Formal Rehabilitation Programs Research Articles

Exploring the infeasibility of enforcing mandatory in-prison rehabilitation in Jamaica

ABSTRACT Only about 21% of adult inmates in Jamaica participate in formal rehabilitation programmes. 1 As such, the government has taken steps to make in-prison rehabilitation mandatory. By drawing on interviews with 73 formerly incarcerated persons, this article explores the viability and practicability of mandatory in-prison rehabilitation. The evidence suggests that if made mandatory, in-prison rehabilitation may not support the effective reintegration of inmates who value agency. Coercion could also amplify change-resistant behaviours, and limited administrative capacity might also challenge the effective enforcement of the mandate. Towards achieving the effective reintegration of newly released persons and lowering the recidivism rate, the article proposes some correctional reforms which the Jamaican state can pursue in the absence of adequate capacity to implement mandatory in-prison rehabilitation. Such reforms include the need to bolster and enhance good governance systems.

Telerehabilitation for lower extremity recovery poststroke: a systematic review and meta-analysis protocol

IntroductionApproximately 30% of individuals with stroke report unmet lower extremity recovery needs after formal hospital-based rehabilitation programmes have ended. Telerehabilitation can mitigate issues surrounding accessibility of rehabilitation services by providing...

Survey of Beak and Feather Disease Virus (BFDV) in Guatemalan Neotropical Psittacine Birds.

Beak and feather disease virus (BFDV), a circovirus, is the etiologic agent of psittacine beak and feather disease (PBFD), a progressive and often fatal disease in Psittaciformes. Even though neotropical psittacine species are more resistant to clinical infection than Old World species, BFDV is recognized as a threat to immunologically naïve wild psittacine flocks and its epidemiologic control is paramount for conservation efforts in Neotropical species. Samples were collected from multiple psittacine species, including Ara species, Amazona species, and the white-crowned parrot (Pionus senilis) from the only rescue center in Guatemala with formal psittacine rehabilitation and reintroduction programs. A total of 117 birds, with 101 adults and 16 juveniles of unknown sex, were tested for BFDV by means of a real-time polymerase chain reaction (PCR) assay. The BFDV prevalence found in this study was 0%, (95% confidence interval, 0%-6.0%). Seven 2-8-year-old scarlet macaws (Ara macao cyanoptera) with positive results from previous surveys by conventional PCR yielded negative results in this study, suggesting complete infection resolution.

Designing an app for home-based enriched Music-supported Therapy in the rehabilitation of patients with chronic stroke: a pilot feasibility study

ABSTRACT Objective After completing formal stroke rehabilitation programs, most patients do not achieve full upper limb motor function recovery. Music-supported Therapy (MST) can improve motor functionality post stroke through musical training. We designed a home-based enriched Music-supported Therapy (eMST) program to provide patients with chronic stroke the opportunity of continuing rehabilitation by themselves. We developed an app to conduct the eMST sessions at home with a MIDI-piano and percussion instruments. Here, we tested the feasibility of the eMST intervention using the novel app. Method This is a pilot study where five patients with chronic stroke underwent a 10-week intervention of 3 sessions per week. Patients answered feasibility questionnaires throughout the intervention to modify aspects of the rehabilitation program and the app according to their feedback. Upper limb motor functions were evaluated pre- and post-intervention as well as speed and force tapping during daily piano performance. Results Patients clinically improved in upper limb motor function achieving the Minimal Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) in most of motor tests. The app received high usability ratings post-intervention. Conclusion The eMST program is a feasible intervention for patients with chronic stroke and its efficacy should be assessed in a clinical trial.

Assessment of Motion Loss in the Thrower's Shoulder

The overhead throwing motion is a complex movement which requires soft tissue flexibility and neuromuscular control to generate force from the legs and trunk and propel the ball forward. Repetitive motions and high levels of torque on the shoulder can compromise soft tissue balance and contribute to the high rate of shoulder injuries commonly seen in throwers. A thorough physical examination including inspection of the entire kinetic chain and total arc of shoulder motion is important in making an accurate diagnosis. Nonoperative treatment with a formal progressive rehabilitation program is typically effective in treating the thrower's shoulder. Occasionally, patients may require operative intervention for posterior inferior capsular release for refractory capsular contracture, and selective treatment of superior labrum tears or rotator cuff tears when nonoperative management has been exhausted. A decrease in a thrower's total arc of motion may be more detrimental than a loss of relative internal rotation.

