Rehabilitation Model Research Articles

Hierarchical Optimization for Personalized Hand and Wrist Musculoskeletal Modeling and Motion Estimation.

Surface electromyography (sEMG) driven musculoskeletal models are promising to be applied in the field of human-computer interaction. However, due to the individual-specific physiological characteristics, generic models often fail to provide accurate motion estimation. This study optimized the general model to build a personalized model and improve the accuracy of motion estimation. Inspired by the coupling effect of wrist/hand movement, a hierarchical optimization approach for personalizing musculoskeletal models (HOPE-MM) is proposed, which aligns with the physiological characteristics of the human wrist and hand. To verify the effectiveness of personalized musculoskeletal model, single joint motions and simultaneous joint motions are estimated. In addition, Sobol sensitivity analysis is conducted to identify the key parameters of musculoskeletal model, providing guidance for model simplification. The mean pearson correlation coefficient between the predicted joint angles and the measured joint angles are 0.95 ± 0.03 and 0.93 ± 0.01 for simultaneous wrist and metacarpophalangeal (MCP) joint movements, respectively, which have a significant improvement compared with the stateof- the-art works. By optimizing only the key parameters including tendon slack length, maximal isometric force and optimal fiber length, the performances of simplified model are comparable to the full-parameter model. These results provide insights into the effects of muscletendon parameters on musculoskeletal model, and musculoskeletal models personalized using hierarchical optimization methods can improve the accuracy of motion estimates. These findings facilitate the clinical application of musculoskeletal models in rehabilitation and robotic control.

A Novel Low-Pressure Robotic Glove Based on CT-Optimized Finger Joint Kinematic Model for Long-Term Rehabilitation of Stroke Patients.

Wearing robotic gloves has become increasingly crucial for hand rehabilitation in stroke patients. However, traditional robotic gloves can exert additional pressure on the hand, such as prolonged use leading to poor blood circulation and muscle stiffness. To address these concerns, this work analyzes the finger kinematic model based on computerized tomography (CT) images of human hands, and designs a low-pressure robotic glove that conforms to finger kinematic characteristics. Firstly, physiological data on finger joint flexion and extension were collected through CT scans. The equivalent rotation centers of finger joints were obtained using the SURF and RANSAC algorithms. Furthermore, the trajectory of finger joint end and the correlation equation of finger joint motion were fitted, and a comprehensive finger kinematic model was established. Based on this finger kinematic model, a novel under-actuated exoskeleton mechanism was designed using a human-machine integration approach. The novel robotic glove fully aligns with the equivalent rotation centers and natural motion trajectories of the fingers, exerting minimal and evenly distributed dynamic pressure on the fingers, with a theoretical static pressure value of zero. Experiments involving gripping everyday objects demonstrated that the novel robotic glove significantly reduces the overall pressure on the fingers during grasping compared to the pneumatic glove and the traditional exoskeleton robotic glove. It is suitable for long-term use by stroke patients for rehabilitation training.

Evaluating the effectiveness and feasibility of a digital health intervention to community-based rehabilitation in older adults: A cluster randomized controlled trial study protocol.

The escalating global aging population underscores the need to effectively manage geriatric diseases, constituting a significant public health concern. Community-based rehabilitation has emerged as a crucial and accessible paradigm for the rehabilitation of older adults. In China, however, the practical implementation of community-based rehabilitation faces formidable challenges, including a dearth of specialized rehabilitation therapists, substantial disparities between demand and supply, and suboptimal satisfaction rates. We aimed to develop a community-based rehabilitation management platform for older adults centered around digital health technology, with the plan to conduct a cluster randomized controlled trial to gather more evidence to explore the best practices and service models of community-based rehabilitation based on digital health technology. This cluster randomized controlled trial will be conducted in Zunyi City, China. We will recruit 286 adults aged ≥60 years and randomly allocate 20 subdistricts in a 1:1 ratio into either the intervention group, which will use the Rehabilitation Journey application, or the control group, which will be given a Rehabilitation Information Booklet for Older Adults. Both groups will undergo a 12-month rehabilitation management program, encompassing six months of guidance and an additional six months of follow-up through online and offline methods. The evaluation indicators will be assessed at enrollment and at 3rd, 6th, and 12th month. This study endeavors to furnish novel insights to develop a tailored community-based rehabilitation management program for older adults, delivering customized, intelligent, and precise rehabilitation services.

