Hospital Rehabilitation Program Research Articles

Preferences for Rehabilitation in Persons with a History of Stroke: A Discrete Choice Experiment.

To investigate the preferences of persons with a history of stroke for various attributes of rehabilitation using a discrete choice experiment (DCE). Cross-sectional study. A web-based survey. A total of 600 adults with a history of stroke who were not asked whether or not they had participated in previous rehabilitation. None. Preference weights by attribute ie, treatment time (30 minutes, one hour, one and a half hours), treatment content (walking exercises, activities of daily living; ADL exercises), priority treatment of paralyzed limbs (upper extremity, lower upper extremity), treatment location (hospital visit, home visit), therapist gender, and out-of-pocket costs for stroke rehabilitation using discrete choice experiment. The most common self-reported diagnosis was cerebral infarction (408 patients, 68%). The mean age was 62.0 ± 9.8 years, and 515 (85.8%) were male. Of the five attributes, excluding out-of-pocket costs, the highest relative importance score was treatment location (0.331), followed by treatment time (0.304). Among the rehabilitation programs, the statistically significant coefficients calculated were one hour of therapy (0.173, 95% CI = 0.088-0.258), hospital visits (0.241, 95% CI = 0.180-0.303), and female therapists (0.186, 95% CI = 0.125-0. 247). No significant differences were obtained regarding the treatment contents or the paralyzed limb to be treated. A discrete choice experiment revealed that persons with a history of stroke prefer a one-hour hospital rehabilitation program with a female therapist, with cost being a major consideration for rehabilitation. The results of this study may provide useful information for rehabilitation professionals.

Nutritional Support During Long COVID: A Systematic Scoping Review.

Introduction: Long COVID is a term that encompasses a range of signs, symptoms, and sequalae that continue or develop after an acute COVID-19 infection. The lack of early recognition of the condition contributed to delays in identifying factors that may contribute toward its development and prevention. The aim of this study was to scope the available literature to identify potential nutritional interventions to support people with symptoms associated with long COVID. Methods: This study was designed as a systematic scoping review of the literature (registration PROSPERO CRD42022306051). Studies with participants aged 18 years or older, with long COVID and who underwent a nutritional intervention were included in the review. Results: A total of 285 citations were initially identified, with five papers eligible for inclusion: two were pilot studies of nutritional supplements in the community, and three were nutritional interventions as part of inpatient or outpatient multidisciplinary rehabilitation programs. There were two broad categories of interventions: those that focused on compositions of nutrients (including micronutrients such as vitamin and mineral supplements) and those that were incorporated as part of multidisciplinary rehabilitation programs. Nutrients included in more than one study were multiple B group vitamins, vitamin C, vitamin D, and acetyl-l-carnitine. Discussion: Two studies trialed nutritional supplements for long COVID in community samples. Although these initial reports were positive, they are based on poorly designed studies and therefore cannot provide conclusive evidence. Nutritional rehabilitation was an important aspect of recovery from severe inflammation, malnutrition, and sarcopenia in hospital rehabilitation programs. Current gaps in the literature include a potential role for anti-inflammatory nutrients such as the omega 3 fatty acids, which are currently undergoing clinical trials, glutathione-boosting treatments such as N-acetylcysteine, alpha-lipoic acid, or liposomal glutathione in long COVID, and a possible adjunctive role for anti-inflammatory dietary interventions. This review provides preliminary evidence that nutritional interventions may be an important part of a rehabilitation program for people with severe long COVID symptomatology, including severe inflammation, malnutrition, and sarcopenia. For those in the general population with long COVID symptoms, the role of specific nutrients has not yet been studied well enough to recommend any particular nutrient or dietary intervention as a treatment or adjunctive treatment. Clinical trials of single nutrients are currently being conducted, and future systematic reviews could focus on single nutrient or dietary interventions to identify their nuanced mechanisms of action. Further clinical studies incorporating complex nutritional interventions are also warranted to strengthen the evidence base for using nutrition as a useful adjunctive treatment for people living with long COVID.

