Multidimensional Rehabilitation Research Articles

Atrial fibrillation, prevention and rehabilitation in a primary healthcare setting. A feasibility study

Abstract Background Atrial fibrillation (AF) often influences daily life with symptoms like palpitations, dyspnoea, fatigue, fear and anxiety. Research show that patients with AF benefit from prevention and rehabilitation interventions. However, evidence is scarce and mainly hospital-based, and it is unknown whether the transition to the primary healthcare sector gives the same positive results. In 2019, a Danish primary care Health Center and the cardiology department at the local hospital completed a multidimensional prevention and rehabilitation intervention for patients with AF. Purpose To investigate the feasibility of delivering a multidimensional prevention and rehabilitation intervention for patients with AF in a primary care Health Center. Methods This study was a mixed-methods, non-randomized, intervention, feasibility study. A convergent mixed-methods design was used, and results were illustrated in side-by-side joint displays. Patients were included at a Hospital AF clinic referring to the Health Center. The prevention and rehabilitation intervention consisted of risk factor management, patient education, physical activity and yoga. Two patient-reported outcomes measures (PROMs) were used, the HeartQoL measuring health-related quality of life (HRQoL) and the Hospital Anxiety and Depression Scale (HADS) measuring symptoms of anxiety and depression. Data were collected at baseline (T0), at end of intervention (T1), and at two-months follow-up (T2) and analysed descriptively. Focus group interviews were analysed thematically and covered experiences of participating, needs and preferences, outcomes and feasibility of collecting PROMs. The reporting was guided by the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results 43 patients (53% women; median age 66 (range 52-81) years) completed the intervention. Table 1 shows that HRQoL increased, and symptoms of anxiety and depression decreased. These results maintained at follow-up. Figure 1 shows the qualitative themes. Patients experienced being understood and supported by health professionals and peers. They thought it difficult to know what their needs were. However, some patients had specific preferences for interventions. For changes in outcomes, the patients identified that gaining tools and knowledge about the disease from the interventions helped. It was feasible to collect PROMs during the intervention and finally, the patients had an attention to what comes next, when finishing the intervention in the primary care setting. Conclusion It was feasible to deliver a multidimensional prevention and rehabilitation intervention for patients with AF at a primary care Health Center. HRQoL increased and symptoms of anxiety and depression decreased. The patients experienced being supported and gaining tools and knowledge to handle AF. Future large randomized controlled trials must confirm these results.

Feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme in community-dwelling people with dementia: a randomised controlled pilot trial

BackgroundA team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.MethodsParticipants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.ResultsParticipants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.ConclusionsThe rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.Trial registrationThe study protocol, ISRCTN59155421, was registered online 4/11/2015.

A phase 2 study of a longitudinal multidimensional rehabilitation program for allogeneic blood and marrow transplantation patients

AbstractAllogeneic blood and marrow transplantation (alloBMT) is a curative treatment for blood cancers associated with various treatment-related adverse events and morbidities for which rehabilitation programs are currently limited. A phase 2 randomized controlled trial (RCT) was conducted to assess the feasibility, acceptability, and impact of CaRE-4-alloBMT, a longitudinal, multidimensional cancer rehabilitation program for patients undergoing alloBMT. The primary outcomes included the feasibility and acceptability of the intervention and the methods. Feasibility was assessed through recruitment, retention, and adherence rates. Acceptability was assessed through qualitative interviews. Secondary clinical outcomes were collected through questionnaires and physiological assessments at 4 time points. A total of 80 participants were recruited and randomized. Recruitment (72%) and retention (70%) rates, along with qualitative findings, support the feasibility of the intervention. Adherence was suboptimal, most notably educational module completion (22.7%). Treatment effect sizes of 0.70 (95% confidence interval [CI], 0.20-1.21; 30-second sit-to-stand test) and 0.46 (95% CI, –0.17 to 1.09; 36-Item Short Form Survey) were observed in favor of the intervention. The results appear promising; however, the findings are limited by missing data owing to attrition. Modifications will be required to refine the program and inform a phase 3 RCT. This trial was registered at www.ClinicalTrials.gov as #NCT04966156.

