Rehabilitation Phases Of Care Research Articles

Behavioral Assessment With the Coma Recovery Scale-Revised Is Safe and Feasible in Critically Ill Patients With Disorders of Consciousness.

Accurate classification of disorders of consciousness (DoC) is key in developing rehabilitation plans after brain injury. The Coma Recovery Scale-Revised (CRS-R) is a sensitive measure of consciousness validated in the rehabilitation phase of care. We tested the feasibility, safety, and impact of CRS-R-guided rehabilitation in the ICU for patients with DoC after acute hemorrhagic stroke. Retrospective cohort study. This single-center study was conducted in the neurocritical care unit at the University of Maryland Medical Center. We analyzed records from consecutive patients with subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH), who underwent serial CRS-R assessments during ICU admission from April 1, 2018, to December 31, 2021, where CRS-R less than 8 is vegetative state/unresponsive wakefulness syndrome (VS/UWS); CRS-R greater than or equal to 8 is a minimally conscious state (MCS). None. Outcomes included adverse events during CRS-R evaluations and associations between CRS-R and discharge disposition, therapy-based function, and mobility. We examined the utility of CRS-R compared with other therapist clinical assessment tools in predicting discharge disposition. Seventy-six patients (22 SAH, 54 ICH, median age = 59, 50% female) underwent 276 CRS-R sessions without adverse events. Discharge to acute rehabilitation occurred in 4.4% versus 41.9% of patients with a final CRS-R less than 8 and CRS-R greater than or equal to 8, respectively (odds ratio [OR] 13.4; 95% CI, 2.7-66.1; p < 0.001). Patients with MCS on final CRS-R completed more therapy sessions during hospitalization and had improved mobility and functional performance. Compared with other therapy assessment tools, the CRS-R had the best performance in predicting discharge disposition (area under the curve: 0.83; 95% CI, 0.72-0.94; p < 0.0001). Early neurorehabilitation guided by CRS-R appears to be feasible and safe in the ICU following hemorrhagic stroke complicated by DoC and may enhance access to inpatient rehabilitation, with the potential for lasting benefit on recovery. Further research is needed to assess generalizability and understand the impact on long-term outcomes.

WTP5.6 Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM): A Qualitative Study of Clinician Experiences on Deploying and Supporting Consumer Wearable Devices

Abstract Introduction Consumer wearables such as smart watches and rings have the potential to provide continuous monitoring of patients receiving cancer treatment in their prehabilitation and rehabilitation phases of care. Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM) is a multi-centre prospective trial evaluating feasibility and acceptability of wearable technologies for patients undergoing treatment for colorectal cancer, lung cancer or lymphoma within Greater Manchester (ClinicalTrials.gov NCT05099237). We report the initial findings of the clinician’s perspective on deploying and supporting the use of wearable devices. Methods A qualitative study was conducted to ascertain the experiences of researchers who recruited participants to EMBRaCE-GM. Three interviewers conducted structured interviews and a thematic analysis was performed. Results Thirteen researchers were interviewed, and 3 major themes identified. The first identifies the importance of the device set-up phase, such as integration into the patient’s existing technological ecosystem, and the training provided to clinical teams. The second theme was patient engagement with the technology, such as the burden of interacting with the device (‘digital load’), and comfort and aesthetics. The final theme involved the support infrastructure for technical issues and device maintenance as well as safe protocols and governance for responding to device alerts, particularly if patients were unwell. Discussion Wearable technologies have the potential to provide ongoing benefit through continuous monitoring outside the hospital setting for patients receiving cancer treatment. This study, as part of the EMBRaCE-GM project, identifies important themes critical for future patient and clinician adoption of wearable devices.