Rehabilitation approach in robot assisted total knee arthroplasty: an observational study

BackgroundThe purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program.MethodA case–control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3 months post-surgery (T3). The primary outcomes were active knee extension and flexion and pain severity. The secondary outcomes were functional capacity and quality of life.ResultsUsing repeated measures ANOVA, we observed at T1 a statistically different difference for the treatment group compared to the control group about KSS (p < 0.05), pain (p < 0.05), and knee flexion (p < 0.05). No statistically significant difference between the two groups was observed for knee extension (p = 0.09) and the SF-12 scale (p = 0.52). At T2 instead, we observed a statistically significant difference for the treatment group compared to the control group as regards KSS (p < 0.05) and knee flexion (p < 0.05), while no statistically significant difference was observed for pain (p = 0.83), knee extension (p = 0.60), and the SF-12 scale (0.44).ConclusionsOur study has demonstrated that robot-NAVIO assisted knee prosthesis surgery, associated with a specific intensive rehabilitation treatment, in the short and medium term, determines good pain control, better flexion recovery and a improvement of functional capacity.

Impact of the Post Deployment Assessment and Treatment Residential Rehabilitation Program on Quality of Life in Veterans with Multiple Medical and Psychiatric Comorbidities

<h3>Research Objectives</h3> To evaluate the impact of a residential psychological rehabilitation program on quality of life of veterans with comorbid mental health, substance use, and neurological conditions (e.g. traumatic brain injury). <h3>Design</h3> Before-and-after trial of a novel neurorehabilitation program for Veterans with complex postdeployment needs. <h3>Setting</h3> Interdisciplinary residential inpatient rehabilitation program in a Veteran's Administration hospital. <h3>Participants</h3> Participants were 48 male residents (24 to 61 years of age, M = 36.85 (SD = 9.50)), 68.8% were non-Hispanic Caucasian, 8.3% Asian/Pacific Islander, 4.2% African-American, 8.3% Hispanic, 10.4% Native-American/Alaskan Native, mean education was 13.00 years (SD = 1.39, range = 9 to 19). Mean months deployed was 14.61 (SD = 8.80, range = 0 to 42). The three most common mental health diagnoses were sleep-wake disorder, trauma and stress-related disorder, and anxiety disorders. A total of 43.8%, n = 21, of participants experienced problems with alcohol abuse. Assessment was completed immediately prior to and up to two weeks after discharge. <h3>Interventions</h3> Participants received intensive individual and group therapies from an interdisciplinary team with an emphasis on community re-integration. The length of treatment varied from two weeks to sixty weeks. <h3>Main Outcome Measures</h3> World Health Organization Quality of Life-Brief (WHOQOL-BREF), a well-validated 26-item measure of quality of life within four domains (physical health, psychological well-being, social relationships, and environment). <h3>Results</h3> Results showed significant change on all four WHOQOL-BREF domains after program participation, t's = 4.15 to 6.20, all p's <.001. Number of military deployments was marginally negatively associated with degree of improvement on the physical health domain (r = -.28, p < .10). Nondeployment during military service was marginally positively associated with increases on the social relationship domain (p < .10, t = -1.83). <h3>Conclusions</h3> Findings support the benefit of the Post Deployment Assessment and Treatment residential rehabilitation intervention for improvement of quality of life. Comprehensive rehabilitation efforts are important and can be helpful with Veterans who experience multiple comorbities. <h3>Author(s) Disclosures</h3> The authors report no relevant disclosures.

