Outpatient Rehabilitation Clinic Research Articles

Patients’ Need for Sexual Counseling in the Cardiac Rehabilitation Service

Objective: To evaluate the need for sexual counseling among patients with heart disease Materials and Methods: Data were collected from 363 patients with heart disease attending a cardiac rehabilitation outpatient clinic. Participants completed the questionnaire independently. Results: The participants consisted of 241 males (66.4%) and 122 females (33.6%) with a mean age of 57.69±14.50 years. Among them, 248 (68.3%) were married. Most participants (91.2%) agreed that healthcare providers should offer sexual counseling to all heart patients of reproductive age, and they wanted their healthcare providers to initiate the counseling. Factors related to the need for counseling were being male (OR=2.07; 95% CI =1.05-4.07), being married (OR=2.04; 95% CI =1.03-4.05) and being 50 years of age or younger (OR 9.05; 95%CI =2.06-39.82). The main obstacles affecting conversations about sexual activity with healthcare providers were feeling embarrassed (45.7%), being physically impaired (45.4%), and having a third person present during counseling (44.9%). Conclusion: Most patients with heart disease want to receive counseling on how to safely resume sexual activity following their illness. They expect healthcare providers to initiate such counseling during visits to cardiac rehabilitation clinics. It is crucial that healthcare providers provide counseling in a format that is tailored to the needs and preferences of each patient.

Application of 3D transparent facemasks in long-term outpatient rehabilitation of facial scars after burns: a retrospective cohort study of improved appearance of target scars with different healing time.

Severe facial burns may cause scarring problems and affect living quality of patients. With the advent of 3D facemasks, it is being used to treat facial scars; however, its efficacy must be confirmed by adequate studies. A retrospective analysis of 26 patients who visited rehabilitation outpatient clinic from 2017 to 2022. Patients were separated into two groups based on the time to healing (TTH) following burn injury: early healing group (TTH ≤ 21 days) and late healing group (TTH > 21 days). To compare treatment outcomes and differences between the two groups, 3D facemask application was assessed using the Vancouver Scar Scale (VSS), patient satisfaction, and complications. In both groups, there were significant improvements in the total VSS scores (P<0.01) and each VSS subscore (P<0.01). These scar characteristics improved over time as the treatment progressed. Compared with the late healing group, the early healing group had more obvious effects on improving scar pigmentation (P<0.05) and vascularity (P<0.05) at similar assessment time points after burns. At the last assessment, there was a significant difference in total VSS scores between groups (P=0.009). For the early and late healing groups, respectively, the mean gradient value (SE) of the total VSS scores was 1.550 (0.373) and 1.283 (0.224) over the course of the treatment periods. 3D facemasks are effective in the rehabilitation of facial scars caused by burns, which should be used for prevention and treatment in the initial stages of scar development.

Cornelia De Lange Syndrome in the International Classification of Functioning, Disability and Health Perspetive: A Case Report

Background: Cornelia de Lange syndrome (CdLS) is a genetic disorder featured by multi-systemic malformations, such as microcephaly, hypertrichosis, upper limb defects, growth retardation, developmental delay, and a variety of associated malformations. Multidisciplinary and holistic care is needed in the management and rehabilitation of individuals with CdLS. One of the tools that can be used as a clinical measurement in holistic care is the International Classification of Functioning, Disability, and Health (ICF). Objective: To provide a holistic approach and intervention by using the ICF assessment in CdLS individuals. Case: A 53-month-old boy was admitted to Physical Medicine and Rehabilitation outpatient clinic of Primasatya Husada Citra (PHC) hospital of Surabaya in February 2021, due to global developmental and growth delay. The patient had low body weight and short stature. The patient had thick eyebrows, a short nose, a concave nasal ridge, thin upper lip vermillion, smooth philtrum, and small hands with small fifth fingers. Was only able to say several words, and it was not clearly pronounced. During the daily activity, he had difficulty going downstairs and wearing his socks, long pants, and shirt. Attended pre-school, had difficulties with speaking, reading, and focusing attention. Conclusion: ICF can help physicians to assess a patient’s condition thoroughly, to set goals, and to provide condition-appropriate treatment and rehabilitation programs for CdLS patients.

