Evaluation Of Rehabilitation Interventions Research Articles

The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID.

Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.

The interaction between changes of muscle activation and cortical network dynamics during isometric elbow contraction: a sEMG and fNIRS study.

Objective: The relationship between muscle activation during motor tasks and cerebral cortical activity remains poorly understood. The aim of this study was to investigate the correlation between brain network connectivity and the non-linear characteristics of muscle activation changes during different levels of isometric contractions. Methods: Twenty-one healthy subjects were recruited and were asked to perform isometric elbow contractions in both dominant and non-dominant sides. Blood oxygen concentrations in brain from functional Near-infrared Spectroscopy (fNIRS) and surface electromyography (sEMG) signals in the biceps brachii (BIC) and triceps brachii (TRI) muscles were recorded simultaneously and compared during 80% and 20% of maximum voluntary contraction (MVC). Functional connectivity, effective connectivity, and graph theory indicators were used to measure information interaction in brain activity during motor tasks. The non-linear characteristics of sEMG signals, fuzzy approximate entropy (fApEn), were used to evaluate the signal complexity changes in motor tasks. Pearson correlation analysis was used to examine the correlation between brain network characteristic values and sEMG parameters under different task conditions. Results: The effective connectivity between brain regions in motor tasks in dominant side was significantly higher than that in non-dominant side under different contractions (p < 0.05). The results of graph theory analysis showed that the clustering coefficient and node-local efficiency of the contralateral motor cortex were significantly varied under different contractions (p < 0.01). fApEn and co-contraction index (CCI) of sEMG under 80% MVC condition were significantly higher than that under 20% MVC condition (p < 0.05). There was a significant positive correlation between the fApEn and the blood oxygen value in the contralateral brain regions in both dominant or non-dominant sides (p < 0.001). The node-local efficiency of the contralateral motor cortex in the dominant side was positively correlated with the fApEn of the EMG signals (p < 0.05). Conclusion: In this study, the mapping relationship between brain network related indicators and non-linear characteristic of sEMG in different motor tasks was verified. These findings provide evidence for further exploration of the interaction between the brain activity and the execution of motor tasks, and the parameters might be useful in evaluation of rehabilitation intervention.

Factors Influencing the Delivery of Intensive Rehabilitation in Stroke: Patient Perceptions Versus Rehabilitation Therapist Perceptions.

Despite increasing evidence regarding the benefit of intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists' perspectives; however, despite an increased emphasis on patient involvement in research, patients' perceptions have not yet been investigated. The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists' perspectives. The design was a cross-sectional qualitative study. The study used semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with factors perceived by rehabilitation therapists. Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard and were satisfied with the graded exercise test, high intensity intervention, and the feedback-monitoring devices. Therapists and patients had contrasting perceptions about their beliefs regarding intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship. People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists' perspective, therapists' beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.

Identification of Major Direct Medical Cost Categories Among Patients with Musculoskeletal Conditions Undergoing Outpatient Rehabilitation

PURPOSE: The goal of this study was to identify major cost categories of direct medical costs among patients with musculoskeletal conditions undergoing outpatient rehabilitation. MATERIALS AND METHODS: Minor cost categories were discriminated from major cost categories by ranking the percentage of direct medical costs represented by each category using a cut-off of 5%. Means and 95% confidence intervals of direct medical costs were estimated using 1000 bootstrap samples. RESULTS: Major cost categories for our sample including osteoarthritis, osteoporosis, back pain and fibromyalgia patients were outpatient physician visits, non physician services, medication and inpatient treatment. Since the 95% confidence intervals of estimated means were overlapping, no statistically significant difference can be assumed between the mean direct medical costs estimated solely with major categories and the one estimated with all available categories. DISCUSSION: The development of a standard brief core set of major direct medical cost categories for musculoskeletal conditions is important regarding the standardization of comparative economic evaluations. The major cost categories we identified can serve as candidate categories and make a valuable contribution to the establishment of a standard brief core set of major cost categories for musculoskeletal conditions which should be included in the alongside economic evaluation of rehabilitative interventions. CONCLUSION: In summary, we have identified a) medication, b) physician visits, c) non physician services use and d) inpatient treatment as major direct medical cost categories for our sample including osteoarthritis, osteoporosis, back pain and fibromyalgia patients.

Special Section: A Memorial Tribute: The VADO Approach in Psychiatric Rehabilitation: A Randomized Controlled Trial

1778 T he results of a recent study of a representative sample of Italian psychiatric services have shown that only 35 percent of patients with schizophrenia who live with their own family are in a psychosocial rehabilitation program and that only 66 percent of these programs ask clients to define their personal goals (1). The most important likely causes are the psychodynamic orientation of many rehabilitation managers, the scarcity of mental health workers trained to teach social and work skills, and the absence of a structured framework to guide rehabilitation practice (2). In 1998 the rehabilitation unit of the Fatebenefratelli Institute of Brescia (Italy), in collaboration with the Italian National Institute of Health and the Institute of Psychiatry of the University of Naples, published a short handbook for the planning and evaluation of rehabilitative interventions in psychiatric centers. The handbook was called VADO—Valutazione delle Abilita e Definizione degli Obiettivi (in English, Skills Assessment and Definition of Goals) (3). It was inspired by the Boston Rehabilitation Center’s approach (4), which identifies patients’ skill deficits and strengths and plans rehabilitative interventions strictly related to patients’ goals. The efficacy of the VADO approach was assessed with a multicenter partially randomized controlled The VADO Approach in Psychiatric Rehabilitation: A Randomized Controlled Trial