Outpatient Rehabilitation Facility Research Articles

Value of using the ICF Core Set for patients with Musculoskeletal Conditions in Outpatient Rehabilitation Facilities in South-Eastern Poland

Value of using the ICF Core Set for patients with Musculoskeletal Conditions in Outpatient Rehabilitation Facilities in South-Eastern Poland

The effects of telerehabilitation in adults with complex biventricular congenital heart conditions: protocol for a multi-centre, randomised controlled trial—CH-FIT

BackgroundAccumulated evidence suggests that exercise training exerts beneficial effects on people with congenital heart conditions. These findings are predominantly derived from small, single-centre exercise trials conducted in outpatient rehabilitation facilities. In recent years, the delivery of exercise interventions remotely has increased through digital communications technology (telerehabilitation). However, very little research to date has been conducted into the efficacy of telerehabilitation in people with a congenital heart condition.AimsTo evaluate the effects of a telehealth-delivered exercise intervention in people with a history of a surgical biventricular repair due to a congenital heart condition.MethodsOne hundred eligible adolescent (≥ 16 years) and adult participants living with a complex biventricular congenital heart condition will be recruited from four Australian sites and randomised to either (1) a 16-week telehealth-delivered combined (aerobic and resistance) exercise training programme of moderate-to-vigorous intensity or (2) usual care (control group), in a 1:1 allocation, with an 8-month follow-up.Outcomes of interestThe primary outcome will be the change in aerobic capacity expressed as peak oxygen uptake (VO2peak). Secondary outcomes will include changes in vascular function, muscle oxygenation, metabolic profile, body composition and musculoskeletal fitness, neurohormonal activation, neurocognitive function, physical activity levels, dietary and nutritional status, and quality of life. Outcomes will be assessed at baseline, 16 weeks, and 12 months (to determine longer-term maintenance potential).DiscussionIf found to be efficacious, telerehabilitation may be an alternative option for delivering exercise, improving health outcomes, and increasing accessibility to exercise programmes. Efficacy data is required to quantify the clinical significance of this delivery mode of exercise.Trial registrationACTRN12622000050752Trial registration date: 17 January 2022Trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382635&showOriginal=true&isReview=trueTrial registry name: Australian and New Zealand Clinical Trials Registry

Population-based examination of substance use disorders and treatment use among US young adults in the National Survey on Drug Use and Health, 2011–2019

BackgroundCompared with adults of other age groups, young adults are more likely to have substance use disorders (SUDs) but less likely to receive treatment. Untreated SUDs can lead to lethal consequences, particularly deaths related to drug overdose. ObjectivesThis study aimed to examine trends and sociodemographic differences in the prevalence and treatment use of SUDs among US young adults aged 18 to 25 in the National Survey on Drug Use and Health 2011–2019. MethodsBivariable logistic regression analyses were conducted to examine annual changes in the prevalence and treatment use of SUDs, and multivariable logistic regression was used to examine sociodemographic differences in SUD prevalence and treatment use in the pooled sample of young adults from 2011 to 2019. ResultsFrom 2011 to 2019, the overall SUD prevalence increased significantly from 5.4% to 6.2%. Cannabis use disorder was the most common SUD annually. Groups with lower prevalence of SUDs included females, young adults aged 22–25, and Hispanic, Black, and Asian participants. Across the survey years, the prevalence of treatment use fluctuated insignificantly between 10.9% and 16.9% among young adults with SUDs, and most young adults received SUD treatment in self-help groups and residential and outpatient rehabilitation facilities. Compared to White participants, treatment use was lower in Hispanic, Black, Asian participants, as well as young adults of two or more races. Young adults covered by Medicaid/CHIP were more likely to use treatment. ConclusionsThis study revealed an alarming level of unmet treatment need and significant disparities in treatment use among young adults with SUDs. To reduce barriers to treatment utilization, more coordinated efforts that leverage policy and structural changes alongside innovations to engage young adults with SUD care are needed.

