Interdisciplinary Rehabilitation Team Research Articles

Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework.

Background While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team. Methods A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Results A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians' and families' skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team. Conclusion The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.

Eating habits and the desire to eat healthier among patients with chronic pain: a registry-based study

Healthcare professionals often meet pain patients with a poor nutritional status such as obesity, unhealthy dietary behaviors, and a suboptimal dietary intake. A poor nutritional status may play a significant role in the occurrence, development, and prognosis of chronic pain. This study investigated eating habits in a specialized pain rehabilitation center using data (N = 2152) from the Swedish quality registry for pain rehabilitation during the period 2016–2021. Patients answered a lifestyle questionnaire regarding their eating habits and desire to modify their lifestyle. The mean (SD) patient age was 46.1 (14.6) years, with 24.8% classified as obese. Suboptimal eating habits included irregular mealtimes (27.2%), weekly consumption of fast-food (20.3%) and nearly daily consumption of confectionery (33.3%). Approximately 20% (n = 426) reported a desire to eat healthier. Frequent confectionery intake (Odds ratio [OR] 1.23, 95% Confidence Interval (CI) 1.04–1.47) and fast-food consumption (OR 1.58, 95% CI 1.24–2.02) increased the likelihood to desire healthier eating. Younger patients (18–29 years), those classified as obese, and those with more extended spatial pain were more likely to express a desire to eat healthier. Eating habits should be addressed in pain management and interdisciplinary pain rehabilitation teams are encouraged to provide nutritional care tailored to the patient's needs.

What mobility factors are critical to include in a comprehensive mobility discharge assessment framework for older adults transitioning from hospital-to-home in the community? An international e-Delphi study

Purpose To prioritize and achieve consensus on mobility determinant factors [cognitive, financial, environmental, personal, physical, psychological, social] considered critical to include in the COmprehensive Mobility Discharge Assessment Framework (COMDAF) for older adults transitioning from hospital-to-home. Materials and methods We conducted a three-round modified e-Delphi process with 60 international experts (seven older adults, nine family caregivers, 24 clinicians, and 20 researchers) from nine countries with universal or near-universal health coverage. Expert members rated 91 factors identified from scoping reviews using a 9-point scale: not important (1-3), important (4-6), and critical (7-9). Result A total of 41 of 91 factors (45.1%) met the a-priori consensus criterion after three rounds: five cognitive, five environmental, two personal, 19 physical, six psychological, and six social factors. No financial factors reached a consensus. The older adult steering committee member recommended the addition of two environmental factors, resulting in 43 mobility factors included in the COMDAF. Conclusions We advanced a comprehensive mobility framework by developing, through consensus, 43 mobility factors to be assessed as part of a COMDAF. However, its use in hospital-to-home may not be feasible. Therefore, future research will determine the core mobility factors for COMDAF and which measurement instruments best measure these factors. Relevance An interdisciplinary discharge rehabilitation team can utilize the COMDAF during hospital-to-home transition. Implications for rehabilitation Mobility assessment following a hospital discharge is a complex process requiring an interdisciplinary discharge rehabilitation team. This study provided a comprehensive list of 91 factors across all seven mobility determinants (cognitive, environmental, financial, personal, physical, psychological, and social) for clinicians in other care settings to use as a starting point to determine which mobility factor should be assessed during older adults’ hospital-to-home transition. This international e-Delphi study identified 43 factors within mobility determinants (cognitive, environmental, personal, physical, psychological, and social) to be included in a Comprehensive Mobility Discharge Assessment Framework to assess older adults’ mobility during the hospital to home transition. Using these 43 factors, clinicians can identify which assessment tool is best suited to assess the factors while reflecting on the logistics and feasibility; this is the next phase of this project

A wolf in sheep’s clothing: when a stroke is not a stroke, and how comprehensive speech and language therapy assessment and intervention can help to set the alarm

