Therapist Satisfaction Research Articles

The Use of Telerehabilitation to Improve Movement-Related Outcomes and Quality of Life for Individuals With Parkinson Disease: Pilot Randomized Controlled Trial.

Individuals with Parkinson disease (PD) can improve their overall mobility and participation in daily activities as they engage in frequent exercise. Despite the need for individually tailored exercises, persons with PD often face barriers to accessing physical rehabilitation professionals who can provide them. Telerehabilitation (TR) may facilitate access to necessary and individually tailored rehabilitation for individuals with PD. The purpose of this study was to assess the feasibility of TR for individuals with PD and explore clinical outcomes compared to in-person care. This was a pilot randomized controlled trial conducted at 2 outpatient neurorehabilitation clinics with 3 study groups: clinic+TR, TR-only, and usual care (UC). TR was administered using a web-based application with a mobile app option. One-hour interventions were performed weekly for 4 weeks, in-person for the clinic+TR and UC groups and virtually for the TR-only group. Home exercises were provided on paper for the UC group and via the web-based platform for the clinic+TR and TR-only groups. Feasibility was assessed by recruitment and retention success and patient and therapist satisfaction, as rated in surveys. Clinical outcomes were explored using performance and patient-reported measures in between- and within-group analyses. Of 389 patients screened, 68 (17.5%) met eligibility criteria, and 20 (29.4% of those eligible) were enrolled (clinic+TR, n=6; TR-only, n=6; and UC, n=8). One patient (TR-only) was withdrawn due to a non-study-related injurious fall. Regardless of group allocation, both patients and therapists generally rated the mode of care delivery as "good" or "very good" across all constructs assessed, including overall satisfaction and safety. In the analysis of all groups, there were no differences in clinical outcomes at the discharge visit. Within-group differences (from baseline to discharge) were also generally not significant except in the UC group (faster 5-time sit-to-stand time and higher mini balance evaluation systems test balance score) and clinic+TR group (higher mini balance evaluation systems test balance score). High satisfaction amongst patients and clinicians regardless of group, combined with nonsignificant between-group differences in clinical outcomes, suggest that TR is feasible for individuals with PD in early-moderate stages. Future trials with a larger sample are necessary to test clinical effectiveness. As larger trials enroll patients with diverse characteristics (eg, in terms of age, disease progression, caregiver support, technology access and capacity, etc), they could begin to identify opportunities for matching patients to the optimal utilization of TR as part of the therapy episode. ClinicalTrials.gov NCT06246747; https://clinicaltrials.gov/study/NCT06246747.

Impact of Leadership Style on Employee Performance And Job Satisfaction Among Jordanian Physiotherapists

Leadership philosophies are essential organizational practices, especially when it comes to promoting and enhancing worker collaboration and job satisfaction. This study aims to ascertain and explore the relationship between job satisfaction and job performance among Jordanian physiotherapists and transformational leadership. Additionally, looks at whether job satisfaction and organizational citizenship behaviours operate as a mediator in the link between transformational leadership and worker performance. This study's design involves a quantitative correlation analysis conducted on a conveniently chosen sample of Jordanian physiotherapists from different healthcare facilities to examine the relationship between their performance level and leadership practices, specifically transformational leadership style, as well as any potential mediating role that organizational citizenship behaviours and job satisfaction may have on that relationship. Additionally, an online questionnaire for 123 physiotherapists in a different facility is used to study the proposed relation connecting transformational leadership style and therapist satisfaction level. Data were acquired about performance, job satisfaction, and organizational citizenship behaviours of therapists as well as their opinions of the leadership styles exhibited by the facility leaders. Organizational citizenship behaviours (OCB) and job satisfaction (JS) fully mediated the relationship between transformational leadership and physiotherapy performance; as a result, the impact of transformational leadership style (TLS) on performance was indirect since the direct influence wasn’t statistically significant. Additionally, TLS has a positive and substantial impact on job satisfaction and organizational citizenship behaviours by regression analysis; likewise, OCB and JS have a positive significant effect on performance (p-value <.001). Transformational leadership and performance among Jordanian physiotherapists are not significant directly but are significant indirectly by the mediator (OCB and JS). Because it impacts worker job satisfaction, the standard of healthcare services provided, and the patient experience in this organization, it encourages the development of transformational leadership abilities in healthcare facilities and ongoing training for leaders in this area.

