Inpatient Rehabilitation Setting Research Articles

Evaluation of Physical Health in an In-Patient Psychiatric Rehabilitation Setting

AimsThe mortality gap between patients with serious mental illness (SMI) and without is around 15–20 years. This has multiple contributing factors including poor physical health, side effects of antipsychotic medications and sub-optimal medical management. Presented here is a detailed cross-sectional study of physical health measures in an in-patient rehabilitation population in Scotland. Results are compared to national averages and clinical guidelines with the aims to a) benchmark physical health in this population and b) where possible improve physical health.MethodsPhysical health data including observations, blood tests, and investigations was collected ahead of detailed structured interviews and physical exams performed by a post-foundation doctor. These results were compared to recommendations for physical health monitoring from numerous national and government guidelines (SIGN, NICE, Scottish Government, Maudsley). Data were collected in 4 domains, 1) Indicators of physical health, 2) Engagement with physical health, 3) Concordance with guidelines and 4) Outcomes of reviews.ResultsData were collected from 57 of all 62 in-patients. 34 reported being generally happy with their health vs 15 unhappy. 42% were obese (compared to 28% of the general population), 84% were smokers (vs 16% in the local population) 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed cancer screening uptake compared to the Scottish population was low; Cervical (30% vs 71%), Bowel (8% vs 59%), Breast (23% vs 72%), AAA (0% vs 84%). Patients were generally up to date in terms of recorded weight (100%), BP (98.2%), HR (98.2%) and lipids (89.4%), but not ECG's (61.4%) and Diabetes screening (59.6%). 17 referrals were made to medics/surgeons, 29 to MDT's, 24 medications started, 9 stopped and 27 changed, most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients).ConclusionCardiovascular disease indicators were notably raised, uptake of screening was very poor and there were areas where the service didn't meet national guidelines. The number of referrals and medication changes suggest an unmet need within such services. The findings, if generalisable across similar populations, suggest that more can be done to address ongoing poor physical health in populations with SMI and indeed patient readiness to comply with physical health screening. Screening for key physical health parameters needs to be augmented by working to engage patients and following up with management plans for abnormalities found.

Uncovering the experiences of engaging in an inpatient occupation-based group program: The LifeSkills group

Background Consumer engagement is an important element for developing and maintaining value-based healthcare standards. Occupation-based practice in the context of a group has been adopted by inpatient rehabilitation clinicians, but little research has explored if these groups are valuable and useful to patients. Aims/Objectives To explore the experiences of patients participating in an occupation-based group intervention for instrumental activities of daily living to understand its value and usefulness in an inpatient rehabilitation setting. Material and methods Interpretive description guided the development of the study. Semi-structured interviews were completed with 15 participants of an occupation-based group, the LifeSkills group. Comparative analysis was used to analyse the data and develop themes. Results Five themes were reported by participants: choice and control, confidence through doing, a real-world connection, the power of the therapeutic relationship and the impact of the shared experience. Conclusions and significance In line with current rehabilitation literature, patient experiences around client-centredness, occupational engagement in a ‘real-world’ environment, and valued relationships can be facilitated through an occupation-based group. This study supports the implementation of valued-based healthcare in understanding patient perceptions of occupation-based interventions into rehabilitation; ensuring that the right intervention is being used at the right time for the right patient.

The First Introduction of Social Robotics in Rehabilitation Care.

Can you imagine to receive treatment through a robot? When talking about the future of healthcare, this is the vision many people have. Currently, the predominant role of social robots in care is entertaining patients. However, this does not have an impact on care process itself. In this paper, we focus on defining use cases other than merely keeping patients' company by implementing a Pepper robot in inpatient rehabilitation setting, and expand upon usability testing the use cases. Our findings showed that, to ensure sustainable implementation of social robots in care organizations, we need excessive collaboration with the target population.

A Retrospective Analysis of q12hr and q8hr Heparin for DVT/PE Prophylaxis in an Inpatient Rehabilitation Setting.

