Hospital-based Rehabilitation Research Articles

Nursing interventions for improving quality of life among patients with coronary heart disease after percutaneous coronary intervention: A scoping review

Background: Percutaneous coronary intervention (PCI) aims to improve the quality of life (QoL) for coronary heart disease (CHD) patients, but many patients still have poor QoL. The impact of poor QoL causes long-lasting feelings of frustration, anxiety, fear, and worry that make a person give up or lose enthusiasm for the future. Objective: This study aimed to describe nursing interventions to improve the QoL of CHD patients after PCI. Methods: This research used the scoping review method by including all full-text primary studies written in English and published between 2013 to 2023 from three databases, EBSCO-host, PubMed, and Scopus, and one e-resource, Sage Journals. The keywords used were “coronary artery disease OR myocardial infarction OR cardiovascular disease AND quality of life AND percutaneous coronary intervention OR PCI OR Angioplasty AND Nursing care OR nursing intervention.” Results: A total of eight articles discussed nursing interventions to improve the QoL among CHD patients after PCI. There are two categories of interventions that nurses can carry out: hospital-based (inpatient or outpatient) rehabilitation and cardiac tele-rehabilitation. Conclusions: Hospital-based (inpatient or outpatient) rehabilitation and tele-rehabilitation interventions potentially improve post-PCI patients’ QoL, psychological well-being, cardiovascular capacity, social support, and adherence to CHD rehabilitation program. Standardized intervention guidelines need to be created in the future for each outcome of interest based on evidence-based findings so that specific interventions to improve the quality of life of CHD patients can be applied directly in daily practice.

Feasibility study of rehabilitation for cardiac patients aided by an artificial intelligence web-based programme: a randomised controlled trial (RECAP trial)—a study protocol

IntroductionCardiac rehabilitation (CR) delivered by rehabilitation specialists in a healthcare setting is effective in improving functional capacity and reducing readmission rates after cardiac surgery. It is also associated with a...

The Relationship Between Rehabilitation and Frailty in Advanced Heart or Lung Disease.

Frailty increases morbidity and mortality in patients with advanced heart and lung disease. Emerging evidence shows that postoperative cardiac or pulmonary rehabilitation can improve the frailty status of these patients. The aim of this hypothesis-generating study was to test the relationship between prehabilitation and frailty in patients with advanced heart or lung disease referred for heart and lung transplantation. The study was a retrospective audit of consecutive patients with advanced heart or lung disease referred for transplant assessment between January 2021 and December 2022. Frailty scores were recorded using Fried's frailty phenotype (range, 0-5), and rehabilitation status of patients at the time of frailty assessment was recorded. Of 286 patients, 124 patients had advanced heart disease (mean age 53 ± 12 y; 82% men) and 162 patients had advanced lung disease (mean age 55 ± 12 y; 43% men). Sixty-nine (24%) patients were robust (score 0), 156 (55%) were prefrail (score, 1-2), and 61 (21%) were frail (score, 3-5). Eighty-two (29%) patients participated in hospital-based rehabilitation, 72 (25%) in home-based rehabilitation, and 132 (46%) in no rehabilitation. Frailty scores were significantly lower in patients participating in hospital-based or home-based rehabilitation compared with patients not participating in rehabilitation (0.8 ± 1.0 versus 0.8 ± 0.9 versus 2.3±1.2, P < 0.0001). This study shows that patients participating in cardiac or pulmonary rehabilitation are less frail compared with patients not participating in rehabilitation. These findings suggest that prehabilitation could be beneficial for patients awaiting heart or lung transplantation.

Comparing domain- and intensity-specific physical activity in coronary heart disease and non-CHD individuals

