Daily Rehabilitation Research Articles

Identifying factors associated with post-hospital falls in older patients: a territory-wide cohort study

ObjectivesPost-hospital falls impose a substantial healthcare burden on older adults, yet contributing factors remain inadequately examined. This study aimed to investigate underinvestigated factors associated with post-hospital falls. Study designRetrospective territory-wide cohort study. MethodsWe examined the electronic medical records of patients aged ≥65 who were discharged from public hospitals in Hong Kong (2007–2018). During the 12 months following discharge, participants were monitored to identify falls based on diagnosis codes or clinical notes from inpatient episodes, the emergency department (ED) visits, and death records. Falls were categorized into two groups: those only requiring ED visits and those requiring hospitalizations. Binary logistic and multinomial logistic regressions examined the associated factors for post-hospital falls and subcategories of falls, respectively. ResultsAmong 606,392 older patients, 28,593 (4.71%; 95% CI = 4.66%–4.77%) experienced falls within 12 months after discharge. Of those, 8438 (29.5%) only required ED visits, and 20,147 (70.5%) required hospitalizations. Discharge from non-surgical wards, length of stay over two weeks, receiving the Geriatric Day Hospital and Rehabilitation Day Program, advancing age, being female, having more comorbidities, taking more fall risk increasing drugs, previous admission for falls, and living in Hong Kong Island were associated with increased fall risk. Receiving allied health service or nurse service was associated with reduced risk. The same factors were more associated with falls requiring hospitalizations rather than falls only requiring ED visits. ConclusionsOlder patients with identified factors were particularly vulnerable to post-hospital falls leading to rehospitalizations. Fall risk assessment and tailored prevention should prioritize this group.

Explicit and implicit locomotor learning in individuals with chronic hemiparetic stroke.

Motor learning involves both explicit and implicit processes that are fundamental for acquiring and adapting complex motor skills. However, stroke may damage the neural substrates underlying explicit and/or implicit learning, leading to deficits in overall motor performance. Although both learning processes are typically used in concert in daily life and rehabilitation, no gait studies have determined how these processes function together after stroke when tested during a task that elicits dissociable contributions from both. Here, we compared explicit and implicit locomotor learning in individuals with chronic stroke to age- and sex-matched neurologically intact controls. We assessed implicit learning using split-belt adaptation (where two treadmill belts move at different speeds). We assessed explicit learning (i.e., strategy-use) using visual feedback during split-belt walking to help individuals explicitly correct for step length errors created by the split-belts. After the first 40 strides of split-belt walking, we removed the visual feedback and instructed individuals to walk comfortably, a manipulation intended to minimize contributions from explicit learning. We used a multirate state-space model to characterize individual explicit and implicit process contributions to overall behavioral change. The computational and behavioral analyses revealed that, compared with controls, individuals with chronic stroke demonstrated deficits in both explicit and implicit contributions to locomotor learning, a result that runs counter to prior work testing each process individually during gait. Since poststroke locomotor rehabilitation involves interventions that rely on both explicit and implicit motor learning, future work should determine how locomotor rehabilitation interventions can be structured to optimize overall motor learning. NEW & NOTEWORTHY Motor learning involves both implicit and explicit processes, the underlying neural substrates of which could be damaged after stroke. Although both learning processes are typically used in concert in daily life and rehabilitation, no gait studies have determined how these processes function together after stroke. Using a locomotor task that elicits dissociable contributions from both processes and computational modeling, we found evidence that chronic stroke causes deficits in both explicit and implicit locomotor learning.

A study on improving cancer-related fatigue and disease-related psychological variables in patients with cervical cancer based on online mindfulness-based stress reduction: a randomized controlled trial

