Efficacy Of Rehabilitation In Patients Research Articles

Effectiveness of Rehabilitation in Patients with Guillain-Barre Syndrome: a Systematic Review of the Literature

Background. Guillain-Barre syndrome is an immune-mediated polyradiculoneuropathy characterized by acute neurological symptoms, usually following an infectious disease. The discovery of links between coronavirus infection and GBS has made the analysis even more relevant. The aim. To evaluate the efficacy of rehabilitation for patients with GuillainBarre syndrome (GBS). Methods. A systematic literature review was performed according to PRISMA statement. A literature search had begun on January 10, 2022, and ended on May 1, 2022. The search was performed in Pubmed, ScienceDirect, and ClinicalKey databases. Inclusion criteria were research articles published less than five years ago, written in English, evaluating the efficacy of rehabilitation for patients with GBS. Results. The research strategy identified 606 results. After excluding duplicates (n = 230), and after a thorough assessment, six studies were included. Every study showed positive effects of rehabilitation in patients with GBS. Two studies used GBS – Disability Score to evaluate rehabilitation efficacy, which had positive results (p < 0.0001 and p < 0.01). Another study found that supervised, individualized exercise was more efficient than unsupervised home exercise. There was also a study with groups of children with GBS, who had electromyographic biofeedback therapy, that showed positive dynamics (p < 0.05). Another study assessed neuropathic pain and presented a reduction in pain after rehabilitation (p < 0.05). Conclusion. Patients with GBS have achieved significant positive changes in mobility, cognitive function, and performance of daily tasks after rehabilitation treatment. Keywords: Guillain-Barre syndrome, rehabilitation, electrical stimulation, physical therapy, exercise.

Rehabilitation in Advanced Cancer Patients with Bone Metastases and Neural Compromise: Current Status and Future Directions.

This review aimed to increase the understanding of oncologists and physiatrists about the necessity, efficacy, and safety of rehabilitation in advanced cancer patients with bone metastases and neural compromise. Recently, there are growing evidence supporting the safety and efficacy of rehabilitation in patients with bone metastases and neural compromise. Despite the potential benefits of rehabilitation, however, rehabilitative services are considerably underutilized in clinical practice. Many oncologists are not familiar with functional issues and have limited understanding of the available rehabilitative services. Moreover, medical professionals, even physiatrists, have uncertainties and concerns about skeletal complications and often regard rehabilitation as a contraindication in this patient group. This review aimed to raise awareness on the role of rehabilitation in the continuum of cancer treatment, to improve its use in clinical practice. A multidisciplinary team approach involving physiatrist may facilitate integration of relevant clinicians.

The Effect of Acute Inpatient Rehabilitation on Functional Outcomes and Discharge Disposition Following Liver Transplant

Background: Patients undergoing liver transplantation often face many challenges with functional independence, which acute rehabilitation can assist them in overcoming. Due to increased yearly liver transplantations, further investigation is required to evaluate the efficiency of acute rehabilitation. The objective of this study is to analyze the efficacy of acute rehabilitation in patients who underwent liver transplantation, primarily using Functional Independence Measure (FIMTM) scores and discharge disposition.
 Methods: A retrospective chart review was conducted on 143 encounters, consisting of 107 patients who underwent liver transplantation. Inclusion factors consisted of undergoing liver transplantation between January 2014–December 2018, admission into acute rehabilitation within 6 months post-transplant, and the availability of admission date, admission FIMTM, duration of stay, discharge FIMTM, and discharge disposition. These factors were evaluated in this study.
 Results: Patients who underwent acute rehabilitation following liver transplantation were found to have statistically significant positive FIMTM change (P < 0.00001) and FIMTM efficiency (P < 0.00001). The mean FIMTM change and efficiency were 25.4±18.5 and 2.0±1.6, respectively, for patients meeting inclusion criteria, and 35.7±11.8 and 2.4±1.0, respectively, when return to acute care (RTAC) encounters were excluded. A positive correlation was found between longer duration of stay in acute rehabilitation and positive FIMTM change for all patients meeting inclusion criteria (P < 0.00001, r = 0.465), and excluding RTAC encounters (P < 0.00001, r = 0.393). 34.3% (n = 49) of encounters had an RTAC, 3.5% (n = 5) were discharged to a skilled nursing facility (SNF), and 62.2% (n = 89) were discharged to the community. Overall, 83.2% (n = 89) of patients ultimately had a community discharge. Infection, respiratory/CV complications, and gastrointestinal complications were the most common causes for RTAC. 
 Conclusion: Acute rehabilitation provides patients who have received a liver transplant with the opportunity to significantly improve their function and independence.