Although increase in physical activity is important to improve prognosis of cardiac patients in addition to hospital-based exercise cardiac rehabilitation, their physical activity levels are not properly understood. This study aimed to examine domain- and intensity-specific physical activity in individuals with coronary heart disease (CHD) and compare them with non-CHD individuals. Data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2019 were analyzed, including 1083 CHD patients and 38,532 non-CHD individuals. The inclusion criteria were age 19 years or older and data not missing for CHD information. Before and after propensity score matching (PSM) for age, sex, body mass index, education, household income, alcohol intake, and smoking status, domain (leisure, work, transportation)—and intensity (moderate, vigorous) -specific physical activity participation levels were compared between individuals with and without CHD. Before PSM, CHD individuals were older, less educated, more sedentary, and participated less in PAs compared to non-CHD individuals. After PSM, CHD individuals had similar levels of domain-specific PAs. However, they had higher work-related PA levels (29.7 ± 209.6 vs. 42.1 ± 291.3 min/week p = 0.022) and more sedentary time (487.2 ± 224.2 vs. 514.1 ± 228.7. p = 0.003) than those without CHD. Subgroup analysis revealed lower leisure-related PA in men with CHD (63.5 ± 165.5 vs. 47.3 ± 140.2, p < 0.05) and higher work-related PA in women with CHD (18.9 ± 159.7 vs. 57.1 ± 397.5, p < 0.01). Among those < 65 years of age, individuals with CHD spent more time sedentary than individuals without CHD. CHD individuals are not physically inactive compared with non-CHD individuals who are similar in sociodemographic status and lifestyle. CHD patients’ PA levels may have been underestimated.

Delirium Prevention in Early Rehabilitation During Acute Hospitalization and Implementation of Programs Specifically Tailored to Older Patients with Cognitive Impairment: A Scoping Review with Meta-Analysis.

No systematic review on delirium prevention within early, hospital-based rehabilitation on implementation of approaches specifically tailored for patients with cognitive impairment (PwCI), such as Alzheimer's disease or vascular dementia, has been published despite the high relevance of specific medical care in this vulnerable population. To document design and effectiveness of delirium prevention programs by early rehabilitation during acute, hospital-based medical care and implementation of programs specifically tailored to PwCI. In a three-step approach, we first identified published systematic reviews of hospital-based, early rehabilitation interventions for older persons (>65 years) in relevant databases. In a second step, we screened each single trial of included reviews according to predefined inclusion criteria. In a third step, we analyzed studies with focus on delirium prevention. Among n = 25 studies identified, almost all intervention programs did not specifically target cognitive impairment (CI). Interventions were heterogeneous (modules: n = 2-19); almost all study samples were mixed/unspecified for cognitive status with more affected patients excluded. Only one study exclusively included delirium patients, and only one included CI patients. Results of random effect meta-analysis showed significant effects of generic programs to reduce delirium incidence during hospitalization by 41% (p < 0.001, odds ratio, 95% confidence interval: 0.59 [0.49, 0.71] with modest heterogeneity (I2: 30%). Study results document a lack of implementation for delirium prevention programs specifically tailored to PwCI by early, hospital-based rehabilitation. Specifying existing rehab concepts or augmenting them by CI-specific modules may help to develop, optimize, and implement innovative delirium prevention in PwCI in acute medical care.

Handheld Devices Utilization for Cognitive Rehabilitation and Medical Assessment Based on Navstar Global Positioning System: Towards Brain-Rehabilitation

There is less than a third of clinically competent brain patients in developed and developing countries utilizing brain rehabilitation through exercise. The lack of hospital-based rehabilitation services and long travel times impede participation. As a consequence, calls have been made for the creation of more adaptable substitutes. The creation of a system that enables the transmission of a patient's unique EEG, sample rate, N-GPS based speed, and position, as well as walking-based brain rehabilitation. A programmed handheld mobile device (HMD) transmits these data to a secure server where an exercise scientist can view them in real-time. To evaluate the viability of this approach, 134 brain patients who were unable to engage in hospital-based rehabilitation underwent remotely supervised exercise assessment and exercise sessions. Completion rates, technical participation, the ability to spot EEG changes, and the six-minute walk test conducted both before and after the participation. The device's efficiency and speed were praised. The participants were able to finish a six-week exercise-based rehabilitation program while they were on the go or close to their homes or places of employment. The bulk of sessions went off without a hitch or technical issues, however sporadic signal loss in underserved areas occasionally caused issues. There were many post-workout and exercise-related EEG abnormalities found. In all countries with data available, less than a third of clinically competent patients use exercise-based brain rehabilitation.

