Days Of Inpatient Rehabilitation Research Articles

Effect of inpatient rehabilitation on the quality of life and life satisfaction in spinal cord injury.

Assess the impact of inpatient rehabilitation on the quality of life and life satisfaction of individuals with spinal cord injury by considering the level of injury. QuasiExperimental study. Rehabilitation Hospital. A total of 71 Patients with Spinal cord injury were admitted for rehabilitation. The quality of life and life satisfaction of patients were assessed both before and after 63 days of inpatient rehabilitation. Functional independence measure score (FIM), the Short Form-36 (SF-36), and the Life Satisfaction Scale (LSS). The average age of the study population was 34 ± 14 years. At the end of 63 days, significant improvements were observed in FIM, mood, health, physical performance, role physical, role emotional, pain, and total score of LSS (Π - Value <0.05). The variation in FIM changes significantly improved the total LSS score in the thoracic and thoracolumbar subgroups, but not in the cervical group. In addition, the total score of SF36 was improved significantly just in the cervical subgroup (Π = 0.006). No significant correlations were found between SF-36 and LSS scores (before and after the intervention) in relation to marriage, education, and time. In the context of spinal cord injury, inpatient rehabilitation can play a role in improving functional independence which, in turn, impacts certain aspects affecting life satisfaction and the quality of life. It is important to note that the extent of this correlation varies among patients with different injury levels. In some cases, even minor changes, such as those seen in quadriplegic patients, could have a significant impact on their quality of life.

Inpatient rehabilitation can improve functional outcomes of post-intensive care unit COVID-19 patients—a prospective study

Purpose To evaluate the impact of an inpatient multimodal and intensive rehabilitation program on neuromuscular, respiratory, and functional impairments of post-ICU COVID-19 patients. Materials and methods Prospective study including post-ICU COVID-19 survivors consecutively admitted to a rehabilitation centre. Rehabilitation was conducted by an interdisciplinary team. Medical Research Council (MRC) score, maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), peak cough flow (PCF), Functional Oral Intake Scale (FOIS), Brief Balance Evaluation Systems Test (Brief-BESTest), Timed Up and Go (TUG) test, 1 min Sit to Stand Test (1′ STST), 6 min Walking Test (6MWT), Fatigue Assessment Scale (FAS), Functional Independence Measure (FIM) were assessed at admission (T0) and discharge (T1). Results A total of 42 patients were included. After 32.00;26.00 days of inpatient rehabilitation, there was a significant improvement in limb and respiratory muscle strength, cough effectiveness, fatigue, balance, exercise capacity, and in the ability to perform activities of daily living. Advanced age, longer acute care hospitalization, depressive symptoms, and cognitive deficits were associated with poorer functional outcomes. Conclusion Post-ICU COVID-19 patients present multiple sequelae with detrimental functional impact. An adapted interdisciplinary rehabilitation program is essential for a thorough evaluation of these patients and results in significant functional gains. IMPLICATIONS FOR REHABILITATION Post-ICU COVID-19 survivors present multiple sequelae and disabilities. An intensive and interdisciplinary inpatient rehabilitation results in significant improvement in limb and respiratory muscle strength, cough effectiveness, fatigue, balance, exercise capacity, and ability to perform activities of daily living. Timely referral from the acute care setting to rehabilitation services is crucial to minimize the functional impact of severe multisystemic disease and prolonged hospitalization.