Feasibility of using acceleration-derived jerk to quantify bimanual arm use

BackgroundAccelerometers have become common for evaluating the efficacy of rehabilitation for patients with neurologic disorders. For example, metrics like use ratio (UR) and magnitude ratio (MR) have been shown to differentiate movement patterns of children with cerebral palsy (CP) compared to typically-developing (TD) peers. However, these metrics are calculated from “activity counts” – a measure based on proprietary algorithms that approximate movement duration and intensity from raw accelerometer data. Algorithms used to calculate activity counts vary between devices, limiting comparisons of clinical and research results. The goal of this research was to develop complementary metrics based on raw accelerometer data to analyze arm movement after neurologic injury.MethodWe calculated jerk, the derivative of acceleration, to evaluate arm movement from accelerometer data. To complement current measures, we calculated jerk ratio (JR) as the relative jerk magnitude of the dominant (non-paretic) and non-dominant (paretic) arms. We evaluated the JR distribution between arms and calculated the 50th percentile of the JR distribution (JR50). To evaluate these metrics, we analyzed bimanual accelerometry data for five children with hemiplegic CP who underwent Constraint-Induced Movement Therapy (CIMT) and five typically developing (TD) children. We compared JR between the CP and TD cohorts, and to activity count metrics.ResultsThe JR50 differentiated between the CP and TD cohorts (CP = 0.578 ± 0.041 before CIMT, TD = 0.506 ± 0.026), demonstrating increased reliance on the dominant arm for the CP cohort. Jerk metrics also quantified changes in arm use during and after therapy (e.g., JR50 = 0.378 ± 0.125 during CIMT, 0.591 ± 0.057 after CIMT). The JR was strongly correlated with UR and MR (r = − 0.92, 0.89) for the CP cohort. For the TD cohort, JR50 was repeatable across three data collection periods with an average similarity of 0.945 ± 0.015.ConclusionsAcceleration-derived jerk captured differences in motion between TD and CP cohorts and correlated with activity count metrics. The code for calculating and plotting JR is open-source and available for others to use and build upon. By identifying device-independent metrics that can quantify arm movement in daily life, we hope to facilitate collaboration for rehabilitation research using wearable technologies.

Abstract 19823: Japanese Multicenter Study on the Prognostic Efficacy of Out-patient Cardiac Rehabilitation in Patients With Coronary Artery Disease: J-REHAB

Introduction: Although the prognostic efficacy of out-patient cardiac rehabilitation (OPCR) in patients with coronary artery disease (CAD) has been established in Western countries, it has not been studied in Japan, where both incidence and mortality of CAD are known to be much lower than in Western counties. Methods: To determine the prognostic efficacy of OPCR in Japan, a prospective, controlled, multicenter study of OPCR (J-REHAB) was conducted in 15 hospitals in Japan. A total of 1047 patients hospitalized with cardiac events were prospectively assigned to either OPCR group (n=848) or Non-OPCR group (n=199) according to patient’s preference at the time of hospital discharge. Patients in OPCR group were scheduled to participate in a comprehensive OPCR program for 3 months and Non-OPCR group received usual care. Event-free survivals for cardiac and all-cause death/rehospitalization were assessed according to the initial group assignment and the “prespecified” actual OPCR performance (attendance >=4 times/month and total exercise time >=150 min/week). Results: Patients were followed-up for 416days on average and the follow-up rate was 99.4%. At baseline, patients were 64±11years of age, 85% was male, 58% acute myocardial infarction, with preserved EF (53±13%). By Kaplan-Meier analysis, OPCR group had significantly better event-free survival for cardiac death/rehospitalization (p<0.05) and all-cause death/rehospitalization (p<0.001) than Non-OPCR group. However, after Cox proportional hazard analysis including patient characteristics (underlying heart disease, NYHA class, EF, residual coronary stenosis, heart rate, peak oxygen uptake, and ACE inhibitor/ARB), these differences were no more significant. In contrast, Cox analysis based on prespecified actual OPCR performance (good [n=352], partial [n=321], and poor [n=374]) revealed that good OPCR performance (i.e., active participation) was a potent independent determinant of both cardiac and all-cause event-free survival (both p<0.01). Conclusions: The first Japanese prospective multicenter J-REHAB study has demonstrated that active participation in OPCR is associated with better event-free survival in CAD patients, independent of baseline clinical characteristics.