BackgroundThe persistent destructive power of cancer-related fatigue (CRF) has been regarded as the biggest influencing factor affecting the postoperative physical and mental health of patients with cervical cancer. During this process, patients might also experience different feelings of disease-related psychological. Therefore, this study aimed to adopt mindfulness-based stress reduction (MBSR) to intervene in patients with cervical cancer, and conducted follow-up for 3 and 6 months to observe the effects of changes in CRF, uncertainty in illness, coping styles, sense of coherence (SOC), and perceived social support (PSS).MethodsA randomized controlled trial was conducted in ShengJing Hospital of China Medical University. A total of 102 patients were selected, and 78 patients completed the whole process, including 40 in the experimental group and 38 in the control group. Data were collected according to Cancer Fatigue Scale, Medical Coping Modes Questionnaire, Multidimensional Scale of Perceived Social Support, and Sense of Coherence-13. The change trend and difference of the two groups of research data were compared by repeated measurement analysis of variance. Bonferroni test was used for multiple tests between groups.ResultsThe CRF, SOC, and coping styles of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR, 3 months follow-up, and 6 months follow-up compared to the before MBSR. However, the uncertainty in illness of the MBSR group showed a decreasing trend (P < 0.001) at after MBSR compared to the before MBSR, and it rose in 3 months follow-up and 6 months follow-up.ConclusionMBSR can effectively alleviate the fatigue of CRF after treatment, while improving their psychological environment. Medical workers can consider implementing online MBSR for patients with cervical cancer in their daily rehabilitation nursing, which is beneficial for their recovery.Trial registrationChina Clinical Trial Registration Center ChiCTR2000040122 (https//www.chictr.org.cn/). Registered on November 21, 2020.

Efficacy and safety of using a unilateral lower limb exoskeleton combined with conventional treatment in post-stroke rehabilitation: a randomized controlled trial.

The incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population. To assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia. This multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21days. The CG underwent a standard daily rehabilitation routine for 21days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21days of rehabilitative training. The BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy's safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population. The LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.

A Randomized Controlled Trial of Home-Based Virtual Rehabilitation to Improve Adherence to Prescribed Home Therapy after Burn Injury: A Northwest Regional Burn Model System Trial.

Daily rehabilitation after burn injury is vital for prevention of function-limiting contractures. However, adherence to prescribed therapy following acute burn hospitalization has historically been low and not well-studied. Studies involving virtual reality technology have demonstrated an association with improved functional outcomes in burn therapy. We conducted a five-year randomized controlled trial comparing 12 weeks of a home-based virtual rehabilitation (HBVR) system with standard burn therapy. Our primary outcome was adherence to prescribed home therapy, measured by e-diary self-report. Secondary outcomes included steps walked daily and patient-reported outcomes regarding stiffness, upper extremity function, and mobility. We enrolled 50 subjects, of which 48 provided data for analysis (23 HBVR, 25 control). Overall adherence to prescribed home therapy was low, 37.2% in the HBVR group and 60.0% in the control group. Reasons for non-adherence in the HBVR group included lack of time, engagement, and replacement of therapy with other physical activity. However, some subjects enjoyed HBVR and believed it aided their recovery. There was no difference in daily steps walked between the two groups. Daily walking gradually improved from 3,500 steps per day in the first week after baseline and plateaued at 6,000 steps per day at week five. There were no differences in stiffness, upper extremity function, and mobility between the two groups at baseline and 3-, 6-, and 12-month follow-up. Subjects demonstrated improved upper extremity function and mobility in the first year after discharge that coincided with increasing stiffness.

The Functional Efficiency of Older Patients after Lumbar Spine Surgery, the Impact of Pain, and the Passage of Time: Tips for Care Providers.

Chronic back pain in adults is often a cause of absenteeism from work, limitations in social interactions, and difficulties in performing daily activities. This study aimed to check whether the functioning of everyday activities in elderly patients after neurosurgery improved over time compared to their condition before the procedure and whether there is a connection between fitness, self-esteem, and pain intensity. This was a cross-sectional study carried out using an anonymous survey. This study included patients over 60 years of age from the neurosurgical ward. The following scales were used to assess cognitive functioning, depression, functional status: basic and instrumental activities of daily living (IADL), back pain disability (QBPDS), pain intensity, and self-esteem. The level of independence in terms of IADL and QBPDS increased, and the intensity of pain decreased. Surgery reduced pain intensity from 8 ± 0.8 to 6.1 ± 1.4 points. The level of self-esteem (RSES) remained at a low level. The passage of time after neurosurgical treatment has a beneficial effect on reducing pain intensity and increasing independence in life activities. Daily physical activity and rehabilitation are important factors supporting the return to independence.

