Follow-up Rehabilitation Research Articles

Dental implantation in patients with comorbid diseases: yes or no?

Patients with multiple pathologies are a high-risk group, which requires a personalized approach to surgical rehabilitation in dentistry. Inadequate diagnosis of clinical manifestations when a patient is in remission often leads to severe surgical complications. However, modern methods of dental implantation and rehabilitation are possible even in patients with oncology, those who underwent surgical therapy, chemo- or radiotherapy. Gilbert syndrome, one of the risk factors for post-surgery inflammatory complications, is associated with defects in bilirubin metabolism. It inhibits platelet activity. It is a genetic disease leading to a loss of liver enzyme activity and the accumulation of indirect bilirubin that can aggravate the course of other diseases in patients. In acute stages, it is characterized by jaundice of the skin, eyes, and mucosa and is followed by immunosuppression and the post-surgical complications associated with it. A patient with Gilbert syndrome was administered for surgical treatment of a chronic infection and follow-up rehabilitation via dental implantation and reconstruction of the bone. In this case, we faced Gilbert syndrome in association with polycythemia (a myeloproliferative disease in the compensation stage). In such cases, dental implantation cannot be achieved in the complex dental rehabilitation process. Such diseases require special attention from dental surgeons due to possible complications (bleeding, thrombosis, or disseminated intravascular coagulation). In this specific case, the patient belongs to the risk group, and its history, although in remission, is still a contraindication for dental surgery and dental implantation.

Differences in gait analysis and clinical outcome after dynamic fixation or screw fixation in acute syndesmosis tear: a prospective randomized pilot study.

Acute syndesmosis tears can be treated by static screw or dynamic fixation. Various studies have compared these techniques regarding postoperative outcome. However, to our knowledge, no study has used 3D-instrumented gait analysis (IGA). We hypothesized that a dynamic fixation would perform non-inferior to screw fixation in terms of biomechanical and clinical outcomes. Patients were prospectively randomized to both groups. All patients received the same follow-up rehabilitation and consultations (6 and 12 weeks; 6 and 12 months) postoperatively. Standardized questionnaires were used to objectify pain and ankle function. At 6 months follow-up, IGA was conducted additionally to objectify the biomechanical outcome. Twenty-five patients in the dynamic fixation (DF) group using TightRope® and twenty-five in the screw fixation group (SF) completed gait analysis. The DF group showed significantly higher mean values for maximum moment in the affected ankle joint (DF: 1.40 ± 0.21 Nm, SF: 1.23 ± 0.30 Nm; p = 0.023) and the unaffected ankle joint (DF: 1.52 ± 0.20 Nm, SF: 1.37 ± 0.27 Nm; p = 0.035). The difference between the affected and unaffected ankle joint was significantly higher in the SF group for active plantarflexion (DF: 1.52 ± 0.20°, SF: 1.37 ± 0.27°; p = 0.035). Both dynamic and screw fixation groups exhibited significantly reduced plantarflexion during the push-off and early swing phase, with moments and powers in the ankle joint also significantly impaired. Our study demonstrated that dynamic fixation has better or similar biomechanical and clinical outcomes compared to screw fixation. Future research should focus on biomechanical differences during gait as well as clinical outcomes in case of earlier weight-bearing after dynamic fixation. DRKS00013562 Date of Registration: 07/12/2017.

Barriers to Early Progress in Adult Cochlear Implant Outcomes.

