Rehabilitation Population Research Articles

Innovative Processes in the Sanatorium and Resort Sector of the Republic of Belarus

INTRODUCTION. The introduction of innovative processes in sanatorium-resort activities helps to approach the individual treatment of a citizen’s disease or preventive measures aimed at reducing the incidence of the population in a sanatorium-resort area, simplify the functioning of health resorts and their provision of high-quality services for sanatorium treatment and rehabilitation. AIM. To determine the level of public awareness about sanatorium-resort organizations in the Republic of Belarus and to propose an algorithm for introducing innovative processes into their activities. MATERIALS AND METHODS. The survey method was used in the study. The research tool was a questionnaire. The representativeness of the sample was ensured by calculating the required number of respondents, taking into account the population of the regions of the Republic of Belarus (923 people) account the power of the study at the level (1 – β) = 80 %. A mobile application has been developed in the Visual Studio Code environment to improve the activities and optimize organizational processes in the health resort in order to raise public awareness, based on a study conducted in the health resorts of the republic to assess the quality of services provided for sanatorium treatment and wellness. RESULTS AND DISCUSSION. To identify the factors influencing the choice of a health resort by the population, cluster analysis, showed the closest correlation between the factors “doctors’ recommendations” and “medical services” influencing the choice of a health resort. The distribution of health resort awareness assessment in the regional context varied from 10.5 % (Grodno region) to 17.7 % (Minsk). The following are proposed: a system for informing the population and an algorithm for meeting the needs of the population in treatment and rehabilitation, the participation of information in sanatorium and resort activities. A selective assessment of the quality of spa treatment and wellness services in health resorts was carried out. A mobile application has been developed. CONCLUSION. The level of awareness of the population of the Republic of Belarus about the activities of sanatorium-resort organizations was assessed using a survey method — regional differences were identified. A model of the public information system and an algorithm for meeting the needs of the population and health improvement, the participation of information in sanatorium and resort activities are presented. A mobile application has been developed for sanatorium-resort organizations.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice.

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Sex differences in the prevalence of individual chronic conditions in a cardiac rehabilitation population

Sex differences in the prevalence of individual chronic conditions in a cardiac rehabilitation population

Validity of the Active Australia Survey in an Australian cardiac rehabilitation population

ObjectivesTo examine the long-term validity of the Active Australia Survey in a cardiac rehabilitation population using accelerometry as the reference measure. DesignCohort validation study. MethodsCardiac rehabilitation participants with coronary heart disease were recruited to a prospective cohort study. Over 7-days, 61 participants wore an ActiGraph ActiSleep accelerometer (1-second epoch, 10-minute bout) and completed the self-administered Active Australia Survey at baseline, 6-weeks, 6 and 12-months. Total daily moderate-to-vigorous physical activity from both methods was compared using Bland-Altman plots and Spearman rank-order correlations. ResultsParticipants tended to over-report moderate-to-vigorous physical activity, with more active participants more likely to over-report moderate-to-vigorous physical activity. There was a good level of agreement between the accelerometer 1-second epochs and Active Australia Survey at all time points (mean bias (ratio) 1.04, 1.16, 1.14, and 1.06, respectively), with weak-moderate correlations (ρ = 0.3-0.48). Conversely, there was a poor level of agreement between the accelerometer 10-minute bouts and Active Australia Survey at all time points (mean bias (ratio) 6.78, 9.09, 6.35, and 5.68, respectively), with weak-moderate correlations (ρ = 0.3-0.52). Agreement between the two measures did not improve over time for both 1-second and 10-minute bout accelerometry data. ConclusionsThe Active Australia Survey may be an acceptable self-report measure of moderate-to-vigorous physical activity in cardiac rehabilitation attendees when capturing any time spent in moderate-to-vigorous physical activity. The Active Australia Survey may be useful to routinely monitor physical activity levels over-time in Australian cardiac rehabilitation programs at both individual and group levels. Trial registrationTrial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx.

Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups.

Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups. Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups. Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis. Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.

Modeling and stability analysis of substance abuse in women with control policies

Substance abuse is considered to be predominantly a problem for all in society, and much substance abuse research is done with a male majority. Recent drug addiction studies, however, reveal that there are substantial gender variations in substance-related epidemiology. The epidemiology of women’s substance misuse raises issues distinct from those addressed by men’s substance abuse. Women with addictions are more likely than males to experience several impediments to accessing and entering substance misuse treatment. In this regard, we framed a mathematical model by considering the whole population as a women population. For this system, we found pair of equilibrium points namely the Addiction-free equilibrium point and the Non-trivial equilibrium point. Moreover, the addicts generation number (threshold parameter) RA has been found to investigate the spread of addiction. Also, the local and global stability analysis for both the equilibrium points have investigated. Further, to analyze the decrease and increase of the infected population and recovery population respectively, an optimum control analysis is done with two control parameters using Pontryagin’s maximum principle. The influence of addict generation numbers on significant parameters involved in RA has been shown. An optimum control study projected that social media awareness is substantially more efficient than the fixed control in optimizing drug addiction among women. Through numerical simulations we have exhibited, the effect of with and without control on each population. Finally, it produced positive efficacy by reducing the number of infected and increasing the rehabilitation population.

Prevalence, Severity and Impact of Visuospatial Neglect in Geriatric Stroke Rehabilitation, a Cross-Sectional Study

ObjectivesVisuospatial neglect (VSN) is a common cognitive deficit of lateralized attention after stroke and can have a negative influence on patients’ daily activities, community participation, and caregiver burden. VSN prevalence has been investigated in several mixed-age populations, but rarely in only an older population. As the population in geriatric rehabilitation (GR) is understudied and VSN may influence rehabilitation goals in GR (return home), we examined the prevalence of VSN as well as associations between VSN (severity) and population characteristics and the impact of VSN on functioning, length of stay, and discharge destination after GR. DesignMulticenter cross-sectional study. Setting and ParticipantsStroke patients admitted to GR. MethodsThree VSN tests (Star cancelation task, Line bisection task, and Catherine Bergego Scale) were administered in the first 2 weeks of GR admission. To examine VSN severity, a composite score was calculated based on scores of the 3 tests. ResultsA total of 114 stroke patients were included [55.3% female; mean age 80.2 (SD 8.0) years]. VSN prevalence was 47.4%, in which allocentric and egocentric neglect were more prevalent than VSN during activities of daily living. Participants with VSN spent more days in GR compared to participants without VSN (median 68.5 vs 35.5 days) and had fewer home returns. In addition, VSN participants showed less mobility, lower cognitive functioning, and less independence during self-care compared to participants without VSN. Mobility, self-care, cognition, duration of rehabilitation, and home return were negatively associated with VSN severity. Conclusions and ImplicationsVSN is very prevalent in the GR stroke population. VSN severely hampers older people during daily activities and their rehabilitation process and, therefore, has a major personal and societal impact. Accordingly, systematic assessment of VSN in the early phase of geriatric rehabilitation with multiple VSN screening tests is recommended.

Improved nursing home end-stage renal disease patient participation in physical therapy with onsite, more frequent dialysis.