Access to cardiological care infrastructure in the federal state of Brandenburg considering the local care needs

In a nationwide comparison, the state of Brandenburg has one of the highest morbidity and mortality rates of ischemic heart disease. Access to medical care infrastructure is considered to be one possible explanation for regional health inequalities. Accordingly, the study aims to calculate the distances to different types of cardiology care at the community level and to consider these in the context of local care needs. Preventive sports facilities, general practitioners, outpatient specialist care, hospitals with cardiac catheterization laboratory and outpatient rehabilitation were chosen and mapped as essential facilities for cardiological care. Thereafter, the distances across the road network from the center of each Brandenburg community to the nearest location of each care facility was calculated and divided into quintiles. Medians and interquartile ranges of the German Index of Socioeconomic Deprivation and the proportion of the population over 65 were used as measures of the need for care. They were then related to the distance quintiles per type of care facility. For 60% of Brandenburg's municipalities, general practitioners were found to be within 2.5 km, preventive sports facilities within 19.6 km, cardiology practices within 18.3 km, hospitals with cardiac catheterization laboratories within 22.7 km, and outpatient rehabilitation facilities within 14.7 km. The median of the German Index of Socioeconomic Deprivation rose with increasing distance for all types of care facilities. The median of the proportion of over 65-year-olds showed no significant variation between distance quintiles. The results show that a high proportion of the population lives far away from cardiology care services, while a high proportion seems to be able to reach a general practitioner. In Brandenburg, a regional and locally oriented cross-sectoral care seems to be necessary.

Web-Based Questionnaire Survey on Heart Failure in Elderly Patients Using Outpatient Rehabilitation - Actual Conditions of Cardiac Rehabilitation in Long-Term Care Insurance Systems.

Background: The purpose of this study was to investigate the actual conditions of cardiac rehabilitation (CR) for elderly patients with heart failure (HF) in outpatient rehabilitation (OR) facilities using long-term care insurance systems. Methods and Results: This was a cross-sectional web-based questionnaire survey conducted at 1,258 facilities in the Kansai region (6 prefectures) of Japan from October to December 2021. In all, 184 facilities responded to the web-based questionnaire (response rate 14.8%). Of these facilities, 159 (86.4%) accepted patients with HF. Among the patients with HF, 94.3% were aged ≥75 years and 66.7% were classified as New York Heart Association functional class I/II. Facilities treating patients with HF generally provided exercise therapy, patient education, and disease management, which were components of CR. Many facilities not currently treating patients with HF responded positively stating they will accept HF patients in the future. However, a few facilities responded by stating that they are waiting for clearer evidence demonstrating the beneficial effect of OR on patients with HF. Conclusions: The present results show the possibility that outpatient CR can be performed for elderly patients with HF in other than medical insurance.

Patient satisfaction with telehealth vs in-person hand therapy: A retrospective review of results of an online satisfaction survey

BackgroundThe COVID-19 pandemic necessitated a shift from in-person to telehealth visits in many outpatient rehabilitation facilities. PurposeTo determine whether patients reported similar levels of satisfaction receivingtelehealth hand therapy as when receiving in-person hand therapy. Study DesignRetrospective review of patient satisfaction surveys. MethodsSatisfaction surveys were reviewed retrospectively among patients who participated in in-person hand therapy between April 21 and October 21, 2019, or after participating in telehealth hand therapy between April 21 and October 21, 2020. Information on gender, age, insurance provider, postoperative status and comments were also collected. Kruskal-Wallis tests were used to compare survey scores between groups. Chi -squared tests were used to compare categorical patient characteristics between groups. ResultsA total of 288 surveys were included: 121 surveys for in-person evaluations, 53 surveys for in-person follow-up visits, 55 surveys for telehealth evaluations and 59 surveys for telehealth follow-up visits. No significant differences in satisfaction were observed between in-person and telehealth visits of either type or when patients were stratified by age (p = 0.78), gender (p = 0.41), insurance payer group (p = 0.099) or postoperative status (p = 0.19). ConclusionsSimilar rates of satisfaction were observed with both in-person visits and telehealth hand therapy visits. Questions that related to registration and scheduling tended to score lower across all groups, while questions related to technology scored lower in the telehealth groups. Future studies are needed to explore the efficacy and viability of a telehealth platform for hand therapy services.

