Rehabilitation Trials Research Articles

Reusing the Ghoufi’s vernacular buildings within the context of sustainable conservation, an action put to the test

PurposeVernacular architectures are now seen as sustainable construction models for their quality and environmental solutions. This study examines Ghoufi’s Chaouie constructive culture, which adapted to harsh climates by optimizing resources and integrating vegetation, construction and animal husbandry. Yet, modernization efforts have often endangered this heritage through harmful rehabilitation. Our main goal is to preserve this resilient architecture through sustainable conservation that respects its cultural integrity.Design/methodology/approachAn experimental method, based on the principles of integrated conservation, was employed to evaluate the reuse and readaptation potential of vernacular buildings. The research involved an initial discovery phase to examine the building practices, environmental context and Chaouie cultural heritage. Evaluation is conducted through a pilot study, where we conduct a rehabilitation trial on a model house, followed by a public survey, to refine the experimentation and obtain reliable and quality results.FindingsThe study concludes with methodological guidelines for a sustainable conservation strategy for Ghoufi. The findings demonstrate the feasibility of reviving traditional techniques, leveraging local expertise and resources and promoting environmentally responsible practices in the conservation of vernacular architecture.Originality/valueThe study lies in its holistic, field-based approach to sustainable conservation, centered on Ghoufi’s cultural and environmental context. Unlike prior interventions, this research integrates traditional construction, Chaoui community values and ecotourism as drivers of sustainable territorial development. It demonstrates the feasibility of reusing vernacular structures through an inclusive, community-focused conservation strategy that preserves Ghoufi’s identity while supporting long-term sustainability.Highlights(1)The Algerian civil war, known in Algeria as the black decade, lasted from 1992 to 2002.(2)The name of the local population of the Aures region I, including Ghoufi.(3)Tourist expansion zone.(4)Permanent Plan for the Conservation and Enhancement of the Protected Sector [Author’s translation].(5)These are development and planning schemes in Algeria at the regional territorial level and at the level of the province (wilaya).(6)These are agencies supporting youth employment, micro-credits and support units for assisting young entrepreneurs in job creation.

Long-Term Post-Stroke Cognition in Patients With Minor Ischemic Stroke is Related to Tract-Based Disconnection Induced by White Matter Hyperintensities.

Over a third of minor stroke patients experience post-stroke cognitive impairment (PSCI), but no validated tools exist to identify at-risk patients early. This study investigated whether disconnection features derived from infarcts and white matter hyperintensities (WMH) could serve as markers for short- and long-term cognitive decline in first-ever minor ischemic stroke patients. First-ever minor ischemic stroke patients (NIHSS ≤ 7) were prospectively followed at 72-h, 6 months, and 36 months post-stroke with cognitive tests and brain MRI. Infarct and WMH volumes were semi-automatically assessed on DWI and FLAIR sequences. Bayesian tract-based disconnection models estimated remote pathological effects of infarcts and WMH. Associations between disconnection features and cognitive outcomes were analyzed using canonical correlation analyses, adjusted for age, education, and multiple comparisons. Among 105 patients (31% female, mean age 63 ± 12 years), infarct volume averaged 10.28 ± 17.10 cm3 and predominantly involved the middle cerebral artery territory (83%). WMH burden was higher in frontal periventricular white matter. Infarct-based features did not significantly relate to PCSI. However, a WMH-derived disconnection factor, involving commissural and frontal tracts, and the right superior longitudinal fasciculus, was significantly associated with PSCI at 6 months (OR = 9.96, p value = 0.02) and 36 months (OR = 12.27, p value = 0.006), particularly in executive/attention, language, and visuospatial domains. This factor, unrelated to WMH volume, outperformed demographic and clinical predictors of PSCI. WMH-induced disconnection may be associated with short- and long-term PSCI in minor stroke. Routine MR-derived features could identify at-risk patients for rehabilitation trials.

Development and Pilot Implementation of a Theory-Based Cognitive Rehabilitation Protocol for Adults With Chronic Cognitive Complaints After Mild Traumatic Brain Injury.