For end-stage renal disease (ESRD) patients residing in skilled nursing facilities (SNFs), the logistics and physical exhaustion of life-saving hemodialysis therapy often conflict with rehabilitation goals. Integration of dialysis care with rehabilitation programs in a scalable and cost-efficient manner has been a significant challenge. SNF-resident ESRD patients receiving onsite, more frequent hemodialysis (MFD) have reported rapid post-dialysis recovery. We examined whether such patients have improved Physical Therapy (PT) participation. We conducted a retrospective electronic medical records review of SNF-resident PT participation rates within a multistate provider of SNF rehabilitation care from January 1, 2022 to June 1, 2022. We compared three groups: ESRD patients receiving onsite MFD (Onsite-MFD), ESRD patients receiving offsite, conventional 3×/week dialysis (Offsite-Conventional-HD), and the general non-ESRD SNF rehabilitation population (Non-ESRD). We evaluated physical therapy participation rates based on a predefined metric of missed or shortened (<15 min) therapy days. Baseline demographics and functional status were assessed. Ninety-two Onsite-MFD had 2084 PT sessions scheduled, 12,916 Non-ESRD had 225,496 PT sessions scheduled, and 562 Offsite-Conventional-HD had 9082 PT sessions scheduled. In mixed model logistic regression, Onsite-MFD achieved higher PT participation rates than Offsite-Conventional-HD (odds ratio: 1.8, CI: 1.1-3.0; p < 0.03), and Onsite-MFD achieved equivalent PT participation rates to Non-ESRD (odds ratio: 1.2, CI: 0.3-1.9; p < 0.46). Baseline mean ± SD Charlson Comorbidity score was significantly higher in Onsite-MFD (4.9 ± 2.0) and Offsite-Conventional-HD (4.9 ± 1.8) versus Non-ESRD (2.6 ± 2.0; p < 0.001). Baseline mean self-care and mobility scores were significantly lower in Onsite-MFD versus Non-ESRD or Offsite-Conventional-HD. SNF-resident ESRD patients receiving MFD colocated with rehabilitation had higher PT participation rates than those conventionally dialyzed offsite and equivalent PT participation rates to the non-ESRD SNF-rehabilitation general population, despite being sicker, less independent, and less mobile. We report a scalable program integrating dialysis and rehabilitation care as a potential solution for ESRD patients recovering from acute hospitalization.

Developing multidimensional participation profiles after traumatic brain injury: a TBI model systems study

Purpose. To characterize societal participation profiles after moderate-severe traumatic brain injury (TBI) along objective (Frequency) and subjective (Satisfaction, Importance, Enfranchisement) dimensions. Materials and Methods. We conducted secondary analyses of a TBI Model Systems sub-study (N = 408). Multiaxial assessment of participation included the Participation Assessment with Recombined Tools-Objective and -Subjective questionnaires (Participation Frequency and Importance/Satisfaction, respectively) and the Enfranchisement Scale. Participants provided responses via telephone interview 1–15 years post-injury. Multidimensional participation profiles (classes) were extracted using latent profile analysis. Results. A 4-class solution was identified as providing maximal statistical separation between profiles and being clinically meaningful based on profile demographic features. One profile group (48.5% of the sample) exhibited the “best” participation profile (High Frequency, Satisfaction, Importance, and Enfranchisement) and was also the most advantaged according to socioeconomic indicators. Other profile groups showed appreciable heterogeneity across participation dimensions. Age, race/ethnicity, education level, ability to drive, and urbanicity were features that varied between profiles. Conclusions. Societal participation is a critical, but inherently complex, TBI outcome that may not be adequately captured by a single index. Our data underscore the importance of a multidimensional approach to participation assessment and interpretation using profiles. The use of participation profiles may promote precision health interventions for community integration. Implications for Rehabilitation Our study found unidimensional measures of societal participation in traumatic brain injury (TBI) populations that focus exclusively on frequency indicators may be overly simplistic and miss key subjective components of participation Taking a multidimensional perspective, we documented four meaningfully distinct participation subgroups (including both objective and subjective dimensions of societal participation) within the TBI rehabilitation population Multidimensional profiles of participation may be used to group individuals with TBI into target groups for intervention (e.g., deeper goal assessment for individuals who do not rate standard participation activities as important, but also do not participate and do not feel enfranchised).

Methodologies to measure access to care post-discharge in adults with serious injury-related disability: a scoping review

Purpose This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. Methods Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. Results The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. Conclusions There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability.

