Rehabilitation Medicine Department Research Articles

Knowledge, Skills, and Attitudes of Faculty Members and Residents-in-Training of the Department of Rehabilitation Medicine of the Philippine General Hospital towards Virtual Learning: A Cross-sectional Study

Background and Objectives. Virtual learning has been utilized in residency programs to continue training amid the COVID-19 pandemic. This study aimed to determine the knowledge, skills, and attitudes of faculty members and residents of the Department of Rehabilitation Medicine of the Philippine General Hospital towards virtual learning.
 Method. This is a descriptive cross-sectional study. Respectively, residents and faculty members answered the Online Learning Readiness Scale (OLRS) and Faculty Readiness to Teach Online (FRTO) through Google Forms.
 Results. Twenty (20) residents and 19 faculty members participated in the study. The majority of the residents preferred asynchronous learning (50%), while faculty members preferred the hybrid mode (74%). Residents’ readiness for online learning was generally high, though problems with easy distractibility (60%) and time management (40%) were revealed. Female residents had higher online communication self-efficacy compared to males (p = 0.0367). Faculty members’ perceived attitude was significantly higher than ability in course design (p = 0.00102), time management (p = 0.00159), and technical competence (p < 0.0001). Males had higher perceived ability in course design (p = 0.0320). Older age groups had lower perceived abilities in course design (p = 0.0301) and technical competence (p = 0.0371).
 Conclusion. This study revealed the levels of readiness of residents and faculty for virtual learning. Finding indicate the need to address both issues by developing programs to enhance faculty’s online teaching abilities and observing best practices to minimize problems such as distractibility. Large-scale studies with longer time frames are also recommended.

Facilitators and barriers for the implementation of exercise are medicine in routine clinical care in Dutch university medical centres: a mixed methodology study on clinicians’ perceptions

ObjectivesDespite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study...

Comparison Between Intra-Articular Steroid Injection And Ultrasound Therapy in Management of Chronic Knee Osteoarthritis

Objective: To compare the mean pain score and range of motion in chronic knee osteoarthritis patients treated with intraarticular Steroid injection versus ultrasound therapy.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Rehabilitation Medicine, Combined Military Hospital, Pano Aqil Pakistan, from Oct 2020 to Apr 2021.
 Methodology: Patients were divided into two groups (50 patients in each group). One group received ultrasound therapy for six weeks, with three sessions per week. The second group received a single 80mg intraarticular Triamcinolone Acetonide. Patients in both the groups were monitored for six weeks to assess the pain score and range of motion.
 Results: A total of one hundred (100) patients with knee pain due to chronic osteoarthritis were included in the study. The mean age in the ultrasound group was 54 ± 4.8 years and in the intra-articular group, the mean age was 54 ± 4.7 years. The mean reduction in pain score and mean improvement in the range of motion were compared between two groups and statistically significant difference was observed (p-value <0.001).
 Conclusion: According to our findings, intra-articular Corticosteroid injection is more effective in comparison to ultrasound therapy. However, there were statistically significant reductions in pain scores and improvements in the range of motion in both groups.

Stroke Rehabilitation Fact Sheet in Korea.

With rapid aging, the number of stroke survivors with disabilities in Korea is increasing even if mortality is declining. Despite coordinated efforts for quality improvement of stroke rehabilitation in Korea, the statistics of stroke rehabilitation were not well reported. This review aimed to provide contemporary and comprehensive statistics and recent changes in stroke rehabilitation in Korea. The Clinical Practice Guideline for Stroke Rehabilitation in Korea was developed in 2009 and updated in 2012 and 2016. Additionally, the representative databases for stroke rehabilitation include the Korean Brain Rehabilitation Database and the Korean Stroke Cohort for functioning and rehabilitation. These nationwide databases provided current information on stroke rehabilitation. Among Korean stroke survivors, one in three had motor impairment, one in four had cognitive impairment, one in three had speech impairment, one in four was dependent in ambulation, one in six had swallowing difficulty, and one in four was dependent in activities in daily living at 5 years after stroke. Comprehensive inpatient rehabilitation following transfer to the department of rehabilitation medicine significantly decreased stroke-related mortality and long-term disability. This review provides an improved understanding of stroke rehabilitation and guidance to implement timely, coordinated, evidence-based stroke rehabilitation services to relieve the socioeconomic burden of stroke.

Spinopelvic Alignment as a Risk Factor for Poor Balance Function in Low Back Pain Patients.