Widening Gaps and Disparities in the Treatment of Adolescent Alcohol and Drug Use Disorders

The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents. This study used publicly available data for adolescents aged 12-17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011-2019. Data were analyzed between July 2021 and November 2022. From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents' gender, age, race, family structure, and mental health. To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed.

Implementing Prism Adaptation Treatment for Spatial Neglect in the Outpatient Setting

<h3>Research Objectives</h3> To implement two evidence-based care tools for spatial neglect in outpatient rehabilitation facilities <h3>Design</h3> Retrospective observation. <h3>Setting</h3> Outpatient clinic. <h3>Participants</h3> Occupational therapists. <h3>Interventions</h3> Professional education and skill acquisition on spatial neglect assessment and treatment. <h3>Main Outcome Measures</h3> Number of neurological patients received the newly implemented care. <h3>Results</h3> We trained two therapists as the leads for the implementation of both the Kessler Foundation Neglect Assessment Process (KF-NAP) and Prism Adaptation Treatment (KF-PAT) in the outpatient occupational therapy care and the cognitive rehabilitation program affiliated with one rehabilitation care provider. The two lead therapists then trained 6 other therapists. From March 2017 to July 2019, when suspecting a patient of having spatial neglect, these 8 therapists assessed 45 individuals (27 men and 18 women; median age = 62) using the Catherine Bergego Scale (CBS) via the KF-NAP. Among those patients, 37 (82%) had stroke, 4 (9%) had traumatic brain injury, and 4 (9%) had other neurological conditions. The median days post neurological diagnosis was 210 (IQR = 123-710), and the median CBS score was 6.25 (IQR = 4-12.5) out of 30 (higher value = greater severity of neglect). 39 (87%) patients received prism adaptation treatment following the KF-PAT protocol, which recommends the treatment course being 10 once-daily sessions over two weeks. 23 (59%) of them received 10 sessions over 24 to 100 days, median = 38 days (IQR = 31-49). 21 (91%) were assessed for spatial neglect after treatment, and the median improvement was CBS change of 3.75 (IQR = 2-5.5). <h3>Conclusions</h3> Clinicians found the KF-NAP assessment tool useful and informative. The KF-PAT treatment, however, could not be delivered as recommended. Further work is needed to ensure the implementation of treatment to be completed within two weeks. <h3>Author(s) Disclosures</h3> KF-NAP and KF-PAT are registered trademarks owned by Kessler Foundation, which is the employer of three authors (Chen, Kaplan, and Masmela). None of the authors receive financial incentive related to the sales of the tools. Mauch and Chirdon have nothing to disclose.

Development of Practice Guidelines for Social Work in Medical Rehabilitation

Social work services are a major part of the treatment spectrum in medical rehabilitation. Given new demands and differences in the practical implementation of social work interventions, there is a need for good clinical practice standards of care. Therefore, practice guidelines (PG) for social work in medical rehabilitation facilities were developed. These are intended to support decision-making processes in interventions and give other professions working in rehabilitative care insight into the range of social work services. The PG were developed in a multi-stage process involving experts from social work practice. A national and international literature search was conducted on the current evidence on social work interventions in medical rehabilitation. In a survey of social work services in inpatient and outpatient medical rehabilitation facilities (all indications except addictive disorders, child/adolescent rehabilitation; Nmax=311), social workers were asked to provide information on current practice and their expectations towards the PG. On this basis, a preliminary version of the PG was modified and expanded in an expert workshop and evaluated in a second survey of social work services in rehabilitation facilities (Nmax=184). The results were discussed at a second workshop and on this basis the final PG version was prepared. The PG include information on framework conditions of social work in rehabilitation and on social diagnostics. At the center of the PG are frequent needs and problems of rehabilitation patients. These include work-related problems, social and financial problems, participation of persons with disability, and aftercare/follow-up. Each chapter provides information on needs assessment, the content and scope of suitable interventions, and additional materials and references. The PE are intended as a practical aid, based on both practical expertise and existing scientific evidence, to provide social work staff and other professional groups in rehabilitation with information on social work services and their implementation. The focus of the content reflects the expressed expectations of social services for PE.