A prospective phase II study of an exercise-nutrition-psychology integrated rehabilitation model based on mobile health and virtual reality for patients with cancer.

e13786 Background: The optimal rehabilitation model for patients with cancer is unclear. Nutritional and psychological interventions have proven to be beneficial for this population. Although mobile health (mHealth) and virtual reality (VR) advances have transformed many clinical areas including cardiovascular and psychiatric care, they are relatively nascent in cancer care. Due to the multidimensional rehabilitation needs of patients, here we explored the feasibility of an exercise-nutrition-psychology rehabilitation model in cancer patients, which based on VR and mHealth. Methods: A single-center, single-arm, prospective phase II study was conducted from November 2022 to April 2023. With the help of mHealth participants received standard cancer therapy and integrated interventions featuring in-person group-based exercise classes, at-home physical activity prescription, behavior change education, nutritional instruction, oral nutritional supplements (Ainst, China), music therapy (MT), VR treatment and psychological counselling. The rehabilitation was provided by a team of medical oncologists, dietitians, psychotherapists, and technicians. An effective intervention course includes two consecutive hospitalization and two periods of home-based rehabilitation (total 8 weeks). The primary endpoint was the feasibility. The paired T test was used to analyze and compare the differences. Results: At the cutoff date of April,10, 2023. 165 patients were screened, 123 were recruited, and the recruitment rate was 75% (123/165). 14 (11.4%) patients were lost to follow-up, and 4 (3.25%) withdrew halfway. Respectively, the completion rate of exercise, nutrition, and VR and mHealth based psychology were 55% (68 / 123), 85% (105 / 123), and 63% (78 / 123). The parameters in nutrition, psychology, and muscle mass after the rehabilitation showed significant improvements than before (P<0.05). There was no significant statistical difference (P> 0.05)in 6-minute walking speed and handgrip strength. All functional domains of life quality were significantly improved, except role optimization function (P> 0.05). Conclusions: The mHealth and VR based exercise-nutrition-psychology integrated rehabilitation model is feasible for cancer patients and shows potential benefits. The mHealth application (app) we used is a rudimentary version and needs to be optimized in the future. This rehabilitation model warrants further investigation in a larger cohort trial. Clinical trial information: ChiCTR2200065748.

Symptom Exacerbation and Adverse Events during a Randomized Trial of Early-stage Concussion Rehabilitation.

Few studies utilize randomized clinical trials (RCT) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster Randomized Controlled Trial (XXX). Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age=20 years; female n=48) across 28 sites from New Zealand professional rugby (n=31), Canadian professional football (n=52), United States (U.S.)/Canadian colleges (n=128) and U.S. high schools (n=40). Two medically supervised interventions: 1) Enhanced Graded Exertion (EGE): international return to sport strategy and sport specific activities only (EGE-only n=119) and 2) Multidimensional Rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR+EGE n=132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with a Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n=1437) were the primary analysis unit. Frequencies, proportions, medians, and Interquartile Ranges (IQRs) were calculated for outcomes by treatment group. The 251 post-injury participants completed 1437 (MDR+EGE=819, EGE-only=618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR+EGE and EGE-only arms respectively. Intrasession symptom exacerbations were equivilantly low in MDR+EGE and EGE-only arms (MDR+EGE: 16.7%, 95% CI:14.1%,19.1%; EGE-only: 15.7%, 95% CI: 12.8%,18.6%). In total, 9/819 MDR+EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a pre- to post-session symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR+EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment

BackgroundBreast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme.MethodsParticipants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni.ResultTwenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high.ConclusionBoth MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise.Trial registrationThe study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.