Purpose: There is little clinical evidence comparing the safety and efficacy of prophylactic subcutaneous heparin given every 8 hours and every 12 hours. We performed a retrospective analysis incorporating these dosing intervals in an inpatient rehabilitation setting. Methods: Heparin usage data was collected and patient charts were analyzed for both therapeutic failure and bleeding events. A 2-tailed Fisher's exact test was performed for both outcomes, with a P-value of less than 0.05 being considered significant. Odds ratios were also calculated with P-values less than 0.05 being considered significant. Study Population: A Cerner report was run to identify patients ordered prophylactic heparin in an inpatient rehabilitation setting from April 7, 2020, to October 27, 2021. One hundred patients receiving heparin every 8 hours and every 12 hours were randomly selected for chart review. These study groups were further stratified by Padua risk scores. Results: In both groups, 4 (4.0%) patients were identified as having a documented bleeding event and 2 (2.0%) patients from each group were identified as having a therapy failure. Conclusion: For both endpoints, no significant differences in bleeding rates or therapy failure rates were detected in any of the population stratifications.

Responsiveness of the International Classification of Functioning, Disability And Health (ICF) Clinical Functioning Information Tool (ClinFIT) in Routine Clinical Practice in an Australian Inpatient Rehabilitation Setting.

ObjectiveTo examine the responsiveness of the International Classification of Functioning, Disability and Health (ICF) Clinical Functioning Information Tool (ClinFIT) in routine clinical practice in an Australian context.MethodsA prospective observational study with consecutive recruitment of inpatients at a tertiary rehabilitation facility. The assessments were at admission (T0), discharge (T1) and 3-month post-discharge (T2), using the following questionnaires: ClinFIT, Functional Independence Measure (FIM) and European Quality of Life (EQ-5D-5L). Extension Indices (EI) were calculated for the ClinFIT set, and responsiveness measured as a change in scores over time. The association between FIM and ClinFIT scores was explored.ResultsParticipants (n = 91, mean age 66.8±13.0 years, 52% male, 48% following stroke) reported ≥ 1 issue related to ClinFIT categories. ClinFIT total raw scores improved significantly across all health conditions compared with T0 (median (interquartile range): 196 (110, 228)) at both T1: 69 (37, 110); p < 0.001 and T2: 46.5 (20.8, 77); p < 0.001, with a medium effect size (r = 0.61 for both). There were significant changes in EI in the entire ClinFIT set from T0 to T1, and from T0 to T2 (p < 0.001 for both), with small to medium effect sizes. Analyses confirmed significant correlation in improvements between ClinFIT and FIM scores.ConclusionClinFIT is useful in evaluating patient functioning and can detect changes in functioning over time and across different health conditions.LAY ABSTRACTRegular patient evaluation and clinical assessment is needed to maximize positive outcomes from rehabilitation intervention. This prospective study assessed the responsiveness of the International Classification of Functioning, Disability and Health (ICF) – Clinical Functioning Information Tool (ClinFIT) for the assessment of functioning in an inpatient rehabilitation facility in Australia. Overall, 91 patients with different health conditions (majority with stroke) were assessed at admission, discharge, and at 3 months after discharge, using the ClinFIT set, and compared with another routinely used instruments, the Functional Independence Measure (FIM). The findings showed that the ClinFIT set is useful in evaluating patients’ functioning over time across different health conditions.

Increasing Compliance of Deep Vein Thrombosis Medical Prophylaxis in Acute Inpatient Rehabilitation Setting.

To improve medication reconciliation and decrease the rate of deep vein thrombosis (DVT) after the transfer of brain-injured neurologically impaired patients from an acute hospital setting to an inpatient rehabilitation facility, a performance improvement strategy was put in place. Such a strategy consisted of adding the proper DVT prophylaxis medication and dosage in the preadmission screen to prevent a delay in receiving the appropriate medication. This resulted in a dramatic reduction of inappropriately discontinued medications from 14.2% of patients to 5.78% over six months (p-value: 0.03). However, after the intervention, we surprisingly observed an increased rate of DVT from 6.2% to 10.11% (p-value: 0.03). This increase may be attributable to a larger number of venous duplex studies performed because of increased awareness of venous thromboembolism (VTE).