High Intensity Gait Training in Anoxic Brain Injury: A Case Study

<h3>Research Objectives</h3> To investigate the effectiveness of high intensity gait training (HIGT) intervention in sub acute anoxic brain injury. The literature suggests this intervention strategy may facilitate an individual's return to function, however a paucity of research exists supporting the use of HIGT for rehabilitation post-anoxic brain injury. <h3>Design</h3> Single case study before-after trial. <h3>Setting</h3> Inpatient rehabilitation at a Level 1 Trauma Center. <h3>Participants</h3> One 24-year old male with anoxic brain injury. <h3>Interventions</h3> Treadmill training and over ground training were performed for a maximum of 30 minutes per session throughout ten days of inpatient rehabilitation. Harness support at 0% bodyweight was utilized on the treadmill to ensure safety. Heart rate was monitored via continuous pulse oximetry with a goal of reaching 70-80% of the participant's age adjusted maximum heart rate. HIGT was achieved by varying speed, increasing incline, and incorporating forward, backward, and lateral stepping. <h3>Main Outcome Measures</h3> Two functional outcome measures were chosen to assess the participant's gait speed and fall risk at admission and discharge. This included Ten Meter Walk Test (10MWT) and Berg Balance Scale (BBS). Minimal detectable change (MDC) for non-traumatic brain injuries was used to evaluate meaningful improvement. <h3>Results</h3> Meaningful change was achieved in the 10MWT comfortable pace (D 0.37sec; MDC 0.18 m/s) and fast pace (D 0.48 sec; MDC 0.13 m/s) and BBS (D 22 points; MDC 4.66 points). Progression from non-ambulatory to household ambulation with assistance was achieved at discharge. <h3>Conclusions</h3> HIGT is a promising intervention for meaningful functional improvement for individuals with anoxic brain injury. Further studies are necessary to validate this finding. No adverse events occurred with HIGT in sub acute anoxic brain injury. <h3>Author(s) Disclosures</h3> The authors declare that they have no financial or personal relationships that relate to the research described in this paper.

Countering disuse atrophy in older adults with low-volume leucine supplementation.

Older adults are at increased risk of being bedridden and experiencing negative health outcomes including the loss of muscle tissue and functional capacity. We hypothesized that supplementing daily meals with a small quantity (3-4 g/meal) of leucine would partially preserve lean leg mass and function of older adults during bed rest. During a 7-day bed rest protocol, followed by 5 days of inpatient rehabilitation, healthy older men and women (67.8 ± 1.1 yr, 14 men; 6 women) were randomized to receive isoenergetic meals supplemented with leucine (LEU, 0.06 g/kg/meal; n = 10) or an alanine control (CON, 0.06 g/kg/meal; n = 10). Outcomes were assessed at baseline, following bed rest, and after rehabilitation. Body composition was measured by dual-energy X-ray absorptiometry. Functional capacity was assessed by knee extensor isokinetic and isometric dynamometry, peak aerobic capacity, and the short physical performance battery. Muscle fiber type, cross-sectional area, signaling protein expression levels, and single fiber characteristics were determined from biopsies of the vastus lateralis. Leucine supplementation reduced the loss of leg lean mass during bed rest (LEU vs. CON: -423 vs. -1035 ± 143 g; P = 0.008) but had limited impact on strength or endurance-based functional outcomes. Similarly, leucine had no effect on markers of anabolic signaling and protein degradation during bed rest or rehabilitation. In conclusion, providing older adults with supplemental leucine has minimal impact on total energy or protein consumption and has the potential to partially counter some, but not all, of the negative effects of inactivity on muscle health.NEW & NOTEWORTHY Skeletal muscle morphology and function in older adults was significantly compromised by 7 days of disuse. Leucine supplementation partially countered the loss of lean leg mass but did not preserve muscle function or positively impact changes at the muscle fiber level associated with bed rest or rehabilitation. Of note, our data support a relationship between myonuclear content and adaptations to muscle atrophy at the whole limb and single fiber level.

Whey protein protects muscle mass loss of older adults during 7 days of inactivity and accelerates recovery of aerobic fitness during rehabilitation

