Outpatient Rehabilitation Program Research Articles

Rationale and design of APOLLO: a personalized rehAbilitation PrOgram in aLLOgeneic bone marrow transplantation

BackgroundHematopoietic stem cell transplantation (HSCT) is a common therapy for many hematologic malignancies. While advances in transplant practice have improved cancer-specific outcomes, multiple and debilitating long term physical and psychologic effects remain. Patients undergoing allogeneic bone marrow transplantation (allo-BMT) are often critically ill at initial diagnosis and with necessary sequential treatments become increasingly frail and deconditioned. Despite modern treatment regimens and support, cardiovascular disease remains a leading cause of non-relapse mortality among allo-BMT survivors. Well-established multi-disciplinary care models such as cardiac rehabilitation offer holistic care including exercise training, nursing support, physical/occupational therapy, psychosocial support and nutritional education. HSCT patients may be excluded from conventional outpatient physical rehabilitation programs due to prolonged pancytopenia and frequent hospital admissions. In Canada, dedicated cancer-specific rehabilitation programs are available only at major tertiary academic centers.MethodsThe primary aim of this study will evaluate the feasibility and acceptability of a multimodal care navigation (nursing, exercise, nutrition) intervention with content delivery facilitated by a supportive care web-based ‘app’ extending from diagnosis to 1 year in the allogeneic bone marrow transplant population. Adult patients scheduled for allo-BMT will receive support from exercise specialist, nursing support and dietician expertise alongside a supportive care ‘app’ with additional in-person or virtual cardiac rehabilitation support.DiscussionTo our knowledge, no research team is taking such a holistic, multidisciplinary approach to address the debilitating physiologic and psychological consequences of allo-BMT. We expect the findings to inform the optimal timing and patient preferences to develop studies examining risk-specific, individualized interventions (including exercise, pharmacotherapy, combination treatments) to reduce or prevent symptoms and dysfunction. We expect this innovative program to identify ways to benefit innumerable patients with hematologic and other malignancies. Ultimately, we hope to transform supportive care in hematopoietic stem cell transplantation.Trial RegistrationClinicaltrials.gov ID: NCT05579678.

Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition: A Randomized Clinical Trial.

Post-COVID-19 condition (PCC) is emerging as a common and debilitating condition with few treatment options. To assess the effectiveness of a brief outpatient rehabilitation program based on a cognitive and behavioral approach for patients with PCC. Patients with mild to moderate PCC were randomized 1:1 to an established transdiagnostic rehabilitation program or care as usual at a single referral center recruiting from the region of the South-Eastern Norway Regional Health Authority. Participants were followed up after treatment completion and 12 months after enrollment using participant-reported outcome measures. Data were collected from February 22, 2022, until April 15, 2024. Intention-to-treat analysis was performed. The program consisted of 2 to 8 outpatient encounters with approximately 2 to 6 weeks between each encounter. The intervention was theoretically grounded in the cognitive activation theory of stress, and physicians and physiotherapists were trained in cognitive and behavioral approaches with targeted negative stimuli and response outcome expectancies being particularly important. Participant-reported physical function assessed by the Short-Form Health Survey 36 Physical Function Subscale (SF-36-PFS) served as the primary outcome. Secondary outcome measures were the remaining subscales of the SF-36, return to work self-efficacy and symptom scores on fatigue, postexertional malaise, breathlessness, cognitive difficulties, sleep problems, anxiety and depression symptoms, and smell and taste abnormalities. Safety measures included primary health care contacts; hospital admissions; initiation of pharmacologic and/or nonpharmacologic therapy; occurrence of novel disease, illness, or other health problems; worsening of selected key symptoms; working abilities; and thoughts of suicide. A total of 473 patients with mild to moderate PCC were assessed for eligibility (n = 364 physician referred; n = 109 self-referred); 314 were included (225 females [72%]; mean [SD] age, 43 [12] years) and 231 completed the primary end point evaluation. The SF-36-PFS scores improved statistically and clinically significantly in the intervention group (score difference between groups, 9.2; 95% CI, 4.3-14.2; P < .001; Cohen d = 0.43; intention-to-treat analysis). The effect was sustained over time. Most secondary and safety measures favored the intervention. In this randomized clinical trial, a brief outpatient rehabilitation program with a cognitive and behavioral approach in patients with PCC was effective and safe. This trial adds to the evidence supporting such interventions in routine clinical care. Future research should investigate which elements of this approach are the most effective and identify subgroups for which the current treatment is most relevant. ClinicalTrials.gov Identifier: NCT05196451.