Enhanced recovery in thoracic surgery

To present an experience of adapting the accelerated rehabilitation protocol at the thoracic surgery department of the Moscow City Clinical Oncology Hospital No. 1. An effectiveness of the accelerated rehabilitation program in the city oncology hospital was retrospectively analyzed for the period from February to December 2019. Lung resections were performed in 252 patients with median age 66 (59; 71) years and an equal ratio of men and women (124/128). Primary non-small cell lung cancer was noted in 194 (77%) patients, secondary malignant neoplasms of lungs - in 58 (23%) cases. ASA grading system of anesthetic risk was applied (American Society of Anesthesiologists): grade II - 56 (22.2%) patients, grade III - 203 (75.2%) patients, grade IV - 7 (2.8%) patients. Lobectomy was performed in 147 patients, segmentectomy - in 32, bilobectomy, pneumonectomy and marginal resection - in 1, 3 and 69 cases, respectively. Endoscopic operations made up 13.6% (n=20), 12.5% (n=4) and 78% (n=54). Postoperative 30-day complications occurred in 19 (7.5%) out of 252 patients (95% CI 4.9-11.5). Postoperative 30-day mortality was 1.98% (5 out of 252 patients, 95% CI 0.9-4.6). Median postoperative hospital-stay was 7 (6; 8) days. Implementation of fast track protocol requires time and the first results can be assessed after 6-12 months. Continuous monitoring of implementation of the protocol elements by all members of multidisciplinary team, analysis of complications and long-term results are required to realize all potential benefits of this program.

Integrated Gait Triggered Mixed Reality and Neurophysiological Monitoring as a Framework for Next-Generation Ambulatory Stroke Rehabilitation.

Brain stroke affects millions of people in the world every year, with 50 to 60 percent of stroke survivors suffering from functional disabilities, for which early and sustained post-stroke rehabilitation is highly recommended. However, approximately one third of stroke patients do not receive early in hospital rehabilitation programs due to insufficient medical facilities or lack of motivation. Gait triggered mixed reality (GTMR) is a cognitive-motor dual task with multisensory feedback tailored for lower-limb post-stroke rehabilitation, which we propose as a potential method for addressing these rehabilitation challenges. Simultaneous gait and EEG data from nine stroke patients was recorded and analyzed to assess the applicability of GTMR to different stroke patients, determine any impacts of GTMR on patients, and better understand brain dynamics as stroke patients perform different rehabilitation tasks. Walking cadence improved significantly for stroke patients and lower-limb movement induced alpha band power suppression during GTMR tasks. The brain dynamics and gait performance across different severities of stroke motor deficits was also assessed; the intensity of walking induced event related desynchronization (ERD) was found to be related to motor deficits, as classified by Brunnstrom stage. In particular, stronger lower-limb movement induced ERD during GTMR rehabilitation tasks was found for patients with moderate motor deficits (Brunnstrom stage IV). This investigation demonstrates the efficacy of the GTMR paradigm for enhancing lower-limb rehabilitation, explores the neural activities of cognitive-motor tasks in different stages of stroke, and highlights the potential for joining enhanced rehabilitation and real-time neural monitoring for superior stroke rehabilitation.

The effect of rehabilitation education on anxiety in knee replacement patients

BACKGROUND:Total knee arthroplasty (TKA) can cause operational anxiety in patients. The purpose of this study was to determine the effects of a hospital rehabilitation program on operational anxiety in patients following TKA.MATERIALS AND METHODS:A nonrandomized clinical trial was conducted on 96 patients who were total knee replacement (TKR) candidates in Milad Hospital, Tehran, Iran. The participants were allocated to two groups of control and experiment each with 48 participants. A rehabilitation training program was implemented in the experimental group and the routine care program was administered to the control group. The data collected through demographic form and Spielberger anxiety questionnaire. The collected data were analyzed using Fisher's exact test, covariance, independent t-test, and paired t-test (P = 0.5).RESULTS:The results of the paired t-test indicated that the mean score of anxiety in both groups was decreased. Independent t-test showed that there was a significant difference between the two groups in terms of the mean scores of anxiety so that it was significantly higher in the control group compared to the experimental group (P < 0.001).CONCLUSIONS:The implementation of the rehabilitation education by a rehab nurse can improve the surgical outcomes in patients under TKR. Despite the positive results in this study, the results should be interpreted and clinically used with caution given the small number of participants and the specific circumstances of this study.