Cancer Rehabilitation in Australia and New Zealand

Objective: Despite increasing evidence of the benefits of cancer rehabilitation worldwide, the nature of cancer rehabilitation programs is not well described in Australia and New Zealand. We report findings of a pilot survey highlighting the current service delivery of cancer rehabilitation programs and health professionals' perspectives on barriers and facilitators to implementation of cancer rehabilitation programs. Methods: A cross-sectional pilot survey of rehabilitation health professionals in hospital and ambulatory care settings in Australia and New Zealand, evaluating current availability of cancer rehabilitation programs, health professional workforce, core components delivered, and barriers and facilitators to provision and delivery of cancer rehabilitation programs. Results: Respondents (n = 60) included rehabilitation physicians and advanced trainees, with a majority of respondents working in non-dedicated cancer rehabilitation programs in Australia and New Zealand. Most rehabilitation programs being provided to cancer patients are led by rehabilitation physicians, followed by allied health. The most common tumor streams referred include central nervous system, hematological, and breast cancers. Patients are most frequently referred during posttreatment phase. The core components of rehabilitation programs include management of complications and provision of education (mood, exercise, and fatigue management), with exercise prescription comprising mainly strengthening exercises, mobilization, and gait training. Common barriers for adequate service delivery included inadequate funding and lack of appropriate staffing with expertise, while most common facilitators identified were encouraging better collaboration and integration of rehabilitation within acute cancer care services and specialty teams and increased enthusiasm and engagement of staff with leadership skills. Conclusion: The pilot survey identified current service provision among rehabilitation programs providing care to cancer patients and highlighted preliminary gaps and facilitators to the implementation of formal cancer rehabilitation programs. These findings need further confirmation in a larger study to assess further outcome measures and the impact of barriers and facilitators for care quality. Collaborative efforts between physicians, patients, policy makers, and related parties may assist in overcoming the barriers identified.

Can Yoga Overcome Criminality? The Impact of Yoga on Recidivism in Israeli Prisons.

In recent years, yoga practices have been integrated into formal prison rehabilitation programs of the Israel Prison Service (IPS), as part of the informal education system, giving rise to innovative criminological theories such as positive criminology that emphasize the development of offenders' strengths by facilitating rehabilitation and reintegration processes. The purpose of the present study was to examine the correlation between yoga practice and recidivism among released prisoners who participated in yoga programs during their incarceration in comparison with a matched control group of those who did not participate in yoga programs over a follow-up period of 5 years. To examine the effectiveness of the program, propensity score matching was used to compile the comparison group from among all convicted prisoners who were released from the Israeli prisons. Study results indicate that yoga may affect recidivism, supported by a finding of lower recidivism rates among released prisoners who had practiced yoga during their incarceration, compared with a matched control group. However, further study is needed including randomized controlled trials (RCTs). In light of these positive results, we recommend policy-makers consider expanding alternative practices such as yoga into prisons, in recognition of their contribution to the rehabilitation process through the development of personal and social strengths.

COST-EFFECTIVENESS FOR RETURN-TO-PLAY (RTP) PROGRAMS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background:Rupture of the anterior cruciate ligament (ACL) is a common injury in young athletes. Safe return-to-play (RTP, i.e. sports competition) is important to patient satisfaction, and appropriate criteria for RTP may reduce the risk of graft injury.Purpose:The purpose of this study is to assess the cost-effectiveness of a comprehensive RTP rehabilitation protocol relative to standard post-ACL reconstruction rehabilitation.Methods:A decision-analysis model was utilized to compare standard rehabilitation with an RTP program which included supplemental neuromuscular retraining, functional testing, and clinical follow-up. Cost-effectiveness was evaluated from a payer perspective. Costs of surgical procedures and rehabilitation protocols, risks of ipsilateral graft rupture and contralateral ACL injury, risk reductions due to the RTP program, and relevant utilities based on International Knee Documentation Committee (IKDC) outcomes were derived from the available literature. An incremental cost-effectiveness ratio (ICER) of <$100,000/QALY was used to determine cost-effectiveness. Sensitivity analyses were performed on pertinent model parameters to measure their effect on base-case conclusions. In the base-case analysis, the cost of an RTP program was conservatively assumed to be $1,721 more than the standard rehabilitation protocol. The relative risk of ACL graft rupture following completion of the RTP program was assumed to be 0.75 (25% reduction).Results:In the base-case analysis, the RTP program was cost-effective compared with the standard rehabilitation protocol (ICER $54,939/QALY). Based on one-way threshold analyses, the RTP program was cost-effective as long as the additional cost was <$2,092 or the RTP program decreased the incidence of graft rupture by >7.7%.Conclusion:Our data suggests that, assuming modest associated decreases in graft failure, the addition of neuromuscular retraining, functional testing, and clinical follow-up to a formal rehabilitation program is cost-effective. The cost-effectiveness of such additions is related to the costs as well as any associated decreases in subsequent event risk, as shown in Figure 1.Figures:Figure 1.Two-way sensitivity analysis of the additional cost of an RTP program (relative to standard rehabilitation) versus the relative risk of graft rupture following completion of an RTP program. The black line represents the base-case assumption of additional cost of an RTP program ($1,721). The white line represents the base-case assumption of the relative risk of graft rupture following completion of an RTP program (0.75).

