Evidence-based Rehabilitation Interventions Research Articles

Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting.

Evidence-based assessment pathways inform early detection of cerebral palsy and access to intervention. This study investigated the relationships between early evidence-based assessments, diagnosis timeline, and rehabilitation intervention access in a population of children with cerebral palsy who were seen between 2010 and 2022 at the University of Wisconsin Waisman Center Newborn Follow Up Clinic. Cerebral palsy-specific assessments were increasingly integrated after the publication of early detection guidelines by Novak et al. in 2017. Age at cerebral palsy first mention (high risk for cerebral palsy) decreased over time, although age at diagnosis remained similar. Infants who received multiple evidence-based assessments were diagnosed at a younger age. Ninety-nine percent of children were referred to rehabilitation therapies before diagnosis. Infant age at referral to outpatient therapies decreased over time. This study provides novel clinical data on diagnosis timelines and identifies remaining gaps related to implementation feasibility toward improved early diagnosis and intervention access.

Effect of Sit-To-Stand Training versus Manual Strengthening Exercises on Mobility and Function in Children with Cerebral Palsy: A Randomized Controlled Trial

Background: Cerebral palsy poses significant challenges to mobility and function in affected children. This study addresses the need for evidence-based rehabilitation interventions by comparing the impact of sit-to-stand training and manual strengthening exercises. Objective: To evaluate and compare the effectiveness of sit-to-stand training and manual strengthening exercises in improving mobility and function in children with cerebral palsy. Method: A randomized controlled trial involving 44 participants (22 in each group) was conducted. Baseline characteristics were assessed, and interventions were implemented over a 12-week period. Regular assessments tracked changes, employing statistical analyses to compare outcomes between the two groups. Results: Both interventions led to positive changes, with a statistically significant superiority favoring the Sit-to-Stand Group at the 12-week mark. Baseline comparability was established, reinforcing the credibility of the findings. Conclusion: Sit-to-stand training, emphasizing weight-bearing activities, demonstrated notable efficacy in enhancing mobility and function. The study provides valuable insights for clinicians, guiding evidence-based practices in pediatric rehabilitation.

A Network of Sites and Upskilled Therapists to Deliver Best-Practice Stroke Rehabilitation of the Arm: Protocol for a Knowledge Translation Study

Implementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors. This prospective pragmatic, knowledge translation study involves four new specialist therapy centers to deliver best-evidence upper-limb sensory rehabilitation (known as SENSe therapy) for survivors of stroke in the community. A knowledge-transfer intervention will be used to upskill therapists and guide implementation. Specialist centers will deliver SENSe therapy, an effective and recommended therapy, to stroke survivors in the community. Outcomes include number of successful deliveries of SENSe therapy by credentialled therapists; improved somatosensory function for stroke survivors; improved performance in self-selected activities, arm use, and quality of life; treatment fidelity and confidence to deliver therapy; and for future implementation, expert therapist effect and cost-effectiveness. In summary, we will determine the effect of a national partnership to increase access to evidence-based upper-limb sensory rehabilitation following stroke. If effective, this knowledge-transfer intervention could be used to optimize the delivery of other complex, evidence-based rehabilitation interventions.

Twice-Weekly Outpatient Rehabilitation Intervention for Young Children With Spinal Muscular Atrophy Treated With Genetic-Based Therapies: Protocol for a Feasibility Study