The Effect of Lower Limb Neuromuscular Electrical Stimulation on Skeletal Muscle Signaling for Glucose Utilization and Systemic Inflammation After Acute Spinal Cord Injury

<h3>Research Objectives</h3> To quantify the effects of a novel combination neuromuscular electrical stimulation (Comb-NMES) training program on muscle signaling for glucose utilization and systemic inflammatory blood markers in individuals with acute spinal cord injury (SCI). <h3>Design</h3> Randomized controlled clinical trial. <h3>Setting</h3> In-patient rehabilitation setting. <h3>Participants</h3> 12 participants between 30.3 ±8.6, with an SCI between C6-L1, within 14 days of the SCI and with no history of diabetes, participated in the study. Muscle samples were collected from the Vastus Lateralis muscle within 14 days of SCI and before discharge from the Spain Rehabilitation hospital. <h3>Interventions</h3> The intervention group received Comb-NMES training program that combines dynamic contractions (resistance training) via high-frequency electrical stimulation with twitch contractions (aerobic training) via low-frequency electrical stimulation on the quadriceps muscle group on both legs. The control group received (sham treatment) passive dynamic exercise of the lower legs and transcutaneous electrical nerve stimulation (TENS). Interventions were given 3 times/week for 3-4 weeks. <h3>Main Outcome Measures</h3> Western blot analysis was performed to quantify signaling proteins (GLUT4, AMPKα, Hexokinase II, CaMKII, Akt, AS160, IRS-1, ACC, GS, and PI3 Kinase) for muscle glucose uptake. In addition, assays were performed to measure the serum proinflammatory and anti-inflammatory cytokines (IFN-γ, IL-10, IL-12p70, IL-1β, IL-6, IL-8, AND TNF-α). <h3>Results</h3> Protein expression for Akt, AMPKα, AS160, CaMKII, GLUT4, Hexokinase II, and PI3 Kinase and circulating levels of anti-inflammatory cytokine IL-10 and IFN-γ increased following Comb-NMES training program. <h3>Conclusions</h3> This preliminary data suggests that Comb-NMES training may increase the expression of proteins for glucose uptake and utilization in the paralyzed skeletal muscle. In addition, Comb-NMES training may increase circulating anti-inflammatory cytokines. This trial is ongoing, and results may change with a larger sample size. <h3>Author(s) Disclosures</h3> All authors listed in this abstract have no conflict of interest. this study is funded by NIH.

Benefits of Missing Value Analyses for Clinical Research using a Tele-Psychology Clinical Trial for Individuals with Spinal Cord Injury

<h3>Research Objectives</h3> Understand and account for missing data in a clinical research study. <h3>Design</h3> Randomized controlled clinical trial. <h3>Setting</h3> Santa Clara Valley Medical Center acute inpatient rehabilitation and general community setting. <h3>Participants</h3> Twenty-six individuals with spinal cord injury who presented with mild to moderate depression within 1-year post-injury. <h3>Interventions</h3> Cognitive Behavioral Therapy-based tele-psychology delivered via iPad FaceTime (10 sessions over 12 weeks). <h3>Main Outcome Measures</h3> Missing values across study variables, including demographics, Patient Health Questionnaire-9, Generalized Anxiety Disorder–7, and Satisfaction with Life Scale. <h3>Results</h3> The whole group Missing Value Analysis (MVA) revealed ∼17% of values were missing (125/754), 9/26 participants had at least one missing value, and 27/29 variables had at least one missing value. Out of 2^29 possible missing value patterns, only 10 were apparent and the most common missingness pattern was no missing data. Little's Missing Completely At Random (MCAR) test (ꭕ2[df=136, N=26]=134.2,p=.528) showed data were MCAR, with no relationship between missing data and any values in the dataset. Principal component analysis suggested four principal components that remained consistent after imputing missing data (mean substitution). Within-arm MVA showed data in both groups was MCAR (Group 1:ꭕ2[df=101, N=15]=63.2,p=.999;Group 2:ꭕ2[df=35, N=11]=10.8,p=1.00) with similar missingness patterns. <h3>Conclusions</h3> Missing data are an inevitable consequence of clinical research. Although often overlooked, MVA provides a mechanism to account for missing data in either the interpretations (e.g., skewed results) or analytics (e.g., imputing missing data). In this study, whole group and within arm MVA showed the data was MCAR and the data remained consistent after imputing missing values. MVA has the benefit of 1) quality control and assurance of data, 2) understanding and accounting for the missingness of data, and 3) reporting patterns in missing data to inform future studies. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest or financial ties to disclose.

