Personalized Rehabilitation Program Research Articles

Implementation of a real-world based ICF set for the rehabilitation of respiratory diseases: a pilot study.

International Classification Functioning (ICF) Core Sets represent a holistic approach to functioning within rehabilitation field. Information-reporting efficacy of a rehabilitation-based Respiratory ICF set applied on a large scale throughout the ICS Maugeri network was tested. A prospective multi-center study (May-November 2018) was conducted for all respiratory inpatients consecutively admitted for rehabilitation. Doctors, physiotherapists, psychologists, nurses used an electronic Respiratory ICF set (33 items among the ICF body functions, activity and participations components) at admission and at discharge to assess the disability changes. The ICF report qualifiers, from 0 (no impairment) to 4 (maximum impairment), guided clinical, diagnostic and rehabilitation prescriptions. 1886 patients (69.6±10.8 years; M=1045) were admitted (589 chronic obstructive pulmonary disease, 494 chronic respiratory failure [CRF], 21 prolonged mechanical ventilation [PMV], 496 with other respiratory diseases), of whom 15 died, and 117 were transferred to acute care. The mean length of stay was 23.1±11.8 days (range 1-122). The mean time to fill in the ICF set was 23.16±0.70 min. The rate of filled charts improved from 16% in May to 100% in November. The baseline distribution of the more severe qualifiers (>2) progressively increased from the whole sample to the PMV subgroup. After rehabilitation, in the whole sample and in the CRF and PMV subgroups, the severity qualifiers significantly decreased (P<0.0001), showing a positive effect of the intervention on patients' disability. Routine use of a Respiratory ICF set for chronic respiratory diseases helps to prepare a personalized rehabilitation program discriminating disability level in different respiratory diseases and assessing disability outcomes pre-post rehabilitation.

Three distinct physical behavior types in fatigued patients with multiple sclerosis

BackgroundMultiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures.MethodsBaseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types.ResultsAnalysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived.ConclusionsPatients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.Trial registrationClinical trial registration no ISRCTN 82353628, ISRCTN 69520623 and ISRCTN 58583714.

Therapist-Guided Telerehabilitation for Adult Cochlear Implant Users: Developmental and Feasibility Study.

BackgroundCochlear implants can provide auditory perception to many people with hearing impairment who derive insufficient benefits from hearing aid use. For optimal speech perception with a cochlear implant, postoperative auditory training is necessary to adapt the brain to the new sound transmitted by the implant. Currently, this training is usually conducted via face-to-face sessions in rehabilitation centers. With the aging of society, the prevalence of age-related hearing loss and the number of adults with cochlear implants are expected to increase. Therefore, augmenting face-to-face rehabilitation with alternative forms of auditory training may be highly valuable.ObjectiveThe purpose of this multidisciplinary study was to evaluate the newly developed internet-based teletherapeutic multimodal system Train2hear, which enables adult cochlear implant users to perform well-structured and therapist-guided hearing rehabilitation sessions on their own.MethodsThe study was conducted in 3 phases: (1) we searched databases from January 2005 to October 2018 for auditory training programs suitable for adult cochlear implant users; (2) we developed a prototype of Train2hear based on speech and language development theories; (3) 18 cochlear implant users (mean age 61, SD 15.4 years) and 10 speech and language therapists (mean age 34, SD 10.9 years) assessed the usability and the feasibility of the prototype. This was achieved via questionnaires, including the System Usability Scale (SUS) and a short version of the intrinsic motivation inventory (KIM) questionnaires.ResultsThe key components of the Train2hear training program are an initial analysis according to the International Classification of Functioning, Disability and Health; a range of different hierarchically based exercises; and an automatic and dynamic adaptation of the different tasks according to the cochlear implant user’s progress. In addition to motivational mechanisms (such as supportive feedback), the cochlear implant user and therapist receive feedback in the form of comprehensive statistical analysis. In general, cochlear implant users enjoyed their training as assessed by KIM scores (mean 19, SD 2.9, maximum 21). In terms of usability (scale 0-100), the majority of users rated the Train2hear program as excellent (mean 88, SD 10.5). Age (P=.007) and sex (P=.01) had a significant impact on the SUS score with regard to usability of the program. The therapists (SUS score mean 93, SD 9.2) provided slightly more positive feedback than the cochlear implant users (mean 85, SD 10.3).ConclusionsBased on this first evaluation, Train2hear was well accepted by both cochlear implant users and therapists. Computer-based auditory training might be a promising cost-effective option that can provide a highly personalized rehabilitation program suited to individual cochlear implant user characteristics.

