Hospital-based Rehabilitation Research Articles

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

ObjectifExaminer l'effet de la création du service de réadaptation visuelle du sud-est de l'Ontario (SOVRS, pour South East Ontario Vision Rehabilitation Service), dont l'administration est centralisée, mais dont les services sont offerts à l’échelle régionale, sur l'accès aux soins de réadaptation visuelle. NatureÉtude d'observation pré- (n = 1196) et post-implantation (n = 414). ParticipantsPatients adressés à la clinique de réadaptation visuelle en milieu hospitalier du Centre des sciences de la santé de Kingston et à l'une des cliniques communautaires de réadaptation en déficience visuelle du sud-est de l'Ontario aux fins d'une évaluation en basse vision entre 2014 et 2019. MéthodesOn a comparé les indicateurs de l'accès aux soins (p. ex., le degré de ruralité du patient, la diversité des sources de références, la distance à parcourir, la durée du déplacement et le temps d'attente) avant et après l'implantation du SOVRS. RésultatsAprès la mise en route du SOVRS, on a noté une hausse significative (p < 0,001) du nombre de patients issus des zones rurales qui ont été examinés dans la collectivité. De même, la clinique de réadaptation visuelle en milieu hospitalier a enregistré une augmentation significative des patients qui lui ont été adressés de l'extérieur de Kingston (p < 0,001) et de la part de médecins autres que des spécialistes des soins oculaires (p < 0,001), ce qui se traduit, pour le patient, par une réduction significative de la distance à parcourir et de la durée du déplacement (p < 0,001) de même que par une baisse de 6 % du temps d'attente médian avant d'obtenir une évaluation en basse vision et une diminution significative du temps d'attente entre le moment où le patient a été adressé à la clinique et le premier rendez-vous disponible (p = 0,011). ConclusionLe SOVRS, modèle innovateur de prestation des soins en réadaptation visuelle, a effectivement amélioré la prestation de ce type de soins ainsi que l'accès à ces soins dans le sud-est de l'Ontario grâce à l'intégration des ressources et des services régionaux.

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.

Patient motivation, satisfaction and attitudes towards involvement in inter-professional collaborative practice: A cross-sectional study

During hospital-based long-term rehabilitation programmes, particularly for patients with spinal cord injuries, healthcare providers must make sure those patients are motivated, satisfied, and have positive views towards inter-professional collaboration among the team members. If they do this, patients will have a higher chance of sticking to their treatment plan, completing prescribed drugs, and getting better health results will have a higher chance of adhering to their treatment plan, taking the therapy recommended, and getting better health results if they comply with this. In a developing nation like Bangladesh, there is still much to learn about how patients feel about their care, what motivates them, and how they see the team that works with them. The purpose of the study was to investigate the level of motivation, attitudes, and satisfaction of people with spinal cord injury towards interprofessional collaborative practice. Quantitative research was applied to achieve the objectives. The overall motivation and satisfaction level of the patient with SCI towards interdisciplinary teamwork was high, 83.35% and 84.2%. Similarly, the patient attitude toward the team was just above average. The study findings could improve the rehabilitation sector's collaboration level by addressing strengths and weaknesses.

Home-based rehabilitation versus hospital-based rehabilitation for stroke patients in post-acute care stage: Comparison on the quality of life

This study focused on the integrated post-acute care (PAC) stage of stroke patients, and employed a retrospective study to examine the satisfaction with life quality in two groups, one that received home-based rehabilitation and one that received hospital-based rehabilitation. A secondary purpose was to analyze the correlations among the index and components concerning their quality of life (QOL) and compare the advantages and disadvantages of these two approaches to PAC. This research was a retrospective study of 112 post-acute stroke patients. The home-based group received rehabilitation for one to two weeks, and two to four sessions per week. The hospital-based group received the rehabilitation for three to six weeks, and 15 sessions per week. The home-based group mainly received the training and guidance of daily activities at the patients' residence. The hospital-based group mainly received physical facilitation and functional training in the hospital setting. The mean scores of QOL assessment for both groups were found to be significantly improved after intervention. Between-group comparisons showed that the hospital-based group had better improvement than the home-based group in mobility, self-care, pain/discomfort and depression/anxiety. In the home-based group, the MRS score and the participant's age can explain 39.4% of the variance of QOL scores. The home-based rehabilitation was of lower intensity and duration than the hospital-based one, but it still achieved a significant improvement in QOL for the PAC stroke patients. The hospital-based rehabilitation offered more time and treatment sessions. Therefore hospital-based patients responded with better QOL outcomes than the home-based patients.

