Multidisciplinary Rehabilitation Research Articles

Impact of Post-acute COVID-19 Syndrome on Mental Health of Healthcare Professionals: A Cross-sectional Study

Introduction: Anxiety, depression, and poor sleep quality are the most common mental health issues in post-acute Coronavirus Disease-2019 (COVID-19) syndrome. Healthcare professionals (HCPs) were overburdened and unable to focus on their own health issues. Previous epidemic diseases, such as Severe Acute Respiratory Syndrome (SARS) in 2003, also accompanied psychiatric issues in HCPs. In light of this, the purpose of this study was to identify the symptoms of COVID19 that continue to affect HCPs and their associations with fatigue, poor sleep, anxiety, depression, and activity levels, in order to provide better care and treatment for them. Aim: To analyse the impact of post-acute COVID-19 syndrome on the mental health of HCPs and compare the results with non COVID-19 infected participants. Materials and Methods: A cross-sectional study was conducted at PGIMS, Rohtak in Haryana, India from October 2021 to September 2022. A total of 280 participants between 25-45 years of age, including doctors, nurses, and dentists involved in direct COVID-19 patient care, were included in the survey. They were divided equally into a non COVID-19 infected group and a post-acute COVID-19 syndrome group, with atleast three months having passed since infection. The survey included scales addressing anxiety, depression, and sleep quality, including the Zung Self-rating Anxiety Scale (SAS), Zung Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). The mean scores were compared between both groups using an Independent sample t-test. Results: The data of 240 participants were analysed and compared between both groups. The mean age was 32.41 years in the post-acute COVID-19 syndrome group and 31.24 years in the non COVID-19 infected group. The post-acute COVID-19 syndrome group consisted of a large proportion of doctors (60, 42.9%) and nurses (53, 37.9%), whereas the non COVID-19 infected group included doctors (47, 33.5%) and nurses (56, 40%). The results showed statistically significant differences for anxiety (p-value=0.001) and sleep quality (p-value =0.001), while no significant differences were found for depression (p-value>0.05). Conclusion: Anxiety and poorer sleep quality occur in healthcare workers suffering from post-acute COVID-19 syndrome. Creating multidisciplinary rehabilitation health teams in hospitals with clinician psychologists, physiotherapists, nurses, and psychiatrists is essential to address mental health issues in the post-COVID-19 population.

Describing healthcare concerns of adolescents and adults with cerebral palsy

AimTo identify healthcare concerns of adolescents and adults with cerebral palsy (CP) followed in a multidisciplinary rehabilitation program and identify patient factors associated with the number of concerns raised. MethodA retrospective chart review of initial consultations of 241 people with CP (53 % male) aged 14 years or older (mean 27 y 5mo, SD 13 y 2mo), over a three-year period. Descriptive statistics were used to summarize data and explore associations. Poisson’s regression was used to predict healthcare concerns from patient demographic factors. ResultsA total of 2237 distinct concerns were raised by the participants, with a median of 9 (range 1–34) concerns per person. Ten healthcare concern categories were reported by more than 25 % of the sample. Only age was associated with the number of healthcare concerns (r = 0.25, p < 0.001). Age and GMFCS significantly predicted total number of healthcare concerns. InterpretationAdolescents and adults with CP reported a high number of healthcare concerns at the initial visit to the Transitional and Lifelong Care program and the number of concerns may increase with advancing age. The concerns identified span a variety of biopsychosocial spheres and supports the need for ongoing specialty and multidisciplinary care of this population through their adult years.

EFFECTIVENESS OF THE REHABILITATION APPROACH BASED ON THE VISUAL MODEL OF MOBIUS TAPE IN THE TREATMENT OF MYOFASCIAL PAIN SYNDROME OF THE CERVICAL REGION IN COMBATANTS