The Effect of Outpatient Rehabilitation Program on the Quality of Life of Drug Abuse Patients in the National Narcotics Agency of North Sumatra Province in 2023

Improving outpatient rehabilitation enhances the lives of those battling substance abuse. This study evaluates its impact at the National Narcotics Agency, North Sumatra. The study aims to assess outpatient rehabilitation's effectiveness on individuals with substance abuse history, focusing on physical health, psychological well-being, social support, and the environment. Using quantitative methodology with pre-post design, the entire patient population (n=54) was included. Research findings reveal significant and positive impacts of the rehabilitation program on physical health, psychological well-being, social support, and patient environmental conditions. Statistical analysis, with a significance level of (p &lt; 0.001), confirms the remarkable success of the intervention, emphasizing the crucial role of the program in enhancing the overall quality of life for patients. This study delves into outpatient rehabilitation program effectiveness, highlighting the need for multidimensional support in the recovery journey.

The impacts of pulmonary rehabilitation following exacerbations of COPD on hospitalizations, significant patient outcomes, and exercise ability: Systematic review

Study aim: This study aimed to determine how pulmonary rehabilitation following exacerbations of COPD affected hospitalizations and other significant patient outcomes. Method: PRISMA criteria were followed in the conduct of this systematic review study. Randomized controlled studies that compare pulmonary rehabilitation versus conventional community care for acute exacerbations of COPD. We looked for relevant studies in the electronic databases MEDLINE, Embase, and Cochrane. We looked through databases to find studies conducted between 2004 and 2024. Result and conclusion: In this systematic review analysis, four randomized controlled trials were taken into account. In one trial, participants started either inpatient or outpatient rehabilitation programs; in another, they underwent inpatient pulmonary rehabilitation starting two to eight days after being admitted to the hospital; and in a third, they underwent outpatient rehabilitation after receiving inpatient therapy for an exacerbation. Participants in two studies received very extensive pulmonary rehabilitation, while those in one study had intensive pulmonary rehabilitation. Readmissions to hospitals were reported in two studies. For these two studies, the median follow-up period was eight months. The findings of these studies showed that pulmonary rehabilitation reduced hospital readmissions.

CHARACTERIZATION OF BASELINE SYMPTOMS AND FUNCTIONAL IMPAIRMENTS IN A LARGE COHORT OF OUTPATIENTS ATTENDING A LONG COVID REHABILITATION CLINIC IN THE UNITED KINGDOM.

In response to the high prevalence and morbidity associated with long COVID (LC), outpatient rehabilitation programmes were created across jurisdictions. We aimed to characterize baseline symptoms and impairments of patients attending outpatient LC rehabilitation. This study was a retrospective quality-improvement analysis. Patients attending outpatient LC rehabilitation at the Oxfordshire Post-Covid Service. Data included age/sex and 6 questionnaires performed at baseline: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Dyspnoea-12 (D12), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment-7 (GAD-7), Visual Analogue Scale (VAS) of self-rated health, and the Work And Social Adjustment Scale (WSAS). All scores were dichotomized (indicating presence/absence of clinically significant pathology). Potential differences between age (</≥ 50 years) and sex were assessed using χ2 tests. A total of 422 patients were included (mean/standard deviation [SD] age = 47.1/13.2;132/31.3% male). A total of 76% had significant fatigue (FACIT-F), 69% had breathlessness (D12), 55% had depression (PHQ-9), 34% had anxiety (GAD-7), 41% self-reported poor health (VAS), and 57% had work/social life dysfunction (WSAS). D12 scores differed between age groups (older > younger, χ2 = 3.19/p = 0.048), with no differences observed on other scales. In this preliminary study, a high proportion of LC outpatients had significant impairments across domains. The findings of this study reaffirm the need for high-quality, multidisciplinary LC rehabilitation, and may be used to help build a standardized set of outcome measures moving forward.

