Outcome Of Rehabilitation Treatment Research Articles

The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program

To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.

Punctural Physiotherapy in Complex Rehabilitation of Elderly Patients with Large Joints Lower Extremities Pathology: a Narrative Review

AIM. To analyze of recently reported domestic and foreign studies on the influence of РhP on the results of rehabilitation of elderly patients after total endoprosthetics operations. MATERIAL AND METHODS. The review examines issues related to the pathogenetic aspects of punctural effects on the body, the peculiarities of using low-intensity physical factors of electromagnetic nature as a therapeutic stimulus when exposed to acupuncture points based on the results of clinical and experimental studies on cell cultures and animals published in Faberlink, Pubmed. The mechanisms of the influence of low-intensity laser, optical and extremely high frequency radiation on the adaptive reactions of the body are discussed. The results of experimental studies on the choice of optimal modes and parameters of low-intensity electromagnetic radiationof extremely high frequency are considered for the purpose of application in complex rehabilitation programs. The results of reflexodiagnosticsin the process of restoring vegetative disorders of the body as predictors of adaptive potential in the process of predicting the direction and volume of rehabilitation load, as well as the outcomes of rehabilitation treatment are evaluated. CONCLUSION. Further studies on the mechanisms of action and rehabilitation potential of low-intensity EMR in different ranges are needed to expand the clinical application of PhP techniques.

Rehabilitation Treatment Outcomes among Stroke Patients with Dysphagia

Objectives: Dysphagia is a major complaint following stroke and occurs 37-78% of the time. It is associated with poor clinical outcome and high mortality rates. There are approximately 220-290 new stroke cases per 100.000 person-years in Mongolia and 178-260 in China. Rapidly changing lifestyles, socioeconomic status, stress, and increasing cardiovascular diseases are leading causes of stroke in the world and its diagnosis and treatment are one of the challenges of health care. Therefore, we aimed to characterize the swallow status and treatment outcome among dysphagic patients. Methods: The study was conducted in a hospital-based, cross-sectional method. Study participants were obtained from the Affiliated Hospital of Inner Mongolian University for the Nationalities between July 2018 and March 2019. All patients were randomly divided into three treatment groups. 149 patients with dysphagia were evaluated by video fluoroscopic assessment (VFSS) before and after the treatment. Results: In total, 149 participants (mean age = 59.70 ± 9.55 years) aged between 34-77 were obtained in this study. There were no statistically significant differences between the three groups in age (p = 0.583). The data showed a statistically significant positive treatment effect for all three groups (p = 0.000). The VFSS score was 7.94 ± 1.04 in the A group, 7.52 ± 1.12 in the B group, and 8.36 ± 0.98 in the C group after the treatment. The VFSS score shows a statistically significant difference, after the treatment (p = 0.000). Conclusion: Rehabilitation treatment combined with neuromuscular electrical simulation shows a better outcome than rehabilitation treatment without combined neuromuscular stimulation among stroke patients with dysphagia. The assessment of swallowing function should include both clinical and video fluoroscopic evaluation. Video fluoroscopic features are important predictors of swallowing abnormalities and complications.

Adverse Childhood Experiences and Chronic Pain Rehabilitation Treatment Outcomes in Adults.

Adverse childhood experiences (ACEs) are commonly reported by individuals with chronic pain. However, little is known about how ACE exposure influences treatment outcomes. The goal of the current study was to evaluate group and treatment-related differences among adults with varying levels of ACE exposure participating in a pain rehabilitation treatment program. Adult participants (N=269) were categorized as 0 ACEs (n=65), 1 to 2 ACEs (n=87), or ≥3 ACEs (n=117). Participants completed self-report measures of pain, physical functioning, and psychosocial functioning at intake and discharge from a 10-week interdisciplinary pain rehabilitation program. ACE exposure was frequently endorsed in this sample, with the majority of participants (78.5%) reporting at least 1 form of childhood adversity. Adults in the ≥3 ACEs group reported a greater level of impairment in mental health symptoms and adjustment to chronic pain; however, all groups endorsed treatment improvements and there were no differences in response to treatment. There were also no differences between groups on measures of pain or physical functioning at intake or discharge. ACE exposure appears common among treatment-seeking adults with chronic pain and is associated with increased clinical complexity. However, adults with and without exposure to ACEs endorsed significant improvements in pain and functioning following participation in an interdisciplinary pain rehabilitation program. This model of treatment may be especially well situated to address the biopsychosocial contributions to pain among those with a history of adversity.

