Rehabilitation Outcomes Research Articles

Fluctuating emotional states before and during child sexual abuse and rape: a file review analysis of males in mandated care in The Netherlands

Purpose The purpose of this study is to examine emotional states preceding and during sexual crimes in a Dutch sample of adult male patients who were admitted to mandated clinical care. Design/methodology/approach Emotional states preceding child sexual abuse (CSA) (n = 63) and rape against adults (n = 60) were compared using the Mode Observation Scale. Findings CSA and rape were equally preceded by feelings of vulnerability, undifferentiated anger and loneliness and characterised by callous unemotionality. Emotional manipulation was more dominant in the events leading up to CSA, whereas an exaggerated sense of self-worth was more dominant in the event preceding rape. Substance-related detachment was more common preceding rape but was equally common during both types of crimes. Controlled anger was more common in rape. Practical implications CSA and rape crimes are predominantly characterised by similar emotional states of persons who were admitted to mandated clinical care. This informs the development of more effective therapeutic interventions and support services tailored to the emotional profiles of patients, potentially improving rehabilitation or treatment outcomes. Scientifically, the results of this study provide a compelling foundation for further research into the psychological mechanisms underpinning sexual violence. Originality/value While previous research has often focused on these crimes in isolation, this study bridges a critical gap by examining the emotional commonalities between them. This study challenges the conventional understanding that treats these forms of sexual violence as entirely distinct, proposing instead that they may share underlying emotional dynamics.

Effectiveness of a check-up for rehabilitation and prevention needs in primary care

Abstract Background General practitioners play a central role in initiating rehabilitation and prevention services. However, systematic screening for rehabilitation and prevention needs has not been carried out in general practices so far. The legislation encourages the implementation and evaluation of so-called ‘check-up 45+’, which target individuals aged 45 and older. The study aims to evaluate the effectiveness of a check-up 45+ in primary care. Methods A pragmatic, randomized controlled trial was conducted in 26 general practices in the German states of Berlin and Brandenburg among patients aged 45 to 59 years (DRKS00028303). The control group (n = 695) received usual care plus a questionnaire on sociodemographic and health-related characteristics. The intervention group (n = 706) completed additionally the 2-page ‘screening 45+’, which captures rehabilitation and prevention needs in five dimensions. After algorithm-based ad hoc evaluation by practice staff, the general practice could modify the recommendation based on available information (e.g., diagnoses, social situation). Information and application documents were provided in case of identified needs. Applications (primary outcome) and approvals (secondary outcome) of rehabilitation and prevention services were recorded using routine data. Results In the intervention group, 64.2% were women, compared to 63.0% in the control group (mean age 52.1 (SD 4.3) and 52.5 (SD 4.4) years). In the intervention group, 85 applications (12.0%) for medical rehabilitation or prevention services were submitted within two months after the study participation, compared to 20 applications (2.9%) in the control group (p < 0.001). The number of approvals for these services was 59 vs. 17 (p < 0.001). Conclusions The application rate for rehabilitation and prevention services was significantly higher in the intervention group compared to the control group, with a relative risk difference by a factor of 4 and an absolute risk difference of 9.1%pt. Key messages • The implementation of a check-up 45+ in primary care leads to a higher rate of applications for rehabilitation and prevention services compared to usual care. • The check-up 45+ may assist general practitioners in systematically identifying rehabilitation and prevention needs of their patients and in applying for these services.

Cardiac rehabilitation attendance and outcomes 3 years after acute coronary syndrome (ACS): Linked national data of the SNAPSHOT ACS audit

