF-36 quality of life scores in the experimental group were significantly improved compared with the control group, and patient satisfaction was significantly higher than the control group, and the 12-month survival rate was significantly higher than that in the control group. Comprehensive rehabilitation intervention can reduce the incidence of postoperative complications, improve the mood and QoL, and increase patient satisfaction and survival rate in patients with advanced liver cancer after UMA.

Sheikh Khalifa Stroke Institute at Johns Hopkins: Transforming the Care of Patients With Stroke: Lessons Learned.

Sheikh Khalifa Stroke Institute at Johns Hopkins: Transforming the Care of Patients With Stroke: Lessons Learned.

EFFECTIVENESS OF THE REHABILITATION APPROACH BASED ON THE VISUAL MODEL OF MOBIUS TAPE IN THE TREATMENT OF MYOFASCIAL PAIN SYNDROME OF THE CERVICAL REGION IN COMBATANTS

During combat activities, the consequences of contusive and traumatic injuries to the spine, which lead to myofascial pain, in particular in the neck area, are of great importance. Myofascial pain syndrome, localized in the muscles and fascia, can range from mild discomfort to excruciating pain. To optimize personal rehabilitation programs in health care practice, for additional visualization of educational and practical activities, it was suggested to consider the rehabilitation process as a "motor and mental dialogue" at the same time, and also to use a topological object - the Möbius strip as a visual, multi-vector, interdisciplinary, plastic model of rehabilitation. The paper focuses on the study of the effectiveness of using the ecological approach in rehabilitation practice. The research was conducted on the basis of the Municipal Enterprise "Poltava Regional Clinical Hospital for War Veterans" of Poltava Regional Council. 42 military servicemen - participants of combat activities with a diagnosis of the myofascial pain syndrome of the cervical area were included in the study. As a component of the ecological approach, an individually developed program of comprehensive rehabilitation intervention aimed at the biomechanically interconnected muscle spirals, the diaphragm and masticatory muscles, and the temporomandibular joint was used. The method of active rehabilitation in patients using a program of comprehensive rehabilitation intervention for biomechanically interconnected muscle spirals, diaphragm and masticatory muscles, and temporomandibular joint, was based on a course of training with a multidisciplinary rehabilitation team lasting 21 days - 3 - 5 sessions with the doctor every day and 6-8 sessions according to the video sample recorded by the doctor. A statistically significant decrease in the intensity of pain according to VAS and an increase in the angle of painless lateral movement with an element of rotation may indicate the effectiveness of rehabilitation measures already on the seventh day of treatment. A decrease in the intensity of pain and an increase in the angle of painless lateral movement with an element of rotation in the experimental group, as compared to the control group, may indicate the advantage of using the proposed program at the same time as standard approaches in rehabilitation. The model proposed in the study can act not only as a treatment and rehabilitation tool but also as a visual training tool for future specialists, which has several advantages over traditional models. In particular, it involves low cost and ease of implementation, and it should be noted that the comprehensive, at first glance, rehabilitation process is simplified due to mathematical logic, sequence, creativity, and game form.

Rehabilitation outcomes in patients with post-COVID-19 vaccine-associated Guillain-Barre syndrome.

With COVID-19 vaccination campaign worldwide, associated Guillain-Barre syndrome (GBS) is being increasingly reported from different countries. The objectives of the study were to observe the clinical profile and rehabilitation outcomes in patients with post-COVID-19 vaccine-associated GBS. This prospective study was conducted in neurological rehabilitation unit with in-patients. A detailed customized rehabilitation program was formulated based on the clinical status and associated complications. Outcome measures were documented on the day of admission and at discharge and compared. The study included 16 patients (eight males) of which 15 (93.75%) received the CoviShield (AstraZeneca) and 1 Covaxin (Bharat Biotech) vaccine. The median (IQR) duration of first symptom was 9 (18.25) days and for motor symptoms 18 (12.75) days. Functional improvement was observed in patients using Barthel index scores and Hughes disability scores and overall neuropathy limitation scale. All rehabilitation outcomes showed a statistically significant improvement (P < 0.05) from the time of admission to discharge. At discharge, complete independence in activities of daily living was achieved in 4 (25%) patients and 5 (31.25%) were minimally dependent. Three (18.75%) patients were walking independently, seven (43.75%) with minimal support, and four with walker (25%). Nine (56.25%) patients needed bilateral ankle-foot orthosis and two bilateral knee gaiters for locomotion. Comprehensive inpatient rehabilitation interventions in patients with post-COVID-19 vaccine-associated GBS result in significant functional recovery.