A 70-year-old male patient, who was diagnosed with human immunodeficiency virus (HIV) in 2001 and did not undergo antiretroviral therapy, was admitted two months after the onset of left cortical-subcortical ischemic stroke, with involvement of the corona radiata and the left thalamus. As a consequence of this vascular event, he suffered aphasia, severe dysarthria, dysphagia, and right hemiparesis. The patient took part in a rehabilitation program at a rehabilitation centre for neurological diseases with a specialised interdisciplinary rehabilitation team. He underwent speech therapy intervention with a frequency of 2-3 hours per day. Despite the intensity of the program, there was a decline in his clinical and functional status during hospitalisation, with decreased capacity to swallow and communicate (either because of the exacerbation of the aphasia, or due to the worsening of dysarthria and apraxic features). Due to this global deterioration, additional imaging, as well as serological and aetiological examination was performed, which led to a diagnosis of progressive multifocal leukoencephalopathy in the context of HIV1 infection. Antiretroviral therapy was administered to reverse the symptoms. This case illustrates the relevance of clinical disclosure for the establishment of appropriate functional prognoses and discharge planning. It also shows that the initial clinical features can be misleading and can lead to concealment of the real aetiology, as well as delays in appropriate treatment, especially in multipathology patients.

Multimodal programmes in the treatment of myofascial pain syndrome (MPS) – a two-step review

Myofascial pain syndrome (MPS) is one of the most common ailments associated with the human musculoskeletal system, characterised by the presence of the so-called trigger points (TrP – trigger point; MTrPs – myofascial trigger points). The International Association for the Study of Pain indicates that MPS may affect approximately one-third of people with chronic musculoskeletal pain, and that there is a lack of appropriate classification which can be attributed to a misunderstanding and/or misinterpretation of the pathophysiology. Given the diverse causes of pain syndromes in myofascial structures, it is vital to properly select and integrate therapeutic methods. The scientific literature indicates that treatment programmes should include a variety of manual therapy methods and rehabilitation exercises. Trigger point therapies, such as dry needling or dry cupping, are also widely used. At the heart of the success of rehabilitation programmes, in the opinion of the authors of this publication, is their multimodality, i.e. selection of therapeutic methods based on the cause of the pain, providing for measurable, reproducible diagnostic methods in therapy. Aim of the study. The aim of this study is to analyse and infer conclusions on multimodal myofascial pain therapy programmes. Material and methods. Given the complex research problem set as the aim, the study was carried out through a literature review in terms of two criteria: Criterion I (C I): analysis of the literature on the etiology and pathogenesis of myofascial pain (i.e. causes and triggers, symptoms, social and environmental factors determining the onset of MPS), diagnostic procedures (initial diagnosis and ongoing monitoring of treatment outcomes), and therapeutic methods used in the course of MPS. Criterion II (C II): a literature study of research publications addressing multimodal programmes for myofascial pain therapy, with their qualitative evaluation using the modified PEDro scale, and empirical testing of hypotheses based on the literature study and the analysis made in Part I. Data sources: PubMed, SCOPUS, Science Direct, MEDLINE, PEDro, Cochrane, Embase, Web of Science Core Collection, Google Scholar electronic databases were searched systematically, restricting the languages to English and German only. Results. The analysis of the literature showed that the causes, symptoms and associations of myofascial pain have been described in detail. There are also numerous reports on a variety of therapeutic methods, together with a precisely described methodology for their implementation. It is not uncommon to recommend combining methods into multimodal programmes, which unfortunately does not mean that there are many such programmes or that studies on MPS are consistent. The literature study on multimodal treatment programmes for MPS revealed that there is no correlation between its pathogenesis and a purposeful selection of specific therapeutic methods. In a small number of cases, a complex etiopathogenesis led to the formation of multidisciplinary teams. This may be associated with the absence of strict recommendations on the diagnostic methods applicable to the assessment of MPS. Conclusions. 1. Multimodal programmes for the treatment of musculoskeletal pain, notably MPS and MTrPs, should include a detailed and comprehensive diagnosis (structural, biochemical, psycho-emotional) which should serve as the basis for the formation of interdisciplinary rehabilitation teams. 2. Musculoskeletal diagnosis, in addition to radiological assessment, should include measurable techniques of postural and functional assessment (such as pedobarography, wearable sensors, assisted anthropometry, i.e. photogrammetry, videogrammetry, etc.), aimed primarily at the ongoing assessment of posture. 3. The choice of therapeutic methods and patient education should be based on the causes of the patient’s pain, taking into account systemic diseases, postural defects, lifestyle and psycho-emotional state. 4. Scientific research in multimodal treatment programmes should be carried out in randomised groups, with due attention to the methodologies of diagnostic and therapeutic procedures and group selection.

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis

Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.

The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning

Objective To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation. Design Observational–cross-sectional study. Setting Inpatient stroke rehabilitation. Subjects Eighty-seven carers, participating in 48 conferences, were evaluated. Interventions The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality. Main measures Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale. Results Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework. Conclusions The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.