Sex-specific guideline target value attainment and prognostic value of low-density lipoprotein cholesterol in tertiary care

Abstract Background Factors contributing to guideline-target-level-attainment of low-density lipoprotein cholesterol (LDL-C) in countries with high healthcare expenditure are incompletely understood. Purpose the primary aim of this study was to test two hypotheses: 1) LDL-C control may be inferior in women versus men; 2) within the secondary prevention group, presence of a previous acute atherothrombotic event (acute myocardial infarction and stroke) may result in superior LDL-C control. Methods LDL-C levels and guideline target level attainment were determined in 4090 consecutive patients referred for myocardial perfusion single photon emission tomography (MPI-SPECT) between 2010 and 2016. Findings were validated in an independent cohort (n=1228) of consecutively enrolled patients in an outpatient cardiac rehabilitation program, between 2016 and 2023. Results About one third of patients (33%) were women, median age was 68 years, 1439 patients had a history of atherothrombosis, 759 patients a history of atherosclerosis without atherothrombosis, and 1892 were in primary prevention. LDL-C levels were higher and guideline target level attainment worse in women than in men in all three strata: age-adjusted difference in atherothrombosis 0.19 mmol/L (95%CI 0.03,0.35 mmol), guideline-target-value-attainment 39.5 % versus 49.4%, p&amp;lt;0.01; in atherosclerosis 0.33 mmol/L (95%CI 0.10-0.57), guideline-target-value-attainment 27.3 % versus 42.2 %, p&amp;lt;0.01; and in primary prevention 0.24 mmol/L (95% CI 0.13-0.38). This was confirmed in the validation cohort. LDL-C levels were higher and guideline-target-value-attainment worse in women versus men: age-adjusted difference age-adjusted difference 0.17 mmol/L (95%CI 0.02-0.33) guideline-target-value-attainment 43.8% versus 49.5%, After multivariate adjustment, female sex remained an independent predictor for higher LDL-C levels. LDL-C concentrations with atherothrombosis was 1.93 mmol/L (IQR 1.48-2.47) versus 2.07 mmol/L (IQR 1.40-2.72, p=0.003) with atherosclerosis and guideline target value attainment 47.5% vs 38.6%, p&amp;lt;0.001, respectively. Conclusion Concerning age-adjusted sex-inequalities with higher LDL-C levels and lower guideline-target-value-attainment in women were found in both primary and secondary prevention. Within secondary prevention, a previous atherothrombotic event was associated with lower LDL-C levels and higher guideline-target-value-attainment.

The utility of cardiac rehabilitation in improving endothelium-dependent vascular function in very elderly patients

