Holistic Rehabilitation Program Research Articles

Holistic Rehabilitation in Action: A Data-Driven Analysis of the Impact on Quality of Life among Individuals with Psychoactive Substance Abuse.

Background: Psychoactive substance abuse can affect biological, psychological, social, and spiritual aspects, as well as the users' quality of life, and obliged to carry out medical and social rehabilitation. Purpose: The purpose of the study was to identify the effect of holistic rehabilitation programs on quality of life among drug abusers. Methods: Quasi-experimental with time series design. The sample of this study amounted to 54 people, taken by G-power, all participants who will take part in the rehabilitation program at the National Narcotics Board rehabilitation clinic. Rehabilitation interventions include health assessment, psychological assessments, health counseling, human immunodeficiency virus-related voluntary counseling and testing, addiction counseling, group therapy, family therapy, client and family monitoring, relapse prevention therapy, and postrehabilitation services. Interventions are provided for 10 weeks, and delivered by health professionals. Measurement of quality of life using World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) MEAT 26 statements consisting of physical, psychological, environmental, and social relationship dimensions, with an alpha value of 0.8756. The data was analyzed with the Friedman test. Results: Holistic rehabilitation influences all dimensions quality of life of drug abusers with a P-value of <0.001. Conclusions: A holistic rehabilitation program improves the quality of life of drug abusers.

Description of an interdisciplinary, holistic cognitive rehabilitation program for adults with mild to moderate cognitive impairment after acquired brain injury

Purpose Cognitive rehabilitation research has progressed slowly, in part due to incomplete reporting of intervention content and delivery and the difficulties this produces for discerning program effectiveness. This knowledge gap can be reduced by providing detailed intervention descriptions. We document the content/ingredients and therapeutic targets of a cognitive rehabilitation program for adults with mild-to-moderate cognitive impairment. Methods The documentation process used a method of participatory/collaborative research. Discussions with the clinical team identified session content/ingredients and therapeutic targets, which were then described using Body Functions, and Activities & Participation domains from the International Classification of Function, Disability and Health (ICF). Domains most frequently targeted by each clinician were identified as Primary Targets. Results Each clinician produced a detailed description of session content, implementation, and ICF-coded therapeutic targets. This revealed that the whole program targets 29 ICF domains, seven of which were identified as Primary Targets: Higher-level Cognitive; Attention; Memory; Emotional; Global Psychosocial, Temperament and Personality, and Conversation. Conclusions Documentation of treatment targets enabled identification of appropriate outcome measures which are now being used to investigate program efficacy. This step-by-step explanation of the documentation process could serve as a guide for other teams wanting to document their rehabilitation interventions and/or establish similar programs. IMPLICATIONS FOR REHABILITATION Incomplete reporting of intervention content and delivery contributes to difficulties in discerning the effectiveness of complex rehabilitation programs. Current recommendations for rehabilitation intervention reporting suggest that these difficulties can be partially overcome by providing detailed descriptions of intervention content/ingredients and treatment targets. Human and physical resources differ widely from one clinical setting to another and the existence of clear program descriptions can guide clinicians who wish to create similar programs. Detailed descriptions of rehabilitation interventions are necessary to accurately measure patient outcomes and generate testable hypotheses about proposed mechanisms of action. Program descriptions are needed for the development of treatment theories and the advancement of evidence-based practice in rehabilitation.

Does the Integration of Primary Reflex Schemas According to Masgutovas Neurosensorimotor Reflex Integration Improve Functioning and Quality of Life Among Children with Spectrum of Foetal Alcohol Disorders?