The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry

Development of a prospective patient registry. To develop a patient registry for persons with traumatic spinal cord injuries (SCI), which can be used to answer research questions and improve patient outcomes. Nine provinces in Canada. The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is part of the Translational Research Program of the Rick Hansen Institute. The launch of RHSCIR in 2004 heralded the initiation of the first nation-wide SCI patient registry within Canada. Currently, RHSCIR is being implemented in 14 cities located in 9 provinces, and there are over 1500 individuals who have sustained an acute traumatic SCI registered to date. Data are captured from the pre-hospital, acute and rehabilitation phases of care, and participants are followed in the community at 1, 2, 5 and then every 5 years post-injury. During the development of RHSCIR, there were many challenges that were overcome in selecting data elements, establishing the governance structure, and creating a patient privacy and confidentiality framework across multiple provincial jurisdictions. The benefits of implementing a national registry are now being realized. The collection of an internationally standardized set of clinical information is helping inform clinicians of beneficial interventions and encouraging a shift towards evidence-based practices. Furthermore, through RHSCIR, a network is forming amongst SCI clinicians and researchers, which is fostering new collaborations and the launch of multi-center clinical trials. For networks that are establishing SCI registries, the experiences and lessons learned in the development of RHSCIR may provide useful insights and guidance.

The Global Evidence Mapping Initiative: Scoping research in broad topic areas

BackgroundEvidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI).MethodsThe GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search.2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers.3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction.ResultsOne hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions.ConclusionsGEM Initiative evidence maps have a broad range of potential end-users including funding agencies, researchers and clinicians. Evidence mapping is at least as resource-intensive as systematic reviewing. The GEM Initiative has made advancements in evidence mapping, most notably in the area of question development and prioritisation. Evidence mapping complements other review methods for describing existing research, informing future research efforts, and addressing evidence gaps.

Grip strength is associated with nutritional status and energy intake in healthy community living older adults

The UK has an ageing population and this will place large demands on future health and social care systems (1) . In an attempt to minimise this increase in expenditure, it is important to encourage the ageing population to optimise their health and ability to live independently. The functional marker grip strength, determined by handgrip dynamometry (HGD), has been shown to be a predictor of all cause mortality (2) , disability (3) and thus dependency and in older adults. While dietary intake and nutritional supplementation has been shown to improve function in the rehabilitation phase of care (4) , the association dietary intake has with nutritional and functional status has not be fully investigated in the community dwelling older adult population. Handgrip may provide an indication of health status in this ever expanding population. The aim of the study was to determine whether an association exists between energy intake, nutritional status and HGD. Healthy, cognitively intact, community dwelling adults aged 65 + years were recruited from community networks. Energy intake (1 kcal = 4.184 kJ) was recorded by a 7-d self-administered unweighed food diary. Anthropometric measurements (weight, height, BMI, waist circumference (WC), tricep skin-fold thickness (TSF) and arm muscle circumference (AMC)), were measured using standard methodology. HGD was measured using a Takei grip strength dynamometer in the non-dominant arm. BMI was compared to age-specific norms, and TSF, AMC, WC and HGD were compared to gender-specific norms. Correlation analysis was used to identify associations between variables. Twenty-one people, 11 men and 10 women, aged 65–82 years (mean 74, SD 4.9), with mean BMI of 27.1 kg/m 2 (SD 2.3) were recruited. When compared to a BMI of 27 kg/m 2 (considered normal in this population (5) there was no significant difference. With the exception of women in relation to TSF there was no significant difference in, WC (cm), TSF (mm), AMC (cm) and HGD (kg) in comparison to normal values (WC: men mean 104.7, SD 9.8, women mean 87.6, SD 9.8, TSF: men mean 12.4, SD 4.5, women mean 18.9, SD 3.0, AMC: men mean 25.6, SD 2.6, women mean 23.4, SD 2.03, HGD men mean 38.0, SD 5.1, women mean 22.4, SD 5.1). HGD correlated with energy intake (r = 0.775, P < 0.001) (see Figure). HGD also correlated with weight (r = 0.576, P < 0.01), height (r = 0.656, P < 0.01), WC (r = 0.66, P < 0.01), TSF (r = - 0.562, P < 0.01) and AMC (r = 0.465, P < 0.05). As HGD is a simple measure and an important marker in monitoring functional change and predicting functional decline the relationship between HGD and diet, particularly in relation to energy intake, it needs further investigation.

Operational Critical Care. Intensive Care and Trauma

Trauma management involves good prehospital, emergency, surgical, anaesthetic and intensive care decision-making. Optimal outcome depends on keeping abreast of the latest thinking in an ever-changing and increasingly technology-rich environment. The...