The aim of this study was to describe the development of and pilot feasibility outcomes for a strategy-based, brief, intensive cognitive rehabilitation intervention delivered to U.S. service members and veterans with mild traumatic brain injury in a recently completed 3-year pragmatic clinical trial: Symptom-Targeted Approach to Rehabilitation for Concussion (STAR-C). To develop STAR-C, we used the Rehabilitation Treatment Specification System to identify core elements and principles from a previous randomized clinical trial of cognitive rehabilitation, and incorporated principles of neuroplasticity (e.g., high-dose spaced practice of personally meaningful tasks), best clinical practices (e.g., client-centered goal setting), health psychology (e.g., a focus on self-efficacy and motivation), and community-based participation research (e.g., the protocol was co-designed by clinicians and researchers). Treatment was based on a resource-allocation theory of everyday cognitive challenges, which predicted that automatic strategy use would reduce cognitive demands of everyday activities and therefore reduce cognitive symptoms. Treatment was delivered by speech-language pathologists (SLPs) and occupational therapists (OTs), using a protocol that included a problem-focused intake questionnaire, manualized treatment, and clinician resources. Therapy was delivered individually in six to 10 virtual or in-person sessions over 3-4 weeks. Therapy focused on desired changes in function, scaled using Goal Attainment Scaling. Trained SLPs and OTs delivered STAR-C to 53 U.S. service members and veterans, with treatment fidelity > 95%. Participants and clinicians rated STAR-C as acceptable, feasible, and appropriate, and most participants attained and maintained targets. STAR-C appears to be a feasible method for improving everyday cognitive performance and efficacy should be tested in a controlled study. https://doi.org/10.23641/asha.28222613.

Monitoring Treatment Fidelity in a Pragmatic Pediatric Rehabilitation Trial Comparing Two Physical Therapy Schedules: Analysis and Unexpected Findings.

This study aimed to describe the monitoring of treatment fidelity in a pragmatic pediatric rehabilitation trial using the National Institutes of Health Behavior Change Consortium framework, and to identify child and therapist factors that influence treatment fidelity. Therapists (n = 28) were trained in the key ingredients (1-on-1, functional, goal-directed, motor learning intervention) and study protocol for a comparative effectiveness trial titled: A Comparison: High Intensity periodic vs. Every week therapy in children with cerebral palsy (ACHIEVE) for children ages 2 to 8years with cerebral palsy. Therapists were instructed to record every tenth hour of treatment. A subset of recordings were used to monitor treatment fidelity so that each therapist was rated twice using the study- specific ACHIEVE Treatment Fidelity Checklist. Generalized linear mixed effects modeling and logistic regression were used to analyze child and therapist factors related to treatment fidelity. Median treatment fidelity scores were high (>80%). With training, therapist's years of experience and specialty certification do not significantly impact treatment fidelity. There is a trend toward lower treatment fidelity scores for children with communication difficulties, particularly for therapist's use of multi-modal instructions to direct the child in the desired activity. Functional, goal-directed, motor learning intervention can be delivered with high fidelity for children with cerebral palsy within a busy clinical setting. Motor learning principles may be implemented differently for children with communication difficulties. More research is needed to explore optimal motor learning strategies for these children. With training, physical therapists can deliver high-fidelity intervention to children with cerebral palsy across all Gross Motor Function Classification System levels within a busy clinical setting. Therapists may use motor learning principles differently in children with communication delays.

An exploration of serious falls after stroke using a large international stroke rehabilitation database.

