Rehabilitation Program Research Articles

Achilles Tendon Mechanical But Not Morphological Properties Change with Rehabilitation in Patients with Chronic Midportion Achilles Tendinopathy

ABSTRACT Purpose Achilles tendinopathy (AT) is associated with altered tendon’s morphological and mechanical properties, yet it is unclear whether these properties are reversed upon mechanical loading to promote tendon healing. This study aims to determine the extent to which pathological tendon’s morphological and mechanical properties adapt throughout a 12-week eccentric rehabilitation protocol. Methods Forty participants with midportion AT were recruited and participated in a 12-week eccentric rehabilitation program. Function and symptoms were recorded through the Victorian Institute of Sports Assessment-Achilles (VISA-A) and hopping. The tendon’s morphological (i.e. volume, midportion cross-sectional area (CSA) and anteroposterior (AP) diameter) and mechanical (i.e. stiffness, Young’s modulus, and tendon non-uniform displacement) properties were measured at baseline and at 6 and 12 weeks of the intervention. Results Significant functional improvements were observed, with VISA-A scores and hopping results showing marked improvements (p < 0.001). Morphologically, no significant changes in volume, midportion CSA, or AP diameter were found, although a trend toward decreased CSA between 30-70% of tendon length was noted. Mechanically, significant increases in Achilles tendon stiffness (p = 0.001) and Young’s modulus (p < 0.001) were observed over the course of the rehabilitation program. No differences in tendon non-uniform displacement were found following a 12-week rehabilitation program. Conclusions These findings suggest that tendon adaptation in response to mechanical loading primarily involves changes in mechanical properties rather than morphology, highlighting the complexity and variability in tendon adaptation. Clinically, these mechanical properties could be considered in the load progression throughout rehabilitation as potentially higher strains will be induced when clinical improvements precede mechanical adaptations.

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.

Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study

Background Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements. Objective This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response–related factors in children with impaired SVMC undergoing inpatient neurorehabilitation. Methods We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children’s Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment. Results Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study. Conclusions The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention. Trial Registration German Clinical Trials Register DRKS00025184; https://tinyurl.com/msnkek9b

Machine learning insights into scapular stabilization for alleviating shoulder pain in college students

Abstract Non-specific shoulder pain is a common musculoskeletal condition, especially among college students, and it can have a negative impact on the patient’s life. Therapists have used scapular stabilization exercises (SSE) to enhance scapular control and mobility. This study investigates the prediction of the impact of scapular stability exercises in treating non-specific shoulder pain, leveraging advanced machine learning techniques for comprehensive evaluation and analysis. Using a diverse range of regression models, including Gamma Regressor, Tweedie Regressor, Poisson Regressor, and others, the study examines the relationship between the effectiveness of various exercises and their impact on shoulder pain management. Furthermore, the study employs optimization techniques, such as Hyperopt, scikit-optimize, optunity, GPyOpt, and Optuna, to fine-tune the exercise protocols for optimal outcomes. The results reveal that scapular stabilization exercises, when optimized using machine learning algorithms, significantly contribute to reducing shoulder pain in college students. Among the optimization techniques, scikit-optimize demonstrated the best performance, resulting in a mean squared error of 0.0085, a mean absolute error of 0.0712, and an impressive R2 score of 0.8501. This indicates that the scikit-optimize approach yielded the most accurate predictions and effectively captured the relationship between the exercises and shoulder pain management. The findings highlight the critical role of scapular stabilization exercise interventions in ameliorating non-specific shoulder pain and underscore the potential of machine learning techniques in optimizing therapeutic strategies for musculoskeletal health management. The utilization of scikit-optimize, in particular, showcases its effectiveness in fine-tuning the exercise protocols for optimal outcomes. The study’s results serve as a crucial stepping stone in developing personalized rehabilitation programs for non-specific shoulder pain, emphasizing the importance of integrating machine learning methodologies in the assessment and treatment of musculoskeletal disorders among college students.