Introduction: Foetal Alcohol Disorder Spectrum (FASD) is an incurable, non-genetic disorder that can occur in children whose mothers consumed alcohol during pregnancy. Patients with FASD are characterised by extensive damage to the central nervous system, neurological disorders, delays in physical and mental development, as well as difficulties in emotional regulation and behavioural disturbances. Neurosensory Integration of Reflexes by S. Masgutova is a holistic rehabilitation and therapeutic programme focused on the diagnosis and integration of primary reflex mechanisms. Intrauterine exposure of the foetus to alcohol affects the lack of proper reflex mechanism integration, which constitutes the foundation of harmonious psychomotor, cognitive, emotional and social development.The aim: The aim of this study is to present the role of primary reflex integration disorders according to MNRI in children with the Spectrum of Foetal Alcohol Disorders (FASD), as well as to discuss the impact of integrating primary reflex disorders according to MNRI on the functioning of FASD in children.Methods: The therapy comprised 103 patients (44 girls and 59 boys) aged 1-13 years with FASD, diagnosed according to the criteria of ICD-10 (Q 86.0). The mean age of the patients was 7.13 years (SD 3.26). Each participant took active participation in 2 rehabilitation interventions according to MNRI, the average interval between the stays was 4 months and 1 week (17 weeks).Results: In patients with FASD, the biomechanics of reflex patterns, such as: Babkin's, ATOS, hand support, paralyzing fear, Galant, grasping hands and Babinski, improved after MNRI therapy.Conclusions: Our research allows to indicate that the rehabilitated FASD patients following MNRI therapy could hug their caregivers more easily, thumb-sucking activity decreased, coordination improved, sleep quality significantly improved while psychomotor hyperactivity decreased.

George P. Prigatano’s contributions to neuropsychological rehabilitation and clinical neuropsychology: A 50-year perspective

In the 1970s and 1980s, a multitude of cognitive rehabilitation programs proliferated to facilitate recovery after brain injury. However only a few programs provided a framework for ameliorating disturbances in the cognitive, psychological, and interpersonal spheres of the brain-injured patient. Greatly influenced by Leonard Diller and Yehuda Ben-Yishay’s ideas and methods, George P. Prigatano began, in early 1980, a holistic neuropsychological rehabilitation program at the Presbyterian Hospital in Oklahoma City (Oklahoma). The objective of this paper is to summarize the contributions of George P. Prigatano to neuropsychological rehabilitation and clinical neuropsychology during his 50th year of practice. The main body of the paper is structured in three sections. The first section briefly explains the history of neuropsychological rehabilitation in the twentieth century and the emergence of holistic neuropsychological rehabilitation programs in the 1970s. The second section describes the contributions of George P. Prigatano to neuropsychological rehabilitation and clinical neuropsychology (written by AGM). In the third section, the second author (GPP) prepared an autobiographical statement, which attempts to summarize some of the personal and professional experiences which influenced his work. George P. Prigatano’s contributions to neuropsychological rehabilitation and clinical neuropsychology are essential to understanding the therapeutic approaches currently used in the treatment of brain-injured patients.

Community reintegration of people with traumatic brain injury in south India: role of a comprehensive transdisciplinary rehabilitation programme

Background/aims Successful community reintegration is the ultimate goal of traumatic brain injury rehabilitation and care. The aim of this study was to explore the community reintegration of people with a traumatic brain injury living in south India who had completed a comprehensive holistic rehabilitation programme. The level of community reintegration based on the demographic variables of the patients was also investigated. Methods A total of 104 community-dwelling people with a traumatic brain injury, and a minimum of 1 year post injury, received treatment from a rehabilitation team in a therapeutic centre for 7 hours a day, 6 days a week for a maximum of 16 weeks. A usual care, transdisciplinary service delivery model was implemented, and the Craig Handicap Assessment and Reporting Technique was used to quantify the main outcome measures. Results The mean and standard deviation scores for each Craig Handicap Assessment and Reporting Technique domain were physical independence (91 ± 23), social integration (87 ± 20), cognitive independence (70 ± 33), economic self-sufficiency (67 ± 40), occupation (66 ± 40) and mobility (63 ± 29). The participants who had gone back to work after their traumatic brain injury showed significantly higher scores in all the domains of the Craig Handicap Assessment and Reporting Technique than those who were unemployed. Only the occupation and mobility domain scores were influenced by the severity of the traumatic brain injury. The economic self-sufficiency, occupation and mobility domain scores were higher among married patients compared to those who were unmarried. Conclusions A significant proportion of the participants were able to return to work and reintegrate into community life through this service delivery model. This comprehensive, holistic approach, which targets physical, cognitive and psychosocial needs and then provides adequate vocational rehabilitation, can result in good outcomes in people with a traumatic brain injury.