Adult cochlear implant (CI) recipients obtain varying levels of speech perception from their device. Adult CI users adapt quickly to their CI if they have no peripheral "bottom-up" or neurocognitive "top-down" limiting factors. Our objective here was to understand the influence of limiting factors on the progression of sentence understanding in quiet and in noise, initially and over time. We hypothesized that the presence of limiting factors, detected using a short test battery, would predictably influence sentence recognition with practical consequences. We aimed to validate the test battery by comparing the presence of limiting factors and the success criteria of >90% sentence understanding in quiet 1 month after activation. The study was a single-clinic, cross-sectional, retrospective design incorporating 32 adult unilateral Nucleus CI users aged 27 to 90 years (mean = 70, SD = 13.5). Postoperative outcome was assessed through sentence recognition scores in quiet and in varying signal to noise ratios at 1 day, 1 to 2 months, and up to 2 years. Our clinic's standard test battery comprises physiological and neurocognitive measures. Physiological measures included electrically evoked compound action potentials for recovery function, spread of excitation, and polarity effect. To evaluate general cognitive function, inhibition, and phonological awareness, the Montreal Cognitive Assessment screening test, the Stroop Color-Word Test, and tests 3 and 4 of the French Assessment of Reading Skills in Adults over 16 years of age, respectively were performed. Physiological scores were considered abnormal, and therefore limiting, when total neural recovery periods and polarity effects, for both apical and basal electrode positions, were >1.65 SDs from the population mean. A spread of excitation of >6 electrode units was also considered limiting. For the neurocognitive tests, scores poorer than 1.65 SDs from published normal population means were considered limiting. At 1 month, 13 out of 32 CI users scored ≥90% sentence recognition in quiet with no significant dependence on age. Subjects with no limiting peripheral or neurocognitive factors were 8.5 times more likely to achieve ≥90% score in quiet at 1 month after CI switch-on (p = 0.010). In our sample, we detected 4 out of 32 cases with peripheral limiting factors that related to neural health or poor electrode-neural interface at both apical and basal positions. In contrast, neurocognitive limiting factors were identified in 14 out of 32 subjects. Early sentence recognition scores were predictive of long-term sentence recognition thresholds in noise such that limiting factors appeared to be of continuous influence. Both peripheral and neurocognitive processing factors affect early sentence recognition after CI activation. Peripheral limiting factors may have been detected less often than neurocognitive limiting factors because they were defined using sample-based criteria versus normal population-based criteria. Early performance was generally predictive of long-term performance. Understanding the measurable covariables that limit CI performance may inform follow-up and improve counseling. A score of ≥90% for sentence recognition in quiet at 1 month may be used to define successful progress; whereas, lower scores indicate the need for diagnostic testing and ongoing rehabilitation. Our findings suggest that sentence test scores as early as 1 day after activation can provide vital information for the new CI user and indicate the need for rehabilitation follow-up.

Patient management with Head and Neck tumors-A nationwide data collection in oral and maxillofacial surgery.

This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany.

Pulmonary rehabilitation in follow-up and inpatient rehabilitation for Long COVID: twelve months of follow-up.

Individuals with persistent impairments due to Coronavirus disease 2019 (COVID-19) can receive pulmonary rehabilitation in Germany. To date, there is no evidence of the medium- or long-term effects of pulmonary rehabilitation on Long COVID. This study examined changes in health and occupational outcomes over time and described the therapeutic content of pulmonary rehabilitation and aftercare. This analysis also compared two rehabilitation groups after COVID-19 who had different levels of access to rehabilitation. Longitudinal observational study with multicenter and prospective data collection. Pulmonary rehabilitation in four different rehabilitation facilities in Germany. Individuals with a mild course of disease and long-lasting impairments (inpatient rehabilitation, IR) and patients with a severe course after hospitalization (follow-up rehabilitation, FuR). Participants had to be between 18 and 65 years of age. Written questionnaires were administered at the beginning and end of rehabilitation, as well as six and twelve months after rehabilitation. Health-related quality of life (HrQoL), fatigue, participation restrictions, COVID-19 symptoms, mental and physical health were assessed, as well as occupational outcomes and questions about rehabilitation and aftercare. IR patients were predominantly female (68.0%) and 52 years of age on average, while 66.1% of Long COVID rehabilitees in FuR were male and three years older. Over the course of rehabilitation, most COVID-19 symptoms decreased with statistical significance. The subjective health scales showed improvements with medium to large effect sizes (ES) over time in IR (P<0.01; ES between 0.55 (cognitive fatigue) and 1.40 (physical fatigue)) and small to large effects in FuR (P<0.01; ES between 0.45 (anxiety) and 1.32 (physical fatigue)). One year after rehabilitation, most effects remained at a moderate level. After twelve months, an increase in neurocognitive symptoms was observed in FuR patients. More than 80% of employed people returned to work one year after rehabilitation, although FuR patients returned to work a median of four weeks later (P<0.01). The comparative analysis showed that rehabilitees in different forms of rehabilitation attended rehabilitation with different impairments and rehabilitation goals, which are partly considered in treatment and aftercare. To provide needs-based rehabilitation to different rehabilitation groups with Long COVID, knowledge of their health histories and preferences is necessary.

