Interdisciplinary Rehabilitation Research Articles

Oral rehabilitation of tooth agenesis frequently starts in paediatric dentistry. A retrospective analysis of 625 patients.

As oral rehabilitation of tooth agenesis usually begins at a very young age, it is important to plan the therapy in advance in order to prepare the patient for the final treatment after the end of skeletal and dental growth. The diverse patterns of tooth agenesis require interdisciplinary oral rehabilitation adapted to individual factors like patient's age, number of missing teeth, and alveolar-bone development. The aim of the present high volume single-center study was to provide an overview of the management of patients with tooth agenesis, in terms of treatment approaches, associations, and long-term implant survival, over a period of 30 years. Descriptive analyses were performed to analyse treatment approaches and and how they reated to severity of agenesis as well as patients' gender and age. Kaplan-Meier survival curves and log-rank-tests were used to investigate implant survival over time. Treatment starts usually in childhood or adolescence; orthodontic therapy was the most common treatment. All treatment options showed similar high survival rates. External bone augmentation might be a risk-factor for implant loss.

Interdisciplinary inpatient rehabilitation of acquired brain injury - Part II - a proposed model of care for Pakistan.

Rehabilitation of acquired brain injury (ABI) is a complex and costly intervention in which the comprehensive rehabilitation services should be integrated with neurosciences units to provide best possible opportunities of recovery to the patients. Keeping in view the diversity and chronicity of impairments, the follow up needs to be well planned in terms of duration and patient convenience. These types of services need to be run by the government and funded by government, with parallel efforts to make national guidelines and registry to keep a track of patients suffering from ABI. In Pakistan, the burden of people with ABI is increasing. This can be attributed to the acts of terrorism and bomb blasts, rapid urbanization and increase in number of motor vehicles resulting in increased frequency of roadside accidents, lack of adequate medical and evacuation services and the absence of hyper acute neurosurgical units. We have proposed an ABI rehabilitation plan considering the local health care system, socio-cultural context and resources. The proposed ABI rehabilitation pathway will not only improve the clinical care and continued support delivered by health services to adults with ABI but will also facilitate community reintegration and support their families and care givers.

An Observational Cohort Study of the Role of Level of Effort in Residential Brain Rehabilitation

<h3>Research Objectives</h3> To investigate the role of participant level of effort (LoE) on outcome in residential brain rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. <h3>Design</h3> Observational cohort study. <h3>Setting</h3> Comprehensive integrated brain rehabilitation program within a skilled nursing facility. <h3>Participants</h3> 101 consecutive admissions with acquired brain injury. <h3>Interventions</h3> Individualized interdisciplinary brain rehabilitation; therapist rating of participant LoE during physical therapy, occupational therapy, and speech and language pathology sessions. <h3>Main Outcome Measures</h3> Mayo-Portland Adaptability Inventory (MPAI-4); Supervision Rating Scale (SRS) <h3>Results</h3> Linear regression showed that discharge MPAI-4 Total scores were significantly associated with mean LoE rating, admission MPAI-4 scores, age at admission, and days from injury (Adj R2 = 0.72; F=65.28; p< 0.0001) but not with LoE variability, sex, type of injury, length of stay, or treatment before or during the COVID pandemic. Discharge SRS scores were significantly associated with mean LoE rating, admission SRS scores, and age. After controlling for other variables, a one-unit increase in mean LoE rating was associated with an improvement of 5.1 in discharge Total MPAI-4 score and 1.5 in discharge SRS score. Logistic regression showed the odds of achieving a Minimal Clinically Important Difference on the MPAI-4 were 8.34 times higher with each one-unit LoE increase. Admission MPAI-4 was negatively associated with mean LoE (β= -0.07, t=-8.85, p< 0.0001). Exploratory propensity score analysis suggests a potential causal effect of mean LoE on outcome. <h3>Conclusions</h3> Average LoE is positively associated with and, pending further study, may be causally related to outcome. Age, time since injury, and initial level of disability are also associated with outcome; initial level of disability is negatively associated with LoE. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

