Rehabilitation Hospital Research Articles

Evaluating the co-designed “kalmer” relaxation intervention for people with aphasia: a feasibility case series

ABSTRACT Background People with aphasia are at increased risk of developing anxiety and depression. There is a need for accessible psychological interventions to be evaluated for this clinical group. Relaxation is a promising treatment option. Aims This case series study aimed to assess the feasibility of the “Kalmer” relaxation intervention. Methods and Procedures Twelve participants with aphasia were recruited via online social media/websites for people with aphasia. After 4 weeks of baseline assessment which included for mood the Behavioural Outcomes of Anxiety Scale (BOA) and Stroke Aphasic Depression Questionnaire − 10 item (SADQ-10), participants accessed the relaxation intervention on Vimeo© for 5 weeks. Participants were encouraged to practice relaxation 5 times a week. Vimeo© analytics were collected to measure participants’ preferences and use of the intervention. Immediately post intervention and at 3- and 6-month follow up time points, BOA and SADQ-10 scores were collected again. The Reliable Change Index was used to determine the impact of the intervention. Outcomes and Results Whilst recruitment was slow, once participants were enrolled the trial appeared feasible. Vimeo© analytics demonstrated participants engaged well in the treatment and preferred imagery-based relaxation recordings. Anxiety symptoms improved for 5/12 participants (42%) immediately post intervention and 7/11 participants (63%) at 3 and 6 month follow-up time points. Depressive symptoms improved for 6/12 participants (50%) immediately post intervention, 4/11 participants (36.3%) at 3-month follow-up and 5/11 participants (45.5%) at 6-month follow-up. Conclusions The Kalmer relaxation intervention appears feasible and shows potential to reduce anxiety and depressive symptoms in people with aphasia. Considerations for future trials include the need for expanding both recruitment (e.g. community and hospital rehabilitation services) and methods of delivery for the intervention (e.g. DVD and in person groups).

29. CLINICAL FEATURES AND DAILY ACTIVITY DEPENDENCE IN STROKE PATIENTS: A BARTHEL INDEX-BASED STUDY AT HA TINH REHABILITATION HOSPITAL IN 2024

Aims: Stroke is a leading cause of disability worldwide, significantly affecting patients' ability to perform daily activities. In Vietnam, stroke survivors often face prolonged dependence on others for daily care. This study aimed to describe the clinical characteristics and assess the level of dependence in daily activities among stroke patients at Ha Tinh Rehabilitation Hospital. Methods: A descriptive cross-sectional study was conducted on 117 stroke patients undergoing rehabilitation at Ha Tinh Rehabilitation Hospital from March to September 2024. Patients were assessed using the Barthel Index, which measures independence in 10 basic activities of daily living. Data were collected through medical record reviews, patient observations, and interviews. Statistical analysis was performed using SPSS 25.0, with chi-square tests for differences between proportions. Results: The average Barthel Index score was 50.44 ± 32.42, indicating moderate dependence. Only 16.2% of patients were fully independent, while 49.6% were completely dependent. Factors such as age, educational level, social support, smoking, and clinical conditions like aphasia and dysphagia were significantly associated with levels of independence (p < 0.05). Conclusion: The majority of stroke patients at Ha Tinh Rehabilitation Hospital demonstrated a high level of dependence in daily activities. Interventions targeting social support, lifestyle changes, and early rehabilitation may enhance patient independence and improve outcomes.

The Effect of Foot Reflexology and Knee Massage With Black Cumin Seed Oil on Knee Osteoarthritis Symptoms.

This study aimed to examine the effect of foot reflexology and knee massage with black cumin seed oil on pain and fatigue symptoms in elderly individuals with knee osteoarthritis and assess which of these 2 applications is more effective. Our randomized controlled trial was conducted with 150 participants. Study data were collected from participants over 65years who received outpatient treatment in a university hospital's physical therapy and rehabilitation unit and were determined to have no perception problems based on the Mini-Mental Test. After randomization, the study sample was classified into 5 groups, each including 30 participants: (1) foot reflexology with black cumin seed oil, (2) foot reflexology with a placebo, (3) knee massage with black cumin oil, (4) knee massage with a placebo, and (5) control. Participants were administered a Patient Descriptive Information Form, the Lequesne Knee Osteoarthritis Index, the Pain-Visual Analog Scale, the Fatigue Severity Scale, and the Western Ontario and McMaster Universities Osteoarthritis Index. Control group participants received standard of care, while participants in treatment groups received the studied interventions for 6weeks. Data were collected by administering questionnaires to the participants in the first and sixth weeks and analyzed using IBM Statistical Package for Social Sciences 22.0 software. The study showed that foot reflexology and knee massage administered using black cumin oil effectively reduced pain and fatigue severity in Osteoarthritis (OA) patients, and overall, foot reflexology administered using black cumin oil was the most effective treatment to reduce pain and fatigue.