Arab healthcare professionals’ knowledge and perception of occupational therapy

BackgroundOccupational therapy (OT) services are not widespread and not well-represented or integrated into many healthcare settings. As a result, OT is not available at many clinical and rehabilitation institutions, which has led to both poor access and reduced knowledge and benefit from OT in many countries worldwide and in the Arab region.ObjectiveTo examine Arab healthcare professionals’ level of knowledge and perception of OT in an attempt to identify what action is required to enhance awareness and promote OT profession.MethodsA descriptive online survey was conducted for healthcare professionals from different disciplines and Arab countries to obtain their knowledge and perceptions of OT.ResultsA total of 281 healthcare professionals completed the survey (57% were male). Of the total, only 96 (34.2%) have had worked with OT before, 144 (51.2%) were uncertain about the main domain of OT, 98 (34.9%) were not fully aware of the diverse OT healthcare work settings and different health conditions handled by OT, and 126 (44.8%) were not sure about the difference between OT and physical therapy (PT). Almost two third of the sample (187; 66.5%) were not satisfied with their knowledge of OT, 195 (69.4%) showed interest in learning further about OT, and 209 (74.4%) agreed that OT plays a vital role in the interdisciplinary rehabilitation team. There were significant associations between the participants’ knowledge of OT and their specialty (p = 0.01) and years of experience (p = 0.02).ConclusionMost Arab healthcare professionals perceive OT as playing a vital role in the interdisciplinary rehabilitation team. However, OT is not clearly understood and healthcare professionals are not well-educated about OT services and benefits. There is an emerging need to educate healthcare professionals on the focus areas of OT practice. Promoting and advocating for OT is key and crucial.

Engaging Rehabilitation Technicians Through a Career Ladder During a Pandemic.

Nursing assistant turnover is a growing healthcare concern that negatively impacts healthcare organization work environments and has significant financial implications. The purpose of this study was to implement a career ladder program for rehabilitation nursing technicians-nursing assistants who specialize in performing care duties aligned with therapeutic goals in inpatient rehabilitation. The study evaluated the effect on organizational quality metrics of employee engagement, job satisfaction, and annual turnover of rehabilitation nursing technicians. This pilot study was conducted using a quality improvement approach and a between-subjects pretest-posttest design. A three-tier career ladder intervention for rehabilitation nursing technicians in a 76-bed inpatient rehabilitation facility was implemented. Employee engagement and job satisfaction were evaluated in all rehabilitation nursing technicians (n = 44), with a pre-implementation sample size of n = 23 and a post-implementation sample size of n = 21, from January 2020 through December 2020. Twelve rehabilitation nursing technicians participated in the intervention, which consisted of online learning modules, added job responsibilities, and continuing education and were included in the post-implementation sample size. Nondirectional statistical tests were performed with the level of significance set at .05 (two tailed). A majority of the pre-post intervention sample (n = 44) were female (91%), African American (91%), and aged 30-59 years. Employee engagement increased from 78% favorable in 2019 to 86% favorable in 2020. Overall job satisfaction improved from 74% favorable in 2019 to 86% favorable in 2020. Annual turnover decreased from 35% in 2019 to 31% in 2020. In this pilot study, a career ladder program for rehabilitation nursing technicians was effective in increasing and improving employee engagement and job satisfaction while reducing turnover. Rehabilitation nursing technicians are crucial members of the interdisciplinary rehabilitation team providing direct bedside care to optimize patient function. Rehabilitation nursing technician career ladders have the capacity to engage an often underrecognized employee population by creating a positive work environment that promotes job growth and retention in the rehabilitation setting.

Clinical, Neurophysiological, and Genetic Predictors of Recovery in Patients With Severe Acquired Brain Injuries (PRABI): A Study Protocol for a Longitudinal Observational Study.