Customized GRASP for rehabilitation therapy scheduling with appointment priorities and accounting for therapist satisfaction

Physical therapy in acute care hospitals plays an important role in the rehabilitation of patients. Nevertheless, the profession must deal with staff shortages caused by a lack of potential employees and absenteeism which are results of high physical and mental workloads. The therapist shortage negatively affects the total number of daily appointments the department can fulfill. For appointments that can be successfully scheduled, continuity of care with the same therapist cannot be guaranteed for individual patients. Lack of continuity of care negatively influences the therapist's satisfaction. Therapist preferences for individual appointments in general cannot always be guaranteed when designing schedules, which also hurts satisfaction. This paper develops a multi-criteria model for the daily therapy appointment-scheduling problem. The primary objective is to minimize the total sum of priority violations for unscheduled appointments. To improve therapist satisfaction, we consider therapist preferences including continuity of care as a secondary objective. Here, our integer programming formulation aims to minimize the total sum of preference violations for scheduled appointments. We are dealing with an operational planning problem with a daily planning horizon. The operational objective is to achieve therapist schedules in at most two hours. The therapists’ schedules together need to include several hundred appointments for a planning day. Due to intractability, the developed integer program cannot provide schedules for such problem sizes. Therefore, we develop a customized Greedy Randomized Adaptive Search Procedure (GRASP) with six innovative local search operations to improve an initially constructed solution. We test the heuristic algorithm on realistic data instances. The metaheuristic provides high-quality schedules for various problem sizes in short runtimes, i.e., within minutes. Comparisons with the optimal solutions for small problem instances show very good results of the GRASP with a similar number of scheduled appointments and good adherence to continuity of care and therapist preference requirements.

User-centered design of a personal-use exoskeleton: a clinical investigation on the feasibility and usability of the ABLE Exoskeleton device for individuals with spinal cord injury to perform skills for home and community environments.

The ABLE Exoskeleton has been tested to be safe and feasible for persons with spinal cord injury (SCI) to complete basic skills in clinical settings but has not been tested for use in home and community environments. A user-centered design process was employed to test the feasibility of the current ABLE Exoskeleton (designed for clinical use) for persons with SCI to perform the basic and advanced skills required for home and community environments, to gain crucial feedback for the development of a novel personal-use exoskeleton. In this prospective pretest-posttest quasi-experimental study across two SCI centers (Germany, Spain), in-and outpatients with SCI were included into a 22-session training and assessment protocol, utilizing the ABLE Exoskeleton. Feasibility and usability measures [level of assistance (LoA) for basic and advanced skills, donning/doffing-time and LoA] were recorded together with safety outcomes, and participant and therapist satisfaction with the device. 10 participants (44.4 ± 24 years), with SCI from C5 to T11, (American Spinal Injury Association Impairment Scale A-D) completed the study. In 209 sessions, six device-related adverse events (pain and skin lesions) were reported. Average total time for don and doff was 10:23 ± 3:30 min. Eight participants were able to complete don and doff with minimal assistance or less. Independence to carry out all skills in the device increased significantly for all participants (p < 0.05). Participants with chronic SCI required a significantly (p < 0.05) lower LoA for six of the nine advanced skills than those in the sub-acute phase. This study shows that the ABLE Exoskeleton is safe, feasible and usable for people with SCI in respect to independent donning, doffing and performance of basic and advanced exoskeleton skills. The supervised exoskeleton use in the clinical environment was a highly valuable approach for identifying the challenging tasks and the necessary technological developments that need to be carried out for a personal-use exoskeleton, including a more independent sit-to-stand transition, faster speed of transitions between states and a richer display on the remote control for the user. https://clinicaltrials.gov/study/NCT05643313.