An Integrated Stroke Transitional Care Intervention Improves Physical Functioning, Self-Management and Patient Experience in Older Adults with Stroke and Multimorbidity: A Multisite Pragmatic Randomized Controlled Trial

Background: The hospital-to-home transition for older adults with stroke is often fragmented, resulting in hospital readmissions and reduced quality of life, patient satisfaction and safety. There is limited evidence for strategies to improve transitions in care for older adults with stroke and multimorbidity. This study aimed to test, in real-world clinical practice, the effectiveness of the Transitional Care Stroke Intervention (TCSI) versus usual care on health outcomes, patient experience, and health and social service use costs in older adults (&gt; 55 years) with stroke and multimorbidity (&gt; 2 chronic conditions).&#x0D; Methods: This pragmatic randomized controlled trial was conducted among older adults with a stroke and multimorbidity discharged from the hospital to the community using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional team from hospital-based outpatient stroke rehabilitation clinics (Physiotherapist, Occupational Therapist, Speech Language Pathologist, Registered Nurse, and Social Worker). The TCSI is a complex, integrated intervention which includes care coordination/system navigation support, phone/video visits, monthly interprofessional case conferences, and an online resource to support system navigation. Data analysis was performed by intention to treat. The primary outcome was risk of hospital readmission (all-cause) after 6 months. Secondary outcomes were mental and physical functioning, depressive symptoms, stroke self-management, patient experience, number of hospital days and readmissions, number of ED visits, survival rates to first hospital and ED visit, risk of ED visits, and health and social service use costs. Older adults with stroke were engaged as co-investigators and informed the research design, implementation, and evaluation through participation in the Patient Partner Advisory and the TCSI Steering Committees.&#x0D; &#x0D; Results: Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Most participants were men (60%), with an average of 7 comorbid conditions, and 78% had experienced their first-ever stroke. No significant group differences were seen for the baseline to six-month risk of hospital readmission (all-cause). However, stroke survivors in the intervention group reported higher levels of physical functioning (SF-12 Physical Component Summary Score mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005) compared with the usual care group. No significant group differences were seen for the other secondary outcomes.&#x0D; Discussion: The TCSI improved physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs compared to usual care.&#x0D; Conclusion:The results provide evidence for the effectiveness of an integrated intervention to optimize transitional care outcomes for older adults with stroke and multimorbidity receiving outpatient stroke rehabilitation services.&#x0D; Suggestions for future research: Future research is needed to further evaluate this intervention in diverse settings and populations, with a larger sample size and a full economic evaluation. &#x0D; &#x0D; &#x0D;

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.

Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study

ObjectivesThe prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DesignCross-sectional study. Setting & ParticipantsInpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. MethodsParticipants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. ResultsThe majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were “not happy with their vision.” This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. Conclusions and ImplicationsReduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.

Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial

To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n=58) or TR (n=56). HBR comprised at least five physical therapy sessions over 10weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12weeks, with a non-inferiority margin of 0.10m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02m/s; 95%CrI, -0.05 to 0.10m/s; week-24 difference, 0.01m/s; 95%CrI, -0.07 to 0.10m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

Breaking the Cycle: Using Serious Illness Communication to Optimize Care Transition Planning in Serious Illness

It is widely recognized that many older adults in their last year of life will cycle between hospitals and skilled nursing facilities—a phenomenon described as “rehabbing to death.” Several strategies to address this complex problem have been proposed, including developing and testing serious illness communication models to provide goal-concordant care by aligning what matters most to patients with how they spend their time in the last months of life. Serious illness communication (SIC) includes structured skills clinicians can use with patients and caregivers to assess illness understanding, goals and values, share information, and make recommendations. Despite the potential of SIC models, there is a lack of literature focused on developing and testing SIC strategies in the context of care transition planning for older adults with serious illness. Our interprofessional team developed “Rehabbing to Death: Practical Strategies to Optimize Care Transitions for Patients with Serious Illness,” an evidence-based, interprofessional SIC training curriculum for hospital-based rehabilitation clinicians. This 3-session curriculum was designed to enable rehabilitation clinicians to acquire knowledge of trajectories and outcomes for patients living with serious illness and communication skills to use with patients, families, and interprofessional colleagues. Nine rehabilitation clinicians (n = 3 equally from Physical Therapy, Occupational Therapy, and Speech-Language Pathology) participated in our pilot. Sessions were highly attended [100% (n = 9) sessions 1 and 2, 89% (n = 8) session 3]. Participants who completed the curriculum reported increased self-rated confidence in knowledge of serious illness and ability to communicate prognostic information and recommendations for care transitions with patients, families, and colleagues. In addition, 78% of participants would recommend the curriculum to a colleague and strongly agreed that curricular content and skills were relevant to their clinical practice. Pilot results suggest that implementing an SIC curriculum for hospital-based rehabilitation clinicians is feasible, given high rates of completion and satisfaction.