Falls are common after stroke and can have serious consequences such as hip fracture. Prior research shows around half of individuals will fall within the 12 months post stroke, and these falls are more likely to cause serious injury compared to people without stroke. However, there is limited research on risk factors collected in the immediate post-stroke period that may relate to falls risk. Furthermore, the circumstances and consequences surrounding falls resulting in serious adverse events (serious falls) is underexplored. Using longitudinal cohort data from A Very Early Rehabilitation Trial (AVERT), we aimed to describe the occurrence, consequences, and circumstances of serious falls over 12 months post stroke and examine potential risk factors associated with these serious falls. Data from participants included in the AVERT trial (n = 2104; recruited from 56 stroke units across five countries) were analyzed. Serious falls were defined as those resulting in death, were life threatening, or required/prolonged hospitalization. Baseline variables included: demographics, pre-morbid function, stroke severity, hemi-neglect, functional independence, and mobility. Statistical analysis included Wilcoxon-Mann-Whitney tests, Fisher's tests, and Firth's logistic regressions (adjusting for age, stroke severity, and AVERT intervention group). Of the 2104 participants, 85 (4%) experienced at least one serious fall (mean age 78.1 years, 45 male), with 91 individual falls. Fifty-five (60%) serious falls resulted in fracture, with 23 (42%) being hip fractures. Two (2%) falls resulted in death. Serious falls were most common during the day (26 of 38 reported), at home (30 of 63 reported) and while ambulating (22 of 42 reported). More serious falls were experienced by participants who were older, had worse pre-morbid mobility, were unable to walk 10 m independently in the first 24 hours post stroke, or required longer than 14 days to walk 50 m unassisted. This large international prospective study found 1 in 25 stroke survivors experienced serious falls in the first year after stroke. Fractures were a common outcome of these falls, but the true post-stroke fracture rate is likely to be underestimated due to our study methods, such as the exclusion of individuals with poor pre-morbid mobility and the absence of data on fractures not relating to falls or leading to an inpatient hospital admission. Clear associations between older age, impaired pre- and early post-stroke mobility and heightened risk of serious falls were found. Integrating these factors into post-stroke screening tools could improve identification of individuals at greater risk of serious falls and lead to more focused rehabilitation and injury prevention.

A100: Effect of Blood Flow Restriction Training on Knee Rehabilitation After ACL Reconstruction

Purpose: To systematically evaluate the effect of blood flow restriction training on knee rehabilitation of patients with anterior cruciate ligament reconstruction and compare the effect of blood flow restriction training and traditional resistance rehabilitation training on knee rehabilitation of patients with anterior cruciate ligament reconstruction. Method: The databases of EBSCO, Embase, PubMed, The Cochrane Library and Web of Science were searched, and the randomized controlled trials of knee rehabilitation after anterior cruciate ligament reconstruction were collected. The search time was from the establishment of the database to June 31st, 2023. After two researchers independently screened the literature, extracted the data and evaluated the bias risk included in the study, they used Stata version 14.0 software for meta-analysis. Results: A total of 8 studies were included, including 203 patients. Meta-analysis showed that blood flow restriction training was superior to traditional resistance rehabilitation training group in improving knee muscle strength [SMD=0.76, 95% CI: (0.42, 1.09), P < 0.001], muscle mass around knee joint [SMD=0.71, 95% CI: (0.36, 1.06), P < 0.001] and knee joint function [SMD=4.22, 95% CI: (2.18, 6.26), P < 0.001]. Subgroup analysis showed that the rehabilitation effect of muscle mass around knee joint [SMD=0.53, 95% CI: (0.06, 1), P=0.03] was more effective than that of traditional resistance rehabilitation training group when training times were ≥ 3 times per week. Conclusion: Blood flow restriction training can improve knee muscle strength, muscle mass around knee joint and knee joint function more effectively than traditional resistance rehabilitation training after anterior cruciate ligament reconstruction. It is suggested that training three times a week or more during rehabilitation can better improve knee joint muscle mass. At the same time, pretreatment of long-term blood flow restriction training for 4–8 weeks before operation is more beneficial to the rehabilitation of knee joint after operation.

Reporting of nutritional screening, status, and intake in trials of nutritional and physical rehabilitation following critical illness: a systematic review.