Towards health benefits in chronic respiratory diseases: pulmonary rehabilitation

In 1895, Dr Charles Denison, a Professor of Diseases of the Chest and of Climatology at the University of Denver, was the first to state that daily walks, hygiene and dietary are important to acquire mental relaxation, happiness and prosperity in “pulmonary invalids” [1]. Notwithstanding, it took another 74 years before Petty et al. [2] described a “comprehensive care programme” for individuals with “chronic airway obstruction” in a landmark peer-reviewed article [2]. This is still regarded as the first article on the short-term and long-term efficacy of rehabilitation for patients suffering from a chronic pulmonary disease. The first international statement on pulmonary rehabilitation with a strong recommendation for its use in the management of patients with chronic obstructive pulmonary disease (COPD) was first published in 1992, and has been offered to physicians, and other healthcare professionals, by the scientific community [3]. That recommendation is still supported by the latest American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement of Pulmonary Rehabilitation [4], as well as by …

Preoperative rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results: Preliminary report.

e18529 Background: The role of preoperative pulmonary rehabilitation is unclear. The aim of the study is short-term efficacy of pulmonary rehabilitation in patients with thoracic tumors and borderline abnormal spirometry results before thoracic surgery. Methods: We observed 12 patients (7 women, 5 men) in mean age of 64 (range 46-82) years. Clinical inclusion criteria were: diagnosis of thoracic tumors and reduced values of FEV1 and FVC predicting postoperative complications. Spirometry and 6MWT were chosen for evaluation of lung function and physical performance during rehabilitation. These tests were performed twice during screening phase to eliminate the factors of learning, and were repeated after first and second week of rehabilitation. Pulmonary rehabilitation included two weeks of training on the treadmill with individually selected speed, physiotherapy exercises and breathing training with using of Triflo. Results: The analyses of results of spirometry and 6MWT before and after 2 weeks of pulmonary rehabilitation indicated the significant differences in values of: 1)FEV1 (L): 1,38 ± 0,23 vs 1,61 ± 0,29 (p=0,01) 2) FEV1 (%N): 56,3 ± 13,9 vs 67,8 ± (p=0,007) 3) FVC (L): 2,24 ± 0,37 vs 2,74 ± 0,67 (p=0,03) 4) FVC (%N): 73,5 ± 15,7 vs 91,2 ± 12,7 (p=0,01) 5) 6MWT distance (m): 251 ± 79 vs 310 ± 74 (p=0,003). Although improvement after rehabilitation, 3 patients were disqualified from lobectomy due to unsatisfactory performance status. Another 3 patients experienced complications during perioperative period. Analysis of pulmonary rehabilitation efficacy showed that 6 patients with favourite outcome after thoracic surgery differed significantly in comparing to others. They achieved significantly higher difference in following parameters: 1) FEV1 (L): 0,4 vs 0,06 (p=0,02) 2) FVC (L): 0,91 vs 0,09 (p=0,02) 3) 6MWT distance (m): 93 vs 25 (p=0,016). Conclusions: A two-week pulmonary rehabilitation leads to significant improvement of lung function and physical performance in patients with thoracic tumors and borderline abnormal spirometry results. A clinically significant increase of absolute values of FEV1, FVC and 6MWT distance may indicate a favourite outcome after thoracic surgery.