Functional outcome after interdisciplinary, acute rehabilitation in COVID-19 patients: a retrospective study

BackgroundSurvivors of severe COVID-19 often exhibit a variety of sequelae including loss of mobility and ADL (activities of daily living) capacity. Acute rehabilitation (AR) is an interdisciplinary rehabilitation intervention applied early while still in a hospital setting. The goal of AR is to improve functional limitations and to increase functional independence at discharge. It is established in the treatment of patients with other severe diseases such as sepsis, polytrauma, or stroke. Data concerning AR in COVID-19 are sparse.AimTo evaluate the changes in physical function during AR in patients after severe COVID-19.MethodsThis monocentric, retrospective observational study examined the functional outcomes of a sample of COVID-19-patients who received interdisciplinary AR at a university hospital. Inclusion criteria were a positive SARS-CoV-2 test in 05/2020–01/2022 and transfer to AR after intensive care treatment. 87 patients were elegible for evaluation, 3 of whom were excluded because of death during AR. Data were extracted from the hospital information system. In a pre-post analysis, mobility (Charité Mobility Index), ADL (Barthel Index), and oxygen demand were assessed. In addition, discharge location after AR, factors associated with AR unit length of stay, and functional improvements were analyzed.ResultsData of 84 patients were analyzed. Mobility increased significantly from a median of 4 [1.25-6] CHARMI points at admission to a median of 9 [8.25-9] at discharge (p < 0.001). ADL increased significantly from a median of 52.5 [35.0-68.75] Barthel Index points at admission to a median of 92.5 [85–95] at discharge (p < 0.001). Oxygen demand decreased from 80.7 to 30.5% of patients. The majority (55.9%) of patients were discharged home, while 36.9% received direct follow-up rehabilitation. Older age correlated significantly with lower scores on the discharge assessment for mobility (Spearman’s ϱ = -0.285, p = 0.009) and ADL (Spearman’s ϱ = -0.297, p = 0.006).ConclusionAcute rehabilitation is a viable option for COVID-19 patients with severe functional deficits after ICU treatment to achieve functional progress in mobility and ADL, reduce oxygen requirements and enable follow-up rehabilitation.Trial registration number and date of registration for prospectively registered trialsTrial registration number: DRKS00025239. Date of registration: 08 Sep 2021.

Assessing the outcome of mobility assistive technology (OMAT) in daily living: results in an Italian sample

Background Despite the widely recognised benefits of assistive technology (AT) in everyday life, AT abandonment rate due to unmet user needs or expectations is high. World Health Organisation emphasised the importance of evaluating AT outcomes as a top research priority, but comprehensive approaches to assess users’ needs and AT impact are still limited. Aim The research study OMAT (outcomes of mobility assistive technology in rehabilitation pathways) aimed to evaluate the feasibility of a new AT assessment protocol for mobility AT, spanning from an initial evaluation of users’ and relatives’ needs to a follow-up after real-world use of assistive products (APs). Material and Methods An observational single-arm study involving 95 AT users was conducted at Fondazione Don Gnocchi (Milan, Italy). The OMAT protocol encompassed baseline assessment, user training, prescription, authorisation, delivery and follow-up. The evaluations blend standard clinical evaluations with validated AT outcome measures for perceived effectiveness of AT, user satisfaction and changes in quality of life. Results The feasibility of OMAT in clinical settings was established, with 67 user participants completing the protocol. Data showed positive impacts on user satisfaction and perceived AT effectiveness by all participants (users and relatives), with an improvement in the perceived degree of severity in problems. Quality of life outcomes, however, showed mixed results across various domains. Conclusion OMAT is a feasible protocol for assessing mobility APs in clinical settings, underscoring the importance of involving users in the prescription process and the need for comprehensive AT monitoring mechanisms. This approach could enhance AT service delivery, exceeding the current standards of the Italian-National-Health-Service. Implication for rehabilitation Personalise assistive technology (AT) based on user needs for higher effectiveness. Include structured follow-up in rehabilitation for better AT outcomes. Enhance patient involvement in AT selection to improve use. Focus on AT’s role in enhancing overall quality of life. Use validated tools for AT impact assessment and monitoring.

Comprehensive and full-cycle cancer health management

In order to realize the "Healthy China 2030" strategic plan, it is necessary to create a new model of all-round and full-cycle cancer health management in line with China's national conditions and the characteristics of the times. Comprehensively strengthen the construction of the whole-chain tumor prevention and control system, shift the front of cancer prevention and treatment to the precancerous cycle, and realize the full-cycle management of accurate screening, regular follow-up, early diagnosis, early treatment and rehabilitation follow-up of cancer patients; all-round interdisciplinary cooperation, strengthen the management of patients with accompanying diseases, and encourage patients to return to society and families in the best condition; comprehensively deploy tumor big data and smart medical care, promote the construction of Internet outpatient clinics and regional medical centers, and develop a three-level linkage palliative care model, Solve a series of problems such as shortage of medical resources and poor homogeneity of medical care.