Surviving critical illness leads to prolonged physical and functional recovery with both nutritional and physical rehabilitation interventions for prevention and treatment being investigated. Nutritional status and adequacy may influence outcome, but no consensus on which nutritional-related variables should be measured and reported in clinical trials exists. This study aimed to undertake a systematic review investigating the reporting of nutritional screening, nutritional status, and nutritional intake/delivery in randomized controlled trials (RCTs) evaluating nutritional and/or physical rehabilitation on physical and functional recovery during and following critical illness. Five electronic databases (MEDLINE, Web of Science, EMBASE, CINAHL, and Cochrane) were searched (last update 9 August, 2023). Search terms included both free text and standardized indexed terms. Studies included were RCTs assessing nutritional and/or physical interventions either during or following intensive care unit (ICU) admission in adults (18 y or older) with critical illness, and who required invasive mechanical ventilation for any duration during ICU admission. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool for RCTs and descriptive data synthesis was performed and presented as counts (%). n t RESULTS: In total, 123 RCTs (30 nutritional, 87 physical function, and 6 combined) were included. Further, ≥1 nutritional variable was measured and/or reported in 99 (80%) of the studies including BMI (n = 69), body weight (n = 57), nutritional status (n = 11), nutritional risk (n = 10), energy delivery (n = 41), protein delivery (n = 35), handgrip strength (n = 40), and other nutritional-related muscle variables (n = 41). Only 3 studies were considered to have low risk of bias in all categories. Few RCTs of physical rehabilitation measure and report nutritional or related variables. Future studies should measure and report specific nutritional factors that could impact physical and functional recovery to support interpretation where studies do not show benefit. This protocol was preregistered at PROSPERO as CRD42022315122.

Symptom Exacerbation and Adverse Events During a Randomized Trial of Early-Stage Rehabilitation After Sport-Related Concussion: Safety Outcomes From the Active Rehab Study.

Authors of few studies have used randomized controlled trials (RCTs) to quantify clinical intervention safety of rehabilitation after sport-related concussion across sport levels. Describe symptom exacerbation and adverse events (AEs) associated with two concussion rehabilitation interventions. Cluster RCT (NCT02988596). Sports medicine clinic and field settings. The RCT enrolled 251 concussed athletes (median age = 20 years; female, n = 48) across 28 sites from New Zealand professional rugby (n = 31), Canadian professional football (n = 52), US/Canadian colleges (n = 128) and US high schools (n = 40). Two medically supervised interventions: (1) enhanced graded exertion (EGE): international return-to-sport strategy and sport-specific activities only (EGE only, n = 119); and (2) multidimensional rehabilitation (MDR) followed by EGE: early symptom-directed exercises once symptoms were stable, followed by EGE after symptoms resolved (MDR + EGE, n = 132). Primary outcomes were intrasession total symptom severity score exacerbation and significant intersession (increase 10+ severity points) sustained total symptom severity exacerbation, each measured with the Postconcussion Symptom Scale (132 total severity points on scale). Reported AEs were also described. Activity-based rehabilitation sessions (n = 1437) were the primary analysis unit. Frequencies, proportions, medians, and interquartile ranges were calculated for outcomes by treatment group. The 251 postinjury participants completed 1437 (MDR + EGE = 819, EGE only = 618) activity-based intervention sessions. A total of 110 and 105 participants contributed data (those missing had no documented session data) to at least 1 activity-based session in the MDR + EGE and EGE-only arms, respectively. Intrasession symptom exacerbations were equivalently low in MDR + EGE and EGE-only arms (MDR + EGE: 16.7%, 95% CI = 14.1%, 19.1%; EGE only: 15.7%, 95% CI = 12.8%, 18.6%). In total, 9/819 MDR + EGE sessions (0.9%) and 1/618 EGE-only sessions (0.2%) resulted in a presession to postsession symptom exacerbation beyond a 10+ severity point increase; 8/9 resolved to <10 points by the next session. Two study-related AEs (1 in each arm) were reported. Participants in MDR + EGE and EGE-only activities reported equivalently low rates of symptom exacerbation.

Patterns of Adherence to Home Blood Pressure Monitoring Among Older Adults With Ischemic Heart Disease: An Analysis From the RESILIENT Trial of Mobile Health Cardiac Rehabilitation.