Efficacy of rehabilitation for patients with ankylosing spondylitis: Comparison of a four-week rehabilitation programe in a Mediteranean and a Norwegian setting

To investigate the sustained effect of a rehabilitation programme for patients with ankylosing spondylitis, and to compare the effect of this intervention given in a Mediterranean vs a Norwegian setting. A total of 107 patients with ankylosing spondylitis applying for rehabilitation were randomized to a 4-week inpatient rehabilitation programme in a Mediterranean country or in Norway. The participants were evaluated clinically before and after the rehabilitation period (week 0 and 4) and in week 16. The ASsessments in Ankylosing Spondylitis working group's Improvement Criteria (ASAS-IC), and tests of spinal mobility and physical capacity were used to measure treatment response. An ASAS20 improvement was still present at week 16 in 50% of the patients treated in a Mediterranean and 23% in a Norwegian centre (p = 0.006). The tests of spinal mobility, physical capacity, and almost all patient's assessments of health status (ASAS-IC components) were still improved at week 16 after therapy in both climatic settings. While the improvements in physical capacity were comparable, the spinal mobility and ASAS-IC components improved more, and improvements were sustained longer, after rehabilitation in a Mediterranean setting. Patients with ankylosing spondylitis benefit from a 4-week rehabilitation programme in Norway, but even more so from a similar programme in a Mediterranean setting.

Efficacy of Rehabilitation for Patients with HAM (HTLV-1 associated myelopathy)

HAM患者は，排尿障害を伴う痙性対麻痺を呈し下部体幹及び骨盤・股関節周囲筋の筋力低下が特徴的であった．これまでに，HAM患者のリハビリテーション（以下，リハ）に関する報告は少なかった．我々は，下部体幹及び骨盤・股関節周囲筋の筋力増強訓練を中心としたプログラムを作成しリハの有効性を検討した．対象は，男性2 例，女性10 例の12 例で，平均年齢53.2 歳，平均罹病期間20.5 年間で，平均リハ日数41 日であった．リハ前後で納の総合運動機能評価OMDS及びFIM，Barthel Indexにて改善を認めた．そして，リハ実施後の下部体幹では体幹屈筋群，体幹伸筋群，体幹回旋群が有意に改善し，股関節周囲筋では腸腰筋，大殿筋，中殿筋でも有意な改善がみられた．この運動機能やADLの改善は，HAM患者では罹病期間は長いがリハの経験も少なく神経原性変化も軽かったので，リハの有効性を示唆している．

The efficacy of rehabilitation for patients with rheumatoid arthritis: comparison between a 4‐week rehabilitation programme in a warm and a cold climate

Objectives: To investigate the long‐term effect (week 16) of a 4‐week rehabilitation programme for patients with rheumatoid arthritis (RA) and to compare the effect of this intervention given in a Mediterranean or a Norwegian climate.Methods: A randomized, controlled, parallel group design, where 124 RA patients applying for rehabilitation were randomized to a rehabilitation programme either in Norway or in a Mediterranean climate. The participants were examined clinically immediately before (week 0) and after (week 4) the rehabilitation period as well as in week 16 and answered a mailed questionnaire in week 28. The 28‐Joint Disease Activity Score (DAS28), American College of Rheumatology (ACR) response and physical tests were used to measure clinical response.Results: The baseline DAS28 value 4.45 (1.16) was reduced by −0.95 (1.05) in the Mediterranean climate and the baseline DAS28 value 4.18 (1.17) was reduced by −0.37 (0.92) in the Norwegian climate at week 16 (p = 0.003). An ACR20 improvement was achieved in 25% of the patients treated in the Mediterranean climate and in 15% of those treated in the Norwegian climate. Sustained improvement in all ACR core components at week 16 and in patient's assessment of health status at week 28 was found in the patients treated in the Mediterranean climate only. Tests of physical function, the 6‐Minute Walk Test (6MWT) and the Timed Up and Go (TUG), showed comparable improvements in patients treated in both climates.Conclusions: RA patients showed immediate positive effects with regard to disease activity, physical function, and symptoms during a 4‐week rehabilitation programme. The effects on disease activity and symptoms were larger and better maintained at least 3 months after rehabilitation in a warm rather than in a cold climate.