Need Assessment for Smartphone-Based Cardiac Telerehabilitation

ObjectivesTo identify the current status of smartphone usage and to describe the needs for smartphone-based cardiac telerehabilitation of cardiac patients.MethodsIn 2016, a questionnaire survey was conducted in a supervised ambulatory cardiac rehabilitation (CR) program in a university affiliated hospital with the participation of heart failure or heart transplantation patients who were smartphone users. The questionnaire included questions regarding smartphone usage, demands for smartphone-based disease education, and home health monitoring systems. Results were described and analyzed according to principal diagnosis.ResultsNinety-six patients (66% male; mean age, 53 ± 11 years), including 56 heart failure and 40 heart transplantation patients, completed the survey (completion rate, 95%). The median daily smartphone usage time was 120 minutes (interquartile range, 60–300), and the most frequently used smartphone function was text messaging (61.5%). Of the patients, 26% stated that they searched for health-related information using their smartphones more than 1 time per week. The major source of health-related information was Internet browsing (50.0%), and the least sought source was the hospital's website (3.1%). Patients with heart failure expressed significantly higher needs for disease education on treatment plan, home health monitoring of blood pressure, and body weight (χ2 = 5.79, 6.27, 4.50, p < 0.05). Heart transplantation patients expressed a significant need for home health monitoring of body temperature (χ2 = 5.25, p < 0.05).ConclusionsHeart failure and heart transplantation patients show high usage of and interest in mobile health technology. A smartphone-based cardiac telerehabilitation program should be developed based on high demand areas and modified to suit to each principal diagnosis.

Cognitive and academic achievement changes associated with day hospital rehabilitation in children with acquired brain injury

ABSTRACTAn evaluation was made of the outcome of a day hospital rehabilitation program for children who experienced an acquired neurological illness, mainly traumatic brain injury. Participants were administered neuropsychological and academic evaluations upon entry to the program, immediately upon discharge and several months after discharge Repeated measures ANOVA results for variables selected from the Reynolds Intellectual Assessment and the Delis-Kaplan Executive Function System found that comparisons showed significant (≥p < .01) improvement occurred between the first and second assessment, generally with large effect sizes. There were some nonsignificant decrements in performance between the discharge and follow-up assessments. A correlational analysis showed that while the association between cognitive function and academic achievement was robust, correlation coefficients did not differ in strength before and following rehabilitation. The study demonstrates significant improvement in children with acquired neurological disorders following rehabilitation.

Effects of T'ai Chi on Serotonin, Nicotine Dependency, Depression, and Anger in Hospitalized Alcohol-Dependent Patients.

The aim of this study was to investigate the effects of t'ai chi on blood serotonin levels, nicotine dependence, depression, and anger in hospitalized alcohol-dependent patients. This study followed an experimental and nonequivalent control group in a non-synchronized design. It was performed in a hospital located in Young Ju city, Korea, from April to August 2013. Thirty-eight patients who were hospitalized with alcohol dependence were included. They were randomly divided into an experimental and a control group, with 19 patients in each group. Patients in the experimental group practiced the 24-posture yang style t'ai chi for 50 min three times per week for 8 weeks as part of the routine hospital rehabilitation program, and those in the control group followed only the routine hospital rehabilitation program. The effect of treatment was measured using blood serotonin levels and a questionnaire on nicotine dependence, depression, and anger. Both measurements were performed before and after 8 weeks of intervention. Data were analyzed using the t-test, chi-square test, and paired t-tests. The experimental group showed a significantly increased blood serotonin level (p = 0.001) and significantly reduced nicotine dependence, depression, and anger (p = 0.001) than the control group did after 8 weeks of treatment. T'ai chi was shown to be an effective nursing intervention in hospitalized alcohol-dependent patients.

Factors Associated With Intestinal Constipation in Chronic Patients With Stroke Sequelae Undergoing Rehabilitation.

