Home-based Rehabilitation Program Research Articles

Modeling rehabilitation dataset to implement effective AI assistive systems

The demand for automated systems monitoring and supporting patients in their home-based recovery programs is substantial. While emerging technologies have been proposed as potential solutions to enhance at-home patient care, limited systems are in place due to their challenges in offering real-time monitoring and corrective feedback. Most proposed methodologies provide an overall measure or score for the executed movement. The proposed work involves the adaptation of an existing published dataset to cater to the needs of a system capable of remotely assisting patients, effectively acting as a virtual physical therapist able to provide corrective feedback. A dataset containing a set of three simple exercises for shoulder rehabilitation was processed. Each movement was meticulously annotated for temporal and categorical motion domains to monitor exercise execution in terms of the range of motion completeness and to evaluate compensatory movement patterns. This work carries substantial significance by offering a standardized and easily accessible model for human movement data, thus fostering the advancement of digital assistive systems designed to support home-based rehabilitation programs.

Ηand dexterities assessment in stroke patients based on augmented reality and machine learning through a box and block test

A popular and widely suggested measure for assessing unilateral hand motor skills in stroke patients is the box and block test (BBT). Our study aimed to create an augmented reality enhanced version of the BBT (AR-BBT) and evaluate its correlation to the original BBT for stroke patients. Following G-power analysis, clinical examination, and inclusion–exclusion criteria, 31 stroke patients were included in this study. AR-BBT was developed using the Open Source Computer Vision Library (OpenCV). The MediaPipe's hand tracking library uses a palm and a hand landmark machine learning model to detect and track hands. A computer and a depth camera were employed in the clinical evaluation of AR-BBT following the principles of traditional BBT. A strong correlation was achieved between the number of blocks moved in the BBT and the AR-BBT on the hemiplegic side (Pearson correlation = 0.918) and a positive statistically significant correlation (p = 0.000008). The conventional BBT is currently the preferred assessment method. However, our approach offers an advantage, as it suggests that an AR-BBT solution could remotely monitor the assessment of a home-based rehabilitation program and provide additional hand kinematic information for hand dexterities in AR environment conditions. Furthermore, it employs minimal hardware equipment.

Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures.

Patients with intertrochanteric hip fractures are at an elevated risk of becoming bedridden compared with those with intraarticular hip fractures. Accurate risk assessments can help clinicians select postoperative rehabilitation strategies to mitigate the risk of bedridden status. This study aimed to develop a two-step prediction model to predict bedridden status at 3 months postoperatively: one model (first step) for prediction at the time of admission to help dictate postoperative rehabilitation plans; and another (second step) for prediction at the time before discharge to determine appropriate discharge destinations and home rehabilitation programs. Three-hundred and eighty-four patients were retrospectively reviewed and divided into a development group (n = 291) and external validation group (n = 93). We developed a two-step prediction model to predict the three-month bedridden status of patients with intertrochanteric fractures from the development group. The first (preoperative) model incorporated four simple predictors: age, dementia, American Society of Anesthesiologists physical status classification (ASA), and pre-fracture ambulatory status. The second (predischarge) model used an additional predictor, ambulation status before discharge. Model performances were evaluated using the external validation group. The preoperative model performances were area under ROC curve (AUC) = 0.72 (95%CI 0.61-0.83) and calibration slope = 1.22 (0.40-2.23). The predischarge model performances were AUC = 0.83 (0.74-0.92) and calibration slope = 0.89 (0.51-1.35). A decision curve analysis (DCA) showed a positive net benefit across a threshold probability between 10% and 35%, with a higher positive net benefit for the predischarge model. Our prediction models demonstrated good discrimination, calibration, and net benefit gains. Using readily available predictors for prognostic prediction can assist clinicians in planning individualized postoperative rehabilitation programs, home-based rehabilitation programs, and determining appropriate discharge destinations, especially in environments with limited resources.

Effect of Home-based Rehabilitation Program on Cardiorespiratory Fitness Level in Post-COVID-19 Patients with Type II Diabetes Mellitus: A Pilot Randomized Controlled Trial

Effect of Home-based Rehabilitation Program on Cardiorespiratory Fitness Level in Post-COVID-19 Patients with Type II Diabetes Mellitus: A Pilot Randomized Controlled Trial

Research and Development of a 3D-Printed Dynamic Finger Flexion Orthosis for Finger Extension Stiffness-A Preliminary Study.