Therapist Satisfaction Using the Activity Measure for Post-Acute Care (AMPAC) in Acute Care at the University of Kansas Health System

Abstract Date Presented 04/21/2023 The Activity Measure for Post-Acute Care (AMPAC) is a valid outcome measure in acute care; however, University of Kansas Health System therapists report dissatisfaction with using the tool in practice. Understanding this topic will aid therapists and institutions in choosing effective outcome measures for patients. Primary Author and Speaker: Kristen Rooker

MS Rehabilitation Research During the COVID Pandemic: Participant and Therapist Satisfaction with Remote Delivery (P12-8.004)

<h3>Objective:</h3> To understand participant and physical therapist (PT) satisfaction with virtual delivery of a multiple sclerosis (MS) rehabilitation research intervention. <h3>Background:</h3> Rehabilitation interventions in people with MS are usually in-person, although virtual delivery can improve access and relevance to patient’s daily lives. We planned a randomized controlled trial of a standardized physical therapy intervention for walking aid selection, fitting and training, (Assistive Device Selection, Training and Education Program [ADSTEP]), to prevent falls in MS. Due to the COVID-19 pandemic we transitioned to virtual delivery by video-teleconference. <h3>Design/Methods:</h3> ADSTEP, piloted as an in-person in-clinic program, consists of six 40-minute one-on-one sessions with a PT. We transitioned to virtual delivery to patients’ homes at the beginning of our full-scale randomized controlled trial. At intervention completion for each subject, we examined subject and PT satisfaction with virtual delivery using a nine-question survey. We analyzed survey responses and associations. <h3>Results:</h3> Forty-eight subjects completed ADSTEP delivered by four therapists; 46 subjects and all therapists completed the survey. For almost all session, subjects and therapists reported no difficulties seeing each other or following instructions, and all found the platform secure and private. 63% of subjects, a higher proportion of women than men (71% vs 50%) and more so for those with fewer falls in the past year (median 5 vs 12 falls), found the virtual visits as good as in-person sessions. 59% of subjects, a higher proportion of women than men (64% vs 50%) and more so for those with fewer falls in the past year (median 5 vs 8), preferred the virtual visits. <h3>Conclusions:</h3> This study supports that PTs and people with MS find virtual delivery of a rehabilitation research intervention feasible and acceptable, with women and those who fall less often being more likely to find virtual visits as good as or preferable to in-person visits. <b>Disclosure:</b> Dr. Cameron has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Greenwich Biosciences/Jazz . Dr. Cameron has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Adamas Pharmaceuticals. Dr. Cameron has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. The institution of Dr. Cameron has received research support from National MS Society. The institution of Dr. Cameron has received research support from Department of Veterans Affairs. Dr. Cameron has received publishing royalties from a publication relating to health care. The institution of Ms. Hildebrand has received research support from National MS Society. Ms. Serdar has nothing to disclose. Mr. Schlimgen has nothing to disclose. Ms. Hugos has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GW Pharmaceuticals. Ms. Hugos has received personal compensation in the range of $0-$499 for serving as a Consultant for Evidera, Inc.. Ms. Hugos has received personal compensation in the range of $0-$499 for serving as a Consultant for Techspert.io Ltd.. Ms. Hugos has received research support from Portland VA. Ms. Hugos has received research support from Oregon Health &amp; Science University. Ms. Hugos has received research support from Oregon Health &amp; Science University. Ms. Hugos has received publishing royalties from a publication relating to health care.

