Recovery Assessment Tools Research Articles

Image-Derived Skeletal Muscle Activation Metric Map: a Forearm Study Using Ultra-Fast Ultrasound Imaging and High-Density Electromyography.

Quantification of the skeletal muscle response can help better understand the fundamentals of the musculoskeletal system and can serve as a diagnostic measure or recovery assessment tool during rehabilitation for neurological injuries. Surface electromyography (EMG) is commonly used to measure muscle activity, but it is limited to detecting myoelectric signals without anatomy associated information. In this study, we proposed to use ultra-fast ultrasound imaging and introduced a new image analysis methodology to quantify a muscle's spatialtemporal mechanical response. The methodology is based on analyzing the spatial-temporal change of the impulsive kinetic energy during the period of muscle contraction. The analysis can derive an anatomy-registered muscle activation metric map that localizes regions of muscle activation. To demonstrate this, we intentionally evoked regional muscle responses in five participants without disabilities by electrically stimulating the median nerve and individual forearm muscle groups, respectively. Both ultrasound images and high-density EMG (HD-EMG) data were recorded and processed. We presented the ultrasound image-derived activation localization from five participants and compared the results with HD-EMG measurements. The comparison indicates a good resemblance for describing muscle recruitment pattern. The proposed methodology can potentially become an alternative or complementary approach to surface EMG for the study of skeletal muscle activation and for diagnosis and prognosis in clinical settings.

Effectiveness of Planned Early Ambulation on Postoperative Recovery among Cesarean Mothers: A Quasi-experimental study in Mangaluru

Abstract Background Mothers with cesarean section need more attention and care. Early ambulation is the essential to restore the maximum muscle function and improve the health during postoperative period. Early ambulation certainly has proven to be effective in preventing postoperative complications. Aim To evaluate the effectiveness of early ambulation on postoperative recovery among cesarean mothers. Methods Nonprobability purposive sampling technique was used to select 60 cesarean mothers, with 30 samples in each of the experimental and control group. Mothers in the intervention group received bed exercises by the investigator such as flexion and extension of the extremities, upper limb exercises, lower limb exercise, turning the patient, sitting with dangling the feet, and deep breathing exercises which was initiated at 10 hours of cesarean section followed by standing and walking at 12 hours of cesarean section for twice a day, whereas the control group received routine treatment as per the hospital protocol. Demographic proforma was used to assess the demographic characteristics, and structured postoperative recovery assessment tool was used to assess four major components such as pain, breast feeding, postnatal changes, and activity of daily living. The obtained data were analyzed using descriptive and inferential statistics. Statistical Analysis Significant difference in the postoperative recovery score was calculated by using RM-ANOVA and independent t-test and the association of postoperative recovery score with selected demographic variables done by chi-square test.Results The majority of mothers in intervention (66.7%) and control group (63.3%) were 24 to 29 years old and had secondary education (60% each). There was significant difference in breast feeding (p = 0.001), involution of uterus (p = 0.047), amount of lochia (p = 0.027), and activity of daily living in the intervention group (p < 0.05) compared with the control group. Conclusion Early ambulation improves the postoperative recovery and helps to achieve a good sense of well-being.

Instruments for Measuring Recovery among Serious Mental Illness: A Systematic Review of Systematic Review