Finger extension stiffness is a common post-traumatic complication that results in the hand's functional impairment. In clinical practice, a dynamic splint enables the patient to stretch the affected finger independently. However, current dynamic splints have drawbacks, such as limited stretching efficacy, and interfere with the hand's functional activities. Therefore, this study aimed to develop a dynamic finger flexion orthosis capable of stretching each finger joint using additive manufacturing (AM) technology, thereby enabling hand functional activity, and analyze the clinical improvement in the range of motion (ROM). One subject with a hand fracture was recruited while undergoing a 7-week home-based rehabilitation program for the orthosis. The outcome measurements included the total active motion (TAM), the tip-to-finger distance (TPD), and the score on the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The results show that the TAM of the participant's fingers increased by 72.7 degrees on average, the TPD decreased by 3.5 cm on average, and the DASH score decreased to 9.5 points. The 7-week home-based rehabilitation program for the orthosis resulted in a 53.6% increase in the TAM on average. The developed orthosis improved hand function and enabled a more complete ROM in finger flexion.

Adapting an evidence-based, home cardiac rehabilitation programme for people with heart failure and their caregivers to the Danish context: DK:REACH-HF study.

Adapting interventions with an existing evidence base offers a more efficient approach than development of a new intervention. The aim of this study was to describe the process of adapting a home-based cardiac rehabilitation (CR) programme (REACH-HF) intervention originally developed in the United Kingdom for people with heart failure (HF) to the Danish health system - the 'DK:REACH-HF' programme. We followed methodological framework for the conduct and reporting of studies adapting interventions, utilizing documentary analysis, qualitative interviews, stakeholder consultations, and mapping of the Danish policy context. Our study found broad support for the REACH-HF intervention as an alternative to existing centre-based CR. We also identified three key areas of adaptation for the Danish context. First, reduce the word-count of the intervention's resources by linking to existing publicly available CR materials. Second, whilst retaining REACH-HF core components, adapt its content and delivery to reflect differences between Denmark and United Kingdom. Thirdly, to develop a digital version of the intervention. Using an evidence-based approach, we successfully adapted the REACH-HF intervention to the context of the Danish healthcare setting, maintaining core components of the original intervention, and developing both a paper based and digital version of the programme material. To inform scaled national implementation of the DK:REACH-HF programme, we seek to undertake a pilot study to test the adapted intervention materials feasibility and acceptability to healthcare practitioners, patients, and their caregivers and confirm the positive impact on the outcomes of HF patients and caregivers.

Efficacy and safety of a music-therapy facilitated pulmonary telerehabilitation program in COPD patients: the COPDMELODY study protocol.

Despite considerable evidence for the benefit in chronic obstructive pulmonary disease (COPD), the implementation of pulmonary rehabilitation (PR) is insufficient. However, music therapy may help address this gap due to its unique benefits. Therefore, we aimed to develop a music-therapy facilitated pulmonary telerehabilitation program based on rhythm-guided walking, singing, and objective telemonitoring. A supervised, parallel-group, single-blinded, randomized controlled clinical trial will be conducted, including 75 patients with COPD anticipated to be randomized in a 1:1:1 ratio into three groups. The intervention groups will receive a 12-week remotely monitored rehabilitation program, while the usual care group will not receive any rehabilitation interventions. Of the two intervention groups, the multi-module music therapy group will contain rhythm-guided walking and singing training, while the rhythm-guided walking group will only include music tempo-guided walking. The primary outcome is the distance of the incremental shuttle walking test. Secondary outcomes include respiratory muscle function, spirometry, lower extremity function, symptoms, quality of life, anxiety and depression levels, physical activity level, training adherence, and safety measurements. The results of this study can contribute to develop and evaluate a home-based music-facilitated rehabilitation program, which has the potential to act as a supplement and/or substitute (according to the needs) for traditional center-based PR in patients with stable COPD. Clinical trial registration: https://classic.clinicaltrials.gov/, NCT05832814.