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial

BackgroundSelf-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. ObjectivesTo determine whether implementation of a self-management program (‘My Therapy’) improves functional independence relative to routine care in people admitted for physical rehabilitation. MethodsThis stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus ‘My Therapy’, comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. Results2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). ConclusionsMy Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/

Path analysis of the effect of positive psychological capital on health-promoting lifestyle in patients with COPD after pulmonary rehabilitation: An observational study.

To investigate the effect of positive psychological capital on the health-promoting lifestyle of patients with chronic obstructive pulmonary disease (COPD) and the intermediary effects of life satisfaction and learned helplessness. A total of 482 patients who completed the pulmonary rehabilitation course at the Nantong Sixth People's Hospital of Jiangsu Province were surveyed using a self-designed questionnaire battery, encompassing the positive psychological capital, health-promoting lifestyle, life satisfaction, and learned helplessness scales. A total of 469 of the 482 questionnaires distributed were effectively returned, leading to an effective response rate of 97.3%. The mean scores on the positive psychological capital, life satisfaction, learned helplessness, and health-promoting lifestyle scales were 105.56 ± 10.44, 19.89 ± 6.33, 50.14 ± 5.47, and 104.22 ± 10.44, respectively. The structural equation model demonstrated good fit indexes. The path analysis revealed that positive psychological capital had a direct effect of 0.431 on health-promoting lifestyle, while life satisfaction and learned helplessness had a mediating effect on this relationship (both P < .05). Patients with COPD have low levels of positive psychological capital and health-promoting lifestyle. Thus, addressing psychological problems and providing continuous rehabilitation nursing to strengthen the psychological construct are essential in this patient group. Moreover, the positive psychological capital of patients with COPD can directly predict their health-promoting lifestyle and exert an influence via the chain mediating effect of life satisfaction and learned helplessness. Therefore, clinical medical staff should assess the positive psychological capital of patients with COPD and adjust the daily rehabilitation activities according to the patients' mental state. Furthermore, enhancing the patients' life satisfaction by employing diverse strategies to reduce learned helplessness can notably improve the health-promoting lifestyle of those with COPD.

Integrated crew organization and work zone scheduling for network-wide daily road pavement rehabilitation

This study develops a new integer-programming model to address the network-wide daily road pavement rehabilitation scheduling problem. In the model, the crew organization and work zone schedule are jointly optimized daily, with the objective of minimizing both the operational cost and user travel time. A day-to-day traffic dynamics model is applied to capture the non-equilibrium traffic evolution against network supply variation over the planning horizon, which leads to a simulation-based optimization problem. To solve this challenging problem, a two-stage hybrid heuristic solution method is proposed. In the first stage, hybrid tabu search (TS) meta-heuristics are comparatively developed to identify a group of active crew work routes without time slacks. The obtained crew routes are then fed to the second stage for work zone scheduling via a discrete compass search algorithm. Some important findings are obtained from numerical experiments. First, crew routing (or crew organization) is the dominant decision in the studied problem, and a desirable work zone schedule encourages a crew to execute the assigned tasks continually. The findings can be used to develop simplified and efficient solution algorithms. Second, the hybrid TS meta-heuristics developed for crew routing exhibit superior performance compared to other solution methods. Finally, a well-defined model for the current problem should consider both user travel time and operation cost. Our model enables decision-makers to make an effective trade-off between these two objectives. An effective measure is suggested to evaluate the cost-effectiveness of budget investment decisions when budgets are limited.

Rehabilitation Oculomotor Screening Evaluation (ROSE)-A Proof-of-Principle Study for Acquired Brain Injuries.