Background: Indicators of recovery outcomes are selected by mental health nurses beginning with a commitment to a holistic and client-centered view of recovery. The purpose of the review aimed to bring together the results of previous systematic reviews on instruments for assessing the recovery of people with serious mental illnesses.
 Methods: A systematic literature review was carried out using the guidelines of the Joanna Briggs Institute for systematic reviews. A literature search using The ScienceDirect, SpringerLink electronic databases, Google Scholar, and a Google search engine was used. Searching in literature published between January 2010 and December 2020, supplemented by reference tracking and Internet searches. The authors independently reviewed all titles, assessed articles’ eligibility for inclusion, determined a methodological quality score for each included article and extracted relevant data.
 Results: Out of 19,724 articles related to the title for potential inclusion in this review, four met the inclusion criteria. The eligibility tools appear to have been studied in various settings and with varied types of patients but are still congruent with SIM. Most importantly, the reviews identified several methodological limitations across the original studies. The lack of a ‘gold standard. This review found twenty-two dimensions in personal recovery instruments and twenty-one in mental health services orientation. Also, many recovery assessment tools are available for the serious mental illness population. However, there is limited evidence about their psychometric properties.
 Conclusion: Three instruments were found that could measure the personal recovery of people with serious mental illnesses. Those instruments' psychometric properties and cultural adaptation are recommended for further studies.

Effect of integrative nursing practices on cognitive recovery among severe traumatic brain injury patients

Background and objective: Cognitive recovery after severe traumatic brain injury (TBI) is the biggest challenge facing the critical care nurses (CCNs). Several studies have been reported that the majority of CCNs are concerned with providing conventional nursing practices to severe TBI patients. These practices are directed to stabilize patients’ status rather than to enhance cognitive recovery after TBI. Application of integrative nursing practices for TBI patients can help in enhancing cognitive recovery. Aim: This study aimed to determine the effect of integrative nursing practices on cognitive recovery among severe traumatic brain injury patients.Methods: A quasi experimental research design was utilized. A convenience sample was conducted on 60 adult patients suffering from severe TBI who admitted to the intensive care units of Alexandria Main University Hospital. Patients were assigned into study group (30 patients) and control group (30 patients). One tool was used for data collection namely “Cognitive Recovery Assessment Tool”. This tool was used to assess recovery of cognitive function domains. It consists of level of consciousness using Full Outline of Un-Responsiveness (FOUR) score, level of cognitive functioning using Rancho Los Amigos (RLA) scale and basic cognitive sensory recovery assessment using Western Neuro Sensory Stimulation Profile (WNSSP) scale.Results: The implementation of integrative nursing practices for the study group was associated with statistically significant positive effects. Patients in the study group showed higher means of consciousness revealed by FOUR score and cognitive function revealed by RLA scale. The basic cognitive sensory recovery revealed by WNSSP scale in the study group was also significantly improved.Conclusions: Implementation of integrative nursing practices has been shown to enhance cognitive recovery among severe TBI patients. Thus, it is recommended for use in a nurse’s daily routine of care for severe TBI patients.

A Qualitative Assessment of Factors That Children, Parents, and Clinicians Prioritize in the Setting of Elective Anesthesia and Surgery.

Assessing the postoperative recovery of pediatric patients is challenging as there is no validated comprehensive patient-centered recovery assessment tool for this population. A qualitative investigative approach with in-depth stakeholder interviews can provide insight into the recovery process and inform the development of a comprehensive patient-centered postoperative assessment tool for children. We conducted open-ended, semistructured interviews with children 6-12 years old undergoing elective surgery (n = 35), their parents (n = 37), and clinicians (n = 23) who commonly care for this population (nurses, anesthesiologists, and surgeons). A codebook was developed and analyzed using NVivo 12 Plus. The codebook was iteratively developed using a qualitative content analysis approach with modifications made throughout to refine codes. We report the results of this thematic analysis of patient, parent, and clinician transcripts. Postoperative recovery priorities/concerns overlapped and also diverged across the 3 groups. Topics prioritized by children included mobility and self-care, as well as access to a strong social support network following surgery. The majority of children reported feeling anxious about the surgery and separating from their parents, as well as sadness about their inability to participate in activities while recovering. Although children highly valued familial support during recovery, there was variable awareness of the impact of surgery on family members and support network. In contrast, parents focused on the importance of clear and open communication among themselves and the health care team and being equipped with appropriate knowledge and resources on discharge. The immediate repercussions of the child's surgery, such as pain, confusion, and nausea, appeared to be a primary focus of both parents and clinicians when describing recovery. Clinicians had a comprehensive awareness of the possible psychological impacts of surgery in children, while parents reported varying degrees of awareness or concern regarding longer-term or more latent impacts of surgery and anesthesia (eg, anxiety and depression). Prior experience with pediatric surgery emerged as a distinguishing characteristic for parents and clinicians as parents without prior experience expressed less understanding of or comfort with managing a child's recovery following surgery. A patient-centered qualitative investigative approach yielded insights regarding the importance of various aspects of recovery in pediatric patients, their parents, and members of the health care team. Specifically, this investigation highlighted the importance of clear communication providing anticipatory guidance for families presenting for elective surgery in an effort to optimize patient recovery. This information will be used in the development of a patient-centered recovery assessment tool.