Retrospective, observational study. This study aimed to examine the association between spinopelvic parameters and balance function in low back pain (LBP). Among patients in the rehabilitation medicine department, the data of 182 patients (mean age, 47.8years; M/F = 64/118) was obtained retrospectively. Spinopelvic parameters were measured through a whole-body low-dose biplanar radiography using the EOS imaging system, and balance function was evaluated by the center of pressure (COP) movement using the Zebris treadmill system. Pearson correlations were used to determine the relationship between radiographic and balance function. Stepwise multiple linear regression analyses were conducted with the balance function as a dependent variable and age and spinopelvic parameters as independent variables. Increased age, knee flexion (KF), pelvic tilt (PT), C7-central sacral line (C7-CSL) and C7 sagittal vertical axis (SVA), and decreased spino-sacral angle (SSA) were associated with both poor static and dynamic balance. Moreover, increased Cobb's angle and decreased thoracic kyphosis (TK) and lumbar lordosis (LL) was associated with poor static balance. Increased pelvic incidence (PI) was related to poor dynamic balance. Increased age, Cobb's angle, SVA, and decreased TK were risk factors for poor static balance. For dynamic balance, increased age, C7-CSL, and PT were risk factors for poor sagittal balance, whereas increased CAM-plumb line and PT were risk factors for poor coronal balance. Balance function was associated with spinopelvic parameters in patients with LBP. Increased SVA, followed by increased PT, was the strongest independent factor associated with poor static and dynamic balance.

Analysis of the influencing factors related to neuropathic pain in patients with spinal cord injuries: a retrospective study

Background The aim of this study was to investigate the related influencing factors of neuropathic pain (NP) in patients with spinal cord injury (SCI). Methods Patients diagnosed with SCI between January 2016 and December 2019 in the Department of Rehabilitation Medicine, Affiliated Hospital of Guizhou Medical University, were screened for NP by using the Douleur Neuropathique 4 (DN4) questionnaire. A total of 133 patients diagnosed with SCI with NP were finally included in the study. We collected the patients’ basic information, including gender, age, body mass index (BMI), disease course, injury segment, American Spinal Injury Association (ASIA) grade, occupation, educational level, whether painkillers were used, stability of economic support, and pain level. Univariate and multiple ordered logistic regression analyses were used to examine the influencing factors of NP in the patients with SCI. Results The chi-square test revealed that disease course, injury level, severity of SCI (ASIA classification), stable economic support during hospitalization, and the use of painkillers had statistical significance (p < .01). A multivariate logistic regression analysis was performed to analyze the influencing factors of NP. ASIA grade, stable economic support, and use of painkillers were independent influencing factors of NP in patients with SCI, among which injury severity was the independent risk factor (odds ratio [OR] > 1). Stable economic support and painkiller use were protective factors (OR < 1). Conclusions In this study, we found no significant correlation between NP after SCI and sex, age, BMI, disease course, injury level, and occupation. However, the injury severity was an independent risk factor, and stable economic support and painkiller use were protective factors.

CUTOFF VALUE OF TWO-POINT DISCRIMINATION DISTANCES IN CARPAL TUNNEL SYNDROME

Background: Two-point discrimination test (2PD) represents large sensor fiber, which is more sensitive than smaller fiber to detect abnormality in carpal tunnel syndrome (CTS). Few studies have focused in 2PD to diagnose CTS.&#x0D; Objective: The study aimed to establish the cutoff value of 2PD to determine CTS.&#x0D; Methods: A descriptive diagnostic study was conducted at the Outpatient Department of Rehabilitation Medicine, Phramongkutklao Hospital. Participants who were suspected of having CTS were included in the study. All participants performed the 2PD test at the thumb, index finger and middle finger. The nerve conduction studies were performed and definitive diagnosis of CTS was based on the results. Data were analyzed using the receiver operation coefficient curve.&#x0D; Results: Of 48 participants (total of 95 hands), CTS was diagnosed in 85 hands (89.5%). Additionally, of all CTS hands, severity was mild degree in 17 hands (28.4%), moderate degree in 31 hands (32.6%) and severe degree in 37 hands (39%). The optimum cutoff values were &gt;4 mm having the sensitivities of 75.3, 68.2 and 68.2% while the specificities were 80, 90 and 90%, respectively, for the thumb, index finger and middle finger. The areas under curve were 0.826, 0.833 and 0.823, respectively.&#x0D; Conclusion: The participants with more than 4 mm of 2PD at the thumb, index finger and middle finger had high probability of having CTS.