Youth With Chronic Pain and a History of Adverse Childhood Experiences in the Context of Multidisciplinary Pain Rehabilitation.

Previous research has shown that youth with chronic pain who presented for a multidisciplinary evaluation report a history of adverse childhood experiences (ACEs) (eg, abuse, neglect, parent/guardian separation or divorce) at a high rate (over 80%) and that those with pain and ACEs experience increased psychosocial impairment. Outside of chronic pain, evidence also suggests that youth with a history of ACEs experience poorer treatment outcomes. However, no study to date has examined treatment outcomes in youth with chronic pain and a history of ACEs. The current study aimed to examine the role of ACEs in multidisciplinary intensive pain rehabilitation treatment outcomes for youth with chronic pain. The sample included 305 youth who had undergone intensive pain rehabilitation. Outcomes examined included pain-related and psychosocial impairment measured at baseline and discharge from the program. Results indicated that ∼59% of this sample reported a history of ACEs with ∼21% reporting a history of ≥2 ACEs. At baseline, youth with an ACEs history reported higher somatic symptoms. However, no significant interaction was found across treatment timepoints between ACEs history and time. ACEs history was not a significant factor in treatment outcomes for youth with chronic pain who presented to intensive pain rehabilitation. However, the difference in report of ACEs history across treatment settings indicates that ACEs may be a barrier for youth to engage in recommended outpatient treatment before presenting to pain rehabilitation. Research is needed to further examine this phenomenon.

Outcomes of Rehabilitation Treatment in Patients with Lumbar Spine Dorsopathies

The review presents the factors that influence the outcomes of rehabilitation treatment after decompressivestabilizing operations on the lumbar spine.

Outcomes of rehabilitation treatment in patients with lumbar spine dorsopathies

The review presents the factors that influence the outcomes of rehabilitation treatment after decompressive- stabilizing operations on the lumbar spine

Applying a computational intelligence method to predict the rehabilitation treatment for females with lateral patellar displacement

A lateral positioned patella has long been regarded as a major contributing factor in the development of patella femoral pain (PFP). Despite extensive research, there is still little consensus as to the most effective treatment strategy for the management of patients with lateral patellar displacement (LPD). Computational intelligence methods are proving useful aids to physicians and other medical staff, improving objectivity when making diagnostic and treatment decisions and reducing the time to make decisions. This study describes an adaptive network-based fuzzy inference system (ANFIS) used to build a model for the indirect prediction of rehabilitation treatment outcomes for females with LPD from only demographic and clinical characteristics. The prediction abilities offered using two ANFIS models are presented using data from 48 female patients referred to rehabilitation clinics of Isfahan Ayatollah Kashani and Al Zahra hospitals, Iran. The results indicate that the ANFIS model has strong potential to improve indirect prediction of rehabilitation treatment for females with LPD with a high degree of accuracy and robustness.

Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses.

The results of a recently performed randomized clinical trial showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness (BA), catastrophizing, and depression was improved by adding psychomotor therapy (PMT), an intervention targeting BA. No significant effects were found on quality of life and disability. The present follow-up study aimed to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated. In total, 94 patients with chronic pain participated in a randomized clinical trial comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability, and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analyzed by linear mixed-model analysis. Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy, catastrophizing, or both. In the regression model with depression as the outcome variable, the regression coefficient of treatment (ie, PMT vs. TAU) decreased by 34% and became nonsignificant when BA was added as a potential mediator. Patients with low BA seemed to benefit more from PMT than patients with high BA, especially on depression, BA, and catastrophizing. BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that seems to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study.

BackgroundIn many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany.MethodsWe analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals.ResultsOf the 239,811 respondents 0.9 % were nationals from Turkey, 0.8 % had a nationality from a former Yugoslavian country, 0.9 % held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9 % were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95 %-confidence interval [95 %-CI]: 1.12–1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95 %-CI: 1.45–1.80) for Turkish nationals and 1.68 (95 %-CI: 1.52–1.85) for nationals from Former Yugoslavia.ConclusionsKnowledge on health outcomes from the patients’ point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.