Cardiac Rehabilitation in Abu Dhabi: A Retrospective Investigation of Program Delivery, Participants, and Factors Associated with Program Completion Utilizing a Hospital Registry.

Investigations into the provision of cardiac rehabilitation from the Arabian Gulf countries are rare, despite suffering from an unusually high prevalence of cardiovascular disease. This study reports patient and program characteristics from an exercise-based cardiac rehabilitation program in Abu Dhabi, and factors associated with program completion. Data was drawn from the institution's cardiac rehabilitation registry, populated from the electronic medical record of patients enrolled in the hospital-based cardiac rehabilitation program, from 2015 to 2022. The program was administered by physical therapist and nurse specialists and guided by individualized exercise parameters. Completion of the program was defined as attendance of ten or more sessions. Relationships between program completion and demographic characteristics, quality of life, depression, and physical function were explored statistically. A total of 1774 patients attended at least one session, with a total of 15,563 sessions. The number of patients and sessions trended upward since program inception. The most common referral diagnoses of participants who completed the program were coronary artery bypass grafting, valve surgery, and percutaneous coronary intervention. Among all 1774 attendees, median age was 56, comprised of 61.6% male, and 77.1% residents of Abu Dhabi, and 73.5% Emirati nationals. 527 (29.7%) patients completed the program, and this group was significantly lower in BMI (29.4 vs 30.4 kg/m2), had lower prevalence of moderate to severe depression (9.0 vs 13.0%), were more often Abu Dhabi residents or Emirati nationals (88.2 vs 72.2%, and 76.9 and 72.0%, respectively), and more likely to have completed the 6-min walk test at the first visit (80.5 vs 72.5%). There were no differences between those who did and did not complete cardiac rehabilitation with respect to age, gender, quality of life, or first 6-min walk test distance. There is a growing demand for cardiac rehabilitation in Abu Dhabi, particularly among Emirati nationals and residents of Abu Dhabi. Potential risk factors for non-completion such as higher body-mass index, depression, lower physical function, non-residence in Abu Dhabi, and non-Emirati nationality warrant further exploration.

Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients

Category: Sports; Other Introduction/Purpose: We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Methods: Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. Results: There were time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS (P &lt; 0.05, all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 (P &lt; 0.05, all). The time and group interaction effects on invertor and evertor strength were also significant (P = 0.047 and P = 0.044). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 (P &lt; 0.05, all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Conclusion: Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.

Improving access to vision rehabilitation care: implementation of the South East Ontario Vision Rehabilitation Service

ObjectiveTo investigate the effect of the South East Ontario Vision Rehabilitation Service (SOVRS), a centrally administered, regionally delivered vision rehabilitation service, on access to vision rehabilitation care. DesignPre-implementation (n = 1196) and post-implementation (n = 414) observational study. ParticipantsPatients referred for low-vision assessment at the hospital-based Kingston Health Sciences Centre Vision Rehabilitation Clinic and community-based Southeastern Vision Loss Rehabilitation Ontario clinics from 2014 to 2019. MethodsMarkers for access to care (e.g., patient rurality, diversity of referral source, distance and time travelled, and wait times) were compared before and after SOVRS implementation. ResultsAfter SOVRS implementation, there was a significant increase (p < 0.001) in the number of rural patients seen in the community. After SOVRS implementation, the hospital-based Vision Rehabilitation Clinic site experienced a significant increase in referrals from outside of Kingston (p < 0.001) and non-eye-care clinicians (p < 0.001), a significant reduction in patient time and distance travelled (p < 0.001), a 6% decrease in median wait time for low-vision assessments, and a significant reduction in wait time between referral and first available appointment (p = 0.011). ConclusionSOVRS, a novel service-delivery model for vision rehabilitation care, improved the delivery of and access to vision rehabilitation care in southeast Ontario through the integration of regional resources and services.