A prospective observational study examining changes in exercise capacity, physical activity, and motivation for physical activity 12 months after a cardiac rehabilitation programme in patients with coronary heart disease

A prospective observational study examining changes in exercise capacity, physical activity, and motivation for physical activity 12 months after a cardiac rehabilitation programme in patients with coronary heart disease

Immunoglobulin G4-related spinal pachymeningitis: A case report

BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a complex immune-mediated condition that causes fibrotic inflammation in several organs. A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis, which manifests as inflammation of the dura mater in intracranial or spinal regions. Although IgG4-RD can affect multiple areas, the spine is a relatively rare site compared to the more frequent involvement of intracranial structures. CASE SUMMARY A 70-year-old male presented to our hospital with a two-day history of fever, altered mental status, and generalized weakness. The initial brain magnetic resonance imaging (MRI) revealed multiple small infarcts across various cerebral regions. On the second day after admission, a physical examination revealed motor weakness in both lower extremities and diminished sensation in the right lower extremity. Electromyographic evaluation revealed findings consistent with acute motor sensory neuropathy. Despite initial management with intravenous immunoglobulin for presumed Guillain-Barré syndrome, the patient exhibited progressive worsening of motor deficits. On the 45th day of hospitalization, an enhanced MRI of the entire spine, focusing specifically on the thoracic 9 to lumbar 1 vertebral level, raised the suspicion of IgG4-related spinal pachymeningitis. Subsequently, the patient was administered oral prednisolone and participated in a comprehensive rehabilitation program that included gait training and lower extremity strengthening exercises. CONCLUSION IgG4-related spinal pachymeningitis, diagnosed on MRI, was treated with corticosteroids and a structured rehabilitation regimen, leading to significant improvement.

High-Intensity Interval Training vs. Medium-Intensity Continuous Training in Cardiac Rehabilitation Programs: A Narrative Review

Exercise-based cardiac rehabilitation (ExCR) programs are essential for patients diagnosed with cardiac diseases. Studies have shown that they aid in the rehabilitation process and may even facilitate a return to previous cardiorespiratory fitness. Also, patients who enroll and follow such programs have shown a lower rate of complications and mortality in the long run. The results vary depending on the type of program followed and the degree of debilitation the disease has caused. Therefore, in order to obtain optimal results, it is ideal to tailor each ExCR program to the individual profile of each patient. At the moment, the two most studied and employed training types are medium-intensity continuous training (MICT) and high-intensity interval training (HIIT). For most of the time, MICT was the first-choice program for patients with cardiovascular disease. In recent years, however, more and more studies have pointed towards the benefits of HIIT and how it better aids patients in recovering their cardiovascular fitness. Generally, MICT is more suited for patients with a severe degradation in functional capacity and who require a higher degree of safety (e.g., elderly, with a high number of comorbidities). On the other hand, while HIIT is more demanding, it appears to offer better outcomes. Therefore, this review aimed to summarize information from different publications on both types of training regimens in ExCR and assess their utility in current clinical practice.

The effect of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery: a randomized controlled trial.

Exergames, which combine digital games and physical exercise, have become increasingly popular for rehabilitation in the health domain. This study aimed to assess the effectiveness of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery. This randomized controlled trial evaluated the effectiveness of exergame rehabilitation on the quality of life of cancer patients who had undergone abdominal surgery. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcome was the quality of life, and data collection occurred at three different time points: upon admission, 48h postoperatively, and on the 7th day after surgery. Quality of life was evaluated using the WHOQOL-BREF Scale. At the third assessment, a statistically significant difference was observed between the two groups (p = 0.016), indicating that the intervention group had a higher quality of life than the control group. The study showed a positive effect of exergames on the population under investigation. By the 7th day after surgery, the intervention group demonstrated an improvement in their quality of life compared to the control group. Center of Open Science OSF https://osf.io/286zb/ , registered in July, 2023.