An observational cohort study of exercise and education for people with chronic obstructive pulmonary disease not meeting criteria for formal pulmonary rehabilitation programmes.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Pulmonary rehabilitation (PR) is offered to patients with functional breathlessness. However, access to PR is limited. The objective of this study was to evaluate whether a 4-week education and exercise programme offered to COPD patients with Medical Research Council (MRC) dyspnoea 1–2 improves disease self-management. Patients were recruited by their GP to attend four weekly 2-h sessions provided by a multidisciplinary team. Patients completed outcome measures before and after the program. Forty-two patients entered the programme and 26 out of 42 (61.9%) completed all sessions. The Bristol COPD Knowledge Questionnaire and Patient Activation Measure improved (both p ≤ 0.001). Disease burden was not reduced according to the COPD assessment test. All patients accepted a referral for ongoing exercise. Fourteen current smokers (81.3%) accepted a referral for smoking cessation, three patients with anxiety or depression (37.5%) accepted a psychological therapies referral. The programme improved COPD disease knowledge, patient activation and stimulated referrals to further services supporting disease management. Randomised controlled trials are warranted for similar interventions for COPD patients with early stage disease.

DOES HARMONICA PLAYING IMPROVE OUTCOMES IN COPD PATIENTS?

SESSION TITLE: Improving Care in COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 PM - 02:30 PM PURPOSE: Primary interventions in COPD include smoking cessation, appropriate inhaler therapy and pulmonary rehabilitation (PR). PR requires a multidisciplinary approach of exercise and education, with instruction in breathing retraining exercises such as pursed-lip and diaphragmatic breathing. Pursed lip breathing may reduce alveolar collapse during exhalation and diaphragmatic breathing may work to improve inspiratory pressures, even at the higher lung volumes seen in COPD. Harmonica playing requires the practice of a similar expiratory maneuver as taught in pursed lip breathing (PLB); diaphragmatic breathing generates adequate force to create musical tones. The purpose of this study was to determine if patients with COPD would benefit from a 12 week program of harmonica playing with improved respiratory muscle strength, ambulation and quality of life. METHODS: COPD patients who had completed a formal pulmonary rehabilitation program (PR) at least 6 months prior were eligible for this trial. After obtaining informed consent, patients attended 12 weeks of harmonica training for two hours, one day per week and were instructed to practice at home for at least 30 minutes a day, 5 days a week. Participants completed spirometry testing, maximum inspired and expired pressure (MIP, MEP) testing and Six Minute Walk test pre- and post- program in addition to recording pre- and post-program St. George Respiratory Questionnaires. We performed paired t-tests and Wilcoxon Signed-Rank Tests, as appropriate. RESULTS: Of the 14 participants upon entry, 11 completed this trial. 3 subjects were male. The average age was 72.5 years. All had been smokers previously with a median 40 [quartile 1 = 30, quartile 3 = 40] pack-year history. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) increased by an average of 15.36 ± 12.04 (p=0.0017) and 14.36 ± 13.76 (p=0.0061), respectively. Additionally, the distance walked in 6 minutes (6MWD) increased by nearly 60 meters (60.55 ± 78.18, p = 0.0280). Median distance improved by 48 meters. SGRQ improved slightly, but not statistically so. CONCLUSIONS: In this small pilot trial, we found that a 12-week harmonica program significantly improved MIP, MEP and 6 MWD in a group of post-PR COPD patients. Larger scale harmonica studies are warranted to evaluate this program’s adjunctive potential benefit to formal pulmonary rehabilitation. CLINICAL IMPLICATIONS: Harmonica playing may be an option for some COPD patients to use in the home for a lung exercise or as an adjunct treatment to be included in pulmonary rehabilitation and better breathing clubs. DISCLOSURES: Speaker/Speaker's Bureau relationship with Monaghan Medical Please note: $1-$1000 Added 02/27/2018 by Mary Hart, source=Web Response, value=Travel No relevant relationships by AAYLA JAMIL, source=Web Response Speaker/Speaker's Bureau relationship with Astra Zeneca Please note: $5001 - $20000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Bohringle Ingleheim Please note: $5001 - $20000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Circassia Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Advisory Committee Member relationship with Novartis Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Advisory Committee Member relationship with GSK Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria No relevant relationships by Elizabeth Stewardson, source=Web Response No relevant relationships by Kristen Tecson, source=Web Response