Home-Based Physiotherapy and Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis: A Review.

The objective of the study is to review the studies on home-based pulmonary rehabilitation practices in idiopathic pulmonary fibrosis patients in the last 5 years. Home-based randomized controlled trials in idiopathic pulmonary fibrosis patients published in the PubMed database within the previous 5 years were searched. As a result of the research, a total of 5 articles were included in the study. Five home-based rehabilitation practices used in these articles were reached. Totally, 176 patients were found to have participated in these programs. As a result, patients who have difficulty accessing hospital-based rehabilitation services due to various reasons will benefit from home-based rehabilitation services. However, the content of the home-based program and the method of follow-up and supervision affect the results.

The impact of dementia on rehabilitation outcomes following hip fracture.

To compare clinical outcomes between patients for whom their participation in inpatient rehabilitation was and was not impacted by dementia through matching patients reporting dementia (dementia group) with those not reporting dementia (non-dementia group). Prospectively collected data held by the Australasian Rehabilitation Outcome Centre (AROC) were analyzed for patients aged 65 years or older receiving inpatient rehabilitation in public hospitals in Australia following a hip fracture and discharged between July 1, 2014, and June 30, 2019. Patients reported as having dementia impacting their rehabilitation program were matched to patients not reporting dementia based on age, admission motor Functional Independence Measure (FIM) score, and accommodation prior to rehabilitation. The matched cohorts were compared in relation to clinical outcomes (motor and cognitive FIM improvement, FIM efficiency, length of stay, and discharge destination) following participation in hospital-based rehabilitation using univariate analysis. Patients with dementia had significantly lower cognitive FIM scores on commencing rehabilitation (17.6 and 26.9, respectively, P < 0.001) and their median length of stay was 2 days shorter than those without dementia (21 and 23 days, respectively, P < 0.001). Relative change in FIM score and FIM efficiency (per week) were lower in the dementia group [relative FIM score change of dementia vs non-dementia, respectively, 26.2% vs. 44.0% (P < 0.001) and FIM efficiency, 6.5 vs. 8.9 (P < 0.001)]. Discharge destination between the two groups was statistically different, with 35.7% of patients with dementia being discharged to residential aged care facilities (RACFs) compared to 21.7% of those without dementia (P < 0.001). More patients with dementia had carers in their private residence in the post-rehabilitation phase, 82.2% vs. 57.6% (P < 0.001). Patients with dementia who sustain a fractured hip benefit from inpatient rehabilitation, although their clinical outcomes are not as good as those without dementia. FIM change and FIM efficiency were lower in the dementia group. Length of stay in the hospital for patients with dementia was shorter due to earlier recognition for the need for placement in either an RACF or at home with carer support. Theneed for placement in an RACF or carer support in a private residence was significantly greater in the dementia group.

A hospital to community exercise referral pathway: results of a pilot project.

People living with chronic disease should ideally engage with community-based exercise services following hospital-based rehabilitation. However, transition from hospital to community exercise settings is extremely challenging and strategies to support this transition are underdeveloped. The aims of this study were to develop and explore the feasibility of a pilot exercise referral pathway between an acute hospital and community gyms for patients with chronic health conditions and to evaluate patient satisfaction with the exercise referral pathway. A stakeholder-informed exercise referral pathway was developed and offered to patients following completion of a hospital-based exercise programme for a chronic health condition. The pathway was evaluated using a mixed-methods approach. Quantitative data examining participant engagement was used to examine feasibility. Quantitative survey data and qualitative data from semi-structured interviews examined satisfaction with the pathway. Forty-nine people living with chronic conditions (mean age 72 ± 7.8years) participated (recruitment rate 59%). The average number of community gym visits over 4months was 17.4 (range 0-51). Twenty-nine (78%) participants reported that they planned to continue their gym membership when the programme ended. Themed responses from participant interviews (n = 12) highlighted the benefits of a supported transition from hospital to gym membership and the need for more structured exercise support in community gyms. A structured exercise referral pathway to support exercise transition between hospital and community settings in populations with chronic health conditions appears feasible. Participants reported high levels of satisfaction with the referral pathway.

Effect of Variation in Early Rehabilitation on Hospital Readmission After Hip Fracture.