Unmet needs in long-term outpatient rehabilitative care: a qualitative and multi-perspective study in Japan

Purpose This study explores the experiences and unmet needs related to post-discharge long-term rehabilitation from triadic perspective of male patients with stroke, caregivers, and rehabilitation professionals. Methods This is an exploratory qualitative study using in-depth interviews conducted in two outpatient rehabilitation facilities in Japan. Nine male patients with stroke, ten caregivers, and five rehabilitation professionals participated in this study. The data were coded, followed by thematic analysis. Results Patients who did not achieve further physical recovery regardless of their efforts experienced a loss of motivation and lost sight of their goals. Moreover, caregivers regarded such patients as lazy and reported feeling frustrated with them. Furthermore, patients and caregivers had unmet needs regarding communication with professionals and psychological and emotional care. In contrast, professionals perceived time constraints on outpatient rehabilitation service provision and sometimes narrowed the scope of the care approach to physical function aspects for providing services efficiently. They also expressed difficulties in identifying patients’ needs, values, and meaningful goals. Conclusions These findings suggest that in Japanese post-stroke outpatient rehabilitation, there is a need to adopt a comprehensive care approach, enhance the quality of communication, and involve caregivers in the rehabilitation process in limited-resource situations. IMPLICATIONS FOR REHABILITATION In long-term outpatient rehabilitation services in the community, stroke patients and their caregivers often face a physical recovery plateau. A comprehensive approach such as enhancing the quality of communication and providing psychological and emotional care —other than physical rehabilitation— is needed, particularly once the patient physical recovery stagnates. Involving caregivers in the rehabilitation process may be helpful for rehabilitation professionals to understand a potential problem that the patient cannot express but the caregiver can. It can be crucial to develop strategies that enable the rehabilitation professionals to provide a comprehensive care approach and prevent too much reliance on physical rehabilitation under the time-constraint situation in outpatient rehabilitation services.

Sustainability of physical work capacity two years post outpatient cardiac rehabilitation

Objective To determine if supervised training, after the completion of cardiac rehabilitation program, performed for a further two years would help maintain beneficial effects achieved during prolonged outpatient cardiac rehabilitation. Design Longitudinal parallel-grouped intervention study. Subjects Patients with coronary artery disease (n = 41, age 59.5 ± 9.3 years), who finished cardiac rehabilitation phase III in our outpatient cardiac rehabilitation facility. Intervention Two years of supervised exercise training consisting of endurance (either high intensity interval training or pyramid training) and resistance training sessions once a week. Main measurement Peak physical work capacity was assessed via an ergometry testing at the beginning and at the end of the study. Results Comparisons between end-of-cardiac rehabilitation and two years post cardiac rehabilitation revealed maintenance of peak physical work capacity after two years (begin vs end: 170 ± 59 W vs 167 ± 60 W; −0.5 ± 12.8%; p = 0.521). This was independent of exercise training protocols (percent change begin vs end: pyramid: 1.5 ± 11.8%; interval: −1.6 ± 13.4%; p = 0.459). Conclusion Improvement of physical exercise capacity gained during outpatient cardiac rehabilitation can be maintained for up to two years by once-weekly supervised exercise training. Long-term, group-based exercise programs offered at the end of cardiac rehabilitation might be an effective tool to help patients maintain their physical work capacity.