"How Can We Help You?" Older Adults' and Care Partners' Perspectives on Improving Care in Hospital: A Mixed Methods Study.

Hospitalized older adults have unique physical, emotional, and psychosocial needs. We sought to understand older patients' and care partners' experiences with multicomponent interventions that support age-friendly care and identify areas for improvement. We conducted a mixed methods study using surveys and interviews to explore older adult patients' (65 years or older) and their care partners' experiences with hospital-delivered multicomponent initiatives. We recruited participants from the Geriatric Rehabilitation (GRU) and Musculoskeletal (MSK) Rehabilitation units in a Canadian academic hospital from October 2021 to April 2022 until we reached data saturation and no new themes emerged. We recruited 18 participants, 10 patients (mean age 78 years, 80.0% female) and 8 care partners (mean age 61, 87.5% female). Surveys revealed overall positive experiences with multicomponent interventions. Interviews revealed five themes: 1) various forms of companionship for patients, 2) recreation and entertainment, 3) physical activity, 4) communication, and 5) pleasant physical environment. Having forms of companionship and proper communication with the care team were highlighted as areas of importance. Physical activity was highly valued, but participants expressed hesitation around safety of mobilizing without physiotherapists. Recreational activities helped distract from social isolation during a hospital stay and participants had diverse preferences for activities. Participants had strong memories of the physical environment, including the lack of natural light, institutionallike décor, and smells. Companionship, recreation and entertainment, physical activity, communication, and the physical environment were important to hospitalized patients and their care partners. Hospital administrators and policy makers should consider these when targeting areas to improve care for the aging population.

Effects of core training based on respiratory therapy on elderly stable COPD patients in the rehabilitation hospital: a study protocol for a randomised controlled trial

IntroductionElderly stable chronic obstructive pulmonary disease (COPD) patients frequently experience walking dysfunction. Research indicates that balance training holds promise for enhancing walking stability in these individuals, whereas respiratory therapy (RT)...

Expanded application of unilateral biportal endoscopy in adult thoracic disease: report of three cases and literature review.

Traditional surgery for degenerative thoracic disorder can be extremely invasive and accompanied by complications. Unilateral biportal endoscopy (UBE), a newly developed technique in the field of spin surgery, is minimally invasive and its popularity and indications have been increasing. In this study, we report three cases of different thoracic diseases treated using UBE. The first case was a 50-year-old male patient with lower extremity tingling sense and right thigh anterior aspect radiating pain. Bilateral decompression and removal of ossification of the ligamentum flavum (OFL) was done. The second case was a 75-year-old female who had symptoms of gait disturbance and motor weakness due to thoracic myelopathy in T12-L1. We performed canal decompression and discectomy using the far-lateral approach. The third case was a 69-year-old female with poor medical condition due to lymphoma who had symptoms of right intercostal pain that occurred after T12 acute compression fracture. UBE treatment was decided, and nerve decompression was performed. In the first case, the tingling sense due to OYL improved three months after the surgery. In the second case, the right lower extremity radiating pain and gait disturbance showed improvement after surgery, but motor weakness continued until four months after surgery. In the third case, intercostal pain showed improvement immediately after surgery. Although UBE surgery is limited in completely replacing traditional treatments for degenerative thoracic disease, it offers the advantages of rapid rehabilitation and short-term hospitalization and can be a good surgical treatment option.