The impact on health status in short- and long-terms of a novel and non-orthodox real-world COPD rehabilitation effort in rural India: an appraisal.

BackgroundRehabilitation has been an integral part of management of COPD. Since the implementation of the standard rehabilitation protocol is hardly possible in the rural developing world, aiming to make a feasible alternate effort may be worthwhile.MethodsCOPD patients diagnosed through spirometry were first stabilized with 6 weeks of uniform pharmacotherapy. Subsequently, they were subjected to a curriculum-based intensive single-session intervention with education, bronchial hygiene, and exercise training. The latter involved whole body exercise, pursed lip breathing, and diaphragmatic exercise. The participants continued to practice the exercises under real-world encouragement and supervision from trained volunteers. The impact was appraised in terms of change in health status through COPD assessment test (CAT) score measurements at stabilization, and after 6 weeks and 1 year of the intensive training and education.ResultsAt stabilization, 70 out of 96 selected COPD subjects (73%) turned up (with mean age 62±9 years and mean FEV1 as 1.16±0.39 L) showing improvement as per CAT score (p=0.0001) from pharmacotherapy. After practicing the imparted education and training for 6 weeks, all these 70 participants had further significant improvement in the health status (n=70, p=0.00001). This improvement, been reinforced and supervised, continued to last even at 1 year (n=54, p=0.0001).ConclusionThe self-managed practice of a single-session education and training under real-world supervision can bring forth significant long-term improvement in the health status of COPD sufferers. Such simple and feasible intervention may substitute formal COPD rehabilitation programs in resource constraint situations.

Mindful neuropsychology : repenser la réhabilitation neuropsychologique à travers la pleine conscience

ObjectivesMindfulness based interventions (MBI) have recently gained much interest in western medicine. MBSR paradigm is based on teaching participants to pay complete attention to the present experience and act nonjudgmentally towards stressful events. During this mental practice the meditator focuses his or her attention on the sensations of the body. While the distractions (mental images, thoughts, emotional or somatic states) arise the participant is taught to acknowledge discursive thoughts and cultivate the state of awareness without immediate reaction. The effectiveness of these programs is well documented in the field of emotional response regulation in depression (relapse prevention), anxiety disorders, obsessive-compulsive disorder or eating disorders. Furthermore, converging lines of evidence support the hypothesis that mindfulness practice improves cognition, especially the ability to sustain attention and think in a more flexible manner. Nevertheless, formal rehabilitation programs targeting cognitive disturbances resulting from psychiatric (depression, disorder bipolar, schizophrenia) or neurologic conditions (brain injury, dementia) seldom rely on MBI principles. This review of literature aims at discussing possible links between MBI and clinical neuropsychology. MethodsWe conducted a review of literature using electronic databases up to December 2016, screening studies with variants of the keywords (“Mindfulness”, “MBI”, “MBSR”, “Meditation”) OR/AND (“Cognition”, “Attention”, “Executive function”, “Memory”, “Learning”) ResultsIn the first part, we describe key concepts of the neuropsychology of attention in the light of Posner's model of attention control. We also underline the potential scope of different therapeutic contexts where disturbances of attention may be clinically relevant. Second, we review the efficacy of MBI in the field of cognition (thinking disturbances, attention biases, memory and executive processes impairment or low metacognitive abilities), mood (emotional dysregulation, anxiety, depression, mood shifts) and somatic preoccupations (stress induced immune dysregulation, chronic pain, body representation, eating disorders, sleep quality, fatigue). In psychiatry, these three components closely coexist and interact which explains the complexity of patient assessment and care. Numerous studies show that meditation inspired interventions offer a promising solution in the prevention and rehabilitation of cognitive impairment. In the last part, we discuss the benefits and risks of integrating meditation practice into broader programs of cognitive remediation and therapeutic education in patients suffering from cognitive disorders. We propose a number of possible guidelines for developing mindfulness inspired cognitive remediation tools. Along with Jon Kabatt Zinn (Kabatt-Zinn & Maskens, 2012), we suggest that the construction of neuropsychological tools relies on seven attitudinal foundations of mindfulness practice. ConclusionsThis paper highlights the importance of referring to holistic approaches such as MBI when dealing with patients with neuropsychological impairment, especially in the field of psychiatry. We advocate introducing mindfulness principles in order to help patients stabilize their attention and improve cognitive flexibility. We believe this transition in neuropsychological care may offer an interesting paradigm shift promoting a more efficient approach towards cognition and its links to emotion, body, and environment.