Abstract Background In international guidelines, cardiac rehabilitation is recommended to reduce readmissions, mortality and improve disease management. However, evidence from a long-term follow-up in a representative cohort is scarce. Purpose To compare 3-year outcomes among acute coronary syndrome (ACS) survivors who attended cardiac rehabilitation programs and those who did not. Methods This was a follow-up of the SNAPSHOT ACS cohort in 1,920 Australians. Clinical data of those presenting with suspected ACS, hospitalised, discharged alive and followed for 18 months were linked to jurisdictional/national regulatory hospitalisation, mortality and pharmacotherapy records. Outcomes were all-cause and cardiovascular mortality, myocardial infarction (MI) and cardiovascular readmissions. Cox regression was used to analyse all-cause mortality, and Fine and Gray competing risk model for cardiovascular mortality, MI and cardiovascular readmissions, where non-cardiovascular mortality or all-cause mortality were competing events. The models were adjusted for age, sex, discharge diagnosis and coronary revascularisation. Results The cohort was aged 66±13.5 years; 60% were male, 31% had a discharge diagnosis of MI, and 490 (26%) attended cardiac rehabilitation. Cardiac rehabilitation attendees more frequently received coronary revascularisation and had a discharge diagnosis of MI during index admission. Attendees were more likely to be men (70% vs 57%, p<0.001) with a family history of coronary disease (43% vs 36%, p=0.008). The prescription of ≥3 guideline-indicated medications was higher in cardiac rehabilitation attendees. Compared to those who did not attend cardiac rehabilitation, the hazard of all-cause mortality was lower for the attendees (4.3% vs 8.6%, HR: 0.55, 95% CI: 0.34-0.91), but the hazard of MI and cardiovascular readmissions significantly greater in the attendees (17% vs 8.5%, HR: 1.99, 95% CI: 1.41-2.82; 42% vs 33%, HR: 1.34, 95% CI: 1.10-1.63; respectively) (Figure). There was insufficient cardiovascular mortality between groups to fit a statistical model (n=7 (1.4%) vs n=24 (1.7%), p=0.705). Conclusions Survivors of ACS attending cardiac rehabilitation were associated with reduced all-cause mortality and increased readmissions related to MI and cardiovascular disease at 3 years follow-up. These findings support secondary prevention strategies to mitigate mortality risk after ACS.

Associations between cardiac rehabilitation and clinical outcomes in patients with heart failure and cognitive frailty

Abstract Introduction Patients with heart failure (HF) often contend with various comorbidities, including cognitive impairment. Cognitive impairment has been increasingly recognised as cognitive frailty, which is reportedly associated with poor outcomes. On the other hand, cardiac rehabilitation (CR) for HF contributes to improved clinical outcomes. However, very few reports have examined whether CR is effective in patients with HF who have cognitive frailty. Purpose The present study aimed to investigate whether CR is associated with clinical outcomes in patients with HF, even in the presence of cognitive frailty. Methods This observational study analysed 1404 consecutive patients who admitted to a university hospital for the treatment of HF and received CR during hospitalisation. Patients who had dementia, did not perform the cognitive function evaluation, or died during hospitalisation were excluded from this study. All patients were encouraged to continue outpatient CR after hospital discharge. Cognitive function was assessed using the Mini-Cog© and a score ≤2 points was defined as the cognitive frailty. As physical function, quadriceps isometric strength (QIS) and 6-min walking distance (6MWD) were measured at the discharge and at the end of outpatient CR. The primary outcome was composite events, comprising all-cause death and re-admission due to HF. The secondary outcome was the change in physical function (ΔQIS and Δ6MWD) following outpatient CR. The association between participation in outpatient CR and composite events was assessed using the multivariate Cox proportional hazard models. We also compared the physical function changes between the presence or absence of cognitive frailty using analysis of covariance. Results The median age of the patients was 75 (interquartile range [IQR]: 66–81) years and 62.3% were males. Among them, 23.4% were identified as cognitive frailty. While 45.1% of overall population participated in outpatient CR, the cognitive frailty was relevant to a lower participation rate (P <0.001). Over a median follow-up period of 1.0 years (IQR: 0.3–2.4 years), a total of 544 composite events occurred. Participation in outpatient CR was associated with a reduced incidence of composite events in both the cognitive frailty and non-cognitive frailty, as well as in the overall patient population (Figure 1). Additionally, ΔQIS and Δ6MWD did not significantly differ between the cognitive frailty status (P = 0.655 and 0.573, respectively). Conclusions Participating in outpatient CR was linked to reduced rates of composite events and improved physical function in patients with HF, regardless of the presence or absence of cognitive frailty. Encouraging active participation in outpatient CR, even among patients with cognitive frailty, is essential as it is associated with favourable clinical outcomes.Survival analysisANCOVA

Importance of cardiac rehabilitation on cardiorrespiratory fitness in patients undergoing percutaneous aortic valve replacement