Differences in 6-Minute Walk Distance Across Heart Disease Recurrence Risk Levels in Cardiac Rehab Patients

Background/Objectives: Cardiac rehabilitation (CR) programs are multi-component interventions comprising structured strength and cardiovascular exercise training, psychological support, education, and therapies to promote positive lifestyle changes. This study aimed to determine if there are differences in the 6-minute walk distance (6MWD) across risk groups for recurrent heart disease. Methods: This retrospective cohort study used existing data collected from electronic medical records. The 6-minute walk distance was measured at baseline (pre-6MWD) and upon the completion of the CR program (post-6MWD). Short-term cardiac event recurrence risk was determined using a two-year recurrent coronary heart disease (2yRCHD) risk percentage, calculated according to the Framingham 2yRCHD calculator. Risk was then stratified into (1) low, (2) moderate, and (3) high-risk groups. Demographic variables (e.g., age, sex, racial/ethnic group) and clinical variables (e.g., BMI, lipid panels, fasting glucose levels, comorbidities) were collected to describe the study participants and identify potential confounders. An ANOVA and ANCOVA were performed to examine the differences in 6MWD across the 2yRCHD risk groups. Results: A total of 394 CR participants’ data were included in this analysis. Ninety-nine percent of the female participants were classified as low risk for recurrent heart disease, resulting in an extremely small sample size in the moderate-risk (n = 1) and no representation (n = 0) in the high-risk group. This lack of representation made it impossible to conduct comparative analyses across all the participants or to analyze female participants separately by risk category. Consequently, only male participant data were included in the final analysis. The study showed that pre- and post-6MWD measurements were significantly different across the three 2yRCHD risk groups (p = 0.006 for pre-6MWD; p = 0.002 for post-6MWD). The ANCOVA indicated that these differences were independent of the selected covariates. Post hoc analyses revealed significant differences in 6MWDs between the low- and high-risk groups and between the moderate- and high-risk groups, but not between the low- and moderate-risk groups, for both pre- and post-6MWD measurements. Compared to the CR participants in the high-risk group, those in the low- and moderate-risk groups achieved significantly longer distances in the 6-minute walk tests. Conclusions: The observed differences in the 6MWD across short-term cardiac recurrence risk levels suggest its potential as a simple, accessible tool for assessing cardiac recurrence risk levels in community settings. Further research is needed to generalize these findings to more diverse populations and to support aging in place for older adults living with heart disease.

Preoperative hip abductor strength predicts discharge destination after total hip arthroplasty.

This study aimed to clarify the association between preoperative physical function and discharge destination after total hip arthroplasty (THA). This retrospective study included patients who underwent primary unilateral THA for hip osteoarthritis. Preoperative physical function was assessed via maximal isometric muscle strength (hip abduction and knee extension) and comfortable walking speed. The patients were divided into two groups according to the discharge destination (home or transfer to other facilities). Multivariate logistic regression analysis was used to identify preoperative physical function associated with discharge destination. Of the 174 patients, 120 were discharged directly to home, and 54 were transferred to other facilities. Those transferred to other facilities were significantly older, more likely to live alone, and had a longer operation time. In addition, they demonstrated lower hip abductor strength on both sides and lower knee extensor strength on the operative side. Multivariate logistic regression analysis revealed that hip abductor strength on both sides, not knee extensor strength, was independently associated with the discharge destination. The largest area under the receiver operating characteristic curve was 0.668 for the hip abductor strength of the contralateral side. The optimal cutoff point was revealed to be 0.035 kgf·m/kg and 0.031 kgf·m/kg for the operative and contralateral sides, respectively. Preoperative hip abductor strength, particularly on the contralateral side with a cutoff value of 0.031 kgf·m/kg, could be a predictor of discharge destination after unilateral THA. Our findings would be useful in planning rehabilitation programs.