Implementation of Social Assistance for Persons with Intellectual Disabilities

Distance Service Program (DSP) is a community based rehabilitation program for persons with intellectual disabilities. This program has been running 11 years and is considered able to improve the wellbeing of persons with intellectual disabilityies and their families. In 2017, DSP implemented in West Bandung regency by rehabilitating 30 persons with intellectual disability. At the end of the program, beneficiaries receive cash aid to be managed as productive economic business capital. This article discusses the process by which the beneficiary families together with community cadres in managing the social assistance. The research method used is qualitative with descriptive research type. 13 selected informants represent program managers, program implementers, and program beneficiaries. The results of the field findings indicate that the beneficiary families of DSP 2017 have used the cash aid in accordance with the plan. Most of them are able to manage productive economic business and supplement family income by involving beneficiaries. The findings also reveal participatory economic empowerment by maximizing the potential of intellectual disabilities. However, there are also some types of endangered businesses consumed, dead fowls exposed to the virus, and businesses that take a long time to earn income for the family.

Three-week inpatient energy management education (IEME) for persons with multiple sclerosis-related fatigue: Feasibility of a randomized clinical trial

BackgroundMultiple sclerosis (MS)-related fatigue limits participation in everyday activities and has a considerable impact on quality of life (QoL), thereby affecting productivity and employment. Outpatient education interventions involving energy conservation strategies and cognitive behavioral therapy techniques are helpful. However, no inpatient program is currently available. The inpatient energy management education (IEME) program is a novel group-based intervention that lasts for 6.5 h and is conducted by a trained occupational therapist (OT) during a 3-week period of inpatient rehabilitation. Persons with MS (pwMS) and OTs previously evaluated the IEME positively in a pilot study test run. The aim of this study was to evaluate the feasibility of a research protocol and collect preliminary data on the IEME effect size. MethodsTo assess the feasibility of conducting a randomized clinical trial, pwMS-related fatigue were recruited during a 3-week inpatient rehabilitation. Six IEME (experimental) group sessions or progressive muscle relaxation (PMR, control) group sessions comprised part of a personalized rehabilitation program. The recruitment and assessment procedures, dropout and follow-up assessment rates and the treatment fidelity were evaluated, and six telephone interviews were conducted with IEME participants after they returned home. Outcomes were fatigue impact, occupational performance, self-efficacy regarding energy conservation strategies, and QoL at baseline, discharge, and 4 months. Paired-sample and independent-samples t-tests were used to assess within- and between-group effects. Effect sizes were estimated using Cohen's d. ResultsBetween August and November 2017, 47 pwMS were included and randomized. The dropout rate (4.2%) was low and the sample was balanced. The PMR was a well-accepted control intervention. The OTs reported no problems in conducting the IEME, and treatment fidelity was high. IEME participants confirmed the adequacy of the IEME. Within-group differences in fatigue impact and some QoL dimensions at discharge were significant (p < 0.05) in both groups. The IEME alone resulted in significant improvements in self-efficacy regarding energy conservation strategies, with a large effect size (Cohen's d: 1.32; 95% CI: 0.54–2.1), and in the QoL physical functioning dimension at T2 (Cohen's d: 1.32; 95% CI: 2.11–0.53). IEME participants spent significantly less time in individual OT sessions. A sample size of 192 participants in a randomized controlled trial would be sufficient to detect clinically relevant between-group differences. ConclusionThis feasibility study has provided promising preliminary data about the effect of the IEME. The research protocol was confirmed to be feasible and a future study is justified. This study was registered in the German Clinical Trials Register (no. DRKS00011634).