Longitudinal Clinical Features of Post-COVID-19 Patients-Symptoms, Fatigue and Physical Function at 3- and 6-Month Follow-Up.

Post-COVID-19 syndrome (PCS) has been described as 'the pandemic after the pandemic' with more than 65 million people worldwide being affected. The enormous range of symptoms makes both diagnosis complex and treatment difficult. In a post-COVID rehabilitation outpatient clinic, 184 patients, mostly non-hospitalized, received a comprehensive, interdisciplinary diagnostic assessment with fixed follow-up appointments. At baseline, three in four patients reported more than 10 symptoms, the most frequent symptoms were fatigue (84.9%), decreased physical capacity (83.0%), tiredness (81.1%), poor concentration (73.6%), sleeping problems (66.7%) and shortness of breath (67.3%). Abnormalities were found in the mean values of scores for fatigue (FAS = 34.3), cognition (MoCA = 25.5), psychological alterations (anxiety, depression, post-traumatic stress disorder), limitation of lung function (CAT) and severity scores for PCS (PCFS, MCRS). Clinical abnormalities were found in elevated values of heart rate, breathing rate at rest, blood pressure and NT-proBNP levels. As the frequency of the described symptoms decreases only slowly but most often significantly over the course, it is important to monitor the patients over a longer period of time. Many of them suffer from an immense symptom burden, often without pre-existing clinical correlates. Our results show a clear association with objectifiable assessments and tests as well as pronounced symptoms.

Reliability, Validity, and Efficiency of an Item Response Theory-Based Balance Confidence Patient-Reported Outcome Measure.

The aims of this study were to calibrate the original 16 items from the Activities-specific Balance Confidence (ABC) Scale to create an item response theory (IRT)-based item bank and scoring metric of balance confidence (BC) and to assess psychometric properties of a computerized adaptive test (BC-CAT) and 6-item short-form (BC-SF) administration modes. This retrospective study included data from patients who were treated in outpatient rehabilitation clinics and assessed for balance impairments by responding to the full ABC Scale at intake. IRT model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were evaluated. BC-CAT-generated scores were assessed for reliability, validity, and administration efficiency, and the newly developed BC-SF was assessed for reliability. Total cohort included 20,354 patients (mean age [SD] = 66 [16] y; range = 14-89). All 16 items were retained in the final item bank based on support for unidimensionality and fit to the IRT model. No items demonstrated DIF. Reliability estimates were 0.95, 0.96, and 0.98 for the BC-SF, BC-CAT, and the full item bank, respectively. Scores discriminated among patient groups in clinically logical ways. After controlling for scores at intake, better outcomes were achieved for patients who were younger, had more acute symptoms, exercised more, and had fewer comorbidities. Scores were responsive to change with a moderate effect size, with negligible floor and ceiling effects. CAT scores were generated using an average of 4.7 items (median = 4) and correlated highly with full-bank scores (Pearson correlation coefficient = 0.99). The IRT-based BC patient-reported outcome measure (PROM) was reliable, valid, moderately responsive to change, and efficient, with excellent score coverage. The measure is suitable for research and routine clinical administration using the BC-CAT or BC-SF administration modes. The full ABC Scale can be administered for increased clinical content when appropriate. The newly developed BC patient-reported outcome measure (PROM) was reliable and valid for assessing perceived balance confidence. In addition, the BC PROM has efficient administration modes with low patient response burden, which enhances feasibility and use during routine clinical practice in busy rehabilitation settings. This study supports a transition to PROMs that are based on modern measurement approaches to achieve the combined benefits of high accuracy and efficiency.