Total sacrectomy rehabilitation: Implementation of the international classification of functioning, disability, and health model – A case report

This study aims to outline an evaluative diagnostic process and intervention for a patient who underwent total sacrectomy based on the International Classification of Functioning, Disability, and Health (ICF) model. A 70-year-old male with a history of an aggressive sacral chordoma experiencing intense pain, constipation, and polyuria without the sensation of bladder filling, underwent a total sacrectomy. Two evaluations at two-time points were conducted 12 weeks apart. The patient then underwent an individualized rehabilitation program tailored to address impairments, activity limitations, and participation restrictions. The care plan was adjusted based on the patient’s health status and relevant personal and environmental factors. The Barthel Scale scores improved from 60 to 80. Motor scores on the American Spinal Injury Association scale increased from 62 to 66, while sensory scores for light touch improved from 86 to 96. However, pain scores remained stable at 86. Functional reach tests showed notable enhancements, with anterior reach increasing from 16.4 cm to 23.7 cm and lateral reach from 9.6 cm to 15.2 cm. The patient also showed progress in mobility, increasing the number of steps taken from 0 to 10. This case report highlights the positive therapeutic outcomes achieved, illustrating improvements in functional activities and patient independence, thereby underscoring the effectiveness of the ICF model in managing patients undergoing total sacrectomy.

Stronger Together: A Qualitative Exploration of Social Connectedness in Parkinson's Disease in the Digital Era.

Social isolation is a common consequence of Parkinson's disease (PD), and social prescribing has become a crucial aspect for fostering well-being in this population. In fact, group work has been shown to improve levels of social connectedness in older adults across different domains. Increased technology use in older adults may also contribute to increased social connections, especially since the COVID-19 pandemic. Still, the impact of digital use on social connectedness remains to be further explored in individuals with PD. Therefore, the purpose of this study was to examine the perceptions of social connectedness in relation with group-based activities and use of digital technologies in this population. Ten individuals with PD participated in focus groups. Transcripts of the video-recorded groups were analyzed qualitatively using thematic analysis. The three constructed themes not only revealed changes and challenges in social connectedness but also underscored the power of family and new relationships established through PD. Results also highlighted the overall positive impact of current digital technologies, although the view on telehealth per se was multifaceted. Referrals for group rehabilitation programs can enhance social connectedness in individuals with PD through fostering new social connections and community building. Hence, group rehabilitation programs should be viewed as a form of social prescribing. The use of digital technologies should be further explored as a means to maximize social engagements in this population.

Enhancing the drug addiction treatment service by introducing a new residential treatment model in the Philippines: A qualitative study.

There is an increased demand for quality treatment and rehabilitation services for people who use drugs (PWUDs) in the Philippines. In response, the Philippines Government's Department of Health (DOH) has established a new residential treatment model, Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET), and integrated it into the existing treatment service platform of 21 DOH-owned Treatment and Rehabilitation Centers (TRCs). We conducted a qualitative study to identify the changes engendered by the implementation of this treatment model. Data were collected through individual face-to-face interviews. We interviewed purposefully selected 29 patients and 35 facilitators of INTREPRET group sessions in seven TRCs. We transcribed the interview records and organized the narrative information into key themes using thematic analysis during the coding process. The changes perceived by the study participants included the attitude and behavior of patients, attitude and competency of facilitators, relationship between facilitators and patients, treatment planning and review process, efficient and standardized treatment services, and monitoring mechanisms of the patient's recovery process. Participants also noted challenges in INTREPRET implementation, including family participation in therapy sessions, lack of facilitators, securing a conducive place for conducting sessions, and reproducing workbooks. The results imply that the introduction of INTREPRET could improve treatment service quality and the effectiveness of treatment, which were primarily associated with behavioral changes in patients, improved relationship between patients and facilitators, and INTREPRET's alignment with key international treatment standards. However, despite the positive changes perceived by the participants, certain challenges pertaining to family participation in therapy sessions and the lack of resources were identified. These criticisms must be addressed by DOH, along with an integration of INTREPRET into its policy and strategic framework, to ensure the effectiveness and sustainability of the new treatment model.

Impact of a dermatological rehabilitation program on cardiovascular risks of psoriasis patients.