Evaluation and Monitoring System for Exercise Rehabilitation Based on Combined Chinese and Western Medicine Technology

INTRODUCTION: Developing exercise rehabilitation assessment and monitoring systems is essential in rehabilitation medicine. Introduces a sports rehabilitation assessment and monitoring system based on combining Chinese and Western medicine technology, aiming to integrate traditional Chinese and Western medicine theory and modern Western medicine technology to provide more comprehensive and personalized rehabilitation services. Through the systematic integration of technologies, the author is committed to building an efficient and precise rehabilitation system to provide patients with more scientific and practical rehabilitation programs. OBJECTIVE: The research system employs various sensor technologies, including motion capture devices, biosensors, and pulse recognition technology, by combining Chinese and Western medicine. The motion capture device enables real-time monitoring of the patient's movement trajectory, joint mobility, and other physiological indicators; the biosensor collects the patient's physiological data, such as heart rate and blood pressure. Meanwhile, Chinese and Western medicine pulse recognition technology was introduced to obtain pulse information specific to Chinese and Western medicine to provide more comprehensive data support for rehabilitation assessment. Integrating these technologies, a multi-level and multi-dimensional rehabilitation assessment system was established. METHODS: This study aims to improve the accuracy and personalization of the rehabilitation assessment and to tailor a rehabilitation plan more in line with the patient's actual situation. Through the combination of Chinese and Western medicine techniques, it aims to break the single perspective of traditional rehabilitation assessment and make the rehabilitation plan closer to the physiological characteristics and pathological state of the patients as well as the needs of the combination of Chinese and Western medicine in the identification and treatment. RESULTS: The system has achieved remarkable results in practical application. The accurate monitoring of the motion capture device provides a more comprehensive understanding of the patient's motor status and accurately analyzes the rehabilitation progress. At the same time, the data collection of biosensors provides doctors with more detailed physiological information, enabling them to formulate rehabilitation plans more comprehensively. The introduction of combined Chinese and Western medicine pulse recognition technology adds a unique auxiliary diagnostic tool of collaborative Chinese and Western medicine to the rehabilitation assessment and improves the personalized level of the rehabilitation plan. CONCLUSION: The sports rehabilitation assessment and monitoring system combining Chinese and Western medicine technology brings new ideas and methods for developing rehabilitation medicine. By fully utilizing the advantages of modern technology and traditional medical knowledge, a comprehensive and in-depth rehabilitation assessment system was constructed to provide patients with more scientific and caring rehabilitation services. Future research will optimize the system's performance and promote the broad application of integrated Chinese and Western medicine technology in rehabilitation.

Development and Validation of a Multidimensional Rehabilitation Protocol for Postmenopausal Women: A Cross-sectional Study

Introduction: Menopause is a normal aging phenomenon in women. The overall prevalence of menopausal symptoms in all domains was reported as 87.7% which includes hot flushes, cognition, autonomic nervous disorders, sleep disturbances, mood changes, anxiety, etc. Therefore, it is necessary to manage these symptoms to improve the quality of life. Aim: To develop and validate a multidimensional rehabilitation protocol for Postmenopausal women. Materials and Methods: A cross-sectional study was conducted from December 2023 to February 2024 after thorough literature review, a 45-50 minute protocol was developed which included warm-up, resistance training, cognition training followed by a cool down session. After which a Delphi survey method was employed to evaluate the content validity of the formed protocol by a multidisciplinary expert panel on the basis of relevancy. Then I-CVI (Item-level Content Validity Index) and S-CVI (Scale- level Content Validity Index) of the developed protocol was calculated. Results: The protocol has been validated by a group of multidisciplinary experts with an average experience of 9.5 years working in Department of Obstetrics and Gynaecology/Women’s Health. A total of seven experts responded and evaluated each item of the protocol and suggested modifications. The I-CVI of each item was found to be between 0.86 and 1 whereas the S-CVI by average method was found to be 0.93 which was above the satisfactory level as suggested by Lynn i.e. above 0.83. Conclusion: The above generated multidimensional rehabilitation protocol for Postmenopausal women is valid.

Effect of Virtual Reality and Augmented Reality Training for Injury Prevention and Accelerating Rehabilitation of Anterior Cruciate Ligament Injury in Athletes: A Scoping Review

