Outcomes Of Rehabilitation Programs Research Articles

Gender impact on the outcome of rehabilitation programs in psychiatry: Brief report from a metropolitan residential rehabilitative service.

Differences based on gender in the presentation and outcome of many psychiatric conditions have been highlighted in the past years. Moreover, women are often underrepresented in research samples, thus leading to a poorer understanding and addressing of their needs. As regards psychiatric rehabilitation, few studies have focused on the influence of gender on the outcomes of rehabilitation programs. This study aimed to analyze the impact of gender on socio-demographic and clinical characteristics, as well as on main rehabilitation outcomes, in a sample of subjects undergoing rehabilitation programs in a metropolitan residential service. We collected socio-demographic, clinical variables and rehabilitation outcomes of all subjects discharged from the metropolitan residential rehabilitative service of the Luigi Sacco Hospital in Milan, Italy, from January 2015 to December 2021. Gender differences were analyzed through t-test and chi-square for continuous and categorical variables, respectively. In a total sample of 129 subjects equally distributed for gender (50.4% women), all subjects improved after their rehabilitation program, as measured through specific psychometric scales. However, women had a higher proportion of discharges to their own household (52.3% vs. 25% of men). They also showed higher educational status (53.8% completed high school vs. 31.3% of men). Clinically, they showed longer duration of untreated illness (3.6 ± 7.31 vs. 1.06 ± 2.35 years) and lower frequency of substance use disorders compared to men (6.4% vs. 35.9%). The main result of this study shows, in light of an equal improvement in psychopathological and psychosocial functioning after the rehabilitation program, better outcomes in women compared to men, with a higher frequency of return to their own household after the completion of a rehabilitation program compared to men.

Exercise rehabilitation in COPD and heart failure: comparison of two national audits.

Pulmonary (PR) and cardiac rehabilitation (CR) are recommended in the management of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); the impact of coexisting COPD and CHF on completion and outcomes of rehabilitation programmes is unknown. We examined enrolment, completion and clinical outcomes of CR and PR in adults with COPD, CHF and coexisting COPD and CHF. The National Audit of CR and National COPD Audit Programme: clinical audits of PR were analysed (211 PR and 237 CR programmes); adults with a diagnosis of CHF, COPD or coexisting COPD and CHF were identified (COPD+CHF or CHF+COPD according to database). Propensity matching was conducted (age, sex, body mass index and functional status) between COPD+CHF and COPD, and CHF+COPD and CHF. Group by time interaction was examined using mixed 2×2 analysis of variance. Those with CHF+COPD had lower enrolment and completion of CR compared to those with CHF; there were no differences in PR enrolment or completion between the two groups. Adults with COPD made a significantly larger gain in the incremental shuttle walk test compared to adults with COPD+CHF following PR (59.3 m versus 37.4 m); the improvements following CR were similar (CHF 77.3 m versus CHF+COPD 58.3 m). Similar improvements were made in the 6-min walk test following CR (CHF 45.1 m versus CHF+COPD 38.8 m) and PR (COPD 48.2 m versus COPD+CHF 44.0 m). Comparable improvements in quality of life and mood state were made following CR and PR, regardless of diagnosis. We have demonstrated that multi-morbid adults benefit from exercise-based rehabilitation, yet efforts are needed to promote completion. These findings support group-based, tailored, multi-morbid exercise rehabilitation.

Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study.

BackgroundEmerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed.ObjectiveThis study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program.MethodsA cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW.ResultsThe sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=–3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender.ConclusionsWorkers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation.

Abstract 10857: Evaluating for Equity in a Safety Net Hospital: Socioeconomic Status, Adherence, and Outcomes in Cardiac Rehabilitation