Background/Objectives: Acquired brain injury (ABI) is a major cause of global disability. Many ABI patients exhibit oculomotor dysfunctions that impact their daily life and rehabilitation outcomes. Current clinical tools for oculomotor function (OMF) assessment are limited in their usability. In this proof-of-principle study, we aimed to develop an efficient tool for OMF screening and to assess the feasibility, acceptability, and relevance in a small sample of ABI and control participants. Methods: We created the Rehabilitation Oculomotor Screening Evaluation (ROSE) by reviewing existing OMF assessments. ROSE was pilot-tested on ABI patients (n = 10) and age-matched controls (n = 10). Data regarding the characteristics of the assessment, such as the duration, level of participant comprehension, and participant experience were also collected. Results: ROSE takes <20 min (x¯ = 12.5), is easy to complete (agreement x¯ = 4.6/5), and is well-accepted (x¯ = 4.8/5). Patients scored higher in all subtests and total score (x¯ = 34.8 for ABI vs. 8.9 for controls). Most subtests did not provoke any symptoms, especially for controls. There were no significant between-group differences in symptom provocation. This proof-of-principle study shows that ROSE is feasible, acceptable, and relevant for adult ABI patients. Conclusions: ROSE needs further evaluation for reliability testing and validation in larger samples and diverse neurological conditions. Establishing norms for various ages, sexes, and populations should be considered for the deployment of ROSE as an OMF clinical tool.

Implementing the Quality of Life and Potential of Social Farming

&lt;p style="text-align:justify"&gt;The present study explores the Quality of Life (QoL) of young people with intellectual disabilities engaged in a social farming initiative, known as ‘‘Tuttincampo: Social Farming and Inclusivity’’. The project stands as an innovative approach to improving social inclusion and providing vocational education and training. The initiative seeks to offer a viable alternative to traditional rehabilitation day centers by establishing a network of both public and private institutions. To explore the QoL of the young people we analyze data from the Personal Outcome Scale (POS), a tool that investigates the perception of QoL through self-assessment and hetero-assessment. Data were collected at the beginning and at the end of the social agriculture project. The results obtained confirm the importance of planning pedagogical actions to support social inclusion and vocational training for people with intellectual disabilities, highlighting, as well, the potential of social farming as a new “space” to achieve a higher level of QoL.&lt;/p&gt;

Association of the @ctivehip tele-rehabilitation with the fear of falling of older adults with hip fracture and their family caregivers: Secondary analysis of a non-randomised controlled trial.

Osteoporotic hip fracture is a major health problem. Falls, the primary cause, might lead to a persistent fear of falling (FoF) among older adults, affecting their daily activities and rehabilitation. While in-person interventions exist, limited research is available on the effects of tele-rehabilitation on the FoF after a hip fracture. Thus, this study aims to test the association of the @ctivehip tele-rehabilitation programme on reducing the levels of FoF experienced by both older adults with hip fracture and their family caregivers. A non-randomised controlled trial (ClinicalTrials.gov; Identifier: NCT02968589) that compared a webpage-based tele-rehabilitation (@ctivehip) against usual care. Fear of falling was assessed using the Short Falls Efficacy Scale-International. Patients' functional status was evaluated using the Functional Independence Measure. Physical performance was assessed by the Timed Up and Go test and Short Physical Performance Battery. We conducted a per-protocol analysis as the primary outcome, and an intention-to-treat approach as secondary analysis. A total of 71 patients with hip fracture (78.75 ± 6.12 years, 75% women) and their family caregivers participated. Participants in the intervention showed a higher decrease in FoF in comparison to those in the usual care (0.5 Cohen's d; p = 0.042). The reduction in FoF resulting from participation in the tele-rehabilitation programme was mediated by improvements in functional status by 79%. The @ctivehip programme did not decrease FoF of family caregivers. @ctivehip is associated with a reduction of the FoF in older adults with hip fractures, but not in their family caregivers, with the reduction being mostly explained by improvements in the patients' functional status. Although the intervention seems promising, it should not be applied in clinical settings until confirmed by appropriate-designed randomised clinical trials.

Long-Term Impact of Deep Brain Stimulation in Parkinson's Disease: Does It Affect Rehabilitation Outcomes?