Psoriasis vulgaris is a common chronic inflammatory skin disease, associated with multiple cardiovascular comorbidities, which can ultimately lead to increased mortality. Dermatological rehabilitation programs represent an additional therapeutic option in patients with psoriasis besides the classical outpatient or inpatient management. This study aimed to investigate the impact of dermatological rehabilitation on cardiovascular risk factors, cardiorespiratory fitness and quality of life at the Clinic of Dermatology, Bad Bentheim, Germany. This prospective study included 105 patients (age >18years) with known psoriasis and/or psoriasis (pustulosa) palmoplantaris committing to a 3-week long rehabilitation program. Various patient reported outcomes including dermatological life and quality index, patient global assessment, physical activity, pruritus and smoking and alcohol consumption history were captured. Body mass index (BMI) and physical fitness were also assessed. Study parameters were collected by telephone at baseline, at discharge, and at 3 and 6months. Significant improvements in cardiorespiratory fitness (p<0.001), BMI (p<0.001), quality of life (p<0.001), patients subjective estimation of disease severity (p<0.001) and psoriasis area and severity index (p<0.001) were shown. The findings emphasize the importance of a rehabilitation program for patients with psoriasis due to its positive and sustained effects on cardiovascular risk factors.

The Intersection of Traumatic Brain Injury, Substance Abuse, and Mental Health Disorders in Incarcerated Women Addressing Intergenerational Trauma through Neuropsychological Rehabilitation

The intersection of traumatic brain injury (TBI), substance abuse, and mental health disorders presents a significant challenge within the incarcerated female population, where rates of these conditions are alarmingly high. This paper explores the multifaceted relationships among TBI, substance abuse, and mental health disorders, emphasizing the impact of intergenerational trauma on this vulnerable group. Women in correctional facilities often experience a history of trauma, exacerbating their mental health challenges and increasing the likelihood of substance use as a maladaptive coping mechanism. The cumulative effects of TBI can further complicate their psychological and emotional well-being, leading to a cycle of trauma that is perpetuated across generations. Through a review of current literature and case studies, this paper advocates for the implementation of neuropsychological rehabilitation programs that address the unique needs of incarcerated women. Such interventions are crucial not only for improving individual outcomes but also for breaking the cycle of trauma that affects families and communities. Recommendations for policy reforms and future research directions are provided to enhance the efficacy of rehabilitation efforts and support the reintegration of these women into society.

Changes in Exercise Performance in Patients During a 6-Week Inpatient Psychiatric Rehabilitation Program and Associated Effects on Depressive Symptoms

Background/Objectives: The impact of exercise on affective disorders has been demonstrated in various studies. However, almost no data are available on performance effects. Therefore, this study investigated exercise performance related to the severity of depression symptoms in a pre–post within-subjects design in a 6-week standard inpatient psychiatric rehabilitation program. Methods: A total of 53 individuals (20 female; mean age, 40.98 ± 11.33) with a primary diagnosis of depression performed a cardiopulmonary exercise test (CPX) to obtain maximal oxygen uptake (VO2max), maximal power output (Pmax), and the first and second ventilatory threshold (VT1, VT2) at the start and the end of the rehabilitation. Degree of depression was assessed by Becks Depression Inventory (BDI) and the Brief Symptom Inventory test (BSI). Overall activity was measured by accelerometer step-counts. Results: Mean total step-count per day during rehabilitation was high (12,586 ± 2819 steps/day). Patients’ BDI and BSI at entry were 21.6 ± 8.83 and 65.1 ± 6.8, respectively, and decreased significantly (p &lt; 0.001) following rehabilitation, to 10.1 ± 9.5 and 54.5 ± 11.3, respectively. Pmax and VO2max increased significantly (p &lt; 0.001) from entry values (182.6 ± 58.7 W, 29.74 ± 5.92 mL·kg−1·min−1) following rehabilitation: by 11.91 ± 12.09 W and 1.35 ± 2.78 mL·kg−1·min−1, respectively. VT1 and VT2 showed a similar behavior. An increase in physical performance could predict improvement in BDI (R2 = 0.104, F(1,48) = 5.582, p = 0.022) but not in BSI. Conclusions: The program was associated with improved mental health status in all patients and increased performance in the majority of patients, although increases were small. Since improvements in exercise performance may be positively related to depression symptoms and comorbidities, it is recommended to individualize and tailor exercise programs, which could yield larger effects.