Experiences from the implementation of physical therapy via telehealth for individuals with Parkinson disease during the COVID-19 pandemic

Purpose To (1) determine the characteristics and participation rate of adults with Parkinson disease (PD) in physical therapy (PT) delivered via telehealth, (2) identify the outcome measures and interventions implemented, (3) determine the safety of and (4) patient and therapist satisfaction with PT via telehealth in a clinic specializing in the care of people with PD during the coronavirus pandemic. Materials & Methods A retrospective analysis of PT services via telehealth was conducted. Participating patients completed a satisfaction survey. Physical therapists (PTs) who delivered this care were interviewed. Three coders conducted thematic analysis of interviews. Descriptive statistics described the participation rate, demographics, outcome measures, interventions, and safety. Results There was a 71.4% participation rate. Participants (n = 55) were white (96%), non-Hispanic (100%), older adult (mean = 69.5 years (8.3)) males (65.5%). Non-participants (n = 22) had similar demographics. Therapists selected patient-reported measures more often than performance-based measures. Therapeutic exercise was the most common intervention. All patients (80% response rate) reported satisfaction with their experience. PTs reported the home enhanced specificity of training but impeded evaluation. Therapists endorsed a hybrid model for future practice. Conclusions Patients reported satisfaction with PT via telehealth during the pandemic. A hybrid model may support optimal delivery of PT. IMPLICATIONS FOR REHABILITATION Physical therapy via telehealth for patients with Parkinson disease was acceptable to patients and physical therapists in our study. Physical therapy via telehealth was safe for people with Parkinson disease in our study, although availability and benefits may not be reaching all populations equitably. Both physical therapists and patients endorse a hybrid model of care (a combination of in-person and remote assessment and treatment) to profit from the strengths of in-person and virtual formats while minimizing barriers to access.

Therapist-Assisted Internet-Delivered Cognitive Behavioral Therapy for Insomnia: A Case Report

Despite its well-documented efficacy, few clinicians are trained to deliver Cognitive Behavioral Therapy for Insomnia (CBT-I), and it remains an inaccessible treatment. Therapist-Assisted Internet-Delivered Cognitive Behavioral Therapy for Insomnia (TAI-CBT-I) holds promise for overcoming barriers to accessing this evidence-based treatment. However, to date, there have been no case reports published that describe how to deliver TAI-CBT-I. This case report fills in this gap by illustrating the application and utility of such a treatment on an asynchronous platform. We report on a course of TAI-CBT-I for a 34-year-old Caribbean Canadian male who presented with chronic insomnia characterized by difficulty falling and staying asleep, night awakenings, and reduced helpfulness from medication. Self-report measures of sleep, depression, functioning and ability, and therapist satisfaction were administered throughout treatment, post-discharge, and at follow-up. Improvement was noted across all measures. This case report demonstrates that TAI-CBT-I can be an effective treatment for chronic insomnia and showcases how to deliver it.

The Safety and Feasibility of Lower Body Positive Pressure Treadmill Training in Individuals with Chronic Stroke: An Exploratory Study.

Lower body positive pressure (LBPP) may provide a novel intervention for gait training in neurological conditions. Nonetheless, studies investigating the safety and feasibility of LBPP in patients with stroke are insufficient. The purpose of this study was to evaluate the safety and feasibility of LBPP as a rehabilitation intervention for individuals with chronic stroke. Individuals with chronic stroke were recruited from the community to participate in LBPP gait training three times a week for six weeks. The LBPP's safety and feasibility were documented throughout the study and at the end of six weeks. Safety and feasibility referred to the incidence of adverse events, complications, the participant and therapist satisfaction questionnaire, and the device limitation including but not limited to technical issues and physical constraints. In addition, blood pressure, pulse rate, and oxygen saturation were taken pre- and post-session. Dependent t-tests were used to analyze the difference between assessments. A Wilcoxon test was used to assess the ordinal data (Trial registration number NCT04767334). Nine individuals (one female, eight males) aged 57 ± 15.4 years were enrolled. All participants completed the intervention without adverse events. All participants reported positive scores from 4 (very satisfying) to 5 (extremely satisfying) in the safety and feasibility questionnaire. No significant differences were observed in blood pressure and oxygen saturation during the intervention sessions. However, significant increases were observed in heart rate from 82.6 ± 9.1 beats/min (pre-session) to 88.1 ± 6.8 beats/min (post-session) (p = 0.027). LBPP is a safe and feasible rehabilitation tool to use with individuals with chronic stroke.