Provision of early rehabilitation services during acute hospitalization after a hip fracture is vital for improving patient outcomes. The purpose of this study was to examine the association between the amount of rehabilitation services received during the acute care stay and hospital readmission in older patients after a hip fracture. Medicare claims data (2016-2017) for older adults admitted to acute hospitals for a hip fracture (n = 131,127) were used. Hospital-based rehabilitation (physical therapy, occupational therapy, or both) was categorized into tertiles by minutes per day as low (median = 17.5), middle (median = 30.0), and high (median = 48.8). The study outcome was risk-adjusted 7-day and 30-day all-cause hospital readmission. The median hospital stay was 5days (interquartile range [IQR] = 4-6 days). The median rehabilitation minutes per day was 30 (IQR = 21-42.5 minutes), with 17 (IQR = 12.6-20.6 minutes) in the low tertile, 30 (IQR = 12.6-20.6 minutes) in the middle tertile, and 48.8 (IQR = 42.8-60.0 minutes) in the high tertile. Compared with high therapy minutes groups, those in the low and middle tertiles had higher odds of a 30-day readmission (low tertile: odds ratio [OR] = 1.11, 95% CI = 1.06-1.17; middle tertile: OR = 1.07, 95% CI = 1.02-1.12). In addition, patients who received low rehabilitation volume had higher odds of a 7-day readmission (OR = 1.20; 95% CI = 1.10-1.30) compared with high volume. Elderly patients with hip fractures who received less rehabilitation were at higher risk of readmission within 7 and 30days. These findings confirm the need to update clinical guidelines in the provision of early rehabilitation services to improve patient outcomes during acute hospital stays for individuals with hip fracture. There is significant individual- and hospital-level variation in the amount of hospital-based rehabilitation delivered to older adults during hip fracture hospitalization. Higher intensity of hospital-based rehabilitation care was associated with a lower risk of hospital readmission within 7 and 30days.

Association of Caregiver Availability and Training With Patient Community Discharge After Stroke

To examine the association between committed caregivers and caregiver training with community discharge from inpatient rehabilitation after a stroke. Secondary analysis of data extracted from electronic health records linked with the Uniform Data System for Medical Rehabilitation. Three hospital-based inpatient rehabilitation facilities (IRF) in a major metropolitan area. 1397 adult patients (mean ± SD age: 69.4 [13.5]; 724 men) transferred from an acute care setting to inpatient rehabilitation after an ischemic or hemorrhagic stroke (N=1397). None. Community discharge from IRF. 82.4% of patients had caregivers, 63.4% of patient caregivers received training at the IRF, and 79.5% had community discharge. After adjusting for age, stroke severity, functional status, and other social risk factors, having a committed caregiver and caregiver training were significantly associated with community discharge (odds ratio [OR]=7.80, 95% confidence interval [CI]: 5.03-12.10 and OR=4.89, 95% CI: 3.16-7.57, respectively). Caregivers increase a patient's likelihood of discharge from IRF; the added benefit of caregiver training needs to be further assessed, with essential elements prioritized prior to patients' IRF discharge.

Effectiveness of an Inpatient Virtual Reality-Based Pulmonary Rehabilitation Program among COVID-19 Patients on Symptoms of Anxiety, Depression and Quality of Life: Preliminary Results from a Randomized Controlled Trial.

Forms of rehabilitation for patients after COVID-19 are gaining interest. The purpose of this study was to investigate and compare an innovative in-hospital pulmonary rehabilitation programs augmented with training elements performed in virtual reality. This randomized controlled study included 32 patients enrolled in post-COVID-19 rehabilitation at a Public Hospital in Poland. The rehabilitation models included exercise capacity training on a cycle ergometer, breathing and general fitness workout, resistance training, and relaxation. The forms of training and relaxation differed between the groups: the experimental group employed virtual reality, and the control group used a traditional form of therapy. Exercise tolerance was assessed using a 6 min walk test (6 MWT), while psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). The analysis of the post-rehabilitation results showed a statistically significant improvement in both groups regarding depression (VR: 6.9 (3.9) vs. 4.7 (3.5), p = 0.008; CG: 7.64 (4.5) vs. 6.6 (4.8), p = 0.017) and anxiety (VR: 8.6 (4.6) vs. 5.6 (3.3), p &lt; 0.001; CG: 9.57 (6.0) vs. 8 (4.8), p = 0.003). No statistically significant improvements in quality of life were noted in both groups. Moreover, the analysis showed a statistically significant improvement in the exercise capacity in both groups after completion of the rehabilitation program, expressed as a distance in the 6 MWT, as well as a statistically significant improvement in dyspnea in the VR group. To conclude, the analysis of the preliminary data revealed that a 3-week hospital-based pulmonary rehabilitation program for COVID-19 patients led to an improvement in exercise tolerance as well as a reduction in the symptoms of anxiety and depression. The virtual reality-based form of training delivery, despite its attractiveness, did not significantly affect patients' performance.

Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD.

Sleep quantity, quality and symptoms of depression or anxiety potentially affect the level of daily physical activity (PAL) and plausibly counteracts benefits from pulmonary rehabilitation programs. Their collective impact on PAL is sparsely investigated, particularly in patients with severely progressed chronic obstructive pulmonary disease (COPD). Aim: To investigate if sleep quantity, quality and symptoms from self-reported hospital anxiety and depression scores (HADS) are associated with PAL. Methods: In this exploratory cross-sectional study data were analysed from 148 participants with COPD; GOLD grade II-IV; GOLD group B to D (52% female, mean 69.7 ± SD of 8.4 years, FEV1% predicted 33.6 ± 10.9, 6MWD 327 ± 122 m, CAT 20 ± 7 points), eligible for conventional outpatient hospital-based pulmonary rehabilitation. Participants had sleep and PAL measured 24 h per day for five consecutive days with an activPAL monitor. Adjusted negative binomial regression was applied to investigate the associations with PAL. Results: Participants walked median (25th, 75th percentile) of 2358 (1325.75; 3822.25) steps per day and 14% walked >5000 steps per day on average. Time in bed (TIB) were a median (25th, 75th percentile) of 8.3 (7.1; 9.7) hours and numbers of nocturnal sleeping bouts (NSB) were 1.5 (0.8; 3), Anxiety (HADS-A) and depression (HADS-D) scores were median (25th, 75th percentile) of 5 (3; 8) points and 3 (2; 6) points, respectively, whereof 29% (HADS-A) and 15% (HADS-D) reported scores ≥8 points indicating significant symptoms. The fully adjusted rate ratio (RR) for steps per day for TIB (hours) [RR 0.97 (95% CI: 0.92; 1.02)], NSB (numbers) [RR 1.02 (95% CI: 0.97; 1.07)] were not significantly associated with number of steps per day, while there was a significantly association with number of steps per day for HADS-A [RR 1.04 (95% CI: 1.01; 1.07)] and HADS-D [RR 0.95 (95% CI: 0.91; 0.99)]. Conclusion: This exploratory cross-sectional study found a statistically significant association between HADS-A and HADS-D with numbers of steps per day in patients with severe COPD.

Using Co-Design To Develop A Hospital-Based Vocational Rehabilitation Intervention For Adults With Acquired Brain Injury

<h3>Research Objectives</h3> Although recommendations are for vocational rehabilitation to commence soon after injury, there are acknowledged challenges to commencing this activity during hospitalisation, when clinical goals are more often centred on basic activities (such as self-care and mobility). This study aimed to develop a vocational rehabilitation intervention for people who have suffered brain injury, that is suitable for delivery in an inpatient rehabilitation setting. <h3>Design</h3> Using an action-research design, this study followed a participatory, intervention mapping approach to develop and pilot the intervention. <h3>Setting</h3> Specialist inpatient brain injury rehabilitation unit, Melbourne, Australia. <h3>Participants</h3> Stakeholder participants included n=14 allied health clinicians (including occupational therapists, speech and language therapists, physiotherapists, clinical and neuropsychologists and social workers) who worked in collaboration with researchers (n=2) to co-design the vocational rehabilitation intervention process. An open invitation was extended to clinicians to participate in the intervention mapping process. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Systematic literature review identified the barriers and enablers to providing work-focussed interventions in the inpatient setting. Qualitative focus groups and document review were used iteratively to identify intervention objectives and outcomes, before intervention strategies were developed and trialed. <h3>Results</h3> Early vocational rehabilitation interventions should be delivered in partnership with the patient, clinicians, family and their social network (inclusive of the workplace). A comprehensive, five phase program was developed: (i) orientation to the worker role, (ii) building awareness of work activities, (iii) improving core work skills, (iv) improving job-specific skills, (v) discharge planning from the program. <h3>Conclusions</h3> Co design offered an excellent opportunity to develop an intervention which supported an interdisciplinary team to embed vocational rehabilitation into usual hospital-based rehabilitation. <h3>Author(s) Disclosures</h3> Study is funded by the Transport Accident Commission through the small grants scheme. Natasha Lannin is supported by the Australian Heart Foundation Future Leader Fellowship (102055).

