Weekend Therapy Research Articles

Effects of weekend rehabilitation on vertebral compression fractures in the elderly.

This retrospective cohort study aimed to investigate the effect of rehabilitation and without weekend therapy on Activities of daily living (ADL) and readmission in vertebral fracture patients aged 60years and older. The present study used a hospital-based database created by JMDC Inc. The JMDC hospital-based database is an epidemiological database that has been storing medical claims and Diagnosis Procedure Combination survey data. This study included 40,743 admitted patients aged 60years or older who were admitted for rehabilitation purposes with a diagnosis of compression fracture of the thoracic and/or lumbar spine based on a previous diagnostic survey. We extracted the medical information from the database. Patients who received rehabilitation 7days a week were classified into two groups: the "weekend rehabilitation group" and "nonweekend rehabilitation group." To reduce confounding effects related to differences in patient background, we used propensity score with multiple logistic regression models. Analysis of the JMDC database was conducted with the approval of the Institutional Review Board (approval number: 1228-1). Because all data were anonymized, informed consent was not required. Propensity score matching resulted in 13,790 cases being included in the analysis. Barthel index (BI) at discharge, change in BI, and readmission were significantly different between the weekend rehabilitation and nonweekend rehabilitation groups. Multiple logistic regression analysis suggested a reduced odds of readmission with weekend rehabilitation (odds ratio=0.907, 95% confidence interval [CI]=0.843-0.975, p-value=0.008). Furthermore, greater changes in BI and BI at discharge were associated with the effect of weekend rehabilitation (unstandardized [B]=3.922, 95% CI=2.925-4.919), (unstandardized [B]=3.512, 9% CI=2.424-4.6), respectively. Weekend rehabilitation was considered as an important part of the treatment program to acquire ADL and to prevent readmission.

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach.

Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study

BackgroundThe first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility.MethodsA prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.ResultsA total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group.After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively.ConclusionsImplementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

Strategies for using topical corticosteroids in children and adults with eczema.

Strategies for using topical corticosteroids in children and adults with eczema.

Safety of topical corticosteroids in atopic eczema: an umbrella review

ObjectiveAn umbrella review summarising all safety data from systematic reviews of topical corticosteroids (TCS) in adults and children with atopic eczema.MethodsEmbase, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and the...

Proactive treatment in childhood psoriasis

Psoriasis affects 0.5% of children. The current therapeutic arsenal includes local treatments, phototherapies and systemic treatments (conventional systemic therapy and biotherapy), which, in most cases, are sufficient to control this skin disease. Subsequent management of these children should focus on maintaining therapeutic efficacy and preventing relapse by reducing any treatment-related toxicity in order to improve their quality of life. It would therefore appear useful to adopt a "proactive" attitude. To be proactive is to anticipate disease progression in order to limit both the severity and the incidence of new flare-ups. This approach must be distinguished from reactive support. Based on our experience of atopic dermatitis and data on adult psoriasis, in the absence of publications specific to childhood-onset psoriasis, herein we propose to provide an overview of this proactive approach in paediatric psoriasis. This proactive management approach concerns four key precepts: therapeutic education: explanation of the disease, its pathophysiology and the various possible therapeutic approaches; prevention of factors triggering flare-ups or worsening psoriatic infections, such as stress, trauma, diet (mainly reduction of obesity); a proactive approach to topical therapy: skin hygiene and use of emollients, but also limitation of active therapies, use of dosing intervals and "weekend therapy" to reduce the risk of relapse; a proactive approach to systemic therapies: improved therapeutic safety, reduced cumulative doses, through reduced doses, use of dosing intervals and weekend therapy. Care for children with psoriasis must be comprehensive and include their environment. The concept of "proactive" treatment in childhood-onset psoriasis can help limit the duration and severity of flare-ups while improving quality of life. Simple measures can in fact ensure effective maintenance of treatments over the long term.

Allied health weekend service provision in Australian rehabilitation units.

To determine current Australian allied health rehabilitation weekend service provision and to identify perceived barriers to and facilitators of weekend service provision. Senior physiotherapists from Australian rehabilitation units completed an online cross-sectional survey exploring current service provision, staffing, perceived outcomes, and barriers and facilitators to weekend service provision. A total of 179 (83%) eligible units responded, with 94 facilities (53%) providing weekend therapy. A Saturday service was the most common (97%) with the most frequent service providers being physiotherapists (90%). Rehabilitation weekend service was perceived to increase patient/family satisfaction (66%) and achieve faster goal attainment (55%). Common barriers were budgetary restraints (66%) and staffing availability (54%), with facilitators including organisational support (76%), staff availability (62%) and staff support (61%). Despite increasing evidence of effectiveness, only half of Australian rehabilitation facilities provide weekend services. Further efforts are required to translate evidence from clinical trials into feasible service delivery models.