Interpretation of Rehabilitation Medicine Specialty Indicators in National Report on the Services， Quality and Safety in Medical Care System

Since 2016, Peking University Third hospital has been entrusted by the National Health Commission to undertake the work of National Center for Healthcare Quality Management in Rehabilitation Medicine. For five consecutive years, it has compiled the National Report on the Services, Quality and Safety in Medical Care System (the section of rehabilitation medicine) (hereinafter referred to as the report), making up the gap in relevant data of rehabilitation medicine in China. This paper aims to interpret the indicators extracted and analyzed in the report, in order to continuously improve the integrity rate and accuracy rate of rehabilitation medical service and quality and safety investigation, and promote the continuous improvement of the quality of rehabilitation medical care in China. The index is composed of two kinds of indexes: quality control index and resource consumption index. The quality control index includes structure index, process quality index and result quality index, and consists of 16 major items and 149 sub-items. The report is carried out by the National Clinical Improvement System (NCIS), and the quality, accuracy and completeness of the data report will be used as the reference for hospital evaluation and key specialty setting. In NCIS indicators, data collection can be divided into the following four forms: automatic extraction of home page, extraction of medical records, manual reading of medical records and provision of relevant departments. This paper focuses on the early rehabilitation intervention, ADL improvement rate, complications and other key indicators, structural indicators and other process quality indicators. In recent years, National Center for Healthcare Quality Management in Rehabilitation Medicine has found that whether the rehabilitation medicine department has established an information system is an important factor determining the accuracy and convenience of quality control data extraction. Rehabilitation medical treatment and quality control information system is changing from information to intelligent, information management will combine with artificial intelligence natural language analysis and other emerging technologies, it can simplify and accurately the extraction process of quality control data, constantly improve the efficiency of rehabilitation medical quality control.

Exploration of the application of Picture-Based Memory Impairment Screen in stroke patients in a preliminary study

Objective The objective was to explore the validity and reliability of the Picture-Based Memory Impairment Screen (PMIS) assessment tool in stroke patients and to provide an objective basis for its application in China. Methods: A total of 30 stroke patients in the Department of Rehabilitation Medicine were assessed using the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the PMIS. The results were evaluated by content validity, simultaneous validity, consistency test of instruments of assessment, inter-scorer reliability, and retest reliability. Results: The correlation coefficient between each item score and total score of PMIS was between 0.422 and 0.778 (p < 0.05), showing good content validity. The total score of PMIS was moderately positively correlated with the MMSE short-term memory score (p < 0.001), highly positively correlated with the MMSE long-term memory score and retrospective memory score (p < 0.001), and highly positively correlated with the MoCA long-term memory score, memory index and total score (p < 0.001), indicating good criterion validity. The consistency test of the two instruments of assessment showed that a PMIS ≤ 5 was used as the demarcation score for dementia, and it was tested for consistency with the MMSE dementia score of stroke patients, and the Kappa value was 0.81 (p < 0.001). The inter-scorer reliability and retest reliability were good (inter-scorer reliability intra-group correlation coefficient (ICC) >0.95; retest reliability ICC 0.904). Conclusion: The PMIS was a reliable and valid assessment tool, which can be used as memory impairment screening tool for stroke patients in China.

Effect of robot-assisted gait training on the biomechanical properties of burn scars: a single-blind, randomized controlled trial.