Context: Recently, the use of Virtual reality (VR) and Augmented reality (AR) tools for assessing athletes’ performance in returning to sports and neuromuscular training has experienced significant growth across all age groups. Through this technology, by utilizing laboratory facilities and creating a three-dimensional simulated sports environment that closely resembles the reality and conditions of each sports discipline, athletes can train and undergo evaluation under controlled conditions. The VR and AR systems have been used recently to prevent and rehabilitate Anterior Cruciate Ligament (ACL) injuries and assess the motor control of injured individuals. This scoping review aimed to investigate the impact of VR and AR exercises on ACL injury prevention, ACL rehabilitation, and expediting the return to sports process. Evidence Acquisition: The scoping review follows the reporting system of systematic and meta-analysis studies (PRISMA-ScR) and utilizes the guidelines provided by the Joanna Briggs Institute for conducting various stages of work and data extraction. This study was registered in the PROSPERO database with code CRD42023446354. The search for English articles was conducted in electronic databases, including PubMed, Embase, Web of Science, SPORT Discuss, PsycINFO, CINAHL, and Cochrane, using keywords such as virtual reality, rehabilitation, injury prevention, simulation, augmented reality, ACL, and anterior cruciate ligament until the end of June 2022. Inclusion criteria encompassed any primary research involving both athletes and non-athletes across all levels (from beginners to professional) and all ages and genders (male and female) who have experienced unilateral anterior cruciate ligament injury and have undergone any type and degree of sports or therapeutic intervention using VR and AR systems. Results: Twenty-six out of 204 comprehensive studies were reviewed based on the inclusion and exclusion criteria. The results showed that biomechanical parameters related to ACL injury were measured using various methods such as real-time biofeedback, virtual reality, and augmented reality. The factors investigated showed significant changes after exercise in VR and AR environments. Conclusions: Anterior cruciate ligament injury (or any other sports injury) cannot be summarized in a single musculoskeletal dimension involving mechanical or movement dysfunction. The failure of current approaches to prevent ACL injuries, rehabilitation, and risk assessment is due to the neglect of cognitive and neurological aspects of the injury. New methods such as augmented neuromuscular training (aNMT), multidimensional rehabilitation approaches, and the utilization of virtual reality technology and novel training strategies based on the strengths of VR and AR systems (such as optimal strategy) can compensate for this scientific and practical gap.

A focus groups study of staff team experiences of providing interdisciplinary rehabilitation for people with dementia and their caregivers—a co-creative journey

BackgroundThe World Health Organization claims that rehabilitation is important to meet the needs of persons with dementia. Rehabilitation programmes, however, are not routinely available. Person-centred, multidimensional, and interdisciplinary rehabilitation can increase the opportunities for older adults with dementia and their informal primary caregivers to continue to live an active life and participate in society. To our knowledge, staff team experiences of such rehabilitation programmes, involving older adults with dementia and their informal caregivers has not been previously explored.MethodsThe aim of this qualitative focus group study was to explore the experiences of a comprehensive staff team providing person-centred multidimensional, interdisciplinary rehabilitation to community-dwelling older adults with dementia, including education and support for informal primary caregivers. The 13 staff team members comprised 10 professions who, during a 16-week intervention period, provided individualised interventions while involving the rehabilitation participants. After the rehabilitation period the staff team members were divided in two focus groups who met on three occasions each (in total six focus groups) and discussed their experiences. The Grounded Theory method was used for data collection and analysis.ResultsThe analysis resulted in four categories: Achieving involvement in rehabilitation is challenging, Considering various realities by acting as a link, Offering time and continuity create added value, and Creating a holistic view through knowledge exchange, and the core category: Refining a co-creative process towards making a difference. The core category resembles the collaboration that the staff had within their teams, which included participants with dementia and caregivers, and with the goal that the intervention should make a difference for the participants. This was conducted with flexibility in a collaborative and creative process.ConclusionsThe staff team perceived that by working in comprehensive teams they could provide individualised rehabilitation in creative collaboration with the participants through interaction, knowledge exchange, time and continuity, coordination and flexibility, and a holistic view. Challenges to overcome were the involvement of the person with dementia in goal setting and the mediating role of the staff team members. The staff pointed out that by refinement they could achieve well-functioning, competence-enhancing and timesaving teamwork.

The Effect of a Multidimensional Home Rehabilitation Program for Post-Total Knee Arthroplasty Elderly Patients.