The Path to Translating Focus of Attention Research Into Canadian Physiotherapy, Part 1: Physiotherapists’ Self-Reported Focus of Attention Use Via a Study-Specific Questionnaire

The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The “Therapists’ Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)” was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ±32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists’ FOA use.

Incorporating handgrip strength examination into dietetic practice: A quality improvement project.

Protein-energy malnutrition is both prevalent and costly within the inpatient rehabilitation population. Registered dietitians play a key role in identifying, diagnosing, and treating protein-energy malnutrition. Handgrip strength has been shown to correlate with clinical outcomes, including malnutrition. Reduced handgrip strength is included as a criterion in national and international consensus guidelines of malnutrition diagnoses for functional changes. However, limited research and quality improvement projects have reported on its actual use in the clinical setting. The purpose of this quality improvement project was to (1) implement handgrip strength testing into dietitian care on three inpatient rehabilitation units to allow dietitians to identify and treat nutrition-related muscle function losses and (2) evaluate the feasibility, clinical utility, and clinical impact of this project. This quality improvement educational intervention demonstrated that handgrip strength is feasible, does not impact dietitian efficiency, and is clinically useful. Dietitians reported three areas in which handgrip strength provided value: assessing nutrition status, motivating patients, and monitoring responses to nutrition interventions. Specifically, they were able to shift away from focusing solely on change in weight to focusing on functional ability and strength. Although outcome measures demonstrated favorable outcomes, the results must be interpreted cautiously because of the small sample and pre-post uncontrolled design. Further high-quality research is required to provide more in-depth information on the utility and limitations of handgrip strength as an assessment, motivational, and monitoring tool for clinical dietetics.

Using Self-Regulation Assessment to Explore Associations between Self-Regulation, Participation and Health-Related Quality of Life in a Rehabilitation Population.

Self-regulation, participation and health-related quality of life are important rehabilitation outcomes. The aim of this study was to explore associations between these outcomes in a multi-diagnostic and heterogenic group of former rehabilitation patients. This cross-sectional survey used the Self-Regulation Assessment (SeRA), Utrecht Scale for Evaluation of Rehabilitation-participation (USERParticipation) and the Patient-Reported-Outcome-Measurement-System (PROMIS) ability and PROMIS satisfaction with participation in social roles, and the EuroQol-5L-5D and PROMIS-10 Global Health. Regression analyses, controlling for demographic and condition-related factors, were performed. Respondents (n = 563) had a mean age of 56.5 (standard deviation (SD) 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. In addition to demographic and condition-related factors, self-regulation subscales explained 0-15% of the variance in participation outcome scores, and 0-22% of the variance in HRQoL outcome scores. Self-regulation subscales explained up to 22% of the variance in satisfaction subscales of participation (USER-Participation and PROMIS) and the mental health subscale of the PROMIS-10. Self-regulation subscales explained up to 11% of the restriction and frequency subscales of participation (USER-Participation) and the physical health subscale of the PROMIS-10. Self-regulation is more strongly associated with outcomes such as satisfaction with participation and mental health compared with outcomes such as restrictions in participation and physical health.

The trajectory of pain and pain intensity in the upper extremity after stroke over time: a prospective study in a rehabilitation population

Purpose To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain. Materials and methods Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0–10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively. Results 678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0–7.0 at 3 and 3.0–6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time. Conclusions The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

The Implementation and Role of Peer Mentor Group in Advancing Clinical Skills in Inpatient Neurorehabilitation