BackgroundRobot-assisted gait training (RAGT) is more effective in the range of motion (ROM) and isometric strength in patients with burns than conventional training. However, concerns have been raised about whether RAGT might negatively affect the scars of patients with burns. Therefore, we investigated the effects of RAGT-induced mechanical load on the biomechanical properties of burn scars.MethodsThis was a single-blind, randomized clinical trial conducted on inpatients admitted to the Department of Rehabilitation Medicine between September 2020 and August 2021. RAGT was conducted for 30 min per day, five days a week for 12 weeks and the control group received conventional gait training for 12 weeks. The pre-training ROM of lower extremity joints was evaluated and the levels of melanin, erythema, trans-epidermal water loss, scar distensibility and elasticity were assessed before training and at 4 and 12 weeks after training. Finally, 19 patients in the gait assistance robot (GAR) group and 20 patients in the control group completed the 12-week trial and all evaluations.ResultsThere were no significant differences in the epidemiologic characteristics, pre-training ROM of joints and pre-training biomechanical properties of the burn scar between the groups (p > 0.05 for all). None of the patients experienced skin abrasion around the burn scar where the fastening belts were applied or musculoskeletal or cardiovascular adverse events during the training. Scar thickness significantly increased in both groups (p = 0.037 and p = 0.019) and scar distensibility significantly decreased in the control group (p = 0.011) during the training. Hysteresis was significantly decreased in the GAR group during the training (p = 0.038). The GAR and control groups showed significant difference in the change in the values of hysteresis between pre-training and 12 weeks after training (p = 0.441 and p = 0.049).ConclusionsRAGT significantly decreased hysteresis in hypertrophic burn scars and did not cause a significant decrease in skin distensibility. Moreover, no skin complications around the burn scars were detected during RAGT.Trial registrationThis study registered on the Clinical Research Information Service (KCT0005204).

Different frequencies of repetitive transcranial magnetic stimulation combined with local injection of botulinum toxin type A for post-stroke lower limb spasticity: study protocol for a prospective, single-center, non-randomized, controlled clinical trial

No definite consensus has currently been reached regarding the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity. The latest research indicates that when combined with local injections of botulinum toxin type A, it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone. We designed a prospective, single-center, non-randomized, controlled clinical trial to investigate the safety and efficacy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen. This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hospital of China Medical University. All enrolled patients will undergo routine rehabilitation training and will be divided into five groups (n = 30 per group) according to the particular area of cerebral infarction and treatment methods. Group A: Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; Group B: Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency (10-20 Hz) repetitive transcranial magnetic stimulation on the affected side; Group C: Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A; Group D: Patients with massive cerebral infarction will be given low-frequency (1 Hz) repetitive transcranial magnetic stimulation on the contralateral side; and Group E: Patients with non-massive cerebral infarction will be given high-frequency (10-20 Hz) repetitive transcranial magnetic stimulation on the affected side. The primary outcome measure of this trial is a modified Ashworth scale score from 1 day before treatment to 12 months after treatment. Secondary outcome measures include Fugl-Meyer Assessment of Lower Extremity, Visual Analogue Scale, modified Barthel index, and Berg Balance Scale scores for the same time as specified for primary outcome measures. The safety indicator is the incidence of adverse events at 3-12 months after treatment. We hope to draw a definite conclusion on whether there are differences in the safety and efficacy of low- or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation, thereby screening out the optimal therapeutic regimen. The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University (approval No. [2021] 2021-333-3) on August 19, 2021. The trial was registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2100052180) on October 21, 2021. The protocol version is 1.1.

Incidence, Disability, and Mortality in Patients With Guillain-Barré Syndrome in Korea: A Nationwide Population-Based Study.

Background and PurposeThis study aimed to identify the epidemiological features of Guillain-Barré syndrome (GBS) in the Korean population.MethodsPatients with GBS were defined as those who were hospitalized with a primary diagnostic code of G61.0 on the Korean Classification of Disease in a department of neurology, rehabilitation medicine, or pediatrics. We evaluated the incidence and prevalence of GBS as well as physical disability, mortality, and cause of death in patients with GBS from 2002 to 2018 in the Korean population using the Korean National Health Insurance Service database.ResultsWe identified 11,146 patients with GBS. The ratio of males to females was 1.48. The age-adjusted incidence rate per 100,000 persons increased steadily from 0.84 in 2002 to 1.68 in 2018, as did the age-adjusted prevalence rate per 100,000 persons, from 0.77 to 15.62. The incidence and prevalence of GBS increased with age, peaking at 70–79 years. Among 10,114 patients without physical disability at the time of GBS being diagnosed, 502 (5.0%) patients had moderate disability and 526 (5.2%) had severe disability by the end of the study period. A total of 1,221 (11.0%) patients with GBS died during the mean follow-up period of 17 years (2002–2019). There were 144 (1.3%) in-hospital deaths.ConclusionsThis was the first nationwide epidemiological study of patients with GBS covering the entire population including patients of all ages in the Republic of Korea. We have revealed the seasonality of admissions, disability, and long-term mortality rates in patients with GBS.

Application Value of Flexible Endoscopic Examination of Swallowing in Acute Stoke Patients With Dysphagia.