BackgroundDue to continuous advances in intensive care technology and neurosurgical procedures, the number of survivors from severe acquired brain injuries (sABIs) has increased considerably, raising several delicate ethical issues. The heterogeneity and complex nature of the neurological damage of sABIs make the detection of predictive factors of a better outcome very challenging. Identifying the profile of those patients with better prospects of recovery will facilitate clinical and family choices and allow to personalize rehabilitation. This paper describes a multicenter prospective study protocol, to investigate outcomes and baseline predictors or biomarkers of functional recovery, on a large Italian cohort of sABI survivors undergoing postacute rehabilitation.MethodsAll patients with a diagnosis of sABI admitted to four intensive rehabilitation units (IRUs) within 4 months from the acute event, aged above 18, and providing informed consent, will be enrolled. No additional exclusion criteria will be considered. Measures will be taken at admission (T0), at three (T1) and 6 months (T2) from T0, and follow-up at 12 and 24 months from onset, including clinical and functional data, neurophysiological results, and analysis of neurogenetic biomarkers.StatisticsAdvanced machine learning algorithms will be cross validated to achieve data-driven prediction models. To assess the clinical applicability of the solutions obtained, the prediction of recovery milestones will be compared to the evaluation of a multiprofessional, interdisciplinary rehabilitation team, performed within 2 weeks from admission.DiscussionIdentifying the profiles of patients with a favorable prognosis would allow customization of rehabilitation strategies, to provide accurate information to the caregivers and, possibly, to optimize rehabilitation outcomes.ConclusionsThe application and validation of machine learning algorithms on a comprehensive pool of clinical, genetic, and neurophysiological data can pave the way toward the implementation of tools in support of the clinical prognosis for the rehabilitation pathways of patients after sABI.

Features of the organization of medical rehabilitation at the present stage

The development of rehabilitation at the present stage is one of the priorities in the field of health and social development. Not only medical organizations, but also other organizations can take part in carrying out medical rehabilitation activities. A prerequisite for the implementation of rehabilitation activities is the availability of a license for medical activity with an indication of medical rehabilitation work. Of great concern is the issue of staffing of medical organizations, especially primary care, by such specialists as a doctor of physical and rehabilitation medicine, a doctor of medical rehabilitation, a medical speech therapist, an ergorehabilitation specialist, etc. In the absence of these specialists in medical organizations, it is impossible to form interdisciplinary rehabilitation teams, and in their absence, the solution of medical rehabilitation issues is questionable.
 The article contains an analysis of the current legal framework for medical rehabilitation. The stages of medical rehabilitation in medical organizations are reflected in accordance with the scale of rehabilitation routing. Four groups of medical organizations carrying out medical rehabilitation have been identified. The shortcomings of the current legal framework for medical rehabilitation are indicated, since a comprehensive rehabilitation system is currently being formed in the Russian Federation. For its successful development and implementation in the practical activities of medical organizations and social institutions, a regulatory and legal framework is being developed and improved.
 The approved Procedure for the organization of medical rehabilitation will allow to systematize and organize this work at a qualitatively new level.

The role of the International classification of functioning in the complex rehabilitation of cardiac patients

BACKGROUND: A new format for assessing impaired functions, disabilities and health in accordance with the international classification (ICF), which is necessary at all stages of rehabilitation, is considered of great importance in the practice of an interdisciplinary rehabilitation team. However, in practice, the use of the ICF is very limited due to a number of organizational reasons.
 AIM: To raise awareness among specialists of different fields involved in the rehabilitation of a disabled person, about the main provisions of the ICF; discuss the gradation of rehabilitation potential developed by the authors in cardiac patients.
 MATERIALS AND METHODS: An analysis of referrals to the medical and social expertise bureau (form 088 / U) of patients with cardiovascular diseases has been carried out with the allocation of groups of low and high rehabilitation potential.
 RESULTS: An analysis of the main provisions of the ICF regulating the section of cardiovascular diseases is presented. This classification is the gold standard for assessing the quality of life and medical services provided, substantiating the need, volume and composition of individual rehabilitation measures for a disabled person. The ways of using the principles laid down by the ICF in clinical practice for evaluating the results of complex rehabilitation of patients with cardiac pathology are discussed. The main provisions of the ICF, influencing the quality of rehabilitation measures in patients with cardiological profile, are highlighted. A list of diseases / conditions has been developed and proposed for use, which involves various levels of rehabilitation.
 CONCLUSIONS: The authors have developed and proposed for discussion the gradation of the rehabilitation potential of patients with cardiovascular diseases, as well as discussed the general provisions of the international classification of functioning, simplifying and facilitating the use of ICF in practical work, taking into account the standards of examination, treatment and rehabilitation for cardiac patients in accordance with the standards of examination, treatment and rehabilitation of cardiac patients approved in the Russian Federation.