During combat activities, the consequences of contusive and traumatic injuries to the spine, which lead to myofascial pain, in particular in the neck area, are of great importance. Myofascial pain syndrome, localized in the muscles and fascia, can range from mild discomfort to excruciating pain. To optimize personal rehabilitation programs in health care practice, for additional visualization of educational and practical activities, it was suggested to consider the rehabilitation process as a "motor and mental dialogue" at the same time, and also to use a topological object - the Möbius strip as a visual, multi-vector, interdisciplinary, plastic model of rehabilitation. The paper focuses on the study of the effectiveness of using the ecological approach in rehabilitation practice. The research was conducted on the basis of the Municipal Enterprise "Poltava Regional Clinical Hospital for War Veterans" of Poltava Regional Council. 42 military servicemen - participants of combat activities with a diagnosis of the myofascial pain syndrome of the cervical area were included in the study. As a component of the ecological approach, an individually developed program of comprehensive rehabilitation intervention aimed at the biomechanically interconnected muscle spirals, the diaphragm and masticatory muscles, and the temporomandibular joint was used. The method of active rehabilitation in patients using a program of comprehensive rehabilitation intervention for biomechanically interconnected muscle spirals, diaphragm and masticatory muscles, and temporomandibular joint, was based on a course of training with a multidisciplinary rehabilitation team lasting 21 days - 3 - 5 sessions with the doctor every day and 6-8 sessions according to the video sample recorded by the doctor. A statistically significant decrease in the intensity of pain according to VAS and an increase in the angle of painless lateral movement with an element of rotation may indicate the effectiveness of rehabilitation measures already on the seventh day of treatment. A decrease in the intensity of pain and an increase in the angle of painless lateral movement with an element of rotation in the experimental group, as compared to the control group, may indicate the advantage of using the proposed program at the same time as standard approaches in rehabilitation. The model proposed in the study can act not only as a treatment and rehabilitation tool but also as a visual training tool for future specialists, which has several advantages over traditional models. In particular, it involves low cost and ease of implementation, and it should be noted that the comprehensive, at first glance, rehabilitation process is simplified due to mathematical logic, sequence, creativity, and game form.

COMPREHENSIVE AND MULTIDISCIPLINARY REHABILITATION IN THE TIME OF CRISIS

Comprehensive and multidisciplinary rehabilitation is gaining momentum as a useful strategy that aims to improve physical, psychological, and social components of health in subjects affected by violence, trauma, and mental distress. Previous and current wars have prioritized essential diagnostic and rehabilitative services to civil subjects and military servicepersons which can be delivered by skilled physiatrists and allied specialists. Stratifying subjects in need of various rehabilitative procedures and offering them psychological support, balanced nutrition, musculoskeletal care, and socialisation in a safe and relaxing atmosphere may improve their mental and functional capacities and resolve numerous health issues. The choice of comprehensive rehabilitative procedures depends on their availability and understanding of complementary effects of various interventions.

Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial

Background: Neuralgic amyotrophy (NA) is a common peripheral nerve disorder caused by auto-immune inflammation of nerves in the brachial plexus territory, characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Recent work has confirmed that NA patients with residual motor dysfunction have abnormal cerebral sensorimotor representations of their affected upper extremity. Objective: To determine whether abnormal cerebral sensorimotor representations associated with NA can be altered by specialized, multidisciplinary outpatient rehabilitation focused on relearning motor control. Methods: 27 NA patients with residual lateralized symptoms in the right upper extremity participated in a randomized controlled trial, comparing 17 weeks of multidisciplinary rehabilitation (n = 16) to usual care (n = 11). We used task-based functional MRI and a hand laterality judgment task, which involves motor imagery and is sensitive to altered cerebral sensorimotor representations of the upper extremity. Results: Change in task performance and related brain activity did not differ significantly between the multidisciplinary rehabilitation and usual care groups, whereas the multidisciplinary rehabilitation group showed significantly greater clinical improvement on the Shoulder Rating Questionnaire. Both groups, however, showed a significant improvement in task performance from baseline to follow-up, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. Conclusions: Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347).

Dealing with uncertainty. A qualitative study on the illness' experience in patients with Long-COVID in Italy.

An unknown proportion of people who had COVID-19 infection continue to experience symptoms such as fatigue, breathlessness, joint or muscle pain, difficulty sleeping, and brain fog. These symptoms have a significant impact on the quality of life. Long-COVID is a new multisystem disease still under investigation. This research aims to explore the illness experienced by patients suffering from Long-COVID in Italy. Qualitative methodology with semi-structured interviews. Participants were recruited on the Facebook patient group between October 2021 and January 2022. Participants had been experiencing symptoms for at least three months following confirmed COVID-19 infection. Interviews were conducted by video call, recorded and transcribed with consent. The thematic analysis method has been chosen to infer data from textual material. 17 interviews with women with Long-COVID have been analysed. The main themes include: a total change of life due to the symptomatology, loss of autonomy that affects social, family and professional life; social isolation, a sense of abandonment often increased by stigma, the difficulty of being believed and achieving diagnosis; difficulty in managing symptoms and accessing to care services; living with uncertainty caused by the lack of institutional, social, professional, familial and medical support. Conclusions: Intervention programs, both institutional and social-health policies should be developed for patients with Long-COVID. The impact of symptoms could be reduced by developing standards and protocols, and by ensuring access to care and to multi-disciplinary rehabilitation. Further development of knowledge on Long-COVID is essential.