Abstract Background Percutaneous Aortic Valve Replacement (TAVR) significantly improves cardiac function in patients with severe aortic stenosis. However, the vast majority of these patients do not reach an adequate functional class despite the valve change, due to the deterioration of hemodynamic function and the repercussions of afterload over time. Cardiac rehabilitation (CR) program is an interdisciplinary intervention aimed at restoring functionality in Post-TAVR patients and the key to optimizing the recovery and enhancing cardiorrespiratory fitness (CRFit). The Purpose of the study is to provide an analysis of the effects of CR on exercise capacity and CRFit in TAVR patients. Methods Quasi-experimental study in TAVR patients that underwent a 4-6 week CR program, including personalized aerobic and strength training. Outcomes assessed pre- and post-rehabilitation included VO2 max, ventilatory thresholds (VT1 and VT2), and exercise capacity. The study also evaluated METs efficiency by comparing actual to predicted METs values before and after the therapy, alongside expired gas analysis test to examine exercise tolerance and its relation to VO2max gains. Results A total of 28 patients were analyzed, with an average age of 73 years (±8.1), initial weight of 68 kg (±12.32), and final weight of 65 kg (±11.13). The average ejection fraction (EF) from echocardiographic parameters was 62% (±10.1). All patients underwent cardiopulmonary exercise testing (CPET) after post-TAVR with improvements in CRFit. Initial exercise test parameters showed an average METs-load at 8.1 (±1.98), VO2max at 4.75 (±1.86), VT1 at 3.05 (±1.86), VAT at 3.85 (±1.62), VT2 at 4.5 (±2.28), and VE/VCO2 at 38 (±5.32). Final test parameters revealed VO2max at 5.8 (±2.09), VT1 at 3.2 (±1.33), VAT at 4.65 (±1.60), VT2 at 5.15 (±2.3), and VE/VCO2 at 36.4 (±69.95). Pearson's correlation analysis between CPET variables and the percentage improvement of various exercise test parameters found no statistically significant correlation. Except for METs-load and final time in Bruce, which show a significant and inversely proportional correlation (r=-0.67, p< 0.001). Conclusions The study demonstrates the effect of cardiac rehabilitation program in enhancing cardiorespiratory fitness and exercise capacity in post-TAVR patients. Notably, improvements in VO2max and ventilatory thresholds highlight the program's efficacy in promoting cardiovascular health. The inverse correlation between initial time in Bruce and METs improvement underscores the importance of baseline exercise capacity in predicting rehabilitation outcomes. Our results allow us to conclude that training volume is not the only variable to consider for proper CR. This insight could guide personalized rehabilitation strategies, making a significant contribution to the field of cardiac recovery post-TAVR.Measured METsBruce time - METs correlation

Wearable Devices for Training and Patient Monitoring: A Comprehensive Review

Introduction:Wearable technologies and remote patient monitoring (RPM) are transforming sports and healthcare by enabling continuous and real-time monitoring of various health parameters. These innovations hold significant potential for improving training outcomes in physical rehabilitation and fitness programs, managing chronic diseases, and enhancing patient engagement. Aim of the Study:This review aims to summarize and highlight the most relevant findings on the current status, clinical applications, challenges, and prospects of wearable health-related sensing technologies in the context of training and chronic disease management. Material and Methods:A review of scientific publications from 2018 to 2024 was conducted using PubMed and Google Scholar databases. Keywords such as "wearable," "remote patient monitoring," "sensors," "training," and "chronic disease management" were used. Conclusions:Wearable devices are gaining popularity among the entire population, not only among individuals with chronic health conditions. The use of wearable technologies has shown promise in improving training and health outcomes by providing continuous monitoring, personalized care, and enhanced training programs. However, challenges such as data accuracy, privacy concerns, and integration with healthcare systems must be addressed and present opportunities for future advancements.

Healthcare professionals' knowledge and perceptions of post-stroke rehabilitation in the peripandemic period: an online cross-sectional survey.