An advanced cost-efficient IoT method for stroke rehabilitation using smart gloves

Stroke represents a severe, widespread, and widely acknowledged health crisis on both national and international levels. It is one of the most prevalent life-threatening conditions. Despite impressive advances in treating stroke, in addition to a need for effective patient care services, many sufferers still rely solely on physical interventions. The present paper describes and explains the use of a newly designed gadget for stroke survivors who cannot move their fingers. This is a sophisticated mobile device that enables stroke patients to regain their muscle memory and thus their ability to perform repetitive actions by continuing to tighten and stretch their muscles without the intervention of a physiotherapist. Gamification methodology is used to encourage patients to become involved in the process of rehabilitation. The device also has sensors that take information and transmit it to an app through an ESP32 connection. This enables physicians to view glove usage information remotely and keep track of an individual patient’s health. Communication between app and glove is facilitated by a broker in the Amazon Web Service IoT. With the robotic glove presented here, the recovery rate is found to be 90.23% over four weeks’ duration, which represents a significant improvement compared with existing hospital-based rehabilitation techniques.

Physical and perceived effort of patients with stroke during hospital-based rehabilitation when performing sit to stand: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background/Information Rehabilitation of patients with stroke includes optimisation of function and increasing individuals’ physical activity levels as a means of improving independence and preventing recurrence of cardiovascular events. Physical effort evaluation and monitoring is important to highlight exercise intensity level during rehabilitation. Sit to stand (STS) is a mechanically demanding functional task. Little is known about the physical effort experienced by patients with stroke when performing this activity during hospital-based rehabilitation. Purpose The study assessed the perceived effort, energy expenditure and metabolic equivalent of task (MET) levels of patients with stroke when performing STS as a means of outlining their physical effort. Methods A descriptive cross-sectional pilot study took place at two hospitals in Johannesburg, South Africa, between November 2018 to February 2020 and March to September 2021. Participants reported their perceived effort using the Modified Borg Scale (MBS) and their energy expenditure and MET level were assessed with a triaxial accelerometer. The Shapiro-Wilk Test was used to test for normality of data and descriptive and inferential statistics were used to determine findings (p-value set at ≤ 0.05). Results The team screened four hundred and twenty eight individuals for potential inclusion in the study. The pilot study consisted of nine participants (n=5 female, 55.5%), with a mean age of 52.77 (SD ± 11.33) years and mean body mass index of 24.31 (±5.36) kg/m2. Most had a haemorrhagic stroke (n=6, 66.6%), left hemiplegia (n=6, 66.6%), ‘mild’ stroke (n=7, 77.8%) as per the National Institutes of Health Stroke Scale and were assessed 9.11 (SD ±6.57) days post stroke. The mean time it took participants to complete STS was 6.04 (±4.03) seconds. Most participants (n=7, 77.8%) perceived STS at a ‘moderate’ or stronger effort level on the MBS. The calculated mean physical energy expenditure during STS was 2.82 (±1.9) kCal/min and the mean MET level 2.99 (±1.89). The correlation coefficient between the subjective perceived effort and physical effort as per energy expenditure was r = 0.61 (p = 0.08) and subjective perceived effort and MET level r = 0.34 (p = 0.38). Conclusion The ability to come from STS is one of the most frequent functional tasks used daily and a prerequisite to walking. Study participants’ exercise intensity during STS was much higher when compared to published literature in healthy individuals. This study found a fair to moderate positive correlation between physical effort parameters and MBS for patients with stroke during STS. The results did not meet statistical significance due to the small sample size, indicating further research is warranted.