Factors Associated with Dual-Fluency Walk Speed Improvement after Rehabilitation in Older Patients.

Walk speed measured under dual-task conditions (neurocognitive tasks) could reflect patient performance in real-life. Rehabilitation programs are effective in increasing walk speed, but few studies have evaluated the associations between geriatric factors and rehabilitation efficacy under dual-task conditions. Our objective was to investigate the association between geriatric factors and an increase in dual-task walk speed (threshold of 0.1 m/s), after a multidisciplinary rehabilitation program. We performed a retrospective cohort study that included patients aged 75 years and over, who underwent a complete rehabilitation program and who had a neurocognitive assessment at baseline. The primary outcome was the increase in the dual-task (fluency verbal task) walking speed between pre- and post-rehabilitation assessments. In this study, 145 patients were included, with a mean age of 83.6 years old. After rehabilitation, dual-task walk speed increase in 62 (43%) patients. In multivariate analysis, the following factors were associated with an increase in dual-task walk speed: IADL (OR 2.50, 95% CI [1.26; 4.94], p = 0.009), vitamin D level (OR 0.83, 95% CI [0.72; 0.95], p = 0.008), severe sarcopenia (OR 0.00, 95% CI [0.00; 0.32], p = 0.016), depression (OR 15.85, 95% CI [1.32; 190.40], p = 0.029), number of drugs (OR 1.41, 95% CI [1.04; 1.92], p = 0.027), initial dual-fluency walk speed (OR 0.92, 95% CI [0.86; 0.98], p = 0.014) and time interval between initial and final assessments (OR 0.98, 95% CI [0.96; 1.00], p = 0.06). Identifying patients that are less resilient to rehabilitation may promote a centered-patient approach for an individualized and optimized rehabilitation care.

The elaboration of approaches to medical rehabilitation of participants in warfare

The article considers social hygienic characteristics of participants in warfare underwent treatment and rehabilitation in specialized medical organization. It is established that patients of neurological profile and with diseases of cardiovascular system predominated in the studied contingent. The high need for medical rehabilitation was determined according results of examination of participants in warfare by multidisciplinary rehabilitation team. The necessity of observance staging and continuity in carrying out rehabilitation measures at all levels is emphasized.

TOPICAL ISSUES OF MEDICAL REHABILITATION OF PATIENTS WITH THE CONSEQUENCES OF SEVERE TRAUMATIC BRAIN INJURY AT THE MUNICIPAL LEVEL

The article presents the age-sex structure of people who have suffered severe traumatic brain injury on the example of a municipal medical organization providing medical care and medical rehabilitation in outpatient settings. The high prevalence of this type of injury among males of working age has been established. The duration of temporary disability and the timing of referral of this category of people for medical and social examination are reflected. There is a high level of disability among people who have suffered severe traumatic brain injury, and in most cases they are assigned more severe first and second disability groups. The article reflects the personnel problems of a municipal medical organization providing outpatient medical care in the formation of a multidisciplinary rehabilitation team, which require their resolution at the regional level.

Effects of Cardiac Rehabilitation on Sleep Quality in Heart Disease Patients with and without Heart Failure

Insomnia is a modifiable cardiovascular risk factor. Previous studies suggested that attending a cardiac rehabilitation program may improve sleep quality in cardiac patients and pointed out the association between heart failure and poor sleep quality. The primary aim of this study was to evaluate sleep quality in patients attending a Multidisciplinary Cardiac Rehabilitation Program (MRCP), and to compare sleep quality between patients with and without heart failure. A prospective observational study was carried out on a consecutive sample of 240 patients attending an 8-week MRCP; 50 patients (20.8%) were included due to heart failure (NYHA stages I-III) and the rest of them after having undergone any revascularization procedure or valvular surgery. Before and after the completion of the MRCP, the quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI) score. Post-intervention global PSQI scores were statistically significantly lower than those of pre-intervention (p = 0.008), but only 60 patients (25%) registered a clinically significant improvement. When comparing patients with heart failure with those without, no differences in sleep quality were found. This suggests that only a small percentage of patients can achieve clinically significant improvements in sleep quality attending conventional MCRP. Suggestions for future research are given.

Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review.

To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care. Scoping review. Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care. A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French between 2000 and 2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR). A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care. Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration.

Personalised rehabilitation to improve return to work in patients with persistent spinal pain syndrome type II after spinal cord stimulation implantation: a study protocol for a 12-month randomised controlled trial—the OPERA study

BackgroundFor patients with therapy-refractory persistent spinal pain syndrome type II (PSPS-T2), spinal cord stimulation (SCS) may serve as an effective minimally invasive treatment. Despite the evidence that SCS can improve return to work (RTW), only 9.5 to 14% of patients implanted with SCS are effectively capable of returning to work. Thus, it seems that current post-operative interventions are not effective for achieving RTW after SCS implantation in clinical practice. The current objective is to examine whether a personalised biopsychosocial rehabilitation programme specifically targeting RTW alters the work ability in PSPS-T2 patients after SCS implantation compared to usual care.MethodsA two-arm, parallel-group multicentre randomised controlled trial will be conducted including 112 patients who will be randomised (1:1) to either (a) a personalised biopsychosocial RTW rehabilitation programme of 14 weeks or (b) a usual care arm, both with a follow-up period until 12 months after the intervention. The primary outcome is work ability. The secondary outcomes are work status and participation, pain intensity, health-related quality of life, physical activity and functional disability, functional capacities, sleep quality, kinesiophobia, self-management, anxiety, depression and healthcare expenditure.DiscussionWithin the OPERA project, we propose a multidisciplinary personalised biopsychosocial rehabilitation programme specifically targeting RTW for patients implanted with SCS, to tackle the high socio-economic burden of patients that are not re-entering the labour market. The awareness is growing that the burden of PSPS-T2 on our society is expected to increase over time due to the annual increase of spinal surgeries. However, innovative and methodologically rigorous trials exploring the potential to decrease the socio-economic burden when patients initiate a trajectory with SCS are essentially lacking.Trial registrationClinicalTrials.gov NCT05269212. Registered on 7 March 2022.

The role of gastrostomy feeding during intestinal rehabilitation for children with short bowel syndrome.

Following extensive bowel resection, many children with short bowel syndrome (SBS) are routinely offered a placement of gastrostomy tube (G-tube) for feeding. This nutritional pathway is aimed to accommodate the gastric and small bowel motor disturbances related to SBS, and to promote weaning off parenteral nutrition (PN) to achieve enteral autonomy (EA). The aim of this study was to investigate the effect of gastrostomy feeding in outcomes of children with SBS. A retrospective cohort of all SBS children managed at our multidisciplinary Intestinal Rehabilitation Center as part of an Intestinal Rehabilitation Program. SBS was defined as PN dependence for more than six weeks following extensive bowel resection. Patients treated with G-tube feeding were compared with patients without G-tube in terms of PN duration, reaching EA, physical development, and surgical parameters. A total of 36 SBS patients diagnosed between 2003 and 2022 were included. The most common etiologies included congenital intestinal atresia (31%) and necrotizing enterocolitis (25%). SBS-G-tube (group A) contained 20 children, and SBS (group B) contained 16 children. A total of 21 children reached EA (58%); ten from group A (50%), and 11 from group B (69%) (p > 0.05). Within EA patients, mean PN duration was 49 ± 44months in group A, and 24 ± 33months in group B (p > 0.05). Patients who reached EA had 22% longer residual small bowel when compared with PN-dependent patients (p = 0.003). However, the outcomes were adjusted for residual small and large bowel length and percentages, a residual ileocecal valve, and a colon in continuity with no differences between the groups. Two-thirds of children from group A reported G-tube related complications (mechanical, bleeding, or infections). We did not find differences in mean height and weight percentiles between the groups (p > 0.05). We did not find significant advantage of gastrostomy feeding in reaching EA. Because there are surgical and mechanical complications related to this procedure, further prospective studies are required to determine G-tube relevance for children with SBS.