Effects of COVID-19 on Outpatient Visitation of Japanese Parkinson’s Disease and Parkinsonism Patients Receiving Rehabilitation

Background: Rehabilitation is effective for preventing progression of Parkinson’s disease (PD) and parkinsonism, but access to services during the COVID-19 pandemic was difficult. The Japanese already practice high levels of social distancing and personal restraint and are keenly aware of dangers related to infectious disease. We therefore presume that many patients discontinued rehabilitation due to behavioral restraint. Objectives: We investigated whether PD patients and parkinsonism patients attending outpatient rehabilitation facilities in Japan initiated rehabilitation interruptions and their associated reasons before and during the COVID-19 pandemic. Methods: Subjects were PD and parkinsonism patients attending a neurology clinic outpatient rehabilitation department in Japan before and during the first year of the COVID-19 pandemic (February 1, 2019, to January 31, 2021). Patients lost to follow-up were investigated as to how long they attended rehabilitation until interruption. We classified factors causing rehabilitation interruption into COVID-19-related factors, disease factors and social reasons. Results: Among 259 subjects (125 men, 134 women, mean age: 76.6 ± 8.5 years), 133 patients (51.4%) initiated interruption of rehabilitation therapy. Cumulative incidence of interruption events was significantly higher during than before the COVID-19 pandemic (p < 0.001). COVID-19-related factors dramatically increased as a reason for interruption after the pandemic started, but disease-related and social factors gradually increased thereafter. Incidences of disease-related and social factors before and during the COVID-19 pandemic were not different. Conclusions: Cumulative incidence of interruption events increased in Japanese PD and parkinsonian patients attending an outpatient rehabilitation facility during the COVID-19 pandemic, primarily due to COVID-19-related factors. Patients and their families need education and guidance to facilitate continuous rehabilitation.

Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial

Objective To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design Feasibility randomised controlled trial. Setting Outpatient rehabilitation facility. Subjects Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.

Adjunctive Physiotherapy – A Case Report on the Management and Effective Treatment of Diabetic Neuropathic Foot Ulcer Using Adjunctive Physiotherapy

Physiotherapy must be considered and reprioritized as an adjunctive medical service for long term health and rehabilitation. Comprehensive physiotherapy has the potential to be administered in out-patient rehabilitation facilities, hospitals, and Thermal Health Centers. A review of select adjunctive physiotherapy methods will be presented along with a case report of the successful treatment, with rationally selected physiotherapeutic agents, of a Diabetic Neuropathic Foot Ulcer scheduled for surgical amputation. By highlighting this case, the author is attempting to bring attention to familiar and time-tested therapies that have fallen out of use in a primary intervention context. This case report aims to exemplify that the role for rational physiotherapeutic methods stretches beyond current mainstream applications. Historical Context. Will supply the historical and foundational work in the field of physiotherapy that contextualizes the rational basis for the applications described in the case. Therapies. Lists the physiotherapy methods highlighted in this case, reviews the mechanism of action, discusses the therapeutic application, and provides modern citation for the rationalization of the therapy. Case Report. Reviews a detailed narrative of the case in review. Covers intake, case history, progression of case, as well as clinical applications for physiotherapy as they arise in the course of case management. Conclusion. Reviews the emphasis for reconsidering the role of Physiotherapy in the primary management of acute and chronic illness.