Pediatric Cognitive Rehabilitation Roadmap

<h3>Research Objectives</h3> To provide clinicians with a structured framework for the application of evidence-based cognitive rehabilitation strategies for children with acquired brain injuries across the neurorehabilitation continuum of care. The roadmap aims to provide guidance in the determination of assessments, evidence based therapeutic strategies and goals specific to defined stages of brain recovery. <h3>Design</h3> This proposed roadmap defines four stages of cognitive recovery, including disorders of consciousness, confusional states, cognitive and behavioral dysregulation, and acute cognitive impairment. It provides interdisciplinary assessment tools to identify a patient's current stage, monitor progress, and determine transitions between stages. It also utilizes research from ACRM's cognitive rehabilitation training, along with additional pediatric specific evidence-based cognitive rehabilitation interventions, to guide the selection of cognitive rehabilitation approaches specific to each stage of recovery based on variables such as allowance of errors, types of cues and the timing of feedback necessary for optimal acquisition. To implement this interdisciplinary cognitive rehabilitation program at our hospital, our staff first completed ACRM online cognitive rehabilitation training. We then conducted in-services to train our staff on the use of the roadmap to guide the application of the stage specific assessments and strategies within our pediatric ABI population. <h3>Setting</h3> Blythedale Children's Hospital (inpatient and day hospital neurorehabilitation program). <h3>Participants</h3> Pediatric ABI patients admitted to our hospital. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> This roadmap has assisted in individualized treatment planning, school accommodations, and transition planning, along with improvement in interdisciplinary communication and collaboration. It also resulted in clearer guidelines for families and schools on how to accommodate students' deficits to improve daily function and adjust plan to foster increased independence over time. <h3>Conclusions</h3> This pediatric cognitive therapy roadmap aims to improve overall pediatric cognitive rehabilitation including staff competency, caregiver education, and classroom recommendations. We also hope this tool and its breakdown of the brain injury recovery trajectory into four stages may provide additional prognostic indicators in future research. <h3>Author(s) Disclosures</h3> No disclosures to report.

The Helplessness Dimension of Pain Catastrophizing Mediates the Relation between PTSD Symptoms and Pain Rehabilitation Measures.

Comorbid chronic pain and post-traumatic stress disorder (PTSD) complicate the treatment of both conditions. Previous research has identified pain catastrophizing as a potentially important variable contributing to the relationship between chronic pain and PTSD. However, little is known regarding how the different dimensions of pain catastrophizing-rumination, magnification, and helplessness-uniquely contribute to the relationship between PTSD symptomatology and measures of pain outcome. 491 treatment seeking participants were admitted to a three-week interdisciplinary pain rehabilitation program between July 2016 and March 2020. The patients completed measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, quality of life (QOL), and PTSD symptoms at pretreatment. Parallel mediation analyses were conducted to evaluate the mediating effect of the Pain Catastrophizing Scale subscales on the relationship between PTSD symptomatology and pain-relevant variables. The helplessness subscale accounted for significant unique variance in the relationship between PTSD symptomatology and pain severity (b = 0.010, SE = 0.002, 95% CI: 0.006, 0.014), pain interference (b = 0.004, SE = 0.002, 95% CI: 0.001, 0.008), and mental health QOL (b = -0.117, SE = 0.031, 95% CI: -0.179, -0.059), while the rumination and magnification subscales had no significant influence. Pain catastrophizing is a multifaceted construct. These results suggest that the helplessness dimension of pain catastrophizing may be the primary target when treating patients with comorbid chronic pain and PTSD symptoms. This study represents the first to evaluate the influence of the individual dimensions of pain catastrophizing on the relationship between PTSD symptomatology and chronic pain outcome.

Factors influencing employment among people with spinal cord injury in South Africa

Purpose The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa. Methods Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis. Results The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI. Conclusion The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa. Implications for rehabilitation Rehabilitation programs should be adapted and tailored to enhance physical independence. Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed. For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.

Young Adult Pain Rehabilitation: Interdisciplinary Development and Preliminary Outcomes of a Novel Treatment Program.

Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.

Efficacy of interdisciplinary rehabilitation in child cancer survivors: Impact on physical fitness, fatigue and body composition after 1-year follow-up.