Improvement of Fecal Incontinence and Quality of Life by Electrical Stimulation and Biofeedback for Patients With Low Rectal Cancer After Intersphincteric Resection

ObjectiveTo assess the efficacy and benefits of pelvic rehabilitation programs in terms of functional outcomes and quality of life for patients with fecal incontinence and defecation disorders after rectal cancer surgery. DesignProspective, observational study. SettingUniversity hospital physiotherapy clinics. ParticipantsPatients (N=32) who experienced fecal incontinence after sphincter-saving surgery with the intersphincteric resection (ISR) technique and could follow and cooperate with the treatment schedule were included in the present study. InterventionsPelvic rehabilitation programs included electrical stimulation (ES) and biofeedback (BF). Main Outcome MeasuresFunctional results, Wexner score, and anorectal manometry were used to assess the clinical outcomes of rehabilitation treatment. ResultsMaximum squeeze pressure improved after rehabilitation training (P=.014). There were no statistical differences in resting pressure, resting muscle electromyography, and maximum squeeze electromyography (P=.061, P=.76, and P=.99, respectively). The mean stool frequency was 18.8 per 24 hours before the pelvic intervention program and 7.8 per 24 hours after ES and BF training (P<.001). Of the 32 patients, 27 required antidiarrheal medications before treatment, and after completion of the training, only 9 patients still needed antidiarrheal medications (P<.001). Significant improvements were observed in the Wexner score (17.74 vs 12.93; P<.001). ConclusionsOur data show that ES and BF are effective in the treatment of fecal incontinence, leading to improvement of quality of life for patients with low rectal cancer after ISR.

(522) The effect of psychiatric comorbidities on treatment outcomes of veterans participating in an interdisciplinary chronic pain rehabilitation program

Psychiatric comorbidities have been shown to adversely affect chronic pain and its treatment, but research is limited regarding its impact on different treatment approaches, particularly interdisciplinary chronic pain rehabilitation. Research on this topic involving veterans is minimal. This study examined the effects of psychiatric comorbidities on veterans’ response to an interdisciplinary outpatient chronic pain rehabilitation program (OCPRP). One hundred patients who completed a VA OCPRP were randomly selected. Participants with psychiatric diagnoses were identified and categorized into one of two groups. Group 1 consisted of 21 patients with no psychiatric diagnoses, and Group 2 included 24 patients with 2 or more psychiatric diagnoses. The 2 groups did not differ on any baseline characteristics, with the exception of non-pain-related psychiatric medications. Patients completed the Pain Outcomes Questionnaire (POQ) and Sleep Problems Questionnaire at intake and discharge, measuring pain intensity, vitality, pain-related negative mood, mobility, pain-related fears, activities of daily living (ADLs), and sleep impairment, with opioid usage also monitored. A MANOVA demonstrated a significant main effect for Time and Group, with a trend effect for the Time x Group interaction (p < .1). Univariate ANOVA’s showed a significant (p < .05) main effect for the Time and Group factors on all POQ and sleep subscale measures except ADLs. Significant Time x Group interactions were also found, with Group 2 patients showing higher pre-and post-treatment scores for negative mood, vitality, and fear, as well as significantly less improvement at discharge in pain, negative mood, and mobility. No significant differences were observed between groups regarding opioid usage. These findings suggest that psychiatric comorbidities have a significant effect on pain rehabilitation treatment outcomes among veterans. Additional research with larger samples, objective measures of functioning, better controls for non-pain psychiatric medications, and longer term follow-up is warranted. Psychiatric comorbidities have been shown to adversely affect chronic pain and its treatment, but research is limited regarding its impact on different treatment approaches, particularly interdisciplinary chronic pain rehabilitation. Research on this topic involving veterans is minimal. This study examined the effects of psychiatric comorbidities on veterans’ response to an interdisciplinary outpatient chronic pain rehabilitation program (OCPRP). One hundred patients who completed a VA OCPRP were randomly selected. Participants with psychiatric diagnoses were identified and categorized into one of two groups. Group 1 consisted of 21 patients with no psychiatric diagnoses, and Group 2 included 24 patients with 2 or more psychiatric diagnoses. The 2 groups did not differ on any baseline characteristics, with the exception of non-pain-related psychiatric medications. Patients completed the Pain Outcomes Questionnaire (POQ) and Sleep Problems Questionnaire at intake and discharge, measuring pain intensity, vitality, pain-related negative mood, mobility, pain-related fears, activities of daily living (ADLs), and sleep impairment, with opioid usage also monitored. A MANOVA demonstrated a significant main effect for Time and Group, with a trend effect for the Time x Group interaction (p < .1). Univariate ANOVA’s showed a significant (p < .05) main effect for the Time and Group factors on all POQ and sleep subscale measures except ADLs. Significant Time x Group interactions were also found, with Group 2 patients showing higher pre-and post-treatment scores for negative mood, vitality, and fear, as well as significantly less improvement at discharge in pain, negative mood, and mobility. No significant differences were observed between groups regarding opioid usage. These findings suggest that psychiatric comorbidities have a significant effect on pain rehabilitation treatment outcomes among veterans. Additional research with larger samples, objective measures of functioning, better controls for non-pain psychiatric medications, and longer term follow-up is warranted.