Client experiences with holistic neuropsychological rehabilitation: “It is an ongoing process”

ABSTRACT The effectiveness of holistic neuropsychological rehabilitation for people with acquired brain injury has previously been demonstrated by means of standardized and routinely administered outcome measures. However, the most important outcomes from the perspective of former clients are largely unknown. This study explored the experience of participating in a holistic neuropsychological rehabilitation programme by conducting three focus groups with twelve former clients who had sustained a brain injury. Data were transcribed verbatim and analysed using thematic analysis. “It is an ongoing process” emerged as the overarching theme for the experience of recovery from brain injury. Four subthemes, or phases, were identified. Participants went through (1) a phase of confrontation, after which they (2) trained their skills and strategies, and (3) experimented with these in daily life. In the end, clients reached a phase of (4) coming to terms with their injury. Participants described increased levels of self-esteem, sense of competence, and adaptation as the most important outcomes of the programme, as these factors helped them regain a sense of identity. The results indicate that including these factors in outcome evaluations of complex interventions after brain injury may be important as they appear essential for capturing the client’s perspective on change.

Level of Implementation of PNP Oplan Double Barrel in the Province of Camarines Sur: Basis in Formulating a Holistic Rehabilitation Program for Drug Surrenderees

In support of the Barangay Drug Clearing strategy of the Philippines, the Oplan Double Barrel program was implemented under PNP Command Memorandum Circular No. 16- 2016. The program impacted almost all sectors of the community, especially the drug surrenderees. This quantitative descriptive research evaluated the level of implementation of PNP Oplan Tokhang in the province of Camarines Sur. It determined the effectiveness of intervention strategies towards the rehabilitation of the drug surrenderees. A survey questionnaire was administered to six hundred twenty-four (624) respondents, and it was collected, analyzed, and interpreted using weighted arithmetic mean Kruskal Wallis H and Mann Whitney U test to compare the response. Data revealed that three (3) phases of Oplan Tokhang were effectively implemented. However, the problem with the scarcity of financial resources to provide health and other social services, insufficient rehabilitation personnel, and limited rehabilitation facilities are encountered. Hence, the government should increase budget allocation for the rehabilitation services and strengthened the holistic community-based rehabilitation towards effective oplan tokhang.

Changes in exercise capacity and anthropometric measures after Work It Out—a holistic chronic disease self-management program for urban Aboriginal and Torres Strait Islander people