Economic Evaluation of an Enhanced Post-Discharge Home-Based Care Program for Stroke Survivors

ObjectivesTo examine the cost-effectiveness of an enhanced postdischarge home-based care program for stroke survivors compared with usual care. MethodsThis was a trial-based economic evaluation study. One hundred and sixteen patients with ischemic stroke were recruited from neurology units in a Chinese hospital and randomized into intervention (n = 58) or usual care groups (n = 58). The intervention commenced with predischarge planning and transitioned to home follow-up postdischarge. Trained nurse case managers supported by an interdisciplinary team provided comprehensive assessment, individualized goal setting, and skill training to support home-based rehabilitation for intervention group participants. Standard care was provided to usual care group participants. Total cost and quality-adjusted life-years gained at 3-month (T1), 6-month (T2), and 12-month (T3) follow-ups were calculated. The incremental cost-effectiveness ratios between the groups were obtained. ResultsThe intervention group showed a significant increase in utility compared with the usual care group at T1 (P = .003), T2 (P = .007), and T3 (P < .001). The average total QALY gain from baseline for the intervention group was higher than for the usual care group at all time points. The likelihood of being cost-effective ranged from 61.9% to 67.2% from the provider perspective, and from 59.7% to 66.8% from the societal perspective. ConclusionsThe results showed that the intervention program was cost-effective with significantly higher quality-adjusted life-years for stroke survivors when compared with usual care. It provides economic evidence to support the development of home-based stroke rehabilitation program, especially in the low- and middle-income countries.

The facilitators and barriers to home-based robotic rehabilitation in India: a pilot feasibility study

IntroductionRobot-assisted rehabilitation has emerged as a promising approach for enhancing motor function in stroke survivors. However, the feasibility and effectiveness of home-based robotic training in this population are underexplored, especially in low/middle-income countries.MethodsThis feasibility study aimed to address this gap by examining the feasibility and effectiveness of independent home-based training using PLUTO, a robotic device for hand training. A total of 7 chronic stroke survivors were recruited, with 5 completing the study.ResultsThe results revealed high engagement and adherence to the home-based training program, with participants averaging 1659.8 min of training over 24.8 days. The PLUTO system demonstrated excellent usability and elicited positive user perceptions. Significant improvements were observed in functional outcomes, as evidenced by a noteworthy increase in Fugl-Meyer Assessment scores (mean increase of 6.2 points, exceeding the minimal clinically important difference (MCID) of 5.35 points). Furthermore, participants showed improvements in the ABILHAND measure (mean improvement of 1.24 logits, surpassing the MCID of 0.2 logits) and the Barthel Index (mean increase of 8.8 points).ConclusionThese findings demonstrate the feasibility and effectiveness of home-based robotic rehabilitation for chronic stroke survivors. This has implications for expanding access to rehabilitation services in low- and middle-income countries, enhancing patient engagement and adherence, and improving functional outcomes. Larger controlled studies are warranted to evaluate the effectiveness of home-based robotic rehabilitation programs.

Assessment of Sensorized Insoles in Balance and Gait in Individuals With Parkinson's Disease.

Individuals with Parkinson's disease (PD) are characterized by gait and balance disorders limiting their independence and quality of life. Home-based rehabilitation programs, combined with drug therapy, demonstrated to be beneficial in the daily-life activities of PD subjects. Sensorized shoes can extract balance- and gait-related data in home-based scenarios and allow clinicians to monitor subjects' activities. In this study, we verified the capability of a pair of sensorized shoes (including pressure-sensitive insoles and one inertial measurement unit) in assessing ground-level walking and body weight shift exercises. The shoes can potentially be combined with a sensory biofeedback module that provides vibrotactile cues to individuals. Sensorized shoes have been assessed in terms of the capability of detecting relevant gait events (heel strike, flat foot, toe off), estimating spatiotemporal parameters of gait (stance, swing, and double support duration, stride length), estimating gait variables (vertical ground-reaction force, vGRF; coordinate of the center of pressure along the longitudinal axes of the feet, yCoP; and the dorsiflexion angle of the feet, Pitch angle). The assessment compared the outcomes with those extracted from the gold standard equipment, namely force platforms and a motion capture system. Results of this comparison with 9 PD subjects showed an overall median absolute error lower than 0.03 s in detecting the foot-contact, foot-off, and heel-off gait events while performing ground-level walking and lower than 0.15 s in body weight shift exercises. The computation of spatiotemporal parameters of gait showed median errors of 1.62 % of the stance phase duration and 0.002 m of the step length. Regarding the estimation of vGRF, yCoP, and Pitch angle, the median across-subjects Pearson correlation coefficient was 0.90, 0.94, and 0.91, respectively. These results confirm the suitability of the sensorized shoes for quantifying biomechanical features during body weight shift and gait exercises of PD and pave the way to exploit the biofeedback modules of the bidirectional interface in future studies.

