Mobile Rehabilitation Research Articles

10.M. Scientific session: JA ImpleMENTAL Abstract Workshop

Abstract JA ImpleMENTAL is major initiative across Europe and was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Programme. The workshop is organized by JA ImpleMENTAL in partnership with EUPHA Mental Health Section, a member of the JA ImpleMENTAL Stakeholder Forum. It will include four presentations that will contribute to an interesting discussion about the future of community mental health services that are user-centered, recovery-oriented and human rights based as well as about the synergies with national strategies and the EU Initiatives. Vasileia Konte the JA ImpleMENTAL Coordinator will provide an overview of the Mental Health System Reforms based on the Belgian Best Practice model, which is implemented in 11 countries. It will elaborate on key activities and prioritized key areas of mental health system transformation as well as enablers, barriers and key lessons learned from the implementation process. Danijela Štimac Grbić from Croatia will present the Croatian experience in the implementation of a mobile rehabilitation team for providing psychosocial interventions in the community in which peer workers are employed for the first time. Based on the successful work of the mobile team, Croatia has included 30 new mobile teams in its network of public health services that will operate throughout Croatia. Teresa Nicolas Lopez from Murcia Spain will present the project “Inclusive Life Projects” which offers comprehensive community care to adults with severe mental illness within projects of autonomous living and provides a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Anna Paradesioti from Cyprus will focus on how to achieve a smooth transition from inpatient to community mental health services promoting collaboration among those services and professionals, by adopting an intersectoral approach. Jutta Lindert will provide valuable comments by bringing helpful insights and views of the Stakeholder Forum. Key messages • Transformation towards community based care increase availability and efficiency of services. • User’s centered human rights based recovery approach care with engaging stakeholders including people with lived experience.

Rehabilitation Recommendations According to § 31 SGB XI: Empiricism, Discussion and Health Policy Implications

The principle of "rehabilitation before care" is a principle of social law. The recommendation of the Medical Service (MD) as part of the assessment (§ 31 SGB XI) plays an important role in rehabilitation recommendations. In around 3% of its assessments, the MD recommends implementation of rehabilitation. Only every fourth to fifth recommendation is actually carried out. The aim of the study was to find out if rehabilitation recommendations are utilized and exploited. This study aimed to examine the perspective of insured persons whose recommended rehabilitation was actually carried out. After evaluating 586,228 routine data records with care assessments by the MD, 1,972 survey questionnaires were sent out in March 2023, and 1,116 analyzable questionnaires were included in the data analysis. In seven questions, the respondents were asked to retrospectively assess the overall success and satisfaction with rehabilitation procedures carried out. The evaluation of the results showed that 87% of the study participants would be ready to undergo repeat rehabilitation. The assessment of the success of rehabilitation in terms of remaining at home for a longer period of time also carried weight. On the other hand, only around 10% of rehabilitation was carried out on an outpatient basis. One previously assumed reason for the low rate of patients taking advantage of recommended rehabilitation was that those in need of care had already received rehabilitation in the previous year. In this study focussing on whether recommended rehabilitation is taken advantage of, this assumption was found not to be correct. The question needs to be raised whether the strong focus in Germany on inpatient rehabilitation is up-to-date, both medically and with regard to the preferences of those entitled to rehabilitation. In contrast to inpatient rehabilitation, individual, outpatient and, if necessary, mobile rehabilitation offers might be more suitable, and these would also take into consideration issues of individual mobility and patient autonomy. The offer of different modes of rehabilitation also enables meeting the wish of those patients who prefer to have rehabilitation carried out in a home environment.

Assessing the recovery process in a mobile rehabilitation team for people with severe mental disorders by using the Recovery Helm

IntroductionPeople with severe mental disorder (SMD) determine the goals and paths of recovery with professional and nonformal supporters such as family and friends. It is crucial that these people, as well as everyone who participates in the recovery process, are familiar with all the elements that contribute to the recovery of mental health in order to help people with SMD identify goals and assess their achievement. We have therefore created a Recovery Helm to assess the functioning in the various areas necessary for recovery to help us assess the needs and monitor the recovery process of people with mental health problems.ObjectivesThe goal is to assess the initial state of mental health and monitor the effects of the mobile rehabilitation team program on the recovery of people with SMI through the use of the Recovery Helm.Methods We used the Recovery Helm: http://shorturl.at/gyCDQ as an instrument for the initial assessment of all areas crucial for recovery to determine the goals of recovery and interventions needed to achieve these goals of rehabilitation in 30 patients included in the program of the mobile rehabilitation team applying different psychosocial interventions according to the individual recovery plan made as a mutual agreement between patients and rehabilitation team. The status of recovery is evaluated after 3 and 6 months.ResultsThe results indicate significant improvements in most areas of the recovery assessed at the Recovery Helm selected as individually important goal for a person included in the rehabilitation programConclusionsThe Recovery Helm is an excellent clinical assessment instrument that helps determine recovery goals and rehabilitation interventions that promote recovery and monitor the achieved results.Disclosure of InterestNone Declared