Background and Objectives: Although the growing literature is now focusing on the long-term effects of Deep Brain Stimulation (DBS) in Parkinson's disease (PD), there is still a large gap of knowledge about its long-term implications in rehabilitation. Therefore, this study aimed at investigating the effects of rehabilitation in PD patients years after DBS implantation. Materials and Methods: This retrospective case-control study analyzed records from Moriggia-Pelascini Hospital, Italy from September 2022 to January 2024. Data of PD patients (n = 47) with (DBS group, n = 22) and without (control group, n = 25) DBS were considered. All study participants underwent a daily rehabilitation program lasting four weeks, including warm-up, aerobic exercises, strength training, postural exercises, and proprioceptive activities. The outcomes assessed were the Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Timed Up and Go (TUG), 6 Min Walk Test (6MWT), and Self-Assessment Parkinson Disease Scale (SPDDS). Results: DBS group showed significant improvements in terms of all outcome measures after the rehabilitation intervention (UPDRS III: -7.0 (-11.5 to -1.0); p = 0.001; UPDRS I II IV: -12.0 (-19.0 to -4.5); p = 0.001; BBS: 7.0 (3.8 to 10.3); p < 0.001; TUG (s): -2.8 (-5.7 to -1.1); p < 0.001; SPDDS: -8 (-13.0 to -4.0); p < 0.001; 6MWT (m): 81 (37.3 to 132.3); p < 0.001). No differences were reported in the between-group analysis (p: NS). Conclusions: This study emphasizes positive rehabilitation effects on PD patients irrespective of DBS status. Further research is essential to elucidate long-term effects of DBS on rehabilitation outcomes of PD patients.

Age-Related Differences in the Effectiveness of Rehabilitation to Improve Activities of Daily Living in Patients with Stroke: A Cross-Sectional Study.

This study aimed to reveal differences in the effectiveness of rehabilitation in improving activities of daily living (ADL) in patients with acute stroke across age groups and propose age-appropriate rehabilitation strategies. This observational study analyzed nationwide administrative data of inpatients admitted to hospitals with acute stroke between April 1, 2018, and March 31, 2020. The data included the average length of daily rehabilitation sessions, weekly frequency of rehabilitation sessions, and initiation of rehabilitation within 3 days. The primary outcome was the improvement in the Barthel Index (BI) score from admission to discharge. We classified the patients based on age and analyzed improvements in ADL according to rehabilitation characteristics. An increased daily rehabilitation dose was associated with improved ADL, except in patients aged &lt;65 years (risk ratio [95% confidence interval] in the 65-74, 75-85, and ≥85 years age groups: 1.20 [1.14‒1.27], 1.21 [1.15‒1.27], and 1.43 [1.34‒1.53], respectively; all p&lt;0.001 vs. &lt;65 years: 1.05 [0.98‒1.12]; p=0.18). A rehabilitation frequency of seven sessions per week was associated with improved ADL in the 75-85 years and ≥85 years age groups (1.06 [1.02‒1.10] and 1.08 [1.03‒1.13], respectively; both p&lt;0.001). The effects of initiating rehabilitation within 3 days on ADL post-admission did not differ across age groups. Increasing the daily dose of rehabilitation was significantly associated with improved ADL in all age groups while increasing the frequency of rehabilitation per week improved ADL in older and very old patients.

Organization of patient-oriented care for children diagnosed with cerebral palsy in outpatient settings

The desire to organize a patient-centered approach in interaction with patients is increasing, as focusing on the needs of the patient becomes an integral element of the quality of modern medical care. Target. To evaluate the provision of medical care to children with cerebral palsy using various methods that address the needs of not only the patient himself, but also his family members involved in his daily rehabilitation and social adaptation. Results. Indicators of the quality of patient-centered care include the actions of the patient and nursing staff, determining the content of care in a specific clinical situation, compliance with standards and algorithms of nursing activities, taking into account partnerships with patients and their relatives, and cooperation with other specialists of the multidisciplinary team. Conclusion. At the global level, the World Health Organization recognizes the patient-centered approach as key to modern assessment of the quality of health care. In this regard, the quality of patient-centered nursing activities, as a component of medical care, is determined by three main characteristics: structure, process and result.