Disexecutive functions and depression in patients with Parkinson disease: the impact on rehabilitation outcome.

Studies relating to patients with Parkinson disease that assess neuropsychologic, psychologic, and clinical aspects are very uncommon. The aim of this study was to analyze the impact of executive functioning (impaired vs. not impaired) or depression (depressed vs. nondepressed) on the outcome of rehabilitation treatment in patients with Parkinson disease without dementia at the medium stage of disease. Forty consecutive inpatients affected by Parkinson disease were psychologically and neuropsychologically assessed by means of standardized tests during the first week of admission and at discharge after undergoing an intensive rehabilitation training. At baseline, the patients (mean [SD] age, 70.1 [8.0]; Mini-Mental State Examination [MMSE], ≥24) showed impairment in the following executive functions: frontal functions (32.5%), selective and divided attention (55.0% and 41.9%, respectively), and word fluency (17.5%). Depressive symptoms reported using the Geriatric Depression Scale were distributed as follows: mild (n = 13), 32.5%; moderate (n = 4), 10.0%; and severe (n = 5), 12.5%. As for the outcome of the intensive rehabilitation treatment, a general improvement in the Unified Parkinson's Disease Rating Scale, the Berg's scale, the 6-min walking test, and the Timed Up and Go test was observed (P < 0.0001). The improvement was homogeneous for all groupings of the patients for all of the considered variables, indicating that the changes in performance as a result of treatment were unaffected by the presence of executive function deficits or moderate-to-severe depression. The patients' executive function impairment or moderate-to-severe depressive symptoms did not seem to interfere with the outcome of the intensive physical and occupational rehabilitation. Therefore, these aspects in patients without dementia should not be considered a contraindication to an intensive rehabilitation program. Furthermore, despite the presence of impaired executive functions and/or of depressive symptoms, the 4-wk multidisciplinary rehabilitation program resulted to be highly effective.

Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction

The purpose of this study was to examine short-term outcomes of rehabilitation treatment in patients with or without previous stapled transanal resection (STARR) for rectal outlet obstruction by using a novel rehabilitation score system (Brusciano score). This is a retrospective cohort study conducted at a single tertiary referral institution including all patients with chronic functional constipation admitted to the outpatient unit from 2004 to 2009. Among 330 consecutive patients, 247 (74.8%) (204 females and 43 males) showing a significantly higher rehabilitation score (mean of 15.7 ± 1.8; range, 7-25) than healthy controls (mean, 3.2 ± 1.2; range 2-6) (p < .0001) were selected for rehabilitation. Of the 247 patients evaluated, group A (no previous surgery) consisted of 170 patients (53 males; mean age, 44.8 ± 12.9years; range, 19-80) of which 38 presented mixed constipation, whereas group B (previous surgery) consisted of 77 patients (18 males; mean age, 47.0 ± 11.2years; range, 22-81). The Brusciano score, Agachan-Wexner score and quality of life improved in both groups of patients after treatment. Better improvements of Brusciano and Agachan-Wexner scores were observed in patients with previous STARR (group B). The rehabilitation score system employed in this study seems to be a useful tool in selecting and assessing the outcome of patients who might benefit from rehabilitation treatment. Constipation and quality of life were significantly improved by the rehabilitation treatment. Further studies are needed to clarify either the impact of rehabilitation treatment on long-term outcome of patients treated for rectal outlet obstruction or its role in those who develop problems over time.