Cryoanalgesia as Essential Component of PerioperativeMultimodal Analgesia in Pediatrics – Literature Review

The article introduces the application of cryoanalgesia as an innovative method utilizing low temperatures toalleviate pain, particularly in perioperative care for pediatric patients. Emphasis is placed on the necessity of paincontrol in accordance with Enhanced Recovery After Surgery (ERAS) principles. Temporary or permanent nervestructure damage due to cooling attenuate pain conduction, finding application across various medical fields. Inthe context of pediatric chest surgery, cryoanalgesia proves exceptionally effective in managing acute pain andpreventing chronic pain. Research demonstrates shortened hospitalization times, potential opioid dose reduction,and improved mobility rehabilitation. The article describes the first intraoperative application of intercostal nervecryoablation during the Nuss procedure in Polish children, showcasing its efficacy in treating acute pain. Twocryoanalgesia techniques are discussed in the article: intraoperative – intrathoracic during the thoracoscopy andpercutaneous – before the surgical procedure. Studies underscore the crucial role of precise probe placement foroptimal results. In conclusion, cryoanalgesia serves as an effective complement to pain control methods, presentingfavorable outcomes in various medical specialties, especially pediatric surgery. The article underscores the need forfurther research and a multidisciplinary approach to achieve optimal results.

Staying Active with Multimorbidity In Acute hospital settings (StAMInA) trial: protocol for a feasibility randomised controlled trial of allied health assistant mobility rehabilitation for patients with multimorbidity

IntroductionKey to improving outcomes for patients with multimorbidity is increasing mobility through prescription of a physical activity programme, but this can be difficult to achieve in acute hospital settings. One...

Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable.

Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.

Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable.

Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.

EEG Based Cortico-Muscular Connectivity During Standing Early Post Stroke.

In this exploratory study we studied brain activation and corticomuscular connectivity during standing in healthy individuals and persons with stroke within 40 days of cerebrovascular accident (CVA). EEG and EMG data were acquired during standing and analysis showed a trend of higher EEG power (hyper activation) in the stroke group. Direct corticomuscular connectivity between sensorimotor cortices and contralateral lower extremity muscles showed lower connectivity between affected motor, premotor, and sensory cortices, and contralateral lower extremity peripheral muscles with moderate effect size. The preliminary data in this paper suggest re-organization in left sensorimotor cortex role in controlling contralateral lower extremity muscles during standing. Correlational analysis in stroke group within 40 days of CVA showed a relationship between higher corticomuscular connectivity and better scores on balance assessments.Clinical Relevance- This study evaluates corticomuscular connectivity during standing in healthy controls and individuals with subacute stroke (within 40 days of injury). Better understanding of cortical control of standing post stroke is important to improve strategies used in mobility rehabilitation.

Virtual reality as a means to explore assistive technologies for the visually impaired.

Visual impairment represents a significant health and economic burden affecting 596 million globally. The incidence of visual impairment is expected to double by 2050 as our population ages. Independent navigation is challenging for persons with visual impairment, as they often rely on non-visual sensory signals to find the optimal route. In this context, electronic travel aids are promising solutions that can be used for obstacle detection and/or route guidance. However, electronic travel aids have limitations such as low uptake and limited training that restrict their widespread use. Here, we present a virtual reality platform for testing, refining, and training with electronic travel aids. We demonstrate the viability on an electronic travel aid developed in-house, consist of a wearable haptic feedback device. We designed an experiment in which participants donned the electronic travel aid and performed a virtual task while experiencing a simulation of three different visual impairments: age-related macular degeneration, diabetic retinopathy, and glaucoma. Our experiments indicate that our electronic travel aid significantly improves the completion time for all the three visual impairments and reduces the number of collisions for diabetic retinopathy and glaucoma. Overall, the combination of virtual reality and electronic travel aid may have a beneficial role on mobility rehabilitation of persons with visual impairment, by allowing early-phase testing of electronic travel aid prototypes in safe, realistic, and controllable settings.

