Number Of Rehabilitation Sessions Research Articles

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Return to Work and Associated Factors After the First Hospitalization for Heart Failure.

Heart failure (HF) is a public health problem worldwide. Employment is vital in terms of personal, social, and economic aspects for patients with chronic diseases. The aim of this study is to investigate returning to work and the associated factors after first hospitalization for HF in working- age patients. In this retrospective cohort study, patients with the first hospitalization for HF in 2017-2020 who were employed before hospitalization were included. The demographic, occupational, and disease-related variables were compared in subjects with and without returning to work. Next, the relationship between the variables and the number of days off work was examined in participants who had returned to work. The data of 204 participants were analyzed. About 90% of the participants returned to work after one year. There was a significant relationship between not returning to work and higher age, female sex, higher New York Heart Association (NYHA) class, Ejection fraction (EF) ≤ 40%, and history of chronic kidney disease (CKD). Among the participants who had returned to work, income level, cause of work exit, employer support, and the number of rehabilitation sessions had a significant relationship with the number of days off work. The results of this study showed that gender, age, EF level, history of CKD, and NHYA class were the most influential factors in returning to work after first HF hospitalization. Furthermore, income, cause of work exit, employer support, and the number of rehabilitation sessions were the most important factors contributing to the number of days off work.

Virtual Rehabilitation of Elbow Flexion Following Nerve Transfer Reconstruction for Brachial Plexus Injuries Using the Single-Joint Hybrid Assisted Limb

PurposeThe upper limb single-joint hybrid assistive limb (HAL), a wearable robot that can support elbow flexion and extension motions, was originally used to rehabilitate patients with stroke. We report the preliminary outcomes of serial HAL use for rehabilitation following nerve transfer (NT) for elbow flexion reconstruction in brachial plexus injuries.MethodsHybrid assistive limb training consisted of virtual and power training courses. Virtual training was started before HAL picked up motor unit potentials (MUPs) from the target muscle through electrodes attached to the skin overlying the original donor muscles. Power training was started after the maturation of MUPs, the stage where the MUPs were strong to be recognized to arise from the target muscles. Hybrid assistive limb assist at this stage was carried out by decreasing the settings in an inversely proportionate manner to the increase in target muscle strength. Fourteen patients underwent HAL training following NT. Eight patients had the intercostal nerve to musculocutaneous nerve (ICN-MCN) transfer, and their postoperative functional outcomes and rehabilitation performance were compared to 50 patients with ICN-MCN transfer who underwent conventional postoperative rehabilitation with electromyographic biofeedback (EMG-BF) techniques.ResultsComparison of the long-term results following ICN-MCN transfer between EMG-BF and HAL groups showed similar follow-up times, elbow flexion range of motion, or power of elbow flexion assessed using the British Medical Council grade, and quantitative measurement using Kin-Com dynamometer. However, the number of rehabilitation sessions was significantly fewer in the HAL than EMG-BF group.ConclusionHAL training accelerated patients’ learning to convert the original muscle function into elbow flexion following NT by replicating elbow flexion during the pre-MUP detection stage and shortening the rehabilitation time.Type of study/level of evidenceTherapeutic IV.

Abstract P227: Incentives for Uptake and Adherence With Outpatient Stroke Rehabilitation: A Three Arm Randomized Controlled Trial

Introduction: While rehabilitation has been demonstrated to be effective in improving outcomes of stroke, uptake of outpatient rehabilitation services (ORS) in Singapore remains relatively low. This study aims to determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense). Hypothesis: It was hypothesized that the uptake rate of ORS over 3 months, number of sessions attended, and time to discontinuation would be greater for participants in the intervention arms of which barriers of transportation and out-of-pocket costs are addressed, as compared to participants in the control arm. Methods: A total of 266 participants were recruited from the stroke and acute rehabilitation units of two tertiary hospitals in Singapore, and randomized to one of three study arms: the control arm, denoted Education ( E ), inclusive of a stroke rehabilitation educational program; the first intervention arm, denoted Transportation Incentives ( T ), inclusive of free transportation services for the first 3 months post-discharge; or the second intervention arm, denoted, Transportation & Sessions Incentives ( T&S ), inclusive of up to 3 months of both free transportation and no out-of-pocket costs for participants’ stroke ORS. Results: The uptake rate of ORS was 73.0% for E (CI, 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). The differences of T and T&S versus the control arm ( E ) were not statistically significant (p = 0.22 and p = 0.10, respectively). However, the average number of rehabilitation sessions attended were significantly higher in both the intervention arms: 5.50 (SD, 7.65) for T and 7.51 (SD, 9.52) for T&S versus 3.26 (SD, 4.22) for the control arm ( E ) (p-value for T vs E = 0.017; p-value for T&S vs E = 0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029). Conclusions: This study has demonstrated that incentives can improve utilization of ORS. Such incentives should be considered in finance policy, such as care bundling, for stroke or similar common conditions.