Cross-Sectional Examination of Patient and Therapist Factors Affecting Participation in Physical Therapy in Acute Care Hospital Settings

Research has demonstrated benefits of early and continued physical therapy for patients in acute care hospitals. Despite known benefits, scheduled sessions do not always result in treatment. Reported percentages for nontreatment are 15% to 25%. Understanding when and why nontreatment occurs is fundamental to future interventions to reduce it and provide patients with needed services. The study objective was to describe nontreatment and the extent to which attributes of the patient, physical therapist, and environment affect its occurrence at a suburban community hospital. This was a cross-sectional study. Medical records for 1,252 patients who were scheduled for 6,246 physical therapy sessions were reviewed. Therapist demographics were collected via a questionnaire. Therapist sexes were equally represented, and most therapists were nonwhite and worked full time at the hospital. The nontreatment percentage for individual therapists ranged from 5.4% to 23.2%. This percentage was 1.3% for the first scheduled session but nearly 20% for the remaining sessions. In more than 30% of nontreatment events, the specific therapist attempting treatment was not identified. Patients were much less likely to experience nontreatment if they were scheduled for therapy on a Tuesday or if they were in the hospital for a musculoskeletal condition. Sunday had a particularly high percentage of nontreatment. The participants were recruited from a single hospital. The specific therapist associated with nontreatment events was not always known. Hospital and rehabilitation department policies and culture for weekend therapy staffing should be evaluated in light of the high percentage of nontreatment on Sunday. The impact of patient diagnosis on nontreatment must be evaluated further and may reflect hospital culture. Future research efforts should be designed to obtain data on the assigned therapist for all instances of nontreatment.

Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.

Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression. People with stroke admitted to inpatient rehabilitation facilities. Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129].

Oral Cyclosporine Weekend Therapy: A New Maintenance Therapeutic Option in Patients with Severe Atopic Dermatitis.

Cyclosporine A (CyA) is a systemic therapy used to control severe atopic dermatitis (AD) in children, but its use may be associated with serious side effects. Intermittent short-course therapy has been used to minimize these risks without the loss of clinical benefits. We conducted a 20-week study using intermittent short-course CyA therapy in five patients with severe AD and a Scoring Atopic Dermatitis (SCORAD) score >40. The result was a reduction in the cumulative dose of CyA and serum CyA level, which allows for a longer duration of CyA treatment and decreases the risk of relapse in patients with severe AD.

Weekend therapy service provision in a sample of rehabilitation facilities throughout Australia

Weekend therapy service provision in a sample of rehabilitation facilities throughout Australia

Implementing an inpatient rehabilitation Saturday service is associated with improved patient outcomes and facilitates patient flow across the health care continuum

Purpose: To evaluate the effectiveness of the introduction of a Saturday inpatient rehabilitation service in improving patient outcomes and facilitating hospital access and flow. Methods: A quasi-experimental study with a historical comparison group is presented. Data were evaluated for the 477 patients admitted and discharged in the 6 months following the implementation (October 2012–March 2013) of the service and 499 patients in the historical control group (April 2012–September 2012). Results: Prior to the introduction of the service median number of patients admitted on a Saturday was 0 (range 0–3), post-implementation the median number of patients admitted on a Saturday increased to 2 (range 0–5), this difference was statistically significant (Z = −3.61, p < 0.001). Median regression modelling demonstrated that, after adjusting for admission Functional Independence (FIM) score, gender, length of stay (LOS) and age, there was a small but significant increase in discharge FIM scores (median increase 2.28, p = 0.027) for those patients admitted in the post-implementation phase. There was no such effect of the service on LOS. Conclusions: The implementation of the Saturday inpatient rehabilitation service was associated with improved patient outcomes and supported an increase in patient flow throughout the organization as evidenced by an increased number of Saturday patient admissions.Implications for RehabilitationInpatient rehabilitation services do not operate in isolation; they are a critical link in the healthcare continuum.There is a mounting body of evidence that the introduction of weekend rehabilitation services has a positive impact on patient outcomes.To maximize health outcomes, access to critical services and patient flow, organizations and staff need to move away from the long-standing 5-day/week inpatient rehabilitation model and start transitioning to a model that incorporates weekend therapy services.

