Disability and Rehabilitation最新文献

Purpose: The Facilitating Integration of Rehabilitation Services Through Training (FIRST) Course provides online professional development on tiered service delivery models for rehabilitation professionals working in education settings. Created by content and e-learning experts, this study describes our use of the Analysis, Design, Development, Implementation, Evaluation (ADDIE) instructional design model and the Successive Approximation Model (SAM) to develop, implement, and evaluate the FIRST Course, and reports the findings of an initial program evaluation.

Method: Rehabilitation professionals who completed the FIRST Course were invited to complete a cross-sectional survey to evaluate its utility.

Results: Between May 1, 2020, and August 11, 2023, 314 occupational therapists, 54 physiotherapists, and 170 speech-language pathologists completed the online course and survey. Respondents perceived the FIRST Course content to be relevant to their practice and to meet their learning needs regarding tiered services in education settings. Most respondents viewed the course positively and would recommend it to colleagues. More experienced respondents suggested a need for training on tiered service delivery models beyond an introductory level.

Conclusions: The ADDIE and SAM instructional design models were successfully applied to develop, implement, and evaluate online professional development for school-based rehabilitation professionals who wish to learn about tiered service delivery models.

Purpose: Despite the substantial impact of pain in Parkinson's, little attention has been given to understanding how individuals, especially those diagnosed at a younger age, perceive and manage their pain. This research aims to fill this gap by exploring the subjective experiences of pain in this population which is at a higher risk of experiencing pain.

Materials and methods: Interpretative Phenomenological Analysis (IPA) was used as a methodological framework. Non-directive, in-depth interviews were conducted with four French-speaking participants with Parkinson's (diagnosed before 50 years old, with various pain profiles), and analyzed using IPA.

Results: Four major themes emerged: (1) the history of the disease, (2) adaptation to the disease, (3) losses related to pain and (4) strategies deployed to regain control over pain. Results highlight the participants' processes of adaptation, despite the major identity disruption caused by the disease and pain. They also shed light on how the experience of pain is influenced by its relational dimension.

Conclusions: Our results offer an understanding of the complexity and diversity of the experience of pain in this population. This complexity contributes to challenges in patients' ability to articulate and represent their pain accurately, advocating personalized, multidisciplinary pain management approaches within this population.

Purpose: People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation.

Materials and methods: 18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis.

Results: Participants' experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding.

Conclusions: Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients' experiences of treatment.

Purpose: The study aimed to assess frailty in adults with congenital heart disease (ACHD) and to compare muscle strength, functional capacity, activities of daily living (ADL), and cognition between frail and non-frail ACHD patients.

Materials and methods: A cross-sectional study design was used. Sixty people with ACHD aged between 18 and 45 years were included. Frailty was determined according to the Fried criteria. Peripheral muscle strength was assessed with a digital dynamometer, functional capacity with the 6-min walk test (6MWT), ADL with the Glittre ADL test, and cognition with the Montreal Cognitive Assessment (MoCA) test.

Results: Frailty was seen in 38.33% (frail = 23 and non-frail = 37) of the participants. In the frail patients, dominant knee extensor strength (p = 0.002), shoulder abductor strength (p = 0.005), 6MWT distance (p = 0.021), and MoCA score (p = 0.005) were significantly lower than those in the non-frail patients. Glittre ADL test (p = 0.002) was significantly higher in the frail patients.

Conclusions: Muscle strength, functional capacity, ADL, functional mobility, and cognition were lower in the frail participants with ACHD. Early assessment of frailty in ACHD and planning individualized exercise training programs for frail individuals may be a strategy to reduce the impact of frailty on adverse clinical outcomes.

Objectives: 1) to develop two maximum heart rate (HR_max) prediction equations for individuals after stroke; 2) to investigate its validity.

Methods: The HR_max was obtained by a Cardiopulmonary Exercise Test (CPET). Participants also completed the Six-minute Walking Test (6MWT) and the Incremental Shuttle Walking Test (ISWT).

Results: 60 individuals (54(12) years; 64(69) months after stroke) were included. Twenty individuals (58(10) years; 67(61) months after stroke) were included in the cross-validation group. For the first model, the following equation was generated (equation-1): HR_max= 87.655 + 0.726 (HR_peak in the 6MWT) - 0.386 (age in years), (R²=0.53; Standard Error of the Estimate (SEE)= 15.35; p < 0.0001). For the second model, the following equation was generated (equation-2): HR_max= 96.523 + 0.681 (HR_peak in the ISWT) - 0.039 (walking distance in meters in the ISWT) - 0.400 (age in years), (R²=0.53; SEE = 15.51; p < 0.0001). Significant and high magnitude agreement was found between the HR_max obtained by the CPET and the predicted HR_max by equation-1 (ICC= 0.85; 95% CI= 0.63 - 0.94) and equation-2 (ICC= 0.72; 95% CI= 0.29 - 0.89).

Conclusions: Two HR_max prediction equations have been developed and showed adequate validity. Professionals will have the option of choosing one of the two equations to use.

Maintenance hemodialysis patients' psychology and physiology will have negative effects. Adherence to exercise can effectively enhance the physical function of maintenance hemodialysis patients and reduce the negative psychological emotions. In recent years, virtual reality technology has been gradually applied to the hemodialysis group, providing a new way for the rehabilitation training and healthy life of maintenance hemodialysis patients.

Objectives: To understand the real experience of maintenance hemodialysis patients participating in virtual reality rehabilitation training, and to make reference for the future clinical development of a more perfect virtual reality rehabilitation training program.