Tinkering with responsive caring in disabled children's healthcare: Implications for training and practice

Health professional education has traditionally relied on the acquisition of vertical expertise whereby learners apply top-down principles and methods to develop clinical skills. In this critical qualitative study, we examined horizontal processes of “knotworking” and “tinkering” in the development of expertise amongst clinicians and trainees in a children's rehabilitation outpatient clinic. Using ethnographic methods of observation, interviews and group dialogues, the study explored what constitutes “good” child healthcare, the risks of separating humanistic from biomedical care, and how discursive assumptions and conventions shaped learning and practices. Our analyses identified processes of responsive caring that integrated medical and humanistic imperatives into transposable, dynamic repertoires through which clinicians could pivot in response to child and family needs and priorities, resource access, and socio-material contexts. We discuss the challenges for teaching and mentoring medical trainees who have to both learn and unlearn particular practices in their efforts to develop responsive expertise.

The Value of Lipocalin-2 in Patients with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune multisystem disease predominantly affecting women in the childbearing period. The majority of the pathology in SLE is related to deposits of immune complexes in various organs, which trigger complement and other mediators of inflammation. SLE is characterized by a very large spectrum of clinical manifestations accompanied by prototypic abnormalities of the immune system. Methods: This study was conducted on thirty SLE patients who were diagnosed according to the American College of Rheumatology (ACR) revised criteria. The patient was selected from the outpatient clinic of Rheumatology and Rehabilitation of Ain Shams University Hospital. Fifteen subjects, matched for age and sex, were included in the study and served as a control group. Comparison of quantitative variables between the study groups was done using the Kruskal Wallis analysis of variance (ANOVA) test with Mann Whitney U test for independent samples as posthoc multiple 2-group comparisons. A probability value (p-value) less than 0.05 was considered statistically significant. All statistical calculations were done using computer programs Microsoft Excel 2007 (Microsoft Corporation, NY, USA) and SPSS (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) version 15 for Microsoft Windows. Results and Discussion: Our results come in agreement with the study done by Farzaneh and his colleagues in 2013, who studied fifty-two lupus patients; urinary lipocalin-2 levels in LN patients were significantly higher than those in non-LN patients. Also, our results were in accordance with the study done by Hammad, who studied 33 children with active SLE (22 with and 11 without LN) and compared them with 15 matched controls. Levels of urinary NGAL were higher in patients with LN than those without LN. These findings come in consistent with previous work done by Youssef and his co-worker in 2015, who studied 44 SLE patients and divided them into two groups, group I (twenty-two patients with LN) and group II (twenty-two patients without LN), the urinary lipocalin-2 had the highest mean levels in LN patients (group I) compared to group II and controls with a statistically significant difference. Also, between SLE patients without nephritis (group II) and controls. Conclusions: In this study, urinary lipocalin-2 was significantly higher in the SLE patients compared to the control group, and the lupus nephritis patients, when compared to the patients with SLE without nephritis,showed significantly higher levels of urinary lipocalin-2. The significant association of the urinary lipocalin-2 with the renal SLEDAI shows that urinary lipocalin-2 can be an early biomarker to diagnose patients with lupus nephritis and to detect renal disease activity.

The microbiome of an outpatient rehabilitation clinic and predictors of contamination: A pilot study.

Understanding sources of microbial contamination in outpatient rehabilitation (REHAB) clinics is important to patients and healthcare providers. The purpose of this study was to characterize the microbiome of an outpatient REHAB clinic and examine relationships between clinic factors and contamination. Forty commonly contacted surfaces in an outpatient REHAB clinic were observed for frequency of contact and swiped using environmental sample collection kits. Surfaces were categorized based on frequency of contact and cleaning and surface type. Total bacterial and fungal load was assessed using primer sets specific for the 16S rRNA and ITS genes, respectively. Bacterial samples were sequenced using the Illumina system and analyzed using Illumina-utils, Minimum Entropy Decomposition, QIIME2 (for alpha and beta diversity), LEfSe and ANCOM-BC for taxonomic differential abundance and ADONIS to test for differences in beta diversity (p<0.05). Porous surfaces had more bacterial DNA compared to non-porous surfaces (median non-porous = 0.0016ng/μL, 95%CI = 0.0077-0.00024ng/μL, N = 15; porous = 0.0084 ng/μL, 95%CI = 0.0046-0.019 ng/μL, N = 18. p = 0.0066,DNA. Samples clustered by type of surface with non-porous surfaces further differentiated by those contacted by hand versus foot. ADONIS two-way ANOVA showed that the interaction of porosity and contact frequency (but neither alone) had a significant effect on 16S communities (F = 1.7234, R2 = 0.0609, p = 0.032). Porosity of surfaces and the way they are contacted may play an underestimated, but important role in microbial contamination. Additional research involving a broader range of clinics is required to confirm results. Results suggest that surface and contact-specific cleaning and hygiene measures may be needed for optimal sanitization in outpatient REHAB clinics.

