Short-term Rehabilitation Research Articles

Posture and gait abilities in patients with myotonic dystrophy (Steinert disease). Evaluation on the short-term of a rehabilitation program

ObjectivesTo evaluate the effects of a rehabilitation program in terms of balance, gait and muscle strength in a population of patients with myotonic dystrophy. PatientsTwenty patients benefited, as outpatients in a hospital setting, from a rehabilitation program with clinical and instrumental evaluations. The evaluation focused on quantitative balance measurement by clinical and stabilometer tests, gait assessed by Locometre® and extensors and flexors knee muscle strength measured in isokinetic concentric mode at 60°/s. ResultsAfter the rehabilitation program, we observed a significant improvement in the patients’ balance capacities measured with the Berg Balance Scale (BBS), fast gait speed and muscle strength. However, the instrumental evaluation did not report any gains for static balance and spontaneous gait speed after the training program. No correlation was found between the various improvements. ConclusionA rehabilitation program focused on strength, gait and balance allowed for significant improvements in some parameters of myotonic dystrophy. These results attest to the relevance of a short-term rehabilitation protocol for these patients in the framework of a multidisciplinary therapeutic care. The disparity observed in the results measured for these patients suggest the contribution of cognitive involvement in the limitations felt by patients with myotonic dystrophy in the areas of gait and balance.

Effects of a short‐term rehabilitation program on airway inflammation in children with cystic fibrosis

Respiratory therapy in cystic fibrosis (CF) consists of airway clearance, infection control, and reduction of airway inflammation. It is well recognized that physical activity as well as daily chest physiotherapy, enhance airway clearance. We investigated the effects of pulmonary rehabilitation, including physical activity and chest physiotherapy, on airway inflammation in children with CF. Eighteen children with stable CF (six females), aged 8.2-16.2 years, participating in a 3-week multidisciplinary inpatient rehabilitation program were recruited. Assessment at the beginning and the end of the program included clinical score, pulmonary function test, exhaled breath condensate (EBC) and sputum analysis. Sputum supernatant and EBC were analyzed for interleukin (IL)-1b, 6, 8, 10, 12, tumor necrosis factor-alpha (TNF-alpha) and LTB4. Median (IQR) symptom scores decreased from 19 [23] to 16 [21], P = 0.005. Vital capacity and FVC increased significantly (P < 0.05). However no difference was found for the total sputum cells and sputum as well as EBC cytokines between the two visits. Significant correlations were found for sputum IL-1 (+), IL-6 (-), and IL-8 (+) to total sputum cell count and neutrophils and for IL-8 to TNF-alpha. We have shown that a short-term inpatient rehabilitation for children with stable CF with intensive physical activity mainly improve subjective clinical symptoms and measures of lung function such as VC and FVC but does not influence airflow obstruction and airway inflammation as assessed by sputum and EBC analysis.

Effect of early short-term cardiac rehabilitation after acute ST-elevation and non-ST-elevation myocardial infarction on 1-year mortality

Objectives:The aim was to evaluate the effect of short-term cardiac rehabilitation (CR) on clinical events during a 1-year follow-up after acute myocardial infarction.Methods:From the observational, prospective Acute COronary Syndromes (ACOS) registry, 4547 consecutive patients after ST-elevation (STEMI: n = 2432) or non-ST-elevation myocardial infarction (NSTEMI: n = 2115), recruited between June 2000 and December 2002, were characterised and evaluated for clinical outcomes during a 1-year follow-up. From the STEMI group 67.8% and from the NSTEMI group 52.3% participated in cardiac rehabilitation (CR+).Results:Age > 70 years and previous myocardial infarction were independent predictors not to attend CR in STEMI and NSTEMI patients, whereas early revascularisation (<48 hours after hospital admission) was associated with increased likelihood to undergo CR. Multivariable analysis adjusting for propensity score shows that CR+ was independently associated with a significant reduction of all-cause mortality (STEMI: OR 0.41, 95% CI 0.28–0.60; NSTEMI: OR 0.53, 95% CI 0.38–0.76) and major adverse cardiac and cerebrovascular events (MACCE; STEMI: OR 0.66, 95% CI 0.49–0.89; NSTEMI: OR 0.73, 95% CI 0.55–0.98) during a 1-year follow-up.Conclusion:The study shows an independent and strong association of CR+ with markedly reduced total mortality and MACCE during a 1-year follow-up after STEMI or NSTEMI. The limitation of the study is that it is not a prospective randomised trial. Furthermore, unequal distribution of risk factors relevant for long-term prognosis had to be corrected by multivariable analysis adjusting for propensity score.