P38-S Evaluating effects of neurorehabilitation on gait pattern in multiple sclerosis with kinetic and electromyographic analyses

Gait deficit is a hallmark of multiple sclerosis (MS) and the walking capacity can be improved with rehabilitation. Technological advances in biomechanics offer opportunities to assess the effects of rehabilitation objectively. Here we employed wearable sensors to measure electromyography (EMG) and body acceleration during walking and to evaluate the changes in walking pattern after rehabilitation. Forty patients with MS (PwMS, mean EDSS: 5.51 ± 1) were enrolled. Ten-meter-walking-test (10MWT) were performed before and after rehabilitation. Clinical symptoms were assessed with self-reported questionnaires. An accelerator attached on the waist and 8 electrodes (BTS bioengineering, Italy) attached on bilateral thighs (Rectus and Biceps Femoris, RF-BF) and legs (Tibialis anterior and gastrocnemius, TA-GM) for measuring body acceleration and EMG recording. Time, cadence (pace/minutes), step-length and coactivation index(CoI) between antagonistic pairs pre- and post-rehabilitation were calculated on more and less affected side (MA/LA) for statistics. The time (p < 0.001) and cadence (p = 0.01) of 10MWT were significantly improved after rehabilitation. Though not statistically significant, CoI of RF-BF reduced in both sides post treatment (MA pre: 22.51 ± 10.10 v.s. post: 18.72 ± 7.14; LA pre: 20.35 ± 7.34 v.s. post: 17.45 ± 4.64). Further, reduced CoI of RF-BF pair on MA side correlated with less walking time in 10MWT (r = 0.43), while the reduction on LA sides correlated with less fatigue (r = 0.38, fatigue evaluated with Fatigue Severity Scale). Our results showed that the improvements of walking capacity after rehabilitation in PwMS may be related to reduced coactivation of the distal muscle. Combining objective assessments of EMG and accelerators allows us to better evaluate the effects of rehabilitation of gait and may benefit in future personalized rehabilitation program.

A web-based carepartner-integrated rehabilitation program for persons with stroke: study protocol for a pilot randomized controlled trial

BackgroundFamily carepartner management and support can improve stroke survivor recovery, yet research has placed little emphasis on how to integrate families into the rehabilitation process without increasing negative carepartner outcomes. Our group has developed creative approaches for engaging family carepartners in rehabilitation activities to improve physical and psychosocial health for both the carepartner and stroke survivor. The purpose of this study is to explore a novel, web-based intervention (Carepartner and Constraint-Induced Therapy; CARE-CITE) designed to facilitate positive carepartner involvement during a home-based application of constraint-induced movement therapy (CIMT) for the upper extremity.MethodsThe primary aim of the study is to determine feasibility of CARE-CITE for both stroke survivors and their carepartners. Carepartner mental health, family conflict surrounding stroke recovery, and stroke survivor upper extremity function will be evaluated using an evaluator blinded, two-group experimental design (blocked randomization protocol according to a 2:1 randomization schema) with 32 intervention dyads and 16 control dyads (who will receive CIMT without structured carepartner involvement). CARE-CITE consists of online education modules for the carepartner to review in parallel to the 30-h CIMT that the stroke survivor receives. The intent of CARE-CITE is to enhance the home-based intervention of CIMT, by helping the carepartner support the therapy and create a therapeutic home environment encouraging practice of the weaker arm in functional tasks.DiscussionThe CARE-CITE study is testing the feasibility of a family-integrated rehabilitation approach applied in the home environment, and results will provide the foundation for larger clinical studies. The overall significance of this research plan is to increase the understanding and further development of interventions that may serve as models to promote family involvement in the rehabilitation process.Trial registrationClinicalTrials.gov, NCT02703532. Registered 9 March 2016

Biomarkers of DNA damage in COPD patients undergoing pulmonary rehabilitation: Integrating clinical parameters with genomic profiling

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by severe respiratory symptoms. COPD shows several hallmarks of aging, and an increased oxidative stress, which is responsible for different clinical and molecular COPD features, including an increased frequency of DNA damage. The current pharmacological treatment options for COPD are mostly symptomatic, and generally do not influence disease progression and survival. In this framework, pulmonary rehabilitation is the most effective therapeutic strategy to improve physical performance, reducing hospital readmissions and mortality. Response to rehabilitation may greatly differ among patients calling for a personalized treatment. In this paper we will investigate in a group of COPD patients those variables that may predict the response to a program of pulmonary rehabilitation, integrating clinical parameters with cellular and molecular measurements, offering the potential for more effective and individualized treatment options. A group of 89 consecutive COPD patients admitted to a 3-weeks Pulmonary Rehabilitation (PR) program were evaluated for clinical and biological parameters at baseline and after completion of PR. DNA fragmentation in cryopreserved lymphocytes was compared by visual scoring and using the Comet Assay IV analysis system. The comparison of DNA damage before and after PR showed a highly significant increase from 19.6 ± 7.3 at admission to 21.8 ± 7.2 after three weeks of treatment, with a significant increase of 2.46 points (p < 0.001). Higher levels of DNA damage were observed in the group of non- responders and in those patients receiving oxygen therapy. The overall variation of %TI during treatment significantly correlated with the level of pCO2 at admission and negatively with the level of IL-6 at admission. Measuring the frequency of DNA damage in COPD patients undergoing pulmonary rehabilitation may provide a meaningful biological marker of response and should be considered as additional diagnostic and prognostic criterion for personalized rehabilitation programs.

