Rehab Group Research Articles

Abstract 4144502: Comparing Readmission Rates and Exercise Capacity Following Left Ventricular Assistive Device Placement With and Without Post-Operative Inpatient Rehabilitation

Introduction: Patients with heart failure may undergo mechanical assistive device placement as a bridge to heart transplantation or for destination therapy. Thereafter, patients may be discharged home or admitted to inpatient rehabilitation. Research Question: We hypothesized that within 8 months, patients admitted to inpatient rehabilitation (IR) would have fewer readmissions and greater exercise capacity compared to patients discharged home following left ventricular assistive device (LVAD) placement. Aim: The readmission rates and exercise capacity of patients admitted to (IR) were compared to those discharged home within 8 months of (LVAD) placement. Methods: Readmission rates, impairment percentages (IP) (determined by Activity Measure for Post-Acute Care scores) and walking distance after (LVAD) placement between March 1 st , 2020 to November 30 th , 2022 were collected via retrospective chart review at Jackson Memorial Hospital. Adults with heart failure and heart assistive device (ICD10 code Z95.811), discharged home or admitted to the Christine E. Lynn Rehabilitation Center for at least 7 consecutive days within 8 months were included. Patients who were noncompliant, expired, transferred, or unable to ambulate were excluded. 24 patients were admitted to rehab, and 16 were discharged home. Statistical significance was denoted at the 0.05 level using the Mann-Whitney U Test. Results: There was a higher proportion of females in the rehab group (45.8%) and males in the no rehab group (93.8%) (p=0.02). The groups were otherwise comparable. Average (IP) at hospital discharge was higher for the rehab group (51.79%, SD 17.65) compared to the no rehab group (14.20%, SD 18.93) (p<.001). Average post-(LVAD) walking distance (feet) at hospital discharge was higher for the no rehab group (305, SD 206.72) compared to the rehab group (127.73, SD 132.11) (p=0.005). Within 8 months, there was no significant difference between groups. Average readmissions were higher for the no rehab group (1.375, SD 0.957) compared to the rehab group (0.958, SD 1.49) (p= 0.059), but was not statistically significant. Conclusions: Patients with greater (IP) and shorter walking distances were admitted to rehab and became functionally comparable to the no rehab group by 8 months. Though readmission rates were lower for the rehab group, this was not statistically significant. Additional studies are warranted to evaluate the impact of (IR) following (LVAD) placement.

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p<.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) <.001 Home health $433 (1,600) $705 (2,118) <.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) <.001 IRF $245 (2,275) $384 (3,277) .434

616. POST-ESOPHAGECTOMY REHABILITATION IS ASSOCIATED WITH EARLY IMPROVEMENTS IN PHYSICAL FITNESS AND SARCOPENIA: PRELIMINARY RESULTS FROM THE FITNESS AFTER OESOPHAGECTOMY (FARO) TRIAL