Atrial fibrillation diagnosed at different phases of myocardial infarction are all associated with excess risk

Abstract Background Atrial fibrillation (AF) in patients with myocardial infarction (MI) is associated with higher mortality and cardiovascular complications such as hospitalisation due to heart failure and ischaemic stroke. It is unknown whether the association with poor outcomes is general or specific for AF diagnosed before, at or during follow-up after an MI. Purpose The aim of this study was to investigate the occurrence of AF, and its clinical correlates at different stages in patients with acute MI. In addition, we also explored whether any association between AF and mortality, incident heart failure or stroke differed for AF diagnosed at these stages. Methods Patients attending cardiac rehabilitation after MI in Sweden 2006-2020 were identified in the Swedish registry for cardiac disease SWEDEHEART. The patients were divided into groups with sinus rhythm at hospitalisation and follow-up (reference group), AF at MI hospitalisation including prior and new-onset AF during MI hospitalisation, and late-onset AF diagnosed at cardiac rehabilitation follow-up visits during the first year post-MI. All patients were followed until 2020-12-31 and the groups were compared regarding overall mortality, hospitalisation due to heart failure, and stroke using log-rank test and Cox-regression adjusted for age in cubic splines and sex. Results Overall 104,325 patients (26% female) between 18-80 years old were investigated. 4731 patients presented with AF at admission for MI (4.5%) and 2,119 (2%) had a persistent AF at discharge. Out of these, 139 had new-onset AF at MI. STEMI was more common in patients with new onset AF compared to those with a history of AF before MI (40.3% vs 31.7%, p=0.013). During the one-year follow-up period after index MI 448 patients had a new-onset AF which was associated with older age, NSTEMI, reduced ejection fraction and more extensive coronary artery disease at the index MI. The association between AF diagnosed at the different phases of MI with outcomes are illustrated in figure 1. During a median follow-up of 7.0 years, patients with AF at MI had a higher mortality (33.3% vs 14.2%, p&amp;lt;0.001), more hospitalisations due to heart failure (25.6% vs 6.7%, p&amp;lt;0.001) and stroke (8.0% vs 3.9%, p&amp;lt;0.001) compared to patients with SR. Patients with new-onset AF at MI had a similar risk for these outcomes compared to patients with a history of AF at MI. Patients with late-onset AF during the one-year follow-up period after index MI also had higher mortality (28.3% vs 12.2%, p&amp;lt;0.001) and more hospitalisations for heart failure (21.9% vs 5.6%, p&amp;lt;0.001) but not stroke (4.2% vs 3.9%, ns) compared to patients that remained in SR. Conclusion In patients attending cardiac rehabilitation after MI, chronic AF, new-onset AF at MI and late-onset AF were associated with increased risk for mortality, heart failure hospitalisations and stroke. Hence, AF should be considered a severe risk factor in patients with MI irrespective of time of occurrence.AF at MI

Breathing New Life Into Acute Respiratory Care: Proactively Improving Long-Term Outcomes