ObjectivesThe Work It Out (WIO) program is a holistic chronic disease self-management and rehabilitation program in Queensland that is tailored for urban Aboriginal and Torres Strait Islander people with/at risk of chronic disease. This study aimed to examine the overall changes in participants’ exercise capacity and anthropometric measurements and to explore the correlations between these changes. Study designQuasi-experimental prepost intervention study. MethodsA total of 406 participants self-identified as Aboriginal and Torres Strait Islander people, who had attended one or more cycles of the program from 2014 to 2017, were included. Health information from the last review assessment was compared with that of the initial assessment using paired t-tests. Multivariate regression models were applied to explore the associations between changes in 6-min walk distance (6MWD) and anthropometric measurements. ResultsAn increase in 6MWD (77 m, 95% confidence interval [CI]: 65, 90), as well as small reductions in waist circumference (WC) (−1.79 cm, 95% CI: −2.76 to −0.82) and hip circumference (−1.11 cm, 95% CI: −2.13 to −0.08) were identified. Statistically significant reductions were observed across all anthropometric measures in the respective highest tertiles (body mass index: −0.71, 95% CI: −1.35 to −0.07; weight: −2.59 kg, 95% CI: −4.84 to −0.34; WC: −5.09 cm, 95% CI: −6.99 to −3.20; waist to hip ratio: −0.033, 95% CI: −0.047 to −0.02). The increments of 6MWD in returning participants (92 m, 95% CI: 75 to 109) was found to be greater than those in one-off participants (59 m, 95% CI: 40–78). In particular, the percentage of 6MWD change from baseline was significantly correlated to the percentage of WC change after adjusting for age, gender, the number of pre-existing chronic conditions, and the number of cycles attended (coefficient: −1.33, 95% CI: −2.42 to −0.24). ConclusionSignificant improvement in functional exercise capacity and modest changes in anthropometric measurements were identified in WIO participants. WC change could be used as an indicator of the change of participants’ six-minute walk distance. Findings may be useful for promoting and guiding similar health programs for improving chronic disease management in Australian Indigenous communities.

Felty syndrome. Case report

The Work It Out (WIO) program is a holistic chronic disease self-management and rehabilitation program in Queensland that is tailored for urban Aboriginal and Torres Strait Islander people with/at risk of chronic disease. This study aimed to examine the overall changes in participants’ exercise capacity and anthropometric measurements and to explore the correlations between these changes.Quasi-experimental prepost intervention study.A total of 406 participants self-identified as Aboriginal and Torres Strait Islander people, who had attended one or more cycles of the program from 2014 to 2017, were included. Health information from the last review assessment was compared with that of the initial assessment using paired t-tests. Multivariate regression models were applied to explore the associations between changes in 6-min walk distance (6MWD) and anthropometric measurements.An increase in 6MWD (77 m, 95% confidence interval [CI]: 65, 90), as well as small reductions in waist circumference (WC) (−1.79 cm, 95% CI: −2.76 to −0.82) and hip circumference (−1.11 cm, 95% CI: −2.13 to −0.08) were identified. Statistically significant reductions were observed across all anthropometric measures in the respective highest tertiles (body mass index: −0.71, 95% CI: −1.35 to −0.07; weight: −2.59 kg, 95% CI: −4.84 to −0.34; WC: −5.09 cm, 95% CI: −6.99 to −3.20; waist to hip ratio: −0.033, 95% CI: −0.047 to −0.02). The increments of 6MWD in returning participants (92 m, 95% CI: 75 to 109) was found to be greater than those in one-off participants (59 m, 95% CI: 40–78). In particular, the percentage of 6MWD change from baseline was significantly correlated to the percentage of WC change after adjusting for age, gender, the number of pre-existing chronic conditions, and the number of cycles attended (coefficient: −1.33, 95% CI: −2.42 to −0.24).Significant improvement in functional exercise capacity and modest changes in anthropometric measurements were identified in WIO participants. WC change could be used as an indicator of the change of participants’ six-minute walk distance. Findings may be useful for promoting and guiding similar health programs for improving chronic disease management in Australian Indigenous communities.

Can acceptance and commitment therapy facilitate psychological adjustment after a severe traumatic brain injury? A pilot randomized controlled trial