Abstract Introduction Curative treatment of gastro-esophageal cancer encompasses surgery and peri-operative chemo(radio)therapy. Advancements in oncological treatment and surgical techniques have resulted in incremental prognostic gains with increasing focus on survivorship and optimising quality of life (QoL). Despite enhanced recovery pathways, patients receive no assistance to improve physical functioning and QoL in the post-esophagectomy recovery period. Post-operative rehabilitation has demonstrated improvement in physical fitness and psychosocial wellbeing among other cancer subtypes. The aim of this study was to determine the impact of a patient-directed, home-based rehabilitation programme upon physical functioning in the early recovery phase following an esophagectomy. Methods The Fitness AfteR Oesophagectomy (FARO) study was a prospective, single-centre, parallel-group, open-label, two-arm, pragmatic randomised controlled external pilot trial. Patients were randomised to receive post-operative rehabilitation (alongside routine care- REHAB) or standard clinical care (NO-REHAB) alone in a 1:1 ratio. The rehabilitation intervention encompassed a 12-week home-based programme with weekly step-count targets, completion of resistance exercises and dietary monitoring. Cardiorespiratory fitness was determined by the 6-minute walk test (6MWT) and the functional impact of sarcopenia was assessed by the hand-grip strength (HGS). Outcomes were measured at baseline and 6 weeks post-esophagectomy. Between-group differences were analysed using linear mixed effects models. Results A total of 60 patients were included and randomised to REHAB (n=31) or NO-REHAB (n=29). A total of 29 patients in the REHAB group (93.5%) completed the rehabilitation programme with a 100% adherence rate. At 6 weeks post-esophagectomy, there was statistically significant improvements in the functional impact of sarcopenia as denoted by improvements in HGS in REHAB versus the NO-REHAB cohorts (mean difference= 4.237; 95% c.i 0.80-7.70; p=0.017). Cardiopulmonary fitness, as determined by the 6MWT, was comparable between cohorts with no statistically significant intergroup differences at 6 weeks (mean difference= 62.008; 95% c.i -5.85-129.91; p=0.073). Conclusion Post-operative rehabilitative interventions result in improvements in physical functioning in the early recovery phase following an esophagectomy. Further analysis from the FARO trial will determine if rehabilitation restores and improves QoL and recovery of cardiopulmonary fitness into survivorship.

Rehabilitation Intervention Is Associated With Improved Neurodevelopment and Modulation of Inflammatory Molecules in Children With Cerebral Palsy.

To evaluate the effects of systematic rehabilitation on both the neuropsychomotor development, and on the peripheral response from immunological and neuroplastic mediators in children with cerebral palsy. This is a prospective cohort study with 90 children with cerebral palsy at 18 months of age. Sixty children received rehabilitation for 6 months, and they were compared to 30 children that were placed in the waiting list. Peripheral biomarkers and neuropsychomotor parameters were compared between the Rehab vs the Nonrehab groups at baseline and at 6 months. Results showed higher Bayley III scores in the Rehab group, with significant differences in inflammatory and neurotrophic biomarkers between groups. Rehabilitation was associated to decreased levels of IL-12p70, IL-6, IL-1β, CXCL8 IL-8, and CXCL9/MIG and increased levels of BDNF and GDNF. Nonrehab children had stable immune molecule levels but decreased BDNF levels over time. Rehabilitation improved neurodevelopment parameters and modulated levels of inflammatory (↓) and neurotrophic (↑) biomarkers.

Effects of Cardiopulmonary Rehabilitation on Cardiorespiratory Fitness and Clinical Symptom Burden in Long COVID: Results From the COVID-Rehab Randomized Controlled Trial.

The aim of the study is to investigate the effectiveness of an 8-wk cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO 2 peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with long COVID. Forty individuals with long COVID (mean age 53 ± 11 yrs), were randomized into two groups: (1) rehabilitation group: center-based individualized clinical rehabilitation program (8 wks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and (2) control group: individuals maintained their daily habits during an 8-wk period. There was a significant difference between groups in mean VO 2 peak improvement ( P = 0.003). VO 2 peak improved significantly in the rehab group (+2.7 mL.kg.min; 95% CI = +1.6 to +3.8; P < 0.001) compared to the control group (+0.3 mL.kg.min; 95% CI = -0.8 to +1.3 P = 0.596), along with VE/VCO 2 slope ( P = 0.032) (-2.4; 95% CI = -4.8 to +0.01; P = 0.049 and +1.3; 95% CI = -1.0 to +3.6; P = 0.272, respectively) and VO 2 at first ventilatory threshold ( P = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group ( P < 0.05). An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions.