Effects of low-level laser therapy on hamstring strain injury rehabilitation: A randomized controlled trial

ObjectivesTo evaluate the effects of low-level laser therapy (LLLT) on functional rehabilitation following hamstring strain injury (HSI) in amateur athletes treated with an exercise-based rehabilitation program. DesignRandomized controlled trial. MethodsMale athletes (18–40 years old) who sustained HSI were randomized in LLLT or placebo groups. All patients were engaged in the same exercise-based rehabilitation program until they met specific criteria to return to sport. Hamstring muscles were treated with LLLT or placebo immediately after each rehabilitation session. The primary outcome was time-to-return to sport. Secondary outcomes were the number of rehabilitation sessions, hamstring flexibility, hamstring strength, and re-injury rate. ResultsTwenty-four athletes began rehabilitation, and 22 (11 per group) completed the study schedule. Participants of LLLT and placebo groups had similar age, body size, injury characteristics, and baseline levels of hamstring flexibility and strength. The two groups increased flexibility and strength similarly throughout the rehabilitation program. Time-to-return to sport was the same for athletes treated with LLLT (23 ± 9 days) and placebo (24 ± 13 days). There were no re-injuries within 6 months after return to sport. ConclusionLLLT, as used in this study, did not optimize functional rehabilitation following HSI in amateur athletes treated with an exercise-based rehabilitation program.

Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy

Introduction: Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear. Objectives: In this parallel-group, randomized, controlled trial, we investigated the efficacy and safety of peritendinous injection of HA in patients with persistent supraspinatus tendinopathy. To this end, we compared the therapeutic outcome of treatment with HA as an adjuvant to physical therapy with that of physical therapy as sole therapeutic intervention. Methods: 84 Patients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient’s perception of efficacy and tolerability. Patients were followed up for 90 days. Results: Overall, VAS and ADL scores showed a progressive decrease during the follow-up ( P<0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P<0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P=0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P=0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group ( P=0.034). Both treatments were safe and well tolerated. Conclusion: Subacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.

Efficacy and Tolerability of a Dietary Supplement Containing Collagen, Hyaluronic Acid, Chondroitin Sulfate and Plasma Proteins in the Recovery After Anterior Cruciate Ligament Reconstruction

Introduction: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) is common in patients with ACL injuries. To enhance recovery after surgery, various nutritional supplements have been proposed as adjuvant treatments to physical therapy. Objectives: Efficacy and tolerability of a nutritional supplement containing hydrolyzed collagen, a complex of HA and CS (HC-15), and a plasma protein concentrate as adjuvant treatment to physical therapy in healing augmentation after ACL reconstruction. Methods: Prospective, multicenter, randomized, open-label trial including patients who underwent arthroscopic ACL reconstruction after injury. 80 patients were randomized into two groups to receive physical therapy only (control group) or combined with a nutritional supplement (composed of hydrolyzed collagen, a complex of hyaluronic acid and chondroitin sulfate, and plasma proteins) (Progen group). Efficacy assessments included a pain VAS score and the International Knee Documentation Committee (IKDC) index. Indirect measures of efficacy included analgesic consumption, the number of days to return to pre-injury activities, the number of rehabilitation sessions needed, and MRI graft maturation. The perceived efficacy and tolerability were assessed by patients and physicians. Results: At baseline, the demographic and clinical characteristics of both groups showed no significant differences. Both interventions showed efficacy in reducing the VAS and IKDC scores, with no significant differences between groups. Compared with patients in the control group, those in the Progen group required fewer rehabilitation sessions (mean [SD] of 48.4 [11.3] sessions vs. 38.0 [9.3] sessions; p < 0.001), thus returning earlier to their pre-injury activities. At the end of the follow-up, analgesic consumption was lower in the Progen group (8.6% of patients vs. 50.0%). According to the MRI findings, 61.8% and 38.2% of patients showed a high or complete maturation of the graft in the Progen and control groups, respectively. No serious adverse events were recorded. Both physicians and patients showed a trend towards a better perceived efficacy and tolerability in the Progen group. Conclusion: Adjuvant oral supplementation may increase the efficacy of physical therapy by shortening the time needed to return to pre-injury activity and the analgesic consumption. Also, MRI assessment revealed that more patients in the Progen group experienced a high or complete maturation of the graft, in line with the consistent trend observed in indirect measures of efficacy and patients’ quality of life at three months of treatment.

Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy: a Multicenter, Randomized, Controlled Trial

BackgroundPhysical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear.MethodsPatients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient’s perception of efficacy and tolerability. Patients were followed up for 90 days.ResultsOverall, VAS and ADL scores showed a progressive decrease during the follow-up (P < 0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P < 0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P = 0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P = 0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group (P = 0.034). Both treatments were safe and well tolerated.ConclusionsSubacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.

Impact of Qigong on quality of life, pain and depressive symptoms in older adults admitted to an intermediate care rehabilitation unit: a randomized controlled trial

Qigong has been used as a complementary therapy to improve different health-related problems. This study aims to test the effects of Qigong on quality of life, pain and depressive symptoms in older hospitalized patients. In this randomized controlled single blind study, we randomized 58 ≥50 years adults admitted to a post-acute intermediate care rehabilitation facility, to receive a 90 min, bi-weekly, 4-week structured Qigong intervention plus usual care and rehabilitation (N = 29) or usual care and rehabilitation alone (N = 29). Outcomes included quality of life (0-100 points visual analogical scale), pain (0-10 points scale), and depressive symptoms (5-item modified Yesavage Geriatric Depression Scale). We also evaluated participants' compliance and safety. Of the enrolled 58 participants (mean age ± SD = 74.3 ± 8.2 years, 88 % women) we dropped-out four in the control group. No statistically significant differences in baseline characteristics were shown between groups, including age, gender, marital status, education, comorbidity and functional status, main diagnostic at admission and number of rehabilitation sessions. In an intention-to-treat analysis (repeated measures ANOVA) the intervention group experienced a significant improvement in quality of life (mean increase of 19 points vs 2.6 points for controls, p = 0.002). Pain and depressive symptoms improved in both groups. Adherence was good (79 % of participants completed the whole program). No adverse events were reported. According to our results, a structured Qigong intervention, together with usual care, might contribute to improve quality of life of patients admitted to a post-acute intermediate care rehabilitation unit, compared to usual care.

Indicators of Conformance With Guidelines of Schizophrenia Treatment in Mental Health Services

The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines. A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy. A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient's level of disability helped to justify a considerable proportion of nonconformant care. The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.

Indicators of Conformance With Guidelines of Schizophrenia Treatment in Mental Health Services

Indicators of Conformance With Guidelines of Schizophrenia Treatment in Mental Health Services

Pre‐program function predicts outcomes in workers’ compensation post‐lumbar fusion patients

The purpose of this study was to determine if pre-program function could predict functional outcomes following a sports performance based rehabilitation program in workers’ compensation patients (n=63). PDL was measured at program start (PDL1) and completion (PDL2). PDL was classified by occasional occupational lifting requirements: LIGHT (L; 20lbs), LIGHT-MEDIUM (LM; 35lbs), MEDIUM (M; 50 lbs), MEDIUM-HEAVY (MH; 75lbs), HEAVY (H; 100lbs), VERY HEAVY (VH; >100lbs). For analysis, PDL was assigned a numerical value: L=1, LM=2, M=3, MH=4, H=5, VH=6. A one-way ANOVA was used to analyze relationships between PDL. Fisher’s Exact Test was used for post-hoc analysis. Pooled comparisons were analyzed by a Student’s t-test. The level of significance was set at p<0.05. Data are mean±SD. PDL1: L=2, LM=42, M=10, MH=6, H=2, VH=1. PDL2: L=1, LM=1, M=11, MH=25, H=7, VH=20. When grouped by PDL1, PDL2 did not vary between groups (p=0.0574), therefore L and LM (L/LM, n=44) were pooled along with M, MH, H, and VH (M/H, n=19). After pooling, PDL2 varied between L/LM and M/H groups (p=0.0225). The number of rehabilitation sessions also varied between L/LM and M/H groups (36±22 v 32±11 respectively). These results indicate that preprogram screening can be used to predict functional outcomes following rehabilitation. In addition, these results indicate that patients starting at lower functional levels require additional rehabilitation sessions to achieve similar outcomes.