Admissions due to asthma contribute substantially to the burden faced by emergency departments (ED) worldwide, with a considerable impact arising from the high number of readmissions among patients with severe asthma. Repeated ED readmittance not only places considerable demand on healthcare resources, but also increases the humanistic burden on patients through reduced lung function, decreased quality of life, and increased exposure to systemic corticosteroids (SCS) and oral corticosteroids (OCS). In addition, patients are subject to the increased morbidity and mortality risk, and quality of life deficit associated with repeated asthma exacerbations. Admission to the ED should be seen as an opportunity to break this readmission cycle and prevent further admissions, while offering patient-centric benefits, such as investigation into the underlying causes of disease, and optimisation of care to prevent further exacerbations. Actions that require no additional resource may be taken directly in the ED, including biomarker tests among routine blood tests, or teaching inhaler technique as part of patient education and safety-netting. In addition, patient discharge may be considered as an opportunity for improving guidance implementation and breaking the cycle of readmission. Unlike emergency cardiac care, where &gt;90% of patients are discharged on secondary prevention drugs and 85% of patients are referred to follow-up rehabilitation, guidelines for care following an ED visit for asthma are not always followed. Furthermore, current tools designed to accelerate specialist referral are not always rigorously implemented following an ED visit, meaning that follow-up may be delayed. Finally, further efforts should be made to identify high-risk patients in the community earlier in the disease pathway, allowing timely intervention before further lung function impairment, or the onset of adverse events due to OCS over-exposure. This article summarises an AstraZeneca-sponsored symposium delivered on 12th September 2023, as part of the European Respiratory Society (ERS) International Congress in Milan, Italy. The faculty, consisting of David Price, Head of the Observational and Pragmatic Research Institute, Singapore; Mona Al-Ahmad, Consultant Allergist and Clinical Immunologist at the Ministry of Health in Kuwait; and Mohit Bhutani, Professor of Medicine at the University of Alberta, Edmonton, Canada, each gave a brief presentation on proactive strategies to improve long-term outcomes in acute respiratory care. During panel discussions following each presentation, Anne Marie Marley, Respiratory Nurse Consultant from Belfast Health and Social Care Trust, UK, provided examples of implementing transition of care by bridging hospital and community care settings.

Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients

Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient’s attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.

A Clinical Review of Physical Rehabilitation Protocol and Early Mobilization Patterns for Post-COVID-19 Patients: Tertiary Healthcare Facility Experience

Several studies have emphasized the urgent need for Physical Rehabilitation guidelines for COVID-19 patients and the effect of Early Mobilization in these patients. Previous reports revealed that dealing with COVID-19 patients was based on expert opinion, evidence from patients with other lung diseases, and not on the recent literature concerning COVID-19. International guidelines have also reported that early mobilization is safe and feasible, starting in the ICU setting. Therefore, this clinical literature review aimed to designate the indications for physical rehabilitation programs and early mobilization benefits to add to the existing literature the necessary up-to-date recommendations and to share the experience of a tertiary healthcare facility in the Kingdom of Saudi Arabia (KSA) in dealing with different stages of post-COVID-19 patients. Conclusion: The multidisciplinary approach of KFSH&amp;RC for rehabilitating COVID-19 patients was integrated through early mobilization and remarkable follow-up of different clinical service divisions, including physical and occupational rehabilitation, respiratory therapy, and nutrition, with the collaboration of the medical and psychological teams aiming to regain optimal physical function, psychological well-being, and better quality of life for those populations.

Gynecological Cancer Survivors' Experiences and Desire for Follow-up After Recent Treatment: A Phenomenological Hermeneutic Study.

Gynecological cancer survivors experience a variety of challenges after discharge from hospital treatment. Cancer support and rehabilitation are recognized as significant facilitators for quality of life in survivorship but are reported to be insufficient by gynecological cancer survivors. To describe the lived experiences of gynecological cancer survivors and how their needs for follow-up should be met following recently completed treatment. This study used a phenomenological hermeneutic design with individual in-depth interviews with 20 women after recently completed cancer treatment. Transcribed interviews were analyzed with the Lindseth and Norberg phenomenological hermeneutic method. Four themes were identified: "a brutal transition to life after cancer," "fear of recurrence overshadowing the existence," "a need for professional support," and "information is not given unless asked for." After completing gynecological cancer treatment, the fear of cancer recurrence is dominating, regardless of prognosis and diagnosis. At the same time, information and support from healthcare professionals are described as lacking. Participants expressed a need to be contacted directly as a formal routine by healthcare professionals after cancer treatment with cancer-specific information as this may alleviate the existential suffering that the cancer experience brings. A person-centered, systematic follow-up rehabilitation is needed as a continuation of the care provided during cancer treatment. Future research is needed to explore the impact on women's quality of life when gynecologic-specific information is given in advance of hospital discharge after completing treatment.