Rehabilitation facilitates functional improvement following intravenous infusion of mesenchymal stem cells in the chronic phase of cerebral ischemia in rats

The primary objective of this study was to investigate the potential facilitating effects of daily rehabilitation for chronic cerebral ischemia following the intravenous infusion of mesenchymal stem cells (MSC) in rats. The middle cerebral artery (MCA) was occluded by intraluminal occlusion using a microfilament (MCAO). Eight weeks after MCAO induction, the rats were used as a chronic cerebral ischemia model. Four experimental groups were studied: Vehicle group (medium only, no cells); Rehab group (vehicle + rehabilitation), MSC group (MSC only); and Combined group (MSC + rehabilitation). Rat MSCs were intravenously infused eight weeks after MCAO induction, and the rats received daily rehabilitation through treadmill exercise for 20 min. Behavioral testing, lesion volume assessment using magnetic resonance imaging (MRI), and histological analysis were performed during the observation period until 16 weeks after MCAO induction. All treated animals showed functional improvement compared with the Vehicle group; however, the therapeutic efficacy was greatest in the Combined group. The combination therapy is associated with enhanced neural plasticity shown with histological analysis and MRI diffusion tensor imaging. These findings provide behavioral evidence for enhanced recovery by combined therapy with rehabilitation and intravenous infusion of MSCs, and may form the basis for the development of clinical protocols in the future.

Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review

ObjectivesWe evaluated interventions to facilitate recovery in children, adolescents and adults with a sport-related concussion (SRC).DesignSystematic review including risk of bias (modified Scottish Intercollegiate Guidelines Network tool).Data sourcesMEDLINE(R) and Epub...

Effectiveness of Cardiac Rehabilitation in Myocardial Infarction Patients After Percutaneous Coronary Intervention.

BackgroundPost myocardial infarction rehabilitation can have a positive impact on overall patient health. Therefore, the present study investigated the role of cardiac rehabilitation in reducing the frequency of arrhythmias, recurrent angina, readmission, and mortality in patients who underwent percutaneous coronary intervention.MethodologyA prospective observational study was conducted at the Cardiology Department, Khyber Teaching Hospital, Pakistan, between 1st March 2021 and 30th May 2021. All patients who were discharged after being diagnosed with acute myocardial infarction were included in the study. Patients who were not able to give consent, had physical fragility, mental impairment, or those who have critical illness were excluded from the study. 40 patients underwent cardiac rehabilitation while the other 40 acted as controls. The cardiac rehabilitation group patients were asked to engage in 15-30 minutes of activity daily and keep a record of all their activities. Death, recurrence, rhythm abnormalities, rehospitalizations, and BMI (body mass index) were all documented on a predesigned proforma and compared between intervention and control. A three-month-long follow-up plan was established.ResultsA total of 80 patients were enrolled in the study. Post-infarction angina (p = 0.0012) was significantly higher in patients who did not receive cardiac rehabilitation (CR). The incidence of arrhythmias was significantly higher in the control group as compared to the rehab group (p=0.002). Moreover, the mean left ventricular ejection fraction (LVEF) was also significantly higher in patients who underwent CR as compared to the control group (44.76 ± 13.8 vs. 42.9 ± 13.5, p = 0.01). There was no significant difference between the post-intervention BMI in the rehab group.ConclusionIn conclusion, the present study findings revealed that mild to moderate cardiac rehabilitation (CR) was related to the less frequent occurrence of post-infarction angina and arrhythmias. Moreover, we found that patients who received CR experienced a significant improvement in left ventricular ejection fraction (LVEF) as compared to the control group. However, further large-scale studies from multiple centers are warranted.

Effectiveness of rehabilitation on pain and function in people affected by hemophilia.

Introduction:Literature provides unclear evidence of the effectiveness of many physiotherapy interventions on pain intensity, quality of life, and functional ability in hemophilic patients, and suggests that rehabilitation programs should be focused on functional goals and the disability of patients.Aim:The aim of the present study is to present the outcome of a case series of patients with hemophilia in which a rehabilitation program has been carried out on the basis of a specific individual patient's functional impairment.Methods:Fifty-one patients were enrolled: 32 patients (Rehab Group) received a rehabilitative treatment, 19 patients for different reasons (living far from the hospital, family problems) did not receive rehabilitation (Control Group). The rehabilitation program was planned with respect to the emergent problems: musculoskeletal pain, joint range of motion limitation, muscle flexibility, walking difficulties, the appearance of hematomas/hemartro, and postural problems. All the patients were assessed at baseline (T0), after 1 month (T1), and after 3 months (T2) through visual analogic scale for musculoskeletal pain, the Hemophilia Joint Health Score for joint range of motion, the Functional Independence Score in Hemophilia for disability, and postural assessment by visual inspection.Results:A significant reduction of pain and improvement of Hemophilia Joint Health Score and Functional Independence Score in Hemophilia score was found in the Rehab Group along with the follow-up. Pain in the Control Group was lower with respect to the other group at baseline and significantly decreased after 1 month.Conclusion:A rehabilitation program focused on individual impairment of patients with hemophylia determined satisfying results in terms of pain control, functional, and disability improvement in 3 months follow-up.