Profiles of TBI Injury Severity as Predictors of Functional Outcomes and Well-being Outcomes

<h3>Research Objectives</h3> To identify profiles of traumatic brain injury (TBI) severity and relate profiles to functional and well-being outcomes. <h3>Design</h3> Longitudinal observational study with assessments during acute rehabilitation, discharge, and one year after injury. <h3>Setting</h3> Santa Clara Valley Medical Center (SCVMC) acute inpatient rehabilitation and general community setting. <h3>Participants</h3> Three hundred and seventy-nine individuals [76.8% male; mean(std) age=34.6(16.9) years] in the Traumatic Brain Injury Model Systems at SCVMC with head computed tomography (CT) data. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> At discharge- length of stay, Functional Independence Measure (FIM), and Disability Rating Scale (DRS). One-year post-injury- Glasgow Outcome Scale (GOS), FIM, and Satisfaction with Life Scale (SWLS). <h3>Results</h3> Reults: Latent profile analysis (LPA) was used to identify subgroups with similar patterns across 12 indicators of injury severity, including duration of post-traumatic amnesia, Glasgow Coma Scale, time to follow commands, and head CT variables. LPA identified four latent classes: Class1 (least severe; N=75), Class2 (intermediate; N=124), Class3 (moderate; N=144), and Class4 (most severe; N=27). Younger age, lower education, rural residence, injury in motor vehicle accidents, and earlier injury years were associated with worse severity (ps <.05). Latent classes were related to outcomes. Compared to Class1, hospital stays were longer, FIM scores lower, and DRS scores larger at discharge among individuals in Class3 and Class4 (all ps < .01). One-year post-injury, GOS and FIM scores were significantly lower in Class3 and Class4 than Class1 (ps <.01). FIM scores were also lower among individuals in Class2, compared to Class1 (p=.015). SWLS scores were lower only among individuals in Class3 (p=.036); other comparisons relative to Class1 were not significant. <h3>Conclusions</h3> Meaningful profiles of TBI severity can be identified from acute injury characteristics and may suggest premorbid populations at risk for worse injuries, including younger individuals and those with lower education. Improving classification may help focus on those at elevated risk for severe injury and inform clinical management and prognosis. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest or financial ties to disclose.

Factors Associated With Ventilator Weaning Success and Failure in People With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting: A Retrospective Study.

To evaluate baseline characteristics, describe pulmonary outcomes, and identify weaning predictors for people with acute traumatic spinal cord injury (SCI) who are dependent on mechanical ventilation at admission to acute inpatient rehabilitation (AIR). The retrospective study was conducted at an AIR facility in the United States. It included 91 adults with acute traumatic SCI from 2015 to 2019 who were dependent on mechanical ventilation. People who successfully weaned (85%) had fewer days from time of SCI to AIR admission (22 vs. 30, p = .04), higher vital capacity at admission to AIR (12 vs. 3 mL/kg predicted body weight [PBW]; p < .001), and lower (caudal) neurological injury level (p < .001) compared to those who failed weaning. The risk of pneumonia was higher in people who failed weaning compared to those who were weaned successfully (risk ratio, 5.5; 95% confidence interval [95% CI], 2.3-13). Receiver operating characteristics (ROC) curves suggest a vital capacity cutoff of 5.8 mL/kg PBW could predict weaning. The vital capacity of ≥ 5.8 mL/kg PBW is associated with 109 times higher odds (95% CI, 11-1041; p < .001) of weaning than vital capacity below that threshold. In this retrospective study, there was an increased risk of pneumonia in people with SCI who failed weaning at discharge from AIR. Vital capacity was a better predictor of weaning from mechanical ventilation compared to the neurological level of injury, with a cutoff of 5.8 mL/kg PBW predictive of weaning success. Further research is needed on this critical topic.

A process evaluation of patient care needs using the Post-Stroke Checklist: A prospective study.