The objective of this study was to define which stroke-related factors constitute independent variables in the incidence of intestinal constipation (IC) of chronic patients admitted to a hospital rehabilitation program. All patients consecutively admitted for rehabilitation were recruited for the study. In the Poisson multiple regression analysis using a hierarchical model, sociodemographic variables, comorbidities, medication, previous history of constipation, life habits, and stroke-related variables were considered for defining factors associated with IC. A 31% prevalence (95% confidence interval [CI]: 25.3-37.1) of IC was detected. Among the factors associated, female gender (adjusted prevalence ratio [PRadjusted] = 1.79; 95% CI: 1.20-2.68), intestinal complaints prior to stroke (PRadjusted = 3.71; 95% CI: 2.60-5.31), intake of less than 800 ml of fluid per day (PRadjusted = 1.72; 95% CI: 1.20- 2.45), age greater than 65 years at brain injury (PRadjusted = 1.67; 95% CI: 1.01-2.75), and partially impaired anterior brain circulation (PRadjusted = 3.35; 95% CI: 1.02-10.97) were associated with IC. Female gender, elderly, prior history of IC, low fluid intake, and partial impairment of anterior brain circulation were factors independently associated with IC in stroke survivors undergoing rehabilitation. These findings require further validation and may serve toward improving bowel retraining programs for this patient group.

Improvement of exercise tolerance in cardiopulmonary testing with sustained safety after regular training in outpatients with systolic heart failure (NYHA III) and an implantable cardioverter-defibrillator. Prospective 18-month randomized study.

IntroductionThe aim of the study was to evaluate the impact of individual training on the level of physical capacity and echocardiographic parameters in patients with systolic heart failure (SHF), NYHA III and an implantable cardioverter-defibrillator (ICD).Material and methodsThe study included 84 patients with SHF, randomly assigned to one of two groups: with regular training (ICD-Ex) and a control group (ICD-control). The ICD-Ex group participated in a hospital rehabilitation program which after discharge was individually continued for 6 months in an outpatient setting. The ICD-control group participated in a training program during hospitalization, but after discharge did not perform any controlled activities. Prior to discharge, at 6 and 18 months cardiopulmonary exercise testing (CPX), standard echocardiographic examination and the 6-minute walk test (6-MWT) were performed in all patients.ResultsAfter 18 months in the ICD-Ex group most of the CPX parameters improved significantly (VO2 peak, ml/kg/min: 13.0 ±4.1 vs. 15.9 ±6.1, p < 0.0017; VCO2 peak, l/min: 1.14 ±0.34 vs. 1.58 ±0.65, p < 0.0008; Watt: 74.5 ±29.7 vs. 92.6 ±39.1, p < 0.0006; METs 3.72 ±1.81 vs. 4.35 ±1.46, p < 0.0131). In the ICD-control group no significant improvement of any parameter was observed. Left ventricular systolic dimensions remained significantly lower at 18 months only in the ICD-Ex group (49.5 ±11.0 vs. 43.4 ±10.0, p < 0.011). Left ventricular ejection fraction in both groups significantly increased at 6 and 18 months compared to baseline (ICD-Ex: 25.07 ±5.4 vs. 31.4 ±9.2, p < 0.001, vs. 30.9 ±8.9, p < 0.002, ICD-C: 25.1 ±8.3 vs. 29.2 ±7.7, p < 0.012 vs. 30.1 ±9.1, p < 0.005). Distance of the 6-MWT was significantly improved after 6 and 18 months in the ICD-Ex group and was overall longer than in the ICD-control group (491 ±127 vs. 423 ±114 m, p < 0.04).ConclusionsAn individual, 6-month training program, properly controlled in patients with SHF and an implanted ICD, was safe and resulted in a significant improvement of exercise tolerance and capacity and echocardiographic parameters.

Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease.

Take-home summaryPersonalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD.PurposeWe previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities.Patients and methodsThe novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan–Meier analyses.ResultsIn both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172–0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296–0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved.ConclusionThe PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.

An evaluation of the uptake and effects of a new exercise-based cardiac rehabilitation program in a Singapore hospital

Implications: While dizziness, motion sensitivity and anxiety were markedly reduced, 50% of the patients continued to experience decreased confidence in balance and postural control even though the BPPV has resolved. As such, therapy may have to be tailored to address balance impairments as well to reduce falls’ risk especially in older adults.