Rehabilitation of Acute and Chronic Ankle Sprain for Male Cricketers Through Headway (Isometric, Isotonic and Proprioception) Exercises

The present study investigated that Headway (Isometric, Isotonic and Proprioception) exercises are effective for acute &amp; chronic ankle sprain injury, which was observed through experimental research. Ninety-four amateur cricketers of age, 15-35 years (Control Injured, N=48; Headway Rehab Group N=46) with a confirmed acute or chronic ankle sprain, selected from four different cities of Punjab, Pakistan was evaluated through Star Excursion Balance Test (SEBT), Single Leg Balance test (SLB) and subject to a set of progressively increasing exercises on ground known as Headway rehab exercises which consisted of Isometric, Isotonic and proprioception protocols. Another group of the same level of cricketers (N=40) was managed parallel for comparisons. The Control Injured and Headway Rehab Group was left with 40 subjects each because during the course of Headway exercise eight and six subjects left the study due to their personal reasons. Comparisons of pre and post-exercise (Control Injured Group) values showed a significant increase (p&lt;0.001) in Lateral direction reach and Posteromedial direction (p&lt;0.05) while the rest of the six directions showed non-significant results. Headway Rehab Group showed an overall improvement of 5.2% and 7.5% with an increase (cm) of 3.4 and 4.9 for the non-injured and injured leg respectively. However, the range of improvement in percentage for all eight directions (anterior, anterolateral, lateral, posterolateral, posterior, posteromedial, medial, anteromedial) lies between 5.7-7.1(range) and 6.3-9.6 (range) for the non-injured and injured leg respectively. Similarly, the difference between pre and post-exercise difference of two positions of non-injured leg and injured leg (closed and open eyes) in seconds were 2.9, 12.1 and 4.1, 27.7 respectively. However, the improvement percentage of two directions (closed and open eyes) of Headway Rehab Group was 44.9 and 75.3 for non-injured and 12.7 and 51.6 per cent for injured group respectively. It was evaluated through the Single Leg Balance Test and analyzed by paired sample t-test found highly significant (p&lt;0.001). The results indicated that Headway exercises improved isometric and isotonic muscular strength, proprioception and stability that ultimately helped to recover, regaining strength and reinstall proprioception. After completing the Headway Rehab plan the subjects were followed for four months to check the recurrence and found recurrence of Control Injured Group and Headway Rehab Group was 17.5% and 12.5% respectively.

Impact of cardiac rehabilitation on ventricular repolarization indices following coronary artery bypass grafting.

Background The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting. Methods Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared. Results There was a significant decrease in the electrocardiographic findings of heart rate (p<0.001), QTc (p<0.001), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001) in the Rehab(+) group before and after surgery. There was a significant decrease in the Rehab(+) group, compared to the Rehab(-) group, in terms of parameters of QT interval (p=0.001), QTc (p=0.017), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001). Conclusion Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.