The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge- FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p < 0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p < 0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p < 0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p > 0.05). The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favourable short-term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

Scoliosis Short-Term Rehabilitation (SSTR) – A Pilot Investigation

There is evidence that physiotherapy is an effective treatment module used in the management of patients with scoliosis. There is a RCT from China as well as a prospective controlled study from Germany supporting physiotherapy. The latter study was on scoliosis in-patient rehabilitation with patient samples treated intensively for 6 weeks. Today in-patient rehabilitation programs have changed and the length of the program has been reduced. Therefore, there is doubt that the results of the study are reproducible today. This is why new concepts of scoliosis rehabilitation have been developed on the basis of the latest methodological studies in this field. Material and Methods: In June 2010 the new 5-day scoliosis short-term rehabilitation was introduced based on experiential learning and the methods of treatment described in literature. 10 patients from New Zealand, US, Canada, Belarus, Rumania and Russia took part. Nine had a scoliosis, one was treated for kyphosis. The concept consisted of two guided 90 min. sessions and one experiential learning session of another 90 min on a daily basis. Finally, 9 patients with the diagnosis of AIS (Adolescent Idiopathic Scoliosis), two males and seven females with an average Cobb angle of 46° (29 – 64°) and with an average age of 14 (11 – 18) years were included. ATR (Angle of Trunk Rotation = Scoliometer) measurements were taken before and after the treatment. Additionally, the ability to correct themselves was measured after four days of treatment. A questionnaire to measure patient satisfaction was also used.Results: The ATR was reduced significantly from 10.3° to 8.2° (p < 0,001) after treatment in the nine patients with scoliosis. The ability to correct themselves as measured with the help of the Scoliometer (ATR 8.2° / ATR auto-corrected (without additional help by the therapist ) 5.7) was 1,45 and the difference between ATR 8.2° / ATR auto-corrected 5.7 was significant as well (p = 0,0035). Patient satisfaction was over average and the patient examination at the end clearly showed that all goals set were achieved for all patients.Conclusions: This new concept of rehabilitation is less time consuming and seems as effective as in-patient rehabilitation of 3-4 weeks. Therefore, in-patient rehabilitation lasting several weeks today seems necessary no more for children and adolescents with scoliosis. Studies with increasing patient samples are needed to substantiate these conclusions. Only the group of patients with scolisois is needed to be included. More explanation is needed. BACKGROUND There is evidence that physiotherapy is an effective treatment module used in the management of patients with scoliosis. In their systematic review Negrini and Coworkers (2008) reported on a RCT from China. There is also a prospective controlled study from Germany supporting physiotherapy in the in-patient mode (Weiss, Weiss and Petermann 2003). The latter study was on scoliosis in-patient rehabilitation with patient samples from 1989 to 1991 treated intensively for 6 weeks. Today, the in-patient rehabilitation program has changed widely and the length of the program has also been shortened. Therefore, there is doubt that the results of the prospective study (Weiss, Weiss and Petermann 2003) are reproducible today. The latest in-patient programs have not been investigated so far, no evidence has been achieved for their use (Yilmaz and Kozikoglu 2010) and this is why new concepts of scoliosis rehabilitation have been developed on the basis of the latest methodological studies in this field. As early as 2006, it has been shown that the outcome of scoliosis in-patient rehabilitation can be improved by adding on the physio-logic® program (Weiss and Klein 2006). Moreover, it has also been shown, that rehabilitation times can be reduced drastically (Weiss, Hollaender and Klein 2006) by adding on treatment methods based on the Scoliosis Short-Term Rehabilitation (SSTR) – A Pilot Investigation 2 of 8 activities of daily living (ADL, see also figure 1 and 2.).