The bi-dimensionality of post-traumatic growth models in the psychological rehabilitation of veterans of the russian-ukrainian war

The article analyzes the models and approaches of post-traumatic growth (PTG) used in the psychological rehabilitation of veterans. Post-traumatic growth (PTG) is a positive psychological change that occurs as a result of psychological processing of the experience of difficult life circumstances—models of PGD help to understand how people can find meaning and strength in their experiences of trauma. Several vital models are often used in the psychological rehabilitation of veterans. The analysis of the existing models of posttraumatic growth as an effective tool in the psychological rehabilitation of veterans of the Russian-Ukrainian war expands the vision of theoretical models of PGT. It enables professionals to expand the basis of psychological interventions in the rehabilitation of veterans, their transition from military and civilian life, and the adaptation of their own experience to family life. Psychological support for a veteran who has gone through severe combat operations and returned home with a sense of loss and helplessness requires a modern psychologist to be aware of their level of training and to master a multimodal approach to this activity. By applying one of the adapted models to the case of a veteran client, a psychologist can help them identify new development opportunities, find meaning in their experience and present life, strengthen ties with family and friends, and strengthen the spiritual foundations of their life. The article presents a model of PTZ for consideration: R.G. Tedeschi and L.G. Calhoun's functional-descriptive as the primary model; a person-centered model by S. Josef, a biopsychosocial model by M. Christopher, a psychological-philosophical model by R. Papadopoulos and others. The variations of coping strategies as models of coping are also considered. The author outlines several views on the possibilities of implementing the theory of coping in psychological support and the implementation of psychological rehabilitation of military personnel, veterans, combatants, etc.

Comparison of a Supervised Home-Based Tele-Rehabilitation with Center-Based Pulmonary Rehabilitation: Protocol for a Randomized Non-Inferiority Multicenter Study in Ningxia.

Pulmonary rehabilitation (PR) is an effective intervention for people with chronic obstructive pulmonary disease (COPD). However, fewer than 5% of eligible individuals receive pulmonary rehabilitation, largely due to limited by the accessibility of rehabilitation and difficulties associated with travel and transport. Supervised home-based tele-rehabilitation (SHTR) is an alternative model to center-based pulmonary rehabilitation. We will determine whether supervised home-based tele-rehabilitation is non-inferior to center-based pulmonary rehabilitation. The participants will undergo an 8-week rehabilitation program. Pulmonary rehabilitation comprises four main modules: exercise training, education, nutritional support, and psychological and behavioral interventions. We mainly focus on the module of exercise training and education. The education module includes information on exercise training, nutrition, and psychology, which are presented in an educational booklet provided to each participant. Blinded assessors will evaluate the outcomes at baseline, post-intervention, and 6 months after the intervention. The primary outcome is the change in the 6-minute walking distance. Secondary outcomes will assess changes in the patients' 1-minute sit-to-stand test, maximal inspiratory pressure (MIP), scales (CAT, mMRC, HAD), diaphragm ultrasound (TD, DE, DIF), changes in extrathoracic muscle volume and mass, completion rate of patient exercise prescriptions, occurrence of adverse events, as well as disease exacerbation and rehospitalization rates after rehabilitation and during the 6-month follow-up. In order to improve the accessibility of pulmonary rehabilitation and patient-related outcomes, it is necessary to propose an alternative model of pulmonary rehabilitation. This trial will establish whether a supervised home-based tele-rehabilitation is not inferior to traditional center-based pulmonary rehabilitation. Chinese Clinical Trial Registry ChiCTR2300076969. Registered on October 25, 2023.