The Transcallosal Highway: The ipsilateral silent period as a neural biomarker for impaired corpus callosum communication in multiple sclerosis

Multiple sclerosis is a neurodegenerative disease that damages myelin sheath within the central nervous system. This axonal demyelination impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in transcallosal communication impairs the coordination of movements requiring precise temporal and spatial components such as lower extremity function during gait. These bilateral movements require constant communication across the corpus callosum to excite and inhibit specific muscle groups. The ipsilateral silent period (iSP) is an indirect marker of the magnitude for transcallosal inhibition. We hypothesize that the iSP may also serve as a neural biomarker for transcallosal impairments originating from the more affected hemisphere and highlight underlying mechanisms for gait asymmetries in PwMS. Our ongoing study utilizes transcranial magnetic stimulation to assess the inhibitory capacity between the brain's hemispheres (i.e., iSPs). A focal magnetic pulse is delivered to the first dorsal interosseous resulting in a suppression of muscle activity, thus reflecting inhibitory transcallosal communication. There is a lack of research analyzing directionality data between the more and less affected hemisphere in PwMS. Therefore, we evaluate outcome metrics dependent upon the individual's more affected hemisphere. Twenty-three PwMS completed the ongoing protocol and inhibitory metrics such as depth iSP% average, duration, depth iSP% max, transcallosal conduction time, and onset latency were collected. No statistically significant differences have been found between the two hemispheres in PwMS. However, beyond directionality data, our study is investigating gait coordination with overall inhibitory capacity. Walking coordination is quantified using a metric called phase coordination index (PCI). A greater PCI value reflects poorer gait coordination. We hypothesize those who demonstrate better gait coordination (lower PCI values), will have a greater iSP. These findings will determine the potential of iSPs as a neural biomarker to address gait asymmetries and stratify participants into individualized mobility rehabilitation protocols. Multiple sclerosis is a neurodegenerative disease that damages myelin sheath within the central nervous system. This axonal demyelination impacts communication between the brain's hemispheres in persons with multiple sclerosis (PwMS). Changes in transcallosal communication impairs the coordination of movements requiring precise temporal and spatial components such as lower extremity function during gait. These bilateral movements require constant communication across the corpus callosum to excite and inhibit specific muscle groups. The ipsilateral silent period (iSP) is an indirect marker of the magnitude for transcallosal inhibition. We hypothesize that the iSP may also serve as a neural biomarker for transcallosal impairments originating from the more affected hemisphere and highlight underlying mechanisms for gait asymmetries in PwMS. Our ongoing study utilizes transcranial magnetic stimulation to assess the inhibitory capacity between the brain's hemispheres (i.e., iSPs). A focal magnetic pulse is delivered to the first dorsal interosseous resulting in a suppression of muscle activity, thus reflecting inhibitory transcallosal communication. There is a lack of research analyzing directionality data between the more and less affected hemisphere in PwMS. Therefore, we evaluate outcome metrics dependent upon the individual's more affected hemisphere. Twenty-three PwMS completed the ongoing protocol and inhibitory metrics such as depth iSP% average, duration, depth iSP% max, transcallosal conduction time, and onset latency were collected. No statistically significant differences have been found between the two hemispheres in PwMS. However, beyond directionality data, our study is investigating gait coordination with overall inhibitory capacity. Walking coordination is quantified using a metric called phase coordination index (PCI). A greater PCI value reflects poorer gait coordination. We hypothesize those who demonstrate better gait coordination (lower PCI values), will have a greater iSP. These findings will determine the potential of iSPs as a neural biomarker to address gait asymmetries and stratify participants into individualized mobility rehabilitation protocols.

Influence Of Baseline Comorbid Diseases on Major Depression and The Effect of Intensive Medical Treatment on Functional Mobility in Depressed Patients Compared with Those Without Depression