Kidney Recovery in Patients With Acute Kidney Injury Treated in Outpatient Hemodialysis or Rehabilitation Facilities

Rationale & ObjectiveSince January 2017, patients with acute kidney injury requiring dialysis (AKI-D) can be discharged to outpatient dialysis centers for continued hemodialysis (HD) support. We aimed to examine the rate of kidney recovery, time to recovery, and hospitalization-related clinical parameters associated with kidney recovery in patients with AKI-D.Study DesignSingle-center prospective cohort study.Setting & Participants111 adult patients who were admitted to the University of Kentucky Hospital, experienced AKI-D, and were discharged with need of outpatient HD.ExposureHospitalization-related clinical parameters were evaluated.OutcomeKidney recovery as a composite of being alive and no longer requiring HD or other form of kidney replacement therapy.Analytical ApproachDiscrete-time survival analysis and logistic regression were used to determine adjusted probabilities of kidney recovery at prespecified time points and to evaluate clinical parameters associated with recovery.Results45 (41%) patients recovered kidney function, 25 (55.5%) within the first 30 days following discharge, 16 (35.5%) within 30 to 60 days, and 4 (9%) within 60 to 90 days. Adjusted probabilities of recovery were 36.7%, 27.4%, and 6.3%, respectively. Of the remaining patients, 49 (44%) developed kidney failure requiring chronic kidney replacement therapy and 17 (15%) died or went to hospice. Patients who did not recover kidney function were older, had more comorbid conditions, had lower estimated glomerular filtration rates at baseline, and received more blood transfusions during hospitalization when compared with those who recovered kidney function.LimitationsSelection bias given that patients included in the study were all eligible for AKI management with outpatient HD as part of Medicare/Medicaid services.ConclusionsAt least one-third of AKI-D survivors discharged from an acute care hospital dependent on HD recovered kidney function within the first 90 days of discharge, more commonly in the first 30 days postdischarge. Future studies should elucidate clinical parameters that can inform risk classification and interventions to promote kidney recovery in this vulnerable and growing population.

Measurement properties of the Michigan hand outcomes questionnaire: Rasch analysis of responses from a traumatic hand injury population

Purpose This study aimed to use Rasch analysis to test the content, scoring, and measurement properties of the Michigan Hand Outcomes Questionnaire (MHQ). Methods MHQ scores from 196 patients with hand and wrist conditions were collected in an outpatient hand rehabilitation facility. Rasch analysis was conducted to assess the fit statistics of MHQ to confirm the scaling structure of disability subscales, and to identify differential item functioning. Results The MHQ did not fit with the Rasch model (χ2 = 2376.78, df = 74, p < 0.001), and most thresholds of item responses were disordered. The original scoring algorithm derived from 5-point Likert response options was adjusted to 3-point Likert (10 items) and 4-point Likert (11 items) based on the visual inspection of the thresholds map. Differential item functioning was present in the revised scale based on the age, sex, and dominant hand. Only 3 revised subscales of the MHQ including activities daily living (one hand), aesthetics, and satisfaction showed acceptable fit to the Rasch model. Unidimensionality was achieved in all revised subscales. Conclusions The overall MHQ had a substantial misfit from the Rasch model. Despite efforts of item reduction and rescoring, we did not reach a satisfactory solution. This calls into question the validity of the statistical evaluations performed on this scale using the traditional scoring. Implications for rehabilitation The MHQ was designed to measure different dimensions of pain and disability but demonstrates multiple measurement problems that undermine it use in present form. It is not appropriate to sum all 37 items of the MHQ into a single score. Three subscales of activities daily living (one hand), aesthetics, and satisfaction can provide unidimensional subscales scores with interval level scaling if scored with our proposed Rasch-based revised scoring. The 27-item version of the MHQ is shown to have strong psychometric properties for administration with patients with hand injuries; however, it requires further validation.

Stroke care in Italy at the time of the COVID-19 pandemic: a lesson to learn.