Itinéraire thérapeutique des enfants atteints de paralysie cérébrale admis en médecine physique et de réadaptation (MPR) à Abidjan en 2018

ObjectiveTo analyze the different stages of the medical and rehabilitation follow-up of children with cerebral palsy (CP) before their admission to the PMR department. MethodsCross-sectional study analyzing the care pathway of 58 children with PC before their admission to the MPR department of the Yopougon University Hospital over the period from June to September 2018. ResultsThe majority of children with male CP (58.6%) were the first or second child in the siblings. The parents lived as a couple (84%) and resided in the city of Abidjan (87%) but the children lived with both parents in 77.6%. Diagnosis made in a university hospital (46.5%) or in a clinic private (29.3%) by specialists in pediatrics (53.4%) and neurology (34.5%). The time to diagnosis was more than 6 months in 55.2 %. These parents used several therapies: medical (62.07%), traditional (31.03%) and spiritual (6.90%). The most used therapeutic route was medical-traditional-medical (29.3%). The factors influencing the choice of route were the parents’ culture and beliefs (75.9%) and family and economic factors. ConclusionNeed to develop a precise therapeutic circuit for children with CP.

Bridging gaps across levels of care in rehabilitation of patients with rheumatic and musculoskeletal diseases: Results from a stepped-wedge cluster randomized controlled trial

Objective To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design A pragmatic stepped-wedge cluster randomized trial. Setting Eight rehabilitation centers in secondary healthcare, Norway. Participants A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients’ needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients’ goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group.

Measurement of body composition by DXA, BIA, Leg-to-leg BIA and near-infrared spectroscopy in breast cancer patients – comparison of the four methods

Body composition plays a crucial role in therapy adherence and the prognosis of cancer patients. The aim of this work was to compare four measurement methods for determining body composition regarding their validity, reliability and practicability in order to be able to draft a practical recommendation as to which method is most suitable as a standard measurement method in oncology. Fat mass (FM) and fat-free mass (FFM) was estimated for 100 breast cancer patients with ages of 18-70 years during a defined 20-week inpatient and outpatient rehabilitation process after primary therapy or follow-up rehabilitation. The four methods used were dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), leg-to-leg BIA and near-infrared spectroscopy (NIRS). At baseline (t0) and after 20 weeks (t20) the agreement between the four body composition analysis methods was quantified by pairwise method comparisons using Bland-Altman bias and limits of agreement estimates, t-tests and Lin's concordance correlation coefficients (CCCs). CCCs and Bland-Altman plots indicated that DXA and BIA, DXA and NIRS as well as BIA and NIRS showed an excellent agreement concerning FM estimation at both time points (CCC>0.9). In contrast, no methods agreed with a CCC higher than 0.9 with respect to FFM estimation. However, most estimates were also significantly different between two methods, except for BIA and NIRS which yielded comparable FFM and FM estimates at both time points, albeit with large 95% limits of agreement intervals. The agreement between DXA and BIA was best in the lowest BMI tertile and worsened as BMI increased. Significant differences were also found for FFM changes measured with DXA versus BIA (mean difference-0.4kg, p=0.0049), DXA versus to Leg-to-leg BIA (-0.6kg, p=0.00073) and for FM changes measured with DXA versus Leg-to-leg BIA (0.5kg, p=0.0011). For accurate and valid body composition estimates, Leg-to-leg BIA cannot be recommended due to its significant underestimation of FM or significant overestimation of FFM, respectively. BIA and NIRS results showed good agreement with the gold standard DXA. Therefore both measurement methods appear to be very well suitable to assess body composition of oncological patients and should be used more frequently on a routine basis to monitor the body composition of breast cancer patients.

The downward referral experiences of stroke caregivers in the regional medical alliance in China: A phenomenological study.

The downward referral platform in the regional medical alliance has provided more possibilities to follow-up rehabilitation and transitional care for increasing stroke survivors, which also has the most contributions in the rational use of resources and health promotion of stroke survivors. However the downward referral rate is low compared to upward referral. At present, no scholars have explored the downward referral experiences of medical demanders from the perspective of qualitative study, and these experiences may also most truly reflect the influencing factors of their unwillingness to downward referral. Therefore, this study explored the subjective experiences of stroke caregivers who had experienced the downward referral, because stroke attacks often lead to lack of autonomy of patients themselves, making it difficult to complete interviews with them. A descriptive phenomenological study was adopted. A purposive sampling strategy was used to recruit 13 stroke caregivers. Interviews were guided by a semi-structured interview-guide encouraging interviewees to reflect on their experiences with downward referral. Coliazzi’s data analysis process was applied. The analysis of the data revealed 4 themes: coping challenges; disrupted information; gaps in medical and nursing transition, and potential enabling factors. The results of this study showed that the lack of knowledge of medical alliance, non-sharing of medical information and non-homogeneousness of medical quality were identified to be impeding positive attitude towards downward referral and be factors of bad experiences. Of course, the interviewees had positive experiences such as smooth referral and comfortable environment. These may be potential enabling factors to their attitude towards downward referral. The challenges and needs of medical demanders after downward referral are worthy of attention, and these should be solved by corresponding measures to improve the downward referral rate and referral experiences.