Awareness and perceptions of managing recovery in psychiatric patients in a rehabilitation center: an observational study

IntroductionIn mental health prevention, person-centered, and rights-based approaches, the role of recovery is highlighted (WHO, 2021). Various evaluation tools are used in rehabilitation objectives and programs, including the Specific Levels of Functioning Scale (SLOF) (Mucci et al. Schizophr Res 2014;159 144-50) and the Recovery Assessment Scale – Domains and Stages (RAS-DS), a self-measure of mental health recovery. It includes 38 items clustered into four recovery domains and meets two functions. In addition to measuring self-reported outcomes, it increases service-user control towards objectives and recovery action plans (Honey et al. BMC Psychiatry 2023;23 500).ObjectivesTo evalue the efficacy of RAD-DS in a psychiatric rehabilitation facility to be used as a routine tool in daily rehabilitation activity.MethodsIn our observational study, we recruited 103 inpatients (total: 103 patients, females: 38 patients, males: 65 patients) in a psychiatric rehabilitation facility. The patient presented with psychiatric disorders that met the diagnostic criteria of DMS-5 (schizophrenia, bipolar disorder, MDD, personality borderline disorder). Epidemiological data are shown in Table 1.All patients were undergoing a psychiatric rehabilitation program and were observed during a one-year evaluation.In all patients, the following rating scales were administered at baseline (T0) and after a year (T1):For the evaluation of social measures, life outcomes, and functioning and recovery:-Recovery Assessment Scale – Domains and Stages RAS-DS-Specific Levels of Functioning Scale (SLOF)-Global Assessment of Functioning (GAF)For psychopathological evaluation:-Brief Psychiatric Rating Scale (BPRS)The data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.ResultsThe RAS-DS total score results (Table 2) show a not significant difference between T0 vs. T1 (mean: 101.80 vs. 104.37, p. 0.193). An improvement in the score was observed after one year of rehabilitation treatment in the subgroup “Doing things I value” (T0 vs. T1: mean 16.15 vs. 18.77, p 0.001). Statistically significant differences were observed in the subgroups “Mastering my illness” (T0 vs. T1: mean 18.3 vs. 20.85, p. 0.021). In the other subgroups, the differences were not statistically significant. Interestingly, these results are comparable to those found with SLOF and GAF (respectively, p. 0.972 and p. 0.873).Image:Image 2:ConclusionsThe current trend of research and clinical practice is to give more importance to psychiatric rehabilitation treatment (Franza Psychiatr Danub 2022;34(Suppl 8) 9-13). The results obtained with our observational study indicate the possible usefulness of indicators of patient well-being, as well as the RAS-DS in the management of psychiatric rehabilitation programs. The expectations, indications, and perceptions of psychiatric patients can be decisive in improving recovery.Disclosure of InterestNone Declared

Effect of Respiratory Telerehabilitation on Pulmonary Function Parameters and Quality of Life in Patients with COVID-19: A Randomized Controlled Trial

Background: Given the heightened impact of post-COVID-19, active involvement in the rehabilitation process, particularly in respiratory rehabilitation, is essential for these patients. This study addresses the urgent need for developing and evaluating remote respiratory rehabilitation methods post-COVID-19, focusing on enhancing patients' quality of life and pulmonary function. Objectives: The study aimed to investigate how respiratory telerehabilitation influences pulmonary function and the quality of life in this patient population. Methods: In this randomized controlled clinical trial, 60 COVID-19 patients from two major hospitals in Mashhad were evaluated during 2021 - 2023. The control group received a training booklet and an incentive spirometer, while the intervention group participated in a telerehabilitation program. This program involved four-week daily respiratory rehabilitation exercises conducted online using the Skyroom platform. At the end of each session, the patient's fatigue and shortness of breath were assessed using the Borg Rating of Perceived Exertion (RPE) Scale and the number of physical exercises completed. All patients completed the Quality of Life (QOL) Questionnaire and undertook the 6-Minute Walk Test (6MWT). Heart rate, respiratory rate, blood oxygen saturation (SPO2), maximum inspiratory pressure (MIP), fatigue, and shortness of breath were measured on the day of discharge and two and four weeks post-discharge. Covariance (ANCOVA) and repeated measures analysis of variance (RMANOVA) were analyzed for data analysis. Results: In both baseline-adjusted and fully-adjusted ANCOVA models, the results indicated a significant intervention effect after 4 weeks for MIP (73.43 ± 5.77), SPO2 (96.90 ± 1.21), Borg scale score (9.77 ± 1.59), and MWT6 (455.90 ± 37.70), (all P &lt; 0.0001), with significantly higher changes observed in MIP, SPO2, Borg Scale score, and MWT6 after 2 weeks as well as after 4 weeks in the intervention group than the control groups. Also, in both models, the results indicated a significant intervention effect after 2 weeks as well as 4 weeks for physical functioning, role physical, vitality, social functioning, role emotional, Physical Health Scale score, and total SF36 score (60.37 ± 6.93) (P &lt; 0.001). Conclusions: Using bidirectional audio and video communication in the telerehabilitation of COVID-19 patients significantly improved their pulmonary function and QOL. Based on these findings, it is recommended that this method be considered as an integral component in rehabilitation programs for COVID-19 patients.