Objectives Somatic diseases, depression and functional mobility were examined in a follow-up study in geriatric patients. The first aim of the study was to assess the independent and moderator effects of baseline diseases on depression before adjustment by examining whether this influence will sustain or switch after adjustment. The second aim was to explore the differential treatment outcomes in functional mobility in depressed patients versus those with no depression. Methods A sample of n = 1,816 multimorbid patients consisting of n = 902 with a diagnosis of major depression and their counterparts n = 914 without depression were examined at two time points. They all underwent acute rehabilitation. Those who were diagnosed with major depression received an antidepressant and psychotherapy treatment. Depressive symptoms were recorded with the Geriatric Depression Scale. Functional mobility was measured using the Tinetti Test. Results We found that 431 patients (47%) were in partial remission at follow-up. The results yield a significant improvement in functional mobility in both groups as an effect of the intensive rehabilitation program. These findings support published findings highlighting an overall functional health enhancement owing to a combined medical rehabilitation, antidepressant and psychotherapeutic treatment as a result of early intensive rehabilitation for elderly patients with multiple medical conditions. The findings show that elderly patients with multiple chronic conditions benefit from intensive rehabilitation, psychotherapy and antidepressant treatment within three weeks of intensive stationary treatment. Results showed that baseline comorbid diseases (mainly focal neurologic deficits and coronary artery diseases) each act as risk factors for major depression before treatment. An intercept effect was unveiled between obesity and arterial hypertension that arises as risk factors for depression before adjustment. After adjustment, we found that baseline chronic conditions, specifically coronary artery disease, focal neurologic deficits, heart or valvular insufficiency, artificial valvular or pace maker and tumour diagnosis in respiratory organ each act as a potential risk factor for depression occurrence. The intercept effect erased after treatment. Functional health was increased significantly in both groups at follow-up. However, there was no difference in the increase of functional mobility (Tinetti Test) in non-depressed and depressed patients following the rehabilitation. Conclusion The results bolster up the conjecture that specific somatic diseases influence major depression before and after treatment and support an association between somatic diseases, depression, and functional health in elderly patients. In depressed and non-depressed patients, geriatric rehabilitation boosts functional mobility, which is crucial for the maintenance of autonomy in elderly patients. Major depression may hamper functional mobility rehabilitation’s outcome only if not well managed or overlooked.

The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial

BackgroundTotal hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. ObjectiveThis study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. DesignRandomised controlled trial. SettingA teaching hospital in Shanghai, China. ParticipantsEighty-six patients who received a unilateral primary total hip or knee arthroplasty. MethodsThe participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. ResultsAt 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = −0.51, 95% CI −0.91 to −0.10, P = .015), and depression (adjusted mean difference = −0.37, 95% CI −0.66 to −0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. ConclusionMobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. Trial registrationRegistered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

CURRENT PROPOSALS ON PHYSICAL THERAPY AS A NECESSARY COMPONENT FOR INCREASE SOCIO-ECONOMIC POTENTIAL OF SOCIETY

This article describes the relationship of socio-economic well-being and human health. The impact of chronic noninfectious diseases on physical performance and quality of life is considered. The economic feasibility of using physical therapy in the treatment of chronic non-infectious diseases is described. Practical problems such as communication, territorial and economic inaccessibility of the services of physical therapists are highlighted. To solve the problems, it is proposed: implementation of protocols of multidisciplinary coordination of specialists, establishment of mobile rehabilitation teams, application of telerehabilitation and use of economically available equipment for physical therapy.

Besonderheiten geriatrischer Rehabilitation: Zielgruppe, Angebote, Zugang

Geriatric rehabilitation is an interdisciplinary offer of rehabilitation services for elderly persons who often have several impairments and, in some cases, an already existing need for nursing care. It aims at maintaining their self-determined participation in everyday life to the greatest possible extent as well as at avoiding or reducing their needs for nursing care. Characteristic features of geriatric patients are high vulnerability due to an age-related reduction of reserves and often multiple chronic diseases. This is why the geriatric assessment and the multi-professional geriatric team present a correspondingly broad base.As a result of the vulnerability of geriatric patients, early rehabilitation that already starts during acute treatment in hospital is of great importance for their rehabilitative care. Of total German geriatric-rehabilitative care 75 % is inpatient- and 8 % day-care in hospital. These kinds of care are largely provided nationwide. Unfortunately, they often cannot make use of the entire rehabilitation potential of geriatric patients. Independent geriatric rehabilitation facilities, however, are not available in all federal states yet and mainly focus on inpatients. They account for 17 % of geriatric-rehabilitative care - for more than 95 % in connection with a previous hospitalization. Up to now, there has not been an adequate focus on the utilization of out-patient and mobile geriatric rehabilitation as well as on the use of geriatric rehabilitation in case of a slowly progressing deterioration of activities and participation without any acute event. Especially, mobile rehabilitation that is directly performed at the patient's home constitutes a particularly suitable rehabilitation setting mainly for persons who will still need nursery care despite reaching their rehabilitation targets. But this kind of rehabilitation care is still little known.The article provides decision-making aids to physicians in hospitals and doctor's offices as well as information on how to gain access to geriatric-rehabilitative care services, including new regulations to facilitate this access, which are planned for 01 July 2022.