Evaluating diastolic and systolic reserve by strain imaging during resistance exercise training in heart failure with preserved ejection fraction

Abstract Background Exercise intolerance is the cardinal manifestation of heart failure (HF), yet its underlying mechanism(s) remain poorly understood. Measures of ventricular function such as ejection fraction often have no relationship with exercise capacity in HF. 2D-STE has proved to be more reliable method to evaluate myocardial mechanical function. Our hypothesis is Resistance exercise training (Resist-HFpEF) will improve exercise tolerance and exertional symptoms in patients with HFpEF. Purpose The study aims to evaluate myocardial mechanical function by strain imaging during resistance exercise training in Heart Failure patients with Preserved Ejection Fraction (HFpEF) Methods This is a single centre prospective pilot study. 24 HFpEF patients were enrolled and their baseline comorbidities were recorded. Baseline 2D-STE imaging was performed at rest and during exercise (Visit 1). Patients were then randomized to either a novel resistance exercise training program for 36 sessions (3 sessions per week for 12 weeks) or a standard of care control group. 2D STE imaging was then repeated at follow-up (Visit 2). Peak Global Longitudinal strain (GLS), systolic strain rate (SSR), early diastolic strain rate (SRe) were measured offline. Results Mean age of the Rehab cohort was 68.57±10.52 years and the control cohort was 68.1±6.47 years. 23 study subjects were male (96%). 17% of the study subjects were hypertensive, 63% were diabetic, 42% had NYHA I, 46% had NYHA II and 13% had NYHA III of heart failure. The mean LV ejection fraction in the control and Rehab group after the training program at rest was 61.88±2.26% &amp; 54.74±2.07% (p-value 0.04) and during exercise was 59.90±2.05% and 53.13±2.05% (p-value 0.04). The peak GLS was −18.80±4.29% and −17.7±2.21% in controls during rest and exercise at Visit 1 (p-value 0.27) while the rehab cohort had −18.71±4.7% and −20.82±2.4% respectively (p-value 0.0268). The peak GLS was −17.40±3.05% and −17.96±2.65% in controls during rest and exercise at Visit 2 (p-value 0.3430) while rehab cohort had −17.97±6.21% and −16.57±3.82% respectively (p-value 0.67). (Figure 1a and 1b shows GLS, SRS, SRe at Baseline and after exercise program respectively) Conclusion This pilot study suggest systolic and diastolic reserve can be measured reliably during low grade exercise. These results could reflect improvement in clinical status and exercise tolerance. Figure 1. Comparison of peak GLS, SSR, SRe amongst HFpEF patients at rest and during exercise before and after the rehab training program. Funding Acknowledgement Type of funding source: None

Randomized Control Trial on the Impact of Exercise on Quality of Life and Functional Capacity in HCT Patients

<h3>Introduction</h3> The current study investigated the impact of an individualized exercise prescription on physical function, muscle strength and QoL in patients and compare it to general exercise and to exercise at liberty. <h3>Patients & Methods</h3> This was a prospective study comparing three groups: Individualized Exercise Prescription (IEP) group, General Exercise (GE) group and exercise at liberty or No Exercise (NE) group. A total of 22 patients were recruited for the study according to strict the inclusion and exclusion criteria. <h3>Intervention: During the in-patient stay</h3> The NE group received education about keeping active, the patients GE group were given a blanket exercise prescription and lastly, the IEP group were prescribed individualized exercise program based on their pre-transplant scores. <h3>Outpatient rehabilitation</h3> The GEG and CG groups were provided with instructions on activities and asked to keep a daily exercise record. The IEP group was divided into two groups, group A) Supervised out-patient rehab group (8 weeks) and B) Home exercise group. <h3>Results</h3> The preliminary results of the trial are presented. Demographic and medical characteristics of study participants are described in Table 1. The upper and lower limb scores had some differences between the groups. The EQ-5D-5L scale (Table. 2) in the IEP group showed significant differences from baseline to 6 months post-HCT. <h3>Conclusions</h3> An individualized prescription plan has the propensity to positively affect the QoL of HCT patients however these results are only preliminary and the trial data is still accumulating thereby definitive conclusions cannot be made based on early results.

Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer

Research supports use of prehabilitation to optimize physical status before and after colorectal cancer resection, but its effect on postoperative complications remains unclear. Frail patients are a target for prehabilitation interventions owing to increased risk for poor postoperative outcomes. To assess the extent to which a prehabilitation program affects 30-day postoperative complications in frail patients undergoing colorectal cancer resection compared with postoperative rehabilitation. This single-blind, parallel-arm, superiority randomized clinical trial recruited patients undergoing colorectal cancer resection from September 7, 2015, through June 19, 2019. Patients were followed up for 4 weeks before surgery and 4 weeks after surgery at 2 university-affiliated tertiary hospitals. A total of 418 patients 65 years or older were assessed for eligibility. Of these, 298 patients were excluded (not frail [n = 290], unable to exercise [n = 3], and planned neoadjuvant treatment [n = 5]), and 120 frail patients (Fried Frailty Index,≥2) were randomized. Ten patients were excluded after randomization because they refused surgery (n = 3), died before surgery (n = 3), had no cancer (n = 1), had surgery without bowel resection (n = 1), or were switched to palliative care (n = 2). Hence, 110 patients were included in the intention-to-treat analysis (55 in the prehabilitation [Prehab] and 55 in the rehabilitation [Rehab] groups). Data were analyzed from July 25 through August 21, 2019. Multimodal program involving exercise, nutritional, and psychological interventions initiated before (Prehab group) or after (Rehab group) surgery. All patients were treated within a standardized enhanced recovery pathway. The primary outcome included the Comprehensive Complications Index measured at 30 days after surgery. Secondary outcomes were 30-day overall and severe complications, primary and total length of hospital stay, 30-day emergency department visits and hospital readmissions, recovery of walking capacity, and patient-reported outcome measures. Of 110 patients randomized, mean (SD) age was 78 (7) years; 52 (47.3%) were men and 58 (52.7%) were women; 31 (28.2%) had rectal cancer; and 87 (79.1%) underwent minimally invasive surgery. There was no between-group difference in the primary outcome measure, 30-day Comprehensive Complications Index (adjusted mean difference, -3.2; 95% CI, -11.8 to 5.3; P = .45). Secondary outcome measures were also not different between groups. In frail patients undergoing colorectal cancer resection (predominantly minimally invasive) within an enhanced recovery pathway, a multimodal prehabilitation program did not affect postoperative outcomes. Alternative strategies should be considered to optimize treatment of frail patients preoperatively. ClinicalTrials.gov identifier: NCT02502760.

Patient-reported Outcomes After Surgery for Lumbar Disc Herniation, a Randomized Controlled Trial Comparing the Effects of Referral to Municipal Physical Rehabilitation Versus No Referral.

Randomized controlled trial. The aim of this study was to investigate the effect of referring patients to municipal physical rehabilitation compared to no referral on patient-reported outcomes (PROs) after surgery for lumbar disc herniation. In surgical spine practice, lumbar discectomy is one of the most frequent interventions. Postoperatively, patients are typically referred to physical rehabilitation at the time of hospital discharge, and in Denmark all patients are legally entitled to a personal rehabilitation plan and referral for free rehabilitation at the municipal facilities. However, whether postoperative rehabilitation is effective in this group of patients remains controversial. This single-center single blinded study randomized subjects into 2 groups. Patients in the REHAB group received municipal rehabilitation starting 4 to 6 weeks postoperative, whereas patients in the HOME group were discharged after surgery without any planned rehabilitation course. Primary outcome was Oswestry Disability Index after 6 months, whereas secondary outcomes included EuroQoL-5D and Visual Analogue Scale for leg and back pain. All PROs were obtained before surgery and at 1, 3 to 6, 12, and 24 months postoperative. A total of 146 patients were enrolled in the study: 73 allocated to the REHAB-group and 73 to the HOME-group. The groups were similar at baseline and the follow-up rate at 12 and 24 months was 78%. PROs in both groups improved significantly after surgery, but no statistically significant differences were observed between the groups at any follow-up time point in either the intent-to-treat, as-treated, and per-protocol analyses. Revision surgeries during the follow-up period were equally divided between the groups. Surgery for lumbar disc herniation is effective in relieving pain, improving function, and quality of life. The postoperative outcome is not altered significantly by referring patients to municipal physical rehabilitation compared to no referral. 1.