Patients with total knee arthroplasty (TKA) experience pain, decreased muscle strength, and decreased knee function, resulting in increases in depression and decreased subjective well-being. A multidimensional home program may prevent these adverse events. The aim of this study was to test the effect of a home rehabilitation program that included education, exercise, aroma massage, and phone counseling for post-TKA patients. We used a randomized control group pretest/posttest design. Fifty-nine patients participated, with 29 in the experimental group and 30 in the control group. Pain, knee joint range of motion (ROM), quadriceps strength, depression, and subjective well-being were measured as outcome variables. Data were analyzed using repeated-measures analysis of variance and generalized estimating equations. The experimental group showed significant improvement in knee pain, active ROM, muscle strength, depression, and subjective well-being with no significant between-groups difference in passive ROM. The multidimensional home rehabilitation program can be an effective nursing intervention for physical and emotional recovery of patients with TKA.

The Effect of Rehabilitation Nursing Interventions on the Quality of Life in Women With Neurogenic Bladder Dysfunction

Objective: Neurogenic bladder (NB) is one of the most common causes of urinary incontinence, and its many long-term problems negatively affect patients' quality of life, especially women, due to a lack of social roles. Due to the chronic nature of this disorder, the implementation of rehabilitation nursing interventions to improve the quality of life of these patients has been recommended. Therefore, this study aimed to evaluate the effectiveness of multidimensional rehabilitation nursing intervention of urinary incontinence on the quality of life of young and middle-aged women with neurogenic bladder. Materials &amp; Methods: The present research was a quasi-experimental study with a pre-test-post-test design that was conducted in Rofeideh Rehabilitation Hospital, Tehran, Iran, in 2021. Data were collected from 30 young and middle-aged women aged 18 to 60 years admitted with neurogenic bladder. The samples completed the demographic questionnaire and incontinence quality of life questionnaire (I-QOL) before and 6 weeks after the intervention during follow-up. Multidimensional rehabilitation nursing intervention of urinary incontinence included two-part training sessions: 1) clean intermittent catheterization and 2) behavioral therapy (Time voiding, delaying urination, diet, and medication) in 7 30-minutes sessions of training conducted daily and individually face-to-face in the first week and then a follow-up of patients in 5 weeks (second, third, fourth, fifth, and sixth weeks), one session per week in the form of virtual classes and online video calls in WhatsApp application. The collected data were analyzed in SPSS software version 25 using one-way ANOVA and paired t-test at a significance level of 0.05. Results: Most participants were 20-30 years old (30%) and married (53.3%). Before and after the intervention, the quality of life of patients with neurogenic bladder disorder increased from 46.46±11.07 to 66.23±9.46, which was statistically significant (t=14.20, P&lt;0.0001). Also, psychosocial impacts due to the disease were reduced based on one of the three subscales of the quality of life questionnaire. In addition, quality of life was significantly lower in younger, unemployed, single, spinal cord injury, body odor, and people with a neurogenic bladder disease diagnosis period of less than one year (P&lt;0001). Conclusion: According to our findings, clean intermittent catheterization and behavioral therapy could significantly improve patient's quality of life with NB. Therefore, it is recommended to investigate the long-term effectiveness of this intervention.

Community-Based Multidimensional Cancer Rehabilitation in Norway: A Feasibility Study.

Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway, this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. This study aimed to assess the feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. A feasibility study with a mixed methods explanatory sequential design was implemented. The intervention was a 12-week group-based rehabilitation program comprising 5 components: goal setting, physical exercise, psychoeducation, individual follow-up consultations, and peer support. Feasibility was assessed through recruitment, retention, and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive, and qualitative data were transcribed and analyzed using framework analyses. Sixty participants started, and 55 completed the 12-week rehabilitation program. The majority were female (80%), and the mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as were adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. High retention, strong adherence, and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway "Home."