Does the Integration of Telehealth into Occupational Therapy Practice Impact Clinical Outcomes for Hand and Upper Limb Rehabilitation? A Matched Case Control Study.

Health services are capitalizing on the rise of telehealth and seeking to develop sustainable models incorporating telehealth into standard care. Further research is required to explore the service and clinical outcomes of telehealth in occupational therapy hand and upper limb practice. This research utilized a case-control study to explore the feasibility and clinical outcomes of case matched patients who received a telehealth hybrid model versus traditional in-person care. One hundred and two patients were recruited (n=51 in the controls and cases) with a mean age of 45 years. Telehealth was not inferior to standard care with no significant increase in therapy time (p=0.441) or length of referral (p=0.047). There was no difference in clinical adverse events (p=0.741). Patients who received telehealth had significantly less withdrawals from the service (p = 0.031). Patient and therapist satisfaction were high, supporting the ongoing use and continued implementation of telehealth in occupational therapy.

Field-Testing an Occupational Therapy Clinical Intervention Manual to Guide Electrical Stimulation in Spinal Cord Injury

<h3>Research Objectives</h3> Evaluate the utility of a manual to guide occupational therapists who administer Electrical stimulation (ES) in SCI. <h3>Design</h3> Field test to assess the manual's impact on participants' ES clinical knowledge and its value for supporting episodic OT treatments. <h3>Setting</h3> Three geographically dispersed inpatient rehabilitation centers. <h3>Participants</h3> 18 occupational therapists were recruited from three geographical dispersed inpatient rehabilitation units. Inclusion criteria includes current OT or OTA license, (b) state-level eligibility to administer ES in an occupational therapy treatment session, and (c) active treatment of SCI within the previous 6 months. <h3>Interventions</h3> Participants received a face-to-face educational in-service, where existing evidence was shared that would guide OT clinical intervention in SCI, and the contents of the clinical intervention manual, with strategies to incorporate the manual into daily practice were also provided. <h3>Main Outcome Measures</h3> Outcome measures included: (1) pre-study survey, (2) field study survey, and (3) a post-study survey. The pre- and post-study survey consisted of 12 questions, identifying current use of ES, current knowledge and comfort using ES, as well as questions on the impact of the manual on their clinical practice patterns. Post-study survey participants completed the field survey after each treatment episode of ES application that explored their ES perceived impact on therapy, patient response, and overall therapist satisfaction of application. <h3>Results</h3> 18 OT clinicians submitted field surveys for 88 intervention episodes. 57% of participants indicated that their patients responded as anticipated by the manual. Participants consulted the manual for 34% of the episodes to promote consistency of ES application, aid in clinical decision making, to ensure consistency with evidence, to guide pad placement, and to solve parameter issues. Qualitative data gathered provided insight into participants' utilization of manual use. <h3>Conclusions</h3> The OT ES clinical intervention manual successfully demonstrated as a method to convey evidence-informed, comprehensible, and clinically relevant information, guiding occupational therapists to greater clinical competence and improved treatment fidelity. <h3>Author(s) Disclosures</h3> No conflict of interests exists.

A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial

BackgroundExercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. MethodsA single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale – Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. ResultsWe found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. ConclusionHBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.

Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health

Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program’s wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings >7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was >5/7. Retention was >80%. Homework completion was high, with <10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.