Objective: To evaluate whether adherence and outcomes in cardiac rehabilitation are associated with socioeconomic status in a safety net hospital that provides care for a diverse patient population. Introduction: Uncovering the racial/ethnic health disparities that exist within cardiovascular medicine offers potential to mitigate treatment gaps that might affect outcomes. Since race is considered a social construct, socioeconomic status may be a more appropriate underlying factor to assess. The area deprivation index (ADI) reflects income, education, employment, and housing quality within a given 9-digit zip code. A higher ADI indicates more disadvantage (range 1-10). Methods: We identified 770 consecutive enrollees of the Cardiac Rehabilitation Program at Boston Medical Center from 2016-2020. The 9-digit zip codes of each enrollee were used to obtain their ADI. Associations between ADI and adherence (attending &gt;70% of sessions) was evaluated while controlling for age, sex, race, education, diagnosis, smoking and transport times. Secondary outcomes included associations of ADI with change in exercise capacity, LDL cholesterol, weight, quality of life, nutrition, and depression scores. Results: Among 770 enrollees, 197 had missing covariates and 147 did not have a zip code with associated ADI, leaving 426 patients for analysis. Enrollees had a mean age of 59.8 years, 34% were female, 44% self-reported as black and 9% as Hispanic. The ADI for patients varied (mean =5; median =6) ( Figure 1 ). The primary outcome adjusted for age, sex, race, education, diagnosis, smoking, and transport time, revealed no association for ADI with adherence to cardiac rehab (OR, 1.03 95% CI:0.99-1.07) or attendance rate (OR, 0.98 95% CI: 0.96-1.004). Secondary outcomes improved among patients regardless of ADI. Conclusion: In our safety net hospital that provides care without exception, we found equity in cardiac rehabilitation program outcomes despite socioeconomic status.

Rehabilitative management of post-acute COVID-19: clinical pictures and outcomes.

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.

Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up.

Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary pain rehabilitation. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning; conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a 3-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

Physical Rehabilitation Outcomes in Patients with Dementia Following Hip Fracture Surgery: A Review

Background: Dementia patients were reported of having high risk for hip fracture. Rehabilitation programs were still being debated for this vulnerable population and the recovery outcomes in this frail elderly population are varied, thus evidenced-based outcomes for this issue are needed.Objective: To investigate rehabilitation programs, especially on physical function outcomes in patients with dementia following hip fracture surgery.Method: PubMed, Scopus and MEDLINE (EBSCO) databases were searched from January 2000 to June 2020 concerning rehabilitation intervention program in dementia patients who received hip surgical treatment. The studies included have the following criteria, (1) investigating physical outcomes of rehabilitation programs (2) Randomized controlled trials (RCTs) study design, (3) study involving dementia patients following hip fracture surgery (4) English full-text journal.Results: Six studies were included in this review. Most study focused on interdisciplinary or multidisciplinary rehabilitation program. Physical outcomes of rehabilitation programs seem to improve physical function, maintaining physical ability for ambulation, and decrease the risk of falls in mild or moderate dementia patients following hip fracture surgery. However, the physical function of older persons with dementia confirmed to be lower than those without dementia.Conclusion: Rehabilitation may show benefit for physical function in elderlywith mild or moderate dementia following hip fracture surgery, and this population needs to be included in the clinical rehabilitation program. Investigating and establishing the strategies to improve outcomes for dementia population is needed for future study.

Inpatient rehabilitation facilities’ hospital readmission rates for medicare beneficiaries treated following a stroke

ABSTRACT Background Stroke is the leading cause for admission to the nearly 1,200 Inpatient Rehabilitation Facilities (IRFs) nationally in the US. For many patients, post-acute care is an important component of their rehabilitation. Several quality measures have been publicly reported for post-acute care providers, including hospital readmissions. However, to date none have focused on specific medical conditions, limiting the usability for patients and quality improvement. Objective To assess hospital readmission rates for Medicare patients receiving inpatient rehabilitation following stroke and to identify risk factors in order to evaluate the feasibility of a stroke-specific hospital readmission measure. Methods Observational study analyzing national Medicare inpatient claims and administrative data to assess hospital readmissions. Using logistic regression, we calculated unadjusted and risk-standardized readmission rates, which adjusted for patient characteristics, including type of stroke and admission function, to capture stroke severity. Results Our national study included 116,073 fee-for-service Medicare beneficiary discharged from IRFs in 2013–2014 following stroke from 1,162 IRFs nationally. The observed hospital readmission rate among IRF patients following stroke was 11.6% and varied by patients’ admission motor function. Patients with greater functional dependence had higher readmission rates on average. Lower admission function, hemorrhagic and other stroke types (relative to ischemic) were significantly associated with higher odds of hospital readmission. Conclusion Results suggest it is feasible to assess hospital readmission rates among a stroke-cohort treated in IRFs. Stroke-focused quality measures would be useful to patients in selecting a provider and for providers in evaluating their stroke rehabilitation program outcomes. Secondary results suggest that admission function (FIM) capture stroke severity, a limitation with other claims-based stroke measures.