Application of Early Multi-dimensional Cardiac Rehabilitation Nursing in Percutaneous Coronary Intervention and Its Effects on Adverse Events and Patients’ Adherence to Medication

Objective: To evaluate the application value of early multi-dimensional cardiac rehabilitation nursing in percutaneous coronary intervention (PCI) and its effects on adverse events and patients’ adherence to medication. Methods: A total of 90 patients that underwent PCI in our hospital from January 2019 to January 2020 were selected as the study subjects. The patients were divided into two groups according to the order of admission, the control group and the study group, with 45 patients in each group. Patients in the control group were cared for using conventional nursing methods, while those in the study group were cared for using conventional nursing methods combined with early multi-dimensional cardiac rehabilitation nursing. The efficacy of nursing and the incidence of adverse events in the two groups of patients were assessed and compared. The exercise of self care agency scale (ESCA) was used to evaluate the self-care ability of patients after intervention. The generic quality of life inventory-74 (GQOLI-74) was used to assess the patients’ quality of life after intervention. The Morisky medication adherence scale 9 (MMAS-8) was used to assess the patients’ adherence to medication before and after intervention. The hospital anxiety and depression scale (HAD) was used to assess the patients’ emotional state before and after intervention. Results: The total nursing satisfaction after intervention in the study group was significantly higher than that in the control group (P&lt;0.05). A remarkably lower incidence of adverse cardiovascular events after intervention was observed in the study group in comparison to the control group (P&lt;0.05). Patients in the study group had significantly higher ESCA, GQOLI-74 and MMAS-8 scores and lower HAD scores than those in the control group (all P&lt;0.001). Conclusion: Early multi-dimensional cardiac rehabilitation nursing for patients undergoing PCI can significantly improve the patients’ adherence to medication and quality of life. It can also reduce the incidence of adverse cardiovascular events. It has remarkable nursing efficacy, and is worthy of more widespread promotion and clinical application.

Digital Graphic Follow-up Tool (Rehabkompassen) for Identifying Rehabilitation Needs Among People After Stroke: Randomized Clinical Feasibility Study.

BackgroundStroke is a leading cause of disability among adults, with heavy social and economic burden worldwide. A cost-effective solution is urgently needed to facilitate the identification of individual rehabilitation needs and thereby provide tailored rehabilitations to reduce disability among people who have had a stroke. A novel digital graphic follow-up tool Rehabkompassen has recently been developed to facilitate capturing the multidimensional rehabilitation needs of people who have had a stroke.ObjectiveThe aim of this study was to evaluate the feasibility and acceptability of conducting a definitive trial to evaluate Rehabkompassen as a digital follow-up tool among people who have had a stroke in outpatient clinical settings.MethodsThis pilot study of Rehabkompassen was a parallel, open-label, 2-arm prospective, proof-of-concept randomized controlled trial (RCT) with an allocation ratio of 1:1 in a single outpatient clinic. Patients who have had a stroke within the 3 previous months, aged ≥18 years, and living in the community were included. The trial compared usual outpatient visits with Rehabkompassen (intervention group) and without Rehabkompassen (control group) at the 3-month follow-up as well as usual outpatient visit with Rehabkompassen at the 12-month follow-up. Information on the recruitment rate, delivery, and uptake of Rehabkompassen; assessment and outcome measures completion rates; the frequency of withdrawals; the loss of follow-up; and satisfaction scores were obtained. The key outcomes were evaluated in both groups.ResultsIn total, 28 patients (14 control, 14 Rehabkompassen) participated in this study, with 100 patients screened. The overall recruitment rate was 28% (28/100). Retention in the trial was 86% (24/28) at the 12-month follow-up. All participants used the tool as planned during their follow-ups, which provided a 100% (24/24) task completion rate of using Rehabkompassen and suggested excellent feasibility. Both patient- and physician-participants reported satisfaction with the instrument (19/24, 79% and 2/2, 100%, respectively). In all, 2 (N=2, 100%) physicians and 18 (N=24, 75%) patients were willing to use the tool in the future. Furthermore, modified Rankin Scale as the primary outcome and various stroke impacts as secondary outcomes were both successfully collected and compared in this study.ConclusionsThis study demonstrated the high feasibility and adherence of the study protocol as well as the high acceptability of Rehabkompassen among patients who have had a stroke and physicians in an outpatient setting in comparison to the predefined criterion. The information collected in this feasibility study combined with the amendments of the study protocol may improve the future definitive RCT. The results of this trial support the feasibility and acceptability of conducting a large definitive RCT.Trial RegistrationClinicalTrials.gov NCT04915027; https://clinicaltrials.gov/ct2/show/NCT04915027

Redefining a minimal rehabilitation assessment protocol for severe acquired brain injuries.