Maintenance treatment of psoriasis with cyclosporine A: Comparison between continuous and weekend therapy

Maintenance treatment of psoriasis with cyclosporine A: Comparison between continuous and weekend therapy

Physical Therapists' Guideline Adherence on Early Mobilization and Intensity of Practice at Dutch Acute Stroke Units

Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early mobilization and augmented exercise therapy time; and (3) identify the perceived barriers to and facilitators for guideline adherence as reported by physical therapists (PTs) working on acute hospital stroke units. All 96 Dutch acute hospital stroke units were requested to assign one PT for participation in the survey. Of the 96 contacted PTs, 91 returned the questionnaire. Seventy-one percent of acute hospital stroke units reported that out-of-bed mobilization of patients was performed within 24 hours. PTs provided a mean of 22 minutes of physical therapy per weekday and weekend therapy was not standard practice. PTs reported having sufficient knowledge of and experience with the clinical practice guidelines for patients with stroke and reported that the clinical practice guidelines for patients with stroke left enough room for them to draw their own conclusions and to take patient preferences into account. PTs perceived insufficient time to comply with the clinical practice guidelines for patients with stroke and a need for financial compensation to realize human resources. Our national survey among PTs suggests that the organization of early stroke rehabilitation varies considerably and that early mobilization and intensity of practice in early stroke rehabilitation are not optimal. Addressing this problem requires agreement between hospital management boards and insurance companies about minimum services and resources required and the introduction of novel methods of increasing duration of exercise therapy with minimal use of resources.

Can a one-weekend group therapy reduce fear of blushing? Results of an open trial

Fear of blushing is a specific syndrome generally subsumed under the diagnostic category of social anxiety disorder (SAD). This study aims at gathering preliminary data about an intensive weekend intervention specifically designed for individuals with fear of blushing as the predominant complaint. Treatment consisted of a combination of attention training and behavioral therapy. Thirty-one blushing-fearful individuals meeting the criteria for SAD following the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) were treated in three groups. The study was conducted as an open trial. Full assessments were performed before treatment, six weeks after treatment, and at six-month follow-up. Only fear of blushing, the main outcome criterion, was assessed immediately before and after the treatment weekend. The intensive therapy program was well accepted. Fear of blushing and SAD were significantly reduced and reductions remained stable. At follow-up, nearly two-thirds of the participants achieved significant changes in fear of blushing. Despite the preliminary nature of this study, the condensed format of weekend therapy for treating fear of blushing calls for further investigation.

Acquired rifamycin resistance: pharmacology and biology

The global emergence of multidrug-resistant and extensively drug-resistant TB has refocused attention on preventing acquired resistance. This article reviews basic science, pharmacology and public policy to understand the contribution of these factors to acquired rifamycin resistance (ARR), a critical factor in multidrug resistance. Directly observed therapy short course (DOTS) effectiveness requires that each drug’s effects persist equally throughout the dosing interval. Although rifampin and isoniazid have similar pharmacokinetics, the postantibiotic effect of rifampin is several times greater than that of isoniazid. As a result, rifampin’s effects may persist unopposed when standard multidrug regimens are administered at intervals longer than 24 h. ARR may occur in this setting when outgrowth is not otherwise contained by the host immune response. Most countries do not provide weekend therapy under DOTS. Limiting TB therapy to weekdays may promote the emergence of acquired drug resistance in patients with advanced AIDS and TB. A large, simple trial to examine this question is both warranted and feasible.

Accuracy of Assignment of Orthopedic Inpatients to Receive Weekend Physical Therapy Services in an Acute Care Hospital

Purpose: To ascertain whether physical therapists (PTs) were accurately applying hospital criteria when assigning patients to weekend PT services in an acute care hospital. Methods: A retrospective chart review was performed on patients assigned to weekend PT services while staying in an inpatient orthopedic unit. Data extraction forms were completed to establish the accuracy of 299 entries to the weekend list. Quantitative analysis was performed to determine the percentage of inaccurate assignments and the percentage of patients who were treated on the weekend and to compare the patient profiles of those accurately and inaccurately assigned with the weekend list. Results: The percentage of subjects inaccurately assigned to weekend PT services (7.4 per cent) was relatively small. Profiles of those inaccurately assigned were not found to differ significantly from those accurately assigned. Weekend therapy staff treated the majority of inaccurately assigned patients. However, this was not found to reduce the availability of treatment to accurately assigned patients. Conclusions: These findings suggest that criteria are being used by PTs with an acceptable level of accuracy to assign patients to weekend PT services. However, further investigation is required for validation and standardization of weekend PT services criteria.