Improvement in quality of life following a multidisciplinary rehabilitation program for patients with Parkinson's disease.

Background: Parkinson’s disease follows a chronic course, and therefore quality of life is important to assess in relation to rehabilitation programs for persons with the disease.Aim: To examine whether a brief rehabilitation program can promote positive changes in functional status, general self-efficacy, and quality of life and to examine factors associated with changes in quality of life.Methods: Patients with Parkinson’s disease (n=83) completed the General Self-Efficacy Scale and the Parkinson’s Disease Questionnaire at the beginning of a rehabilitation program and at three weeks follow-up. Within-person changes were analyzed with paired t-tests. A hierarchical linear regression was conducted to assess the independent associations between the independent variables and changes in quality of life during the three weeks program, while adjusting for the covariance between the independent variables.Results: Patients reported higher functional status (d=0.37, p<0.001), general self-efficacy (d =0.28, p<0.01), and quality of life (d=0.32, p<0.001) at three weeks follow-up, compared to their baseline scores. The regression analysis showed that having a better initial functional status (β =−0.26, p<0.05) and lower quality of life (β =0.51, p<0.001) were associated with more improvements in quality of life.Conclusion: The study suggests that actual functioning in persons with Parkinson’s disease is a better predictor of improved quality of life than self-efficacy beliefs and that those who have lower levels of initial quality of life benefit more from rehabilitation.

Hirschsprung disease and Down syndrome: From the reappraisal of risk factors to the impact of surgery

IntroductionThe association of Hirschsprung disease (HSCR) and Down Syndrome (DS) is not uncommon (HSCR+DS). This paper aims at reporting the results of a 24-year series focusing on surgical approach, complications and long term outcome. Materials and methodsThe notes of all patients admitted with a diagnosis of HSCR+DS have been retrospectively reviewed. Surgical details, intraoperative complications, long term issues and functional outcome have been recorded. The results have been compared to those of patients without DS and were assessed based on surgical approach. ResultsA total of 23 HSCR+DS out of a series of 385 HSCR (6%) have been included. Preoperative enterocolitis (HAEC) was reported by 32%. Associated anomalies were detected in more than half of the patients. In particular, Congenital Heart Defects (CHDs) were reported by 57%. Postoperative complications (mostly symptomatic anal sphincter achalasia) were experienced by 55%. Constipation was experienced by 30%; severe continence issues, by 53%. One patient suffering from severe CHDs died. With regard to complications, only symptomatic anal achalasia requiring intrasphincteric BoTox injection was significantly more frequent in HSCR+DS (30% vs 10%, p = 0.0071). Similarly, continence proved to be significantly worse in HSCR+DS. DiscussionWith the exception of symptomatic anal achalasia, HSCR+DS patients proved not to have a higher likelihood of complications compared to HSCR alone. On the other hand, functional results in the long term are worse. As a consequence, long term follow up and personalized rehabilitation programs are warranted for this delicate subset of HSCR patients. Level of evidenceLevel III.

Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Tymruk-Skoropad K, Pavlova I, Stupnytska S. Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review. Advances in Rehabilitation. 2019;33(4):51-65. doi:10.5114/areh.2019.89827. APA Tymruk-Skoropad, K., Pavlova, I., & Stupnytska, S. (2019). Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review. Advances in Rehabilitation, 33(4), 51-65. https://doi.org/10.5114/areh.2019.89827 Chicago Tymruk-Skoropad, Kateryna, Iuliia Pavlova, and Svitlana Stupnytska. 2019. "Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review". Advances in Rehabilitation 33 (4): 51-65. doi:10.5114/areh.2019.89827. Harvard Tymruk-Skoropad, K., Pavlova, I., and Stupnytska, S. (2019). Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review. Advances in Rehabilitation, 33(4), pp.51-65. https://doi.org/10.5114/areh.2019.89827 MLA Tymruk-Skoropad, Kateryna et al. "Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review." Advances in Rehabilitation, vol. 33, no. 4, 2019, pp. 51-65. doi:10.5114/areh.2019.89827. Vancouver Tymruk-Skoropad K, Pavlova I, Stupnytska S. Educational component in rehabilitation programs for persons with chronic obstructive pulmonary disease: a systematic review. Advances in Rehabilitation. 2019;33(4):51-65. doi:10.5114/areh.2019.89827.