Interdisciplinary Education Improves Knowledge on Nonmotor Symptoms and Quality of Life in People With Parkinson's Disease

Research Objectives Nonmotor features, including neuropsychiatric symptoms, are common in Parkinson's disease (PD) and can negatively affect quality of life and outcomes. Education regarding these topics is often limited, and nonmotor/neuropsychiatric issues remain under-recognized and under-treated in PD. Our study objectives were to increase awareness of nonmotor/neuropsychiatric issues in PD and examine changes in knowledge, quality of life, and caregiver stress after an educational intervention. Design We conducted 10 monthly education sessions on nonmotor/neuropsychiatric topics, offered in-person and online, and led by an interdisciplinary rehabilitation team. Setting Rehabilitation hospital. Participants People with PD and care partners. An average of 23 participants attended the in-person sessions (range 19-29); an average of 55 participants attended online (range 29-75). The majority of participants attended 9-10 of the 10 sessions (PD 60%, care partners 66.7%). Interventions Educational sessions, research survey questions. Main Outcome Measures Knowledge questions (Likert scale), PD Questionnaire-8 (PDQ-8), SF-12, Multidimensional Caregiver Strain Index. Results The majority of participants were ages 61-80 years, with equal proportions males and females for those with PD and greater female care partners (83.6%). Of those with PD, 3.5% had been diagnosed < 1 year, 33.7% within 1-3 years, 15.9% within 4-6 years, 27.4% within 7-10 years, and 19.6% > 10 years. Across all sessions, pre-session knowledge of people with PD and care partners was low with 57.7-96.1% reporting “average or below” knowledge about nonmotor/neuropsychiatric symptoms, treatments, role of interdisciplinary care, and effects on relationships. Post-session knowledge improved significantly with 71.4-100% PD and care partners reporting “very high or above average” knowledge on these topics. Pre-and post-series quality of life improved in PDQ-8 scores (p=0.025), but there was no significant change in caregiver scales. Conclusions Interdisciplinary team-delivered education sessions demonstrably improved knowledge gaps on nonmotor/neuropsychiatric symptoms and management in people with PD and care partners. These sessions may have a positive effect on quality of life in PD, though their effect on health-related quality of life and caregiver stress requires additional research and participants. Author(s) Disclosures Goldman - Parkinson's Foundation. Merkitch, Marchbanks - none. Nonmotor features, including neuropsychiatric symptoms, are common in Parkinson's disease (PD) and can negatively affect quality of life and outcomes. Education regarding these topics is often limited, and nonmotor/neuropsychiatric issues remain under-recognized and under-treated in PD. Our study objectives were to increase awareness of nonmotor/neuropsychiatric issues in PD and examine changes in knowledge, quality of life, and caregiver stress after an educational intervention. We conducted 10 monthly education sessions on nonmotor/neuropsychiatric topics, offered in-person and online, and led by an interdisciplinary rehabilitation team. Rehabilitation hospital. People with PD and care partners. An average of 23 participants attended the in-person sessions (range 19-29); an average of 55 participants attended online (range 29-75). The majority of participants attended 9-10 of the 10 sessions (PD 60%, care partners 66.7%). Educational sessions, research survey questions. Knowledge questions (Likert scale), PD Questionnaire-8 (PDQ-8), SF-12, Multidimensional Caregiver Strain Index. The majority of participants were ages 61-80 years, with equal proportions males and females for those with PD and greater female care partners (83.6%). Of those with PD, 3.5% had been diagnosed < 1 year, 33.7% within 1-3 years, 15.9% within 4-6 years, 27.4% within 7-10 years, and 19.6% > 10 years. Across all sessions, pre-session knowledge of people with PD and care partners was low with 57.7-96.1% reporting “average or below” knowledge about nonmotor/neuropsychiatric symptoms, treatments, role of interdisciplinary care, and effects on relationships. Post-session knowledge improved significantly with 71.4-100% PD and care partners reporting “very high or above average” knowledge on these topics. Pre-and post-series quality of life improved in PDQ-8 scores (p=0.025), but there was no significant change in caregiver scales. Interdisciplinary team-delivered education sessions demonstrably improved knowledge gaps on nonmotor/neuropsychiatric symptoms and management in people with PD and care partners. These sessions may have a positive effect on quality of life in PD, though their effect on health-related quality of life and caregiver stress requires additional research and participants.