Abstract Background Endothelial function is crucial for cardiovascular health and diseases. Cardiac rehabilitation has been reported to be useful in enhancing physical performance, quality of life, and endothelial function. The aging of patients with cardiovascular diseases is further progressing, and it is unclear whether cardiac rehabilitation improves physical function and endothelial function in very elderly patients with cardiovascular diseases. Purpose The purpose of this study is to investigate whether outpatient cardiac rehabilitation for individuals aged 80 and above improves physical function, quality of life (QOL), and vascular endothelial function. Methods Forty nine patients aged over 80 years with cardiovascular diseases participated in an outpatient cardiac rehabilitation program. Cardiac rehabilitation was conducted for 1 hour per session, 1-2 times per week for 3-4 months. Cardiopulmonary exercise testing (CPX) was conducted for the evaluation of physical function. QOL was assessed with Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. The reactive hyperemia index (RHI) was measured using EndoPAT2000 in each patient to assess endothelial function. An RHI ≤ 1.67 was defined as endothelial dysfunction. Results The mean ± standard deviation of age was 84 ± 4 years, with 16 (33%) being male. Peak oxygen uptake improved significantly (from 14.1 ± 4.0 to 15.4 ± 3.9 mL/kg/min, P=0.002), as did short physical performance battery scores (from 10.1 ± 2.7 to 10.7 ± 2.0, P=0.004), mini-mental state examination scores (from 27.7 ± 2.2 to 28.2 ± 2.0, P=0.004), Japanese version of the Cardiovascular Health Study criteria (from 2.3 ± 1.3 to 1.5 ± 1.2, P&amp;lt;0.0001), and KCCQ scores (from 76.8 ± 18.4 to 81.4 ± 20.4, P=0.02) after the cardiac rehabilitation program. Endothelial function also improved (LogRHI 0.48 ± 0.39 to 0.57 ± 0.30, P=0.027), and the prevalence of endothelial dysfunction decreased from 54% to 36% after the cardiac rehabilitation program. Conclusion Even in the very elderly patients, outpatient cardiac rehabilitation is beneficial for improving physical function, quality of life, and endothelial function.

Undetected heart failure in tertiary care: prevalence, predictors and outcomes

Abstract Background Undetected heart failure (HF) seems to be unexpectedly common in primary care. We hypothesized that undetected HF may also be common in tertiary care, even in care pathways including cardiologists. Methods We assessed prevalence, predictors, and outcome of undetected HF in a large prospective cohort study enrolling patients referred for myocardial perfusion single photon emission tomography (MPI-SPECT) with central adjudication of HF according to guidelines. Findings were validated in two independent prospective cohorts (outpatient cardiac rehabilitation program, major noncardiac surgery). Prevalence of undetected HF, ratio of undetected HF to known HF and number needed to screen (NNS) were the primary endpoints. Results Among 3623 patients, median age 68 years, 31% women. 100 patients (3%) had known HF and 928 patients (25.6%) were adjudicated to have undetected HF, resulting in a ratio of undetected to known HF of 9.3-to-1 and a NNS of 2.8. Older age, atrial fibrillation, and previous pacemaker implantation were strong independent predictors of undetected HF. Patients with undetected HF were at significantly higher risk of cardiovascular death or HF hospitalization (adjusted HR 1.47 [95%CI, 1.17-1.85] versus no HF). These findings were confirmed in both validation cohorts: among 970 and 1563 patients the prevalence of undetected HF was 21.5% and 19%, ratio of undetected HF to known HF 0.7-to-1 and 2.8-to-1, NNS 2.2 and 3.7, respectively. Conclusion The prevalence of undetected HF is high also in tertiary care, even higher with older age, atrial fibrillation, and previous pacemaker implantation, and associated with increased risk of cardiovascular death or HF hospitalization.Prevalence of undetected HFKaplan-Meier cumulative incidence curves

Effectiveness of Home Tele-Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review of The Literature

The aim of this systematic review is to analyze the published studies on the scientific evidence of the effectiveness of home telerehabilitation in patients with chronic obstructive pulmonary disease (COPD), in particular to determine whether its benefits are not inferior to those of classic outpatient or inpatient pulmonary rehabilitation. A systematic review of the electronic databases Medline, Cochrane Library, PEDro, BMJ Best Practice, BMC Pulmonary Medicine, LILACS, academic search and ScienceDirect was performed to identify randomized controlled clinical trials, a parallel non-inferiority trial and a pilot study. Reference lists of selected studies were also reviewed for additional eligible articles focusing on telerehabilitation via videoconferencing (n = 2), one study focusing on an online respiratory therapist-delivered exercise program (n = 1), and one study focusing on a mobile phone-based COPD exercise program (n = 1). The telerehabilitation programs showed that exercise capacity and quality of life were not inferior to those of a hospital-based outpatient pulmonary rehabilitation program. The level of scientific evidence is moderate. More high-quality studies are needed to evaluate the effectiveness of telerehabilitation in patients with COPD.