Hypertension (HTN) is common and represents a major modifiable risk factor for ischemic heart disease in older adults. While home blood pressure monitoring (HBPM) is important in HTN management, patterns of HBPM engagement in older adults undergoing mobile health cardiac rehabilitation (mHealth-CR) are unknown. We aimed to identify patterns of adherence to HBPM in a cohort of older adults undergoing mHealth-CR to optimize HBPM use in the future. We used interim data from the ongoing Rehabilitation using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting (RESILIENT) randomized trial, in which intervention arm participants (adults≥65years with ischemic heart disease) were instructed to monitor blood pressure (BP) at least weekly. Engagement groups were determined by latent class analysis and compared using ANOVA or Chi-Square tests. Longitudinal mixed effect modeling determined the associations between weekly HBPM and baseline covariates including uncontrolled HTN, obesity, diabetes, depression, alcohol, and tobacco use. Of the 111 participants, the mean age was 71.9±5.6years, and 83% had HTN. Over the 12-week study, mean HBPM engagement was 2.3±2.3d/wk. We observed 3 distinct patterns of engagement: high engagement (22%), gradual decline (10%), and sustained baseline engagement (68%). HBPM adherence decreased in two of the engagement groups over time. Of the covariates tested, only depression was associated with weekly HBPM after adjusting for relevant covariates (OR 9.09, P =.03). In this older adult cohort undergoing mHealth-CR, we found three main engagement groups with declining engagement over time in two of the three groups. These patterns can inform future mHealth-CR interventions.

Randomized trial of early exercise rehabilitation and its effects on patients with acute coronary syndrome

To assess the psychological and physiological benefits of early exercise rehabilitation in patients with acute coronary syndrome (ACS). Among 559 ACS-diagnosed patients at Fuzhou University Affiliated Provincial Hospital from January to December 2021, 200 eligible participants were assigned to two groups. The control group received standard care, while the experimental group received early exercise rehabilitation in addition to standard care. The outcomes measured included changes in depression levels (PHQ-9), fasting blood glucose, and troponin I (TnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Data were analyzed using SPSS, with t tests and chi-square tests for group comparisons. In comparison to the control group, the experimental group demonstrated significant improvements in PHQ-9 scores (P < 0.001) and lower fasting blood glucose levels before discharge (P = 0.046). Additionally, the experimental group had notably reduced TnI levels at 72 h after admission (P = 0.001), especially among non-diabetic NSTEMI patients over 60 years old, who showed decreased TnI levels at the 48-hour mark (P = 0.016). However, there were no significant differences in NT-ProBNP change values between the two groups (P > 0.05). Subgroup analysis revealed enhanced outcomes in the intervention group for ACS patients without smoking or drinking history and no heart failure (P = 0.025,P = 0.014,P = 0.018). Early exercise rehabilitation has notable benefits for ACS patients, including reduced depression, improved blood glucose control, and enhanced myocardial protection, especially in nondiabetic NSTEMI patients aged 60 and above.

A study to explore the role of a low threshold, fitness focussed physical rehabilitation intervention with protein supplementation to target physical function and frailty in people with problematic substance use and homelessness: protocol for a single-arm pre-post intervention study.

People who are homeless are more likely to experience poor mental health and addiction as well as suffering from non-communicable diseases. There is evidence of frailty and accelerated physical ageing among people experiencing homelessness. Appropriate physical rehabilitation and nutritional supplementation strategies can stabilise or reverse frailty and general physical decline, but it is not known how this type of intervention would work in practice in this population. To evaluate the feasibility and pre-post intervention impact of a low threshold physical rehabilitation intervention with protein supplementation to target physical functioning and frailty in people with problematic substance use who are experiencing homelessness. The intervention will consist of a 12-week low threshold rehabilitation programme with protein supplementation. Participants will be service users of the Ballyfermot Advance Project, a day services centre for people with addiction issues and experiencing homelessness. Primary outcomes will be feasibility including numbers recruited, retention of participants and adherence to the exercise intervention and protein supplement. Any adverse events will be recorded. Secondary outcomes will be strength and muscular mass, physical performance and lower extremity physical function, pain, frailty and nutritional status. An immediate impact may be simply a distraction from difficult circumstances and potentially an improvement of physical health of participants, which can be a conduit for the emergence of other positive behaviours and recovery. Longer term, this study will generate preliminary data on which to inform the design of a definitive randomised controlled trial of physical rehabilitation and protein supplementation, if indicated. Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee in TCD. Study findings will be disseminated through publication into an international peer-reviewed journal and presented at national and international conferences.

