Clinical Rehabilitation最新文献

ObjectiveTo assess the feasibility of the Yale Swallow Protocol and refine it for parsimony.DesignCross-sectional study.SettingFour diverse units at a medical centre.ParticipantsHospitalised adults at high risk of dysphagia (i.e., those aged over 65 years, admitted for stroke, Parkinson's disease, or head and neck cancer treatment) using consecutive sampling.Main MeasuresA research nurse administered the protocol, recording adverse events, administration time, and failure rates, with an 85% failure rate threshold to assess the ceiling effect. The protocol consists of contraindications, cognitive screenings, oral motor examinations, and a 3-ounce water swallow challenge, but pass/fail decisions are based solely on contraindications and the water challenge. Parsimonious combinations of items were explored to refine and potentially shorten the protocol. The measurement precision of the refined and shortened protocols was evaluated using the Rasch model.ResultsOf the 502 patients enrolled (mean age 71; 59.8% male), no adverse events occurred, and the protocol took under 3 min. The failure rate was 41.8%, indicating no ceiling effect. Five well-fitting items were retained from cognitive screenings and oral motor examinations: location, year, tongue sticking out, lingual motion, and facial symmetry. Both refined protocol (contraindications, five well-fitting items and water challenge) and shortened protocol (contraindications and five well-fitting items) enhanced measurement precision beyond the original version.ConclusionThe Yale Swallow Protocol is a safe, quick, and ceiling-effect-free screening for identifying dysphagia, even among diverse high-risk hospitalised patients. Our study also refined the protocol, achieving better measurement precision than the original protocol.

ObjectiveEarly mobility after cardiac surgery in the intensive care unit improves patient outcomes, yet implementation by clinicians remains inconsistent. To inform interventions to increase adoption, this study sought to explore clinicians' perspectives on the definition of early mobility in the cardiac surgery intensive care unit and describe perceived barriers and facilitators to implementation.DesignThis qualitative study was guided by interpretive description.SettingA tertiary hospital that performs 1000 cardiac surgeries annually.ParticipantsA total of 26 clinicians, including nurses, physicians, healthcare aides, respiratory therapists, and physiotherapists, participated.Main MeasuresThe nine focus groups and four individual interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.ResultsThree themes and 13 categories were created from the data: (1) Incongruent operationalization and conceptualization (across micro, meso, and macro levels), (2) uncertainty, and (3) inconsistency in mobilization practices. Themes were rooted in ambiguous definitions of "early" and "mobility," discrepancy between conceptualization and implementation of timing, varied interpretations of success, and perceived safety concerns. In addition, 4 barriers and 4 facilitators were identified and categorized into patient-care and clinician-related.ConclusionDeveloping early mobility protocols and education informed by clinicians may enhance its implementation in the cardiac surgery intensive care unit. Incorporating the perspectives of clinicians into early mobility protocol development is essential to support behaviour change and provide this beneficial care.

ObjectiveTo describe the structure and composition of personal social networks in burn survivors and examine their associations with social participation.DesignA 6-month cohort study.SettingCommunity.Participants23 adult burn survivors.Main MeasuresParticipants completed the Personal Network Survey and Life Impact Burn Recovery Evaluation Social Interactions and Social Activities short forms at baseline, 3-month, and 6-month. Personal Network Survey assesses individual social network in two categories: network structure depicts the architecture of social connections, while network composition describes the characteristics of network members. Life Impact Burn Recovery Evaluation measures social participation after burn injury.ResultsThe average age of the 23 participants was 49.1 (SD 12.5) years, with an average of 45.0% (SD 25.9%) total body surface area burned. Friends and family were the major relationship types, while camaraderie, emotion, and advice were the major support types. Multilevel models results showed that within-person smaller (β=-0.91; 95% CI = -1.48, -0.33; p = .004) and more close-knit (β=-1.29; 95% CI = -2.22, -0.37; p = .009) networks, as well as between-person networks in which burn survivors had fewer advisors (β=-40.97; 95% CI = -69.56, -12.38; p = .008) and received less health support (β=-20.35; 95% CI = -37.91, -2.79; p = .030), were significantly associated with better social participation.ConclusionThe findings advance the current understanding of burn survivors' social networks and their impact on social participation and lay the foundation for developing targeted strategies to promote social engagement and well-being by optimizing network composition and the balance of received support.