Influence of Nursing Intervention Based on Risk Assessment Model on Self-Efficacy and Postoperative Rehabilitation of Surgical Patients.

The study aims to explore the effect of nursing intervention based on risk assessment model on self-efficacy and postoperative rehabilitation of surgical patients. The study applied a risk assessment model to the behavioral intervention of rehabilitation exercise in patients after percutaneous coronary intervention (PCI). A total of 157 patients were selected from a certain hospital, with 52 cases in the experimental group and 55 cases in the control group. A comprehensive cardiac rehabilitation intervention strategy based on TTM is given by researchers trained with professional knowledge, including dividing the stages of behavior change, developing a rehabilitation exercise plan through exercise teaching and exercise training, diet and lifestyle guidance, and urging patients to take regular medication and regular follow-up. The stage of rehabilitation movement behavior change improved. The preexperiment health status was (35.39 ± 14.31), and the overall health of the control group was (32.59 ± 15.41). Overall health status and QOL scores were relatively low in both the groups. The intervention group scored higher than the control group. After coronary stent implantation, the heart restores its original pumping function, various organs and tissues receive effective blood perfusion, and the symptoms of myocardial infarction such as profuse sweating, dizziness, fatigue, and precordial discomfort are effectively relieved. The physical discomfort can gradually improve or even recover to the functional state before the onset of the disease. Before the intervention, the self-efficacy score of the intervention group was (23.68 ± 4.49). After the intervention, the self-efficacy score of the intervention group was (26.21 ± 4.09), while the self-efficacy score of the control group before the intervention was (22.21 ± 4.1). After the intervention, the self-efficacy score of the control group was (25.23 ± 4.41). Although the self-efficacy score of the control group was improved, the difference was small, and the intervention effect was not obvious. It indicates that risk assessment intervention can improve patients' self-efficacy level and quality of life of postoperative rehabilitation patients.

The Effect of Branched Chain Amino Acid Supplementation on Stroke-Related Sarcopenia.

BackgroundStroke-related sarcopenia is caused by various factors, such as brain damage, systemic catabolic state, skeletal muscle imbalance, and malnutrition. In the long-term care plan after stroke, appropriate rehabilitation strategies to achieve maximum functional improvement and prevent the development of sarcopenia are important. This study has investigated the effect of branched-chain amino acid (BCAA) supplementation on sarcopenia after stroke. We also evaluated the effect of BCAA on functional improvement during the intensive rehabilitation period.MethodsPatients with subacute stroke with stroke-related disabilities were enrolled and given dietary supplement powder containing BCAAs for 1 month. These BCAAs were supplied through the nutrition team during feeding time. Patients whose age, sex, and stroke lesions were similar to those of the study group were enrolled in the control group through medical record review. Both groups received personalized intensive inpatient rehabilitation therapy in a single-unit rehabilitation center. All patients' target calories were calculated regularly by the nutritional support team in our institution. Sarcopenia status was evaluated using grip strength and the skeletal muscle index (SMI), which was assessed by dual-energy X-ray absorptiometry (DEXA). The functional status associated with stroke was evaluated every month, including activities of daily living, balance, gait, and swallowing.ResultsA total of 54 patients were enrolled, with 27 patients in each of the two groups. The study group showed significantly greater improvement in SMI after intervention than the control group. Both groups improved functionally over time, but the improvement in the study group was significantly greater than that in the control group. Univariate analysis revealed that patients with better functional status had a greater SMI with a combination of BCAA supplementation and intensive rehabilitation therapy.ConclusionOur results showed a positive effect of BCAA supplementation on sarcopenia after stroke. We also found that nutritional support helps functional improvement during neurological recovery. These results suggest that comprehensive rehabilitation intervention combined with BCAA supplementation could be a helpful option during the critical period of post-stroke neurological recovery.