Artificial Intelligence-driven Remote Monitoring Model for Physical Rehabilitation

In recent times, the quality of life of several individuals has been affected by chronic diseases. Traditional forms of rehabilitation occasionally involve face-to-face sessions, which restricts accessibility and presents challenges for real-time monitoring. Lack of comprehensive understanding of the aspects impacts long-term patient engagement and adherence to remote rehabilitation programs. Individuals and healthcare systems incur a significant portion of the costs associated with rehabilitation treatment. A home-based rehabilitation program reduces the rehabilitation cost. However, the clinicians’ absence may affect the effectiveness of rehabilitation programs. There is a demand for an artificial intelligence-based remote monitoring model for evaluating the physical movements of individuals. Therefore, the study proposes a framework for generating scores for physical rehabilitation exercises. It supports the home-based rehabilitation program by assessing the individual’s movements. The authors employ the You Only Look Once V5–ShuffleNet V2-based image processor for generating scores using the variations between the joints. In addition, they build bidirectional long short-term memory networks for delivering a score for each exercise. Finally, the two outcomes are compared using the modulated rank averaging method for presenting the final score. The authors evaluate the performance of the proposed model using the KiMoRe dataset. The comparative analysis outcome suggested that the proposed model obtained an exceptional mean absolute deviation, mean absolute percentage error, and root mean square error of 0.425, 1.120, and 0.985, respectively. It highlighted the significance of the proposed framework in assessing the individual’s physical movement. Further studies will improve the performance of the proposed framework.

Home-based rehabilitation versus centre-based programs in patients with temporomandibular disorders—a systematic review and meta-analysis

To compare the effects of home-based rehabilitation and occlusal splints or centre-based rehabilitation in patients with temporomandibular joint disorders (TMD). A systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov electronic databases were consulted from inception to August 2023, searching for randomized controlled trials (RCTs) that compared home-based rehabilitation for TMD with splints or centre-based rehabilitation. The risk of bias was assessed using the Cochrane risk of bias tool. 23 RCTs (1402 participants, three comparator interventions) were identified. Very low-certainty evidence suggested there are no clinically difference between home-based rehabilitation and splints in pain intensity (mean difference (MD) 7.75, 95% confidence interval (CI): 2.17 to 13.32), maximal mouth opening (MMO) (MD 1.83, 95% CI: −0.27 to 3.93) at short and long-term follow-up, in sleep quality (MD: 1.67, 95% CI: −2.04 to 3.56) and quality of life (psychological: MD 0.94, 95% CI: −4.43 to 6.31; general: MD −1.18, 95% CI: −5.72 to 5.37) at short-term follow-up. Low-certainty evidence suggested that home-based rehabilitation plus manual therapy is more effective for TMD treatment compared to home-based rehabilitation at short-term follow-up (pain intensity: MD: 14.93, 95% CI: 7.72 to 21.93; MMO: MD −2.93, 95% CI: −5.3 to −0.54; sleep quality: MD 1.4, 95%CI: 0.09 to 2.71). Compared with home-based rehabilitation, Transcutaneous Electrical Nerve Stimulation (TENS) and Low-Level Laser Therapy (LLLT) was superior in pain relief at short-term follow-up. Low and very low-certainty evidence suggests home-based rehabilitation could be considered a low-cost, beneficial therapy alternative for TMD patients to relieve symptoms.