재활 낮병동 프로그램이 뇌성마비아동의 대동작기능에 미치는 효과

본 연구에서는 뇌성마비아동의 대동작기능이 재활 낮병동 프로그램을 통한 효과를 알아보고자 실시하였다. 연구대상자는 경직성 뇌성마비아동 57명으로 최근 6개월 사이에 보톨리눔 독소나 수술적 병력이 없는 아동을 대상으로 하였다. 대동작기능 측정(GMFM)와 대동작기능 분류체계(GMFCS)를 기능적 변화와 기능적 수순에 대한 평가를 실시하였으며, 낮병동 프로그램은 8주로 이루어졌다. 연구결과는 다음과 같다. 첫째, 낮병동 프로그램 적용을 통한 치료 전 후 대동작기능의 유의한 차이를 보였다(p<.001). 둘째, 연령별 운동발달은 1-2세, 3-4세 뇌성마비아동이 5-6세 뇌성마비아동보다 사후검정 결과 더 높은 것으로 나타났다. 마지막으로, 대동작기능 분류체계(GMFCS) 수준l에 따른 대동작기능 측정(GMFM)의 유의한 차이를 보였는데(p<.05), 특히 경도와 중등도 뇌성마비아동이 중증도 뇌성마비아동보다 유의한 차이를 보였다. 낮병동 프로그램은 뇌성마비아동의 대동작기능의 운동발달에 효과적이며, 경도, 중등도와 4세 이하의 뇌성마비아동에게 조기 중재가 필요할 것으로 생각된다. The purpose of this study was to find the effect of Day Hospital Rehabilitation programs on gross motor function in children with cerebral palsy. The subjects were 57 children with spastic cerebral palsy with no previous botulinum toxin injection or operation history within 6 months. The Gross Motor Function Measure(GMFM) score and Gross Motor Function Classification System(GMFCS) were used to evaluate as functional change and functional level. The Programs for Day Hospital Rehabilitation period for cerebral palsy children was 8 weeks. The results of the study are as follows: 1, GMFM Score of pre- and post-programs for Day Hospital Rehabilitation showed the statistically significant difference(p <.001). 2, The age group in 1-2 was higher than age 5-6 group, 3-4 was higher than age 5-6 group by Post-hoc analysis. Lastly, there was significantly different of GMFM in GMFCS level(p<.05), especially mild(GMFCS level I) and moderate(GMFCS level II, III) of CP showed that gross motor function was significantly different than severe(GMFCS level IV, V). The programs for Day Hospital Rehabilitation was effective on gross motor function for children with cerebral palsy, and for early intervention needs to mild, moderate CP, and below age 4 group.

Assistive devices – integration into a hospital rehabilitation program

In the People’s Republic of China, assistive devices are recognized as part of the rehabilitation process, with national policies and a network of assistive device centres in place. However, the use of assistive devices is rarely recognized by the hospital therapist as part of their role. Before OTs in China can include assistive devices in their daily work, it is necessary for both the local profession and their teachers to understand the context of rehabilitation in the Chinese hospital. Close examination of patient beliefs, health regulations, and understanding financial healthcare policies are all contributing factors. This article discusses the perspective of a Canadian therapist working with OTs in a municipal hospital of a major city in western China, attempting to introduce assistive devices into the practice of OTs, by strengthening their knowledge base, modeling various strategies of working with patients, exploring local resources, and visiting communities to understand the needs.

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work

Return To Work (RTW) is an important indicator of recovery from coronary artery disease (CAD), associated with social and economical benefits, and improved quality of life. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are effective procedures relieving symptoms and reducing the risk for new events, but psychosocial problems are frequent among these patients. The aim was to determine psychosocial and treatment-related factors associated with RTW among PCI and CABG patients in Northern Norway. Cross-sectional design based on questionnaire data from CABG and PCI patients 3-15 months following discharge, and from hospital records. Of the 348 responding patients, 168 were younger than 67 years and working prior to hospitalization. Factors associated with RTW were examined in a logistic regression analysis. A total of 108 (64%) had RTW within 3-15 months. Four factors made unique significant contributions to the model, including higher education, time since hospital discharge and Internal Locus of Control (LoC) of the Multidimensional Health Locus of Control Scale (MHLC) as positively associated factors, and Powerful Others LoC as a negatively associated factor. Analyses controlled for data on demographics, emergency status, type of treatment, number of days at the hospital, physical exercise, attending a rehabilitation program, mental distress, Type D personality, and for the CABG patients additional data on coronary health. Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed.