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.

Long-term results of outpatient rehabilitation after coronary artery bypass graft surgery

Aim. To assess the impact of adherence to various outpatient rehabilitation programs during the first three months after coronary artery bypass grafting (CABG) on the development of cardiovascular events over four years of follow-up.Materials and Methods. The study evaluated the influence of adherence to outpatient cardiac rehabilitation programs on the incidence of cardiovascular events in patients following open coronary artery revascularization surgery. Adherence to cardiac rehabilitation was assessed over a threemonth period, and the observation period for cardiovascular events extended to four years from the time of the surgery.Results. During the first year of observation, we did not find significant differences in the effectiveness and safety of outpatient cardiac rehabilitation programs. However, we revealed statistically significant differences in the patient adherence to physical training. Over the four-year observation period, a higher number of cardiovascular events were recorded in the group of patients who were non-adherent to physical training. Statistically significant differences were observed with regards to the incidence of myocardial infarction and cardiovascular death.Conclusion. Adherence to recommendations following open revascularization procedures is crucial for the prognosis of myocardial infarction and cardiovascular death. Modern methods of providing medical care in the outpatient phase of cardiac rehabilitation enable patients to engage in effective and safe physical training comparable to those conducted in specialized cardiac rehabilitation facilities under the direct supervision of medical personnel.

Usefulness of Inter-Hospital Heart Team Conference Based Collaborative Outpatient Cardiac Rehabilitation in Patients with Cardiovascular Disease.

An inter-hospital heart team conference based collaborative follow-up (FU) may facilitate outpatient cardiac rehabilitation (CR) programs, especially in hospitals without an outpatient CR center. Consecutive 145 patients with cardiovascular disease who received inpatient treatment at Yamagata University Hospital were divided into collaborative (n = 76) and same-hospital (n = 69) FU groups. In the collaborative FU group, patients received outpatient care at a university hospital and outpatient CR at different hospitals. In the same-hospital FU group, patients received outpatient care and outpatient CR at the same hospital other than the university hospital. The collaborative FU group held monthly 60-minute inter-hospital heart team conferences with CR specialists. No cardiovascular accidents occurred during the outpatient CR program in either group. Peak oxygen uptake VO2, anaerobic threshold, brain natriuretic peptide level, and left ventricular ejection fraction significantly improved in both groups. Kaplan-Meier analysis revealed no significant difference in prognosis between the collaborative and same-hospital FU groups (P = 0.246). Of the patients who had collaborative CR programs, 29 (38.2%) patients (37 consultations) were discussed at an inter-hospital heart team conference. Eighteen (48.6%) consultations were for issues related to continuing outpatient CR programs. Collaborative FU was as useful as same-hospital FU in terms of safety, efficacy, and prognosis in patients with cardiovascular disease. We conclude that regular inter-hospital heart team conferences are useful for facilitating collaboration among outpatient CR programs.

The Effect of Lavender Aromatherapy on Heart Rate, Blood Pressure, and Perceived Stress Among Cardiac Rehabilitation Patients: A Pilot Study.

The purpose of this study was to test the efficacy of lavender aromatherapy via inhalation as a stress management modality for patients in cardiac rehabilitation. This was a quasi-experimental design. Aromatherapy was provided via inhalation to participants before a cardiac rehabilitation session over 8 minutes using lavender essential oil. The same protocol was used in the non-aromatherapy session without the essential oil. Blood pressure and radial pulse were measured, and subjective data were also collected including assessment of stress level (1-10 scale) and affect using the Positive and Negative Affect Schedule (PANAS). Analyses were performed using SPSS Statistics version 20. Quantitative measures were analyzed using Mann-Whitney nonparametric equivalent to the t test. Inferential measures were analyzed using the χ 2 or Fisher's exact test. In the outpatient cardiac rehabilitation program, 25 patients participated in this study. The average change in negative affect (PANAS-) between pre and post-aromatherapy compared with pre- and post-non-aromatherapy sessions was statistically significant. Results showed a reduction in blood pressure following both aromatherapy and non-aromatherapy sessions with no statistical significance between sessions. Heart rate decreased equally post-aromatherapy and non-aromatherapy sessions. Aromatherapy may be a useful stress management tool for cardiac rehabilitation patients.