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

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

Effects of yogic exercises on functional capacity, lung function and quality of life in participants with obstructive pulmonary disease: a randomized controlled study.

Knowledge of hatha yogic exercises, the most used yoga style, for increasing functional capacity in patients with obstructive pulmonary diseases remains limited. The aim was to evaluate the effects and feasibility of hatha yoga (HY) compared to a conventional training program (CTP) on functional capacity, lung function and quality of life in patients with obstructive pulmonary diseases. Randomized clinical trial. The study was performed at the Karolinska University Hospital, Stockholm, among outpatients. Thirty-six patients with obstructive pulmonary disease. Forty patients were randomized with 36 (24 women, median age =64, age range: 40-84 years) participating in HY (N.=19) or CTP (N.=17). Both HY and CTP involved a 12-week program with a 6-month follow-up. Functional capacity (using the 6-Minute Walk Test), lung function (spirometry), respiratory muscle strength (respiratory pressure meter), oxygen saturation (SpO2), breathlessness (Borg), respiratory rate (f) and disease-specific quality of life (CRQ) were measured at baseline, at 12 weeks and at a 6-month follow-up. Testing for interactions (group x time) with ANOVAs showed significant effects on the CRQ fatigue (P=0.04) and emotional (P=0.02) domains, with improvements in the CTP group after the 12-week intervention (P=0.02 and 0.01, respectively) but not in the HY group. No between group effects emerged, however, within each group, significant improvements emerged for the six-minute walk distance (6MWD) after 12-week intervention (HY: mean difference 32.6 m; CI: 10.1-55.1, P=0.014; CTP: mean difference 42.4 m; CI: 17.9-67.0, P=0.006). within-group improvements in CRQ appeared in both groups. Within the HY group, f decreased and SpO2 increased. Improved effects after follow-up emerged only for the CTP group for diastolic blood pressure (P=0.05) and CRQ emotional and fatigue domain (P=0.01). There were no between-group differences. After 12 weeks, 6MWD improved significantly within both groups. Within the HY group, improvements in the CRQ mastery domain, f and SpO2 emerged. Within the CTP group, there were improvements in lung function parameter forced vital capacity, respiratory muscle strength and all CRQ-domains. The CTP also exhibited effects on CRQ after the 6months follow-up. Limited effects of HY and CTP emerged. HY seems feasible and safe as a form of physical exercise for pulmonary disease patients. As part of the rehabilitation, HY may constitute an alternative to other physical training activities and may be a useful addition to formal rehabilitation programs.

Yoga in the Management of Chronic Disease: A Systematic Review and Meta-analysis.

Heart disease, stroke, and chronic obstructive pulmonary disease (COPD) are the leading causes of death and disability worldwide. Although individuals with these conditions have been reported to benefit from yoga, its effectiveness remains unclear. To perform a systematic review of the effectiveness of yoga on exercise capacity, health related quality of life (HRQL), and psychological well-being for individuals with chronic disease and describe the structure and delivery of programs. We performed a systematic review of randomized controlled trials examining yoga programs for individuals with heart disease, stroke, and COPD compared with usual care. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.3. The protocol was registered on PROSPERO (CRD42014014589). Ten studies (431 individuals, mean age 56±8 y) were included and were comparable in their design and components, irrespective of the chronic disease. The standardized mean difference for the mean change in exercise capacity was 2.69 (95% confidence interval, 1.39-3.99) and for HRQL it was 1.24 (95% confidence interval, -0.37 to 2.85). Symptoms of anxiety were reduced after yoga in individuals with stroke, although this was not observed in individuals with COPD. The effect of yoga on symptoms of depression varied across studies with no significant effects compared with usual care. Yoga programs have similar designs and components across chronic disease populations. Compared with usual care, yoga resulted in significant improvements in exercise capacity and a mean improvement in HRQL. Yoga programs may be a useful adjunct to formal rehabilitation programs.