Background Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that causes muscle weakness and is the leading genetic cause of infant mortality worldwide. While no definitive cure exists, the approval of 3 genetic-based therapies in Canada since 2018 has led to significant improvements in muscle function for children with SMA. With that, there are no evidence-based rehabilitation interventions and minimal evidence on the combined effects of genetic-based therapies and rehabilitation. Objective This protocol describes the methodology to assess the feasibility of a twice-weekly outpatient rehabilitation intervention focusing on gross and fine motor function to inform the methodology and sample size of a definitive clinical trial. Methods We will conduct a single-center nonrandomized pilot and feasibility trial to explore an outpatient rehabilitation intervention for children aged 6 months to 3 years with SMA treated with genetic-based therapies. Participation in the study will occur over a 25-week period, with a baseline assessment visit followed by a 12-week intervention period and a 12-week nonintervention period. The rehabilitation intervention comprises weekly physical and occupational therapy for 11 weeks. Assessments will occur at baseline (week 0), end of intervention or early withdrawal (week 12), and follow-up (week 24). Predetermined feasibility indicators will evaluate study feasibility across process (recruitment rates, eligibility criteria, adherence rates, retention rates, questionnaire suitability, and acceptability), resource (time, implementation, and execution), management (materials and data), and scientific (safety, tolerability, and preliminary efficacy) domains. Results This project was funded in March 2022, and data will be collected between March 2023 and December 2023. Data analysis will occur between January 2024 and March 2024, with publication expected in the fall of 2024. The protocol for the feasibility trial will be considered successful if it meets the success criteria set out for the feasibility indicators. Indicators of specific interest include all process indicators, as well as time. Exploratory indicators will be reported. Pragmatically, the results of the feasibility trial will inform changes to the protocol and the start-up of a definitive multisite trial. Conclusions This novel twice-weekly outpatient rehabilitation intervention will be the first step toward filling the need for an evidence-based rehabilitation intervention for children with SMA treated with genetic-based therapies. It is expected that consistent and intensive rehabilitation therapy will augment functional gains being observed in this population. In the future, a definitive trial will measure the efficacy of the intervention. Trial Registration ClinicalTrials.gov NCT05638750; https://clinicaltrials.gov/study/NCT05638750 International Registered Report Identifier (IRRID) DERR1-10.2196/46363

The Use of Kinematic Features in Evaluating Upper Limb Motor Function Learning Progress Based on Machine Learning.

Evaluating progress throughout a patient's rehabilitation process helps choose effective treatment and formulate personalised and evidence-based rehabilitation interventions. The evaluation process is difficult due to the limitations of current clinical assessments. They lack the ability to reflect sensitive changes continuously throughout the rehabilitation process. Kinematic features have been extracted from individual's movement to address this problem due to their sensitivity and continuity. However, choosing appropriate kinematic features for rehabilitation evaluation has always been challenging. This paper exploits the application of kinematic features to classify movement patterns and movement qualities. 12 kinematic features were firstly extracted from a 7-segment triangle pattern of motion to monitor the learning progress with more numbers of drawing attempts. A statistical analysis was then conducted to compare the selected kinematic features with the clinically validated normalised jerk. Two supervised machine learning models were finally developed to classify movement patterns and movement qualities based on the selected kinematic features. The study was based on data recorded from 14 participants using a single position sensor. 6 kinematic features were able to reflect sensitive changes during the experiment and all kinematic features contributed to the classification tasks. Consistent with the literature, the results indicated that features based on movement velocity were the most beneficial in the classification tasks.

Rehabilitation Interventions for Physical Capacity and Quality of Life in Adults With Post–COVID-19 Condition

Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC. To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC. A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially relevant studies included long-covid, post-covid, sequelae, exercise therapy, rehabilitation, physical activity, physical therapy, and randomized controlled trial. This study included randomized clinical trials that compared respiratory training and exercise-based rehabilitation interventions with either placebo, usual care, waiting list, or control in patients with PCC. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pairwise bayesian random-effects meta-analysis was performed using vague prior distributions. Risk of bias was assessed using the Cochrane risk of bias tool version 2, and the certainty of evidence was evaluated using the GRADE system by 2 independent researchers. The primary outcome was functional exercise capacity, measured at the closest postintervention time point by the 6-minute walking test. Secondary outcomes were fatigue, lower limb muscle function, dyspnea, respiratory function, and quality of life. All outcomes were defined a priori. Continuous outcomes were reported as standardized mean differences (SMDs) with 95% credible intervals (CrIs) and binary outcomes were summarized as odds ratios with 95% CrIs. The between-trial heterogeneity was quantified using the between-study variance, τ2, and 95% CrIs. Of 1834 identified records, 1193 were screened, and 14 trials (1244 patients; 45% female participants; median [IQR] age, 50 [47 to 56] years) were included in the analyses. Rehabilitation interventions were associated with improvements in functional exercise capacity (SMD, -0.56; 95% CrI, -0.87 to -0.22) with moderate certainty in 7 trials (389 participants). These improvements had a 99% posterior probability of superiority when compared with current standard care. The value of τ2 (0.04; 95% CrI, 0.00 to 0.60) indicated low statistical heterogeneity. However, there was significant uncertainty and imprecision regarding the probability of experiencing exercise-induced adverse events (odds ratio, 1.68; 95% CrI, 0.32 to 9.94). The findings of this systematic review and meta-analysis suggest that rehabilitation interventions are associated with improvements in functional exercise capacity, dyspnea, and quality of life, with a high probability of improvement compared with the current standard care; the certainty of evidence was moderate for functional exercise capacity and quality of life and low for other outcomes. Given the uncertainty surrounding the safety outcomes, additional trials with enhanced monitoring of adverse events are necessary.