Current physical therapy practice and implementation factors regarding the evidence-based ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline in Germany: a cross-sectional online survey

BackgroundEvaluation of the current physical therapy practice for German stroke rehabilitation with respect to the ‘Rehabilitation of Mobility after Stroke (ReMoS)’ guideline recommendations and the associated implementation factors.MethodsA descriptive cross-sectional study employing an online survey was performed among German physical therapists in 2019. The survey consisted of three sections with open and closed questions: 1) self-reported use of ReMoS recommendations, 2) barriers of guideline use and 3) socio-demographic characteristics. The benchmark level for guideline adherent physical therapy was set at > 80%.ResultsData from 170 questionnaires were eligible for analysis. Participants’ mean age was 41.6 years, 69.4% were female, while 60.1% had no academic degree. The ReMoS guideline was unknown to 52.9% of the responders. Out of all the 46 ReMoS guideline recommendations, only ‘intensive walking training without a treadmill’ was reported to be performed in a guideline adherent manner. Respondents usually denied any personal limitations, such as limited knowledge, or that the ReMoS guideline did not fit their routine practice.ConclusionsAmong German physical therapists, the ReMoS guideline is not well-known and many interventions are not performed as recommended, illustrating the discrepancies between the ReMoS guideline recommendations and current physical therapy practice. Interventions aimed at overcoming this gap should consider both knowledge of existing barriers and facilitators of guideline usage.Trial registrationThe study was retrospectively registered to the German Clinical Trials Register (DRKS00026681).

Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework.

ObjectiveEvidence-based guidelines are important for informing clinical decision-making and improving patient outcomes. There is inconsistent usage of guidelines among physical therapists involved in stroke rehabilitation, suggesting the existence of a gap between theory and practice. Addressing the German guideline “evidence-based rehabilitation of mobility after stroke (ReMoS),” the aims of this project are (1) to describe the current physical therapy practice within the context of stroke rehabilitation in Germany, (2) to evaluate barriers and facilitators of guideline usage, (3) to develop, and (4) to pilot test a theory-based, tailored implementation intervention for the benefit of guideline recommendations.Materials and MethodsThis study uses a stepwise mixed methods approach for implementing a local guideline. A self-reported online questionnaire will be used to survey the current physical therapy practice in stroke rehabilitation. The same survey and systematic-mixed methods review will be used to evaluate the barriers and facilitators of guideline usage quantitatively. Semi-structured interviews will add a qualitative perspective on factors that influence ReMoS guideline implementation. The Behavior Change Wheel and Theoretical Domains Framework will be used to support the development of a tailored implementation intervention which will be pilot tested in a controlled study. Patient and physical therapy-related outcomes, as well as the appropriateness, such as acceptance and feasibility of the tailored implementation intervention, will be analyzed.ConclusionThis will be the first endeavor to implement a guideline in German stroke rehabilitation with a focus on changing care provider behavior based on the knowledge of current practice and determining factors using a tailored and theory-based intervention.

Mobile rehabilitation support versus usual care in patients after total hip or knee arthroplasty: study protocol for a randomised controlled trial

BackgroundThe global increase in total hip or knee arthroplasty has led to concern about the provision of postoperative rehabilitation. Telerehabilitation may be a strategy to meet the patients’ requirements for rehabilitation after arthroplasty. This study aims to investigate the effectiveness of a telerehabilitation programme delivered via the mobile application WeChat in patients after total hip or knee arthroplasty on the following outcomes: self-efficacy, physical function, pain, depression, anxiety and health-related quality of life.MethodsThis is a single-centre, single-blinded, parallel-group, superiority randomised controlled trial conducted in Shanghai, China. Eighty-four eligible participants who undergo primary total hip or knee arthroplasty will be recruited preoperatively in a university teaching hospital and randomly assigned to the experimental or control group with their informed consent. Once discharged, the control group (n = 42) will receive the usual care provided by the hospital. The experimental group (n = 42) will receive usual care and a 6-week mobile application rehabilitation programme that consists of physical exercises and techniques for enhancing participants’ self-efficacy for rehabilitation. Baseline assessments will be conducted on the day before hospital discharge, and outcome assessments will be conducted 6 and 10 weeks postoperatively. The primary outcomes are changes in self-efficacy and physical function 6 weeks postoperatively, and the secondary outcomes include pain, depression, anxiety and health-related quality of life. The approach of a generalised estimating equation will be used to analyse the effect of the intervention on outcomes at a significance level of 0.05.DiscussionThis study is the first of its kind conducted in China to incorporate self-efficacy and learning theories as a framework to guide the development of a mobile application rehabilitation programme after arthroplasty. This study will contribute to the knowledge about the effectiveness of mobile application-based rehabilitation among patients after total hip or knee arthroplasty. If the findings are positive, they will support the implementation of mobile application-based rehabilitation in practice, which may potentially increase the accessibility of rehabilitation services as well as patient adherence to rehabilitation.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12621000867897. Retrospectively registered on July 6, 2021