Adapting to Adulthood: A Review of Transition Strategies for Osteogenesis Imperfecta.

Osteogenesis Imperfecta (OI), known as "brittle bone disease," presents a rare genetic disorder characterized by bone fragility, often accompanied by skeletal deformities and extraskeletal complications. OI is primarily associated with collagen type I defects, responsible for the syndromic nature of the disease affecting a broad range of tissues. As such, its multisystemic complexity necessitates multidisciplinary care approaches in all patient life stages. OI treatment remains largely supportive, commonly including bisphosphonates and orthopedic surgeries, which show promise in children. Although rehabilitation programs for children exist, guidelines for adult care and especially the transition from pediatric to adult care, are lagging behind in OI care and research. The current systematic review summarizes the literature on OI patient pediatric to adult care transition experiences and compares OI transition approaches to other chronic diseases. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were conducted across multiple databases. Search terms encompassed synonyms and closely related phrases relevant to "OI" and "Transition to adult care". The initial screening involved the evaluation of article titles, followed by a thorough review of abstracts to assess relevance for the purpose of the current review. Programs aimed at easing the transition from pediatric to adult OI care necessitate a multifaceted approach. Collaborative efforts between different medical disciplines including pediatricians, endocrinologists, orthopedics, cardiology, pulmonology, ophthalmology, otolaryngologists, maxillofacial specialists, psychologists and medical genetics, are crucial for addressing the diverse needs of OI patients during this critical life phase. Comprehensive education, readiness assessments, personalized transition plans, and further follow-up are essential components of a structured transition framework. Further research is warranted to evaluate the feasibility and efficacy of sequential stepwise transition systems tailored to individuals with OI.

Adverse childhood experiences, subsequent negative life events, and their impact on health in occupational rehabilitation patients: a mixed-methods study

IntroductionAdverse childhood experiences (ACEs) are prevalent globally and can negatively impact an individual's lifespan by not only increasing the likelihood of encountering other negative life events (NLEs), but also escalating the risk of illness, absenteeism due to sickness, unemployment, and reliance on disability benefits in adulthood. Therefore, the objective of this study was to explore the prevalence of ACEs and NLEs, as well as their health impacts among patients undergoing occupational rehabilitation.Materials and methodsA total of 80 participants diagnosed with musculoskeletal disorders and/or common mental disorders who participated in two occupational rehabilitation programs in Norway were included. Data were collected by questionnaire and in-depth interviews (39 participants) at the start of the intervention. Comparative quantitative and qualitative analysis was conducted between individuals with a history of ACEs and those without these experiences. Thematic analysis was used to identify the impact of ACEs and NLEs on the health of the informants.ResultsHalf of the participants reported ACEs. Of these, 18% reported one ACE, 22% reported 2–3 ACEs and 9% reported 4 or more ACEs. Also, 25% were categorized as revictimized. The two groups with ACEs had more NLEs in adulthood compared to those without ACEs (p &amp;lt; 0.001), revictimized the most (mean numbers between groups 3.1, 4.5 and 5.9). Furthermore, a history of ACEs was associated with a higher number of reported mental health issues compared to those who had not experienced ACEs (p &amp;lt; 0.01). However, there were no significant differences between the two ACE groups. NLEs had a substantial impact on the participants’ current health status, whether they occurred in childhood or adulthood. In adult life, a high workload (psychologically or physically), interpersonal challenges, and financial struggles had an especially negative impact. Additionally, accidents and complications related to surgeries were also significant NLEs causing health problems. For most, there were complex interactions between NLEs and health.ConclusionsThe prevalence of ACEs and NLEs is high among occupational rehabilitation patients. ACEs are associated with subsequent victimization, interpersonal challenges, financial struggles, and increased mental health issues in adulthood. These findings highlight the need for systematic screening and a holistic, individualized approach in occupational rehabilitation programs to potentially mitigate the adverse effects of NLEs on health and work participation.