Online Telehealth Delivery of Group Mental Health Treatment Is Safe, Feasible, and Increases Enrollment and Attendance in Post-9/11 U.S. Veterans

Post-9/11 U.S. veterans are clinically complex with multiple co-occurring health conditions that lead to increased morbidity and mortality, risk for suicide, and decreased quality of life, but underutilization and resistance to treatment remain significant problems. Increased isolation and decreased community and social support due to coronavirus disease (COVID-19) have exacerbated mental health risk. This study evaluated the safety and feasibility of home-based telemental health group workshops to improve reintegration and social connection in post-9/11 U.S. military personnel. Seventy-four (61 males/13 females) post-9/11 U.S. military veterans were randomized to receive 12 sessions of STEP-Home cognitive-behavioral group workshop or present-centered group therapy. Treatment was delivered either in person (traditional medical center setting, treatment as usual [TAU]), or via home-based synchronous videoconferencing (VC). The change to VC occurred due to social distancing guidelines during COVID-19. Mean age was 41.0 years (SD = 11.5, range 24–65). Forty-five (36 males/9 females) participated in VC and 29 (25 males/4 females) in TAU. Demographics were similar across treatment milieu. There were no differences in therapist treatment adherence for TAU versus VC. Therapist satisfaction was higher for TAU groups (q value < .05). Veterans showed higher enrollment, attendance, group cohesion, and veteran-to-veteran support for VC compared to TAU (q values < .05). Safety procedures were successfully implemented via VC. Results demonstrate the safety, feasibility, and high satisfaction of group telemental health in U.S. veterans. Higher enrollment and treatment adherence for telemental health delivery resulted in a greater likelihood of receiving an effective treatment dose than TAU. Strong group cohesion and veteran-to-veteran support were achievable via telehealth. Telemental health offers convenient, efficient, and cost-effective care options for veterans and may be particularly helpful for patients with high psychiatric burden.

Improving Rehabilitation Information-Giving to Intensive Care Unit Survivors to Aid in Physical and Psychological Recovery

Intensive care unit (ICU) survivors have an increased mortality rate and reduced quality of life associated with post-ICU syndrome: a triad of physical, psychiatric and cognitive decline. Following evidence on the benefits of early rehabilitation, the National Institute of Clinical Excellence (NICE) CG83 guidelines instruct the provision of rehabilitation information to ICU patients before discharge. Only 33% of UK trusts meet these guidelines.The aim of this project was to reach 100% patient and ICU therapist satisfaction with the rehabilitation information given before ICU discharge at Medway Maritime Hospital, within four months.Patient and therapist satisfaction was assessed using questionnaires at baseline and following each Plan-Do-Study-Act (PDSA) cycle. In PDSA1, a generalised rehabilitation information booklet was created and distributed to ICU survivors pre-discharge. For PDSA2, a personalised rehabilitation plan completed by therapists was added. During PDSA3, the booklet was enriched with mental health and speech and language therapy sections.Results showed a shift in patient satisfaction scores, indicating a significant change in the median from 20% at baseline to 87% after PDSA3. This was also reflected in the therapist satisfaction scores, which increased significantly from 60% at baseline to 100%.The introduction of a generalised information booklet, supplemented with a personalised recovery plan, is an effective way of increasing critical care patient and therapist satisfaction with post-discharge rehabilitation information provision. This should translate to greater patient engagement with rehabilitation and improved long-term outcomes. This is ever more pertinent, as the COVID-19 pandemic will exponentially increase the numbers of ICU survivors at risk of long-term morbidity and mortality.

Individualized Aerobic Exercise in Neuromuscular Diseases: A Pilot Study on the Feasibility and Preliminary Effectiveness to Improve Physical Fitness.