Study on the Application Effect of Family Follow-Up Rehabilitation Nursing in Elderly Autistic Patients in Community Institutions

Objective: To study the effect of family follow-up nursing in rehabilitation of elderly autistic patients in community institutions. Methods: 120 elderly autistic patients from February 2021 to July 2022 were randomly divided into a control group and a test group with 60 cases each. The patients in the control group were cared for at home by their family members, while the patients in the test group were given family follow-up rehabilitation care on the basis of the control group. The compliance of patients in the rehabilitation process, the UCLA loneliness score, the autism treatment assessment scale (ATEC) score of patients after this nursing care, and the quality-of-life scores of patients of the two groups before and after nursing care were compared. Results: The compliance of patients in the process of rehabilitation treatment was better in the experimental group than in the experimental group. The physical function score of patients after nursing was better in the experimental group than in the experimental group. The UCLA loneliness score and ATEC score of patients in the experimental group after nursing were lower than those of the control group (P &lt; 0.05); the quality-of-life score was higher in the experimental group (P &lt; 0.05). Conclusion: The application of family follow-up nursing in the rehabilitation of elderly autistic patients in community institutions can significantly improve patients’ compliance and improve their prognosis, thus having high clinical value.

Enhancing a Rehabilitation Pathway for Pediatric Heart Transplant Recipients: An Improvement Project to Increase Adherence, Satisfaction, and Outcomes

Aims To refine a cardiac rehabilitation pathway for pediatric heart transplant recipients; assess clinician knowledge and adherence to the program; and evaluate patient outcomes. Methods The center has utilized a rehabilitation pathway for pediatric heart transplant recipients. Challenges in practice include access to centers, lack of data tracing, and adherence to the pathway. The quality initiative focused on program refinements: implementation of text templates to improve data collection, collection of the Pediatric Cardiac Quality of Life Inventory (PCQLI), Functional Independence Measure (WeeFIM) and Child Occupational Self-Assessment (COSA), development of an outreach program, and creation of an educational program for therapists to increase content knowledge and improve clinician satisfaction. Results In the evaluation of rehabilitation follow-up post-transplant, there was no statistical significance between the pre- and post-implementation groups. After the implementation of the refined pathway, there was an increase in the completion of the six-minute walk test post-transplant (p = 0.048). Clinicians’ responses post educational session noted familiarity with the pathway (88%), documentation (78.8%), and outcome measures (97%). Results of outcomes noted improvement in six-minute walk distances and a decrease in the rate of perceived exertion post-transplant. To ensure future pathway adherence, clinical support should be implemented, and key players identified to maintain sustainability.

Physical condition, psychological status, and posttraumatic stress disorder among recovered COVID-19 subjects: A mediation analysis.

The physical condition of individuals who contracted COVID-19 had a profound influence on mitigating the physical and psychological impact of the disease and the symptoms of posttraumatic stress disorder (PTSD). Little attention has been focused on the influence of physical condition on PTSD among recovered COVID-19 subjects. This study explored the relationship between physical and psychological status and PTSD and the potential mechanisms. Questionnaires were completed by 73 (50.7%, 73/144) COVID-19 recovered subjects who were diagnosed in Taizhou, Zhejiang, China. We conducted a face-to-face survey from January 17 to March 10, 2020. The mediation analysis approach was applied in this research. Our data show that recovered COVID-19 subjects who were in better physical condition exhibited fewer psychological problems [B (95%CI), (−1.65 −3.04, −0.26)] and lower PTSD [B (95%CI), −6.13 (−9.43, −2.83)]. In addition, the worse the psychological status of recovered COVID-19 subjects was, the stronger the PTSD (B [95%CI], 0.58 [0.02, 1.14]). Moreover, psychological status could significantly mediate the impact of physical condition on PTSD (β1θ2 = −0.87). Together, COVID-19 recovered subjects who have better physical condition could decrease their PTSD, and the worse the physical condition of COVID-19 recovered subjects would increase their psychological problems. Our finding about psychological status could significantly mediate the impact of the physical condition on PTSD might be useful for medical institutions and the government seeking to help with the follow-up rehabilitation training of recovered COVID-19 subjects.