Evaluation of the Clinical and Demographic Characteristics of Patients aged 65 and Over Who Applied to the Physiotherapy and Rehabilitation Outpatient Clinic

Background: The aim of this study is to evaluate the cilinical and demographic characteristics of geriatric patients aged 65 and over who presented at the physical medicine and rehabilitation polyclinic of university hospital. Material and Methods: The study was conducted in the physical medicine and rehabilitation (PMR) department of Harran University Hospital. In the study, the records of geriatric patients aged 65 and over who presented at the PMR polyclinic in the first 10 months of 2022 were retrospectively analyzed. Demographic characteristics and diagnoses of patients in the geriatric age group were examined. Results: A total of 759 people were included in the study, 546 of whom were women (71.9%) and 213 of them (28.1%) were men aged 65 and over. The gender distribution was determined to be significantly predominantly female (p&amp;lt;0.001). The mean age of the patients was 72.3±6 (65-98) years. The mean age of men was 71.6±5 (65-89) and the mean age of women was 72.6±6 (65-98), and there was no significant difference between the mean ages of both groups (p&amp;gt;0.05). Conclusion: We observed that the most common diagnoses of the older adult patients who presented at our PMR polyclinic, the most frequent were degenerative diseases and osteoporosis, followed by other diagnoses. To reduce pain and disability in patients, it is important that protective measures are taken against the risk factors that can worsen the clinical condition of the disease in older adults. Nevertheless, we think that there is a need for multicenter clinical studies with wider patient participation related to the prevalence of musculoskeletal diseases in elderly individuals.

The Buffalo Concussion Treadmill and Bike Tests in People With Mild-to-Moderate Traumatic Brain Injury: An Exploratory Clinical Audit.

To assess the performance on the Buffalo Concussion Treadmill and Bike Tests in nonathletic people following a mild-to-moderate traumatic brain injury. An outpatient rehabilitation clinic. Forty-nine patients with mild-to-moderate traumatic brain injury who underwent the Buffalo Concussion Treadmill or Bike Test as usual clinical care. A retrospective clinical audit. Demographics and brain injury-specific clinical data, Depression Anxiety Stress Scale; Rivermead Post-Concussion Symptom Questionnaire, and performance outcomes on the Buffalo Concussion Treadmill or Bike Test. Forty-nine patients (mean age: 33.7 ± 13.0 years), on average 56.2 ± 36.4 days post-injury, completed the Buffalo Concussion Treadmill or Bike Test. Fourteen patients stopped the test due to symptom exacerbation with a mean test duration of 8.1 ± 4.5 minutes, reaching an age-predicted maximum heart rate of 72.9% ± 12.4% and reporting a rating of perceived exertion of 13.4 ± 2.2. Those who terminated the test for other reasons had a significantly longer test duration (14.0 ± 4.7 minutes, P = .01), with a higher age-predicted maximum heart rate (83.3% ± 12.8%, P = .01) and rating of perceived exertion (17.0 ± 2.5, P = .01). Within the group who stopped for other reasons, 10 were due to symptoms deemed unrelated to the injury at the time of the test and 2 were stopped by the therapist for safety reasons. A significant but weak correlation between heart rate and rating of perceived exertion existed only for those who terminated the test for other reasons ( r = 0.38, P = .02). Overall, a shorter test duration was associated with higher scores of both self-reported depression ( r = -0.41, P < .01) and late postconcussion symptoms ( r = -0.40, P < .01). The Buffalo Concussion Treadmill or Bike Test can be used in the nonathletic mild-to-moderate traumatic brain injury population to differentiate between those who experience symptom exacerbation during exercise and those who do not based on symptom exacerbation, test duration, and poor perception of exertion. Further research is required to determine whether other reasons for test termination are related to the injury.