Effectiveness of organizational-functional model for complex rehabilitation of children requiring upper limb replacement for congenital diseases

Effectiveness of organizational-functional model for complex rehabilitation of children requiring upper limb replacement for congenital diseases

Clinically important changes and adverse events with centre-based or home-based pulmonary rehabilitation in chronic respiratory disease: A systematic review and meta-analysis.

Objectives: To determine the proportion of people who achieve minimal clinically important differences (MCID) with centre-based or home-based pulmonary rehabilitation and to synthesise data on adverse events.Methods: Cochrane reviews and electronic databases were searched to identify randomised trials comparing centre-based to home-based pulmonary rehabilitation, or either model to usual care, in people with chronic respiratory disease. Primary outcomes were the proportion of participants achieving MCIDs in exercise capacity and disease-specific quality of life. Secondary outcomes were symptoms and adverse events. Cochrane Risk of Bias 1.0 and GRADE were used to assess the risk of bias and certainty of evidence respectively.Results: Forty-nine trials were eligible. Compared to usual care, a higher proportion of pulmonary rehabilitation participants achieved the MCID for exercise capacity (6MWT: 47% vs 20%, p = 0.11), dyspnoea (43% vs 29%, p = 0.0001), fatigue (48% vs 27%, p = 0.0002) and emotional function (37% vs 25%, p = 0.02), with all of these between group differences statistically significant except for exercise capacity. There were no differences between centre-based and home-based pulmonary rehabilitation in the proportion of participants who achieved MCIDs (34%- 58% across studies). Ninety percent of trials reported no adverse events. Certainty of evidence was low-to- moderate with all outcomes except for CRQ-mastery (centre-based vs home-based pulmonary rehabilitation, or pulmonary rehabilitation vs usual care in COPD), ESWT (pulmonary rehabilitation vs usual care in COPD) and 6MWT (pulmonary rehabilitation vs usual care in bronchiectasis) where evidence was very uncertain.Discussion: Clinically meaningful outcomes are achieved by similar proportions of participants in centre-based and home-based pulmonary rehabilitation, with few adverse events. Reporting of trial outcomes according to MCIDs is necessary for informed decision making regarding pulmonary rehabilitation models.

New technologies for eye care practitioners

Keywords: orthoptics, optometry, visual rehabilitation, visual therapy.In the 1920s, Mary Maddox opened a vision rehabilitation center in London, being considered the first orthoptist (an unknown profession in Spain, whose competences fall on Optics‐Optometry). Her father, Ernest E. Maddox, an ophthalmologist, had developed various instruments to investigate binocular vision. The new discipline seeks to improve the binocular state of the patient, affected by symptomatic tropias or phorias, through exercises that train eye movements, ductions, versions, vergences, fixations and saccades. Amblyopia, on the other hand, is still treated by occlusion of the fellow eye, following practices that began in the 18th century (George L. de Buffon).During the 20th century, orthoptic specialists used different instruments, which have survived to this day, for the diagnosis and treatment of deviations. Perhaps the most advanced of them is the synoptophore, capable of determining objective and subjective deviations, the presence of normal or abnormal correspondences, and the presence of suppression scotoma. The synoptophore is also used in rehabilitation, together with the aperture rule, vectograms or the Brock string. However, in the case of tropias and during the 20th century, orthoptic therapy occupies a very marginal place compared to the surgical solution. The Hubel and Wiesel experiments in the 60s and 70s were interpreted restrictively, rooting concepts such as the so‐called critical period, which discouraged any attempt to treat amblyopia beyond occlusion, particularly in adulthood.However, research carried out from the second half of the 20th century to nowadays provides evidence of the usefulness of vision rehabilitation in the treatment of strabismus and non‐strabismus visual dysfunctions, and in the recovery of amblyopia in adulthood. Basic research led by Dennis M. Levi of the University of California at Berkeley and Robert F. Hess of McGill University, as well as clinical research by the Paediatric Eye Disease Investigator Group, PEDIG, are good examples.New technologies based on computers are currently renewing and revitalizing orthoptic practice, both in diagnosis and treatment. Eye‐trackers combined or not with Virtual Reality allow (a) to record eye movements accurately and objectively, and to identify visual behaviour and deficits, and (b) to train those movements, providing positive feedback to the patient. Screens have evolved from conventional models, later 3D and finally Virtual Reality, allowing dynamic exercises and avoiding other limitations, such as postural ones. Software algorithms adapt the difficulty of the exercises to patient's performance, record therapy compliance, and store the results in the cloud for remote control of home therapy. In addition, gamification techniques allow increasing the patient's motivation and adherence to treatment. These improvements are essential in perceptual learning, the paradigm of the new visual rehabilitation model.