Investigation of Study Procedures to Estimate Sensitivity and Reliability of a Virtual Physical Assessment Developed for Workplace Concussions: Method-Comparison Feasibility Study

Abstract Background Remote approaches to workplace concussion assessment have demonstrated value to end users. The feasibility of administering physical concussion assessment measures in a remote context has been minimally explored, and there is limited information on important psychometric properties of physical assessment measures used in remote contexts. Objective The objectives of this feasibility study were to determine recruitment capability for a future larger-scale study aimed at determining sensitivity and reliability of the remote assessment, time required to complete study assessments, and acceptability of remote assessment to people with brain injuries and clinicians; document preliminary results of the sensitivity of the remote assessment when compared to the in-person assessment; and estimate the preliminary interrater and intrarater reliability of the remote assessments to inform procedures of a future larger-scale study that is adequately powered to reliably estimate these parameters of interest. Methods People living with acquired brain injury attended 2 assessments (1 in-person and 1 remote) in a randomized order. The measures administered in these assessments included the finger-to-nose test; balance testing; and the Vestibular/Ocular Motor Screening (VOMS) tool, including documentation of change in symptoms and distance for near point convergence, saccades, cervical spine range of motion, and evaluation of effort. Both assessments occurred at the Ottawa Hospital Rehabilitation Center. After the assessments, a clinician different from the person who completed the original assessments then viewed and documented findings independently on the recordings of the remote assessment. The same second clinician viewed the recording again approximately 1 month following the initial observation. Results The rate of recruitment was 61% (20/33) of people approached, with a total of 20 patient-participants included in the feasibility study. A total of 3 clinicians participated as assessors. The length of time required to complete the in-person and remote assessment procedures averaged 9 and 13 minutes, respectively. The majority of clinicians and patient-participants agreed or strongly agreed that they were confident in the findings on both in-person and remote assessments. Feedback obtained revolved around technology (eg, screen size), lighting, and fatigue of participants in the second assessment. Preliminary estimates of sensitivity of the remote assessment ranged from poor (finger-to-nose testing: 0.0) to excellent (near point convergence: 1.0). Preliminary estimates of reliability of the remote assessment ranged from poor (balance testing, saccades, and range of motion: κ=0.38‐0.49) to excellent (VOMS change in symptoms: κ=1.0). Conclusions The results of this feasibility study indicate that our study procedures are feasible and acceptable to participants. Certain measures show promising psychometric properties (reliability and sensitivity); however, wide CIs due to the small sample size limit the ability to draw definitive conclusions. A planned follow-up study will expand on this work and include a sufficiently large sample to estimate these important properties with acceptable precision.

Effectiveness of geriatric rehabilitation in inpatient and day hospital settings: a systematic review and meta-analysis

BackgroundGeriatric rehabilitation is a multidisciplinary intervention that promotes functional recovery in older adults. Our objective was to assess the efficacy of geriatric rehabilitation in inpatient and geriatric day hospital settings.MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, PEDro and AgeLine from inception to September 30, 2022 for randomized controlled trials (RCTs) including older adults (age ≥ 65 years) undergoing geriatric rehabilitation (inpatient or day hospital) with a usual care comparator group. Primary outcome measures included mortality, long-term care home (LTCH) admission, and functional status. Secondary outcomes included discharge/remaining at home, functional improvement, length of stay, cognition, mood, and quality of life. Records were screened, abstracted and assessed for risk of bias (Cochrane Risk of Bias [RoB] 2) by two reviewers independently. We conducted a random effects meta-analysis to summarize risk ratios (RR, dichotomous outcomes) and standardized mean differences (SMD, continuous outcomes).ResultsOf the 5304 records screened, 29 studies (7999 patients) met eligibility criteria. There were 23 RCTs of inpatient geriatric rehabilitation (6428 patients) and six of geriatric day hospital (1571 patients) reporting outcomes of mortality (26 studies), LTCH admission (22 studies), functional status (19 studies), length of stay (18 studies), cognition (5 studies), mood (5 studies) and quality of life (6 studies). The primary outcome of mortality at longest follow up was lower in the rehabilitation group (RR 0.84, 95% confidence interval [CI] 0.76 to 0.93, I2 = 0%). LTCH admission was lower in the rehabilitation group at longest follow up (RR 0.86, 95% CI 0.75 to 0.98, I2 = 8%). Functional status was better in the rehabilitation group at longest follow up (SMD 0.09, 95% CI 0.02 to 0.16, I2 = 24%). Cognition was improved in the rehabilitation group (mean difference of mini-mental status exam score 0.97, 95% CI 0.35 to 1.60, I2 = 0%). No difference was found for patient length of stay, mood, or quality of life.ConclusionsGeriatric rehabilitation in inpatient and day hospital settings reduced mortality, LTCH admission, and functional impairment. Future studies should explore implementation of this intervention for older adults.Review registrationPROSPERO: CRD42022345078.

