Hospital-based Outpatient Rehabilitation Research Articles

Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to compare the effectiveness of home-based tele-rehabilitation programs with hospital-based rehabilitation programs in improving pain and function at various time points (≤6 weeks, ≤14 weeks, and ≤ 52 weeks) following the initial total knee arthroplasty. This study used PRISMA and AMSTAR reporting guidelines. We systematically searched 5 databases (PubMed, Embase, Web of Science, Cochrane Library, and Medline) to identify randomized controlled trials published from January 1, 2019, to January 1, 2023. The primary outcomes were pain, knee injury and osteoarthritis outcome score, and mobility (knee range of motion). We included 9 studies involving 1944 patients. Low-quality evidence showed hospital-based rehabilitation was better than home-based tele-rehabilitation in knee injury and osteoarthritis outcome score (mean difference [MD], -2.62; 95% confidence interval [CI], -4.65 to -0.58; P = .01) at ≤ 14 weeks after total knee arthroplasty. Based on low-quality evidence, home-based tele-rehabilitation was better than hospital-based rehabilitation in knee range of motion (MD, 2.00; 95% CI, 0.60 to 3.40; P = .005). There was no significant difference between hospital-based rehabilitation and home-based tele-rehabilitation in knee pain at ≤ 6 weeks (MD, 0.18; 95% CI, -0.07 to 0.42; P = .16), 14 weeks (MD, 0.12; 95% CI, -0.26 to 0.49; P = .54), and ≤ 52 weeks (MD, 0.16; 95% CI, -0.11 to 0.43; P = .24). Home-based tele-rehabilitation and hospital-based rehabilitation programs showed comparable long-term outcomes in pain, mobility, physical function, and patient-reported health status after primary total knee arthroplasty. Considering the economic costs, home-based tele-rehabilitation programs are recommended as a viable alternative to hospital-based rehabilitation programs.

Clinical Outcomes for Patients Classified by Fear-Avoidance Beliefs and Centralization Phenomenon

Werneke MW, Hart DL, George SZ, Stratford PW, Matheson JW, Reyes A. Clinical outcomes for patients classified by fear-avoidance beliefs and centralization phenomenon. Objectives To (1) determine the prevalence of pain pattern classification subgroups (centralization, noncentralization, and not classified) observed during the initial evaluation of patients experiencing high versus low Fear-Avoidance Beliefs Questionnaire for physical activity (FABQ-PA) scores, (2) examine the association between discharge pain intensity and functional status (FS) outcomes based on FABQ-PA and pain pattern subgroups, and (3) compare minimal clinically important improvement for FS and pain intensity for FABQ-PA and pain pattern classification subgroups. Design Observational cohort design. Setting Suburban hospital-based outpatient rehabilitation clinic. Participants Consecutive patients with low back syndromes (N=238, mean ± SD, 59.1±17.0y; minimum=20, maximum=91). Interventions Interventions were designed to match patient classification by fear-avoidance level and pain pattern. Main Outcome Measures Two outcome measures were assessed: patient self-reported FS and pain intensity. FS was assessed by using computerized adaptive testing methods. Maximal pain intensity was assessed by using an 11-point numeric pain scale: 0 (no pain) to 10 (worst imaginable pain). Results There were no differences (χ 2 2=3.7, P=.16) in proportion of patients classified by pain pattern experiencing high or low fear-avoidance beliefs. After controlling for the effect of available risk-adjustment variables, only dual-level classification subgroups, symptom acuity, payer type, and intake FS or pain intensity were associated with discharge FS or pain outcomes. The highest proportion of patients achieving minimal clinically important improvement in pain and FS were reported by the following patient subgroup: centralization and low fear. Conclusions Pain pattern and FABQ-PA characteristics impacted rehabilitation outcomes. We recommend that both factors be considered when managing patients with low back pain in an effort to optimize rehabilitation outcomes.