Creating a Volunteer Training Program to support the Advance Care Planning Process

IntroductionThe ageing population and the increasing need advance care planning (ACP) increase the need to bring ACP to the community's attention. Limited resources led us to develop a group of...

The cost-effectiveness of various rehabilitation patterns for children with cerebral palsy

Objective To analyze the economic effects of different rehabilitation patterns for children suffering from cerebral palsy. Methods A total of 153 cerebral palsy patients were divided into a hospital-community-family rehabilitation group(n = 52), a hospital rehabilitation group (n = 50) and a non-intervention control group (n = 51). Those in the first group were provided with a hospital-community-family rehabilitation therapy pattern, those in the sec-ond only hospital rehabilitation and the third no intervention. All the patients were evaluated using the Gross Motor Function Measure-88 (GMFM-88) Scale and the Cost Measure Scale at admission, and at the end of the 3rd and 6th months of treatment. Results There were no significant differences in gross motor function among the three groups at admission. At the end of the 3rd month and the 6th month there were significant differences between the children in the hospital-community-family rehabilitation program and those in the hospital rehabilitation program in terms of gross motor function. Their general percentage, monthly percentage and monthly relative percentage results were all significantly different. But there was no significant difference in the non-interventian control group since admission. Every unit of improvement in gross motor function cost $101.87±97.59, $75.11±45.75 in the hospital-community-family reha-bilitation program and $387.21±54.76, $170.31±123.16 in the hospital rehabilitation program at the end of the 3rd and the 6th month respectively. So the cost of the former was only about 30% of the latter. Conclusion Hospital rehabilitation is suitable for the early rehabilitation of cerebral palsy children. Hospital-community-family rehabilitation is better for long-term rehabilitation of cerebral palsy children, and what is more, it can decrease the rehabilitation ther-apy cost substantially. So a hospital-community-family rehabilitation pattern is more compatible with China's national situation. Key words: Hospital-community-family rehabilitation ; Cerebral palsy ; Gross motor function ; Cost-effec-tiveness analysis ;

An Intervention Program to Reduce Falls for Adult In-Patients Following Major Lower Limb Amputation

A qualitative and quantitative assessment was conducted regarding falls sustained by in-patients receiving rehabilitation therapy following major lower limb amputation at the Glenrose Rehabilitation Hospital. During the nine-month assessment period, 18 of 58 patients in the amputee unit experienced a fall, of which 17% resulted in a moderate injury. The majority of falls occurred during patients' use of a wheelchair (14 of 18) and involved poor balance (nine of 14). Patient wheelchair self-transfers accounted for 71% (10 of 14) of the falls, while sitting in the wheelchair and reaching represented 29/ (four of 14). The hospital's rehabilitation program teaches patient safety including using assistive devices such as wheelchairs but did not include a comprehensive graded learning path to monitor patients' ongoing risk for falls. Based upon the data collected, an intervention program was initiated to improve patient safety and reduce the number of falls. The multidisciplinary program encompassed aspects ranging from an environmental assessment of the patients' room to medication management, continuous patient wheelchair skills training and alteration of the care plan. The effectiveness of the intervention program was assessed through a series of interviews and questionnaires administered to medical personnel. This article presents the preliminary data collected during the first three months of the six-month study. Overall, satisfaction has significantly improved as a direct result of the intervention program. The article provides evidence-based interventions that improve safety for a subset of in-patients known to be susceptible to falls when using wheelchairs. Other in-patient groups will also benefit from these findings as many are universally applicable.