Exploring the Art Rehabilitation Model for Children with Autism Spectrum Disorder from the Perspective of Holistic Development

Exploring the Art Rehabilitation Model for Children with Autism Spectrum Disorder from the Perspective of Holistic Development

Screening of New-Born through Otoacoustic Emission Device in a Rural Setting for Early Detection of Hearing Impairment - An Observational Study

BACKGROUND
 Hearing is a special sense needed for proper speech, language, mental development and academic performance. The objectives of our study were to screen neonates at rural area with otoacoustic emission device for detecting hearing impairment and develop a comprehensive rehabilitation model for hearing impaired children in rural areas. Hearing loss initial signs are subtle and therefore for early detection routine neonatal hearing screening is the most effective tool. At first otoacoustic emissions are done, failing which neonates undergo BERA as final screening method to identify hearing impairment as a confirmatory test. In a country like India where neonatal hearing tests are not a part of the routine screening program, the chances of missing early detection and possible rehabilitation are large. In this context, the current project envisages to develop a practical and pragmatic screening model for detecting early neonatal hearing impairment using otoacoustic emission technique in a rural sector reaching every door step possible.
 METHODS
 From the government health records collected for a duration of one and half years, all babies delivered in PHC were included for the screening. The babies were screened every Thursday (Immunisation day) with OAE devices by an audiologist at the PHC. The total number of infants screened were 1737. The first screening test done was otoacoustic emission, failing which patient was referred for BERA as a confirmatory test.
 RESULTS
 The total number of babies screened by OAE in our study was 1737. Out of the total infants screened, 1st OAE referrals were 327 babies. All the 327 infants were screened by OAE for the 2nd time, out of which 10 infants were referred for the 2nd consecutive time. 317 infants were passed on 2nd OAE screening. All the 10 infants who were referred for the 2nd time were subjected to BERA at Ramaiah medical Hospital. Out of these 10 infants, BERA showed severe to profound bilateral hearing loss in 7 infants (Confirmed Hearing loss). Other 3 infants had normal BERA reading hence normal hearing. The statistics showed that the overall rate of hearing loss prevalence was 4.03 per thousand.
 CONCLUSIONS
 In order to diagnose hearing loss in neonates, it is critical to identify hearing loss at birth and provide a screening test for it. OAE screening of neonates should be done at the earliest to detect hearing impairment so that hearing and speech rehabilitation can be started at the earliest. It should be done at each & every health care centre on a large-scale basis to cover all the babies.

Supplemental Material for Confirmatory Factor Analysis of the 12-Item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) Within the Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Supplemental Material for Confirmatory Factor Analysis of the 12-Item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) Within the Clubhouse Model of Psychosocial Rehabilitation for Serious Mental Illness

Confirmatory factor analysis of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) within the clubhouse model of psychosocial rehabilitation for serious mental illness.