ABSTRACT This study i⁠nvestigated if an Acceptance and Commitment Therapy (ACT) intervention (ACT-Adjust) can facilitate psychological adjustment and reduce psychological distress following severe traumatic brain injury (TBI). The study design comprised a single centre, two-armed, Phase II pilot randomized controlled trial. Nineteen individuals with severe TBI (PTA ≥7 days) who met a clinical threshold for psychological distress (Depression Anxiety Stress Scales-21; DASS > 9) were randomly allocated to either ACT-Adjust (n = 10) or an active control, Befriending Therapy (n = 9), in conjunction with a holistic rehabilitation programme. Primary (psychological flexibility, rehabilitation participation) and secondary (depression, anxiety & stress) outcomes were measured at three-time points (pre, post and follow up). Significant decreases were found for DASS-depression (group by time interaction, F 1,17 = 5.35, p = .03) and DASS-stress (group by time interaction, F 1,17 = 5.69, p = .03) in comparison to the Befriending group, but not for the primary outcome measures. The reduction in stress post-treatment was classed as clinically significant, however interaction differences for stress and depression were not maintained at one month follow up. Preliminary investigations indicate potential for ACT in decreasing psychological distress for individuals with a severe TBI with further sessions required to maintain treatment gains. The pilot results suggest further investigation is warranted in a larger scale clinical trial.

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning.

Persisting post-concussive symptoms are challenging to treat and may delay return-to-work (RTW). The aims of this study were to describe a multidisciplinary and holistic vocational rehabilitation (VR) program for individuals with mild traumatic brain injury (mTBI) and to explore course and predictors of employment outcome during VR. The VR program was described using the Standard Operating Procedures (SOPs) framework. Further, a retrospective, cohort study on individuals with mTBI receiving VR was conducted based on clinical records (n = 32; 22% males; mean age 43.2 years; 1.2 years since injury on average). The primary outcome was difference in hours at work per week from pre- to post-VR, and the secondary outcome was change in a three-level RTW-status. Time since injury, age, sex, and loss of consciousness were investigated as predictors of the outcomes. The VR intervention is individually tailored and targets patients' individual needs. Thus, it may combine a variety of methods based on a biopsychosocial theoretical model. During VR, hours at work, 17.0 ± 2.2, p < 0.001, and RTW-status, OR = 14.0, p < 0.001, improved significantly with 97% having returned to work after VR. Shorter length of time since injury and male sex were identified as predictors of a greater gain of working hours. Time since injury was the strongest predictor; double the time was associated with a reduction in effect by 4.2 ± 1.4 h after adjusting for working hours at start of VR. In sum, these results suggest that individuals facing persistent problems following mTBI may still improve employment outcomes and RTW after receiving this multidisciplinary and holistic VR intervention, even years after injury. While results are preliminary and subject to bias due to the lack of a control group, this study warrants further research into employment outcomes and VR following mTBI, including who may benefit the most from treatment.

Injury and Disordered Eating Behaviors: What is the Connection for Female Professional Dancers?

Dancers, like athletes, frequently endure injuries and disordered eating as a result of performance-specific demands. The purpose of this study was to explore the relationship between severe injuries and disordered eating from the perspectives of female professional dancers. In-depth, semi-structured interviews were conducted with 13 female professional dancers ages 18–38 (M = 23;SD = 6.2) whose dance participation was suspended for 4–36 weeks (M = 12.69;SD = 10.09) due to a dance-related injury. We adopted a social constructivist stance to view the experiences of dancers through the lens of a phenomenon highly influenced by environmental and cultural factors. A thematic analysis yielded five themes including negative emotions associated with injury, anxiety and uncertainty around future involvement, modifications in nutritional intake (e.g., reduction of calories), coping with injury, and the need for an effective and holistic injury rehabilitation program.

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for Adults with Acquired Brain Injury. The European PRM position (UEMS PRM Section).

Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI. The aim was to formulate recommendations on the PRM physician's professional practice for persons with ABI in order to promote their functioning and enhance quality of life. This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM Section: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds. The literature review as well as thirty-one recommendations are presented. The expert consensus is that structured, comprehensive and holistic rehabilitation program delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.

An Integrative Neuroscience Framework for the Treatment of Chronic Pain: From Cellular Alterations to Behavior.