ObjectiveTo assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting.MethodsProspective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2.ResultsParticipants’ mean age was 67.7 years (standard deviation; SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 strokerelated problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p<0.001, with large effect sizes).ConclusionThe mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention.LAY ABSTRACTPatients with stroke can develop significant long-term functional, communication and psychosocial disability, which can limit their daily activities and quality of life. Hence, regular follow-up is important to identify the patients’ clinical needs after discharge from the hospital to the community. This study used a universal tool, the modified Post-Stroke Checklist (mPSC) to identify common persisting stroke-related issues of patients admitted to a rehabilitation unit to facilitate appropriate referrals during discharge. The mPSC is feasible to implement in an inpatient rehabilitation setting and community for treating clinicians to identify relevant stroke-related problems and provide appropriate intervention.

The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord injury: 2021 update

Study designClinical practice guidelines.ObjectivesThe objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI).SettingThe guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada.MethodsThe guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations.ResultsThe working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made.ConclusionsThe CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.

Sociodemographic, geographic and clinical factors associated with functional outcome and discharge location in US inpatient rehabilitation settings

ABSTRACT Objective To assess the impact of sociodemographic factors, clinical factors and regional differences on both patients’ functional outcome and discharge location in U.S. inpatient rehabilitation settings. Methods Using eRehabData, 536,453 admissions was used for functional outcome analyses (based on FIM gain) while 259,308 admissions was used for the discharge location analyses. Regression models were used to look at both outcomes. Results Having private insurance and being young and male was associated with the higher FIM gains while being African American, widowed, and living in the Midwest was associated with the lower FIM gains. Furthermore, having private insurance, being young, male, married and African American or Hispanic was associated with the lower odds of being discharged to a skilled nursing facility while living in the Midwest was associated with the greatest odds of being discharged to a skilled nursing facility. Clinical factors such as days from onset and length of stay also had a significant effect on both outcomes. Conclusion Our findings suggest that, in the U.S., one of the challenges to successful recovery in the inpatient rehabilitation setting includes insurance status (Medicare/Medicaid), race (African American) but also regional differences (Midwest) and length of stay.

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients.

Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma-informed and recovery-orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over-reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self-initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed-methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in-depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three-month period following implementation (mean difference from baseline = -30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.

Non-Pharmacological Pain Self-Management in an Inpatient Rehabilitation Setting: An Exploratory Quality Improvement Study

Non-Pharmacological Pain Self-Management in an Inpatient Rehabilitation Setting: An Exploratory Quality Improvement Study

Occupational Therapy Interventions to Address Depressive and Anxiety Symptoms in the Physical Disability Inpatient Rehabilitation Setting: A Systematic Review.

Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear. To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy. Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.

The sustainability of upper limb robotic therapy for stroke survivors in an inpatient rehabilitation setting

Purpose To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice. Methods Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL. Results During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists. Conclusions RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients. IMPLICATIONS FOR REHABILITATION RT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting. The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level. RT-UL may be considered a “bridging” form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice.

A Lifestyle Management for Arthritis Group education intervention for people with inflammatory and degenerative arthritis: An observational study.

Occupational therapy self-management groups aim to assist individuals to incorporate health-promoting behaviours and management strategies into their daily routines to promote wellbeing. The Lifestyle Management for Arthritis Group (LMAG) is a 2-h-long, occupational therapy educational-behavioural group intervention adapted from the evidence-based Lifestyle Management for Arthritis Programme (Hammond & Rayner,2013) and was delivered to inpatients with inflammatory and degenerative arthritis separately. The aim of this study was to evaluate the effectiveness of this intervention in an inpatient Rheumatology Rehabilitation setting. This was an observational study with a pretest-posttest design using multiple methods. A knowledge of joint protection survey was gathered at three intervals. In-depth semi-structured phone interviews were undertaken 6weeks post intervention. The quantitative data was analysed using IBM SPSS version 25, whilst thematic analysis was used to analyse the interviews. The results confirmed that the 36 participants who completed the study had increased joint protection knowledge immediately after LMAG and continued to retain that knowledge 6weeks post intervention. The majority of participants evaluated the intervention as excellent whilst empowerment emerged as the core concept from the qualitative analysis. These study findings suggest that the LMAG intervention can have a beneficial effect inimproving the self-management skills and confidence levels of patients with inflammatory and degenerative arthritis.