The assessment of patients with severe Acquired Brain Injury (sABI) is mandatory in every phase and setting of care, and requires a multidimensional and interdisciplinary approach, to develop the individual rehabilitation project, and monitor long-term functional outcomes. In 2001 the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the minimal assessment protocol for traumatic sABI, providing a comprehensive, standardized functional assessment based on the International Classification of Functioning, Disability and Health (ICF), 2001. In 2007, a new protocol was published, extended to all sABI patients (PMGCA). In 2019, the SIMFER appointed a working group to provide a revised, updated version: the PMGCA2020. The purpose of this study was to describe the minimal assessment protocol to be applied at every stage and setting of the care process of patients with sABI. The working group, including one neurologist and 11 physiatrists experts in sABI rehabilitation, performed a review of the international recommendations for sABI assessment focusing on the following key words: "sABI assessment," "sABI rehabilitation," "sABI prognostic factors," "sABI rehabilitation assessment," "sABI outcome," in MEDLINE. Revision and integration proposals by each member were written and motivated, discussed and voted. The PMGCA2020 is addressed to sABI adult patients. It investigates the main clinical problems of sABI at any time of the rehabilitation pathway. It includes a demographic/anamnestic section, a clinical/functional assessment section and an outcome measures section following the ICF model of functioning and the model of the construction of the rehabilitation project. The PMGCA2020 provides an updated tool for the multidimensional rehabilitation assessment of sABI patients, at any stage of the rehabilitation pathway. Further studies will allow the validation of this minimum set of variables paving the way to an assessment standardization of patients with sABI in the rehabilitation settings. This minimum set of variables, defining patient's functioning and clinical status and outcomes, at every stage and setting of the care process to provide a framework for the standardization of the clinical evaluation of patients with sABI in rehabilitation settings.

Increased Levels of Beta-Endorphin and Noradrenaline after a Brief High-Impact Multidimensional Rehabilitation Program in Multiple Sclerosis.

Finding new solutions for the management of multiple sclerosis (MS) is crucial: further research is needed to study the effect of non-pharmacological interventions on the symptoms and the course of the disease, especially on lifestyle. Benefits from a proper lifestyle are evident not only on a clinical level but also on immune and neuro-endocrine systems. A brief high-impact multidimensional rehabilitation program (b-HIPE) was proposed for a sample of people with MS (pwMS) with a medium level of disease disability. We tested the change on clinical parameters and quality of life (QoL) after participation in B-HIPE. We furthermore decided to measure beta-endorphin and catecholamines concentrations pre- and post-participation in the b-HIPE program, due to the relationship between these hormones and the immune system in neurodegenerative diseases. Our results showed that after the b-HIPE program, an improvement of clinical parameters and QoL occurred. Moreover, we found higher levels of beta-endorphin and noradrenaline after participation in the program. These findings highlight the importance of implementing lifestyle interventions in the clinical management of MS. Furthermore, we hypothesize that the B-HIPE program increased beta-endorphin and noradrenaline levels, helping to reduce the inflammation related to MS disease.

Sarcoidosis - a multisystem disease.

Sarcoidosis is a systemic inflammatory disease, characterised by granuloma formation upon an unknown trigger in genetically predisposed individuals. The inflammation is characterised by an activation of both the innate immune system, with macrophages differentiating into epitheloid cells and dendritic cells, and the adaptive immune system, particularly T helper (Th) 1 and Th17 cells. Since all organs can be affected to varying extents, clinical presentation is often diverse. Most commonly, the lungs, lymph nodes, skin and eyes are involved, whereas cardiac, renal and neurological manifestations are less common but associated with higher morbidity. Depending on the clinical symptoms, a detailed evaluation including thorough clinical examination, imaging and laboratory tests should explore all possible organ involvements. In some patients, fatigue manifests as a para-sarcoidosis symptom impacting quality of life, even if sarcoidosis is in remission. Some acute syndromic presentations, such as Löfgren's syndrome, have a good prognosis and are commonly self-limiting. If possible, a topical treatment, for example for cutaneous sarcoidosis or bronchial involvement, should be applied. Treatment of severe cases with persisting disease activity necessitates long-term immunosuppressive drugs, with glucocorticoids as the first-line option. Steroid-sparing and second-line drugs include methotrexate, azathioprine, mycophenolate mofetil and immunomodulators such hydroxychloroquine, with the latter being first-line therapy in cutaneous sarcoidosis. Tumour necrosis factor-alpha inhibitors (particularly adalimumab and infliximab) are used as third-line agents but are administered earlier in cases of persistent disease activity, severe organ-involvement or intolerance to conventional drugs. Treatment decisions should be based on a multidisciplinary approach, depending on organ involvement and treatment tolerability. Para-sarcoidosis manifestations, particularly fatigue, should also be carefully addressed, where the patient could also be enrolled in multidimensional rehabilitation programmes. With various organ involvement and different phenotypes, larger studies including real-world data from registries are necessary to evaluate different sarcoidosis endotypes and preferential treatment pathways.