The Clubhouse model (CM) for serious mental illness is a recovery-oriented and member-driven program that aims to facilitate functional recovery. Efficacy evaluation of the CM is limited by lack of uniform functional disability assessment. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a widely accepted measure of functional disability, but its psychometric properties have yet to be examined within the CM. This research sought to confirm the generic six-factor structure of the 12-item WHODAS-2.0 using retrospective administrative data from 339 adults with serious mental illness from an accredited Clubhouse. A second-order confirmatory factor analysis was conducted, followed by secondary known-groups analyses to examine whether the WHODAS-2.0 differentiates between subgroups with varying degrees of disability. The WHODAS-2.0 demonstrated good overall reliability. The generic six-factor structure produced nonsignificant loadings due to lack of independence between the "participation" and "getting along" factors. The items of these two factors were combined into a five-factor model, which displayed excellent fit, with all significant paths and adequate-to-strong loadings, and no correlation among errors. The WHODAS-2.0 significantly differentiated members by receipt of public assistance, employment status, and number of medical comorbidities, supporting construct validity. These results provide initial support for the use of the 12-item WHODAS-2.0 as a CM-related outcome measure and encourage future research of the full 36-item version. The intentional community approach of the CM is unique and may require adjustments to the factor structure of the WHODAS-2.0 by merging the "participation" and "getting along" domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neuropsychological assessment and rehabilitation: an experience report at the ILCN - Instituto Luso Cubano de Neurologia in Porto, Portugal

This experience report aims to describe a period of observational/ethnographic activity in Neuropsychology, carried out at the ILCN - Instituto Luso Cubano de Neurologia, in the city of Porto, Portugal. This study presents the unit's assessment and rehabilitation models, drawing parallels with the assessment and therapeutic models in Brazil; a characterization of the Institute is carried out, with a profile of the patients and the functions performed by the multi-professional team. The theoretical concepts referenced by the neurosciences will also be described, as will the procedures and instruments used in the follow-ups, the aim of which was to qualify the treatments in order to promote the development and functionality of the users in the face of the difficulties they face on a daily basis, variables which have a direct impact on the establishment of their autonomy and quality of life. To illustrate the activities carried out, two case studies were selected which were monitored by the team from the renowned institute

Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review

Purpose The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). Methods A scoping review guided by Arksey and O’Malley’s framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. Results The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. Conclusion This review discusses BRICS countries’ rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

Outcomes following intensive day rehabilitation for young people in Western Australia.

Intensive rehabilitation aims to improve and maintain functioning in young people who experience disability due to illness or injury. Day rehabilitation may have advantages for families and healthcare systems over inpatient models of rehabilitation. This study evaluated the goals and outcomes of a cohort of young people in Western Australia who attended a specialist intensive day rehabilitation programme ("iRehab") at Perth Children's Hospital. Analysis of the iRehab service database was performed. Rehabilitation goals and outcomes were recorded as per the Canadian Occupational Performance Measure (COPM), Children's Functional Independence Measure (WeeFIM), and Goal Attainment Scale (GAS). There were 586 iRehab admissions between August 11, 2011, and December 31, 2018. Admissions were divided by diagnosis: Cerebral Palsy (228, 38.5%), Acquired Brain Injury (125, 21.3%), Spinal Cord Disorders (91, 15.5%), and Other (141, 24.2%). Mean COPM Performance increased by 2.78 points from admission to discharge (95% CI 2.58 to 2.98, p < 0.001). Mean COPM Satisfaction was 3.29 points higher at discharge than admission (95% CI 3.07 to 3.51, p < 0.001). Mean total WeeFIM score improved by 6.51 points between admission and discharge (95% CI 5.56 to 7.45, p < 0.001), and by 3.33 additional points by six months post discharge (95% CI 2.14 to 4.53, p < 0.001). Mean GAS T-scores increased by 27.85 (95% CI 26.73 to 28.97, p < 0.001) from admission to discharge, and by 29.64 (95% CI 28.26 to 31.02, p < 0.001) from admission to six months post discharge, representing improvement consistent with team expectations. This study describes a model by which intensive rehabilitation can be delivered in a day rehabilitation setting. A diverse population of young people who experienced disability achieved significant improvements in occupational performance, independence, and goal attainment after accessing intensive day rehabilitation. Improvements were measured in all diagnostic subgroups and were maintained six months after discharge.