Postacute Care Setting Is Associated With Employment After Burn Injury

ObjectiveTo examine differences in long-term employment outcomes in the postacute care setting. DesignRetrospective review of the prospectively collected Burn Model System National Database. Setting and ParticipantsA total of 695 adult survivors of burn injury enrolled between May 1994 and June 2016 who required postacute care at a Burn Model System center following acute care discharge were included. Participants were divided into 2 groups based on acute care discharge disposition. Those who received postacute care at an inpatient rehabilitation facility (IRF) following acute care were included in the IRF group (N=447), and those who were treated at a skilled nursing facility, long-term care hospital, or other extended-care facility following acute care were included in the Other Rehab group (N=248). InterventionsNot applicable. Main Outcome MeasuresEmployment status at 12 months postinjury. Propensity score matching and logistic regression were utilized to determine the effect of postacute care setting on employment status. ResultsIndividuals in the IRF group had larger burns and were more likely to have an inhalation injury and to undergo amputation. At 12 months postinjury, the IRF group had over 9 times increased odds of being employed compared to the Other Rehab group, using propensity score matching (P=.046). ConclusionsWhile admitting patients with more severe injuries, IRFs provided a long-term benefit for survivors of burn injury in terms of regaining employment. Given the current lack of evidence-based guidelines on postacute care decisions, the results of this study shed light on the potential benefits of the intensive services provided at IRFs in this population.

Comparison of Tendon Lengthening with Traditional vs. Accelerated Rehab Following Achilles Tendon Repair: A Randomized Controlled Trial

Objectives: Operative repair of Achilles tendon ruptures have shown successful outcomes. However, little is know about the amount of tendon or repair site lengthening after repair and if lengthening is affected by rehab protocols. The purpose of our study was to compare lengthening of the Achilles tendon after surgical repair, comparing traditional and accelerated rehab protocols. Methods: Twenty patients undergoing primary repair of Achilles tendon ruptures were assessed for participation. We performed a prospective randomized controlled trial in accordance with the CONSORT (Consolidated Standards of Reporting Trials) 2010 statement. The study arms included operative repair of Achilles tendon rupture with either accelerated (graduated weight bearing at 2 weeks) or traditional rehab (weight bearing at 6 weeks). During repair, two 2-mm tantalum beads with laser-etched holes were sutured to the Achilles tendon at the repair site. Beads were evaluated via CT scans immediately post-operatively and at 12 weeks. X-rays were obtained at time 0 and then at 2, 6, and 12 weeks. The primary outcome of the study was the difference in tendon or repair site lengthening between the study arms. Randomization was by a computerized algorithm. The observer was blinded and the patient was not blinded to the intervention. Results: Zero patients declined participation and all 20 patients were included for final analysis. All patients showed statistically significant lengthening at two weeks following surgery. There was a trend toward increased lengthening at 6 weeks in the accelerated rehab group (9.9 mm, range 2.6 -13.9 mm) compared to the traditional rehab group (4.1 mm, range 1.5 -9.0 mm), although this was not statistically significant; p = .07. However the final amount of tendon lengthening at 12 weeks after surgery was not different between the accelerated rehab group (14.4 mm, range 11.7 -17.0 mm) and the traditional rehab group (13.4 mm, range 10.7 -17.0 mm); p = .38. Conclusion: This study’s findings suggest that all patients undergoing operative repair of Achilles tendon ruptures have significant lengthening after surgery. Although there was a trend toward increased lengthening at 6 weeks in the accelerated rehab group, there was no difference in tendon lengthening at final follow up between the two groups.