Interventions for Driving Disruption in Community Rehabilitation: A Chart Audit

Purpose After injury or illness, a person’s ability to drive may be impacted and they may experience a period of “driving disruption,” a period during which they cannot drive although they have not permanently ceased driving. They may require additional information and supports from treating rehabilitation services; however, this process is less understood than others related to driving. Materials and methods This study aimed to document the prevalence of driving-related issues and the current practices of a community rehabilitation service, regarding driving interventions. An audit of 80 medical records was conducted in a multidisciplinary community rehabilitation service in Brisbane, Australia. Results In total, 61% of clients were “driving-disrupted” on admission and 35% remained driving-disrupted on discharge. Majority of driving-disrupted clients had an acquired brain injury (ABI). Driving-related interventions were not routinely provided, with 29% receiving no information or supports. Clients with ABI more frequently received information; provision of psychosocial support and community access training was infrequent. Conclusions This study highlights that return to driving is a common issue and goal for people undergoing community rehabilitation, with the period of driving disruption extending beyond rehabilitation discharge. It also highlights gaps in community rehabilitation practice, and opportunities to better support these clients. IMPLICATIONS FOR REHABILITATION Many clients of community rehabilitation services experience driving disruption, often beyond discharge. Driving disruption should be recognised and documented by community rehabilitation services. Current practices may not adequately address the practical and psychological needs of clients experiencing driving disruption.

Association between volume of patients undergoing stroke rehabilitation at acute care hospitals and improvement in activities of daily living

BackgroundThis study aimed to determine the relationship between the annual volume of patients undergoing rehabilitation per hospital and the outcomes of patients admitted for acute stroke. MethodsThis observational study used nationwide administrative data. Data on stroke patients aged ≥ 20 years who underwent rehabilitation were extracted from 1,182 acute care hospitals in Japan. The exclusion criteria were extended hospital stay exceeding 180 days and death during hospitalization. Hospital volumes were divided into four quartiles of total patients per hospital. The primary outcome was an improvement in activities of daily living from admission to discharge measured using the Barthel index. Poisson regression analysis of activities of daily living improvement was performed using inverse probability of treatment weighting. ResultsHigh rehabilitation volume was significantly correlated with improvements in activities of daily living using the “very low group” as a reference (risk ratio [95% confidence interval]): 1.06 [1.05–1.08], P<0.001). Low volume was also significantly associated with activities of daily living improvement (risk ratio [95% confidence interval]: 1.04 [1.03–1.06], P<0.001). ConclusionsThe annual volume of stroke patients undergoing multidisciplinary rehabilitation at a specific hospital may be a factor in the degree of patient improvement in activities of daily living

Early rehabilitation to improve functional outcomes in childhood cancer in Singapore

Dear Editor, We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary Material).1 The study was funded by

Group-based pulmonary telerehabilitation is feasible, safe, beneficial and well-received in patients who have been hospitalised with COVID-19.

Coronavirus disease 2019 (COVID-19) has caused worldwide mass hospitalisation. The need for multidisciplinary post-hospitalisation rehabilitation is becoming increasingly apparent, and telerehabilitation has been endorsed. The aim of study was to investigate the feasibility and efficacy of pulmonary telerehabilitation for COVID-19 survivors. This was a single-centre, mixed-methods, fast-track (wait-list), randomised controlled trial of telerehabilitation for patients who had been hospitalised with COVID-19. 40 patients discharged from two university teaching hospitals in the north of England were recruited. Telerehabilitation consisted of 12 exercise classes, six education events and opportunity for peer support. Patients commenced telerehabilitation 14 days after randomisation in the fast-track group and 56 days after randomisation in the wait-list group. Descriptive and statistical improvements were noted in several clinical outcome measures. Exercise capacity increased from a median (interquartile range) 20 (14-24) sit-to-stand repetitions in 1 min at baseline to 25 (24-30) post-telerehabilitation. Breathlessness rated using the Medical Research Council dyspnoea scale changed from 3.5 (3-4) at baseline to 2 (1.5-3) post-telerehabilitation, with additional favourable outcomes noted in respiratory symptoms measured using numerical rating scales and visual analogue scales (VAS). Quality of life measured using the EuroQol VAS improved from 55 (60-70) units at baseline to 70 (55-80) units following telerehabilitation. Improvements in fatigue (modified Functional Assessment of Chronic Illness Therapy: Fatigue) and mood (Hospital Anxiety and Depression Scale - Depression) were also observed. Natural recovery was observed in the wait-list group prior to receiving telerehabilitation; however, improvements were accelerated by early telerehabilitation in the fast-track group. We have shown that group-based telerehabilitation is feasible, safe, beneficial and well-received in this population.

Assessment and nonsurgical management of low back pain: a narrative review.

Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.