Fusion of Artificial Intelligence in Neuro-Rehabilitation Video Games

In this paper, an intuitive neuro-rehabilitation video game has been developed employing the fusion of artificial neural networks (ANNs), inverse kinematics (IK), and fuzzy logic (FL) algorithms. The embedded algorithms automatically adjust the game difficulty level based on the player’s interaction with the game. Moreover, it is manifested as an alternative approach for possible movements to improve incorrect positioning through real-time visual feedback on the screen; 52 participants volunteered to engage in the program. Motor assessment scale (MAS) was determined to assess the participants’ functional ability pre- and post-treatments. The system input is received via the Microsoft Kinect, a foot Pedal (Saitek), and the Thalmic Myo armband. The ANN classifier integrates the limb joints orientation, angular velocity, lower arms’ muscle activity, hand gestures, feet sole (plantar) pressure parameters, and the MAS scores to learn from data and predict the improvement following the intervention. The fuzzy input generates a crisp output and provides a personalized rehabilitation program with the potential to be integrated into clinical protocols. Experiments to obtain the input signals and desired outputs were conducted for the learning and validation of the network. The networks pattern recognition, self-organizing map, and non-linear auto-regression analysis performed using feed-forward and Levenberg–Marquardt backpropagation (LMBP) procedure. The results showed the effectiveness of the non-linear auto-regression using the optimized LMBP algorithm to classify and visualize the target categories. Furthermore, the state of the network demonstrates the prediction accuracy exceeding 94%. Clustering algorithm grouped the data based on the similarity. Self-organizing map trained the network to learn the topology of samples with high correlation, presented outputs with high achievement.

Towards Personalized Rehabilitation for Gait Impairments in Parkinson's Disease.

Non-pharmacological interventions are essential in the management of gait impairments in Parkinson’s disease. The evidence for these interventions is growing rapidly. However, studies evaluating these interventions do generally evaluate a one-size-fits-all concept, and do usually not distinguish between subgroups, treatment dose and delivery mode. For two main reasons, this approach will not reach the full potential of gait rehabilitation. First, non-pharmacological interventions (e.g., external cueing) can improve gait in certain patients, but have no effect or sometimes even exacerbate gait deficits in others. Second, the success and benefit of gait rehabilitation relies on therapy adherence and training intensity achieved, and multi-target therapy not tailored to the individual runs the risk of hitting nothing. Hence, to apply non-pharmacological interventions in an individualized and evidence-based manner, clinicians and therapists need to know which patient characteristics predict the efficacy of various training modes and what type of training delivery works best. Current evidence is not sufficient to develop such personalized rehabilitation programs. In this viewpoint, however, we describe how tailored use of gait rehabilitation can be reached within a 20-year time frame.

Dynamic balance assessment during gait in children with Down and Prader-Willi syndromes using inertial sensors

Down (DS) and Prader-Willi (PWS) syndromes are chromosomal disorders both characterized by obesity, ligament laxity, and hypotonia, the latter associated with gait instability. Although these shared features may justify a common rehabilitation approach, evidence exists that adults with DS and PWS adopt different postural and walking strategies. The development of an instrumented protocol able to describe these strategies and quantify patients’ gait stability in the current clinical routine would be of great benefit for health professionals, allowing them to design personalized rehabilitation programs. This is particularly true for children with DS and PWS, where motor development is dramatically constrained by severe hypotonia and muscle weakness. The aim of this study was, thus, to propose an instrumented protocol, integrated with the clinical routine and based on the use of wearable inertial sensors, to assess gait stability in DS and PWS children.Fifteen children with DS, 11 children with PWS, and 12 typically developing children (CG) were involved in the study. Participants performed a 10-meter walking test while wearing four inertial sensors located at pelvis, sternum, and both distal tibiae levels. Spatiotemporal parameters (walking speed, stride frequency, and stride length) and a set of indices related to gait symmetry and upper-body stability (Root Mean Square, Attenuation Coefficient and Improved Harmonic Ratio) were estimated from pelvis and sternum accelerations. The Gross Motor Functional Measures (GMFM-88) and Intelligence Quotient (IQ Wechsler) were also assessed for each patient. A correlation analysis among the GMFM-88 and IQ scales and the estimated parameters was then performed.Children with DS and PWS exhibit reduced gait symmetry and higher accelerations at pelvis level than CG. While these accelerations are attenuated by about 40% at sternum level in CG and DS, PWS children display significant smaller attenuations, thus reporting reduced gait stability, most likely due to their typical “Trendelenburg gait”. Significant correlations were found between the estimated parameters and the GMFM-88 scale when considering the whole PWS and DS group and the PWS group alone.These results promote the adoption of wearable technology in clinical routines to monitor gait patterns in children with DS and PWS: the proposed protocol allows to markedly characterize patient-specific motor limitations even when clinical assessment scores provide similar results in terms of pathology severity. This protocol could be adopted to support health professionals in designing personalized treatments that, in turn, could help improving patients’ quality of life in terms of both physical and social perspectives.