Augmentative and alternative communication intervention for in-patient individuals with post-stroke aphasia: study protocol of a parallel-group, pragmatic randomized controlled trial

BackgroundPeople with post-stroke aphasia commonly receive speech-language therapy (SLT) when they are admitted to hospitals. Commonly, these patients reported communication difficulties in in-patient settings. Augmentative and alternative communication (AAC) has been reported as an effective treatment approach to improve communication effectiveness, language performance, decreasing depression, and improving quality of life for this population. However, little evidence has demonstrated the use of AAC intervention (AACT) in early recovery from people with post-stroke aphasia in in-patient rehabilitation settings for improving these patients’ communication effectiveness. The pilot randomized controlled trial (RCT) will explore the effectiveness and feasibility of including AACT in regular SLT for in-patient people with post-stroke aphasia.MethodThis pilot RCT is a single-blind, randomized controlled trial with two parallel groups. Both groups receive a 1-h treatment session, including either both AACT and SLT or SLT only for ten consecutive days. We aim to include 22 in-patient participants with post-stroke aphasia in each group. Participants will be assessed at pre- and post-intervention and 2 weeks after intervention. The primary outcomes are the ability of communication measured by the communication of basic needs subtest in the Functional Assessment of Communication Skills for Adult (FACS) and the overall language performance measured by the Chinese Standard Aphasia Battery (ABC). The secondary outcomes include a 10-min conversation, the 10-item Hospital version of the Stroke Aphasic Depression Questionnaire (SADQH-10), the Stroke-Specific Quality of Life Scale (SS-QOL), and a patient and caregiver satisfaction questionnaire.DiscussionThis pilot RCT will contribute to new scientific evidence to the field of aphasia rehabilitation in early recovery during the in-patient period. The paper describes the trial, which will explore the effect of combining AACT and SLT and SLT only, our choice of primary and secondary outcome measures, and proposed analyses. The study results will provide information for implementing AACT in the regular in-patient SLT of future RCTs.Trial registrationChinese Clinical Trial Registry database (ChiCTR) ChiCTR2000028870. Registered on 5 January 2020

Environmental enrichment for stroke and other non-progressive brain injury.

Rehabilitation is effective for recovery after stroke and other non-progressive brain injuries but it is unclear if the rehabilitation environment itself, outside of limited therapy hours, is maximally conducive to recovery. Environmental enrichment is a relatively new concept within rehabilitation for humans. In this review, this is defined as an intervention designed to facilitate physical (motor and sensory), cognitive and social activity by the provision of equipment and organisation of a structured, stimulating environment. The environment should be designed to encourage (but not force) activities without additional specialised rehabilitation input. To assess the effects of environmental enrichment on well-being, functional recovery, activity levels and quality of life in people who have stroke or non-progressive brain injury. We conducted the search on 26 October 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers. We planned to include randomised controlled trials (RCTs) that compared environmental enrichment with standard services. Two review authors independently assessed eligible studies, extracted data, and assessed study quality. Any disagreements were resolved through discussion with a third review author. We determined the risk of bias for the included study and performed a 'best evidence' synthesis using the GRADE approach. We identified one RCT, involving 53 participants with stroke, comparing environmental enrichment (which included physical, cognitive and social activities such as reading material, board and card games, gaming technology, music, artwork, and computer with Internet) with standard services in an inpatient rehabilitation setting. We excluded five studies, found two studies awaiting classification and one ongoing study which described environmental enrichment in their interventions. Of the excluded studies, three were non-RCTs and two described co-interventions with a significant component of rehabilitation. Based on the single small included RCT at high risk of bias, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the provision of environmental enrichment. The gap in current research should not, however, be interpreted as proof that environmental enrichment is ineffective. Further research is needed with robust study designs, such as cluster RCTs, and consistent outcome measurement evaluating the effectiveness of environmental enrichment in different settings (inpatient versus outpatient), the relative effectiveness of various components of environmental enrichment, cost-effectiveness, and safety of the intervention in people following stroke or other non-progressive brain injuries. It should be noted, however, that it is challenging to randomise or double-blind trials of environmental enrichment given the nature of the intervention.