Outcome of home-based rehabilitation program following arthroscopic anterior cruciate ligament reconstruction in nonathletic patient

Abstract Background: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is thought to be important by almost all surgeons. It has even been considered by some to be as important as surgery itself. As the surgical procedure for these injuries evolved, so has the rehabilitation. A traditional approach to rehabilitation which focused on delayed weight bearing and mobilization is now being replaced by accelerated rehabilitation which advocates early weight bearing and results in early return to sports. Materials and Methods: This is a observational case-control comparative study conducted in our department from September 2019 to February 2021. About 30 cases of more than 20 years of age with comparable matching group are included in our study. Assessment of Lysholm score, International Knee Documentation Committee (IKDC) score, ACL quality of life score, and Tegner activity level is done. Functional assessment was carried out by Carioca test, one leg hop test, and Shuttle test. Assessment of clinical status is done by anterior drawer test, Lachman test, and Pivot shift test. Results: All patients participating in study although nonathletic had complaints of instability and giving away episodes of knee in their day to day activities and therefore were considered as candidates for surgery. Following an arthroscopic ACL reconstruction, they were given written home-based protocols with goals and exercises being explained to them at the time of discharge. All the patients participating in the study were able to return to their preinjury activity level as assessed by the Tegner activity scale at the final follow up. Their functional outcome as measured by Lysholm score, IKDC score, and ACL quality of life score was significantly lower when compared to an age, sex, and activity matched control group. The patients functional performance as assessed by one leg hop test, Carioca test, and Shuttle test was also below the level of what was seen in control groups. More than 90% patients had a stable knee as assessed by the anterior drawer test, Lachman test and pivot shift test (29 patients has anterior drawer of ≤5 mm, 27 patients had Lachmann test ≤5 mm and all 30 patients had pivot shift grades in absent or glide category). Conclusions: Home-based rehabilitation is an effective method of rehabilitation in low demand individuals following ACL reconstruction. In the future, adequately powered randomized controlled trials are needed to assess the usefulness of one rehabilitation protocol over other in these group of low demand patients.

Implementation of Home-based Cardiac Rehabilitation Program in Patients with Coronary Artery Disease: A Literature Review

Introduction: Coronary artery disease (CAD) is the major cause of disability and death worldwide. The cardiac rehabilitation (CR) program is the management strategy for CAD patients with exercise as the main component to increase functional capacity. This program has been proven beneficial in reducing mortality and morbidity due to CAD. It also reduced the healthcare burden and improved the quality of life. Although the benefits of CR are widely proven, participation and adherence of CAD patients to this program are low. The home-based cardiac rehabilitation (HBCR) program is the strategy developed to increase the coverage of CR services. This program is equally effective as center-based cardiac rehabilitation (CBCR) and is considered safe. This review aimed to find out more about the HBCR program with a focus on its implementation in CAD patients.&#x0D; Methods: Original articles and systematic or narrative reviews were searched using PubMed, Google Scholar, and Research Gate databases. Further exploration of literature citations was also done to meet the inclusion criteria needed to explain the topic.&#x0D; Results: Compared to CBCR, the HBCR program provide comparable benefits, both in medical and functional outcomes. The HBCR program is proven to be feasible and safe with better adherence. The components of the HBCR program are generally the same as the CBCR program and direct supervision given in the CBCR program can be replaced by remote supervision through communication devices or home visits.&#x0D; Conclusion: The HBCR program can be used as an alternative to CBCR in managing patients with CAD.

Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALIREHAB randomized controlled trial

Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALIREHAB randomized controlled trial

Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: a critical review

BackgroundHeart failure (HF) is the most common cardiovascular reason for hospital admission, particularly among patients older than 60 years old. Heart failure with reduced ejection fraction (HFrEF) comprises approximately 50% of all heart failure cases. Home-based cardiac rehabilitation (HBCR) is an alternative option to enhance the participation rate in cardiac rehabilitation (CR) interventions for patients who are not able to attend center-based cardiac rehabilitation (CBCR). The purpose of this review is to clarify the extent to which present studies of HBCR align with the core components defined by both the European Society of Cardiology (ESC) and the British Association for Cardiac Prevention and Rehabilitation (BACPR).MethodsA critical review was conducted through four databases, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, to identify randomized controlled trials up until June 2022. We scrutinized the commonalities between BACPR and ESC and developed a list of standards. The risk of bias was assessed using the RoB 2 tool.ResultsAmong the 87 papers selected for full-text screening, 11 studies met the inclusion criteria. Six papers possessed a high proportion of fidelity to essential standards, four studies had a medium alliance, and one intervention had a low level of alliance.ConclusionOverall, the majority of included studies had medium to high alignment with standards and core components. However, a need for more attention to long-term strategy as an important standard is revealed. Rapid identification and initial assessment are the most met standards; however, lifestyle risk factor management and long-term outcomes were recognized as the least met standards.