Metchods: Phenomenological research method was used to conduct semi-structured interviews with 10 maintenance hemodialysis patients, and the interview data were compiled and analyzed using Colaizzi's seven-step analysis.

Results: Four themes were distilled: (1) Maintenance hemodialysis patients' overall perceptual experience of the virtual reality rehabilitation system; (2) Physical and psychological improvement of maintenance hemodialysis patients with virtual reality rehabilitation system; (3) Individualized needs of maintenance hemodialysis patients during virtual reality rehabilitation training; (4) Future improvements and recommendations for the virtual reality rehabilitation system.

Conclusion: The results of the study suggest that virtual reality improves patients' motivation to recover and shows positive results and potential benefits in improving physical functioning and negative emotions in maintenance hemodialysis patients.

Objective: Individuals with chronic conditions have long-term needs which can be addressed by maintenance rehabilitation. The 2013 Jimmo v Sebelius settlement in the United States (US) clarified the Medicare coverage of maintenance rehabilitation as a skilled service, even when no improvement is expected. A scoping review was conducted to describe maintenance rehabilitation.

Materials and methods: A systematic search was performed across 9 databases. Maintenance rehabilitation was defined as services (e.g. occupational, physical, or speech language therapies), intended to maintain a person's condition and prevent decline. Studies focused on medical, or non-rehabilitative, interventions (e.g. opioid cessation or chemotherapy) were excluded. Of the 734 abstracts reviewed, 90 met inclusion criteria. Two reviewers extracted data and used descriptive statistics. An exploratory thematic analysis in a convenience sample contextualized the works.

Results: Most works (90%) were peer-reviewed publications. The works represented 12,638 individuals, with predominant populations being cardiac (4,122 individuals) and pulmonary (2,324 individuals). Physical activity interventions were identified most frequently (87%). Outcome measures primarily focused on activities (49%) or body systems (42%). Thematic analysis suggests maintenance rehabilitation may support domains contributing to quality of life.

Conclusions: While evidence exists for maintenance therapy, future research on intervention design will guide implementation by health systems.

Purpose: The aim of the study was to discriminate the risk of falling in patients with Multiple Sclerosis with low to moderate impairment who do not use walking aid using the Timed Up and Go (TUG) Test.

Methods: This study was planned as a prospective descriptive study with 204 patients. Falls were recorded in three-month prospective diaries, and the balance was evaluated using the TUG Test.

Results: By using three-month prospective diaries, the mean age of 109 faller patients and 95 non-faller patients was 35.87 ± 8.35 and 35.35 ± 9.39 years, respectively. The faller group's mean TUG Test score was 9.46 ± 4.14, whereas the non-faller group's was 7.74 ± 2.02 s. The TUG Test has an area under the receiver operating characteristic curve value of 0.666 in discriminating fallers from non-fallers (0.592-0.740, %95 Cl). To identify fallers, the TUG Test score of ≥7.85 s has a sensitivity of 0.65 and a specificity of 0.65.

Conclusion: As a result of the present study, the TUG Test was found to have moderate sensitivity and specificity in predicting the risk of falling. It is not a sufficient stand-alone measure for fall risk prediction, so it is recommended that this test be included as part of a comprehensive falls screening programme.

Objectives: This study investigated whether exercising with different relative loads would be associated with different experienced pain intensities in individuals with patellar tendinopathy.

Materials and methods: We recruited 14 individuals with patellar tendinopathy for this randomized crossover study. In a randomized order, participants performed one set of single-legged leg presses during one session with three relative loads (6 repetition maximum (RM), 10RM, and 14RM). The primary outcome was pain during exercise measured on a 0-10 Numerical Rating Scale (NRS) (0 = no pain, 10 = worst pain), which participants rated after performing the exercise set with each relative load.

Results: No differences in pain during either of the three relative loads were observed (F(2, 26) = 0.06, p = 0.942). The participants' experienced pain was 4.5 NRS (SD1.7), 4.5 NRS (SD1.7), and 4.6 NRS (SD2.0) during the 6RM, 10RM, and 14RM loads, respectively. A secondary analysis revealed no statistically significant difference in pain intensity between the performance of the first, second, or third exercise set regardless of the load (F(2, 26) = 1.06, p = 0.367).

Conclusions: There was no difference in pain intensity during either relative load among individuals with patellar tendinopathy. Therefore, higher loads may be applied, associated with enhanced tendon adaptation.

Purpose: To implement a job retention vocational rehabilitation (VR) intervention (MSVR) for people with multiple sclerosis (MS) and their employers in the UK National Health Service (NHS).

Methods: Multicentre, single-arm feasibility study with post-intervention interviews. MSVR was delivered by an occupational therapist (OT). Feasibility was assessed by recruitment rates, compliance, and practicality of delivery. Acceptability was assessed with post-intervention interviews. A survey assessed change in eight vocational outcomes (e.g., vocational goals, work instability) immediately post-intervention and at 3-month follow-up.

Results: Recruitment and training an OT was challenging. Twenty participants with MS, three employers, and three healthcare professionals were recruited. All participants but one completed the intervention. Factors affecting intervention adherence included annual leave and family responsibilities.MSVR was associated with improved vocational goal attainment post-intervention (t(18) = 7.41, p = <0.001) and at follow-up (t(17) = 6.01, p = <0.001). There was no change to the remaining outcomes. Interviews identified six themes: intervention impact, accessibility of support, the OT's role, readiness for support, workplace supportiveness, and barriers to NHS delivery.

Conclusion: Challenges with recruitment, identifying newly diagnosed MS participants, and understanding the OT's training needs to deliver the intervention were identified. The intervention demonstrated acceptability, but participants wanted it to continue for longer to address further needs.