Background:The aim was to study the application value of flexible endoscopic examination of swallowing (FEES) for the aspiration screening, the diagnosis of dysphagia and evaluation of the therapeutic effect in acute stoke patients with dysphagia.Methods:A total of 525 patients with acute stoke who were hospitalized from October 2015 to January 2021 in the Rehabilitation Medicine Department of our hospital underwent FEES for analyzing the characteristic performance. Twenty-one cases of them were examined by video fluoroscopic swallow study and compared with the results of FEES for evaluating the reliability of the FEES, the reliability of diagnosis of dysphagia, and the consistency of the 2 methods. The effect of rehabilitation was evaluated by comparing the FEES test results before and after treatment.Results:In 525 patients, the FEES revealed 378 cases of aspiration (139 cases were silent aspiration), showing a higher detection rate than water swallow test. Patients with potential cricopharyngeus achalasia got the same results through both of examinations. FEES can provide more positive indicators, guide clinical rehabilitation treatment and objectively assess the effect of rehabilitation.Conclusions:Acute stoke patients with dysphagia have characteristic pharyngeal and laryngeal performance. FEES is simple to operate and has high application value in the diagnosis and treatment of dysphagia.

Stay Home, Work Safe: Attitudes and Beliefs of Members of a Department of Palliative Care, Rehabilitation, and Integrative Medicine Regarding Remote Work during the COVID-19 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic compelled rapid transition to work from home for the University of Texas MD Anderson Cancer Center Palliative, Rehabilitation, and Integrative Medicine (PRIM) department to ensure social distancing and prevention of transmission. Objectives: To survey the attitudes and beliefs of personnel toward remote work during the COVID-19 pandemic. Methods: One hundred forty-eight clinical, research, and administrative PRIM department employees were invited to participate in an anonymous voluntary survey in May 2020, two months after the beginning of the COVID-19 pandemic and transition to work from home in the geographic location of Houston, Texas. The survey comprised 25 questions, including employee demographics and attitudes and beliefs toward working from home and the COVID-19 pandemic. Results: Ninety-four percent (139) of employees responded, with high response rates among all three employee arms. The majority of respondents were female (74%), between the ages of 30 and 59 years (87%), had broadband Internet (93%), and shared office space before working from home (59%). There were overall positive reports of experience (87%) and emotional response (79%) toward working from home, especially for those more concerned about COVID-19 illness and spread, shared office space, and those reporting adequate resources and equipment for remote work. Clinical role, however, was associated with a less positive response (80%), less productivity (29%), and higher levels of stress (62%). Most of the department also reported increased emotional exhaustion (68%). When surveyed about permanently working from home, most of the department responded favorably (69%). Conclusions: The PRIM rapid transition to remote work was associated with positive perceptions by most members of the clinical, research, and administrative teams. Insight from this survey can serve as a model for future rapid transitions in remote work and merits follow-up studies to prepare us for a postpandemic work environment. Clinical Trial Registration number NCI-2021-01265.

Effect of gait training using Hybrid Assistive Limb on gait ability and the risk for overwork weakness in the lower limb muscles in patients with neuromuscular disease: a proof-of-concept study.

Few previous studies have reported the efficacy of robot rehabilitation for improving gait ability or its adverse events in patients with neuromuscular diseases. The aim of the present study was to elucidate the effects of gait training with a hybrid assistive limb (HAL) on gait ability and to investigate serum enzyme levels associated with skeletal muscle damage. Proof-of-concept study. Department of rehabilitation medicine in university hospital. Twenty-one patients with neuromuscular disease (NMD, 13 males and 8 females, mean age of 60.6 years). All patients underwent 1 to 5 series of gait rehabilitation which consisted of 9 sessions of HAL training. Gait ability was assessed with the 10-meter walk test and the 2-min walk test before and after HAL training, while serum creatine phosphokinase, aspartate aminotransferase, and lactic acid dehydrogenase values were measured before, midway through, and after HAL training. Gait velocity and step length for 10-meter walk test, and 2-min walk distance were significantly improved after HAL gait training. There was no significant change in serum level of all 3 measured enzymes between the three time points. HAL gait training with the practical setting as this study improved gait ability in patients with progressive NMD and did not damage skeletal muscle, as indicated by no significant change in serum level of muscle enzymes. Robot assisted gait training could be safely applied to the patients with NMD, as one of the effective rehabilitation programs to improve gait ability.

Self-report Versus Measured Physical Activity Levels During Outpatient Cardiac Rehabilitation.