Measuring the determinants of implementation behavior in multiprofessional rehabilitation.

The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. A two-round Delphi study. National-level online survey. Purposively recruited experts in multiprofessional rehabilitation (N.=25). Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals' implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts' suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93. A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

A national survey of evidence-based stroke rehabilitation intervention use in clinical practice among Canadian occupational therapists.

More than 1,000 randomized controlled trials have been published examining the effectiveness of stroke rehabilitation interventions. The objective of this study was to explore the use and non-use of evidence-based stroke rehabilitation interventions in clinical practice among Occupational Therapists across various stroke rehabilitation settings in Canada. Participants were recruited from medical centres providing rehabilitation to stroke patients in each of the ten provinces across Canada (January-July 2021). Adult (18 + years) Occupational Therapists who provide direct rehabilitative care to individuals after a stroke completed a survey in either English or French. Therapists rated their awareness, use, and reasons for non-use of stroke rehabilitation interventions. 127 therapists (female = 89.8%), largely from Ontario or Quebec (62.2%) were included; most worked full-time (80.3%) in moderate-large (86.1%) cities. The greatest use of interventions were those applied to the body peripherally, without a technological component. Few individuals were aware of interventions applied to the brain (priming or stimulating) with a technological component, and they were rarely, if ever, used. Significant efforts should be made to increase the awareness of interventions which are supported by strong evidence through knowledge translation and implementation initiatives, particularly for those with a technological component.

Psychiatric rehabilitation patterns in Italy: Results from the Italian Society of Psychosocial Rehabilitation (SIRP) survey.

Psychiatric rehabilitation can be considered a bidirectional technique, designed to allow patients to achieve their personal target, focusing on the individuals' strengths and challenges related to these targets and also on the community organizations in which they will live them out. Unfortunately, psychiatric rehabilitation is too often not considered a first line treatment. Moreover, rehabilitation has been confused with a generic and rough practice, consisting of extemporary actions and aimless entertainments designed to fill "the time passing". The aim of this study was to increase the knowledge and awareness about the state of the art of different systems of management and funding of psychosocial rehabilitation in the Italian "real-world" rehabilitative settings, using a specifically developed questionnaire. The data obtained are positive for some aspects of the rehabilitation interventions, in particular for the use of validated tools for the evaluation and revision of projects and for the trend to work on a team, even though the scarcity of evidence-based rehabilitation interventions applied in Italian psychiatric services is less encouraging. This survey presents, at least partially, the "real-world" of rehabilitation in Italy so that we can lay the foundations for the definition of an updated, validated and shared network of what is implemented in the context of psychiatric rehabilitation.

Abstract WP55: Development Of Comprehensive Post-Acute Stroke Program Standards

Introduction: Evidence-based rehabilitation and secondary prevention interventions improve post-stroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where post-acute care (PAC) is delivered. Purpose: The American Heart Association (AHA) developed quality standards based on the AHA 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. Methods: An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. AHA staff and PAC sites in Montana (MT) convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in MT, and quantitative results from the nationwide survey and MT sites were analyzed and used to refine the standards further. Results: The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding MT findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure performance improvement initiatives are followed. However, with adequate support and resources, most MT sites stated they would be able to meet the proposed standards. Conclusions: The Stroke PAC Program Standards are applicable in diverse PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Application of physical therapy methods for patients after stroke with spasticity in the early period