Medical Rehabilitation in Patient with Post ORIF et causa Neglected Epiphyseal Fracture Distal Radius-Ulna Sinistra: A Case Report

Distal radius-ulna fracture is one of the most common human osseous injuries, with incidence rate increasing worldwide. There are two peaks of prevalence: the first around the 10th and the second around the 60th year of life. During childhood, they are among the most common pediatric fractures accounting for 19.9 to 35.8% of all pediatric fractures. We reported a case of a boy 13 years old diagnosed as post open reduction internal fixation distal radius ulna et causa epiphyseal fracture. He came to rehabilitation outpatient clinic with chief complaint pain on his left forearm. He underwent a surgery two weeks ago at the distal radius ulna. The surgeon did osteotomy on ulna and then fixated with plate and screw. On physical examination, there were pain and range of motion limitation mainly on the forearm and wrist joint. The patient was treated with low level laser therapy at the surgical wound to promote healing and decrease edema, initial digital motion exercise along with active range of motion of the uninvolved joints. He was also educated about icing and medicamentation if pain still persisted. Once adequate bony healing had occurred, active, active-assisted, progressive passive wrist motion, and strengthening exercise using resistance were performed to maximize the result. At the end of rehabilitation program, there was great improvement on pain and also range of motion improvement. Albeit, there was still a slight range of motion limitation on ulnar deviation and wrist extension by 5 degrees. In conclusion, rehabilitation program is very beneficial in treating post-surgery patient using modalities and exercises to improve functional function. Keywords: epiphyseal fracture; radius-ulna; medical rehabilitation

Does osteoporosis cause pain even without a fracture? An observational study

Introduction/background Osteoporotic fractures are usually painful. However, data on whether osteoporosis without fracture causes pain are insufficient. This study aims to determine whether osteoporosis without fracture is the cause of pain. Methodology Patients aged over 18 years who visited the Physical Medicine and Rehabilitation outpatient clinic of a tertiary university hospital for dual-energy X-ray absorptiometry scan and were suitable for dual-energy X-ray absorptiometry scan without a history of fracture were included in the study. Patients with a history of fractures or those with fracture/fracture sequelae on X-rays were excluded. The cervical, lumbar, and thoracic spine and general body pains of the patients were questioned and dual-energy X-ray absorptiometry results were recorded. Results The study was conducted with 139 patients. Lumbar bone mineral density and T score values of the patients were found to be negatively correlated with the numerical rating scale levels of the cervical, thoracic, lumbar spine, and general body pain. Hip total bone mineral density and T score values were also negatively correlated with numerical rating scale scores of the lumbar and thoracic spine and general body pain. When the patients were divided into two groups as those with and without osteoporosis, it was found that the cervical, lumbar, thoracic spine, and general body pain numerical rating scale levels of the patients with osteoporosis were significantly higher than the group without osteoporosis. Conclusion The results of this study showed that osteoporosis might be associated with pain even though there is no fracture.

Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study

ObjectiveTo investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain. DesignCross-sectional study. SettingInterdisciplinary outpatient rehabilitation clinic for back and neck pain. ParticipantsPatients with chronic neck pain (n=30), patients with chronic low back pain (n=30), and age- and sex-matched asymptomatic control subjects (n=30; N=90). InterventionsNot applicable. Main Outcome MeasuresPatients and asymptomatic control subjects completed a test procedure for the JPS of the cervical spine, lumbar spine, and ankle in a randomized order. Between group differences were analyzed with the univariate analysis of variance and associations of the JPS with clinical features using the Pearson's correlation coefficient. ResultsBoth patients with chronic neck pain (P<.001) and patients with chronic low back pain (P<.01) differed significantly from asymptomatic controls in the JPS of the cervical spine, lumbar spine and ankle joint, regardless of the painful area. No difference was shown between patient groups (P>.05). An association of the JPS with clinical characteristics, however, could not be shown. ConclusionThese results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.