Rehabilitation of intubated COVID-19 patients in a Singapore regional hospital with early intensive care unit and sustained post-intensive care unit rehabilitation

BackgroundA proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients.ObjectiveTo describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation.MethodsRetrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database.ResultsMost patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation.ConclusionEarly ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients.

ОНТОЛОГІЧНА ПІДСИСТЕМА МОДЕЛЮВАННЯ ЗДОРОВ’Я ЛЮДИНИ

In the development of subsystems of the transdisciplinary intelligent information-analytical system of pandemic rehabilitation&nbsp;support (TISP), in particular the ontological subsystem of the White Book of Physical and Rehabilitation Medicine (PRM), an important&nbsp;component is the stage of human health modeling based on the International functioning, restriction of vital functions and health (ICF).&nbsp;This modeling provides increased reliability of the fi nal results of the project. The work uses simulation modeling, which involves the&nbsp;following stages: stage 1 – development of an ontological conceptual model; stage 2 – development of a set of models and algorithms of&nbsp;interaction between stages of modeling and corresponding programs; stage 3 – planning and conducting computer simulations and stage&nbsp;4 – analysis and interpretation of simulation results. Stage 1 in addition to the development of ontological conceptual model allows the&nbsp;formation of the main components of the ontological subsystem and the elementary processes of interaction between concepts, taking&nbsp;into account the relevant relationships. Stage 2, in addition to the development of algorithms and programs, also allows for research to&nbsp;create new architectures and programs for computer systems and a variety of tools to support the processes of reproduction and fixation&nbsp;of health, including sensors for health. At this stage, UML-diagrams of architecture, algorithms and application of the ontological&nbsp;subsystem at diff erent stages of rehabilitation processes are developed. Stage 3 considers computer modeling of rehabilitation processes&nbsp;as the most relevant today. This means that a person is ill, including in connection with a pandemic. At the same time, we have a person&nbsp;with limitations of daily functioning who needs rehabilitation. Rehabilitation is carried out by an interdisciplinary rehabilitation team.&nbsp;From the point of view of building the TISP knowledge base and medical applications, the description of Section 7 of the White Paper&nbsp;needs to be considered in more detail. The well-known expert model of human health assessment is also considered and the results of the research are presented in the form of a list of group coeffi cients of signifi cance of indicators and health factors. Methodological bases&nbsp;of construction of ontological subsystem of modeling of human health are developed, which include system-ontological analysis of&nbsp;knowledge domain “Modeling of human health”, its ontological representation and conceptual model.

Stroke Characteristics and Outcomes of Adult Patients in Northwest Ethiopia.

Stroke is becoming one of the leading causes of adult disability and death in sub-Saharan African countries. The aim of the present study is to provide an up-to-date account of the clinical and demographic characteristics of patients with stroke admitted to the University of Gondar College of Medicine and Health Science Comprehensive Specialized Hospital (CMHS). A hospital based retrospective study design was used to analyze the medical records of all patients with stroke admitted to CMHS from June 20th 2012 and April 30th 2018. Data were cleaned and entered into SPSS for analysis. Among the 448 patients with stroke admitted to CMHS, 58.0% (n = 260) of patients were female, and 42.0% (n = 188) were male. In the present sample, 141 (31.5%) had an ischemic stroke confirmed by neuroimaging, 82 (18.3%) had a hemorrhagic stroke confirmed by neuroimaging, and 252 (50.2%) had a stroke with undetermined type. The mean age of stroke was 63.9 years (range = 18–100, SD: 15.1 years), with no differences observed between stroke subtypes. The most common symptoms that led to patients seeking medical intervention were hemiparesis (67.4%), communication difficulties (56.0%), facial deviation (37.3%), and globalized headache (36.4%). Hypertension was the most commonly reported risk factor (37.1%), which was more prevalent in hemorrhagic (n = 37, 45.1%) than ischemic stroke patients (n = 53, 37.6%), stroke with undetermined type (n = 76, 33.8%). Stroke places a significant burden on sub-Saharan African countries. Results of the current study highlight the need to develop programs that educate the Ethiopian populace about the risk factors and symptoms of stroke, the importance of seeking medical care within the golden window, and the benefits of neuroimaging to accurately diagnose stroke subtype. In addition, the current study provides hospital administrators with empirical data that they can use to form an interdisciplinary stroke rehabilitation team capable of improving outcomes of Ethiopian patients with stroke.