The relation among tinnitus distress, psychoacoustic parameters and anxiety state in hearing-impaired patients with chronic tinnitus: a pilot study

Background and Aim: Anxiety and depression are prevalent psychological disorders accompany tinnitus that have adverse effects on quality of life of these patients and on the outcomes of rehabilitation programs. The goal of this study was determining and quantifying the relation among perceived tinnitus severity, its psycho­acoustic parameters and anxiety symptoms in hearing-impaired individuals with subjective chronic tinnitus and residual inhibition (RI) by using Persian version of Spielberger's State-Trait Anxiety Inventory (STAI), tinnitus handi­cap inventory-Persian version (THI-P) and visual analogue scale (VAS) besides psychometric evaluations.&#x0D; Methods: Fourteen patients with chronic tinnitus were enrolled in this cross-sectional study. Con­ventional psychoacoustic tinnitus evaluations (i.e. determining quality of tinnitus, pitch match­ing, loudness matching, minimum masking level and RI) were conducted for all subjects, and they also completed the Persian version of STAI and THI-P. For screening of tinnitus perceived loud­ness and distress, VAS was used.&#x0D; Results: There was no correlation among THI-P, VAS scores and psychoacoustic parameters. There was a positive significant correlation bet­ween THI-P and Persian STAI scores (r = 0.63; p = 0.01). There was not any significant corre­lation between tinnitus duration and VAS, STAI or THI-P. There also had no significant corre­lation between VAS and THI-P (r = 0.56; p = 0.2).&#x0D; Conclusion: The present pilot study showed that Persian version of THI and STAI are corre­lated questionnaires. Therefore, Persian version of these questionnaires are valuable tools for evaluation of patients with chronic tinnitus.&#x0D; Keywords: Anxiety; tinnitus; tinnitus handicap inventory; state-trait anxiety inventory; visual analog scale; psychoacoustics

Intervention Content and Outcomes of Postdischarge Rehabilitation Programs for Adults Surviving Major Burns: A Systematic Scoping Review.

Improvement in burn care has led to more patients surviving the injury but has also led to more burn survivors requiring rehabilitation for a protracted period after discharge. Thus, this review sought to map the intervention content and outcomes associated with existing postdischarge rehabilitation programs for adults surviving major burns. A systematic scoping review approach was utilized. The Template for Intervention Description and Replication (TIDieR) and core outcome set for adult burn survivors were used to guide data extraction following which a narrative synthesis was undertaken. In all, 23 papers were retained in the review. Following discharge and up to 1 year postburn, the components of the rehabilitation programs comprised of physical, psychological, and social components. Beyond 1 year postburn, the rehabilitation programs demonstrated a preponderance of physical therapies. Support for family members was not highlighted in the included studies. Outcomes of rehabilitation programs up to 1 year postburn covered the seven core outcome domains. Outcomes associated with rehabilitation programs beyond 1 year postburn were, however, limited to the perceived quality of life, neuromuscular, and physical role functioning domains. Although most studies reported statistically significant findings, the outcome measures varied across studies which makes it difficult to draw overarching conclusions. The findings suggest that long-term rehabilitation programs for adult burn survivors are lacking. More robust studies are also needed to examine community participation outcomes associated with burns rehabilitation programs. The nature of burns and its far-reaching consequences suggest a patient- and family-centered approach to rehabilitation.

Quality of life of patients with lower limb amputation with prostheses

Abstract Quality of life is often acknowledged as an important outcome of rehabilitation programs for people with amputation. Despite the importance of the subject, the number of studies focusing on the multiplicity of factors influencing this matter is still limited. These assessments are increasingly needed to demonstrate changes related to intervention over time. In order to evaluate the quality of life of patients with lower limb amputation and wearing prostheses, a study was conducted with 49 patients followed in a rehabilitation hospital in the Midwest region of Brazil. A generic instrument (Medical Outcomes Study 36-Item Short-Form Health Survey) for quality of life assessment and Trinity Amputation and Prosthesis Experience Scale-Revised that is specific for people with amputation were used in addition to a functional assessment measure. The results showed that the time since amputation, male gender and below-knee amputations were predictors of a better perception of quality of life and better adjustment to amputation.