Impact of the COVID-19 Pandemic on the Level of Anxiety and Depression in Caregivers of Children Benefiting from Neurorehabilitation Services.

At the turn of March and April 2020, due to the occurrence of COVID-19 in Poland, the first restrictions on the provision of rehabilitation services were introduced. Nevertheless, caregivers strived to ensure that their children could benefit from rehabilitation services. To determine which of the selected data presented in the media reflecting the intensity of the COVID-19 epidemic in Poland differentiated the level of anxiety and depression in caregivers of children benefiting from neurorehabilitation services. The study group consisted of caregivers of children (n = 454) receiving various neurorehabilitation services in the inpatient ward of Neurological Rehabilitation of Children and Adolescents (n = 200, 44%), in the Neurorehabilitation Day Ward (n = 168, 37%), and in the Outpatient Clinic (n = 86, 19%) of the Clinical Regional Rehabilitation and Education Center in Rzeszow. The average age of the respondents was 37.23 ± 7.14 years. The Hospital Anxiety and Depression Scale (HADS) was used to measure the severity of anxiety and depression in caregivers of children. The questionnaires were distributed from June 2020 to April 2021. As a measure of the severity of the COVID-19 epidemic in Poland, the figures presented in the media were adopted. In addition, data on the COVID-19 pandemic presented in the media (Wikipedia, TVP Info, Polsat Nes, Radio Zet) on the day preceding the completion of the survey were analyzed based on statistical analysis methods. 73 of the surveyed caregivers (16.08%) suffered from severe anxiety disorders, and 21 (4.63%) from severe depressive disorders. The average severity of anxiety (HADS) in the subjects was 6.37 points, and the average severity of depression was 4.09 points. There was no statistically significant relationship between the data presented in the media-such as daily number of infections, total number of infections, daily number of deaths, total number of deaths, total number of recoveries, number of hospitalizations, and people under quarantine-and the level of anxiety and depression of the studied caregivers (p > 0.05). It was not found that the selected data presented in the media, showing the intensity of the COVID-19 epidemic in Poland, significantly differentiated the level of anxiety and depression among caregivers of children using neurorehabilitation services. Their motivation to continue the treatment, caused by concern for their children's health, resulted in less severe symptoms of anxiety and depression during the peak period of the COVID-19 pandemic.

Is a history of episodic low back pain an indicator of Modic changes?

BackgroundPrior work demonstrated that a history of episodic low back pain was highly indicative of discogenic pain. Recently, there has been more focus on vertebrogenic pain, however little is known about the clinical features of this condition. PurposeTo determine if a history of severe episodic low back pain correlates with Modic endplate changes on lumbar spine magnetic resonance imaging (MRI), presumed to be a marker of vertebrogenic pain. Study design/setting: Retrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center. Patient sampleConsecutive patients who received a lumbar spine MRI between January 1, 2020, and December 31, 2020. MethodsA retrospective chart review identified patients who received a lumbar spine MRI in 2020. Chart review then determined if patients had a history of episodes of low back pain lasting at least 2 days, or if they had non-episodic low back pain (pain beginning with a gradual onset or after a specific event with continuous symptoms for >3 months). Patients were excluded if they had prior lumbar spine surgery, radicular leg pain without low back pain, indeterminate presentations based on chart review, acute spine fractures, or metastatic spine lesions. For the primary analysis, the MRIs were reviewed and were dichotomized into positive (having for either type 1 or type 2 Modic changes at any level) or negative (no Modic changes at any level). ResultsA total of 111 patients were analyzed. Inter-rater reliability for determining whether a patient's low back pain was episodic was strong (kappa ​= ​0.83), as was inter-rater reliability for determining if a patient had any levels with type 1 or type 2 Modic changes (kappa ​= ​0.81). Seventy-one out of 111 patients had type 1 and/or type 2 Modic changes at one or more spinal levels. The sensitivity of the test (episodic vs non-episodic low back pain) in finding patients with Modic changes was 20% and the specificity was 70%. The diagnostic confidence odds were 1.2, with a diagnostic confidence of 55%. Subgroup analyses for type 1 Modic changes, and for type 2 Modic changes, showed similar values. ConclusionsA history of episodic low back pain is not a strong indicator for a vertebrogenic etiology.