Discharge Destination, Mortality Outcomes and Rehabilitation Utilization, a One Year Follow Up of Frail Older Medical Inpatients

Abstract Background Patients with increasing frailty constitute a large proportion of acute hospital admissions. Deconditioning is a known complication of acute medical admission. This study reviews the outcomes for a population identified as frail during their admission, including utilisation of formal rehabilitation and discharge destination. Mortality rates at 6 and 12 months are also reviewed to assess if frailty could be used as a prognostication tool. Methods The patients selected were included in a hospital wide point prevalence study in 2023. Patients included were over 70 years of age and admitted under a medical team. Clinical frailty scale (CFS) score was recorded on all patients. The hospital electronic record provided information on transfer for formal rehabilitation, discharge home with home care package or discharge to long term care. The cohort were coded based on discharge destination. Mortality outcome at 6 and 12 months were also obtained via electronic record and RIP.ie. Results 233 patients were included, 177 (75.9%) were identified as frail. Only 8 (3.43%) of the group were discharged to formal rehabilitation. 52 (22.3%) were transferred directly to Long term care from hospital without a trial of formal rehabilitation. 8 of this group had specific rehab needs documents, all 8 were alive at 6 and 12 months. Approximately 40% of the total group had died within 12 months. Conclusion Rehabilitation benefits the individual patient and the health service as a whole, by impacting care needs and facilitating discharge home (Van Craen et al., 2010). This study has shown that approximately 1 in 4 patients over 70 were discharged directly to long term care without appropriate rehabilitation. Just over 3.4% of the group received formal rehabilitation outside of the acute hospital. This has highlighted the need to radically act on egress pathways to provide appropriate rehabilitation and care for our patients.

A Systematic Review of Worldwide Female Enrollment in Randomized Controlled Trials of Post-Stroke Lower Extremity Rehabilitation.

This review systematically examined the reporting of sex and female participation in post-stroke lower extremity (LE) motor rehabilitation randomized controlled trials (RCTs) over time and identified differences in female participation across RCTs conducted in low-and-middle-income countries (LMICs), high-income-countries (HICs), and HIC-regions. Systematic searches were conducted of MEDLINE, Embase, CINAHL and PsycINFO from 1970 to May 2022. RCTs in English were included if they examined post-stroke LE motor rehabilitation interventions in adults diagnosed with stroke. A total of 1,285 RCTs were analyzed; 4.5% of RCTs did not report sex, and the overall female participation was 39.4%. The percentage of female participants did not significantly differ between HICs and LMICs. Within HICs, the percentage of female participants was significantly higher in European RCTs than RCTs in Asia & Oceania (P = 0.008). No significant changes in female participation were found for any of the countries or regions over the last two decades. Female participation was significantly higher in RCTs conducted in the acute phase compared to those in the chronic phase (p < 0.001). More research is needed to understand the reasons behind female under-enrollment and further efforts are required to ensure adequate enrollment of males and females.

Financial analysis of a locomotor exercise trial for post-stroke recovery: insights from the HIT Stroke Trial

BackgroundNavigating the complexities of post-stroke recovery trials requires addressing challenges in participant recruitment and retention and effective resource management to ensure trial success. The aim of this study was to examine the financial requirements associated with conducting the Moderate-Intensity Exercise vs. High-Intensity Interval Training to Recover Walking Post-Stroke (HIT Stroke Trial) at a single site encompassing a wide catchment area, recognizing the intricate challenges of participant recruitment and retention inherent in post-stroke recovery trials.MethodsTo determine cost, study expense reports were gathered and divided into seven categories: recruitment, screening assessments, baseline assessments, intervention, outcome assessments, retention, and oversight. Categories were then further divided into chronological order for initial contact and prescreening, consenting, initial screening, and baseline testing. The 12-week intervention was divided into 4-week blocks: intervention block 1, post 4-week outcome testing, intervention block 2, post 8-week outcome testing, intervention block 3, and post 12-week outcome testing.ResultsTotal direct cost for site execution was $539,768 with cost per participant approximated as $35,984. Oversight costs accounted for 65.8% of the budget at $355,661. To achieve goals related to inclusive participant recruitment ($21,923) and retention ($28,009), our site costs totaled $49,932. Direct study-related costs included screening assessments ($5,905), baseline assessments ($15,028), intervention ($76,952), and outcome assessments ($36,288).DiscussionClinical trials focusing on walking rehabilitation and exercise, particularly those requiring multiple assessment visits, demand rigorous oversight. This cost analysis provides important and critical insight into the expenses required to successfully execute an exercise-based walking rehabilitation trial in the United States.