Impaired Trunk Flexor Strength, Fatigability, and Steadiness in Postpartum Women.

To determine whether postpartum women (vaginal and cesarean delivery) have deficits in trunk flexor strength, fatigability and steadiness, compared with nulligravid women, up to 26 wk postpartum. We hypothesized that postpartum women would be weaker, more fatigable, and have greater torque fluctuations than controls, with cesarean delivery showing greater deficits than vaginal delivery. Twenty-two control women (nulligravid) and 29 postpartum women (20-40 yr, 19 who delivered via vaginal birth, 13 via Caesarian section) participated. Postpartum women were tested 8 to 10 wk and 24 to 26 wk postpartum. Control women were tested 16 to 18 wk apart. Maximal voluntary isometric contractions (MVC) were performed at multiple trunk positions with the trunk flexor muscles. To determine trunk flexor fatigability, subjects performed intermittent isometric contractions at 50% MVC (6-s contraction, 4-s rest) in upright sitting until task failure. An MVC was performed during the fatiguing task (one per minute) and at 10 and 20 min of recovery. At 8 and 26 wk, postpartum women (groups pooled) were weaker at all trunk angles (38% and 44% respectively, P < 0.05) than controls despite no differences in handgrip strength. Postpartum women were more fatigable (71% and 52% respectively) and had greater torque fluctuations than controls (P < 0.05). At 8 wk postpartum, women who had a cesarean delivery, were 59% more fatigable (P = 0.004) than the vaginal delivery group, with no difference between delivery types at 26 wk postpartum. Musculoskeletal recovery, including trunk flexor muscle strength and fatigability, is incomplete at 26 wk postpartum. These findings provide a rationale for future studies to address outcomes of rehabilitation programs specifically targeted at improving strength and fatigability of the trunk flexor muscles after pregnancy and childbirth.

Validation of the Italian Version of the Dizziness Handicap Inventory, the Situational Vertigo Questionnaire, and the Activity-Specific Balance Confidence Scale for Peripheral and Central Vestibular Symptoms.

Neurophysiological measurements of the vestibular function for diagnosis and follow-up evaluations provide an objective assessment, which, unfortunately, does not necessarily correlate with the patients’ self-feeling. The literature provides many questionnaires to assess the outcome of rehabilitation programs for disequilibrium, but only for the Dizziness Handicap Inventory (DHI) is an Italian translation available, validated on a small group of patients suffering from a peripheral acute vertigo. We translated and validated the reliability and validity of the DHI, the Situational Vertigo Questionnaire (SVQ), and the Activities-Specific Balance Confidence Scale (ABC) in 316 Italian patients complaining of dizziness due either to a peripheral or to a central vestibular deficit, or in whom vestibular signs were undetectable by means of instrumental testing or clinical evaluation. Cronbach’s coefficient alpha, the homogeneity index, and test–retest reproducibility, confirmed reliability of the Italian version of the three questionnaires. Validity was confirmed by correlation test between questionnaire scores. Correlations with clinical variables suggested that they can be used as a complementary tool for the assessment of vestibular symptoms. In conclusion, the Italian versions of DHI, SVQ, and ABC are reliable and valid questionnaires for assessing the impact of dizziness on the quality of life of Italian patients with peripheral or central vestibular deficit.

ALTERNATIVE METHOD OF UPPER EXTREMITY FUNCTION ASSESSMENT OF STROKE PATIENTS BY ANGULAR KINEMATIC PARAMETERS

This study focuses on the functional assessment of the upper extremity of stroke patients via analysis of angular kinematics features. Amplitudes and angular velocities of multi-joint movements more precisely describe functional state at different impairment levels. However, the arm movement as a whole could be analyzed by means of joint angle–angle diagrams, which illustrate the 2D trajectory of upper extremity during movement and show the visual ranges of upper extremity in different cycles of motion. The functional range of motion of each upper extremity segment in all patient groups for more accurate assessment of capability was calculated. Moreover, we calculated the area (S) between two curves in joint angle–angle diagrams as a novel index of the complete upper extremity movement range evaluation. Our findings correspond to clinical rates and upper extremity assessment based on joint angle–angle diagrams seems to be a promising method for accurate assessment and/or predicting the outcomes of rehabilitation programs.