Trajectory of Anxiety, Depression and Quality of Life in Ankylosing Spondylitis: A Descriptive Study.

To investigate anxiety, depression, and health-related quality of life (HRQoL) over 15 years and associations between demographic, disease-related variables, anxiety and depression, and HRQoL in patients with AS. Descriptive study. Place and Duration of the Study: Istanbul Medeniyet University Goztepe Prof. Dr. Suleymsan Yalcin City Hospital, from June to December 2021. Seventy-five patients with AS, who were followed up in Physical Medicine and Rehabilitation outpatient clinic for 15 years, were included in this study, after their diagnosis was confirmed by the hospital system. The demographic information (gender, age, accommodation status, educational status, employment status, and time unemployed), diagnosis time, remission time, drugs used, usage of TNF-inhibitor drugs and duration of usage were recorded. Bath ankylosing spondylitis disease activity index (BASDAI) was used to the measure the disease activity, the hospital anxiety depression scale (HADS) was used for anxiety and depression screening and Short Form-36 (SF-36) was used for HRQoL. SF-36 physical component summary score, general health, social functioning, and role limitations due to physical health subscale scores improved significantly (p=0.004; p<0.000; p=0.024; p=0.002, respectively). It was observed that the effects of BASDAI, HADS anxiety and depression scores were significant on SF-36 (p=0.044; p=0.050; p=0.023), and time has a substantial impact on SF-36 (p=0.003). The effects of gender, education level, and occupation were not found statistically significant (p>0.05 for each). Within 15 years, quality of life increased, anxiety and depression decreased in AS patients. Along with disease activity, anxiety and depression were found to be the most important factors affecting the change in quality of life over time. Ankylosing spondylitis, Anxiety, Depression, Disease activity, Quality of life.

Effect of Inclination Changes in High-Intensity Interval Training on Quality of Life of Male with Overweight and Obesity

Background: Overweight and obesity are major public health concerns globally and cause poor quality of life. Physical exercise plays a major role in reducing body weight, however, lack of time for exercise leads to a lack of regular exercise. High-intensity interval training (HIIT) is proposed as an alternative exercise in dealing with overweight and obesity and ultimately increases the quality of life. Aim: To proposed as an alternative exercise in dealing with overweight and obesity and ultimately increases the quality of life. Material and Methods: A randomized-controlled trial was conducted in a rehabilitation outpatient clinic. Twenty-two subjects with overweight or obesity were randomly allocated into the intervention and control group. The intervention group received HIIT using a treadmill (HR rest + 80-90% HR reserve) with inclination changes for 30 minutes (preceded by warming up and ending with cooling, 5 minutes each), 3 times a week, for 2 weeks. The Control group received no intervention. Change of quality of life was assessed by using SF-36 before and after the intervention. Results: Subjects’ baseline body height, body weight, BMI, VO2Max, and SF-36 on both groups showed no significant differences (p&lt;0.05). Subjects in the control group are older than the intervention group (34.82±3.09 vs 30.36±2.58, p=0.002). Significant improvement of SF-36 was found only in domains of physical function in the intervention group (p=0.02). However,he between-group comparison analysis showed no difference of SF-36 Δ Value between groups. Conclusion: High-intensity interval training can be proposed as an exercise therapy option to improve the quality of life of males with overweight and obesity. It is necessary to do further research on HIIT with a larger number of samples, longer time, group training, and combined with other exercises.