Listening to the patient voice on home-based cardiac rehabilitation: a qualitative audit mapping patient-reported outcomes to current european guidelines

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NHS Lothian. Background and Purpose Increasing evidence supports the efficacy of facilitated home-based cardiac rehabilitation as an alternative to hospital-based rehabilitation for individuals recovering from myocardial infarction and revascularisation. The objective of this audit was to explore qualitative patient-reported outcomes of a home-based cardiac rehabilitation programme in relation to current european guidelines. Methods Following their participation in the six-week cardiac rehabilitation programme, patients completed an evaluation questionnaire consisting of 1) a 25-item survey rating their satisfaction with elements of the programme and 2) five open-ended questions regarding their experiences and resulting outcomes. The anonymous patient responses were transcribed and stored securely using an electronic database. For the purpose of this audit, the qualitative data from 203 patients between April 2021 and January 2023 were analysed. The data was coded into the key risk, psychosocial and behavioural factors presented in current european guidelines, while also capturing additional themes. Once identified, inductive thematic analysis was employed to extract further meaning from featured codes. Results Deductive coding identified the following constructs from the guidelines within the data: risk factors (blood pressure, cigarette smoking, diabetes mellitus, adiposity), sex and gender and their impact on health, communication of cardiovascular disease risk, psychosocial factors, optimising lifestyle (physical activity and exercise, and nutrition and alcohol) and medication adherence. Within this, inductive themes that emerged included: successful risk modification (of factors such as diabetes and adiposity), successful behaviour modification, increased awareness, understanding and confidence, decreases in stress and anxiety, increased pacing and relaxation, preference for more content, resentment of generalised information, the impact of Covid-19 and the benefit of the programme to family members. Conclusions The results of this qualitative audit suggest that patient satisfaction was high, post-participation in the cardiac rehabilitation programme. The findings of reported successful risk and behaviour modification in relation to nutrition, exercise, smoking, alcohol intake, diabetes, adiposity and psychological factors indicate the programme’s efficacy in facilitating lifestyle changes amongst cardiac rehabilitation patients with multiple conditions. The preference for more content with regard to blood pressure and factors specific to women provides valuable insight for ongoing resource development and research.

Postoperative Rehabilitation after Anterior Cruciate Ligament Reconstruction through Telerehabilitation with Artificial Intelligence Brace during COVID-19 Pandemic.

Due to the rapid spread of the coronavirus disease-19 (COVID-19), most of the patients expressed a reluctance to undergo postoperative rehabilitation at a rehabilitation clinic. Therefore, in this scenario it was necessary to reshape the crucial role of postoperative rehabilitation of these patients. We conducted a telerehabilitation program based on an artificial intelligence brace (AI brace) which can monitor the progress of rehabilitation through an app and an internet server. Our hypothesis was that home-based telerehabilitation might provide clinical outcomes comparable to face-to-face, hospital-based rehabilitation programs in terms of effectiveness. A retrospective cohort study enrolled patients who received anterior cruciate ligament reconstruction (ACLR) between January and September 2020. Patients were divided into two groups: the tele-AI group received telerehabilitation with an AI brace while the FTF group had face-to-face, hospital-based rehabilitation. Clinical knee functional scores and Tegner Activity Scale (TAS) were assessed and analyzed until 12 months after the operation. The tele-AI group had higher IKDC scores at 3 months (p = 0.0443) and 6 months (p = 0.0052) after surgery and higher KOOS scores at 1 month (p = 0.0365) and 6 months (p = 0.0375) after surgery. However, no significant difference between the two groups was detected at the end of the follow-up. The tele-AI group had higher TAS than FTF group after 1 year. Telerehabilitation after ACLR seems to provide a superior short-term outcome compared to hospital-based rehabilitation during the COVID-19 pandemic.

Occupational Therapy Practice: Time From Stroke Onset to Outpatient Upper Limb Rehabilitation.

Upper limb stroke rehabilitation has been understudied in usual occupational therapy. The study's purpose was to describe the timing and amount of usual occupational therapy in the stroke population for hospital-based outpatient upper limb rehabilitation. A multi-site study of timing and amount of occupational therapy was calculated for mild and moderate upper limb stroke impairments using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Mild stroke participants (n = 58) had a mean of 164.25 days, and the moderate stroke participants (n = 64) had a mean of 106.75 days from the date of stroke onset to first treatment which was significantly different (p = .047). There were no significant differences in the amount of therapy between mild or moderate stroke patients. Mild stroke patients experience a longer delay in receiving outpatient occupational therapy compared with moderate impairments which may be attributed to the subtlety of the impairments that impact participation in daily activities.

Identifying priorities for balance interventions through a participatory co-design approach with end-users

BackgroundMost individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance.MethodsTwo individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants’ experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers.ResultsFour themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one’s balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual’s unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously.ConclusionsEnd-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.