The COVID-19 pandemic has profoundly affected healthcare systems, particularly post-stroke rehabilitation centers. The elevated severity of strokes and delayed hospital admissions caused numerous hurdles to rehabilitation administration during the peri-pandemic period. This study surveyed healthcare professionals' knowledge and perceptions of post-stroke rehabilitation during this period. An online cross-sectional survey was administered from September 17, 2023 to February 23, 2024, utilizing the SurveyMonkey platform. The questionnaire included 30 questions addressing participant baseline characteristics, knowledge of definitions and experiences, post-stroke rehabilitation procedures, obstacles encountered during the peri-pandemic period, and the utilization of telerehabilitation. Only complete responses from health professionals were considered. This report utilized convenience sampling. Data were analyzed via descriptive statistics and chi-square tests, with a significance threshold of p < 0.05. A total of 79 health professionals, predominantly physiatrists, neurologists, and physiotherapists, from eight countries participated in the study. Over half of the participants (64.6%) indicated the existence of a dedicated department for post-stroke rehabilitation. Significant obstacles comprised an absence of advanced rehabilitative treatments (60.8%), inadequately skilled workers (50.6%), and restricted space for rehabilitation (46.8%). Telerehabilitation was regarded as a feasible option by 45.6% of participants; nonetheless, obstacles, including patients' telecommunication proficiency and the possibility of diagnostic inaccuracies, were acknowledged. Complementary therapies, such as music and dance therapy, received favorable evaluations from 67.1% to 63.3% of respondents, respectively. The pandemic reduced rehabilitation admissions due to infection concerns (75.9%) and increased multimorbidity cases among patients (48.1%). The study underscores the pandemic's negative effect on post-stroke rehabilitation, emphasizing the necessity for multidisciplinary, customized therapy and enhanced integration of telerehabilitation to overcome access barriers. Addressing obstacles regarding infrastructure, training, and access to advanced approaches, particularly in a post-pandemic context, is essential to improving rehabilitation outcomes.

An Overview of Reviews on Predictors of Neurorehabilitation in Surgical or Non-Surgical Patients with Brain Tumours

(1) Background. People suffering from brain cancer, regardless of histological tumour characteristics, often experience motor disturbances, cognitive–behavioural difficulty, language impairments, and functional and social limitations. The current treatment approach entails surgery and adjuvant therapy such as chemotherapy and radiotherapy combined with intensive rehabilitation. The primary focus of rehabilitation is usually motor and functional recovery, without specifically addressing the patient’s quality of life. The present systematic review identifies and evaluates the predictors of functional and cognitive rehabilitation outcomes and their influence on quality of life in adult patients with brain cancer. (2) Methods. Three electronic databases (PubMed, Elsevier, Cochrane) were searched for reviews about functional, cognitive, and quality-of-life outcomes in patients with central nervous system tumours, including articles published between January 2018 and May 2024. (3) Results. The search retrieved 399 records, 40 of which were reviewed. Five main areas of predictive factors were identified: diagnosis, therapy, complications, outcomes (in the motor, cognitive, and quality-of-life categories), and tailored rehabilitation. (4) Conclusions. These indicators may inform integrated care pathways for patients with primary central nervous system tumours.

Evaluating Muscle Mass Changes in Critically Ill Patients: Rehabilitation Outcomes Measured by Ultrasound and Bioelectrical Impedance

Background/Objectives: The loss of muscle mass is common in critically ill patients and is associated with poor prognosis, and efforts have been made to mitigate muscle loss through rehabilitation. This study aimed to evaluate changes in muscle mass in critically ill patients following rehabilitation. Methods: We enrolled 53 patients expected to stay in the ICU for more than 7 days, dividing them into rehabilitation (15 patients) and no rehabilitation groups (38 patients). Muscle mass was measured using ultrasound and bioelectrical impedance analysis (BIA). Results: Baseline characteristics and comorbidities showed no statistical differences between the two groups. Initial measurements of muscles showed no significant differences between the groups in rectus femoris thickness, total anterior thigh muscle thickness, cross-sectional area, echogenicity, or in-body skeletal muscle mass at baseline and 7 days. However, at 14 days, significant differences emerged. The rehabilitation group had greater rectus femoris thickness (1.42 cm vs. 0.81 cm, p = 0.007) and total anterior thigh muscle thickness (3.79 cm vs. 2.32 cm, p = 0.007) compared to the no rehabilitation group. Additionally, the rehabilitation group experienced a significantly smaller reduction in rectus femoris cross-sectional area (−4.6% vs. −22.8%, p = 0.021). Although survival rates were higher in the rehabilitation group (73.3% vs. 52.6%), this difference was not statistically significant (p = 0.096). Conclusions: Our findings suggest that rehabilitation in critically ill patients is associated with a slower rate of muscle loss, particularly in the cross-sectional area of the rectus femoris muscle, which may be beneficial for patient recovery.

The effect of unaffected side resistance training on upper limb function reconstruction and prevention of sarcopenia in stroke patients: a randomized controlled trial

Aging has made stroke a top killer and disabler, with post-stroke sarcopenia worsening disability and quality of life. While resistance training benefits the elderly, its impact on stroke patients is understudied. This study evaluates the potential of a 4-week unilateral resistance training (URT) program to prevent sarcopenia in stroke patients. It assesses the impact of URT on hand grip strength (HG), muscle thickness (MT), upper limb functionality, and the psychological status of the patients. The study aims to quantitatively analyze these indicators to inform evidence-based post-stroke rehabilitation practices. This study employed a randomized controlled trial (RCT) involving 77 eligible stroke survivors, equally allocated into a control group (n = 39) and an intervention group (n = 38). The control group received standard rehabilitation, while the intervention group additionally underwent a 4-week URT program. The primary outcomes were unaffected side HG and MT, measuring muscle mass and function. Secondary outcomes included the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) for upper limb functionality and the Hamilton Depression Rating Scale (HAMD) for psychological well-being changes. Statistical analysis showed significant differences (p < 0. 05) in all measured parameters between the intervention and control groups after the 4-week period. Intra-group comparisons also indicated substantial improvements (p < 0. 05). Unilateral resistance training significantly mitigates muscle atrophy in stroke patients, preventing sarcopenia and enhancing upper limb function. It also ameliorates depressive symptoms, improving rehabilitation outcomes and overall quality of life.

The challenge of thigh tendon reinjuries: an expert opinion.

This review critically examines the issue of thigh tendon reinjury in athletes, drawing on recent advancements and diverse perspectives in sports medicine. The findings underscore the paramount importance of an early and accurate diagnosis, which significantly influences treatment efficacy and rehabilitation outcomes. We explore the intricacies of tendon anatomy and the mechanisms underlying injuries, highlighting how these factors interplay with athlete-specific risk profiles to affect reinjury rates. A major finding from the review is the necessity for individualized rehabilitation approaches that integrate both traditional methods and emerging technologies. These technologies show promise in enhancing monitoring and facilitating precise adjustments to rehabilitation protocols, thus improving recovery trajectories. Additionally, the review identifies a common shortfall in current practices- premature to play (RTP)- which often results from inadequate adherence to tailored rehabilitation strategies or underestimation of the injury's severity. Such premature RTP significantly heightens the risk of further injury. Through this synthesis of contemporary research and expert opinion, the review advocates for a multidisciplinary approach in managing thigh tendon injuries, emphasizing the need for ongoing research to refine RTP criteria and optimize rehabilitation techniques. The ultimate goal is to support athletes in achieving safer and more effective recoveries, thereby reducing the likelihood of tendon reinjury.

Comparison Between Total Hip and Knee Arthroplasty on Short-Term Performance-Based Outcomes and Factors Associated with the Improvement of Gait Function During Post-Acute Inpatient Rehabilitation

Background: Data on the differences in functional recovery between inpatient rehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA) are lacking, and the factors influencing the improvement of short-term functional mobility remain unknown. In this study, we compared the short-term functional outcomes of both procedures and identified early postoperative predictors of physical function gain during post-acute rehabilitation. Methods: A total of 435 patients who underwent THA and TKA were included. The main outcomes were knee extension strength, the motor component of the Functional Independence Measure, Numerical Rating Scale, 10 Meter Walk Test, Timed Up and Go (TUG) test, and the Berg Balance Scale. The recovery process and rehabilitation outcomes were compared between patients with THA and TKA. Additionally, predictors related to physical performance improvement were examined for each procedure. Results: Patients with THA and TKA achieved significant short-term functional recovery after multidisciplinary rehabilitation (time; p &lt; 0.001). However, the pain score was higher at discharge in patients with TKA (p &lt; 0.001). Age (β: −0.264, p = 0.009) and TUG test (β: −0.884, p &lt; 0.001) in THA, and non-operated knee extension strength (β: 0.234, p = 0.016) and TUG test (β: −0.783, p &lt; 0.001) in TKA were significant early postoperative predictors of functional mobility. Conclusions: Multidisciplinary rehabilitation was beneficial for functional improvement in patients with THA and TKA despite persistent pain at discharge after TKA. Baseline functional levels in both groups and non-operated knee extension strength in TKA can be useful performance-based predictors of short-term gait function improvement.

Long-Term Outcomes of Dysphagia Rehabilitation With an Adjustable Resistance Training Device in LaryngectomizedIndividuals.

This study investigated long-term outcomes of dysphagia rehabilitation with an adjustable resistance training device (Swallowing Exercise Aid, SEA2.0) in laryngectomized individuals. Seventeen laryngectomized participants who participated in a Clinical Phase II Trial were reevaluated at T3 (approximately 6 months after T2), including an interview, PROMS, oral intake, and swallowing capacity. Results of T3 were compared with the earlier time points T0 (baseline), T1 (after 6 weeks of training), and T2 (after 8 weeks of rest). All outcomes at T3 remained improved compared to T0. Compared to findings at T2, participants reported some deterioration in swallowing at T3. Swallowing capacity and oral intake slightly decreased. Swallowing-related quality of life slightly improved. Benefits of swallowing rehabilitation with the SEA2.0 in laryngectomized individuals are still noticeable long term. The need for continued exercising to fully maintain improved function is likely, but the required intensity and extent should be determined in further research.

Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation

Background: Stroke survivors frequently encounter malnutrition, adversely impacting clinical outcomes. Nevertheless, malnutrition and food consumption in post-stroke patients have not been frequently assessed, and their correlation with rehabilitation outcomes remains inadequately explored. The objective of this observational study was to evaluate malnutrition at admission in these patients, assess food consumption during a six-week rehabilitation program, and analyze their correlation with rehabilitation outcomes. Methods: Subacute post-stroke patients were evaluated at admission (T0) and after a six-week rehabilitation treatment (T1). At T0, we assessed clinical and demographic characteristics, and we diagnosed malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Weight, BMI, hematochemical parameters, and activities of daily living with the modified Barthel Index (mBI) were evaluated at both T0 and T1; recovery was registered as a change in the mBI (ΔmBI = mBIT1 − mBIT0). Patients’ food consumption was recorded through visual plate waste estimation of three meals a day, 5 days a week, for six weeks of hospitalization for rehabilitation. Results: A total of 109 patients completed the study (51 women, mean age 69 ± 11). According to the GLIM criteria, 105 of these patients were at risk of malnutrition, while 43 were malnourished, with 15 severely malnourished. Malnourished patients wasted more food, with respect to non-malnourished patients, as measured by visual plate waste of total meals (25 ± 17% vs. 15 ± 14%; p = 0.001) and reached a lower ΔmBI. A linear regression analysis found a significant correlation between the ΔmBI, the waste of a “second dish”, which contained mainly protein, and serum albumin at admission, even after controlling for age. Conclusions: Malnutrition assessed with the GLIM criteria at admission and food consumption are two important nutritional parameters to evaluate in post-stroke patients hospitalized for rehabilitation due to their association with recovery.

Examining Factors That Contribute to Poststroke Depression Within the Family Caregiver and Care Recipient Dyadic Experience

Purpose: Stroke survivors often experience biochemical changes in the brain. This decreases the ability to experience positive emotions. Stroke survivors contend with the loss of their former self and are often left with residual physical, cognitive, communicative, and psychological changes leading to a depressive state. With an increasing number of stroke survivors returning to the community, informal care provided by family members will continue to rise. Many of the challenges faced by stroke survivors with poststroke depression (PSD) and by family caregivers (FCGs) have a significant impact on the relationship itself. With the goal to obtain insight into potential contributing factors to poststroke depressive features in stroke survivors, this qualitative research study aimed to investigate the experiences, behaviors, and perceptions of participants with PSD living in the dyadic relationship between FCG and stroke survivors. Method: Six FCG–stroke survivor care recipient dyads served as the participants. All stroke survivor care recipients were diagnosed with or had signs and symptoms of depression poststroke. Semistructured interviews were conducted with stroke survivors within each dyadic relationship. All participants were within this dyadic relationship for at least 3 months. Results: Six themes emerged from the stroke survivors. The findings indicated that grieving of the former self, lack of self-efficacy, isolation, difficulty with communication, perceived stress of the FCG, and lack of depressive coping skills are factors that contribute to PSD. Conclusions: There were multiple factors experienced by stroke survivors within the dyad affecting their emotional state and leading to or exacerbating depressive symptoms. Additionally, stroke survivors have limited coping strategies for depressive symptoms. Stroke survivor informational counseling, training, and education may improve coping strategies and decrease symptoms of depression and therefore lead to strengthened rehabilitative outcomes. Supplemental Material: https://doi.org/10.23641/asha.27156381

Effect of lower-limb isokinetic muscle strengthening on knee function and joint contact force in knee osteoarthritis patients awaiting total knee arthroplasty: study protocol for a randomized controlled trial.

Knee osteoarthritis (OA) is a common and serious joint disease and patients mainly suffer from knee pain and dysfunction, significantly impacting their quality of life and daily activities. Non-pharmacological treatments and total knee arthroplasty (TKA) are the two major treatments for knee OA. TKA is the primary treatment for severe knee OA patients, however, the postoperative rehabilitation results are not entirely satisfactory. To enhance postoperative rehabilitation outcomes, preoperative lower-limb muscle strengthening has aroused attention and demonstrated significant results on functional recovery after TKA. Specifically, isokinetic muscle strengthening (IMS) has been highly anticipated as an efficient training method. Nevertheless, its effects in perioperative and long-term periods of TKA require further investigation. This study aims to evaluate the impact of preoperative lower-limb IMS during the 4weeks before TKA on the perioperative and postoperative outcomes, with particular attention on knee function, pain, and inflammatory response. In this study, 104 patients awaiting TKA will be randomized to 2 groups: the IMS and health education groups. All patients will be evaluated at baseline, post-intervention, discharge day, and postoperative day 14, with follow-up assessments at 6weeks, 3, 6, and 12months after discharge. The primary outcome will be the Knee Injury and Osteoarthritis Outcome Score 3months after TKA and the medial-to-lateral knee contact force ratio. The secondary outcomes will be changes in lower-limb muscle strength, knee pain, inflammation response, active range of motion, performance-based function (5-times Sit-to-Stand Test, Time Up-and-Go Test, 3m walking speed), Berg Balance Scale, and surgical need. Lower-limb IMS can improve muscle strength, pain, and function for early knee OA patients. However, the effects of different doses of IMS on perioperative and postoperative knee pain, inflammation response, and function after TKA are inconclusive. This study will provide high-quality evidence to assess the efficacy of IMS in end-stage patients who will undergo TKA. Understanding IMS in end-stage knee OA patients will help guide future surgical management for this population. Trial Registration Chinese Clinical Trial Registry ChiCTR2400088136.

Primary healthcare rehabilitation users’ views on activity limitations and participation in South Africa

Background: Increasing functional limitations and disabilities have raised the need for comprehensive rehabilitation services at the primary healthcare (PHC) level, particularly in low- and middle-income countries. To support the integration of these services into PHC in South Africa, assessing outcomes from the service users’ perspectives is essential.Objectives: This study examined service users’ views on their PHC rehabilitation outcomes in a Metropolitan District of Gauteng, South Africa. The aim was to understand perceived changes in activity limitations and participation restrictions following the rehabilitation intervention.Method: A quantitative survey design, including self-rating measurements and structured interviews, was employed. Thirty-eight rehabilitation service users from eight clinics and community health centres were purposively sampled. Participants rated their pre- and post-rehabilitation levels of difficulty in activity limitations and participation restrictions, with open-ended questions providing additional insights. Data analysis used descriptive statistics, quantitative content analysis, and non-parametric tests.Results: Significant improvements in mobility, self-perception, and quality of life were reported by both adult and child service users. Caregivers of child service users also noted positive experiences (p = 0.019) in community, social, and civic life.Conclusion: This study highlights the perceived positive changes experienced by PHC rehabilitation service users in addressing functional limitations and disabilities. It underscores the effectiveness of integrated rehabilitation service delivery in improving user outcomes.Contribution: The findings offer valuable insights into how rehabilitation interventions enhance functional abilities, social participation, and overall well-being. By focusing on activity limitations and participation restrictions from service users’ perspectives, this study supports the priority of providing person-centred rehabilitation services at the PHC level.