Patient experiences receiving rehabilitation care via telehealth: Identifying opportunities for remote care.

Use of telehealth has grown substantially in recent times due to the COVID-19 pandemic. Remote care services may greatly benefit patients with disabilities; chronic conditions; and neurological, musculoskeletal, and pain disorders, thereby allowing continuity of rehabilitation care, reducing barriers such as transportation, and minimizing COVID-19 exposure. In March 2020, our rehabilitation hospital, Shirley Ryan AbilityLab, launched a HIPAA-compliant telemedicine program for outpatient and day rehabilitation clinics and telerehabilitation therapy programs. The objective of this study was to examine patients' experiences and satisfaction with telemedicine in the rehabilitation physician practice, including novel virtual multidisciplinary evaluations. The present study examines survey data collected from 157 patients receiving telemedicine services at Shirley Ryan AbilityLab from December 2020-August 2021. Respondents were 61.8% female, predominantly White (82.2%) with ages ranging across the lifespan (69.4% over age 50 years). Diagnostic categories of the respondents included: musculoskeletal conditions 28%, chronic pain 22.3%, localized pain 10.2%, neurological conditions 26.8%, and Parkinson's and movement disorders 12.7%. Survey responses indicate that the telemedicine experiences were positive and well received. The majority of participants found these services easy to use, effective, and safe, and were overall satisfied with the attention and care they received from the providers-even for those who had not previously used telehealth. Respondents identified a variety of benefits, including alleviating financial and travel-related burdens. There were no significant differences in telehealth experiences or satisfaction across the different clinical diagnostic groups. Respondents viewed the integrated physician and rehabilitation therapist telehealth multidisciplinary model favorably, citing positive feedback regarding receiving multiple perspectives and recommendations, feeling like an integrated member of their healthcare team, and having a comprehensive, holistic team approach along with effective communication. These findings support that telemedicine can provide an effective care model in physiatry (physical medicine and rehabilitation) clinics, across different neurological, musculoskeletal, and pain conditions and in multidisciplinary team care settings. The insights provided by the present study expand our understanding of patient experiences with remote care frameworks for rehabilitation care, while controlling for institutional variation, and ultimately will help provide guidance regarding longer term integration of telemedicine in physiatry and multidisciplinary care models.

Increase of advanced tumor stages during the corona pandemic? An analysis of 13,228 patients from an uro-oncology outpatient rehabilitation clinic

Increase of advanced tumor stages during the corona pandemic? An analysis of 13,228 patients from an uro-oncology outpatient rehabilitation clinic

Neurorehabilitation for the Uninsured: Georgia Rehabilitation Services Volunteer Partnership Clinic.

Individuals who experience brain injury and are uninsured often do not have access to health care services following their injury. The Georgia Rehabilitation Services Volunteer Partnership (GA RSVP) Clinic is a free outpatient rehabilitation program for uninsured individuals with acquired brain injury (ABI) and/or spinal cord injury (SCI) for all racial and ethnic backgrounds. While the clinic serves people with ABI and SCI, this clinical focus article will focus on people with ABI by describing the clinic, lessons learned from operations, an ABI patient case study, and future directions. Our mission is to provide free outpatient rehabilitation care that maximizes independence, wellness, and community participation. The clinic has been in operation since September 2020, staffed by volunteers who provide services once a month in donated space at a rehabilitation hospital. We currently have 69 active volunteers, seven founding Board of Directors, and 17 founding Advisory Board members. We provide education to clients and their families and run peer and family support groups. For clients who cannot attend due to medical or transportation challenges, we have added telehealth services. We have 11 partner organizations as well as individual donor's financial support. The Chair of the clinic volunteers 50% of time managing clinic operations. From September 2020 to December 2021, we provided care for 40 clients: 23 clinic admissions and 17 were provided information/referral services to access necessary health care services. A volunteer, free outpatient rehabilitation clinic is feasible and can contribute to improved outcomes for uninsured individuals with ABI. Further research to understand impact on patient outcomes is needed.