Relevanz der Neuropsychologie für die Rehabilitation von Epilepsiepatienten

A comprehensive interdisciplinary approach including medical treatment, neuropsychological and psychiatric assessment, occupational therapy, social work counselling and physical exercise is a prerequisite for effective rehabilitation in patients with epilepsy. In the face of high rates of unemployment and early disability in patients with epilepsy work (re-)integration is the main goal of rehabilitation. A literature review on the relevance of neuropsychological findings for vocational rehabilitation suggests that intelligence or other measures of general cognitive abilities seem to be closer related to employment status than specific deficits such as verbal memory. The main task of neuropsychology in rehabilitation is diagnosis and therapy of cognitive impairments. A professionally experienced interpretation of test results is crucial, especially with respect to functional relevance for work performance and further rehabilitation planning. A systematic overview of the functional implications of specific cognitive impairments and suggested interventions is given. Close collaboration of the different professions involved in rehabilitation interventions as found in our short-term inpatient rehabilitation unit is extremely helpful for a correct interpretation of test results and other findings of neuropsychological assessment.

Predictors of functional ambulation and patient perception following total knee replacement and short-term rehabilitation

Purpose. To investigate whether measured and patient-perceived function 6 months after total knee replacement (TKR) can be predicted from factors measured during post-operative rehabilitation.Method. Retrospective analysis of data from a randomised clinical trial involving 100 patients after TKR. High- and low-performing subjects for pain, WOMAC score and 6-min walk test (6MWT) at 2, 8 and 26 weeks post-TKR were partitioned and analysed. Multiple stepwise regression analysis was applied to the contributing factors to determine associations with outcome.Results. Prediction of outcome was unconvincing based upon variables recorded at 2 weeks; however, status at 8 weeks was a better indicator of functional performance and perception at 26 weeks. 6MWT at 26 weeks could be predicted from VAS pain scores and 6MWT at 8 weeks (r = 0.789; p < 0.001). Prediction of pain and patient perceived function at 26 weeks was also dependent on performance in 6MWT at 8 weeks (r = 0.51; p < 0.05). Males and those with lower body mass index values demonstrated better functional outcomes.Conclusion. Functional status at 2 weeks post-surgery gives few indicators of ultimate status, possibly because of pain, joint swelling and other immediate post-operative factors. However, measurements taken at 8 weeks, following an outpatient-based exercise programme, provides a reasonable estimate of performance and response 26 weeks after surgery. Patient and clinician expectations for longer-term recovery could be informed by these findings.

Effects of Nordic Walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome — a controlled trial

Objective: To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome. Design: A controlled trial. Setting: Cardiac rehabilitation service of a provincial hospital. Subjects: Eighty men 2—3 weeks after an acute coronary syndrome, with good exercise tolerance. Interventions: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group). Main measures: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test. Results: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 ± 1.8 versus 9.2 ± 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 ± 1.5 versus 0.7 ± 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group. Conclusions: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

The effectiveness of long-term rehabilitation in patients with cardiovascular diseases

Screening results of EuroAspire III study have revealed the failure of effective correction of cardiovascular risk factors in all 22 participating EU countries. How long should cardiac rehabilitation programs last to impact motivation for lifestyle change? To compare the impact of long-term (6 months) rehabilitation versus short-term (4 weeks) rehabilitation on the reduction of risk factors and cardiac events, as well as on the use of cardioprotective drugs. Study contingent of 150 patients, suffering from functional class III-IV (NYHA) chronic heart failure caused by ischemic and hypertensive cardiomyopathy, was subjected to complex rehabilitation: exercise training, dietary corrections, and smoking cessation. The patients were divided into two groups: long-term rehabilitation group (n=80) and short-term rehabilitation group (n=70). Blood pressure, body mass index, dietary habits, dyslipidemia, sedentary lifestyle, smoking, chronic fatigue, and use of cardioprotective drugs were evaluated in all patients at the onset of study, after 4 weeks, and 6 months. Cardiovascular events were estimated throughout the whole 6-month period. In the long-term rehabilitation group, there was a significant reduction (P<0.05) in systolic blood pressure (151+/-9.2 vs. 135+/-9.7 mm Hg), diastolic blood pressure (92.3+/-6.5 vs. 75.4+/-3.8 mm Hg,) body mass index (35.4+/-3.5 vs. 27.2+/-4.8 kg/m(2)), dyslipidemia (56.3 vs. 23.4%), sedentary lifestyle (31.3 vs. 4.7%), and smoking (10.0 vs. 0%). The impact of a short-term rehabilitation was not significant. Because of cardiac events, 13 patients (16.3%) in the long-term rehabilitation group and 26 (16.3%) in the short-term rehabilitation group failed to complete the 6-month study (P<0.05). The following change in drug use pattern was noted in the long-term rehabilitation group: nitrates, 74 vs. 65%; digitalis, 42 vs. 32%; antiarrhythmic agents, 15 vs. 10%; statins, 36 vs. 20% (P<0.05). During 6 months, in both groups, because of better physician monitoring, there was no decrease in the use of major cardioprotective drugs, such as antiaggregants, beta-blockers, and ACE inhibitors. Long-term (6 months) versus short-term (4 weeks) rehabilitation of cardiovascular patients significantly reduces manifestation of major cardiovascular risk factors, the rate of cardiac events, chronic fatigue and improves the use of cardioprotective drugs.