Chronic pain can result from many pain syndromes including complex regional pain syndrome (CRPS), phantom limb pain and chronic low back pain, among others. On a molecular level, chronic pain syndromes arise from hypersensitization within the dorsal horn of the spinal cord, a process known as central sensitization. Central sensitization involves an upregulation of ionotropic and metabotropic glutamate receptors (mGluRs) similar to that of long-term potentiation (LTP). Regions of the brain in which LTP occurs, such as the amygdala and hippocampus, are implicated in fear- and memory-related brain circuity. Chronic pain dramatically influences patient quality of life. Individuals with chronic pain may develop pain-related anxiety and pain-related fear. The syndrome also alters functional connectivity in the default-mode network (DMN) and salience network. On a cellular/molecular level, central sensitization may be reversed through degradative glutamate receptor pathways. This, however, rarely happens. Instead, cortical brain regions may serve in a top-down regulatory capacity for the maintenance or alleviation of pain. Specifically, the medial prefrontal cortex (mPFC), which plays a critical role in fear-related brain circuits, the DMN, and salience network may be the driving forces in this process. On a cellular level, the mPFC may form new neural circuits through LTP that may cause extinction of pre-existing pain pathways found within fear-related brain circuits, the DMN, and salience network. In order to promote new LTP connections between the mPFC and other key brain structures, such as the amygdala and insula, we propose a holistic rehabilitation program including cognitive behavioral therapy (CBT) and revolving around: (1) cognitive reappraisals; (2) mindfulness meditation; and (3) functional rehabilitation. Unlike current medical interventions focusing upon pain-relieving medications, we do not believe that chronic pain treatment should focus on reversing the effects of central sensitization. Instead, we propose here that it is critical to focus on non-invasive efforts to promote new neural circuits originating from the mPFC.

Rehabilitation in Autism. Pilot Project on the Health Centre-Based Primary Care Model within the National Health Plan Implementation Projects

Background: In Italy, there is a lack of reliable data on the epidemiology of Autism Spectrum Disorder (ASD) on a national scale. The exact etiopathogenesis of ASDs is still largely unknown, with autism representing the final common pathway of different pathological conditions. Aim of the Study: Assessment of the effects produced by the individualised, intensive and holistic rehabilitation programme used by the Il Cireneo Foundation on the daily living skills of people diagnosed with ASD. Materials and Methods: Out of the eighty-seven (n = 87) enrolees, seventy-nine (n = 79), of whom 19 were females (24.1%) and 60 were males (75.9%), with a mean age of 13.41 years (SD = 6.93 years; range = 2 - 33 years) terminated the three-year study. The enrolees were evaluated two times: at the beginning of the rehabilitation programme and at the end of the three-year goal-oriented project. Results: Statistically significant results between T0 and T1 were recorded for CARS (t-4.221; p < 0.05) and for the domains of Communication (t-2.750; p < 0.05), Daily Living Skills (t-6.526; p < 0.05) and Motor Skills (t-3.524; p < 0.05) of the VABS. Conclusions: People diagnosed with autism can be helped to become more autonomous and independent in carrying out activities of daily living thanks to an intensive psycho-educational and cognitive-behavioural rehabilitation programme, of which the Il Cireneo Foundation is the only expression in the Abruzzo region.

Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury

BackgroundA holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. ObjectivesThis study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. MethodsWe used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. ResultsWe included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). ConclusionParticipant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality improvement.

Dysexecutive symptoms and carer strain following acquired brain injury: Changes measured before and after holistic neuropsychological rehabilitation.