From March to May 2020, the Italian health care system, as many others, was almost entirely devoted to the fight against the COVID-19 pandemic. In this context, a number of questions arose, from the increased stroke risk due to COVID-19 infection to the quality of stroke patient care. The overwhelming need of COVID-19 patient management made mandatory a complete re-organization of the stroke pathways: many health professionals were reallocated and a number of stroke units was turned into COVID-19 wards. As a result, acute stroke care suffered from a shortage of services and delays in time-dependent treatments and diagnostic work-up. In-patient and out-patient care and rehabilitation facilities for stroke survivors were also reduced or slowed down, to direct resources to COVID-19 patients care and to reduce contagion risks. Overall, this is likely to result in a significant future increased burden of complications and disabilities that will impact the health care systems in the coming months. Thus, while still fighting against COVID-19 disease, authorities need to promptly implement robust action plans, including an increase of workforce, without forgetting the assurance of a high level of stroke care. The medical community and the health care administrators should always keep in mind that stroke was before, and will be after the pandemic, a, sometimes, life-threatening condition, and almost always a disease with a severe impact on the quality of life.

Health status of Medicare-enrolled autistic older adults with and without co-occurring intellectual disability: An analysis of inpatient and institutional outpatient medical claims.

Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as "institutional outpatient" healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.

Rehabilitation During COVID-19 Pandemic: An Indian Perspective.

It has been noted that as high as 20.3% of patients hospitalized for coronavirus disease 2019 (COVID-19) require intensive care unit (ICU) admission. This has most commonly been attributed to the development of acute respiratory distress syndrome. These patients require prolonged periods of ICU stay, averaging approximately 20 days. As people recover and are discharged, there will be a new pandemic of critical illness survivors. These patients would present with impairments and disabilities arising because of prolonged ICU stay as well as consequences of severe respiratory illness. The longer the duration of ICU stay, the higher is the risk for long-term physical, cognitive, and emotional impairments needing comprehensive and early rehabilitation. This article focuses on the indispensable role of early and interdisciplinary rehabilitation in effective disaster management, restoring functions, and improving quality of life in COVID survivors. It outlines how to practically expand rehabilitation services in a resource-limited country, such as India, and lists the limitations being faced that prevent the uniform application of rehabilitation services in India. This would help to deal with the rapid increase in demand of postacute care facilities, be it in hospital services, in the form of inpatient or outpatient rehabilitation or home care facilities, including telemedicine.

Abstract TP367: Dimensions of Social Support and Post-Stroke Depressive Symptoms in Saudi Arabia: A Mixed Methods Approach

Stroke is the second leading cause of death and a major cause of serious long-term disability worldwide. Post stroke depressive symptoms (PSDS) affect one third of stroke survivors. The prevalence of PSDS ranges from 17%–63.3% in Saudi stroke survivors. Stroke survivors use social support as a coping mechanism and as a protective factor against the adverse effects of stroke outcomes. The purpose of this study was to describe the nature of PSDS and to compare the influence of perceived and received social support among stroke survivors in Saudi Arabia. The aims were: (1) to examine the influence of perceived social support on PSDS, (2) to explore the nature of PSDS and received social support, and (3) to characterize the contribution of perceived social support and received social support and PSDS. A convergent embedded mixed methods design was used. 135 participants were recruited for the quantitative purpose from outpatient clinics and inpatient rehabilitation facilities in Saudi Arabia and 34 participants were selected from the original sample for qualitative purposes. The data were gathered using structured instruments and interviews. The findings were: (a) 54% had depressive symptoms (DS); (b) DS were negatively associated with perceived social support ( r = -.65, p &lt; .001) and the functional independency ( r = -.45, p &lt; .001), whereas perceived stress was positively associated ( r = .71, p &lt; .001); (c) social support, stress level, and literacy were associated with DS (β = -.31, p &lt; .001; β = .45, p &lt; .001; β = .16, p = .01, respectively) and partially mediate the association of DS with functional independence; (d) there is a typology of experiencing DS and receiving social support, Satisfied and Deprived , and those with DS and social support, Discrepancies . The results of this mixed methods study show that a lack of social support was associated with DS. The integration of quantitative and qualitative data provided a broad, in-depth perspective on the nature of DS and social support influenced by individual’s life changes after stroke. Future research is needed to examine the interventions to improve social support among caregivers and to reduce DS in stroke survivors. 2