Effect of tiotropium bromide on efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Effect of tiotropium bromide on efficacy of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Musculoskeletal Rehabilitation

This work examines the current state of knowledge regarding the efficacy of rehabilitation for patients with major lower-extremity joint replacements, hip fractures, and amputations. Of particular focus is the use of inpatient rehabilitation strategies for functional restoration. These areas of rehabilitation involve common conditions in the elderly population. Cost-containment pressures have highlighted the focus on the efficacy of inpatient rehabilitation for persons with joint replacements in particular. Medicare's "75% rule" specifically limits persons with elective joint replacements from entering rehabilitation units after their surgeries. This article highlights research relevant to these issues and was written to examine the state of knowledge about these topics with the goal of highlighting areas that need more research attention.

Pulmonary Rehabilitation

Pulmonary rehabilitation programs use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. These programs provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one may be unsupervised) for at least 6 wk. The programs usually consist of exercise training, education, and psychosocial/behavioral components. Upper extremity exercises and instruction on breathing technique are included in most rehabilitation programs and reduce dyspnea, but the contribution of these to improved functional capacity remains unproven. Decreases in the sensation of dyspnea, increased functional exercise capacity, and enhanced quality of life of patients with chronic obstructive pulmonary disease (COPD) are established benefits of pulmonary rehabilitation. Evidence is lacking for the efficacy of rehabilitation for patients with non-COPD causes of pulmonary impairment, but many of these patients probably benefit. Despite the availability of strong evidence to support the efficacy of pulmonary rehabilitation programs in patients with severe COPD, third-party reimbursement policies have been inconsistent. Nonetheless, enrollment in a pulmonary rehabilitation program is encouraged for all appropriate candidates with chronic respiratory impairment, particularly for those with severe COPD.

Efficacy of post-acute brain injury rehabilitation for patients with anoxic brain injury

Efficacy of post-acute brain injury rehabilitation for patients with anoxic brain injury

IMPROVEMENT IN FUNCTIONAL CAPACITY AND QUALITY OF LIFE FOLLOWING PARTICIPATION IN A NON-TRADITIONAL CARDIOPULMONARY REHABILITATION PROGRAM IN PATIENTS WITH SEVERE HEART FAILURE. 12

The efficacy of rehabilitation for patients with severe heart failure has not been well-documented and remains controversial. To evaluate the effectiveness of rehabilitation, twenty-four New York Heart class II-IV heart failure patients participated in a program including: 1) dyspnea control; 2) use of medications; 3) nutritional interventions; 4) functional conditioning utilizing low level interval training techniques. All patients were referred following medical optimization. Average ejection fraction was 20%. Symptom-limited metabolic treadmill testing and quality of life assessment (QL) Minnesota Living with Heart Failure was performed prior to and after 12 weeks of rehabilitation. Results: (Table)TableConclusions: 1) Improved functional capacity is consistent with improvements in quality of life. 2) Non-traditional cardiopulmonary rehabilitation including incremental exercise conditioning and education in disease management result in a significant improvement in functional capacity and QL in patients with severe heart failure.

The Efficacy of Vestibular Rehabilitation for Patients with Head Trauma

Head injury patients often develop vertigo and imbalance. The mechanisms of these symptoms include unilateral or bilateral vestibular hypofunction, benign paroxysmal positioning vertigo (BPPV), and central vestibular dysfunction. Vestibular rehabilitation techniques have developed over the past 50 years to help patients compensate for these deficits. Liberatory maneuvers effectively treat BPPV. Rotational head movements with visual fixation (ie, vestibulo-ocular reflex [VOR] exercises) may enhance compensation for vestibular hypofunction. Motion habituation may decrease dizziness associated with head movements. Balance retraining can improve stability during ambulation. While few controlled studies have been performed, results suggest fair to good efficacy for most vestibular diagnoses, especially BPPV.