Older adults are at a greater risk for losing muscle mass and strength during inactivity. Many experience lasting impairments in physical function following an illness or injury that requires hospitalization. We hypothesize that providing older adults with a high quality protein during inactivity will partially preserve muscle mass and function during bed rest and promote recovery during rehabilitation. Up to this point in recruitment, men and women (12 male, 7 female) with an average age of 68.6 years old have been randomized and admitted to the Institute for Translational Sciences' Clinical Research Center for 7 days of bed rest followed by 7 days of inpatient rehabilitation. Dietary intake was strictly controlled and energy intake was calculated for subjects' level of activity. The protein composition of the subjects randomized to the control group (Mixed; n=10) was a mixture of moderate to high quality plant and animal protein. Subjects randomized to the whey group (Whey n=9) received 70% of their protein as whey protein isolate. We are assessing body composition using iDEXA, measuring muscle strength using isokinetic dynamometry, aerobic capacity via VO‐2‐ max testing. Preliminary findings indicate that consuming whey may slow the loss of lean leg mass (−1035 ± 167 vs. −709 ± 101 g for Mixed vs Whey), promote fat mass loss (−14 ± 92 vs. −407 ± 155 g for Mixed vs. Whey) during inactivity. Furthermore, consuming whey protein during rehabilitation accelerates recovery of relative VO2 max (−8.9 ±3.6 vs. 0.41 ± 3.65 ml/kg/min for Mixed vs. Whey).Support or Funding InformationThis research was supported by: Dairy Research Council, RO1 NR012973, and P30 AG024832.

Is Inpatient Rehabilitation After Total Knee Arthroplasty Worth It

Inpatient rehabilitation often is recommended following knee arthroplasty. In this Australian study, 165 adults (mean age, 67; mostly women) who had undergone total knee arthroplasty were randomized to 10 days of inpatient rehabilitation followed by 8 weeks of monitored home physical therapy (PT) or to the monitored home PT program alone. An additional …

Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty

Formal rehabilitation programs, including inpatient programs, are often assumed to optimize recovery among patients after undergoing total knee arthroplasty. However, these programs have not been compared with any outpatient or home-based programs. To determine whether 10 days of inpatient rehabilitation followed by a monitored home-based program after total knee arthroplasty provided greater improvements than a monitored home-based program alone in mobility, function, and quality of life. In this 2-group, parallel, randomized clinical trial, including a nonrandomized observational group, conducted at 2 public, high-volume arthroplasty hospitals in Sydney, Australia (July 2012-December 2015), 940 patients with osteoarthritis undergoing primary total knee arthroplasty were screened for eligibility. Of the 525 eligible patients consecutively invited to participate, 165 were randomized either to receive inpatient hospital rehabilitation and home-based rehabilitation or to receive home-based rehabilitation alone, and 87 patients enrolled in the observation group. Eighty-one patients were randomized to receive 10 days of hospital inpatient rehabilitation followed by an 8-week clinician-monitored home-based program, 84 were randomized to receive the home-based program alone, and 87 agreed to be in the observational group, which included only the home-based program. Mobility at 26 weeks after surgery, measured with the 6-minute walk test. Secondary outcomes included the Oxford Knee Score, which ranges from 0 (worst) to 48 (best) and has a minimal clinically important difference of 5 points; and EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) visual analog scale, which ranges from 0 (worst) to 100 (best), and has a minimal clinically important difference of 23 points. Among the 165 randomized participants, 68% were women, and the cohort had a mean age, 66.9 years (SD, 8.4 years). There was no significant difference in the 6-minute walk test between the inpatient rehabilitation and either of the 2 home program groups (mean difference, -1.01; 95% CI, -25.56 to 23.55), nor in patient-reported pain and function (knee score mean difference, 2.06; 95% CI, -0.59 to 4.71), or quality of life (EQ-5D visual analog scale mean difference, 1.41; 95% CI, -6.42 to 3.60). The number of postdischarge complications for the inpatient group was 12 vs 9 among the home group, and there were no adverse events reported that were a result of trial participation. Among adults undergoing uncomplicated total knee arthroplasty, the use of inpatient rehabilitation compared with a monitored home-based program did not improve mobility at 26 weeks after surgery. These findings do not support inpatient rehabilitation for this group of patients. clinicaltrials.gov Identifier: NCT01583153.