Many patients with coronary artery disease (CAD) do not achieve the recommended physical activity (PA) levels during and after cardiac rehabilitation (CR). The aim of this study was to analyze moderate to vigorous physical activity (MVPA) levels and the differences between perceived (self-reported) and measured (activity monitor) MVPA in CAD patients during CR. The second aim was to analyze which patient characteristics were associated with this difference. A two-center observational-sectional study was conducted within the Department of Rehabilitation Medicine of the University Medical Center Groningen between January and April 2018. Adults with CAD, following an outpatient CR program, were included. Perceived MVPA was assessed with the Short Questionnaire to Assess Health-enhancing Physical Activity and compared with ActivPAL3 activity monitor outcomes over a period of 7 d. Fifty-one patients with CAD (age 59.4 ± 7.1 yr, eight females) were recruited. Four patients (8%) did not achieve the recommended guideline level of ≥150 min/wk of MVPA. Patients spent ≥80% of the week in sedentary activities. Patients overestimated MVPA with a median of 805 (218, 1363) min/wk (P< .001). The selected patient characteristics (age, body mass index, type of CAD, type of CR, social support, and self-efficacy) were not associated with this overestimation. Most patients with CAD, participating in an outpatient CR program, do achieve MVPA exercise recommendations but spend simultaneously too much time in sedentary activities.

Development of a feedback evaluation tool for the assessment of telerehabilitation as a teaching-learning tool for medical students

Introduction: In the Philippines, telerehabilitation has been at the forefront of integrating telemedicine into the medical curriculum. However, the course evaluation tool used for traditional classroom-based courses is not appropriate in evaluating the unique teaching-learning tool that is telerehabilitation. This study aimed to develop a questionnaire that will aid in addressing this gap. Method: A mixed methods study was devised to gather information from medical students exposed to telerehabilitation from the College of Medicine, University of the Philippines Manila as well as the residents from the Department of Rehabilitation Medicine, Philippine General Hospital from October to November 2019. The investigators obtained informed consent from all participants as well as their demographics before undergoing interviews. Themes were identified to create questions under the previously identified constructs, along with items derived from other course evaluation tools and opinions gathered from experts in telerehabilitation. Results: In total, 26 individuals participated in the study. Most of the respondents had experience or ownership of various communication technologies and were well-versed in communication strategies through these technologies. There were 52 questions formulated from the interviews and review of previous tools. Conclusion: This study is the first step in providing more research in the student evaluation of telerehabilitation and telemedicine. To match the needs of changing times evaluation of new standards and methods should follow. More research must be done to standardise teaching evaluation tools to validate the data gathered, and allow courses, such as telerehabilitation, an opportunity to adapt and promote further learning.

Optimizing Protocol Selection for Cardiopulmonary Exercise Testing in Slowly Progressive Neuromuscular Diseases

<h3>Research Objectives</h3> To develop a predictive model for cardiopulmonary exercise test (CPET) workload increments in individuals with slowly progressive neuromuscular diseases (NMD). <h3>Design</h3> Observational study. <h3>Setting</h3> Data were collected from multiple research projects at the Department of Rehabilitation Medicine at the Amsterdam UMC, location AMC. <h3>Participants</h3> Individuals (29 men, age: 59.8 ± 12.5) with post-polio syndrome (N = 25), Charcot-Marie-Tooth disease (N = 34) and other slowly progressive NMD (N = 10). <h3>Interventions</h3> Participants underwent a CPET on a cycle ergometer to determine the maximal peak power output in Watts (Wpeak-measured). <h3>Main Outcome Measures</h3> Forward linear regression analysis was performed with Wpeak-measured as dependent variable and age, gender, body mass index, Medical Research Council sum score (MRCsum) of muscle strength, 6-minute walking (6MWT) distance and energy consumption as independent variables. Determinants significantly associated with Wpeak-measured (p < 0.05) were included in a multivariate regression model to predict peak power output: Wpeak-predicted. The mean difference between Wpeak-measured and Wpeak-predicted was assessed with a paired t-test, and the Limits of Agreement (LoA) to determine the individual bias. <h3>Results</h3> The regression analysis resulted in the following model: Wpeak-predicted = - 64.308 + 45.743 x gender (0 = female; 1 = male) + 1.060 x MRCsum + 0.287 × 6MWT distance (R2 = 0.58). No significant difference was found between Wpeak-measured (mean = 127.7 ± 56.5 Watts) and Wpeak-predicted (mean = 122.1 ± 43.2 Watts). The LoA were -64.5, +75.7 Watts. <h3>Conclusions</h3> Our model predicted Wpeak accurately in patients with slowly progressive NMD. However, based on a lack of accuracy the model is not yet recommended in clinical practice and further research with higher sample size is required. <h3>Author(s) Disclosures</h3> None.