Childhood cancer survivors experience reduced physical activity level, participation as well as health-related quality of life. This prospective, pre-/post-intervention and follow-up cohort study aims to determine the efficacy of an interdisciplinary rehabilitation on improving physical fitness, fatigue and body composition. A total of 24 childhood cancer survivors (mean age: 12.15 years ± 3.2; 14 females; 10 males) were recruited 6 months after medical treatment and received a 4-month interdisciplinary intervention. Cardiorespiratory fitness (PredVO2peak and PredLoadmax ), body composition (dry lean weight) and quality of life (general fatigue) were assessed at baseline, post-intervention and 1-year follow-up. Linear mixed models were used to analyse data. Linear mixed modelling revealed a significant main effect of time on predicted maximal load (F = 13.189, df = 36.179, p < 0.001), dry lean weight (F = 64.813, df = 37.019, p < 0.001) but also significant improvement of general fatigue score (-9.039 ± 4.300, 95% CI -17.741 to -0.336, p = 0.042), indicating a decline in general fatigue. With emerging evidence that physical activity is safe and feasible, together with increasing numbers of childhood cancer survivors at risk for long-term chronic co-morbidities, this study advocates for better access to interdisciplinary rehabilitation programmes in order to improve their physical condition and their body composition and reduce fatigue.

A Novel Concentrated, Interdisciplinary Group Rehabilitation Program for Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Nonrandomized Clinical Intervention Study.

Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD. The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients. This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV1) <80% of expected and a FEV1/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05. The recruitment period will last from April 2022 until June 2023. If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD. ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281. PRR1-10.2196/40700.

Study design of an interdisciplinary and participatory nature-based palliative rehabilitation intervention in a Danish nursing home for people with severe dementia

BackgroundA limited amount of research has examined how nature-based palliative rehabilitation can be implemented in nursing homes for people with dementia, even though evidence suggests that these gardens are underused. This paper will present the study protocol of an intervention study co-designed in an interdisciplinary collaboration with a nursing home for people with dementia, to develop a tailored nature-based palliative rehabilitation program to increase qualified use of garden with the purpose of promoting a range of health outcomes.MethodsThe study is a single-cased quasi-experimental mixed methods study. The intervention will be developed, designed, and implemented in collaboration with the nursing home, using different co-design tools and methods. The effect of the intervention will be evaluated using the The Neuropsychiatric Inventory Nursing Home version in combination with medication use, a survey on staff burnout, and cameras in the garden to register garden use. A process evaluation with single- and focus group interviews consisting of various stakeholders in the study will be used to gain knowledge on the intervention processes and implementation.DiscussionThe paper presents new approaches in the field of palliative rehabilitation for people with dementia using nursing home gardens, through interdisciplinary collaboration, participatory co-design approach and mixed methods design. Using both effect and process evaluation, the study will provide unique insights in the role and importance of participatory process, interdisciplinary collaboration, and tailoring palliative rehabilitation activities in gardens at nursing homes to local needs and wishes. These results can be used to guide other nursing homes and renewal projects in the future.Trial registrationISRCTN, ISRCTN14095773. Registered 15 July 2022—Retrospectively registered.

Evaluation of a non-pharmacological interdisciplinary pain rehabilitation and functional restoration program for chronic pain in veterans.

To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high-impact chronic pain, offered in a large metro-area Veterans Health Administration (VHA) system. VHA Corporate Data Warehouse electronic medical record data for patients treated by EVP between 2015 and 2019. This retrospective design first compared EVP patients considered engaged or not engaged in completing treatment in terms of demographic characteristics and post-treatment changes in clinical measures related to opioid use and mental health. We then compared mortality risk between matched groups of treated and untreated patients with chronic pain and concurrent opioid prescriptions using propensity score matching and Cox proportional hazards methods. "Treated" in the matched groups was defined as any level of EVP participation (i.e., both engaged and not engaged). We first identified 1053 EVP patients with 1year of pre-and post-treatment follow-time and determined their engagement level. From those with chronic pain and prescription opioids, we matched 237 EVP patients to 375 untreated patients. Engaged patients (57.4% of treated patients), were somewhat older than the non-engaged (mean age 57.1 vs. 53.7, Cohen's D=0.30), and achieved lower mean PHQ9 depression scores in the post-treatment year (9.2 vs. 10.6, Cohen's D=0.20). Participation in EVP was associated with a 65% lower mortality risk among Veterans with chronic pain and opioid use when compared to the untreated patients: (HR: 0.35, 95% CI: 0.17, 0.75). EVP was associated with a large reduction in mortality risk for Veterans with both chronic pain and opioid use. This result could inform the decision process in a VA station or region when considering providing or expanding access to an interdisciplinary rehabilitation/functional restoration program for chronic pain.