Admissible multiarm stepped-wedge cluster randomized trial designs.

Numerous publications have now addressed the principles of designing, analyzing, and reporting the results of stepped‐wedge cluster randomized trials. In contrast, there is little research available pertaining to the design and analysis of multiarm stepped‐wedge cluster randomized trials, utilized to evaluate the effectiveness of multiple experimental interventions. In this paper, we address this by explaining how the required sample size in these multiarm trials can be ascertained when data are to be analyzed using a linear mixed model. We then go on to describe how the design of such trials can be optimized to balance between minimizing the cost of the trial and minimizing some function of the covariance matrix of the treatment effect estimates. Using a recently commenced trial that will evaluate the effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older persons after hip fracture as an example, we demonstrate that our designs could reduce the number of observations required for a fixed power level by up to 58%. Consequently, when logistical constraints permit the utilization of any one of a range of possible multiarm stepped‐wedge cluster randomized trial designs, researchers should consider employing our approach to optimize their trials efficiency.

The acceptance and commitment therapy model in occupational rehabilitation of musculoskeletal and common mental disorders: a qualitative focus group study

Aims: The aim of this study was to examine whether and how intended processes of behavioural change were reflected in participants’ experiences after an inpatient occupational rehabilitation programme. The programme was transdiagnostic, lasted 3½ weeks and was based on the acceptance and commitment therapy model.Methods: Twenty-two participants (17 women and 5 men) took part in five qualitative focus group interviews after the programme. Analysis was data-driven, categorising participants’ experiences using an initial explorative phenomenological approach. The emerging data-driven categories were re-contextualised within the theoretical framework of the therapy model.Results: The participants referred to experiences within all three intended domains of the model (openness, awareness, and engagement). Our results indicate that the transdiagnostic approach may have facilitated openness, while the attainment of flexible self-awareness was less evident. Participants expressed engagement and behavioural changes linked to personal values, but did not mention actions leading to imminent return to work.Conclusions: The results imply that for implementation in occupational rehabilitation, further development of this model is needed specifically regarding processes related to self-awareness and committed action towards work. These findings are relevant for the interpretation of results from randomised clinical trials on acceptance and commitment therapy in occupational rehabilitation.Implications for rehabilitationAcceptance and commitment therapy seems to be a feasible component in an occupational rehabilitation programme for persons with different diagnoses.A transdiagnostic approach mixing musculoskeletal pain disorders and common mental disorders in the same rehabilitation programme seems to facilitate the process of openness and acceptance.There is a need to further develop and operationalise some of the processes in Acceptance and commitment therapy to accommodate the approach to the occupational rehabilitation context.

0Effects of physical exercise after allogenic stem cell transplantation: A five years retrospective study