Who Cares? We Do and We Always Will

Who Cares? We Do and We Always Will

Yes, Things Will Change in Your Facility

Yes, Things Will Change in Your Facility

Planning Ahead for Better Outcomes

For 15 years, a small community hospital has sent registered nurses into the home to do a preoperative visit with patients planning joint replacement surgery. These visits help the patient by providing a better understanding of what to expect from the preadmission visit through the recovery period. It also ensures a safe environment for the recovery process whether at home or alternative environment with family/friends or at a short-term rehabilitation facility. Its success in patient and nurse satisfaction has not only saved it from cost cutting measures but also allowed it to expand over the years to include follow-up home visits and now includes patients undergoing shoulder replacement. This was a great undertaking for a hospital of this size in 1993 and is one of the few, if not the only, such home visit programs in Massachusetts, doing both pre and postoperative visits, funded by a hospital, utilizing nursing hours.

Gender differences in risk factors and outcomes after cardiac rehabilitation

Objective — We compared the baseline characteristics, cardiovascular risk factors and outcomes between men and women in an Iranian cardiac rehabilitation programme after adjusting for age, body mass index and waist-to-hip ratio.Methods — In a self-controlled descriptive study performed between 1996 and 2006, we evaluated 547 patients with documented coronary heart disease before and after a 24-session cardiac rehabilitation programme.Results — Women were older, more likely to be obese, anxious, depressed, and had more traditional coronary heart disease risk factors than men. At baseline, exercise capacity was lower (P < 0.001), but total cholesterol (P < 0.001), high-density lipoprotein cholesterol (P = 0.007), lowdensity lipoprotein cholesterol (P = 0.001), fasting blood sugar (P = 0.002), left ventricular ejection fraction (P < 0.001), systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and heart rate (P = 0.016) were higher in women. Although there was significant improvement in most of the variables and risk factors after cardiac rehabilitation, changes were not statistically significant between men and women except for significantly more improvement in exercise capacity (P < 0.001) and less reduction in body mass index (P = 0.04) in men.Conclusion — Following a short-term cardiac rehabilitation programme, modification in cardiac risk factors and quality of life occurs. Both genders benefit alike in most aspects from this programme.

All the Residents Win in This Marathon

All the Residents Win in This Marathon

Short-term assessment of burn severity using the inversion of PROSPECT and GeoSail models

Accurate estimations of burn severity and its distribution in post fire scenarios are critical for short-term mitigation and rehabilitation treatments. The use of remote sensing techniques, coupled with radiative transfer models (RTMs) can improve the accuracy, precision (in terms of number of classes) and cost-effectiveness of burn severity assessment. In this paper, an improved simulation model that combines PROSPECT and GeoSail to estimate burn severity from satellite data was tested in three Mediterranean forest fires. The determination of burn severity was based on a new version of the CBI index (named GeoCBI), that takes into account the vegetation fraction cover (FCOV) to compute burn severity of the total plot. Model inversion results showed accurate estimations of GeoCBI values (RMSE between 0.18 and 0.21) and a uniform performance in all three sites (107 field plots in total) throughout the full GeoCBI range (0–3).

Pulmonary rehabilitation and follow-on services: a Northern Ireland survey

There should be a clear pathway through pulmonary rehabilitation and follow-on services. The aim of this survey was to determine the characteristics of the different components of the patient pathway, that is, pulmonary rehabilitation programs, ongoing exercise facilities, and support networks in Northern Ireland. Questionnaires were sent to current providers of pulmonary rehabilitation, providers of ongoing exercise, and support groups in Northern Ireland. Findings relating to the current status of pulmonary rehabilitation in Northern Ireland up to January 2007 are reported. There are currently 23 pulmonary rehabilitation programs in Northern Ireland. There appears to be a pathway through the short-term pulmonary rehabilitation program (6-8 weeks). Programs met standards for structure and format, except for the frequency of supervised exercise. Not all programs have links for the provision of ongoing exercise, but a range of exercise programs are available in leisure centers in Northern Ireland that include people with respiratory disease. There are 13 support groups for patients with respiratory disease in Northern Ireland and their function is diverse. Pulmonary rehabilitation is established in Northern Ireland, although not all patients are able to access these. Facilities for ongoing exercise and support groups are less developed. Improvements could be facilitated by better communication within the patient pathway and a strategic coordinated approach.