AimThe development of a new intervention designed to reduce persistent fatigue following acquired brain injury through personalised support.RationaleFatigue is a common and long-lasting consequence after brain injury. Evidence indicates that tailored, multimodal interventions targeting individual experiences are more effective than standardised approaches.Materials and proceduresThe intervention combines real-time data collection using the Experience Sampling Method via a dedicated mHealth app with a workbook containing practical instructions and an online secure feedback environment. Patients complete eight short daily assessments for three consecutive days each week, collecting detailed information on fatigue and contextual factors such as mood, physical activities and social situations.Providers, setting, and deliveryTied by Tiredness is delivered by psychologists or occupational therapists in rehabilitation or outpatient settings to adults with acquired brain injuries aged 18 and over. In face-to-face therapy sessions, patient-collected data are used to tailor personalised feedback and advice on strategies, emphasising collaborative decision-making and active engagement.Dose and personalisationPatients attend six weekly 1-h sessions. Intervention strategies are adjusted to individual needs and goals throughout the programme, based on ongoing assessment data.Unique featuresContinuous personalisation and the integration of real-time data into therapy sessions distinguish this intervention.Purpose and implicationsThe programme aims to provide insight into the personal and environmental factors that contribute to a person's fatigue, enabling patients to implement cognitive and behavioural strategies for effective daily fatigue management. Tied by Tiredness represents a novel, practical approach to supporting self-management after brain injury.Trial registrationOverview of Medical Research in the Netherlands (OMON), ID: NL-OMON21265.

ObjectiveTo qualitatively explore the perceptions and experiences of patients with coronary artery disease regarding discontinuation of home-based exercise rehabilitation.DesignA qualitative, descriptive design was utilized in this study.SettingThis study focused on home-based exercise rehabilitation.ParticipantsA purposive sample of 24 patients who had voluntarily participated in the home-based exercise rehabilitation program was recruited.Main measuresSemistructured interviews were undertaken. Data were analyzed using a framework approach.ResultsA total of 24 participants (13 males and 11 females) from 28 to 77 years were recruited for this study to examine the endogenous and exogenous factors that influence withdrawal from exercise rehabilitation. The four major themes identified were (1) "exercise inertia," (2) "perception deviation," (3) "disruption of habit loop," and (4) "weakness in exercise literacy." These themes were further divided into 12 subthemes.ConclusionsSustained implementation of home-based exercise rehabilitation is crucial for patients with coronary heart disease. Discontinuation of exercise regimens frequently stems from patients' internal perceptions, including exercise inertia, cognitive biases, disruptions in established habit loops, and insufficient exercise literacy. Consequently, enhancing patient awareness of exercise rehabilitation and strengthening supervision of exercise routines are imperative. Establishing a multidisciplinary home-based exercise management system would further facilitate the optimization of exercise-related benefits.

ObjectiveTo explore how task and stimuli influence response accuracy in assessing functional communication in adults emerging from a Prolonged Disorder of Consciousness (PDOC).SettingSpecialist post-acute brain injury assessment centre.SubjectsTwelve adults (7 male; 5 female) emerging from PDOC, recruited consecutively between June 2021 and August 2023.MethodsA prospective study exploring the impact of task and stimuli on response accuracy. Yes/no questions and spoken word-to-referent (colour/object) matching tasks were presented. Stimuli were controlled for psycholinguistic variables to reduce linguistic confounds in the assessment of consciousness. Accuracy was compared to a standard measure (visually based situational yes/no questions from the Coma Recovery Scale-Revised).ResultsResponses were most accurate for word-to-referent matching tasks compared to yes/no questions (t(23) = -6.49, P < 0.001, d = 1.33), with greater accuracy to colour than object stimuli (t(23) = 2.79, P = 0.01, d = 0.57). Participants also responded with greater accuracy to word-to-referent matching and yes/no questions involving colours and objects compared to the Coma Recovery Scale-Revised situational yes/no questions.ConclusionTask influences accuracy of responses in assessing return of consciousness. The advantage of colours over objects can be attributed to simpler visual processing and higher lexical frequency of these words. The current standard situational yes/no tasks from the Coma Recovery Scale-Revised resulted in lowest scores and should not be relied upon as the only measure of functional communication.

ObjectiveTo examine the feasibility and acceptability of Neuromuscular Bridges, a personalised self-management support intervention adapted for people with neuromuscular disorders, and to explore contextual factors influencing its implementation in specialist care.DesignA hybrid type II feasibility study employing mixed methods to evaluate clinical and implementation feasibility, incorporating quantitative outcomes with qualitative process evaluation.SettingA specialist neuromuscular tertiary centre in the United Kingdom.ParticipantsThirty-three adults with diverse neuromuscular disorders and six trained clinicians (physiotherapists and clinical nurse specialists).InterventionNM-Bridges, a co-designed, person-centred self-management support intervention delivered in a single clinical consultation, underpinned by the Bridges approach and Social Cognitive Theory.Main measuresRecruitment, retention, fidelity, and patient-reported outcomes were collected at baseline, post-intervention, and 3-month follow-up. Implementation was assessed using validated instruments and qualitative interviews.ResultsOf 106 eligible patients invited, 33 (31.1%) enrolled, with full retention and no missing data. Quantitative outcomes showed moderate pre- and post-improvements in patient-centred care, especially goal setting and activation. Small positive changes were noted in social participation, emotional well-being, mood, and self-efficacy, with effects generally sustained at follow-up. Fidelity was high, and implementation measures indicated strong clinician engagement. Qualitative data reinforced these findings, highlighting collaboration, relevance, and acceptability within routine care.ConclusionNM-Bridges was feasible and acceptable within specialist neuromuscular care. By integrating clinical outcomes with implementation learning, this hybrid feasibility study provides early evidence and a foundation for future evaluation of self-management support as a relational and sustainable component of neuromuscular rehabilitation.