ObjectiveClear guidelines to prescribe aerobic exercise in neuromuscular diseases (NMD) are lacking, which hampers effective application in neuromuscular rehabilitation. This pilot study evaluated the feasibility and preliminary effectiveness of an individualized aerobic exercise program according to a recently developed training guide (B-FIT) to improve physical fitness in individuals with NMD.MethodsThirty-one individuals who were ambulatory and had 15 different slowly progressive NMD participated in a 4-month, polarized, home-based, aerobic exercise program. The program included 2 low-intensity sessions and 1 high-intensity session per week. Feasibility outcomes were the following: completion rate, proportion of followed sessions, adverse events, and participant and therapist satisfaction based on a self-designed questionnaire. Submaximal incremental exercise tests were used to assess the effects on physical fitness.ResultsTwenty-six participants (84%) completed the B-FIT program, and the proportion of followed sessions was >75%. Three adverse events were reported and resolved. Regarding satisfaction, participants (based on n = 9) reported feeling fitter, but training was considered insufficiently challenging. Physical therapists (n = 5) reported that B-FIT provides a clear, well-grounded guidance. They perceived the time investment for initiating the program and the carry-over to primary care as the main barriers. The mean (SD) submaximal heart rate (based on n = 20) reduced significantly by −6.5 beats per minute (95% CI = −11.8 to −1.2), from 121.7 (16.5) at baseline to 115.2 (14.3) after intervention. Submaximal ratings of perceived exertion, anaerobic threshold, and peak workload also improved significantly (P < .05).ConclusionThe outcomes of this pilot study suggest that individualized aerobic exercise according to B-FIT is feasible and has potential to improve physical fitness in a wide variety of slowly progressive NMD. However, some barriers must be addressed before investigating the efficacy in a randomized controlled trial.ImpactThe outcomes of this study demonstrate the feasibility of individualized aerobic exercise according to the B-FIT training guide and the potential to improve physical fitness in NMD. Physical therapists indicated that the use of B-FIT provides a clear, well-grounded guidance. The training guide can support health care professionals in the application of aerobic exercise in adult neuromuscular rehabilitation.Lay SummaryIndividualized exercise according to the B-FIT training guide is feasible in a wide variety of slowly progressive NMD and might help improve physical fitness.

Feasibility and outcomes of a goal-directed physical therapy program for patients with metastatic breast cancer.

To evaluate the feasibility and outcomes of a tailored, goal-directed, and exercise-based physical therapy program for patients with metastatic breast cancer (MBC). This was an observational, uncontrolled feasibility study. The physical therapy intervention was highly tailored to the individual patient's goals, abilities, and preferences and could include functional, strength, aerobic, and relaxation exercises. Feasibility outcomes were participation rate (expected: 25%), safety, and adherence (percentage of attended sessions relative to scheduled sessions). Additional outcomes were goal attainment, self-reported physical functioning, fatigue, health-related quality of life, and patient and physical therapist satisfaction with the program. Fifty-five patients (estimated participation rate: 34%) were enrolled. Three patients did not start the intervention due to early disease progression. An additional 22 patients discontinued the program prematurely, mainly due to disease progression. Median intervention adherence was 90% and no major intervention-related adverse events occurred. A goal attainment score was available for 42 patients (of whom 29 had completed the program and 13 had prematurely dropped out). Twenty-two (52%) of these patients achieved their main goal fully or largely and an additional 15 patients (36%) partially. Eighty-five percent would "definitely recommend" the program to other patients with MBC. We observed a modest improvement in patient satisfaction with physical activities (Cohen's dz 0.33). The tailored intervention program was feasible in terms of uptake, safety, and outcomes and was highly valued by patients and physical therapists. However, disease progression interfered with the program, leading to substantial dropout. NTR register: NTR6475.

Interdisciplinary multimodal pain therapy under the protective measures of the COVID-19 pandemic : Analysis and progress report