The Use of Computer Technologies in Special Education Teacher Training Programs in East Jerusalem: Students' Perspectives and Its Impact on Practical Applications"

Abstract: This research aims to explore the degree of use of computerized technologies in the special education teacher qualification program in East Jerusalem, and the extent of its impact on their performance in practical applications from the students’ point of view, explore students’ opinions about the effectiveness of computerized technologies in improving their educational experience and teaching skills, and reveal the differences in the use of computerized technologies. In qualifying special education teachers and its impact on their performance according to the variables of gender, number of years of experience, and experience in using computerized technologies, the descriptive approach was used, and the questionnaire was used as a tool for collecting data after ensuring its validity and reliability. The study population consisted of all students in special education teacher training colleges, numbering (680) teachers, distributed among 3 main colleges. The study sample consisted of (245) students selected by the available method, and the results were based on the reality of using computerized techniques in rehabilitation programs as a whole (3.80) and to a large degree, and the absence of statistically significant differences ( = 0.05) due to the effect of variables (gender, age, or experience in The use of computerized techniques) for the impact of the use of computerized techniques in the special education teacher qualification program in East Jerusalem on performance in practical applications from the point of view of students in all fields and the overall grade. Based on the results of the study, the researcher recommends strengthening the training of special education teachers within education teacher qualification programs. Specialize in the use of computerized technologies to ensure their effectiveness.

Abstract 4141442: The Feasibility and Adherence of Online Intensive Cardiac Rehabilitation Program for Coronary Artery Disease-A pilot Study

Introduction/Background: Remote cardiac rehabilitation is becoming more popular, but most are exercise-based cardiac rehabilitation programs, and online intensive cardiac rehabilitation (ICR) programs that include not only exercise training but also dietary guidance, stress management, and group support have not been widespread. Research Questions/Hypothesis: Whether high adherence and improvement of CAD risk factors demonstrated for the online ICR program. Goals/Aims: We assessed the program adherence by participation rate as the primary endpoint and physical findings, typical CAD risks and nutritional indices as the secondary endpoint. Methods/Approach: The J-ICR program provides online instruction using Zoom (San Jose, CA: Zoom Video Communications Inc.). The program consisted of four parts: aerobic exercise training, dietary education for the Japan diet, stress management training through mindfulness, and group support (10 participants per group) for 3 hours per session, once a week for 12 weeks (36 hours total). Twenty-two patients were enrolled and adherence to the program was examined. Changes in CAD risk factors were also analyzed. Results/Data: After excluding 3 patients who withdrew consent before the program, the current study population consisted of 19 male participants. The mean age was 66 years old, 95% had hypertension, 37% had diabetes mellites and all had hyperlipidemia. Eight patients had myocardial infarction and 15 cases of angina pectoris. The average participation rate of the program was 90.2% and there was no drop out during the program. As the secondary endpoint, body weight （69.2kg vs. 68.2kg; p=0.02), systolic and diastolic blood pressure (126.8mmHg vs. 121.4mmHg; p&lt;0.01 and 79.5mmHg vs. 77.6mmHg; p=0.18), LDL cholesterol (78.9mg/dl vs 77.6mg/dl; p=0.68), HbA1c (6.3% vs. 6.4%; p=0.39), and amount of sodium intake (9.5 g/day vs. 9.5g/day; p=0.68) and total energy intake (2,137kcal/day vs. 2,076kcal/day; p=0.25). Conclusion: The J-ICR program is feasible and may yield improvements in CAD risk factors such as body weight and systolic blood pressure. Since this is a pilot study to explore the feasibility of the online J-ICR, its secondary prevention effect should be verified with appropriately powered randomized trials at multiple centers.