Effect of nurse directed rehabilitation programme on quality of life among patients with HIV attending care and support centers of Kottayam district, Kerala, South India

Background: HIV has become a long-term condition, which not only affect the physical health, but also lead to psychological and social problems. Nurse directed rehabilitation programme may help people by improving their overall health and their ability to deal with stress. Objectives: To assess the pretest level of quality of life in both experimental and control group and to evaluate the effectiveness of nurse directed rehabilitation programme on quality of life. Methods: This is a randomized control study conducted at selected Care & Support Centers under the Medical College ART unit of Kottayam District. Purposive sampling was done for selection of care & support centers and simple random sampling for patients. 130 HIV infected patients were selected for the study and randomly divided into 2 groups with Mean ±SD age of 35.84±7.45years. Both groups were homogenous. Experimental group were given rehabilitation programme for 30 minutes 4 days / week for 6 months. QOL Scale (WHOQOLHIV-BREF) was used to assess quality of life and outcome of rehabilitation programme. Results: Findings show that there is mean quality of life (62.95) falls on the poor level among patient with HIV infection and 98% subjects experiences poor quality of life (χ2=0.341). Paired difference and t value proves that nurse directed rehabilitation programme highly significant in increasing quality of life (p<0.001) when compared with control group. Conclusion: The practice of nurse directed rehabilitation programme is effective as an adjunct therapy in patients with HIV infection that significantly improves the quality of life.

Interfacing brain with computer to improve communication and rehabilitation after brain damage.

Communication and control of the external environment can be provided via brain-computer interfaces (BCIs) to replace a lost function in persons with severe diseases and little or no chance of recovery of motor abilities (ie, amyotrophic lateral sclerosis, brainstem stroke). BCIs allow to intentionally modulate brain activity, to train specific brain functions, and to control prosthetic devices, and thus, this technology can also improve the outcome of rehabilitation programs in persons who have suffered from a central nervous system injury (ie, stroke leading to motor or cognitive impairment). Overall, the BCI researcher is challenged to interact with people with severe disabilities and professionals in the field of neurorehabilitation. This implies a deep understanding of the disabled condition on the one hand, and it requires extensive knowledge on the physiology and function of the human brain on the other. For these reasons, a multidisciplinary approach and the continuous involvement of BCI users in the design, development, and testing of new systems are desirable. In this chapter, we will focus on noninvasive EEG-based systems and their clinical applications, highlighting crucial issues to foster BCI translation outside laboratories to eventually become a technology usable in real-life realm.

A Skill Acquisition Based Framework for Aiding Lower Limb Injury Rehabilitation using a Single Inertial Sensor with Concurrent Visual Feedback

Technology to aid the acquisition and performance of motor skills is becoming increasingly commonplace however there is distinct disconnect between these technological interventions and a detailed understanding of how to design technology to best instruct a learner. Using a single inertial sensor with bespoke concurrent visual feedback, based in a MATLAB data visualisation environment, this paper presents a skill acquisition framework to facilitate home based physiotherapy interventions. When athletes and patients are prescribed at home based physiotherapy interventions the current literature reports low rates of adherence. In addition the lack of monitoring and exercise classification raises concerns towards the quality of rehabilitation program outcomes. A trial was conducted randomly assigning twenty two uninjured participants to two categories, one with the aid of the rehabilitation software and the other a control group with no feedback. Both groups received the same visual instructions on the three simple leg static stretching tasks that are indicative of lower limb injury physiotherapy interventions. The results showed statically significant improvements in both the program adherence as well as the error mitigation of the feedback group in comparison to the control. Substantiating the skill acquisition framework errors for the feedback group seemed to lessen over time synonymous with an immediate learning effect as a result of the concurrent feedback. The findings suggest that at home physiotherapy interventions could be enhanced by using a concurrent biofeedback skill acquisition based single inertial sensor system. Evidently improving adherence, technique and allowing for the data to be accrued over time and relayed to practitioners and coaching staff ultimately giving them heightened confidence in monitoring physiotherapy progress. The wider implications means this research could be useful in tracking and providing feedback for a range of sports injury circumstances to ultimately improve the outcomes of the physiotherapy interventions.

Interesting Correlation Between the Circulating Pentraxin 3 and Cardiac Rehabilitation Program Outcomes in Coronary Artery Bypass Grafting Patients.