"What should a rehabilitation hospital be like?" Priorities and expectations of people with spinal cord injury in Türkiye.

Survey study OBJECTIVES: To understand the priorities and expectations of individuals with disabilities caused by spinal cord injuries(SCI) who require long-term inpatient rehabilitation at a rehabilitation hospital. Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye METHODS: This cross-sectional clinical study included individuals over the age of 18 with SCI who had previously been hospitalized in a rehabilitation hospital. The 18-question survey, titled "What should a rehabilitation hospital be like according to persons with spinal cord injuries?" was administered to individuals hospitalized in the inpatient service of Çam Sakura City Hospital. It was also disseminated to people with SCI through social media. The participants' demographic data was recorded. The survey was completed by 120 participants, comprising 70 males and 50 females. The mean age was 37.47 ± 11.63 years. The time since the SCI was less than one year for 20 individuals and more than one year for 100 individuals. The results showed that robotic rehabilitation and psychological support were the most requested rehabilitation domains, while interest in sexual rehabilitation was less than that in other rehabilitation domains. Furthermore, in the correlation analysis, elderly participants indicated that there should be more specialized services and outpatient clinics exclusive to the SCI. The study revealed a striking trend - participants expressed a strong desire for SCI-specific rehabilitation units and robotic rehabilitation. Additionally, the significance and necessity of sexual rehabilitation should be conveyed to people with SCI.

Characteristics of cerebellar cognitive affective syndrome in patients with acute cerebellar stroke and its impact on outcome

Purpose To evaluate the cerebellar cognitive affective syndrome scale (CCAS-S) in patients with acute cerebellar stroke (ACS) and examine its relationship with the discharge destination. Methods Patients with first-time ACS admitted to our hospital between April 2021 and April 2023 were included. The CCAS-S, Mini-Mental State Examination (MMSE), and Scale for the Assessment and Rating of Ataxia (SARA) were evaluated 1 week after stroke onset, and Functional Independence Measure (FIM)/Barthel Index (BI) at discharge, duration of hospitalization, and discharge destination were evaluated. The Mann–Whitney U test was used to compare CCAS-S and variables. Results Thirteen consecutive patients with ACS and age-matched comparison groups were included. The MMSE was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, IQR 66–80) and a higher number of failed tests (median 4, IQR 3–5) than comparison. Significant deficits were observed in semantic fluency (p = 0.008), category switching (p = 0001), and similarity (p = 009). Definite CCAS were diagnosed 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI but similar CCAS-S compared to those discharged to rehabilitation hospitals. Conclusion In patients with ACS, it is the impairment of motor function, not CCAS, that affects discharge destination.

Validation of a Set of Clinical Criteria for the Diagnosis of Secondary Progressive Multiple Sclerosis.

Background/Objectives: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by progressive impairment of neuronal transmission due to focal demyelination. The most common form is RRMS (relapsing-remitting multiple sclerosis), which, under the influence of certain factors, can progress to SPMS (secondary progressive multiple sclerosis). Our study aimed to validate the criteria proposed by a working group of the Romanian Society of Neurology versus the criteria proposed by a group of experts from Spain, Karolinska, and Croatia concerning the progression from RRMS to SPMS. Methods: This was done by gathering epidemiological data (age, gender) and by applying clinical tests such as the 9HPT (9-hole peg test), 25FWT (25-foot walk test), and EDSS (expanded disability status scale) tests and the SDMT test (symbol digit modalities test). The present research is a cohort study that included a number of 120 patients diagnosed with MS according to the McDonald Diagnostic Criteria 2017. The study was carried out between January 2023 and April 2024, including patients hospitalized in the Neurology Clinic of the Clinical Rehabilitation Hospital from Iasi, Romania. The data were collected at baseline (T0) and at a 12-month interval (T1). Results: The statistical analysis was conducted using Kaiser-Meyer-Olkin analysis, which indicated a value of 0.683, thus validating the clinical tests used. The correlation matrix and the linear regression for all the tests showed highly significant statistical results. Furthermore, the ROC curve analysis of the criteria suggested by the working group of the Romanian Society of Neurology demonstrated that the EDSS, 9HPT, and 25FWT are highly sensitive in diagnosing SPMS, an opinion that is shared with the Spanish experts, but not with the Karolinska expert panel. Using the criteria given by the Croatian expert group in the ROC curve analysis showed that only the EDSS was strongly significant for the progression to the SPMS phase. Conclusions: In conclusion, all clinical methods used demonstrated that they are valid and can contribute to identifying patients with an increased risk of progression. The model proposed by the Romanian Society of Neurology working group is similar to other countries' expert opinions and can be used to detect the risk of disease progression and establish a more tailored therapeutic management of SPMS.