Effects of early rehabilitation on the outcome of cerebro-vascular insult rehabilitation in women over 65 in correlation with initial neurological deficit gravity

This study aims at verifying the effects of short- and long-term rehabilitation on the outcome of encephalic vascular accident (EVA) in women older than 65 years; establishing the correlation between the impact of the neurological deficit severity on the prediction of the rehabilitation treatment outcome as well as investigating the possibility of the follow-up of individual parameters at the Functional Independence Measure (FIM) when predicting the EVA rehabilitation outcome. The EVA is currently the third major cause of death in the world’s population, as well as the main cause of permanent disability. In the present scenario, cardiovascular and cerebrovascular diseases, which used to be observed almost exclusively in the male population, now affect the female population as well. On the other hand, we observe a linear correlation between aging and the occurrence of these diseases. We conclude that the implementation of early rehabilitation leads to a significant acceleration in the treatment and recovery process post-EVA in women older than 65 years. We also conclude that certain FIM parameters can be used to predict the patient’s overall recovery, as they present the same evolution pattern.

Using the Millon Behavioral Medicine Diagnostic to Delineate Treatment Outcomes in Rehabilitation

Patients undergoing rehabilitation have been evidenced to improve in different ways depending on their coping styles. Amplifiers, Repressors, and Social Copers are examples of patients who present differently in rehabilitation settings and tend to have differing levels of success in their response to treatment. The current study examined the differential treatment outcomes of three coping style groups undergoing multidisciplinary rehabilitation. A sample of 59 patients suffering from injuries associated with chronic pain were assessed using the Multidimensional Pain Inventory, Beck Depression Inventory, and Beck Anxiety Inventory before, during, and after multidisciplinary pain management treatment. Coping style groups derived from the Millon Behavioral Medicine Diagnostic consisting of Amplifiers, Repressors, and Social Copers were compared with regard to reductions in depression, anxiety, pain, functional impairment, and associated outcomes. Repeated measures ANOVA revealed that Amplifiers, Repressors, and Social Copers had varying levels of success in the treatment program. Hierarchical linear modeling analyses revealed the coping style groups to have significantly different change curves from pre to post-treatment in depression, anxiety, pain severity, functional impairment, affective distress, life control, social support, and soliciting help from others. These findings support prior research emphasizing the value of tailoring treatments in rehabilitation settings toward patients’ coping styles in order to maximize outcomes.

Vertrauen in den Arzt („VIA”) - Psychometrische Testung der deutschen Version der „Trust in Physician Scale”

Hintergrund und Fragestellung: Das Vertrauen der Patienten in ihren Arzt wird als Kernelement der Arzt-Patienten-Beziehung und als Prädiktor gesundheitsbezogener Outcomes beschrieben. Bislang lag kein deutschsprachiges Assessmentinstrument zur Erfassung dieses Konstrukts vor. Im vorliegenden Beitrag wird eine deutsche Version der „Trust in Physician Scale” vorgestellt und psychometrisch überprüft (Skala „Vertrauen in den Arzt”: „VIA”). Ferner werden Ergebnisse zum Zusammenhang mit dem Outcome einer Rehabilitationsmaßnahme referiert.

Die Anwendung Hierarchischer Linearer Modelle für Einrichtungsvergleiche in der Qualitätssicherung und Rehabilitationsforschung