Design and validation of a pediatric gait assistance exoskeleton system with fast non-singular terminal sliding mode controller

Existing exoskeletons for pediatric gait assistance have limitations in anthropometric design, structure weight, cost, user safety features, and adaptability to diverse users. Additionally, creating precise models for pediatric rehabilitation is difficult because the rapid anthropometric changes in children result in unknown model parameters. Furthermore, external disruptions, like unpredictable movements and involuntary muscle contractions, add complexity to the control schemes that need to be managed. To overcome these limitations, this study aims to develop an affordable stand-aided lower-limb exoskeleton specifically for pediatric subjects (8-12 years, 25-40 kg, 128-132 cm) in passive-assist mode. The authors modified a previously developed model (LLESv1) for improved rigidity, reduced mass, simplified motor arrangement, variable waist size, and enhanced mobility. A computer-aided design of the new exoskeleton system (LLESv2) is presented. The developed prototype of the exoskeleton appended with a pediatric subject (age: 12 years old, body mass: 40 kg, body height: 132 cm) is presented with real-time hardware architecture. Thereafter, an improved fast non-singular terminal sliding mode (IFNSTSM) control scheme is proposed, incorporating a double exponential reaching law for expedited error convergence and enhanced stability. The Lyapunov stability warrants the control system's performance despite uncertainties and disturbances. In contrast to fast non-singular terminal sliding mode (FNSTSM) control and time-scaling sliding mode (TSSM) control, experimental validation demonstrates the effectiveness of IFNSTSM control by a respective average of 5.39% and 42.1% in tracking desired joint trajectories with minimal and rapid finite time converging errors. Moreover, the exoskeleton with the proposed IFNSTSM control requires significantly lesser control efforts than the exoskeleton using contrast FNSTSM control. The Bland-Altman analysis indicates that although there is a minimal mean difference in variables when employing FNSTSM and IFNSTSM controllers, the latter exhibits significant performance variations as the mean of variables changes. This research contributes to affordable and effective pediatric gait assistance, improving rehabilitation outcomes and enhancing mobility support.

Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

ObjectiveTo investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program. MethodsPeople with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction. ResultsThere were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke. ConclusionCardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.

Effectiveness of the Interdisciplinary Home‐bAsed Reablement Program (I‐HARP) on improving functional independence of people living with dementia and process outcomes

AbstractBackgroundThis project evaluated a model of care integrating evidence‐based dementia rehabilitation strategies into a time‐limited, home‐based, interdisciplinary rehabilitation package: Interdisciplinary Home‐bAsed Reablement Program (I‐HARP). The aims were: to determine I‐HARP effectiveness on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I‐HARP cost‐effectiveness; and to evaluate processes, outcomes and influencing factors of the I‐HARP implementation.MethodThe project was mixed‐methods action research combining a multi‐centre pragmatic RCT and realist evaluation. I‐HARP was a 4‐month model of care for community‐dwelling people with mild‐moderate dementia and family carers, incorporated into community aged care services and hospital‐based geriatric services in Sydney, Australia (2018‐22) and compared with usual care. Outcome assessments were conducted at baseline, 4‐ and 12‐month. Semi‐structured interviews with participants and focus groups with I‐HARP interventionists and participating site managers occurred post intervention. (ACTRN12618000600246)ResultOf 130 dyads of clients and their carers recruited, 116 dyads (58 per group) completed the trial (89% retention). The I‐HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months. Post‐hoc sub‐group analysis of 66 clients with mild‐dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4,19.1; p = .005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7,23.7; p = .007; ES 0.69) at 12 months. Preliminary results of economic evaluation pointed to potential benefits of I‐HARP over usual care. Interviews and focus group findings highlighted system and research design barriers (e.g., workforce, hospital system, communication, blinding and recruitment) and program facilitators (focus on enablement, interdisciplinary and teamwork).ConclusionThe I‐HARP model enhanced functional independence of participants with mild‐dementia but not in those with moderate‐dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe. Key facilitators and barriers to I‐HARP implementation provide further insights to developing dementia rehabilitation model of care.