Comparative characteristics of minimally invasive and classical (median sternotomy) methods of coronary artery bypass grafting

Objective. To analyze the results and comparative characteristics of minimally invasive and classical coronary artery bypass grafting in multivessel coronary artery disease and the presence of critical stenosis. Materials and Methods. Over the past two years, the National Scientific Center of Surgery and Transplantation named after O. O. Shalimov performed mini­invasive coronary artery bypass grafting for multivessel lesions of the coronary arteries in 27 patients (group 1). The comparative study also included 27 patients operated on using the classical method (group 2). The average age of patients was (53.1 ± 3.9) years. There were 46 men (85.2%) and 8 women (14.8%). According to the main indicators, including the number of affected coronary arteries, age, physiological parameters, etc., the groups did not differ statistically significantly. The main methods of the study were coronary angiography, multislice computed tomography of the coronary arteries with 3D reconstruction of the architecture of the great vessels, chest and heart. Results. During the follow­up of patients in both groups for up to a year after the operation, no clinical manifestations of angina and heart failure were noted, which gives reason to state the good function of the shunts. Intra­ and postoperative complications in group 1 occurred in 2 patients: the need for conversion due to cardiac rhythm and hemodynamics (1) and repeated thoracotomy due to bleeding from the arterial shunt (1). In group 2, complications also occurred in 2 patients: sternal diastasis requiring sternoplasty (1) and surgical wound exudation requiring the installation of a vacuum device for 4 days with subsequent secondary suturing (1). Conclusions. Minimally invasive coronary artery bypass grafting is a safe method of myocardial revascularization in multivessel coronary artery disease and critical stenosis. The technique allows for rapid rehabilitation and shorter hospital stays, which is economically beneficial for the hospital. Minimally invasive coronary artery bypass grafting can be considered as an alternative to the classical method of coronary artery bypass grafting with midline sternotomy.

Abstract 4137823: Influence of Hospital and Cardiac Rehabilitation Facility Proximity on Enrollment Rates Among Medicare Beneficiaries

Background: Participation in cardiac rehabilitation (CR) is enhanced by proximity to CR facilities and communication between inpatient and outpatient settings but may become fragmented when patients are distant from their discharging hospital and nearest CR facility. Research Question: This study investigates how patient distance to both hospitals and CR facilities impacts the rates of CR participation. Methods: This study included 100% Medicare fee-for-service claims for beneficiaries with 12 months of continuous Part A/B coverage who had coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or surgical or transcatheter aortic valve replacements (SAVR or TAVR) between 07/2016-12/2018, excluding patients discharged to hospice or died within 30 days. Google Maps defined travel distances from the patient to hospital and CR facility locations using geographic centroids of ZIP codes, which were then categorized into quartiles. CR enrollment was defined as attending at least one session within one year of discharge. Logistic regression models estimated marginal CR enrollment rates across both hospital and CR facility distance categories adjusting for patient, hospital, and regional factors. Results: The study included a total sample of 501,049 beneficiaries undergoing PCI (62%), CABG (19%), SAVR (7%), and/or TAVR (15%). The median travel distance to the hospital was 18.6 miles (IQR 8.2-43.3 miles) and to the CR facility was 7.7 miles (IQR 2-15.3 miles). A total of 188,963 (37.7%) beneficiaries attended at least one CR session, which varied across categories of distance to hospital (Q1: 36.8% to Q4: 37.5%) and CR facility (Q1: 44.7% to Q4: 30.0%, p<0.01). Adjusted CR enrollment rates improved when beneficiaries lived farther from their admitting hospitals but closer to CR facilities (Figure 1), with the highest enrollment for those located farthest from their admitting hospital but closest to the CR facility (47.5%) and lowest enrollment among those closest to the hospital but farthest from the CR facility (20.6%). Conclusions: Greater distance to the admitting hospital was associated with higher CR enrollment, while greater distance to the CR facility was associated with lower enrollment among eligible Medicare beneficiaries. Addressing geographic barriers to CR participation may require tailored solutions based on patient proximity to hospitals and CR facilities.