Aufgrund der COVID-19-Pandemie mussten elektive medizinische Leistungen auf ein Minimum reduziert werden, wovon auch die schmerzmedizinische Versorgung betroffen war. Nach diesen drastischen Einschnitten steht nun eine vorsichtige Wiederaufnahme der elektiven Versorgungen an. Dies betrifft auch die Durchführung von stationären und teilstationären interdisziplinären multimodalen Schmerztherapien (IMST). Nachdem bis dato der Großteil der schmerzmedizinischen Einrichtungen geschlossen hat, stellte sich die Frage, ob unter den geforderten Schutzmaßnahmen eine Wiederaufnahme des Regelbetriebs problemlos umsetzbar ist. Um diese Fragestellung zu beantworten führten wir eine Patientenbefragung bei Patienten durch, die einen direkten Vergleich ziehen konnten zwischen einer IMST unter Normalbedingungen und unter den aktuell benötigten Schutzmaßnahmen. Die Umfrage erfasste dabei den Beeinträchtigungsgrad der unterschiedlichen Schutzmaßnahmen bei den verschiedenen Therapiebausteinen. Die Auswertung der Fragebögen von zwei Patientengruppen sowie aller beteiligten Therapeuten ergab, dass eine interdisziplinäre multimodale Schmerztherapie auch unter den benötigten Schutzmaßnahmen ohne größere Einschränkungen möglich ist. Insbesondere das Tragen einer Mund-Nasen-Schutzmaske erwies sich als die am stärksten beeinträchtigende Schutzmaßnahme. Durch Optionen wie die Verwendung einer Schutzscheibe oder die Verlegung der Therapiebausteine ins Freie stehen aber praktikable Schutzalternativen zur Verfügung. Die Zufriedenheit sowohl von Patienten als auch von Therapeuten war trotz dieser Einschränkungen groß und die persönliche Sorge vor einer möglichen Infektion gering.

Treating Adults With Complex Posttraumatic Stress Disorder Using a Modular Approach to Treatment: Rationale, Evidence, and Directions for Future Research.

ICD-11 complex PTSD (CPTSD) is a new condition, and, therefore, there are as yet no clinical trials evaluating interventions for its treatment. In this paper, we provide the rationale for a flexible multimodular approach to the treatment of CPTSD, its feasibility, and some evidence suggesting its potential benefits. The approach highlights flexibility in the selection of empirically supported interventions (or a set of interventions) and the order of delivery based on symptoms that are impairing, severe, and of relevance to the patient. The approach has many potential benefits. It can incorporate the use of interventions for which there is already evidence of efficacy allowing the leveraging of past scientific efforts. It is also consistent with patient-centered care, which highlights the importance of patient choice in identification of the problems to target, interventions to select, and outcomes to monitor. Researchers on modular treatments of other disorders have found that, compared to disorder-specific manualized protocols, flexible multimodular treatment programs are superior in resolving identified problems and are associated with greater therapist satisfaction and reduced patient burden. We briefly identify types of interventions that have been successful in treating trauma-exposed populations as well as emerging interventions that are relevant to the particular problems associated with exposure to complex trauma. We conclude with examples of how such treatments can be organized and tested. Research is now urgently needed on the effectiveness of existing and new intervention approaches to ICD-11 CPTSD treatment.

Design feasibility of an automated, machine-learning based feedback system for motivational interviewing.

Direct observation of psychotherapy and providing performance-based feedback is the gold-standard approach for training psychotherapists. At present, this requires experts and training human coding teams, which is slow, expensive, and labor intensive. Machine learning and speech signal processing technologies provide a way to scale up feedback in psychotherapy. We evaluated an initial proof of concept automated feedback system that generates motivational interviewing quality metrics and provides easy access to other session data (e.g., transcripts). The system automatically provides a report of session-level metrics (e.g., therapist empathy) and therapist behavior codes at the talk-turn level (e.g., reflections). We assessed usability, therapist satisfaction, perceived accuracy, and intentions to adopt. A sample of 21 novice (n = 10) or experienced (n = 11) therapists each completed a 10-min session with a standardized patient. The system received the audio from the session as input and then automatically generated feedback that therapists accessed via a web portal. All participants found the system easy to use and were satisfied with their feedback, 83% found the feedback consistent with their own perceptions of their clinical performance, and 90% reported they were likely to use the feedback in their practice. We discuss the implications of applying new technologies to evaluation of psychotherapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).