FC18: Can rehabilitation improve functional independence of older people with dementia? A pragmatic randomized controlled trial (RCT) of the Interdisciplinary Home-bAsed Reablement Program (I-HARP)

Objective:The Interdisciplinary Home-bAsed Reablement Program (I-HARP) integrates evidence-based rehabilitation strategies into a dementia-specific person-centred, time-limited, home-based, interdisciplinary rehabilitation package. I-HARP was a 4-month model of care, incorporated into community aged care services and hospital-based community geriatric services. I-HARP involved: 8-10 individually tailored home visits by occupational therapist and registered nurse; 2-4 optional other allied health sessions; up to A$1,000 minor home modifications and/or assistive devices; and three individual carer support sessions. The aim of the study was to determine the effectiveness of I-HARP on the health and wellbeing of people living with dementia and their family carers.Methods:A multi-centre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and family carers in Sydney, Australia (2018-22). Assessments of the client’s daily activities, mobility and health-related quality of life, caregiver burden and quality of life were conducted at baseline, 4- and 12-month follow-up. Changes from baseline were compared between groups.Results:Of 260 recruited, 232 (116 dyads of clients and their carers, 58 dyads per group) completed the trial to 4-month follow-up (89% retention). Clients were: aged 60-97 years, 63% female, 57% with mild dementia and 43% with moderate dementia. The I-HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months (reduction: 2.29 on Home Safety Self-Assessment Tool, 95% CI: 0.52, 4.08; p=.01, effect size [ES] 0.53). Post-hoc sub-group analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4, 19.1; p=.005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7, 23.7; p=.007; ES 0.69) at 12 months.Conclusion:The I-HARP model enhanced functional independence of people with mild dementia only but not significantly in people with moderate dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe.

Attitude to the disease and quality of life in elderly patients with mild vascular dementia after the novel coronavirus infection

In order to study the types of attitude towards the disease and quality of life (QoL) in elderly patients with mild vascular dementia (MVD) living in the conditions of the psychoneurological institution Social Service House “Severnoye Izmailovo” in Moscow, there were 2 study groups: the patients with the clinical debut of the novel coronavirus infection (NCVI) of 6 months +/– 1 month with the recovery outcome (n=65; 33 men, 32 women) and those who did not have COVID-19 (hospital control group; n=67; 34 men, 33 women). The mean age of the studied patients was 73.05±3.48 years. The age and sex composition of the two groups was homogeneous (p&gt;0.05). Emotional disorders were investigated using the Cornell Scale for Depression in Dementia (CSDD); cognitive disorders – by means of the Montreal Cognitive Assessment (MoCA); QoL – by the Quality of Life in Alzheimer's Disease scale (QoL-AD): QoL self-assessment (QoL-AD-SR (self-rating)) and proxy QoL rating (QoL-AD-PR (proxy rating)); the type of attitude towards the disease – by the TATD scale (Wasserman L.I. et al., 2005). It was found that COVID-19 aggravates cognitive deficits in patients with MVD (according to MoCA 20.80±0.59 /21.40±0.78 points; p&lt;0.05) in the absence of depression (according to CSDD 1.52±0.50 / 1.52±0.84 points in the group of the patients after NCVI / hospital control group, respectively; p&gt;0.05). In the patients after COVID-19, a correlation was found between the proxy QoL rating and the severity of cognitive dysfunction according to the MoCA (R= – 0.28), while in the hospital control group – between the proxy QoL rating and the severity of depressive manifestations (R= – 0.33). The first group of the patients was characterized by a mixed type of attitude to the disease and intrapsychic maladaptation (the neurasthenic type ranked first at 16.03±8.29 / 9.34±5.03 points), while the second group had a diffuse type of attitude to the disease and interpsychic maladaptation (the sensitive type ranked first at 10.31±5.71 / 14.90±7.62 points by the TATD scale among the elderly patients with MVD who have / have not undergone NCVI; p&lt;0.05). The revealed patterns can contribute to the optimization of personalized models of medical and psychological rehabilitation of elderly patients with MVD living in closed-type care facilities.