For a fair comparison of rehabilitation centres with respect to the effects of the treatment provided (e. g. for the purpose of quality assurance programmes), it is essential that those factors which influence the outcome of rehabilitation treatment and over which the rehabilitation centres have no control (the so-called "confounders", such as co-morbidity and age of the patients on commencement of treatment) are included in the statistical analysis. Simple linear regression models without random effects and without interaction terms are frequently used for this purpose. However, this method has certain limitations which can be avoided if hierarchical linear modelling (HLM) is employed. HLM has the advantage over standard regression analysis methods in that it can be used to take into account the multi-level structure of a comparison problem, allows predictors to be introduced at the level of the centres and also makes it possible to model variations of regression coefficients for the centres. When the HLM technique is used, separate linear models can be produced for the various hierarchically structured data levels of the question (e. g. the levels "patients" and "centres" for rehabilitation centres, for example). Moreover, it can be empirically tested with HLMs whether the rehabilitation coefficients (e. g. effects of mean age of patients on the outcome of rehabilitation) differ significantly between the centres. In this article, we describe the use of hierarchical linear modelling on the basis of data obtained from the quality assurance programme of the statutory health insurance schemes in the field of medical rehabilitation ("QS-Reha").

Association between apolipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke patients

Treger I, Froom P, Ring H, Friedman G. Association between apolipoprotein E4 and rehabilitation outcome in hospitalized ischemic stroke patients. Arch Phys Med Rehabil 2003;84:973–6. Objective:To determine the value of apolipoprotein E4 (APOE∗E4) allele in predicting discharge impairment and disability in ischemic stroke patients after acute rehabilitation. Design:Prospective study comparing results of rehabilitation in patients with different APOE genotypes. Setting:Acute neurologic rehabilitation department in Israel. Participants:One hundred one consecutive patients 75 years old or less with a first ischemic stroke. Interventions:Not applicable. Main Outcome Measure:Impairment, as measured by the National Institutes of Health Stroke Scale (NIHSS), and disability, as assessed with the FIM™ instrument. Results:On admission, there was no significant difference in the FIM or NIHSS measurements between the apo E4 group and other patients, but the prevalence of aphasia was 2.07 times more frequent in those with the APOE∗E4 genotype (95% confidence interval, 0.98–4.4). A logistic regression model demonstrated that score measurements on admission were highly predictive of the NIHSS score at discharge (receiver operator curve=96.1%), whereas the presence of the APOE∗E4 genotype did not add significantly to the model in predicting poorer rehabilitation treatment outcome as measured by the FIM or the NIHSS. Conclusions:The presence of the apo E4 allele did not predict a poorer outcome of rehabilitation treatment after ischemic stroke, but it was associated with an increased prevalence of aphasia. Further studies are warranted to confirm this association.

A descriptive study of psychiatric disorders and psychosocial burden in rehabilitation patients with musculoskeletal diseases

Härter M, Reuter K, Weisser B, Schretzmann B, Aschenbrenner A, Bengel J. A descriptive study of psychiatric disorders and psychosocial burden in rehabilitation patients with musculoskeletal diseases. Arch Phys Med Rehabil 2002;83:461-8. Objective: To investigate current, 12-month, and lifetime prevalence rates, and associated psychosocial burden of psychiatric disorders in rehabilitation inpatients with musculoskeletal diseases. Design: Two-stage epidemiologic survey. Setting: Four orthopedic rehabilitation inpatient clinics in southwest Germany. Participants: A total of 910 inpatients with different musculoskeletal diseases participated in the survey. According to their General Health Questionnaire-12 scores, 205 patients were selected randomly for standardized interviews. Interventions: Not applicable. Main Outcome Measures: Psychosocial burden (Hospital Anxiety and Depression Scale, Lübeck Alcoholism Screening Test) and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), assessment of diagnosis and somatic parameters through standardized medical records. Clinical interview (Munich Composite International Diagnostic Interview) in the second-stage examination to obtain Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnoses of psychiatric disorders. Results: Prevalence rates of psychiatric disorders are 31.1% for the 4-week period, 47.1% for the 12-month period, and 64.6% for the lifetime period. The most prevalent current disorders are anxiety (15%), affective (10.7%), and substance-related disorders (9.2%). Half of the comorbid ill patients have 2 or more simultaneous psychiatric disorders and report elevated levels of psychosocial burden (eg, intense pain, low quality of life, more days of sick leave). Conclusions: Patients undergoing musculoskeletal rehabilitation should be assessed carefully for comorbid psychiatric illnesses. Further research should be undertaken to evaluate the effectiveness of psychosocial interventions for comorbid psychiatric disorders on life quality, therapeutic compliance, and outcome of rehabilitation treatment. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation