Outpatient Physical Rehabilitation Research Articles

Factors Predicting the Ability to Perform Activities of Daily Living among Stroke Patients in Rural Community Southern Thailand.

The aim of this study was to explore the factors associated with the ability to perform activities of daily living (ADL) among post-stroke patients participating in outpatient physical rehabilitation programmes in community hospital in southern Thailand. In this cross-sectional study, data were collected from 258 patients diagnosed with stroke through the HOSxP programme from 2018 to 2022. Patients' ADL were assessed using the Barthel Index measurement. Characteristics were described by percentages and medians (IOR). Associations of categorical variables were examined using the chi-squared test, and multiple logistic regressions were employed to identify factors predicting Barthel Index scores among stroke patients. Patients' capacity levels were categorised based on Barthel Index scores and rehabilitation criteria, and unadjusted and adjusted odds ratios (OR/AOR) were presented, with a significance level of 0.05. Of the 258 stroke patients, 59.30% were male, with a median age of 67 years old. Significant differences in Barthel Index scores were found with respect to gender, age, marital status, comorbidities and duration of rehabilitation (P < 0.05). Binary logistic regression analysis indicated that male stroke patients (AOR = 1.89; 95% confidence interval [CI]: 1.10, 3.26), individuals with single marital status (AOR = 4.62; 95% CI: 1.58, 13.49), absence of comorbidities (AOR = 0.53; 95% CI: 0.29, 0.98), and rehabilitation duration of less than five days (AOR = 4.38; 95% CI: 2.14, 8.96) were more likely to achieve independence in ADL with higher Barthel Index scores (P < 0.05). Several factors contribute to the effective planning of care and rehabilitation for stroke patients in rural area. Stroke rehabilitation programmes in this region should consider various elements, including patient characteristics, family involvement and clinical factors, to improve ADL performance.

The 5-STS is a prognostic factor of sub-acute stroke patients who will not become community walkers at discharge from rehabilitation.

The recovery of community ambulation is a common concern among individuals after stroke. (1) To develop a potential readily applicable prognostic model able to correctly discriminate stroke patients who will not become independent community walkers at discharge; (2) To investigate the effects of early reassessment during the first month of treatment on the prediction accuracy of this model. This was a prospective cohort study. A consecutive sample of 80 patients at ≤60 days poststroke were assessed at baseline of outpatient physical rehabilitation and reassessed one month later. Non-functional community ambulation was measured. Seventy-four patients were followed until discharge. Of these, 47 patients were non-functional community walkers at discharge. A prediction model based on baseline performance in the five repetition sit-to-stand [5-STS] test was able to discriminate those patients of the sample (Area-under-curve = 0.956), and again with data from reassessment (AUC = 0.952). A time of 21 s at baseline was a highly prognostic cut-off point for discrimination (sensitivity = 87.2% and 85.1%). The combined use of baseline and reassessment data improved sensitivity (98.1%)CONCLUSION:Early findings of the 5-STS among stroke patients is an independent prognostic factor associated with independent community walking at discharge. It could discriminate individuals who will not become community walkers at discharge.

Effect of physical therapy and modalities on frozen shoulder patients at Baptist Hospital Batu: a retrospective study

Introduction: Frozen shoulder was one of top 10 diseases with frequent visits at Baptist Hospital’s rehabilitation clinic in 2020. Treatment for this condition includes physical therapy and modalities. This study aims to compare the range of motion and pain scale before and after treatments on frozen shoulder patients in Baptist Hospital Batu. Material and Methods: This is a retrospective study using the data from medical records of patients known to have frozen shoulder who came to outpatient physical rehabilitation clinic at Baptist Hospital, Batu, for at least a month period of treatment. The parameters used are range of motions after interventions, pain scale using VAS, sex, and age. Result: Twenty-two patients were diagnosed with frozen shoulder, 16 patients were included in further analyses, 9 of 16 were women, and the most common age presentation was between 50-60 years. There were improvements in 12 patients being recorded for their shoulder flexion and abduction. The flexion ROM increased from 115 to 156 degrees, while abduction ROM increased from 95 to 144 degrees, on average. About 9 out of 13 patients had decreasing pain scale according to VAS, declining from 5.5 to 4.7. Conclusion: The combination of physical exercises as well as SWD / ultrasound with TENS (transcutaneous electrical nerve stimulation) has a positive impact on the improvement of frozen shoulder. There was an increase in the range of motion of the joint flexion and abduction, and a decrease in pain scores in the majority of the patients after treatment.

Design and rationale of a pilot randomized clinical trial investigating the use of a mHealth app for sarcoidosis-associated fatigue

Fatigue is the most reported symptom in patients with sarcoidosis (SPs) and is a significant predictor of decreased quality of life that is strongly associated with stress and negative mood states. Few medications exist for treating fatigue in SPs, and outpatient physical rehabilitation programs are limited by availability and cost. Sarcoidosis in the US predominantly impacts minorities and underserved populations who are of working age and often have limited resources (e.g., financial, transportation, time off work) that may prevent them from attending in-person programs. The use of mobile health (mHealth) is emerging as a viable alternative to provide access to self-management resources to improve quality of life. The Sarcoidosis Patient Assessment and Resource Companion (SPARC) App is a sarcoidosis-specific mHealth App intended to improve fatigue and stress in SPs. It prompts SPs to conduct breathing awareness meditation (BAM) and contains educational modules aimed at improving self-efficacy.Herein we describe the design and methods of a 3-month randomized control trial comparing use of the SPARC App (10-min BAM twice daily) to standard care in 50 SPs with significant fatigue (FAS ≥22). A Fitbit® watch will provide immediate heartrate feedback after BAM sessions to objectively monitor adherence. The primary outcomes are feasibility and usability of the SPARC App (collected monthly). Secondary endpoints include preliminary efficacy at improving fatigue, stress, and quality of life. We expect the SPARC App to be a useable and feasible intervention that has potential to overcome barriers of more traditional in-person programs.

Efficacy of Computerized Visual Tracking Technology Throughout Concussion Recovery: A Case Series

<h3>Research Objectives</h3> To compare results of computerized eye tracking assessments to concussion patient reported outcomes and other objective oculomotor function tests throughout the concussion recovery. <h3>Design</h3> Retrospective case series of three physical therapy plan of cares completed between April 2021 and September 2021. <h3>Setting</h3> Outpatient physical rehabilitation clinic. <h3>Participants</h3> Included three female patients (mean age 34.7 years). Brain injury conditions vary from sub-acute to chronic. Selected via volunteer sample. <h3>Interventions</h3> Manual therapy, postural stabilization, aerobic conditioning, ocular motor training, and balance exercises. Average physical therapy visit count of 15.3. <h3>Main Outcome Measures</h3> RightEye™ Dynamic Visual Acuity (DVA) Test, Concussion Clinical Profile Screen (CCPS), Clinical DVA, Somatosensory Organization Test (SOT), and Vestibular Ocular Motor Screen (VOMS). <h3>Results</h3> All final RightEye™ DVA composite scores declined or had minimal change compared to evaluation scores. Initial VOMS similar findings to initial RightEye™ DVA subdomain scores. CCPS composite and ocular profile scores improved with each re-assessment. Clinical DVA scores improved and within normal limits at final assessments. 2/3 of participants had normal composite scores on SOT at re-evaluation. <h3>Conclusions</h3> In this case series subjective recovery of concussion symptoms did not correlate with performance on computerized ocular motor assessments. There were conflicting results on several other objective tests compared to results of RightEye™ DVA. Some confounding factors that may have impacted scores are co-morbidities of cervical pain, anxiety, depression, and migraine. Even though the assessments did not correlate, it is important to note the tracking assessments and games were engaging and offered repetition. In conclusion, clinicians should not rely on one single measurement for concussion screening and determination of readiness for return to prior activities. More research is needed to determine the efficacy of computerized visual tracking assessments for individuals with complex medical history and post-concussion. <h3>Author(s) Disclosures</h3> The author has nothing to disclose.

Efficacy of a 5-day, intensive, multidisciplinary, outpatient physical and occupational therapy protocol in the treatment of functional movement disorders: A retrospective study

BackgroundThe use of rehabilitation services has been shown to be beneficial for patients with functional movement disorders (FMD). However, there is great variability in the type of rehabilitation services utilized. In the present study we aimed at determining the efficacy of an intense outpatient physical rehabilitation program as a treatment modality for patients with FMD. MethodsEighteen participants underwent treatment in a specialized outpatient rehabilitation program utilizing a multidisciplinary approach for the treatment of FMD. Participants completed a series of tests on day one and day five of the program. ResultsResults indicated statistically significant improvements in all but one motor and gait outcomes in patients with functional movement disorders treated with physical rehabilitation. Conclusion: These results provide support for the continued use of physical and occupational therapy for functional movement disorder patients. Further research is needed to fully validate these findings and there remains a need for further study into multidisciplinary approaches that may be even more efficacious.

Effects of physical rehabilitation on exercise tolerance in post-COVID patients: results of an open controlled trial

The issue of physical rehabilitation of post-COVID patients stays relevant up to this day. Most publications discuss inpatient rehabilitation and only few publications describe outpatient physical rehabilitation of such patients.The aim. Our study was performed to investigate efficacy of outpatient physical rehabilitation of post-COVID patients with lung injury.Methods. This was a prospective non-randomized open controlled study. All patients with COVID-19-associated lung injury were referred to supervised outpatient rehabilitation program. We analyzed 6-minute walk test (6-MWT) results, evaluation of dyspnea using Borg scale and assessment of oxygen saturation (SpO2) using pulse oxymeter before and after walking.Results. The rehabilitation group included 24 patients and the control group included 6 patients. The baseline and demographic findings did not differ significantly between the groups. The 6-minute distance (6-MWD) (р = 0.000018), heat rate at rest (р = 0.017) and after walking (р = 0.017), dyspnea after walking (р = 0.017), oxygen saturation at rest (р = 0.030) and after walking (р = 0.0021) improved significantly in the rehabilitation group and did not change significantly in the control group. At the end of the study, 6-MWD increased by 63.2 ± 36.3 m in the rehabilitation group compared to 14.0 ± 28.8 m in the control group (р = 0,01) and exertional dyspnea score increased by 0 (0 – 1) compared to 1 (1 – 2) in the control group (p = 0.033).Conclusion. Supervised outpatient physical rehabilitation in outpatient settings can accelerate physical recovery in post-COVID patients with lung injury.

Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study.

BackgroundPhysical rehabilitation interventions address functional deficits caused by impairments that affect someone’s performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector).ObjectivesThis article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation.MethodData were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organisations or faith-based organisations.ResultsTwo hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities’ catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier.ConclusionRehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families.ContributionData on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda.

A Retrospective Analysis of Transitioning a Concussion Support Group to a Virtual Platform

<h3>Research Objectives</h3> To investigate the success of transitioning a support group for adults who have sustained a concussion from an in-person meeting to a virtual platform due to the impact of COVID-19. <h3>Design</h3> Retrospective analysis of virtual concussion support group meetings performed between July 2020 and March 2021, compared to in-person concussion support group meetings performed between January 2017 and March 2020. <h3>Setting</h3> Outpatient physical rehabilitation clinic. <h3>Participants</h3> Adults who sustained a concussion and attended at least one support group meeting, either in-person or virtually. <h3>Interventions</h3> Comparing attendance and participant feedback between in-person and virtual meetings. <h3>Main Outcome Measures</h3> Feedback surveys, Attendance count. <h3>Results</h3> Attendance count for virtual meetings was comparable to that of in-person meetings, however on average was higher for virtual meetings (average of 9 virtual participants per month vs. 6.85 for in-person). However, there was a significant decline in feedback survey participation for virtual meetings (42% participation vs. 88% participation in-person). <h3>Conclusions</h3> Virtual support group meetings can be an effective way to offer education and an outlet to individuals with a concussion during a world-wide pandemic. Individuals appear equally likely to attend virtual meetings versus in-person meetings, with virtual meeting attendance higher on average so far than over the last 3 years of in-person meetings. This may be due to the ease of access of a virtual meeting versus driving to a location. However, participants appear less likely to submit feedback surveys for virtual meetings compared to in-person meetings. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.

Pain Intensity and Functional Outcomes for Activities of Daily Living, Gait and Balance in Older Adults Accessing Outpatient Rehabilitation Services: A Retrospective Study.

PurposeOlder adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program.Patients and MethodsA retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant.ResultsThe TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10).ConclusionThese results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.

“I Don’t Have a Magic Wand”: The Why and How of Patient Education in Outpatient Physical Rehabilitation

Abstract Date Presented 04/04/19 This session presents findings from an interpretive descriptive study exploring OTs’ perspectives of patient education in outpatient physical rehabilitation. The recognition of “I don’t have a magic wand” drove the purpose and process of patient education and encouraged alignment of practice with the profession's agentic and client-centered philosophy. Discussion of findings will facilitate attendees’ critical reflection on their own views of patient education. Primary Author and Speaker: Abigail Brody Additional Authors and Speakers: Brocha Stern, Emma Gentile, Emma Hecht, Kathryn Pelech Contributing Authors: Promita Banik, Alisa Doshi, Prema Khan, Joy Sarraf

One-Quarter of People Leave Inpatient Stroke Rehabilitation with Physical Capacity for Community Ambulation

Background and PurposeAbility to walk in the community is important for independence and participation in life roles, but is difficult for many people following stroke. The purpose of this study was to determine the proportion of people with stroke with the physical capacity to be independent community ambulators at discharge from a publicly funded inpatient rehabilitation setting. MethodConsecutive medical records were audited to collate walking outcome at discharge, and to clarify if people with stroke had potential to walk independently in the community as defined by 4 criteria: independence with stairs; ability to traverse slopes and inclines; walking speed of .8m/s or more; and walking distance 367 m or higher on 6-Minute Walk Test. ResultsWhile 80% of the 124 persons with stroke could walk indoors, only 27% could perform 4 essential skills needed to walk independently in the community at discharge from hospital. The proportion that met each criterion was 52% for stairs, 39% for slopes and inclines, 58% for speed, and 40% for distance. For the overall sample, mean (standard deviation) walking speed was .90 (.33) m/s, and distance for 6-Minute Walk Test was 349.6 (146.5) m. Discussion and ConclusionA retrospective review found that three quarters of stroke survivors lacked physical capacity for 4 skills required to walk independently in the community at the time of discharge from a public inpatient rehabilitation. Our findings recommend that people with stroke have access to outpatient physical rehabilitation to optimize walking outcome.

Factors Affecting Length of Stay in Adult Outpatient Physical Rehabilitation: A Scoping Review of the Literature

To identify factors affecting length of stay (LOS) for adults participating in outpatient physical or occupational therapy programmes. A scoping review of the literature was conducted using the Ovid MEDLINE, EMBASE, CINAHL, AMED, and Cochrane Library databases. A total of 19 articles were retained from the search, and 2 additional articles were retrieved from grey literature (i.e., non-published sources). Personal factors affecting LOS are age and sex, both of which had inconsistent effects on LOS, and communication, language, physical, and cognitive difficulties, for which higher levels of function were generally associated with shorter LOS. Institutional factors affecting LOS were location, interdisciplinary communication, number of disciplines involved, and type of rehabilitation setting. Finally, two clinician-related factors-fewer treatment goals and a selection of evidence-informed treatment techniques-were associated with shorter LOS. Research on factors affecting adult outpatient rehabilitation LOS is limited and inconsistent. A preliminary list of LOS factors was produced, but this topic should be further explored with the collaboration of researchers and clinical institutions.

Development and Reliability Testing of Spanish Language and English Language Versions of the Multidimensional Task Ability Profile

The purpose of this study was to assess the: (1) test-retest reliability of the English and Spanish language versions of the Multidimensional Task Ability Profile (MTAP), (2) cross-cultural adaptation of the Spanish language version of the MTAP, and (3) practicality of both versions in terms of time required for administration. The MTAP is a patient-reported outcome measure of physical function that uses a combination of text and pictorial illustrations. An observational study was conducted with a convenience sample of patients with musculoskeletal disorders from three outpatient physical rehabilitation centers. Participants (n = 110) completed the MTAP two times, whereby the second test was completed 24-72 h after the first test. Focus groups were conducted at the end of the study. Correlation analyses were used to assess test-retest reliability and qualitative analyses were used to assess cultural adaptation of the MTAP. The English and Spanish versions of the MTAP displayed good test-retest reliability (ICC 2,1 = 0.87-0.97, p < 0.05). Qualitative analyses demonstrated adequate cross-cultural adaptation of the Spanish language version of the instrument. The findings of this study indicate that the MTAP has been adequately adapted from its original English version for use with Spanish-speaking individuals. The MTAP in its current form of 50 items is reliable when administered to individuals with musculoskeletal disorders in either English or Spanish.

Visual Art in Physical Rehabilitation: Experiences of People with Neurological Conditions

Aims: The aims of this study were to understand the experience of participation in visual art from the perspective of adults undergoing outpatient physical rehabilitation and to determine whether art has a place in this context. Method: This qualitative study involved interviewing adults who attended a weekly art class run by a qualified art teacher and occupational therapists in an outpatient physical rehabilitation setting. Nine participants with neurological conditions discussed their experience of the programme and the goals they were working towards or had achieved through painting. Findings: The themes that emerged from the study show that art contributed to the participants meeting their individual rehabilitation goals. It also assisted the participants in using time, increasing enjoyment, regaining confidence and planning for engagement in future activities. All these achievements were seen by the participants to contribute to their rehabilitation or recovery. The identified themes align with the aims of rehabilitation and are similar to findings from many other studies investigating the use of art by people affected by illness or disability. Conclusion: The findings of this study inform clinical practice in the use of visual art with clients in rehabilitation and validate its place in a physical rehabilitation programme.

The Occupational Therapy Practice Checklist for Adult Physical Rehabilitation

Although the practice of occupational therapy is described in textbooks, research, and professional standards, a tool for outcomes research is needed. The Occupational Therapy Practice Checklist (OTPC), based on the Model of Occupational Performance (Pedretti, 1996), includes domains of adjunctive, enabling, purposeful, and occupational performance. Practices are also identified by phase of therapy (early, middle, late). The OTPC was piloted with 40 adults in an outpatient physical rehabilitation center. The Kuder Richardson 20 coefficient of internal consistency was .91. Practices on the OTPC discriminated between clients with and without neurological disorders. The OTPC has potential for yielding knowledge about occupational therapy practice. Results of the pilot show that occupational therapy practice was not linear, as theorized, but rather a complex integration of techniques.

Social support and health-related quality of life in hip and knee osteoarthritis.

To document the association between social support and health-related quality of life (HRQoL) in hip and knee osteoarthritis (OA). A prospective survey including the SF-36 and the Social Support questionnaire (SSQ) was administered to 108 hip and knee OA patients attending an outpatient physical rehabilitation and rheumatology clinic. Multiple regression analysis were performed to study the relation between social support and each dimension of the SF-36, controlling for age, sex, body mass index, number of comorbid conditions, socioeconomic status, site of survey completion and severity of OA which was gauged with the pain dimension of the WOMAC, an OA-specific health status instrument. Greater social companionship transactions were associated with higher physical functioning (standardized regression coefficients: beta = 0.26, p < 0.01), general health (beta = 0.32, p < 0.001), mental health (beta = 0.25, p < 0.01), social functioning (beta = 0.20, p < 0.05) and vitality (beta = 0.25, p < 0.05). Satisfaction with problem-oriented emotional support was related to better physical functioning (beta = 0.22, p < 0.01), mental health (beta = 0.38, p < 0.001), role-emotional (B = 0.23, p < 0.01), social functioning (beta = 0.19, p < 0.05) and vitality (beta = 0.26, p < 0.01). Social support components significantly account for HRQoL. Health interventions in OA, primary dedicated to pain and physical disability, could be supplemented with social support component to enhance health outcomes.