Rehabilitation Environment for Patients with Chronic Impairment of Consciousness

The article discusses aspects of providing care to patients with chronic impairment of consciousness at the post-hospital stage: it describes the difficulties faced by relatives of patients caring for loved ones at home; the prospects for the use of remote technologies for the rehabilitation of patients are indicated on the example of the experience of foreign researchers; the experience of creating a rehabilitation environment similar to home (Casa Iride model) is presented with an indication of its strengths and weaknesses. Thus, the basis of modern remote and mobile rehabilitation services should be system platform IT solutions that, based on the principles of digitalization, ensure coordination of interdepartmental interaction and efficient use of resources in the process of providing post-hospital rehabilitation care to patients with severe consequences of organic brain damage.

A Framework for Determining the Performance and Requirements of Cable-Driven Mobile Lower Limb Rehabilitation Exoskeletons.

The global increase in the number of stroke patients and limited accessibility to rehabilitation has promoted an increase in the design and development of mobile exoskeletons. Robot-assisted mobile rehabilitation is rapidly emerging as a viable tool as it could provide intensive repetitive movement training and timely standardized delivery of therapy as compared to conventional manual therapy. However, the majority of existing lower limb exoskeletons continue to be heavy and induce unnecessary inertia and inertial vibration on the limb. Cable-driven exoskeletons can overcome these issues with the provision of remote actuation. However, the number of cables and routing can be selected in various ways posing a challenge to designers regarding the optimal design configuration. In this work, a simulation-based generalized framework for modelling and assessment of cable-driven mobile exoskeleton is proposed. The framework can be implemented to identify a ‘suitable’ configuration from several potential ones or to identify the optimal routing parameters for a given configuration. For a proof of concept, four conceptual configurations of cable-driven exoskeletons (one with a spring) were developed in a manner where both positive and negative moments could be generated for each joint (antagonistic configuration). The models were analyzed using the proposed framework and a decision metric table has been developed based on the models’ performance and requirements. The weight of the metrics can be adjusted depending on the preferences and specified constraints. The maximum score is assigned to the configuration with minimum requirement or error, maximum performance, and vice versa. The metric table indicated that the 4-cable configuration is a promising design option for a lower limb rehabilitation exoskeleton based on tracking performance, model requirements, and component forces exerted on the limb.

Restorative rehabilitation robotics to promote function, independence and dignity: users’ perspectives on clinical applications

People with mobility impairments have reported that improving their walking is one of the most important goals of their rehabilitation. Novel robotic technologies using powered exoskeletons for the lower limb could potentially offer efficient and less labour-intensive approaches to rehabilitation with shorter recovery times. To gather users’ and carers’ perspectives of assistive device use to provide information to design personalised and safe mobility rehabilitation technology. Semi-structured interviews were carried out with people with experience of mobility impairments. Iterative data collection was used to gather information about the social phenomena surrounding patient interaction and requirements for assistive devices for mobility impairments. Cycles of continuous data collection and thematic analysis using a theoretical, semantic approach was used to develop key themes within the data. We interviewed eight people: six people with mobility impairments and two carers. We identified five main themes: relationship with assistive technology, requirements for assistive technology, function and goal setting, personal factors to assistive device use and psychosocial factors to assistive device use. There was variability in the importance placed on each theme, particularly in the trade-off between the function and comfort of assistive technology. Patients emphasised the need for assistive technology to be personalised; they reported the ability to stand, control spasticity and involvement in community roles as key goals of their rehabilitation. These results highlight the variation in requirements for assistive technology between people with different mobility impairments; individuals’ experiences are unique and future prototypes need to account for different levels of impairments and personal goals. These findings will also inform the user evaluation stage of assistive device testing. The acceptability of assistive devices is dependent upon a number of factors, including personalisation, comfort and function. Future pilot studies should gather qualitative data to determine the acceptability of actual device use.