<h3>Research Objectives</h3> To measure the effectiveness of a peer mentor group in improving clinical knowledge and application for novice occupational therapists on an adult inpatient rehabilitation unit. <h3>Design</h3> Current mentorship models were evaluated using a staff survey and available literature. Based on results, peer mentor group was established and pre/post measures were taken for each group session to evaluate effectiveness. <h3>Setting</h3> 48 bed adult inpatient neurorehabilitation unit in an academic teaching hospital in New York City. <h3>Participants</h3> Novice occupational therapists with 0-3 years experience working with the brain injury population in inpatient rehabilitation. <h3>Interventions</h3> Peer mentor group provides novice occupational therapists working with the brain injury population a safe environment to share challenges related to specific topics and administration of interventions. Each session, senior level therapists facilitate guided clinical discussions regarding specific topics/interventions and work to promote a knowledge sharing environment to support education of when interventions are clinically indicated and techniques for administration of each specific intervention. <h3>Main Outcome Measures</h3> Pre and post peer mentor group surveys are administered to staff therapists prior to each peer mentor group and the same question set is administered immediately following. This tool uses a Likert scale to measure knowledge of when interventions are clinically indicated, confidence level in administering interventions, and confidence in knowing where to locate resources. <h3>Results</h3> Results demonstrate improvements for staff therapists in knowledge of when specific interventions are clinically indicated as well as knowledge in administration of specific interventions following participation in the peer mentor group. <h3>Conclusions</h3> Improved scores on post-surveys following participation in a peer mentor group indicate participation is beneficial for novice staff therapists as a supplement to advance clinical skills in working with patients with acquired brain injury, specifically knowledge of when interventions are clinically indicated and individual confidence levels in administering interventions. Further investigation is warranted to develop a standard protocol for facilitators of each peer mentor group to determine the optimal structure of the group in order to maximize outcomes and increase efficacy of the program. <h3>Author(s) Disclosures</h3> None.

Gender-Specific Effects of 8-Week Multi-Modal Strength and Flexibility Training on Hamstring Flexibility and Strength.

The purpose of this study was to investigate the effects of multi-modal strength training or flexibility training on hamstring flexibility and strength in young males and females. A total of 20 male and 20 female college students (aged 18-24 years) participated in this study and were randomly assigned to either a multi-modal flexibility intervention group or strength intervention group. Passive straight leg raise and isokinetic strength test were performed before and after the intervention to determine flexibility and strength of the participants. Multivariate repeated-measure ANOVA was used to determine the effect of training group and gender on hamstring strength and flexibility. Both male and female participants in the strength intervention group significantly increased peak torque, relative peak torque, and flexibility (all p ≤ 0.029). Both male and female participants in the flexibility intervention group significantly increased flexibility (both p ≤ 0.001). Female participants in the flexibility intervention group significantly increased peak torque and relative peak torque (both p ≤ 0.023). However, no change was seen in peak torque and relative peak torque of male participants in the flexibility intervention group (p ≥ 0.676). An 8-week strength training program involving various training components can increase flexibility in both males and females, although the flexibility of male participants only increased slightly. While hamstring flexibility training protocol consisted of different types of stretching improved both flexibility and strength in female participants, male participants increased only flexibility but not strength, indicating such effects were gender-specific. For subjects with relatively low strength (e.g., older adults, sedentary women, postoperative rehabilitation population, etc.), strength training alone or flexibility training alone may increase both strength and flexibility.

111 THE INFLUENCE OF THE ANDAGO® ON GAIT PARAMETERS AMONG OLDER ADULTS IN THE POST-ACUTE REHABILITATION SETTING: A PILOT STUDY