Post-Stroke Activity Engagement in Community Dwellers: Association with Illness Perceptions and Perceived Environment

<h3>Research Objectives</h3> To test the hypothesis that post-stroke individuals' activity engagement is associated with their perceptions of stroke, as well as their perceptions of their physical and social environment. <h3>Design</h3> This study used a cross-sectional design. <h3>Setting</h3> Various rehabilitation settings in Beijing, China, including 4 hospital-based rehabilitation outpatient clinics, 2 rehabilitation centers, and 2 community rehabilitation health stations. <h3>Participants</h3> A convince sample of 202 dyads of Chinese community-dwellers with stroke and their caregivers participated in this study. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> We used: the Assessment of Life Habits, Mandarin version, to assess activity engagement; the Stroke-Specific Illness Perceptions Questionnaire–Revised to assess stroke individuals' and caregivers' illness perceptions; and the Social Support Survey and abbreviated Neighborhood Environment Walkability Scale to assess stroke individuals' perceived social and physical environment. <h3>Results</h3> In our participating samples, stroke individuals with positive illness perceptions performed better in their personal level activity engagement, and those who believed their neighborhoods positively support their daily lives performed better in their societal level activity engagement, after controlling for demographic and performance skill factors. <h3>Conclusions</h3> Post-stroke activity engagement is associated not only with stroke individuals' performance skills but also with their perceptions of stroke, and how they perceive their physical environment. The findings of this study may assist clinicians' decision making when developing comprehensive, targeted interventions for improving activity engagement and maximizing recovery after stroke. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.

The Impact Of Illness Perceptions On Post-Stroke Activity Engagement And The Moderating Role Of Gender

<h3>Research Objectives</h3> The objective of the study was to describe the illness perceptions of community-dwelling individuals with stroke in the first two years post-stroke. Specifically, it was to examine whether illness perceptions are associated with activity engagement and to explore the moderating role of gender in this relationship. <h3>Design</h3> This study used a cross-sectional design. <h3>Setting</h3> Various rehabilitation settings in Beijing, China, including 4 hospital-based rehabilitation outpatient clinics, 2 rehabilitation centers, and 2 community rehabilitation health stations. <h3>Participants</h3> 202 community-dwelling individuals with stroke in the first two years post-stroke. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The Stroke-Specific Illness Perceptions Questionnaire-Revised was used to measure illness perceptions and the Assessment of Life Habits was used to measure activity engagement at the personal and societal levels. <h3>Results</h3> Stronger perceptions of consequences and controllability were related to better performance in activity engagement at the personal level; stronger perceptions of coherence were related to better performance in activity engagement at the societal level. In addition, gender differences in the relationship between illness perceptions and activity engagement were described. <h3>Conclusions</h3> How stroke individuals perceived their conditions dictated their levels of activity engagement in their community of residence. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.

Hospital-Based Rehabilitation of Patients Who Had Undergone an Open Reduction and Internal Fixation of the Ribs Due to a Flail Chest: Case Series

Flail chest, a severe chest injury, is caused by multiple rib fractures. The open reduction and internal fixation (ORIF) of rib fractures is an effective treatment; however, the patients' subsequent condition remains unsatisfactory in terms of the activities of daily living (ADL) and pain. No research study has, as yet, reported on hospital-based rehabilitation of patients who had undergone an ORIF. Our aim was to evaluate the efficacy of hospital-based rehabilitation of flail chest post-ORIF patients. Physical therapists assessed the pain, functional independence measure (FIM), and the Berg balance test. A total of three females and four males (mean age 59.43 ± 18.88) were hospitalized. A significant reduction in pain was observed (7.00 ± 1.83 upon admission to 4.10 ± 2.05 pre-discharge (Z = -2.07, p = 0.027). A significant improvement in FIM (69.43 ± 14.86 upon admission to 113.57 ± 6.40 pre-discharge, Z = -2.37, p = 0.018), and the Berg balance test (35.23 ± 5.87 upon admission to 49.50 ± 3.40 pre-discharge, Z = -2.37, p = 0.018), was observed. Upon admission, all the patients required moderate to complete ADL assistance. Upon discharge, all were independent for all ADL functions. Patients after flail chest post-ORIF can benefit from hospital-based rehabilitation.