BackgroundPentraxin 3 (PTX3) is an inflammatory mediator, reaches to the high levels after ischemic heart diseases (IHD) and could be a helpful tool to predict cardiac rehabilitation (CR) outcomes. The aim of this study was to investigate the possibility of the circulating levels of PTX3 in prediction of CR outcomes in patients with IHD who had undergone coronary artery bypass grafting (CABG).MethodsOne hundred patients who had undergone CABG were included in this study. The CR plan was started 6 weeks after CABG and then PTX3 level, high-sensitivity C-reactive protein (hs-CRP), ejection fraction (EF) and metabolic equivalent (MET) were assessed before and after the CR program. Finally, all gathered data were analyzed using SPSS version 22.ResultsAfter a 3-month course of CR program, EF, MET, PTX3 and hs-CRP values changed. Statistically significant changes were observed in EF, MET and PTX3 values (P < 0.05) after the CR program and no statistically significant changes were seen in hs-CRP value (P = 0.546) at the end of CR program. Correlations between EF levels and MET with pre-PTX3 levels were also assessed and most changes were observed in the group with pre-PTX3 level more than 0.40 ng/dL.ConclusionOur study showed that a regular sufficient CR program based on exercises in IHD patients after CABG increases EF and MET levels, particularly in those patients with pre-PTX3 levels more than 0.40 ng/dL.

Working toward a good life as a cancer survivor: a longitudinal study on positive health outcomes of a rehabilitation program for young adult cancer survivors.

Background:Research on cancer rehabilitation targeting young adult cancer survivors (YACS) is limited, and little is known about the positive health outcomes of rehabilitation programs tailored specifically for this vulnerable group.Objective:The aim of this study was to investigate whether a complex rehabilitation program improved the health-related quality of life (HRQOL) and physical capacities of YACS.Methods:A longitudinal prospective study using Norwegian norm-based comparisons was conducted. Twenty YACS (24–35 years old) with different cancer diagnoses participated in a complex rehabilitation program lasting for 6 months, focusing on goal setting, exercise, psychoeducation, individual follow-up, and peer support.Results:Health-related quality of life was measured by EORTC QOL C-30 and the scores showed significant increases in overall HRQOL (P < .005–.001) and all functional dimensions (P < .001–.05) and a decrease in fatigue (P < .000–.05) and effect sizes between 0.72 and 1.30. Significant changes occurred within physical fitness (P < .005), lung capacity (P < .05), and left-hand strength (P < .001), but not right-hand strength and body mass index, with effect sizes between −0.04 and 0.48. The values of HRQOL were stable after a 1-year follow-up.Conclusions:A complex cancer rehabilitation program especially tailored for YACS seems to build positive health outcomes such as HRQOL and physical capacity in a long-term perspective. The content and structure of the program were feasible with high compliance. The results underline the importance of targeting rehabilitation interventions to YACS in need after cancer treatment, acknowledging rehabilitation as a process that requires adequate time and follow-up.Implications for practice:Healthcare providers should be aware of YACS’ symptom burden and monitor HRQOL and physical parameters to ascertain holistic cancer survivorship care.

Home or away? Choosing a setting for a falls-prevention program for people with multiple sclerosis.

Evidence suggests that choice of setting may be important in influencing the outcomes of rehabilitation programs, as well as optimizing participant satisfaction and adherence. This article aims to examine the factors that may inform the choice of setting for a falls-prevention program tailored to the needs of people with multiple sclerosis, including the influence of setting on program effectiveness, participant engagement, cost, and sustainability. Any new program should ensure that the choice of setting is informed by the intended program outcomes as well as an awareness of the opportunities and challenges presented by each type of setting. Evaluations of falls programs for older people suggest that immediate outcomes are similar regardless of setting; however, long-term outcomes may differ by setting, possibly owing to differential effects on adherence. Programs based away from home may offer benefits in terms of maintaining motivation, providing peer-support opportunities, and allowing regular access to facilitator input, while home-based programs offer unique opportunities for context-based practice and the integration of falls-prevention activities into real life. Additionally, home-based programs may address some of the long-term feasibility issues associated with programs away from home. A "mixed" program incorporating elements of home- and community-based activity may be the most sustainable and effective choice to achieve both long- and short-term goals within a falls-prevention program. However, currently there are significant gaps in knowledge relating to comparative program outcomes, cost, and long-term sustainability.