The Deleterious Impact of Opioids on Sleep-Related Respiration During Acute Inpatient Rehabilitation From Moderate to Severe

<h3>Research Objectives</h3> To identify differences sleep related respiration between those receiving and not receiving opioid medications. <h3>Design</h3> Cross-sectional, secondary analyses. <h3>Setting</h3> Acute inpatient rehabilitation for moderate to severe TBI. <h3>Participants</h3> 248 consecutive admissions who underwent level-1 polysomnography. <h3>Interventions</h3> Receipt of opioid medications on the day of polysomnography (PSG). <h3>Main Outcome Measures</h3> PSG including respiratory measures: oxygen saturation, central apneas events per hour, obstructive apneas and hypopnea events per hour, and total apnea-hypopnea index (AHI). <h3>Results</h3> After adjustment for number of prescribed medications, those receiving opioids on day of PSG experienced increased frequency of central sleep apnea events and higher frequency of obstructive sleep apnea events. Compared to those who did not, receiving opioids was associated with lower oxygen saturation nadir during and a greater number of oxygen desaturations across. Greater total AHI was observed for those receiving opioids. <h3>Conclusions</h3> Opioid use early after TBI appears to impact important sleep parameters and sleep related respiration that may influence recovery. Further investigation is needed to understand the impact of opioid medications, alone or in combination with other medications, on functional outcomes both early after TBI and in the chronic phase to develop recommendations on how and when to use these medications given their usage in managing pain after injury. <h3>Author(s) Disclosures</h3> Research reported in this article was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1511-33005). This research was sponsored by VHA Central Office VA TBI Model Systems Program of Research; Subcontract from General Dynamics Information Technology (W91YTZ13-C-0015; HT0014-19-C-0004) from the Defense Health Agency TBI Center of Excellence and National Institute on Disability, Independent Living, and Rehabilitation Research (University of Texas Southwestern Medical Center, 90DPTB0013-01-03; Indiana University School of Medicine, Rehabilitation Hospital of Indiana, 90DRTB0002; Division of Rehabilitation Psychology, Department of Rehabilitation Medicine, University of Washington School of Medicine, 90DPTB0008). The TBI Model Systems is a funded collaboration between the Department of Veterans Affairs and the Department of Health and Human Services: National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Clinicaltrial.gov Registration Number: NCT03033901.

The Effectiveness of High-Intensity Laser Therapy (HILT) on de Quervain's Tenosynovitis: A Randomized, Double-Blinded (Patient and Assessor), Controlled Trial

<h3>Research Objectives</h3> To investigate the added-on effect of high-intensity laser therapy (HILT) over standard treatment (splinting and exercise) in patients with de Quervain's tenosynovitis. <h3>Design</h3> Experimental study, randomized by computer generating sequence with block of four method, allocation concealment, double-blinded (patient and assessor), controlled trial. Total 6 weeks duration of the study for each participant. <h3>Setting</h3> Out-patient clinic at department of rehabilitation medicine, King Chulalongkorn Memorial Hospital. <h3>Participants</h3> Nineteen subjects; ten in intervention group and nine in control group. <h3>Interventions</h3> First 3 weeks; high-intensity laser therapy (HILT) in intervention group and sham HILT in control group. Both groups were instructed hand exercise and thumb spica splint wearing along total 6 weeks of the study. <h3>Main Outcome Measures</h3> Visual analog scale (VAS) and grip strength at baseline (before HILT or sham HILT), after laser treatment (3rd week of the study), and 3 weeks after laser treatment (6th week of the study). <h3>Results</h3> Both groups demonstrated statistically significant improvement in VAS compared with baseline. However, there was no statistically significant difference of GS in both groups. And there was no statistically significant difference between groups for both outcomes. <h3>Conclusions</h3> There is no additional benefit of HILT on reducing pain and improving hand functional outcome in patients with de Quervain's tenosynovitis over the standard treatment of thumb spica splint and exercise. <h3>Author(s) Disclosures</h3> No conflicts of interest have been declared.