Utilization of early supported discharge and outpatient rehabilitation services following inpatient stroke rehabilitation

BackgroundStudies examining factors associated with patient referral to early supported discharge (ESD)/outpatient rehabilitation (OPR) programs and utilization of ESD/OPR services after discharge from inpatient stroke rehabilitation (IPR) are scarce. Accordingly, we examined utilization of ESD/OPR services following discharge from IPR and patient factors associated with service utilization.MethodsStroke patients discharged from IPR facilities in Alberta between April 2014 and March 2016 were included and followed for one year for ESD/OPR service utilization. Multivariable linear and negative binomial regressions were used to examine association of patients’ factors with ESD/OPR use.ResultsWe included 752 patients (34.4% of 2,187 patients discharged from IPR) who had 40,772 ESD/OPR visits during one year of follow-up in the analysis. Mean and median ESD/OPR visits were 54.2 and 36 visits, respectively. Unadjusted ESD/OPR visits were lower in females and patients aged ≥ 60 years but were similar between urban and rural areas. After adjustment for patient factors, patients in urban areas and discharged home after IPR were associated with 83.5% and 61.9%, respectively, increase in ESD/OPR visits, while having a right-body stroke was associated with 23.5% increase. Older patients used ESD/OPR less than their younger counterparts (1.4% decrease per one year of older age). Available factors explained 12.3% of variation in ESD/OPR use.ConclusionESD/OPR utilization after IPR in Alberta was low and varied across age and geographic locations. Factors associated with use of ESD/OPR were identified but they could not fully explain variation of ESD/OPR use.

The Clinical Outcome of Cardiac Rehabilitation in Coronary Artery Disease Patients with Regard to the Presence of Left Ventricular Systolic Dysfunction.

Background: Despite the use of advanced treatment techniques, coronary artery disease (CAD) still remains the main cause of left ventricular (LV) dysfunction and heart failure. Participation in cardiac rehabilitation (CR) programs can lead to a number of beneficial effects, but some patients do not demonstrate the expected improvement. The aim of this study is to evaluate the impact of CR on changes in exercise capacity with regard to the presence of LV dysfunction. Methods: A group of 428 patients with CAD were consecutively admitted to an outpatient comprehensive cardiac rehabilitation program comprising 24 exercise sessions of interval training on cycle ergometers, three times a week for 45 min, and a health education. The patients were compared in two subgroups, i.e., with LV systolic dysfunction (LVEF < 50%, n = 175) and LVEF ≥ 50% (n = 253). Results: In the LVEF < 50% group, the exercise capacity improved by 1 ± 0.78 MET (median 1.15 MET), and 0.86 ± 0.77 MET (median 1.08 MET) in the LVEF ≥ 50% group. Women with LVEF < 50% demonstrated a significant increase in exercise capacity by 1.2 MET, while those with LVEF ≥ 50% did not display any such increase. All men, regardless of LVEF, exhibited a similar improvement in exercise capacity greater than 1 MET. Conclusions: An outpatient eight-week cardiac rehabilitation program based on 45 min aerobic interval training sessions three times a week appears less effective for women with CAD and EF ≥ 50%. In this group, the proposed training intervention is insufficient in improving exercise capacity to an extent that could indicate a reduction in mortality risk.

A brief mindfulness-based intervention for stress, pain, emotion and attention regulation in military service members with mild traumatic brain injury.