HOME-BASED REHABILITATION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN THE KURDISTAN REGION OF IRAQ: EPIDEMIOLOGY AND OUTCOMES

IntroductionOver the past 30 years multiple wars and embargos have reduced healthcare resources, infrastructure, and staff in Iraq. Subsequently, there are a lack of physiotherapists to provide rehabilitation after an anterior cruciate ligament reconstruction (ACLR). The implementation of home-based rehabilitation programmes may provide a potential solution to this problem. This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.MethodsA cohort observational study of patients aged ≥ 16 years with an ACL rupture who underwent an ACLR under a single surgeon. This was performed arthroscopically using a hamstring autograft (2 portal technique). Patients completed a home-based rehabilitation programme of appropriate simplicity for the home setting. The programme consisted of stretching, range of motion and strengthening exercises based on criterion rehabilitation progressions. A full description of the programme is provided at: https://ngmvcharity.co.uk/.Demographics, mechanisms of injury, operative findings, and outcome data (Lysholm, Tegner Activity Scale (TAS), and revision rates) were collected from 2016 to 2021. Data were analysed using descriptive statistics.ResultsThe cohort consisted of 545 patients (547 knees), 99.6% were male with a mean age of 27.8 years (SD 6.18 years). The mean time from diagnosis to surgery was 40.6 months (SD 40.3). Despite data attrition Lysholm scores improved over the 15-month follow-up period, matched data showed the most improvement occurred within the first 2 months post-operatively. A peak score of 90 was observed at nine months. Post-operative TAS results showed an improvement in level of function but did not reach pre-injury levels by the final follow-up. At final follow-up, six (1.1%) patients required an ACLR revision.ConclusionPatients who completed a home-based rehabilitation programme in Kurdistan had low revision rates and improved Lysholm scores 15 months post-operatively. To optimise resources, further research should investigate the efficacy of home-based rehabilitation for trauma and elective surgery in low- to middle-income countries and the developed world.

Safety and effects of a home-based Tai Chi exercise rehabilitation program in patients with chronic heart failure: study protocol for a randomized controlled trial

IntroductionChronic heart failure (CHF), as the final stage of the progression of many cardiovascular disorders, is one of the main causes of hospitalization and death in the elderly and has a substantial impact on patients' quality of life (QOL). Exercise-based cardiac rehabilitation (CR) has been shown to considerably enhance QOL and prognosis. Given the barriers to center-based CR faced by most developing countries in the form of expensive instruments, the development of home-based CR is necessary. Tai Chi, as an instrument-free exercise, has been shown to be successful in treating elderly CHF individuals. Fu Yang, as one of the academic concept of Traditional Chinese Medicine (TCM), believes that the fundamental pathogenesis of CHF is the gradual decline of Yang, and emphasizes the restoration of Yang physiological function in the treatment process. Therefore, we develope a home-based Tai Chi exercise rehabilitation program called Fu Yang Tai Chi (FYTC) for elderly CHF patients by combining the Fu Yang Theory of TCM with the CR theory. The objective of this study is to evaluate the effectiveness, acceptability, and safety of the program.Methods and analysisWe suggest conducting a parallel randomized controlled clinical trial with open label. Eighty CHF elderly participants will be randomly assigned in a 1:1 ratio to the FYTC rehabilitation program group or the moderate-intensity aerobic walking control group. Eligible participants will engage in either three sessions weekly of FYTC or walking exercise for 12 weeks. The primary outcome is the relative change in 6 min walk distance (6MWD). The secondary outcomes are the plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), QOL, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), self-rating anxiety scale (SAS) and depression scale (SDS), exercise skills, and noninvasive hemodynamic monitoring. Throughout the trial, adverse events will be recorded for safety evaluation. Researchers who are blinded to the treatment allocation will analyze the data.Ethics and disseminationThis research was authorized by the Guang'anmen Hospital Ethics Committee of the Chinese Academy of Medical Sciences (2022-141-KY). Our findings will be shared online and in academic conferences as well as in peer-reviewed journals. Trial registration numberChiCTR2200063511.