Effect of Sarcopenia on Functional Recovery in Acute Stroke Patients Admitted for Standard Rehabilitation Program.

Background and Objectives: Sarcopenia is a significant concern in stroke rehabilitation, with a high prevalence reported in acute stroke patients. This study examines the effect of sarcopenia on rehabilitation outcomes in acute stroke patients. Materials and Methods: This study was conducted with acute stroke patients admitted within 90 days of onset to the rehabilitation hospital. Participants were divided into a stroke with sarcopenia group and a stroke without sarcopenia group. Evaluations were conducted at baseline, 4 weeks, and 8 weeks, including the following assessments: manual muscle testing (MMT), Berg Balance Scale (BBS), functional ambulation category (FAC), and Modified Barthel Index (MBI). Both groups received an identical rehabilitation program for 8 weeks. Results: Significant within-group improvements were observed in both groups across all measures (p < 0.05). However, the stroke with sarcopenia group showed significantly less improvement in MMT, BBS, FAC, and MBI compared to the stroke without sarcopenia group at both 4 and 8 weeks (p < 0.05). Conclusions: These results underscore the significant impact of sarcopenia on functional recovery in stroke patients, despite both groups receiving identical rehabilitation programs. The presence of sarcopenia was a critical predictor of poorer outcomes in muscle strength, balance, ambulation, and activities of daily living. Given these findings, specific rehabilitation strategies targeting sarcopenia are needed to improve recovery in stroke patients. Future research should include larger sample sizes, longer follow-ups, and sarcopenic patient-specific rehabilitation programs.

Wearable Online Freezing of Gait Detection and Cueing System.

This paper presents a real-time wearable system designed to assist Parkinson's disease patients experiencing freezing of gait episodes. The system utilizes advanced machine learning models, including convolutional and recurrent neural networks, enhanced with past sample data preprocessing to achieve high accuracy, efficiency, and robustness. By continuously monitoring gait patterns, the system provides timely interventions, improving mobility and reducing the impact of freezing episodes. This paper explores the implementation of a CNN+RNN+PS machine learning model on a microcontroller-based device. The device operates at a real-time processing rate of 40 Hz and is deployed in practical settings to provide 'on demand' vibratory stimulation to patients. This paper examines the system's ability to operate with minimal latency, achieving an average detection delay of just 261 milliseconds and a freezing of gait detection accuracy of 95.1%. While patients received on-demand stimulation, the system's effectiveness was assessed by decreasing the average duration of freezing of gait episodes by 45%. These preliminarily results underscore the potential of personalized, real-time feedback systems in enhancing the quality of life and rehabilitation outcomes for patients with movement disorders.

Designing Hand Orthoses: Advances and Challenges in Material Extrusion

The intricate structure of human hands requires personalized orthotic treatments, especially with the growing aging population’s demand for accessible care. While traditional orthoses are effective, they face challenges of cost, customization time, and accessibility. Additive manufacturing, particularly material extrusion (MEX) techniques, can effectively address challenges in orthotic device production by enabling automated, complex, and cost-effective solutions. This work aims to provide engineers with a comprehensive set of design considerations for developing hand orthoses using MEX technology, focusing on applying design for additive manufacturing principles, to enhance rehabilitation outcomes. This objective is achieved by establishing design requirements for hand orthoses, reviewing design choices and methodologies across conventional and state-of-the-art MEX-based devices, and proposing an innovative approach to orthotic design. Hand orthosis design requirements were gathered through workshops with occupational therapists and categorized into engineer-, medical-, and patient-specific needs. A review of 3D-printed hand orthoses using MEX analyzes various design approaches, providing insights into existing solutions. The study introduces a modular design concept aimed at improving rehabilitation by enhancing customizability and functionality. It highlights the potential of MEX for creating personalized, cost-effective orthoses and offers recommendations for future research, to optimize designs and improve patient outcomes.