Qualitative study exploring perceptions and experiences of Pharmacy technicians’ professional identity in NHS Scotland

Abstract Introduction Pharmacy technicians worldwide share workplace challenges including: job role; scope of practice; level of pharmacist’ supervision; and education1. In the USA, Canada and many European countries, pharmacy technicians require national or state registration2. In the UK, Pharmacy technicians became registered professionals in 2011, as a means of improving patient safety through compliance with General Pharmaceutical Council (GPhC) standards. There are approximately 2,500 pharmacy technicians and 5,500 pharmacists registered with the GPhC in Scotland3. Given the importance of professional identity, and the lack of research exploring pharmacy technicians’ professional affiliation, we explored the perspectives and experiences of pharmacy technicians’ professionalism across Scotland. Aim To explore pharmacy technicians’ perceptions and experiences of their professional status and professional identity. Methods Following West of Scotland Research and Ethics Service Scientific Officer’s approval, Pharmacy technicians from all fourteen Scottish territorial health boards were invited by email using snowball sampling technique to provide a national representation. A draft semi-structured interview was piloted on four pharmacy technicians. Between May and August 2023, 36 pharmacy technicians were recruited: 23 from acute services; mental health (n=1); rehabilitation hospitals (n=1); primary care (n=8); and community pharmacy (n=3). Twenty two participants were interviewed in person and 14 on line. Interviews lasted between 17-91 minutes, were audio recorded, transcribed verbatim and accuracy checked, then analysed thematically using a framework approach and NVivo software. Three researchers analysed data including initial coding, categorisation, and theme generation. Any disagreements were discussed and addressed within the research team. Results Seven themes emerged from the data describing pharmacy technicians: feeling stuck in the shadow of pharmacists; underrepresented in policy and practice; and marginalised, undervalued and underpaid. There was frustration at the lack of awareness of pharmacy technician roles amongst the wider healthcare team. Primary care pharmacy technicians were thought to have more opportunities than secondary care colleagues. There was a pervasive feeling that pharmacy technicians were increasingly squeezed between pharmacists and support workers and a lack of confidence and feeling unsupported in the delivery of clinical roles. Pharmacy technicians acknowledged that they may not have used their initiative to take new opportunities, but did not feel they had sufficient clinical and educational opportunities. Catalysts to professional development were recognised including pharmacy technician led management and leadership, readiness to undertake traditional pharmacist roles and the potential positive impact of strengthened professional identity. Interviewees described the absence of a structured, funded career framework, and lack of post-registration higher-level professional qualification as inhibiting increased responsibility and scope of practice. Discussion/Conclusion Professional registration does not appear to have strengthened pharmacy technicians’ professional identity. There is a pervasive lack of development opportunities impacting negatively on pharmacy technicians and therefore, service delivery across Scotland. A review of defined roles is required. A lack of previous qualitative evaluation limits comparisons with the perceptions and experiences of pharmacy technicians worldwide. Findings offer a starting point to inform practice and policy. Further research could explore pharmacy technicians’ perceptions of the potential impact of the emerging career framework on developing roles and responsibilities. Keywords: Pharmacy technician, Professional identity

Stored Energy and Recovery: A Key Factor in Post-stroke Sarcopenia Management.

This study aimed to determine the effects of Stored Energy on changes in body weight (BW) and skeletal muscle mass (SMM) in patients with post-acute stroke and sarcopenia. Methods: This retrospective cohort study included patients with stroke and sarcopenia consecutively admitted to a Japanese rehabilitation hospital between 2015 and 2022. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia in 2019 criteria. Total Stored Energy (kcal) was defined as total energy intake minus total energy requirements during hospitalization, and energy requirements were estimated as actual BW (kg) × 30 (kcal/day). Multiple regression analysis was used to adjust for the effects of confounders and to analyze the association between Total Stored Energy divided by length of hospital stay (= Stored Energy) and changes in BW and SMM during hospitalization. Of the total 556 patients, 193 patients (mean age, 80 years; 43% male) were analyzed. The median (IQR) Total Stored Energy was -1544 (-18524, 16566) kcal and Stored Energy was -23 (-169, 165) kcal/day; 90 patients had Stored Energy > 0. Multiple linear regression analysis showed that Stored Energy was independently and positively associated with BW gain (β=0.412, P<0.001) and SMM gain (β=0.263, P<0.001). Stored Energy has a positive impact on BW and SMM in patients with post-acute stroke and sarcopenia.

Outpatient clinic for children with obstetric brachial palsy admitted to a rehabilitation hospital in Brazil: 10 years of experience in a multidisciplinary approach

Introduction/Background: Obstetric brachial palsy (OBP) is characterized by flaccid paralysis secondary to injury to one or more roots of the brachial plexus during laborious labor. Specialized and systematized evaluation by a multidisciplinary team is important in the follow-up of these patients. The authors describe the ten first years of the specialized outpatient clinic in a health institution. Methods: The medical records of all patients admitted with a brachial plexus injury that occurred during delivery at a health institution were evaluated. The children were evaluated using the Active Movement Scale (AMS) and the test score was applied at three months. Patients older than 2 years of age at the time of admission were excluded from the analysis. Results: 454 children with PBO up to 2 years of age were admitted. Of the total, 54% of babies are female. The average age at admission was 4.7 months of age, with 56.4% being admitted at up to 3 months of age. Of the total admitted, 113 children underwent surgery to treat the brachial plexus. Conclusions: Systematized evaluation associated with multidisciplinary monitoring allows a better evolution of the child who presented a brachial plexus injury at birth

The Impact of Lesser Trochanter Displacement on Hip Flexor Strength Recovery in Patients With Trochanteric Fracture.

Trochanteric fractures (TFs) are common in older individuals and are expected to increase with Japan's aging population. These fractures often result in poor long-term outcomes, such as decreased independent walking and reduced hospital discharge rates. A significant aspect of TF involves displacement of the lesser trochanter (LT), which can weaken hip flexor muscles and potentially affect the recovery of activities of daily living (ADLs), including walking. Previous research has shown conflicting results regarding the effect of lesser trochanteric displacement on hip function and walking ability. This study aimed to determine whether displacement of the LT affects the recovery of hip flexor strength and walking ability at discharge in patients with TF. This prospective cohort study included 29 patients with TF admitted to a rehabilitation hospital between April 2023 and June 2024. The patients were classified into two groups: the LTdisplacement and the non-LT (NLT) displacement groups. Muscle strength (hip flexion, abduction, and knee extension) was measured using a handheld dynamometer. Walking ability assessments included gait speed, timed up-and-go test (TUG), 6-minute walk test (6 MWT), and functional ambulation category (FAC). Cognitive function was evaluated using the Hasegawa Dementia Rating Scale-Revised (HDS-R). Statistical analyses included repeated-measures analysis of variance (ANOVA) for muscle strength comparisons over time, with adjustments for violations of sphericity using the Greenhouse-Geisser correction. There were no significant differences between the LT and NLT groups in terms of demographic characteristics such as age, sex, or cognitive function. Repeated-measures ANOVA revealed a significant difference in hip flexor strength on the injured side between the groups, with the LT group showing persistent weakness until discharge. Significant improvements were noted in hip abduction and knee extension strength on the injured side, although no group differences were observed. Post-hoc analysis indicated significant strength improvements over time, particularly between admission and discharge, for most muscle groups, except for hip flexor strength in the LT group. Lesser trochanteric displacement in patients with TF resulted in a specific decline in hip flexor strength on the injured side, which persisted until discharge. However, no significant impact on walking ability was observed, likely because of compensatory mechanisms involving other muscles.

Rehabilitation Therapists Have Better Job Satisfaction Than Nurses in a Tertiary Rehabilitation Healthcare Setting: A Cross-Sectional Study.

It is an established fact that job satisfaction of medical staff is a crucial factor that affects healthcare quality and plays a major role in the retention of qualified staff. This study aims to assess the occupational satisfaction of nurses and physiotherapists in a tertiary rehabilitation institution, holding a bed capacity of 511 beds, by utilizing the Job Satisfaction Survey (JSS) questionnaire. This cross-sectional survey was conducted at a tertiary rehabilitation hospital between August and November 2022. The study targeted full-time nurses and rehabilitation therapists working in the institution using an English questionnaire focusing on the Job Satisfaction Survey (JSS) that was sent electronically to all eligible staff. The JSS questionnaire assessed job satisfaction and consisted of 36 items in nine domains of job satisfaction, which included pay, promotion, supervision, benefits, rewards, operational procedures, coworkers, work itself, and communications. The response rate was 64.43% among nurses and 64.93% among therapists. The satisfaction rate was higher among therapists (34.41%) compared to nurses (26.25%). The overall job satisfaction mean score was significantly higher among therapists compared to nurses at 149.28±27.12 compared to 143.14±31.67, respectively.This was also observed in the pay domain (13.06±4.06 versus 12.36±4.29), fringe benefits domain (12.77±4.89 versus 11.90±4.82), and coworkers' domain (15.55±3.67 versus 14.71±4.17), while it was significantly higher among nurses compared to therapists when looking at the promotion domain at 14.27±3.52 versus 13.75±3.16, respectively. When doing regression analysis, the odds ratio (OR) was the highest among bachelor nurses and those with more than 40 years of age for therapists. Rehabilitation therapists are more satisfied than nurses with the main satisfaction domains being financial benefits in the form of pay, fringe benefits, and contingency rewards. Age, gender, and work duration did not show any significant value in this study, and overall, the dissatisfied group for both rehabilitation therapists and nurses did not manifest any difference in most of the job satisfaction factors.

Dyadic coping, resilience, and posttraumatic growth in spinal cord injury patients and their spouses: An actor-partner interdependence mediation model analysis.

Despite the recognized importance of posttraumatic growth (PTG) in the recovery process, the mechanisms that promote PTG in spinal cord injury (SCI) patients and their spouses, especially the roles of dyadic coping (DC) and resilience, have not been fully explored. This study aimed to assess the PTG of patients with SCI and their spouses and to investigate the interrelationships among DC, resilience, and PTG within the dyadic context. A total of 154 SCI patient-spouse dyads were recruited from a rehabilitation hospital in China. All participants completed questionnaires about DC, resilience, and PTG. Our study was based on the actor-partner interdependence mediation model (APIMeM). SCI patients and their spouses experienced comparable PTG level, M(patients) = 56.05 ± 14.09, M(spouses) = 54.74 ± 15.31. In the APIMeM, the patients' and their spouses' DC exerted actor effects on their own resilience, β(patients) = .418, p < .001; β(spouses) = .409, p < .01, and their own resilience also exerted actor effects on their own PTG, β(patients) = .416, p < .001; β(spouses) = .431, p < .001. The mediating effects of resilience on the impact of patients' and spouses' own DC on their own PTG were confirmed. Our research offers new insight into the PTG of SCI patients and their spouses at the individual and dyadic levels. Resilience partially mediates the relationship between DC and PTG in couples coping with SCI. Specifically, DC between SCI patient-spouse dyads can not only directly influence the level of PTG but also impact PTG through resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development and validation of the Fall Risk Assessment Scale for patients in rehabilitation hospitals: A methodological study.

Falling is a serious threat for patient safety in hospitals. This study aimed to identify the risk factors of fall amongst rehabilitation patients and to use them for developing and validating the Persian version of Fall Risk Assessment Scale (FRAS). The current methodological study was conducted in two phases. In the first phase, based on the review of the literature and investigation of the medical records of 251 patients selected via purposive sampling, the risk factors of fall were extracted and the FRAS was developed accordingly. In the second phase, the face and content validities of the designed scale were determined by cognitive interview and Content Validity Index (CVI) and to evaluate the construct validity, known-groups comparison was performed. Its inter-rater reliability was analyzed using the weighted Kappa Coefficient (κ*). The study adhered to COSMIN guidelines. Fall was significantly associated with disease diagnosis, used medications, history of fall, cognitive impairments, and three items of the Functional Independence Measure (toilet transfer, bed transfer, and shoer transfer). The CVI of the scale was 0.94. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known-group validity. Its weighted kappa coefficient was >0.85, its sensitivity was 73%, and its specificity was 82%. The valid and reliable FRAS may accurately assess the level of Fall Risk patients in Rehabilitation wards, helping to predict fall during hospitalization. So, enabling the planning and implementation of effective caring interventions.