Centralization: Prevalence and Effect on Treatment Outcomes Using a Standardized Operational Definition and Measurement Method

Retrospective, observational cohort design. Purpose 1 was to determine the association between age, symptom chronicity, and prevalence of centralization in a sample of patients with nonserious cervical or lumbar spinal syndromes referred to a hospital-based outpatient rehabilitation clinic. Purpose 2 was to examine if classifying these patients at intake to centralization or noncentralization predicts functional status, pain intensity, and number of treatment visits at discharge from rehabilitation. Purpose 3 was to compare clinically meaningful changes in functional status and pain intensity between patients subgrouped by centralization and noncentralization. Variations in operational definitions and measurements used to identify centralization affect patient classification, contribute to variation in reported prevalence rates, and influence treatment strategy and outcome interpretation. Investigating a standardized operational definition and measurement method for centralization may reduce practice and outcomes variation. Adults (n=418) with cervical or low back syndromes (mean +/- SD age, 58 +/- 17 years; range, 19-91 years; 33% male; 76% lumbar symptoms; 53% chronic symptoms) were assessed. Therapists classified patients using a standardized operational definition and method for centralization during initial evaluation. Prevalence rates were calculated for centralization by age and acuity. Multivariate models were used to assess discharge functional status, pain intensity, and visits while controlling important variables. Percentage of patients subgrouped by centralization and noncentralization achieving minimal clinically important differences (MCID) in functional status and pain intensity was assessed. Overall prevalence rate for centralization was 17%, but increased for patients who were younger and reported acute symptoms regardless of body part. For patients with lumbar syndromes, noncentralization was associated with lower discharge functional status and more pain, but not associated with number of visits compared to patients classified as centralization. For patients with cervical syndromes, noncentralization was associated with more pain but not associated with functional status or number of visits compared to patients classified as centralization. Pain pattern classification affected percentage of patients with lumbar and cervical impairment achieving MCID. Results supported the clinical use of a standardized definition of centralization to facilitate patient classification and management and interpretation of outcomes.

A Canadian, Multicentre, Randomized Clinical Trial of Home‐Based Pulmonary Rehabilitation in Copd: Rationale and Methods

Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation. To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD). A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD. Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthly with telephone interviews and in person at enrollment, three months and 12 months. The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain-specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one-year study period; and direct and indirect costs of COPD treatment. An intent-to-treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two-sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables. The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short-term and long-term effectiveness of home-based pulmonary rehabilitation strategies. The authors will also determine if home-based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital-based outpatient pulmonary rehabilitation.

Reliability of the Dynamic Gait Index in individuals with multiple sclerosis

McConvey J, Bennett SE. Reliability of the Dynamic Gait Index in individuals with multiple sclerosis. Objectives To determine if the Dynamic Gait Index (DGI) is a reliable tool for assessing balance in people with multiple sclerosis (MS) and to determine the validity of the DGI by using the 6.1-m timed walk. Design Instrument reliability test: physical therapists viewed a videotape of 10 subjects with MS performing the DGI and scored their gait by using DGI criteria. Two weeks after the first session, therapists’ viewed the videotape again and scored subjects’ gait to establish interrater reliability. Setting Hospital-based outpatient rehabilitation clinic. Participants Eleven physical therapists and 10 people with MS. Interventions Not applicable. Main outcome measures Total DGI scores and each of the 8 DGI items were compared between and within raters (physical therapists). Time to walk 6.1m was compared with the total DGI score to examine concurrent validity. Results Interrater reliability for total DGI scores was .983, with each of the 8 items ranging from .910 to .976 (intraclass correlation coefficient, P<.05). Intrarater reliability for total DGI scores ranged between .760 and .986 (Pearson bivariate analysis, P<.05). An inverse relationship of −.801 (Pearson bivariate analysis, P<.01) existed between the total DGI scores and the 6.1-m walk. Conclusions The DGI is a reliable functional assessment tool that correlated inversely with timed walk, showing its concurrent validity.

Providing low vision rehabilitation services with occupational therapy and ophthalmology: a program description.

This article describes a low vision rehabilitation program operating within a hospital-based outpatient rehabilitation clinic. The program uses a team approach combining ophthalmology and occupational therapy services. Patients are referred to the program by their primary care physician for a low vision evaluation completed jointly by the ophthalmologist and occupational therapist. The ophthalmology portion of the evaluation includes assessment of visual acuity, contrast sensitivity function, and macular perimetry with a scanning laser ophthalmoscope. The occupational therapy evaluation focuses on assessing the functional limitations experienced by the patient due to the vision loss and determining how the patient is best able to use remaining vision to complete daily activities. Occupational therapy treatment emphasizes training the patient to use remaining vision as efficiently and effectively as possible to complete daily activities and includes training in use of optical devices. Because of the specialized nature of the service provided, additional postgraduate preparation is needed to enable occupational therapists to provide effective low vision rehabilitation.