Assessing social recovery of vulnerable youth in global mental health settings: a pilot study of clinical research tools in Malaysia

BackgroundA social recovery approach to youth mental health focuses on increasing the time spent in valuable and meaningful structured activities, with a view to preventing enduring mental health problems and social disability. In Malaysia, access to mental health care is particularly limited and little research has focused on identifying young people at risk of serious socially disabling mental health problems such as psychosis. We provide preliminary evidence for the feasibility and acceptability of core social recovery assessment tools in a Malaysian context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample.MethodsNine vulnerable young people from low-income backgrounds were recruited from a non-government social enterprise and partner organisations in Peninsular Malaysia. Participants completed a battery of social recovery assessment tools (including time use, unusual experiences, self-schematic beliefs and values). Time for completion and completion rates were used as indices of feasibility. Acceptability was examined using qualitative interviews in which participants were asked to reflect on the experience of completing the assessment tools. Following a deductive approach, the themes were examined for fit with previous UK qualitative accounts of social recovery assessments.ResultsFeasibility was indicated by relatively efficient completion time and high completion rates. Qualitative interviews highlighted the perceived benefits of social recovery assessments, such as providing psychoeducation, aiding in self-reflection and stimulating goal setting, in line with findings from UK youth samples.ConclusionsWe provide preliminary evidence for the feasibility and acceptability of social recovery assessment tools in a low-resource context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. We also suggest that respondents may derive some personal and psychoeducational benefits from participating in assessments (e.g. of their time use and mental health) within a social recovery framework.

A study of modified Aldrete score and fast-track criteria for assessing recovery from general anaesthesia after laparoscopic surgery in Indian adults

Study ObjectiveThe primary objective of the study was to compare and evaluate two of the recovery assessment tools, i.e. the Modified Aldrete score (MAS) and fast-track criteria (FTC), for assessing time to recovery from general anaesthesia after laparoscopic surgeries in Indian settings. As a secondary objective we explored the factors associated with time to recovery. DesignLongitudinal observational study. SettingOperative room, Post-op recovery area and general ward of SSK Hospital, New Delhi, India PatientsAfter a thorough pre-anesthetic evaluation, 100 consecutive subjects 18–65 years, ASA I/II, posted for laparoscopic surgery were included. MeasurementsBaseline and clinical parameters were noted. Post-extubation recovery scores were recorded every 5 min until 30 min and at 2, 6, 12 and 24 h in the post-operative period using both the criteria. Main ResultsMean time to recovery from anaesthesia was found to be 14.8 ± 3.8 and 13.0 ± 3.5 minutes when assessed by MAS (score ≥ 9) and FTC (score ≥ 12), respectively. At 2 and 6 h. post-extubation a dip in the FTC scores were observed in 7% and 3% of the subjects though the MAS scores remained unaffected. This corresponds to the incidence of severe post-op pain and nausea vomiting in the study subjects. Older age > 35 years, pre-operative medication with fentanyl and midazolam and duration of surgery are factors which were significantly associated with time to recovery. ConclusionFTC and MAS seem to be equally good in assessing recovery in immediate postoperative period from general anaesthesia after laparoscopic surgery. However, the former criterion is better for documenting adequate recovery for transfer of patients from post-anaesthesia-care-unit/high-dependency-unit (PACU / HDU) to the ward as it provides assessment of postoperative-nausea-vomiting (PONV) and pain.