Palliative rehabilitation in end-stage renal failure

BackgroundIn end-stage chronic kidney disease (CKD), patients experience disabilities stemming from organ failure. These can be worsened by symptoms and complications of underlying cause(s), and the conditions associated with the CKD. There is a dearth of literature regarding palliative rehabilitation in end-stage CKD. Our case highlights the complex medical and rehabilitative issues that such patients face.Case presentationA 64-year-old male had end-stage CKD and declined dialysis. After sustaining a myocardial infarction, he suffered a posterior circulation stroke the following month. Whilst undergoing stroke rehabilitation, his progress was further hampered by symptoms of kidney failure. The patient underwent interdisciplinary rehabilitation for 29 days. Goal-setting was performed with the patient and family to allow contextualization to the patient’s stage of disease, beliefs and environment. Care-giver training was provided to facilitate discharge back home. He demonstrated improvements in physical endurance and function. His Functional Independence Measure score improved from 51 to 82. He outlived his prognosis of 3–6 months and demised 15 months after discharge.ConclusionsIn end-stage CKD without renal replacement therapy, rehabilitation and palliative care efforts align to enhance quality of life, in the face of unlikely cure. While palliative care provides symptom management and supportive care, rehabilitation safeguards physical endurance and ability. It is in the hope of doing so, independence and thence, self-esteem, can be maintained. Future research should explore the benefits of palliative rehabilitation in renal failure.

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.

A values-based approach to goal setting in neuro-rehabilitation following severe brain injury: An audit of service development

BackgroundA patient-centred, values-based goal setting pathway was launched on a level 1 neuro-rehabilitation service to create a holistic process that adhere to national guidelines, promotes interdisciplinary goal-focused rehabilitation and makes rehabilitation of personal value to patients.MethodsA service audit was completed following implementation and provision of training. The audit was separated into neuro-rehabilitation versus Prolonged Disorder of Consciousness (PDoC) assessment. Surveys and interviews were completed with staff and service users to elicit their views.ResultsA global improvement in adherence to goal setting processes was seen, however, less adherence was noted with PDoC patients. Staff reported increased confidence in goal setting, but had ongoing challenges in PDoC patient scenarios. All service users provided positive feedback.ConclusionThis approach appears to be acceptable and meaningful to service users and an appropriate method of goal setting in rehabilitation after severe acquired brain injury, with more exploration needed in PDoC groups.

Lower urinary tract symptoms following discontinuation of long-term non-medical use of testosterone preparations

Introduction. The aging process in men is accompanied by a progressive decrease in the level of serum testosterone (Tc). In addition to chronological aging, various factors contribute to the decline in testosterone levels. One of such factors contributing to the decrease in endogenous Tc and the development of secondary hypogonadism is the long-term use of testosterone preparations (TPs) used for non-medical purposes.Objective. To assess the nature of lower urinary tract symptoms following discontinuation of long-term non-medical use of testosterone preparations.Materials and methods. A clinical and statistical analysis of examination results in 31 men aged 22 – 46 years who received TPs for non-medical purposes while visiting gyms and subsequently turned to urologist with complaints of lower urinary tract symptoms (LUTS) was carried out. The study used the International Prostatic Symptom Score (IPSS) questionnaire, laboratory and instrumental examinations: general urine examination, general blood examination, prostate secretion microscopy, evaluation of serum total Tc, follicle-stimulating and luteinizing hormones, prolactin, estradiol, prostate ultrasound and bladder ultrasound, uroflowmetryResults. When assessing LUTS, the prevalence of irritative symptoms was noted. The level of serum total Tc in 13 (41.9%) men was in the range of 8 – 11 nmol/l, in 18 (58.1%) men it was below 8 nmol/l. In addition, most patients (77.4%) had areas of reduced blood flow in the prostate, and 67.7% had prostate fibrosis.Conclusion. Discontinuation of the use of long-term non-medical TPs can lead to the development of secondary hypogonadism and LUTS, which in most cases are irritative. In the treatment of these patients, an interdisciplinary rehabilitation program should be developed.