acute cerebrovascular accident is the leading cause of disability. Stroke ranks 4th among diseases that lead to death or disability. The consequences of stroke include neurological disorders, motor disorders (plegia, hemiparesis, paresis, muscle spasticity), loss of sensation, pelvic dysfunction, loss of coordination and balance, high risk of falls, and impaired ability to move independently and perform daily activities. To achieve optimal independence, stroke patients need qualified rehabilitation care as part of a multidisciplinary team. Evidence-based medicine, treatment, and rehabilitation interventions have improved significantly in the acute and early periods for stroke patients. However, in the late period, today, more than half of patients remain limited in their daily activities and have movement disorders that significantly affect their quality of life and independence. Description of the objective. To substantiate the use of evidence-based medicine methods in physical therapy to restore motor function in patients after stroke in the early period. Materials and methods. From October to December 2021, 20 patients with spasticity, aged 47-85 years, who had suffered an ischemic and hemorrhagic stroke, took part in the examination and rehabilitation activities at Kyiv City Clinical Hospital № 6, Palliative Care Department, for a period of 3 weeks to 1 month. Voluntary consent for examination, treatment, and rehabilitation was obtained from all patients and their caregivers. The diagnostic methods used were computed tomography, magnetic resonance imaging, and, if necessary, laboratory tests. Tests and scales for physical therapy were used to determine functional impairment in stroke patients with muscle spasticity: Rankin Scale, Riverbed Mobility Index, Pain Score, Modified Ashworth Scale, Degree of Arm and Hand Recovery; Degree of Leg and Foot Recovery. Results. After analyzing the methods of evidence-based medicine on the topic of the problem, we have confirmation that in the early period, recovery rates are high. However, in the late period after a stroke, the onset of muscle spasticity significantly limits the motor capabilities of patients and complicates the recovery process. In the late period, the effectiveness of methods to overcome spasticity has not been fully developed, and attention is not focused on the complications that arise and accompany them throughout the recovery period. The appearance of muscle spasticity significantly limits the motor capabilities of patients, affects the psycho-emotional state of a person, and causes pain, which prevents the full use of the affected limb. Muscle spasticity inhibits and complicates the restoration of motor function in the long term. Conclusions. The study confirms the high effectiveness of the proposed methods of evidence-based medicine in reducing pain and increasing the range of motion in the shoulder, elbow, and wrist joints in the early period in patients after stroke. As for the late period, this issue remains incomplete and requires further study. In the palliative care unit of Kyiv City Clinical Hospital № 6, an individual multidisciplinary approach to patients after stroke was used, which contributed to the achievement of the goals. It can be stated that evidence-based medicine methods for the acute and early period have a positive effect on patient independence, and improve cognitive function and motor activity of the affected limbs.

Pediatric Cognitive Rehabilitation Roadmap

<h3>Research Objectives</h3> To provide clinicians with a structured framework for the application of evidence-based cognitive rehabilitation strategies for children with acquired brain injuries across the neurorehabilitation continuum of care. The roadmap aims to provide guidance in the determination of assessments, evidence based therapeutic strategies and goals specific to defined stages of brain recovery. <h3>Design</h3> This proposed roadmap defines four stages of cognitive recovery, including disorders of consciousness, confusional states, cognitive and behavioral dysregulation, and acute cognitive impairment. It provides interdisciplinary assessment tools to identify a patient's current stage, monitor progress, and determine transitions between stages. It also utilizes research from ACRM's cognitive rehabilitation training, along with additional pediatric specific evidence-based cognitive rehabilitation interventions, to guide the selection of cognitive rehabilitation approaches specific to each stage of recovery based on variables such as allowance of errors, types of cues and the timing of feedback necessary for optimal acquisition. To implement this interdisciplinary cognitive rehabilitation program at our hospital, our staff first completed ACRM online cognitive rehabilitation training. We then conducted in-services to train our staff on the use of the roadmap to guide the application of the stage specific assessments and strategies within our pediatric ABI population. <h3>Setting</h3> Blythedale Children's Hospital (inpatient and day hospital neurorehabilitation program). <h3>Participants</h3> Pediatric ABI patients admitted to our hospital. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> This roadmap has assisted in individualized treatment planning, school accommodations, and transition planning, along with improvement in interdisciplinary communication and collaboration. It also resulted in clearer guidelines for families and schools on how to accommodate students' deficits to improve daily function and adjust plan to foster increased independence over time. <h3>Conclusions</h3> This pediatric cognitive therapy roadmap aims to improve overall pediatric cognitive rehabilitation including staff competency, caregiver education, and classroom recommendations. We also hope this tool and its breakdown of the brain injury recovery trajectory into four stages may provide additional prognostic indicators in future research. <h3>Author(s) Disclosures</h3> No disclosures to report.

Trajectories of Cognitive and Motor Functional Independence in Hispanic Individuals During the 10 yrs After Traumatic Brain Injury.