The primary aim of this study was to conduct an open pilot clinical trial of a brief mindfulness-based intervention for persistent postconcussion symptoms that occur after mild traumatic brain injury in military service members. For many service members, operational tempo and other time constraints may prevent them from completing a standard mindfulness-based stress reduction course. Thus, this study sought to examine the effectiveness of a five-session intervention called mindfulness-based stress, pain, emotion, and attention regulation (MSPEAR). Participants were active duty service members with a history of mild traumatic brain injury (TBI) and persisting postconcussion symptoms, all of whom were recruited from an outpatient TBI rehabilitation program at a military treatment facility. Of the 38 service members that were initially enrolled, 25 completed the 5-session MSPEAR intervention, and 20 returned for a 5-week follow-up evaluation. Questionnaires assessing perceived stress, positive affect, pain interference and catastrophizing, sleep disturbances, perceived behavioral and attention regulation, self-efficacy and satisfaction with life were administered at preintervention, postintervention, and at 5-week follow-up intervals. Neuropsychological testing at preintervention and 5-week follow-up included performance validity measures, attention, working memory, and executive function measures. T-tests were run to compare for questionnaire measures at preintervention (Time 1) to postintervention (Time 2). Repeated analysis of variances were conducted to compare questionnaire and neuropsychological measures at Time 1, Time 2, and at Time 3 which is the 5-week follow-up. Improvements in perceived stress, positive affect, behavioral regulation, metacognition, sleep disturbance, self-efficacy, and satisfaction with life were found immediately after the MSPEAR intervention and were maintained at the 5-week follow-up. Magnification and helplessness aspects of pain catastrophizing improved when comparing preintervention to the 5-week follow-up. Pain interference was not significantly different across study assessment times. Neuropsychological testing revealed improvements in sustained attention, working memory, cognitive flexibility, and inhibitory control when comparing preintervention to the 5-week follow-up assessment. The MSPEAR intervention appears to show promise as a brief and effective therapy for specific postconcussion symptoms after mild traumatic brain injury in military service members. Each of the components of MSPEAR including stress, pain catastrophizing, emotion and attention regulation showed improvements in this study, and bears further investigation in a larger scale, preferably randomized controlled trial in those active duty military service members who experience persisting symptoms after a mild traumatic brain injury.

Pharmaco- and ozone therapy in outpatient medical rehabilitation programs for patients with chronic cerebral ischemia

Abstract. Purpose of the study. To evaluate the effectiveness of medical rehabilitation of patients with stage 1 chronic cerebral ischemia using ozone therapy in an outpatient setting. Material and methods. A randomized, prospective, single-center, open-label, controlled study was conducted on 80 patients with stage 1 chronic cerebral ischemia, who were divided into 2 groups by means of simple randomization: in the study group (SG/41 patients), the patients received rehabilitation in accordance with the federal clinical guidelines and intravenous ozone therapy; in the control group (CG/39 patients), the patients underwent only standardized treatment. The effectiveness of rehabilitation measures was monitored using validated rating scales, electroencephalography, and quality of life assessment. Results. The implementation of the medical rehabilitation program for patients with stage 1 chronic cerebral ischemia in an outpatient setting provides a significant reduction in pain (p &lt; 0.01), correction of psycho-emotional and cognitive disorders (p &lt; 0.01), normalization of lipid metabolism (p &lt; 0.01), and improvement in quality of life (p &lt; 0.01). The efficacy of the developed outpatient medical rehabilitation program for patients with stage 1 chronic cerebral ischemia was 85.4 %, and that of the standardized program — 77.0 %. Conclusion. Integrated pharmacotherapy and ozone therapy provide a significant increase in the effectiveness of medical rehabilitation of patients with chronic cerebral ischemia at the outpatient stage.