In the last few years, the increase of the number of allogenic hematopoietic stem cell transplantation (HSCT) posed new issues in Physical Medicine and Rehabilitation. Many complications occur before, during and after conditioning and transplant, among others infectious and immunological complications, cytopenias, denutrition. These elements affect the back to a better quality of life, also, they slowdowns the rehabilitation. We did a review of patient's folder being cared in our department between 2012 and 2017 ( n = 65). We proposed individual and personalized program, with physiotherapy, adapted physical activity and psychomotricity. We observed the benefit on their physical abilities and the limits of intervention, to bring out the best way to evolve the personalized rehabilitation program in the years to come. At the beginning of the support, the performances were very weak because of the physical deconditioning, especially during Six minutes’ walk test and Sit to Stand Test. Length of stay was very varied, often because of some medical events. At the end of program, conducted one day per week to five day per week, scores were significantly improved, and opportunity to carry out dailies life activities has been ameliorated. We were able to highlight the need to perform two levels of management for these patients according to their physical abilities: level one for patients with major deconditioning, based on individual support with physiotherapy and psychomotricity; level two for patients with better physical ability and with less fatigue, based on collective activities, with adapted physical activity and psychomotricity. All patients should benefit from psychological and dietetic follow-up program. This global and functional approach aims at improving physical and psychological well-being as well as achievement of activities of daily living.

S241. COMBIMOD: A FRENCH INTEGRATIVE PROGRAMME IN PATIENTS WITH SCHIZOPHRENIA FOCUSING ON RECOVERY: PRELIMINARY RESULTS

BackgroundCognitive remediation is a key tool in rehabilitation programs but not sufficient recovery. Meta-analyses in cognitive remediation insist on combinating programs in schizophrenia (Wykes and al.,2012; Lindenmayer and al., 2013). Futhermore, other subjective and clinical factors must be taking account in order to create a personalized rehabilitation program facilitating skills transfer in an ecological context. CRISALID (Center of cognitive rehabilitation and cognitive remediation), Clermont de l’Oise psychiatric department (Hauts de France area, France) offers an integrative care program, COMBIMod; it combines several modules of therapeutic education and of cognitive remediation, after an individual assessment, clinical, cognitive and functional (quantitative and qualitative) of each patient. A personalized and contractualized project of rehabilitation is then created with all the care partners around the patient. Objectives are: first to present COMBIMod with the description of each integrative education therapeutic programs based on cognitive deficits; then to proceed to a statistical neuropsychological comparative analysis. We postulate that using an integrative and ecological approach including remediation cognitive technics and ecological psychoeducation programs, can improve cognitive deficits.MethodsFirst, we described all the steps to enter COMBIMOD program since the global personalized assessments to the creation of an individualized program including cognitive remediation (Neurocognition and Social-cognition) and therapeutics education programs (MODip, MODen). We illustrated this program with patients verbatim. Then, we recruited 15 stabilized patients with schizophrenia according to DSM-IV-TR criteria. All the patients were assessed using neuropsychological tests at the baseline and after completed the program. We used Wilcoxon test analysis with level of significancy < 0,05.ResultsWe found significant improvement in some visuospacial memory test (p< 0,02) and executive functions (semantic verbal fluency: p<0,02; alphabetical verbal fluency: p<0,01; TMTB: p<0,003). Verbatim show some impact on the daily living and cognitive perceptions of the patient.DiscussionThese preliminary results confirm the importance of an integrative rehabilitation program including personalized assessments, motivation working, mixed cognitive remediation and psychoeducation programs. In order to facilitate ecological skills transfer, rehabilitation program should focus on subjective and will assessments. Further studies must be conducted in a larger cohort to better understand recovery

Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study).

ObjectiveTo subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination.DesignCross-sectional, registry-based study.Setting and subjectsChronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015.MethodsData from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares–discriminant analysis.ResultsFour subgroups were identified. Group 1 was characterized by low “psychological strain”, the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high “psychological strain” and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high “social distress”, the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low “social distress”, and high pain intensity.ConclusionsThe identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived “social distress” raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.

Reflections of patients and therapists on a multidisciplinary rehabilitation programme for persons with brachial plexus injuries

Purpose: There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels.Aim: To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation.Materials and methods: A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach.Results: Patients reported (1) Time to diagnose: “Finally I’m in the right place;” (2) Awareness: “They gave me a mirror;” (3) Partnership: “There was real contact with the therapists; we made decisions together;” (4) Close collaboration: “Overlapping scopes of practice; doing the same from a different perspective;” and finally (5) Self-management: “Now I can do it myself.” Therapists reported (1) “Patients knowledge and understanding is critical to success;” (2) “Activate problem solving and decision making;” (3) “Personalize your therapy; it’s more than just giving exercises and information;” (4) “Constant consultation within the team; consistency in messages and approach;” and (5)” Ultimately the patient is in charge.”Conclusions: The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme.Implications for rehabilitationBoth patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries.A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions.Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient–therapist and within the team; patient activation and self-reflection; and personalised care.Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.