Following acquired brain injury (ABI), deficits in executive functioning (EF) are common. As a result many brain-injured patients encounter problems in every-day functioning, and their families experience significant strain. Previous research has documented the benefits of cognitive rehabilitation for executive dysfunction, and rehabilitation programmes designed to ameliorate functional problems associated with ABI. This study primarily aims to evaluate whether a neuropsychological rehabilitation programme reduces reported symptoms of everyday dysexecutive behaviour and carer strain. In this study 66 ABI outpatients attended comprehensive holistic neuropsychological rehabilitation programme. A repeated-measures design was employed to determine the effect of rehabilitation on EF and carer strain, as part of a service evaluation. Outcome measures comprised the dysexecutive questionnaire (DEX/DEX-I) and carer strain index (CSI), applied pre- and post-rehabilitation. Results indicate rehabilitation benefited clients and carers in 5 of 6 DEX/DEX-I subscales, and 2 of 3 CSI subscales, (p < 0.05). An effect of aetiology on rehabilitation was found on the metacognitive scale of the DEX-I. Therefore, this study supports a comprehensive holistic neuropsychological rehabilitation programme as effective in reducing reported symptoms of dysexecutive behaviour and carer strain following ABI.

The mediating effect of caregiver burden on the caregivers' quality of life.

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver’s QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers’ QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers’ QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers’ well-being.

0114: Effects of holistic cardiac rehabilitation on anxiety and depression: gender difference

The aim of this prospective study was to compare the effects of an ambulatory cardiac rehabilitation program (CRP) on anxiety and depression between women and men. 893 patients, 256 women and 637 men, with identical age (56/55 years respectively) were included. All patients performed a 6-week multidisciplinary holistic CRP including exercise training, psychological screening and support as well as education concerning lifestyle. Reasons of admission were: coronary artery bypass graft surgery (41%), angioplasty & stent (25%), angor pectoris & myocardial infarction (8%), valve replacement (13%), dilated cardiomyopathy (4%), other (9%). Level of anxiety (A) and depression (D) were measured by the psychologist using the Hospital Anxiety and Depression (HAD) scale, before and after the CRP. At baseline, women had a significant higher score for A (11.24 vs 9.02, p<0.001) with a higher prevalence of A [HAD≥11] (57% vs 34% – p<0.001) compared to men. Women had also a significant higher score for D (7.39 vs 5.91 – p<0.001) with a higher prevalence of D [HAD≥8] (44% vs 31% – p<0.001). At the end of the program, the entire population studied achieved significant improvements characterised by a statistically significant fall in anxiety/depression. However, mean fall for A was significantly higher in women (–36% vs –28%, p<0.05) as compared to men. Identical trends was found for D (–54% vs –41%, p<0.05). Consequently, prevalence of A (18% vs 14% – p=0.059) and D (9% vs 9%).were similar in women and men at the end of the rehabilitation. In our study, at baseline, women had a higher level of anxiety and depression compared to men. A holistic rehabilitation program including psychological screening and support is able to reduce significantly the level of anxiety and depression in both women and men. However, women achieved higher improvement. Consequently, at the end of the program, women and men had a similar prevalence for anxiety and depression.

Effectiveness of holistic neuropsychological rehabilitation for Spanish population with acquired brain injury measured using Rasch analysis

The Rasch model is increasingly used in the field of rehabilitation because it improves the accuracy of measurements of patient status and their changes after therapy. To determine the long-term effectiveness of a holistic neuropsychological rehabilitation program for Spanish outpatients with acquired brain injury (ABI) using Rasch analysis. Eighteen patients (ten with long evolution - patients who started the program > 6 months after ABI- and eight with short evolution) and their relatives attended the program for 6 months. Patients' and relatives' answers to the European Brain Injury Questionnaire and the Frontal Systems Behavior Scale at 3 time points (pre-intervention. post-intervention and 12 month follow-up) were transformed into linear measures called logits. The linear measures revealed significant improvements with large effects at the follow-up assessment on cognitive and executive functioning, social and emotional self-regulation, apathy and mood. At follow-up, the short evolution group achieved greater improvements in mood and cognitive functioning than the long evolution patients. The program showed long-term effectiveness for most of the variables, and it was more effective for mood and cognitive functioning when patients were treated early. Relatives played a key role in the effectiveness of the rehabilitation program.