A supportive home visit program for older adults implemented by non-professionals: Feasibility and effects on physical performance and quality of life at one year – A pilot study

Knowledge of supportive home rehabilitative procedures is needed to improve the independent home training and psychosocial wellbeing of older people. The primary focus of this study was to assess the feasibility of a home visit program involving the use of non-professional home rehabilitation assistants (HRAs) support among elderly. The secondary objective was to investigate the effects to physical performance and health-related quality of life (HRQL) of older people. A controlled intervention study was implemented at two war veterans’ rehabilitation centers in Finland. The study included 22 long-term unemployed people aged 26–58 years, who were educated in HRA tasks and 417 community-dwelling persons aged 65–99 years, who participated in 10–28 days of inpatient rehabilitation. The intervention group (IG) received 10–14-month physiotherapist-supervised HRA home visit program. The control group (CG) received no home visit intervention. Additional information was collected to assess the feasibility of the intervention. Structured interviews were carried out. Physical performance was evaluated through several validated tests, pain with the Visual Analog Scale (VAS), and HRQL with the Leipad questionnaire. The HRAs adopted their supporting role through the social activation of the rehabilitees and continued to study to become practical nurses. At 10–14 months, HRQL among women (p=0.029) and chair rising among men (p=0.028) improved in the IG but declined in the CG. The supportive home visit program was feasible and improved the HRQL in women and chair rising in men. This model could motivate long-term unemployed people to educate themselves.

Poster 166: Bilateral thigh pain after unilateral deep brain stimulator placement: a case report.

Setting: Rehabilitation hospital. Patient: An 81-year-old right-handed woman with bilateral essential tremor. Case Description: The patient underwent deep brain stimulator placement in the ventral intermediate nucleus of the left thalamus at another institution to treat right-sided tremor. The procedure was complicated by injury to the anomalous left subclavian artery. Left upper-extremity arterial emboli resulted and required open thrombectomies. The postoperative course was notable for confusion attributed to anesthesia and urinary tract infection. Because of ongoing functional deficits (patient required moderate assistance with dressing and bathing and minimum assistance to ambulate 75ft with an assistive device), the patient was admitted to inpatient rehabilitation on postoperative day 10 from stimulator placement. On admission to rehabilitation, she complained of bilateral thigh pain, which had developed during hospitalization. The aching thigh pain disrupted sleep and therapies and did not respond to anti-inflammatory, narcotic, or neuropathic pain medications. Lumbar spine imaging revealed degenerative disease without foraminal stenosis. Electromyography of the lower extremities was normal. Head computed tomography confirmed stimulator placement in the left thalamus. Assessment/Results: Bilateral thigh pain resolved after the deep brain stimulator frequency was increased to control upper-extremity tremor. Pain medications were subsequently discontinued successfully. The patient was discharged to home at a modified independence level and could ambulate >1000ft after 22 days of inpatient rehabilitation. Discussion: Complications associated with deep brain stimulator placement can cause functional impairments requiring rehabilitation, and physiatrists should be familiar with side effects associated with deep brain stimulation (DBS). Although parasthesias are a known side effect of deep brain stimulator placement, discomfort is typically treated by decreasing stimulation. This is the first reported case, to our knowledge, of bilateral pain from unilateral DBS that responded to increased frequency of stimulation. Conclusions: Unilateral DBS can cause bilateral pain; increasing DBS frequency can relieve pain.

Socialization to the Culture of a Rehabilitation Hospital: An Ethnographic Study

Most previous research on rehabilitation of patients after spinal cord injuries has dealt with the attainment of outcomes valued by staff members or with the prediction of successful outcomes based on sociodemographic characteristics of patients. This study examined the rehabilitation process from the insider's perspective of an individual patient to determine his view of important adaptive problems and to examine how these problems were addressed. Ethnographic methods were used for fine-grained documentation of the experiences of one 30-year-old man with spinal cord injury. Daily interview were conducted with this patient during his 116 days of inpatient rehabilitation. An interdisciplinary research team analyzed the data with the constant comparative method to identify a number of recurring themes. Findings indicate that in addition to learning how to function in the local world of the rehabilitation hospital, the patient also learned a new identify as a person with a long-term disability. A central theme was the patient's ongoing attempt to figure out how his future was related to his life before the injury and how he could use previous competencies in adapting to disability. Staff members seemed so intent on teaching the patient new skills that they often discounted the significance of his past experience and failed to engage in helping the patient connect his future life story to his past.