Study on the Effect of Comprehensive Rehabilitation Intervention on Patients with Schizophrenia during Rehabilitation

Study on the Effect of Comprehensive Rehabilitation Intervention on Patients with Schizophrenia during Rehabilitation

Outpatient holistic neuropsychological rehabilitation in moderate-severe traumatic brain injury: A pilot study

The present study examined the preliminary efficacy and feasibility of a novel, brief, comprehensive neuropsychological rehabilitation intervention for adults with moderate-severe traumatic brain injury (TBI) in the chronic phase. Eight participants with TBI attended a 10-week outpatient programme combining weekly psychoeducation and project-based group interventions with individual neuropsychological rehabilitation. Following the pilot, participants showed clinically significant improvements in goal attainment, were rated by family members as improved in their psychosocial functioning and behavioural competency and reported better quality of life and overall health. Improvements were maintained at three-month follow-up, with the exception of overall health. Retention and attendance rates were high (100 per cent and 90 per cent respectively), as was satisfaction with the programme. The results suggest that brief interventions that combine context-sensitive experiential learning with psychoeducation and goal-focused strategy training are feasible and offer potential to improve functional goal attainment and QoL. Further larger, controlled studies are warranted.

Effect of Branched Chain Amino Acid Supplementation on Prevention of Sarcopenia after Stroke

<h3>Research Objectives</h3> To investigate the effect of branched chain amino acid (BCAA) supplement on prevention of sarcopenia after stoke. We also evaluate the BCAA effect on functional improvement during intensive rehabilitation period after stroke. <h3>Design</h3> Age, stroke-lesion matching study. <h3>Setting</h3> Rehabilitation Center in University Hospital. <h3>Participants</h3> Subacute stroke patients who had stroke-related disabilities and need to undergo intensive rehabilitation intervention were prospectively enrolled. Age, stroke lesion matched control group were enrolled retrospectively medical record review. <h3>Interventions</h3> Patients with study group were administered dietary supplement containing 6g of BCAA twice a day for 1 month. Control group received only conventional rehabilitation therapy. <h3>Main Outcome Measures</h3> Functional status relating stroke were evaluated using the Modified Barthel index, berg balance scale, functional ambulatory category, manual function test, and videoflouroscopic swallowing study. Sarcopenia status were evaluated by using grip strength, and dual energy X-ray absorptiometry (DEXA). Skeletal muscle index (SMI) was defined as appendicular lean mass, assessed by DEXA divided by height in meter squared. All evaluations were measured every 1 month. <h3>Results</h3> Study group showed significantly increased SMI after BCAA supplementation and intensive rehabilitation therapy compared with control group. Both group exhibited functional improvement over time, but the improvement in the study group was more significant than the improvement in control group. 56% of patients who were unable to walk due to stroke, able to walk again with assist after treatment in study group. Univariate analysis revealed that patients with osteoporosis and lower functional status showed decreased SMI after stroke rehabilitation therapy despite of BCAA supplementation. <h3>Conclusions</h3> Our results presented positive effect of BCAA supplement on prevention of sarcopenia after stroke. We also found that nutritional support helps functional improvement on neurologic recovery. Stroke leads to complex systemic metabolic changes, thus loss of muscle mass and malnutrition frequently occurs after stroke. These results suggest that comprehensive rehabilitation intervention with BCAA supplement could be a helpful option during the critical period for post-stroke neurologic recovery. <h3>Author(s) Disclosures</h3> The author reports no conflicts of interest in this work.

A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community

The National Institute for Health and Care Excellence (NICE) describe “post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.