Sarcoidosis - a multisystem disease.

Sarcoidosis is a systemic inflammatory disease, characterised by granuloma formation upon an unknown trigger in genetically predisposed individuals. The inflammation is characterised by an activation of both the innate immune system, with macrophages differentiating into epitheloid cells and dendritic cells, and the adaptive immune system, particularly T helper (Th) 1 and Th17 cells. Since all organs can be affected to varying extents, clinical presentation is often diverse. Most commonly, the lungs, lymph nodes, skin and eyes are involved, whereas cardiac, renal and neurological manifestations are less common but associated with higher morbidity. Depending on the clinical symptoms, a detailed evaluation including thorough clinical examination, imaging and laboratory tests should explore all possible organ involvements. In some patients, fatigue manifests as a para-sarcoidosis symptom impacting quality of life, even if sarcoidosis is in remission. Some acute syndromic presentations, such as Löfgren's syndrome, have a good prognosis and are commonly self-limiting. If possible, a topical treatment, for example for cutaneous sarcoidosis or bronchial involvement, should be applied. Treatment of severe cases with persisting disease activity necessitates long-term immunosuppressive drugs, with glucocorticoids as the first-line option. Steroid-sparing and second-line drugs include methotrexate, azathioprine, mycophenolate mofetil and immunomodulators such hydroxychloroquine, with the latter being first-line therapy in cutaneous sarcoidosis. Tumour necrosis factor-alpha inhibitors (particularly adalimumab and infliximab) are used as third-line agents but are administered earlier in cases of persistent disease activity, severe organ-involvement or intolerance to conventional drugs. Treatment decisions should be based on a multidisciplinary approach, depending on organ involvement and treatment tolerability. Para-sarcoidosis manifestations, particularly fatigue, should also be carefully addressed, where the patient could also be enrolled in multidimensional rehabilitation programmes. With various organ involvement and different phenotypes, larger studies including real-world data from registries are necessary to evaluate different sarcoidosis endotypes and preferential treatment pathways.

A Qualitative Study of Cancer Survivors' Experienced Outcomes of a Multidimensional Rehabilitation Program in Primary Healthcare.

Cancer survival rates are increasing, but survival is often followed by several late effects. Cancer survivors' need for complex rehabilitation is well documented, but this is mostly missing in primary healthcare. The aim of this study was to explore cancer survivors' experienced outcomes of a multidimensional rehabilitation program in primary healthcare. The study used a qualitative method with a descriptive research design. Fifty-six cancer survivors completed a 12-week rehabilitation program built upon the 5 elements of goal setting, physical exercise, psychoeducation, individual follow-up, and peer support. Data were collected at the end of the program via 8 focus group interviews, and systematic text condensation was used to analyze the data. "Increased coping and participation" was identified as the overarching theme of the participants' experienced outcomes from the program, and this was elaborated by 3 main themes: (1) "increased energy and capacity," (2) "acceptance and understanding," and (3) "structure and hope." The multidimensional rehabilitation program seemed to address cancer survivors' multiple challenges in survivorship. Proximity and accessibility to a local rehabilitation program and professionals' competence seemed to be essential factors for the participants' experienced outcomes of the program. A multidimensional rehabilitation program integrated in a Healthy Life Centre in primary healthcare may be beneficial for cancer survivors' coping and participation in everyday life. Cancer nurses play a crucial role in initiating and facilitating such programs.