A behaviour change intervention to reduce sedentary behaviour in chronic obstructive pulmonary disease: a qualitative study

ObjectivesTo document the experiences of people with chronic obstructive pulmonary disease (COPD) who underwent a behaviour change intervention to reduce sedentary behaviour (SB) in a clinical trial. Design and participantsQualitative study using semi-structured interviews to explore perspectives of the behaviour change intervention and specific intervention components in people with stable COPD on the waitlist for pulmonary rehabilitation. SettingThree outpatient pulmonary rehabilitation programmes in Sydney, Australia. InterventionsThe six-week behaviour change intervention with once weekly contact with a physiotherapist aimed to reduce SB by replacing it with light-intensity physical activity (PA) and by breaking up prolonged SB. Main outcome measuresOf 30 participants who completed the behaviour change intervention, interviews were conducted with 13 participants and analysed using the ‘capability, opportunity, motivation, behaviour (COM-B)’ framework of behaviour change. ResultsIntervention components regarded as most helpful by participants were verbal education on health consequences on SB, goal setting, and self-monitoring of, and feedback on, step count using activity trackers. There was a clear preference during goal setting to increase PA rather than to reduce SB. Physical limitations and enjoyment of SB were the most reported barriers to reducing SB. ConclusionsGoal setting, verbal education, and self-monitoring of, and feedback on step count, were viewed positively by people with COPD and may show promise for reducing SB and increasing PA based on individual preference. Contribution of the paper•When given the choice, most people with stable COPD undergoing a behaviour change intervention preferred to increase their physical activity levels rather than reduce sedentary behaviour, which challenges previous assumptions that reducing sedentary behaviour is more feasible for people with COPD than increasing physical activity.•The behaviour change intervention improved the confidence and motivation of people with stable COPD to reduce their sedentary behaviour but did not alter their physical limitations or enjoyment of sedentary behaviour, which were perceived as barriers to change.•Goal setting, verbal education, and self-monitoring of, and feedback on, step count using activity trackers were identified as the most helpful strategies for changing sedentary behaviour and physical activity in people with stable COPD.

Schizophrenia and schizoaffective disorder: Length of stay and associated factors.

Patients with schizophrenia and schizoaffective disorder often require longer admissions. To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period. The study was conducted at Tara Hospital in Johannesburg. A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay (< 30 days), medium-stay (31-90 days) and long-stay (> 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category. Mean LOS was 128 days (median 87, interquartile range [IQR] 49-164, range 0-755 days). A significantly greater proportion had long-stay admissions (p < 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p < 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment (> 80%), comorbid substance use disorders (> 40%), medical illnesses (> 40%), antipsychotic polypharmacy (> 40%) and readmissions (> 80%) were high. Most (> 80%) were discharged. Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital. This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.

Influential factors for final neurorehabilitation outcome scores in patients with spinal cord injury: A longitudinal cohort study

Study designLongitudinal prospective cohort study. ObjectivesTo assess the coefficient of efficacy and the influence of various demographic and neurological factors on changes in Spinal Cord Independence Measure III (SCIM-III) scores over time in traumatic spinal cord injury (TSCI) patients. SettingPatient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center in Imam Khomeini Hospital Complex, Tehran, Iran. MethodsThe study was performed over an 8-year period in our outpatient rehabilitation setting. Changes in SCIM-III scores were assessed in 559 TSCI patients (of 1460 enrolled patients) who fit the inclusion criteria. All included patients participated in our outpatient rehabilitation program, which consisted of a multidisciplinary education program combined with occupational therapy, physical therapy, and home nursing as a rehabilitation package for a 6-month period. Patients then received follow-up assessments every 6 months. ResultsPredictors of the SCIM-III score as a rehabilitation outcome tool, and of its change over time, included age (younger patients had better outcomes, p = 0.067), marital status (married patients had better outcomes, p = 0.031), education level (patients with university education had better outcomes, p = 0.003), occupation status (employed patients had better outcomes, p = 0.009), and neurological level of injury (patients with injuries at lower levels had better outcomes, p < 0.001). However, sex and injury severity as per the American Spinal Injury Association Impairment Scale (AIS) had no significant effects on functional outcomes (i.e., SCIM-III score changes over time). ConclusionAge, marital status, education level, employment, and neurological level all affected the final SCIM-III scores of SCI patients. By contrast, sex and AIS grade were not significant predictors of SCIM-III outcomes. Further studies that include additional factors may be useful for future SCIM-III models.