Can a structured home-based rehabilitation program reduce dorsal central wrist pain?

ObjectivesDorsal central wrist pain, often a consequence of peri-scapholunate ligament injury, can result in a decline in functional performance. There is a scarcity of clinical data evaluating the effectiveness of conservative management on peri-scapholunate ligament injury. Conservative management includes education, immobilization with orthotic devices, scapholunate-stabilizing muscle strengthening, and proprioception training. The identification of the ligamento-muscular reflex and scapholunate-stabilizing muscles formed the rationale for a rehabilitation training program. We have devised an innovative standardized 16-week treatment program for patients with dorsal central wrist pain associated with acute peri-SL ligament injury. We hypothesized that the program can effectively reduce dorsal wrist pain and improve functional performance. Materials and methodsRecruited subjects underwent the 16-week home-based program, which included immobilization and rehabilitation exercises, to improve their wrist stability. Follow-up was arranged every 4 weeks for progress monitoring. The Short-Form 12 item questionnaire version 2, power grip, pinch grip, wrist range of motion, total performance score and total pain score when performing activities of daily living were used to evaluate the effectiveness of the program. An exercise adherence questionnaire was used to evaluate adherence to the home rehabilitation program. ResultsTwenty-three subjects (26 wrists) completed the program. Pain on visual analog scale improved by 5.1 cm and total pain score improved from 14.4/20 to 19.5/20. Total performance score reached 39/40, which indicated near-normal wrist function. Power grip and pinch grip increased by 22.3% and 17.8%, respectively. The physical component scale of the Short-Form 12 item questionnaire showed significant improvement, while the mental component scale did not. Overall adherence was fair. DiscussionConservative management, including immobilization and rehabilitation training, can provide significant clinical improvement in patients with dorsal central wrist pain associated with acute peri-scapholunate ligament injury. ConclusionStandardized wrist rehabilitation can be taken as a reference treatment modality. It is an evidence-based non-invasive treatment option for clinicians and therapists.

Developing a home-based pulmonary rehabilitation programme for patients with chronic respiratory diseases in Malaysia: A mixed-method feasibility study.

The COVID-19 pandemic has underscored the importance of remote healthcare and home-based interventions, including pulmonary rehabilitation, for patients with chronic respiratory diseases (CRDs). It has also heightened the vulnerability of individuals with underlying respiratory conditions to severe illness from COVID-19, necessitating exploration and assessment of the feasibility of delivering home - pulmonary rehabilitation (home-PR) programmes for CRD management in Malaysia and other countries. Home-based programmes offer a safer alternative to in-person rehabilitation during outbreaks like COVID-19 and can serve as a valuable resource for patients who may be hesitant to visit healthcare facilities during such times. We aimed to assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia. We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a home-PR programme. Following centre-based assessment, patients performed the exercises at home (five sessions/week for eight weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes Walking Test (6MWT) and Health-Related Quality-of-Life (HRQoL) (COPD Assessment Test (CAT)) at baseline and post-PR at nine weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback on the home-PR programme. The interviews were audio recorded, transcribed verbatim, and analysed thematically. We included 30 participants; two withdrew due to hospitalisation. Although 28 (93%) adhered to the full programme, only 11 (37%) attended the post-PR assessment because COVID-19 movement restrictions in Malaysia at that time prevented attendance at the centre. Four themes emerged from the qualitative analysis: involvement of family and caregivers, barriers to home-PR programme, interactions with peers and health care professionals, and programme enhancement. Despite the COVID-19 pandemic, the home-PR programme proved feasible for remote delivery, although centre-based post-PR assessments were not possible. Family involvement played an important role in the home-PR programme. The delivery of this programme can be further improved to maximise the benefit for patients.