Integration of satisfaction and quality of recovery.

Among patient-reported outcomes, patient satisfaction and quality of recovery are key measures of patient-centred care. The measurement of patient satisfaction should use validated, multidimensional scales. There are general scales that aim to evaluate the entire perioperative period and scales focused on specific periods (post-operative) or techniques (loco-regional anaesthesia). Recovery assessment tools (such as the PostopQRS) share some domains with satisfaction scales and also have major differences by construction. As such, recovery and satisfaction scales are complementary. Because there is no reference value of patient satisfaction, the scales are used to compare two management strategies or to follow similar populations of patients with time. Improving patient satisfaction goes beyond quality improvement. In a large database, the highest satisfaction was associated with the lowest morbidity and mortality. Thus, it is likely that the process of improving quality changes multiple components of medical management, hence improving several patient outcomes.

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications.

Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. Asa result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients' perceived quality of care, recovery, and satisfaction. Recovery tools also differ in their assessment of recovery as a continuous vs dichotomous variable and in their focus at the group vs individual level. Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels,respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.

A review of the scope and measurement of postoperative quality of recovery.

To date, postoperative quality of recovery lacks a universally accepted definition and assessment technique. Current quality of recovery assessment tools vary in their development, breadth of assessment, validation, use of continuous vs dichotomous outcomes and focus on individual vs group recovery. They have progressed from identifying pure restitution of physiological parameters to multidimensional assessments of postoperative function and patient-focused outcomes. This review focuses on the progression of these tools towards an as yet unreached ideal that would provide multidimensional assessment of recovery over time at the individual and group level. A literature search identified 11 unique recovery assessment tools. The Postoperative Quality of Recovery Scale assesses recovery in multiple domains, including physiological, nociceptive, emotive, activities of daily living, cognition and patient satisfaction. It addresses recovery over time and compares individual patient data with base line, thus describing resumption of capacities and is an acceptable method for identification of individual patient recovery.

The Surgical Recovery Score correlates with the development of complications following elective colectomy

BackgroundThe Surgical Recovery Score (SRS) is a validated, comprehensive recovery assessment tool used to measure functional recovery after major surgery. To further evaluate its clinical applicability, this study investigated whether the SRS correlates with clinical outcomes and the occurrence of complications after elective colectomy. Materials and methodsWe conducted a retrospective review of prospectively collected data for consecutive patients undergoing elective colonic resection within an enhanced recovery program at our institution from September 2008 to September 2011. We administered the 31-item SRS questionnaire preoperatively (baseline) and on postoperative days 1, 3, 7, 14, and 30. We scored individual questionnaires as a percentage of the maximum possible score, with a higher SRS indicating improved functional recovery (range, 17–100). We prospectively recorded clinical outcomes and graded 30-d complications as per the Clavien-Dindo classification. We conducted univariate and logistic regression analysis to determine the correlation of the SRS to the development of complications. ResultsWe evaluated 134 patients, 62 of whom developed minor complications (grades 1–2) (46%) and 21 of whom developed major complications (grades 3–5) (16%). The SRS was similar at baseline in the complicated and uncomplicated groups but significantly lower on postoperative days 3, 7, 14, and 30 in patients who developed major complications, and on days 7 and 14 in patients who developed minor complications. In a logistic regression analysis, the SRS on postoperative day 3 was independently associated with the development of any complication, as well as major complications specifically. ConclusionsIn addition to measuring functional recovery, the SRS closely correlates with the development of complications after elective colectomy and offers a reliable outcome measure to assess overall postoperative recovery.