This study examined demographic and injury-related predictors of cognitive and motor functional independence in Hispanics with traumatic brain injury at years 1, 2, 5, and 10 after hospital discharge. Hispanic participants ( n = 1360) from the TBI Model Systems Study were included if they had at least one Functional Independence Measure (FIM) Cognitive and Motor score at any time point (years 1, 2, 5, or 10). Hierarchical linear modeling was used to examine baseline predictors of FIM Cognitive and Motor trajectories across this period. FIM Cognitive trajectories showed a quadratic movement (initial increase followed by a plateau or slight decrease), whereas FIM Motor trajectories showed a cubic movement (initial increase, followed by a plateau, then another increase). Higher FIM Cognitive trajectories were predicted by younger age, shorter length of posttraumatic amnesia, higher education, and having experienced a nonviolent mechanism of injury. Higher FIM Motor trajectories were predicted by younger age, shorter posttraumatic amnesia, and a nonviolent mechanism of injury. The baseline predictors of functional trajectories identified may help create tailored, evidence-based rehabilitation interventions along the continuum of recovery during the first 10 yrs for Hispanics with traumatic brain injury at risk for reduced functional outcomes.

The rehabilitation of cancer patients and the role of nurses: a scoping review

Introduction. Cancer survivors represent a growing population with very specific physical and psychosocial needs. The nurse’s intervention is focused on the management of symptom burden and challenges due to cancer, treatment-related morbidities, the maximization of independence, and the improvement of the quality of life of cancer patients. The purpose of this scoping review is to identify different specific rehabilitation interventions delivered by nurses in response to physical, psychological, and cognitive impairments that may be experienced by cancer patients and to understand whether these interventions should be implemented at a specific phase of cancer care. Methods. A scoping review was performed (Joanna Briggs Institute, 2019) and multiple databases and Google Scholar were searched from January 2016 to August 2021. Articles published in English, Spanish or Portuguese, which included nurses who provided evidence-based rehabilitation interventions and psychosocial support, patient education, and health promotion to adult cancer patients, were considered for inclusion. Results. A total of 59 studies were included yielding 3 nurse-led intervention categories: exercise, psychoeducation, complementary and alternative medicine therapies. Most nurse-led interventions were delivered after cancer surgery or during treatment. Outcomes were mostly symptom-focused and frequently included quality of life. Many interventions provided beneficial physical and psychological outcomes or showed a positive trend. Conclusions. Scientific publications concerning nurses as cancer rehabilitation providers still come as a relatively new approach. Further research and tailored interventions are needed to help nurses in decision-making and evidence-based practice.

Hamstring Strain Injury Rehabilitation.

Hamstring strain injuries are common among athletes and often require rehabilitation to prepare players for a timely return to sport performance while also minimizing reinjury risk. Return to sport is typically achieved within weeks of the injury; however, subsequent athlete performance may be impaired, and reinjury rates are high. Improving these outcomes requires rehabilitation practitioners (eg, athletic trainers and physical therapists) to understand the causes and mechanisms of hamstring strain injury, know how to perform a thorough clinical examination, and progress loading to the site of injury safely and effectively. This narrative review discusses current clinical concepts related to these aspects of rehabilitation for hamstring strain injury, with the aim of helping practitioners improve athletes' outcomes. Collectively, this knowledge will inform the implementation of evidence-based rehabilitation interventions.

Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990\u20132017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates

BackgroundRehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)‘s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability.MethodsThis study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012–2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018–2022).ResultsTrends for YLDs counts per condition year (1990–2017) and forecasted values (2018–2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions.ConclusionRehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.

Intensive and app-delivered occupational therapy to improve upper extremity function in early diffuse cutaneous systemic sclerosis: a pilot two-arm trial.

SSc reduces upper extremity function and performance of everyday activities; however, there are few evidence-based rehabilitation interventions. This study examined short and longer-term effects of two occupational therapy interventions on hand disability. Participants with diffuse cutaneous SSc were randomized to one of two 18-week interventions: Intensive group, receiving eight weekly in-person occupational therapy sessions with App-delivered home exercises, or App Alone group. The primary outcome was QuickDASH hand disability; secondary outcomes were physical function (PROMIS scale), and total active hand motion. Linear mixed models were used to examine treatment effects. Most participants were female (72%); the mean age was 52 years (13.4) (n = 32). There were no significant between-group effects on QuickDASH (P = 1.0; mean change -6.4 on 0-100 scale in both groups at 18 weeks). Left lateral pinch, an exploratory outcome, improved in App Alone compared with Intensive from baseline to 18 weeks. Within groups, the Intensive group had the largest improvements after 8 weeks (-8.5 on QuickDASH; P = 0.03), but then lost gains from 8 to 18 weeks while the App Alone group had modest improvements from baseline to 8 weeks, but then continued to improve. Of completers, 50% had clinically meaningful improvement on QuickDASH in the Intensive group and 64% had improvement in App Alone. Both interventions showed beneficial effects on hand disability. Participants in the App Alone group improved equally to the Intensive group at 18 weeks. Our findings provide support for further study into telehealth rehabilitation approaches. NCT03482219.