Abstract Background Electromechanical devices incorporating body-weight support have been developed to enable a repetitive approach to gait rehabilitation whilst decreasing physical strain on treating therapists. The Andago® gait trainer provides dynamic body weight support for individuals while simultaneously enabling them to walk overground. The purpose of this study was to compare the effect of the Andago® versus conventional overground walking on gait parameters, fear of falling (FOF) and ratings of perceived exertion in a post-acute rehabilitation population. Methods Patients undergoing rehabilitation were randomly assigned to the Andago® or conventional walking condition on day one with the alternate testing condition completed on day two. Participants completed a 10-metre walk test where stride length, walking speed and cadence were recorded. Participants then undertook a 20-minute gait re-education session where number of steps, distance walked and number of siting breaks were recorded. Ratings of perceived exertion (BORG) and FOF scores were recorded at minutes 1, 10 and 20. Results Twenty-seven participants (mean age 78 (SD 9.2), female 55.6%(n=15)) completed the study. Reasons for rehabilitation included neurological (51.8%; n= 14), orthopaedic (33.3%; n=9) and medical conditions (14.8%; n=4). Forty-four percent of participants (n=12) had a mild cognitive impairment. Body weight support ranged from 10% to 17% (mean 11%, SD 2). No significant differences in the 10-metre walk test were found between conditions. A reduction in the number of sitting breaks (p &amp;lt;0.05) and FOF at minutes 10 (p&amp;lt;0.05) and 20 (p&amp;lt;0.05) was found in favour of the Andago® during the gait re-education session. Conclusion Preliminary results suggest the Andago® is a feasible modality for gait re-education in patients undergoing rehabilitation, being at least comparable to conventional overground gait training. A reduction in FOF in patients coupled with decreased physical strain on therapists may provide opportunities for more intensive practice and warrants further investigation.

Evaluation of physical health in an in-patient psychiatric rehabilitation setting

BackgroundThe mortality gap between patients with and without serious mental illness (SMI) is around 15–20 years. Here, we aim to identify some of the factors contributing to that gap via poor physical health and sub-optimal medical management. MethodsWe report the results of a detailed cross-sectional study of physical health parameters in an in-patient rehabilitation population in Scotland, including a consideration of concordance with guidelines and comparisons to healthy populations. ResultsData was collected from 57 of all 62 in-patients. 42% were obese (compared to 28% of the population), 84% were smokers (vs 16%), 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed screening uptake compared to the Scottish population was low: Cervical (30% vs 69%), Bowel (8% vs 64%), Breast (23% vs 72%), Abdominal Aortic Aneurysm (0% vs 78%). Patients generally had up to date recorded weight (100%), blood pressure (98.2%), heart rate (98.2%) and lipids (89.4%), but not ECG's (61.4%) or Diabetes screening (59.6%). Following review, 17 referrals were made to medics/surgeons, 29 to broader specialties, 24 medications were started, 9 stopped and 27 changed: most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients). ConclusionsThe findings highlight cardiovascular risk factors and cancer screening as specific areas to target for improving poor physical health in populations with SMI. Patients are often willing to engage but specific ways to lower the barriers to screening and treatment are required.

Prevalence of frailty and frailty outcomes within the inpatient rehabilitation setting: use of routinely collected electronic health information.

Frailty within the older adult rehabilitation population is relatively under-explored. We aimed to derive a frailty index (FI) from electronic routinely collected data to determine frailty prevalence, and to assess its ability to predict adverse outcomes in the rehabilitation setting. A FI was derived and retrospectively applied to electronically recorded health information of older adults admitted for inpatient rehabilitation. For analysis, subjects were allocated into frailty score (FS) groups (0-5). Primary outcome was a six-month hospitalistion rate, and other outcomes were: mortality, entrance into long-term care (LTC) at one year, length of stay (LOS), 30- and 90-day hospitalistions. Univariate and multivariable logistic regressions analysed associations between frailty and outcomes. One hundred and sixty-two patient electronic notes were reviewed. Mean (SD) age was 86 (8.2) years, 147 (90.7%) were considered frail (FS>0.25). The most frail group (FS 5) had higher risk of six-month hospitalisations (OR=6.19; 95%CI=1.82, 21.13; p=0.004). A higher frailty score was associated with shorter LOS compared to lowest frailty scores (15.7 days vs 25.4 days; p=0.04). No relationship was found with shorter-term outcomes. Prevalence of frailty is high in the rehabilitation setting. Association of frailty with shorter LOS and lack of association found with shorter-term outcomes warrant further study.