Importance of bone mineral density and comorbidity index for functionality

Background: Assessing elderly ambulatory patients at risk of osteoporotic fractures is crucial for achieving appropriate functioning, including daily activities, rehabilitation, lifestyle improvements, and dietary optimization. Aim: This study focuses on evaluating bone health and comorbidities in patients to predict osteoporotic fracture functionality, using multiple logistic regression and comparing cohorts for optimal operating points. Methods: A retrospective study was conducted at Prince Rashid bin Al-Hasan Military Hospital, Jordan, to examine the correlations and quality of patients' functionality statuses based on Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD). The study categorized patients into two cohorts, with functional grades ranging from III-IV to I-II. The results were analyzed using statistical tests and confidence intervals. Results: A Multiple Logistic Regression model was developed to simulate the relationship between patients' Age-adjusted Charlson Co-Morbidity Index (AACCI) and femoral hip bone mineral density (fH_BMD) and their functionality statuses. The model was statistically significant, explaining variation in the dependent variable from 30%-40.2% depending on the reference method. It correctly classified 78.2% of cases, with the explained variation ranging from 30%-40.2% depending on the method used. Conclusion: A small, non-sponsored study found an exponential association between patients' femoral bone mineral density and their functionality status, with this correlation shifting to the right when the Age-adjusted Charlson Co-Morbidity Index is ≥4.

Handbike for Daily Use, Sport, and Rehabilitation Purposes: A Literature Review of Actuation and Technical Characteristics

With respect to alternative devices like traditional wheelchairs, handbikes can offer advantages from biomechanical and physiological perspectives, to several kinds of users. Assuring high mechanical efficiency and homogeneous force distributions along cycles, and being suitable for indoor and outdoor activities, these systems are used for rehabilitation, sports, and daily applications. From a technical perspective, their main characteristics can vary with the device final purpose and operational context. This review aims to provide an overall outline of handbikes in the literature from a general and comprehensive point of view, up until 2022. The analysis is performed (i) with a systematic approach, without a priori limitations on document type and content focus, and (ii) to identify the areas of interest for the scientific development of these systems. A systematic evaluation method for the identification and analysis of the documents was designed and implemented and the selection criteria, as well as the rationale for the procedure, are described. A specific taxonomy was defined and applied for the subsequent analysis, and each category is specifically evaluated and described, detailing the main outcomes of the literature analysis and relative discussion. Particular attention is paid to actuation strategies and propulsion efficiency. Finally, the main results of the work and future developments for handbikes are briefly synthesized.

Brief Review: Virtual Reality and Physical Exercise as Countermeasures of Coping the Space Missions

Microgravity is an environment incompatible with human physiology that induces unique physiological changes to the body. Exposure to microgravity environment can cause some possible physiological hazards, such as impairment of immune function, bone mass and skeletal muscle mass, in addition to possible negative psycological alterations (depression, anxiety, apathy, and personality changes). These pysico-physiological changes negatively impact health status and quality of life and result in operational difficulties on a space mission for the astronauts. Countermeasures designed to lessen the effect of microgravity on the human body include daily physical exercise and rehabilitation, psychotherapy, specific diets, pharmaceutical treatments, and the use of technologies. Virtual reality (VR) added to physical exercise programs, in the training and preparation of the astronauts for the space missions, could have more exuberant effects. Therefore, the aim of this perspective article is to present the application of VR and physical exercise as countermeasures for training and preparation before, during and after a space missions.