ObjectiveFibrosis can develop after surgical or radiation treatments for cancer and is often seen in rehabilitation settings, yet few measures exist for standardized assessment. The aims of this study are to describe the validity and reliability of a new measure for cancer treatment-related fibrosis in survivors of breast or head/neck cancer.DesignFace validity of the Courage Kenny-Fibrosis Grading Scale was established using an iterative survey process. Reliability and concurrent validity were assessed using repeated measures by blinded raters and concurrent assessment with the Common Terminology Criteria for Adverse Events, Late Effects Normal Tissue-Subjective, Objective, Management, Analytic scales, and adheremeter rating of skin mobility.SettingOutpatient rehabilitation clinic.ParticipantsQuestionnaires were completed by 43 clinicians and researchers in the first round of face validation and 21 in the second. For reliability and concurrent validity, 41 cancer survivors, including 26 post-breast cancer and 15 post-head/neck cancer, were assessed by four physical therapists.ResultsAdequate face validity of the final version was established using responses from 21 clinicians. Inter-rater and intra-rater reliability of the final scale was adequate at ICC = 0.810 and 0.941, respectively. Associations between the Fibrosis Grading Scale and the Common Terminology Criteria for Adverse Events and Late Effects Normal Tissue scales were moderately significant (r_S = 0.290-0.574, p < 0.05), indicating concurrent validity.ConclusionAfter development of the Fibrosis Grading Scale using an iterative survey process, sufficient reliability and validity was established to use as an assessment in breast and head/neck cancer survivors.

ObjectivesThe aims of this scoping review were to (i) map education from randomised controlled trials and public websites for Achilles tendinopathy to pre-defined categories and (ii) appraise the quality of education available.Data sourcesSources were extracted via a search of multiple databases and from the first three pages of targeted Google searches in English, Chinese, and Spanish (websites).Review methodsThe frequency of sources that reported on each pre-defined category (n = 15) was reported, and the content within each category was summarised descriptively. Quality and reliability were assessed with the DISCERN tool (1-5 points, higher score means higher quality and trustworthiness). Understandability and actionability of education was assessed using Patient Education Materials Assessment tool (0-100%, higher scores indicate more comprehensible information with clearer messages and more identifiable actions). Alignment with current international guidelines was reported.Results119 randomised controlled trials and 385 websites were included. Education coverage was better in websites compared to trials, particularly related to pathology and management. Conflicting advice was found on websites (e.g. when treatment should be sought). Quality (1.6 ± 0.5) and reliability (2.1 ± 0.7) of education were poor, with low scores for treatment risks and shared decision-making. Understandability was moderate (59%) and actionability was poor (28%). Alignment with clinical guidelines was low, with key information commonly omitted.ConclusionEducational sources found in randomised controlled trials and public websites on Achilles tendinopathy are poorly aligned with clinical guidelines. The information gaps in these sources mean that they are unhelpful to patients and may steer them towards inappropriate decisions. The review highlights the need for the development of accurate, meaningful, and evidence-based educational resources for individuals with Achilles tendinopathy.

ObjectiveTo identify and prioritize aspects of quality in geriatric rehabilitation from the perspective of older adults.DesignQualitative study using a structured Nominal Group Technique.SettingThree nominal group technique sessions were conducted in geriatric rehabilitation settings in the Netherlands.ParticipantsWe included older adults admitted to geriatric rehabilitation, Dutch proficiency, the ability to communicate and engage in group discussions, and an intention to return to independent living.InterventionParticipants engaged in structured nominal group technique sessions. Each session included five steps: introduction, idea generation, exchange of ideas, discussion, and ordering and rankingMain measuresAudio-recorded sessions were transcribed verbatim and analyzed using a combined inductive and deductive coding. Quality aspects were prioritized based on their summed ranking scores, relative importance, and selection frequency.ResultsEighteen older adults were included. Participants identified five key priorities for quality in geriatric rehabilitation: (1) good preparation with clear expectations, (2) well-organized therapy and care, (3) relationships with healthcare professionals that acknowledge individual needs, (4) clear, respectful communication, and (5) autonomy in treatment decision-making. The qualitative analysis supported these priorities with three overarching themes: the value of a supportive environment, feeling heard and understood, and the need for guidance and involvement.ConclusionThis study provides priorities for improving quality in geriatric rehabilitation, according to the experiences of older adults and offers direction for implementation in clinical practice.