Peak oxygen uptake after cardiac rehabilitation: a randomized controlled trial of a 12-month maintenance program versus usual care.

BackgroundExercise capacity is a strong predictor of survival in patients with coronary artery disease (CAD). Exercise capacity improves after cardiac rehabilitation exercise training, but previous studies have demonstrated a decline in peak oxygen uptake after ending a formal rehabilitation program. There is a lack of knowledge on how long-term exercise adherence can be achieved in CAD patients. We therefore assessed if a 12-month maintenance program following cardiac rehabilitation would lead to increased adherence to exercise and increased exercise capacity compared to usual care.Materials and MethodsTwo-centre, open, parallel randomized controlled trial with 12 months follow-up comparing usual care to a maintenance program. The maintenance program consisted of one monthly supervised high intensity interval training session, a written exercise program and exercise diary, and a maximum exercise test every third month during follow-up. Forty-nine patients (15 women) on optimal medical treatment were included following discharge from cardiac rehabilitation. The primary endpoint was change in peak oxygen uptake at follow-up; secondary endpoints were physical activity level, quality of life and blood markers of cardiovascular risk.ResultsThere was no change in peak oxygen uptake from baseline to follow-up in either group (intervention group 27.9 (±4.7) to 28.8 (±5.6) mL·kg (-1) min (−1), control group 32.0 (±6.2) to 32.8 (±5.8) mL·kg (−1) min (−1), with no between-group difference, p = 0.22). Quality of life and blood biomarkers remained essentially unchanged, and both self-reported and measured physical activity levels were similar between groups after 12 months.ConclusionsA maintenance exercise program for 12 months did not improve adherence to exercise or peak oxygen uptake in CAD patients after discharge from cardiac rehabilitation compared to usual care. This suggests that infrequent supervised high intensity interval training sessions are inadequate to improve peak oxygen uptake in this patient group.Trial RegistrationClinicalTrials.gov NCT01246570

Functional outcomes in patients with chronic obstructive pulmonary disease: a multivariate analysis

BackgroundMultiple factors can influence the severity of chronic obstructive pulmonary disease (COPD) and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. ObjectiveTo evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ) in COPD patients. MethodParticipants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second - FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score) were considered. ResultsThe best regression model for predicting the SGRQ activity score (r2=0.477) included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r2=0.426) included the variables gender, oxygen therapy, and SGRQ symptoms. ConclusionsThe results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters.

Oncology Rehabilitation Provision and Practice Patterns across Canada

Rehabilitation is increasingly recognized as an important therapeutic intervention for people with cancer. The main objective of this study was to explore the current practice pattern and provision of oncology rehabilitation in Canada. A descriptive cross-sectional online survey was administered to Canadian facilities offering cancer treatment and/or listed as offering rehabilitation services during or after cancer treatment (cancer centres, rehabilitation hospitals, community centres, and private clinics). Of the 116 sites contacted, 62 completed the questionnaire, 20 of which reported having an oncology rehabilitation programme. The majority of respondents indicated that they are not meeting their clients' rehabilitation needs. Rehabilitation programmes were provided by multidisciplinary health care teams, the majority of which included a physiotherapist. Funding and availability of resources were identified as the main barriers to the development of oncology rehabilitation programmes. Formal oncology rehabilitation programmes appear to be scarce, despite growing evidence that rehabilitation offers benefits across the cancer survivorship continuum.

Criminals with ‘Community Spirit’: Practising Citizenship in the Hidden World of the Prison

Contra the notion of prisons as discrete, ‘hidden’ spaces, contemporary research has stressed a range of connections, transactions and exchange. The relationship between the offender and the outside communities—captured in the policy rhetoric of rehabilitation and the promotion of good citizenship—is just one of these connections. This paper explores contemporary, liberal imaginations of the ‘ideal’ citizen; it goes on to critique formal rehabilitation programmes and highlight informal mechanisms developed within the prison environment which disrupt these constructions. Ultimately, this allows a deeper appreciation of how, despite attempts to practise citizenship in an environment that renders conventional rights and responsibilities absent, the prisoner remains altogether ‘less than ideal’.

Exercise, Vascular Health, and Abdominal Aortic Aneurysms

Exercise, Vascular Health, and Abdominal Aortic Aneurysms