Evaluating a community interdisciplinary neurological rehabilitation team using patient interviews focused on self-management

The Planned Rehabilitation Team is a community interdisciplinary neurological rehabilitation team (CINRT) in the south west of England, providing rehabilitation for adults who have long-term neurological conditions such as multiple sclerosis and motor neuron disease. The service aims to help develop service users’ ability to self-manage their condition and become more independent by providing rehabilitation in their homes and local community. This paper reports an evaluation of the service via service-user interviews with individuals who have a long-term progressive neurological condition. The data, alongside a literature review and clinician feedback, were then used to develop recommendations about information provision, staff training and service protocols, which may be applicable to other similar teams.

Physical activity promotion in daily exercise therapy: the perspectives of exercise therapists in German rehabilitation settings

BackgroundThis study aims to explore exercise therapists’ perspectives on the topic of physical activity promotion (PAP) with a focus on identifying (i) the intervention content and methodological approaches used for promoting physical activity (PA) in daily practice and (ii) the barriers and facilitators that affect PAP.MethodsThis qualitative study comprised the heads of exercise therapy departments (n = 58; 41% women; mean age = 45 years) from different rehabilitation clinics in Germany. Each participant took part in a semi-structured focus-group discussion on PAP in exercise therapy. The findings of the focus groups were processed and interpreted using a conventional qualitative content analysis.ResultsThe exercise therapists demonstrated detailed didactic–methodological strategies and action orientations for PAP. The identified core topics of the content and methods of PAP were (1) conceptualization, (2) exercise and PA for enjoyment and pleasure, (3) education with practice–theory combinations, (4) media and materials for self-directed training, and (5) strategies to enhance personal responsibility and independence. The core topics for the associated barriers and facilitators were (1) structural conditions, (2) the role of exercise therapists, (3) the interdisciplinary rehabilitation team, (4) rehabilitant experiences and expectations, and (5) aftercare services.ConclusionThe topic of PAP is addressed with a high level of variability; exercise therapists involved in this study identify various methods and content for the promotion of PA within their individual practices. However, they display a limited awareness of existing evidence- and theory-based concepts for the promotion of PA as well as underlying theories of behavioural change. This variability may be due to the lack of a defined common framework for promoting PA, insufficient emphasis being placed on PA promotion in the current curricula and training, or extensive conceptual differences within German exercise therapy departments (e.g. different weighting of PAP).

NARRATIVES ENHANCING TRAINEES’ ATTITUDES TOWARD AGING

We analyzed narratives from graduate students trained in aging themes who then interviewed older hospitalized adults about their life experiences. Three Discovery Fellows given a 90-minute training on open-ended interviewing, the medical care system, empathy, and aging themes derived from the Reframing Aging Program performed semi-structured interviews of 30-90 minutes. Subjects were hospitalized older veterans receiving care by an interdisciplinary geriatric rehabilitation team. Narratives were composed following the interviews and electronically uploaded to a secure site. Qualitative analysis was performed with each statement treated as a separate quote using a hierarchical coding system. A total of 774 codes were used to describe the themes present in 582 quotes. A conceptual framework from the narrative themes emerged with 5 groupings: 1) personal experience, 2) people important in life, 3) self-reflection, 4) medical condition, and 5) health maintenance. Concepts displayed included openness, compassion, and morality, as components of wisdom.

Validity and Interrater Reliability of the SOAR Tool during Ambulation in Individuals with Parkinson Disease

Parkinson disease (PD) leads to neurological impairments yet the auditory system remains intact. Rhythmic Auditory Stimulation (RAS) and Patterned Sensory Enhancement (PSE) have been shown to impact gait in PD. Music therapists (MT) can individualize auditory protocols but for a physical therapist (PT) to incorporate PSE into treatment, a new tool is needed. The Synchronized Optimization Auditory Rehabilitation (SOAR) tool is a new software created to simulate PSE techniques and allow for customization depending on the individual’s reaction to the cue. The purposes were to evaluate the validity of the SOAR tool with RAS and the interrater reliability between disciplines’ application of the SOAR tool. Day one - MT measured gait parameters during no cue, RAS, and SOAR tool. Day two - PT measured gait parameters while using the SOAR tool. A moderate to high correlation between RAS and the SOAR tool on gait was found. The interrater reliability between the MT and PT was high. These finding suggest the SOAR tool is an additional auditory cue delivery tool that PTs could use in the treatment of individuals with PD when auditory cues are deemed appropriate and a MT is not an available member of the interdisciplinary rehabilitation team.