Evaluation of the nation-wide implementation of ALS home monitoring & coaching: an e-health innovation for personalized care for patients with motor neuron disease

BackgroundTo improve the care for patients with motor neuron disease an e-health innovation for continuous monitoring of disease progression and patients’ well-being (ALS H&C) was implemented in 10 multidisciplinary rehabilitation settings. The first aim was to evaluate the implementation of ALS H&C by assessing several implementation outcomes, technology acceptance and usability of the innovation according to the end users. The secondary aim was to explore differences in these outcomes between the teams with sustainable and unsustainable implementation.MethodsThe chosen implementation strategy was a combination of the implementation process model by Grol & Wensing and a participatory action research approach. In three meetings with multidisciplinary project groups the innovation was introduced, the expected barriers/facilitators identified, and action plans to resolve each barrier developed. After a 3-month pilot phase, patients and their healthcare providers were asked to complete an online evaluation survey to assess implementation outcomes, based on Proctor’s evaluation framework (i.e., acceptability, feasibility, fidelity, sustainability). Telemedicine technology acceptance was assessed according the technology acceptance model of Chau, and user experiences with the System Usability Scale (SUS). Implementation outcomes of teams with sustainable implementation (continuation after completion of the pilot phase) and unsustainable implementation (discontinuation after the pilot phase) were compared.ResultsThe implementation outcomes from the patients’ perspective (N = 71) were positive; they found ALS H&C to be an acceptable and feasible care concept. Patients’ technology acceptance was high, with positive attitudes towards ALS H&C, and positive views on perceived technology control, usefulness, and ease of use. Patients rated their satisfaction with the (web) app on a scale from 1 (not satisfied at all) to 10 (very satisfied) with a 7.0 (median; IQR 1.0). Healthcare providers (N = 76) also found ALS H&C acceptable and appropriate as well, but were less positive about the feasibility and usability of ALS H&C (mean SUS 58.8 [SD 11.3]). ALS H&C has largely been implemented as intended and the implementation was sustainable in 7 teams. Teams who discontinued ALS H&C after the pilot phase (N = 2) had more fidelity issues.ConclusionsA participatory action research approach supported by theoretical approaches used in implementation science led to a sustainable implementation of ALS H&C in 7 of the participating teams. To improve implementation success, additional implementation strategies to increase feasibility, usability and fidelity are necessary.Trial registrationTrial NL8542 registered at Netherlands Trial Register (trialregister.nl) on 15th April 2020.

Chronic low back pain: a prospective study with 4 to 15 years follow-up after a multidisciplinary biopsychosocial rehabilitation program

BackgroundMultidisciplinary biopsychosocial rehabilitation (MBR) in patients with chronic low back pain (CLBP) is superior to less intensive treatments for at least one year, but the long-term course of the disease is largely unknown. The primary aim of this study was to describe the long-term course of an MBR in relation to pain, disability, and quality of life from the beginning of an MBR to between 4 to 15 years after participation. The secondary aim was to explore the long-term course of an MBR in relation to physiological outcomes of functioning.MethodsThis was a observational study conducted at a university hospital. The cohort consisted of participants of a 3-week, CLBP-specific MBR program between August 2001 and January 2013. The North American Spine Society questionnaire (NASS) pain and disability scale was the primary patient -reported outcome measure (PROM). The NASS neurogenic symptoms scale and the Short-Form 36 (SF-36) health survey were secondary PROMs. Patients were assessed before entry to the MBR (T0), at entry (T1), at discharge (T2) and 4 to 15 years after discharge (T3). Effects were quantified by effect size (ES). Score differences were tested for significance using parametric or non-parametric tests and linear mixed models.ResultsOf 299 consecutive patients from the MBR program, 229 could be contacted. Of these, 84 declined participation, five did not meet the inclusion criteria, and 26 had incomplete data. Thus, 114 patients were included. The mean follow-up time was 9.2 years. At T3, patients exhibited beneficial effects for NASS pain and disability with a moderate ES (ES = 0.63; p < 0.001). The NASS neurogenic symptoms scale was stable. The SF-36 scales showed an improvement in the bodily pain domain (ES = 1.02; p < 0.001), but no significant changes for physical functioning, physical role, general health, vitality, social functioning, emotional role, or mental health. The physical health component summary was improved (ES = 0.40, p = 0.002), and the mental health summary was unchanged. The linear mixed model analysis confirmed improvements in pain and disability between T1 and T3 (p = 0.010).ConclusionsThe results of this study suggest that there is a long-term benefit of MBR participation in patients with CLBP.