Gamma-Band Modulation in Parietal Area as the Electroencephalographic Signature for Performance in Auditory-Verbal Working Memory: An Exploratory Pilot Study in Hearing and Unilateral Cochlear Implant Children.

This pilot study investigates the neurophysiological patterns of visual and auditory verbal working memory (VWM) in unilateral cochlear implant users (UCIs). We compared the task-related electroencephalogram (EEG) power spectral density of 7- to 13-year-old UCIs (n = 7) with a hearing control group (HC, n = 10) during the execution of a three-level n-back task with auditory and visual verbal (letters) stimuli. Performances improved as memory load decreased regardless of sensory modality (SM) and group factors. Theta EEG activation over the frontal area was proportionally influenced by task level; the left hemisphere (LH) showed greater activation in the gamma band, suggesting lateralization of VWM function regardless of SM. However, HCs showed stronger activation patterns in the LH than UCIs regardless of SM and in the parietal area (PA) during the most challenging audio condition. Linear regressions for gamma activation in the PA suggest the presence of a pattern-supporting auditory VWM only in HCs. Our findings seem to recognize gamma activation in the PA as the signature of effective auditory VWM. These results, although preliminary, highlight this EEG pattern as a possible cause of the variability found in VWM outcomes in deaf children, opening up new possibilities for interdisciplinary research and rehabilitation intervention.

Clinician reports of self-awareness after traumatic brain injury: a retrospective chart review

BackgroundImpaired self-awareness (i.e., a lack of insight) is experienced by most individuals who have sustained a moderate to severe traumatic brain injury (TBI). During the early recovery period post-injury, these individuals may not be able to recognize their abilities and limitations, hence, negatively impacting their daily life and function. Although there are assessments and interventions to improve self-awareness after TBI, little is known about how clinicians assess and address this impairment in an inpatient rehabilitation setting.ObjectiveTo examine how clinicians assess, report, and provide interventions for impaired self-awareness after TBI.MethodsA retrospective chart review was conducted on interdisciplinary rehabilitation clinician entries for individuals with TBI (n = 67) who received inpatient rehabilitation within a five-year period (2014–2019). A reflexive thematic analysis was used to identify themes pertaining to self-awareness.ResultsThree themes were generated to explore clinician responses to their clients’ impaired self-awareness: 1) ‘recalling and understanding’ described clinician observations of client behaviors and expressions of self-awareness, 2) ‘applying and analyzing’ identified clinicians providing relevant tasks and advice to clients, and 3) ‘evaluating and creating’ described clinicians actively interacting with clients by providing feedback, guided prompts, and a follow-up plan.ConclusionClinicians produced varied responses to clients’ impaired self-awareness after TBI. Findings may help to develop research priorities and integrated knowledge translation initiatives to increase evidence-based practice for impaired self-awareness after TBI.

Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOveR): protocol of an investigator-blinded, randomised, case series with multiple baseline design to evaluate the feasibility and preliminary efficacy of a 12-week treatment for persistent post-concussion symptoms

BackgroundUp to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored.MethodsFifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews.DiscussionResults from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes.Trial registrationANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118

Healthcare professionals’ experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study

Purpose There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. Methods Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. Results The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: “Frustration” includes the informants’ doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. Conclusions The informants’ frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team’s need for additional time and support. IMPLICATIONS FOR REHABILITATION Healthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identities In order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from experts For appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretation The rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language

Management of Anti-melanoma Differentiation-Associated Gene 5 (Anti-MDA5)-Positive Dermatomyositis in an Acute Rehabilitation Center: A Case Report

Dermatomyositis is an immune-mediated myopathy predominantly characterized by skin and musculoskeletal manifestations. Although often described in the context of its pathognomonic cutaneous features, dermatomyositis may have variable presentations depending on the subtype. In this report, we present a case of anti-melanoma differentiation-associated gene 5 (anti-MDA5)-positive dermatomyositis that initially presented with respiratory symptoms. An appropriate diagnosis and comprehensive interdisciplinary rehabilitation led to a significant improvement in functional status and a better overall prognosis for the patient.