100 Post-Acute Care Setting is Associated with Employment After Severe Burn Injury

Despite the growing use of post-acute care in the United States, few studies have examined differences in long-term outcomes by specific post-acute care setting. Adult burn survivors represent a population that exhibit impaired long-term outcomes and often require post-acute care. Currently, limited data exist regarding which care setting provides the most benefit to this population. The purpose of this study is to examine differences in long-term employment outcomes of adult burn survivors by post-acute care setting. Data was obtained from the Burn Model System National Database between 1994 and 2016. Adult burn survivors who were alive at discharge and required post-acute care following acute care discharge were included. The population was divided into two groups - those who received post-acute care at an inpatient rehabilitation facility (IRF Group) and those who received post-acute care at a skilled nursing facility, long-term care hospital, or other extended care facility (Other Rehab Group). Employment status was assessed at 12 months post injury. Propensity score matching (controlling for 16 demographic and clinical variables) and logistic regression were used to determine the impact of post-acute care setting on employment status. This study included a total of 695 burn survivors (447 in the IRF Group; 248 in the Other Rehab Group). Individuals in the IRF Group had larger burns and were more likely to have an inhalation injury and to have undergone an amputation. Additional demographic and clinical characteristics can be found in Table 1. Logistic regression analysis using propensity score matching found the IRF Group had over 9 times increased odds of being employed at 12 months post-injury compared to the Other Rehab Group (p=0.046). Inpatient rehabilitation facilities provided a long-term benefit for burn survivors in terms of regaining employment when compared to other acute care settings such as skilled nursing facilities, long-term care hospitals, and other extended care facilities. Given the current lack of evidence-based guidelines on post-acute care decisions, the results of this study shed light on the potential benefits of the intensive services provided at inpatient rehabilitation facilities in this population. Demographic and clinical characteristics of the study population Demographic and clinical characteristics of the study population

Influence of training protocols on text input speed on a computer in individuals with cervical spinal cord injury: a randomised controlled trial.

Randomised controlled trial. To evaluate the impact of two different word prediction software (WPS) training protocols on text input speed (TIS) in people with tetraplegia and to determine which was the most effective. Rehabilitation department, Garches, France. Participants with neurological levels between C6 and C8 were allocated to one of three different groups. The REHAB group underwent training with an occupational therapist. The SELF group carried out a standardised home self-training with a written training guide. The CONTROL group had no training. Participants were assessed at day 15 (D15) and day 30 (D30). The primary outcome was a copying task with and without WPS (WITH and WITHOUT). Forty-two participants (mean age ± SD of 39.8 ± 12) were included and 38 completed the study. At D30, the mean (95% confidence interval) difference in TIS between the CONTROL and SELF groups was 3.8 [-1.7 to 9.4] characters per minute (cpm) (p = 0.23), between the REHAB and SELF groups was 12.9 [7.4 to 18.4] cpm (p < 0.001), and between the REHAB and CONTROL groups was 9.1 [3.5 to 14.6] cpm (p < 0.001). The results of this study showed that occupational therapist-supervised training improved TIS but word prediction software did not increase TIS. These results suggest that supervised training should be provided to all individuals who are prescribed with devices and systems to facilitate computer access in order to increase their TIS.

Training programs on text input speed in persons with cervical spinal cord injury

Computer access is important for social participation for people with cervical spinal cord injury (SCI). Different devices have been developed to enable them to use a computer but text input speed (TIS) with them is low. Several methods [e.g., word prediction software (WPS)] have been developed to increase TIS. In the literature, the effect of WPS on TIS was debatable. One hypothesis to explain the disparity is the lack of specific WPS-training programs for people with cervical SCI. The aim of this study was to compare the influence of three WPS-training programs on TIS in people with cervical SCI, and to determine which was the most effective. Participants were randomized to one of three different groups: a group with training with an occupational therapist (REHAB), a group with a standardized home self-training with a written training guide (SELF), and a third group that had no training (CONTROL). Forty-two participants were included and 38 completed the study. TIS improved significantly more in the REHAB group (with and without WPS) than in the CONTROL ( P < 0.001) and SELF groups ( P < 0.001) between D0 and D30. The results of this study showed that OT-supervised training improved TIS but did not provide any specific improvements in the use of WPS on TIS, although the number of recorded errors decreased when using WPS after training and the improvement of the rate of word prediction use. These results suggest that supervised training should be developed when providing patients with word prediction software, in order to increase their TIS.