The efficacy and applicability of a pulmonary rehabilitation programme for patients with COPD in a secondary‐care community hospital

Pulmonary rehabilitation is known to have beneficial effects in COPD patients. This study aimed to assess the applicability and efficacy of a pulmonary rehabilitation programme in a community hospital lacking specialist pulmonary rehabilitation services. This randomized, controlled, prospective study included a total of 78 patients. Questionnaires were used to collect data on sociodemographic characteristics, respiratory function tests, the Modified Medical Research Council dyspnoea scale, 6MWD, the Short Form-36 (SF-36) quality of life scale, the Hospital Anxiety and Depression Scale (HADS) and the St George's Respiratory Questionnaire (SGRQ). The experimental group underwent a pulmonary rehabilitation programme while the control group did not participate. The first, second and third month measurements for all parameters were compared between the two groups. No significant differences in pulmonary function tests or dyspnoea scale (P > 0.05) were observed between the two groups. Significant differences were observed in the 6MWD measurements at the third month (P < 0.05), as well as in the SF-36 quality of life scale, SGRQ and HADS measurements at the second and third months (P < 0.01). Short-term pulmonary rehabilitation had a positive impact on exercise capacity and quality of life of patients with COPD, irrespective of FEV(1). This study demonstrated the efficacy of a pulmonary rehabilitation programme in a secondary care hospital not staffed by a specialist pulmonary rehabilitation group.

Short-term rehabilitation of patients with posttraumatic otolith disorders by auditory feedback training: A pilot study

In a prospective, non-randomized pilot study, two groups of patients with dizziness for more than one year due to posttraumatic otolith disorders had been investigated. They were treated by a one-day vestibular rehabilitation training with/without auditory feedback. It could be shown that auditory feedback training for a limited period of time can reduce significantly trunk sway compared to those patients who did vestibular exercises alone without auditory feedback. This audiofeedback-based therapy seems to be a promising tool in the vestibular rehabilitation and in treating patients with otolith disorders in particular. Long-term effects cannot yet be assessed with the present data of our series.

Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: Relation to type of substance and type of crime

Mixed findings have been made with regard to the long-term predictive validity of antisocial personality disorder (ASPD) on criminal behaviour in samples of substance abusers. A longitudinal record-linkage study of a cohort of 1052 drug abusers admitted 1977–1995 was undertaken. Subjects were recruited from a detoxification and short-term rehabilitation unit in Lund, Sweden, and followed through criminal justice registers from their first treatment episode to death or to the year 2004. In a ML multinomial random effects regression, subjects diagnosed with antisocial personality disorders were 2.16 times more likely to be charged with theft only ( p < 0.001), and 2.44 times more likely to be charged committing multiple types of crime during an observation year ( p < 0.001). The findings of the current study support the predictive validity of the DSM-III-R diagnosis of ASPD. ASPD should be taken seriously in drug abusers, and be targeted in treatment to prevent crime in society.

Intervention Planning Facets—Four Facets of Occupational Therapy Intervention Planning: Economics, Ethics, Professional Judgment, and Evidence-Based Practice

This study determined occupational therapists' perceptions of the following facets of intervention planning: economics, ethics, independent professional judgment, and evidence-based practice. A cross-sectional survey of 142 occupational therapists who provide short-term rehabilitation in five northeastern states was undertaken. Most occupational therapists (n = 137, 96.5%) fell into one of four clusters, with the largest cluster (n = 86, 60.6%) having positive perceptions about ethics and independent professional judgment but negative perceptions about economic issues. Smaller clusters of occupational therapists were more positive about economic issues or less positive about ethics and independent professional judgment. Negative perceptions about the ability to implement evidence-based practice spanned all clusters. American Occupational Therapy Association's efforts to educate occupational therapists about ethics appear to be effective. Most occupational therapists exercise independent professional judgment but perceive economic limitations when developing intervention plans. Practicing occupational therapists need additional research to support evidence-based practice and help in accessing and using research.