Evaluation of cephalexin intermittent therapy (weekend therapy) in the control of recurrent idiopathic pyoderma in dogs: a randomized, double‐blinded, placebo‐controlled study

The purpose of this study was to evaluate the efficacy of cephalexin intermittent therapy 2 days a week (weekend therapy) in the prevention of relapses of recurrent idiopathic superficial or deep pyoderma in dogs. Twenty‐eight dogs were entered into the study. A diagnosis of chronic idiopathic pyoderma was made based on: (1) history, including at least two previous relapses cured in the 12 months before inclusion; (2) clinical signs of pyoderma without underlying skin disease based on clinical presentation; and (3) appropriate diagnostic tests (compatible cytological examination and bacterial culture). In phase 1 of the study, dogs were treated with cephalexin (15 mg/kg twice daily) if sensitivity testing was compatible until 2 weeks after cure, for a minimum of 4 weeks and a maximum of 2 and 4 months for superficial and deep pyoderma, respectively. In phase 2, the cured dogs were then randomly and blindly allocated into two groups: Group 1 received cephalexin (15 mg/kg twice daily) on Saturdays and Sundays for 1 year, and Group 2 received a placebo in the same way. Dogs were examined every 3–4 weeks during phase 1 and every 2 months during phase 2, except in case of relapse justifying an earlier examination. Clinical signs of pyoderma were scored at each examination (11 parameters scored 0–3). No other systemic antibacterial or anti‐inflammatory treatments nor topical antibacterial or anti‐inflammatory treatments were permitted during both phases. The two groups were compared using Fischer's exact test for sex and clinical signs, and the Wilcoxon Rank‐Sum test for age, weight, number of relapses before inclusion, and duration of treatment in phase 1. The number of dogs remaining free of relapse, i.e. free of any pyoderma lesion, was compared between the two groups using a survival analysis with the Log‐Rank Test. The average time before relapse was compared between the two groups using the Wilcoxon Rank‐Sum test. In phase 1, one case was lost to follow‐up; two cases were excluded due to treatment failure and an additional two cases because of resistance in vitro to cephalexin. Various species of staphylococci sensitive to cephalexin were isolated in the 23 remaining dogs. In phase 2, 13 dogs received placebo and 10 received cephalexin. The two groups were not statistically different according to clinical signs (six cases of folliculitis in each group, three and five cases of furunculosis, one and two cases of cellulitis in Groups 1 and 2, respectively), sex, age, weight, number of previous relapses, and duration of treatment in phase 1. There was a significant difference between the two groups in the number of dogs that did not relapse. Two dogs in Group 1 did not relapse. Further, the rate of relapse over time was more rapid in the dogs receiving placebo. The average time until relapse in Groups 1 (6.6 months) compared to Group 2 (2.5 months) was significantly different. Resistance to cephalexin did not increase during the study. We conclude that cephalexin weekend therapy can be beneficial in dogs with idiopathic recurrent pyoderma. Funding: Virbac SA.

Discussion 2

Discussion 2

Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: Effects on the duration of improvement

Background: Weekend therapy with superpotent topical corticosteroids has been used for the long-term treatment of psoriasis. Recently, calcipotriene ointment has been added to this regimen for use on weekdays, but there are no long-term studies of that combination. Objective: The purpose of this study was to determine whether the addition of weekday calcipotriene to a pulse therapy regimen of weekend superpotent corticosteroids results in a longer duration of remission of plaque psoriasis. Subjects: This was a double-blind, placebo-controlled, parallel-group study. Forty-four patients with mild to moderate psoriasis were treated with calcipotriene ointment in the morning and halobetasol ointment in the evening for 2 weeks. Thereafter, 40 patients who were at least moderately (50% or greater) improved were randomized to 2 treatment groups. After 2 weeks of treatment with calcipotriene ointment in the morning and halobetasol ointment in the evening, 20 patients were randomized to receive halobetasol ointment twice daily on weekends and calcipotriene ointment twice daily on weekdays, and 20 patients were randomized to receive halobetasol ointment twice daily on weekends and placebo ointment twice daily on weekdays. Results: Seventy-six percent of patients applying halobetasol ointments on weekends and calcipotriene ointment on weekdays were able to maintain remission for 6 months compared with 40% of patients applying halobetasol ointment on weekends only with the vehicle on weekdays. Conclusion: The addition of calcipotriene ointment applied on weekdays to a weekend pulse therapy regimen of superpotent corticosteroids can increase the duration of remission of psoriasis. (J Am Acad Dermatol 1998;39:447-50.)