A systematic review of upper extremity outcome measures assessed in randomized controlled trials of post stroke upper extremity rehabilitation over time

ABSTRACT Background The heterogeneity in outcome measures of post stroke rehabilitation trials suggests the need for consensus approach in stroke recovery measurement. To reach this aim, it is important to understand the past and current use of outcome measures in randomized control trials (RCTs) of stroke rehabilitation. Objective To systematically review RCTs of post stroke UE rehabilitation interventions to understand the use of UE outcome measures in research and their changes over time. Methods CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to 1 April 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were affected by stroke, 3) included adults ≥ 18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of the study. Results 1,276 RCTs met inclusion criteria, and 112 different outcome measures were identified. Outcome measures were classified according to the International Classification of Functioning, Disability and Health (ICF) framework. Outcome measures most frequently assessed body function and structure (n = 1,692), followed by activities (n = 1,572) and participation (n = 162). The most used outcome measures were the Fugl-Meyer Assessment (n = 619), the modified Ashworth Scale (n = 255), Action Research Arm Test (n = 211), Wolf Motor Function Test (n = 184), and Box and Block Test (n = 178). Conclusions Understanding the breadth of outcome measures that have been used over time emphasizes the need for proposed standardization of outcome measures but also the need to adjust and expand consensus recommendations based on past and ongoing research trends.

Biomarkers and Rehabilitation for Functional Neurological Disorder.

Functional neurological disorder, or FND, is widely misunderstood, particularly when considering recent research indicating that the illness has numerous biological markers in addition to its psychiatric disorder associations. Nonetheless, the long-held view that FND is a mental illness without a biological basis, or even a contrived (malingered) illness, remains pervasive both in current medical care and general society. This is because FND involves intermittent disability that rapidly and involuntarily alternates with improved neurological control. This has in turn caused shaming, perceived low self-efficacy, and social isolation for the patients. Until now, biomarker reviews for FND tended not to examine the features that are shared with canonical neurological disorders. This review, in contrast, examines current research on FND biomarkers, and in particular their overlap with canonical neurological disorders, along with the encouraging outcomes for numerous physical rehabilitation trials for FND. These findings support the perspective endorsed here that FND is unquestionably a neurological disorder that is also associated with many biological markers that lie outside of the central nervous system. These results suggest that FND entails multiple biological abnormalities that are widely distributed in the body. General healthcare providers would benefit their care for their patients through their improved understanding of the illness and recourses for support and treatment that are provided in this review.

Immediate and One-Year Outcomes of an Asthma-Tailored Pulmonary Rehabilitation Programme in Overweight and Obese People with Difficult-to-Treat Asthma.

Management of difficult-to-treat asthma is particularly challenging in people with elevated body mass index (BMI). Our randomised controlled trial of pulmonary rehabilitation (PR) showed improved outcomes at 8weeks. Here we assess immediate and one-year effects of asthma-tailored PR in participants with difficult-to-treat asthma and BMI ≥25 kg/m2, and identify response predictors. A prospective observational study of PR, tailored to asthma, comparing outcomes at baseline (V1), immediately after 8 weeks of PR (V2), and at 1 year (V3). Baseline characteristics were compared in responders/non-responders defined by achievement of minimum clinically important difference (MCID) for asthma control questionnaire (ACQ6) (0.5) at 8weeks and 1 year. Of 92 participants, 56 attended V2 and 45 attended V3. Mean age was 60 (SD 13) years, 60% were female, and median (IQR) BMI was 33.8 (29.5-38.7) kg/m2. At V1, V2, and V3, respectively, there were significant differences in ACQ6 (mean (95% CI): 2.5 (2.1-2.9), 2.2 (1.8-2.5), and 2.3 (1.9-2.7), p<0.003), Borg breathlessness score post-6-minute walk test (median (IQR): 2 (0.5-3), 1 (0-2), and 1 (0.5-2), p<0.035), and annualised exacerbations requiring prednisolone (median (IQR): 3 (2-5), 0 (0-4.7), and 1.5 (0-4.2), p<0.003). A total of 27/56 (48%) had improvements >MCID for ACQ6 at V2 and 16 (33%) at V3. Participants with higher ACQ6 scores at baseline (suggesting poorer asthma control) were more likely to achieve MCID. Baseline BMI, within the range studied, was not predictive. Pulmonary rehabilitation induced improvements in asthma-related outcomes including perception of breathlessness, asthma control, and exacerbation frequency at 1 year. Those with poorer baseline asthma control were more likely to benefit.