Psychosocial Rehabilitation Interventions in the Treatment of Schizophrenia and Bipolar Disorder.

Schizophrenia and bipolar disorder are chronic conditions with the early onset, higher relapse rate, and functional impairment that often persist despite optimum pharmacotherapy, underscoring the need for adjunctive psychosocial treatments and rehabilitation interventions. Evidence-based psychosocial treatment and rehabilitation interventions for both illnesses are adherence therapy, psychoeducation, cognitive-behavioral therapy, interpersonal and social rhythm therapy, cognitive remediation, social skills training, family education, vocational rehabilitation, case management, assertive community treatment, occupational/art therapy, and peer support. The efficacy of these interventions has been shown in many studies. Trials generally reveal that symptom reductions, relapse preventions, reduced hospitalizations, increased social functioning, increased employment rate, and satisfactory quality of life for patients with schizophrenia and bipolar disorder are possible by using these interventions adding to optimal pharmacotherapy. This review describes the psychosocial rehabilitation interventions that have been used successfully and extensively in patients with schizophrenia and bipolar disorder.

A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study

ABSTRACT Introduction Rehabilitation post-stroke is critical for maximizing patient outcomes. This study assessed the feasibility of implementing and evaluating a continuing professional development (CPD) intervention aimed at increasing the uptake of stroke best practice guidelines among physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) in six university-affiliated stroke rehabilitation centers in Quebec, Canada. Method Twelve stroke best practice recommendations with reflective tools were sent weekly by e-mail. Participants’ eligibility criteria included: a) profession; b) practicing more than 1 year in a stroke rehabilitation program; c) fluency in French or English; and d) basic computer literacy. Feasibility (operationalized via participation, satisfaction and relevance), cognitive impact, perceived application in practice and expected patient outcomes were measured over 24 weeks using three questionnaires and analyzed using descriptive statistics. Results The sample totaled 62 of 133 eligible (47%) clinicians. Satisfaction, relevance and cognitive impact of delivered information varied across disciplines and recommendations. Agreement with the recommendations was high across disciplines. On average, three-interdisciplinary recommendations (related to post-stoke depression, post-stoke fatigue and patients’ and caregivers’ learning needs) were rated as the most relevant for at least one patient. The majority of clinicians would use the recommendations for a specific patient and expected health benefits by applying those recommendations. Conclusion This study demonstrated the feasibility of assessing the impact of a CPD intervention in stroke rehabilitation uptake and informed the design of a research program aimed at increasing the use of stroke evidence-based rehabilitation interventions.

Addressing Severe Mental Illness Rehabilitation in Colombia, Costa Rica, and Peru.

Many Latin American countries face the challenge of caring for a growing number of people with severe mental illnesses while promoting deinstitutionalization and community-based care. This article presents an overview of current policies that aim to reform the mental health care system and advance the employment of people with disabilities in Colombia, Costa Rica, and Peru. The authors conducted a thematic analysis by using public records and semistructured interviews with stakeholders. The authors found evidence of supported employment programs for vulnerable populations, including people with disabilities, but found that the programs did not include people with severe mental illnesses. Five relevant themes were found to hamper progress in psychiatric vocational rehabilitation services: rigid labor markets, insufficient advocacy, public subsidies that create conflicting incentives, lack of deinstitutionalized models, and lack of reimbursement for evidence-based psychiatric rehabilitation interventions. Policy reforms in these countries have promoted the use of medical interventions to treat people with severe mental illnesses but not the use of evidence-based rehabilitation programs to facilitate community integration and functional recovery. Because these countries have other supported employment programs for people with nonpsychiatric disabilities, they are well positioned to pilot individual placement and support to accelerate full community integration among individuals with severe mental illnesses.