919: Randomised trial of nurse-led sexual rehabilitation after radiotherapy for gynaecological cancers

919: Randomised trial of nurse-led sexual rehabilitation after radiotherapy for gynaecological cancers

PRACTICE: Development of a Core Outcome Set for Trials of Physical Rehabilitation in Critical Illness.

Rationale: Findings from individual trials of physical rehabilitation interventions in critically ill adults have limited potential for meta-analysis and informing clinical decision-making because of the heterogeneity in selection and reporting of outcomes used for evaluation. Objectives: The objective of this study was to determine a core outcome set (COS) for use in all future trials evaluating physical rehabilitation interventions delivered across the critical illness continuum of recovery. Methods: An international, two-round, online, modified Delphi consensus process, following recommended standards, was conducted. Participants (N = 329) comprised three stakeholder groups-researchers, n = 58 (18%); clinicians, n = 247 (75%); and patients and caregivers, n = 24 (7%)-and represented 26 countries and nine healthcare professions. Participants rated the importance of a range of relevant outcomes. Outcomes included in the COS were those prioritized of "critical importance" by all three stakeholder groups. Results: Survey response rates were 88% (Round 1) and 91% (Round 2). From a total of 32 initial outcomes, the following outcomes reached consensus for inclusion in the COS: physical function, activities of daily living, survival, health-related quality of life, exercise capacity, cognitive function, emotional and mental well-being, and frailty. Conclusions: This study developed a consensus-generated COS for future clinical research evaluating physical rehabilitation interventions in critically ill adults across the continuum of recovery. Ascertaining recommended measurement instruments for these core outcomes is now required to facilitate implementation of the COS.

A Randomized Controlled Trial of Home-based Virtual Rehabilitation to Improve Adherence to Prescribed Home Therapy After Burn Injury: A Northwest Regional Burn Model System Trial.

Daily rehabilitation after burn injury is vital for the prevention of function-limiting contractures. However, adherence to prescribed therapy following acute burn hospitalization has historically been low and not well-studied. Studies involving virtual reality technology have demonstrated an association with improved functional outcomes in burn therapy. We conducted a 5-year randomized controlled trial comparing 12 weeks of a home-based virtual rehabilitation (HBVR) system with standard burn therapy. Our primary outcome was adherence to prescribed home therapy, measured by e-diary self-report. Secondary outcomes included steps walked daily and patient-reported outcomes regarding stiffness, upper extremity function, and mobility. We enrolled 50 subjects, of which 48 provided data for analysis (23 HBVR, 25 control). Overall adherence to prescribed home therapy was low, 37.2% in the HBVR group and 60.0% in the control group. Reasons for nonadherence in the HBVR group included lack of time, engagement, and replacement of therapy with other physical activity. However, some subjects enjoyed HBVR and believed it aided their recovery. There was no difference in daily steps walked between the 2 groups. Daily walking gradually improved from 3500 steps per day in the first week after baseline and plateaued at 6000 steps per day at week 5. There were no differences in stiffness, upper extremity function, and mobility between the 2 groups at baseline and 3-, 6-, and 12-month follow-up. Subjects demonstrated improved upper extremity function and mobility in the first year after discharge, which coincided with increasing stiffness.