Advances in rehabilitation science and practice最新文献

Background: Patients admitted to neurological critical care unit (NCCU) frequently require ventilator support and tracheostomy. This prospective longitudinal observational study collated outcomes following tracheostomy amongst patients admitted to NCCU.

Methods: In this prospective longitudinal observational study, we collected a predetermined set of clinical data for all patients admitted to the NCCU who underwent tracheostomy, until they were discharged from the unit. Exploratory data analysis of the tracheostomy outcomes was performed to identify the clinical parameters influencing decannulation.

Results: Fifty four (5.4%) of 999 consecutive patients admitted to NCCU required tracheostomy. The mortality among people who had tracheostomy was 11.1% (n = 6) and decannulation rate was 59.3% (n = 32). Tracheostomies were more commonly done in men, those admitted with GCS of 3.0 and had cerebrovascular accidents. Thirty (55.6%) patients had sialorrhea during their NCCU admission which demonstrated significant associations with the total length of NCCU admission, time taken for decannulation, admission GCS, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) referrals, need to recannulate following decannulation, pulmonary infections, and oral candidiasis. Incidence of chest infections was higher prior to the institution of pharmacological management of oral secretions. Prevalence of oral candidiasis was higher among patients who received pharmacotherapies for oral secretion.

Conclusion: Oral secretion issues increase incidences of pulmonary infections, delay decannulation, increase the need for recannulation, and prolong the stay of patients in NCCU. Pharmacological management of oral secretions was associated with a reduced incidence of chest infections and a shorter duration to achieve decannulation.

Background: Cardiac rehabilitation using mobile health is increasingly being described as effective in improving exercise habits and physical function. However, the effectiveness of combined mobile health and hospital-based cardiac rehabilitation in older patients with cardiovascular disease is unknown.

Objective: To investigate the effect of a wearable watch device combined with hospital-based cardiac rehabilitation in older patients with cardiovascular disease compared with those with usual care.

Methods: A randomized, controlled trial was conducted in patients with cardiovascular disease aged ⩾60 years who underwent hospital-based cardiac rehabilitation. The patients were randomized 1:1 in those with a wearable watch (Fitbit Versa 3) or usual care. During out-of-hospital cardiac rehabilitation, patients with a wearable watch were advised to check their heart rate with a wearable watch and to target their physical activity at the heart rate determined by cardiopulmonary exercise testing. The primary endpoint was a change in physical activity obtained from the International Physical Activity Questionnaire (metabolic equivalents [METs]-minute/week) between the 2 groups during 12 weeks.

Results: Among 39 patients (median age = 73 years, 82% men), the change in physical activity was significantly greater in patients with a wearable watch than in those with usual care (median: 2073 [1155-4400] vs 148 [-1261-899] METs-minute/week; analysis of covariance; P < .001). In patients with a wearable watch, 6-minute walk distance, the peak oxygen uptake, peak METs, and anaerobic threshold were significantly improved, whereas no significant increase was observed in patients with usual care from baseline to 12 weeks.

Conclusions: In older patients with cardiovascular disease, a wearable watch device combined with hospital-based cardiac rehabilitation increases physical activity and improves exercise capacity outside of hospital.

Introduction: Many people with spasticity or pain managed with intrathecal drug delivery pumps have very impaired mobility and are at high risk of developing pressure sores, which may prevent them from travelling to a clinic in their wheelchair. Some patients may be transported by stretcher, but some will be bedbound at home. Routinely refilling all pumps at home is established practice in several parts of Europe and USA.

Method: Freedom of information requests were emailed to trusts and health boards hosting intrathecal drug delivery services in the UK and Ireland, asking about frequency of home visits for pump refills, how many staff travelled, use of prefilled syringes and how they would manage a patient's long-term inability to attend clinic.

Results: Detailed data was received from all but 1 of 54 active clinics in the UK, but Irish legislation did not allow this data to be returned. Two thousand one hundred forty-five patients were managed with intrathecal pumps in the UK. Eleven services had less than 10 patients and 5 had more than 100. Twenty-one services did less than 1 home refill/year and 9 did more than 12/year. Twenty had travelled to patients more than 50 miles from the clinic, or to an island. Twenty-two services would send 2 clinicians and 10 would bring prefilled sterile syringes, rather than aspirate from bottles at the bedside.

Conclusion: FoI requests can generate a very high response rate in the UK. Many services manage a small number of patients, which would make it difficult to provide cover when a single-handed clinician is unavailable or to train a second clinician.

Heart Rate Variability (HRV) refers to variation in time intervals between consecutive heartbeats, indicating autonomic nervous system's control over the heart. Time and frequency analysis of HRV could serve as predictors for severity and functional outcome in stroke. Aim of this study is to verify if HRV, measured during cognitive and sensorimotor upper limb (UL) tasks, can be used as a biomarker of cognitive-motor interaction in post-stroke patients. Forty-six patients with unilateral brain injury following stroke were enrolled: 27 (58.7%) ischemic, 19 hemorrhagic, 24 (52.2%) subacute (<6 months), and 22 chronic. Mean age at evaluation was 61 years. Right side was affected in 16 subjects (34.8%). Each patient underwent HRV recording in the following conditions: (1) Rest (5 minutes); (2) Visuomotor simulation training of the affected upper limb (UL) using Dessintey IVS3 (DE, 5 minutes); (3) Motor Imagery of the affected UL (MI, 5 minutes). UL functional outcome measures were collected for both affected and less affected sides. All patients showed reduced HRV in time and frequency domains and sympathetic tone predominance at rest. During DE and MI, a significant reduction in time domain was observed. In frequency domains, low frequency decreases during DE, with parasympathetic tone predominance. In the subgroup analyses for lesion side, only right hemiparetic patients showed parasympathetic predominance during mental tasks of the upper limb (DE and MI. No correlation was found between HRV parameters and UL functional scales. Different HRV response in time and frequency domains to mental task was observed between right and left hemiparetic subjects. This could be explained by different anatomical-functional substrates between right and left hemisphere and could reflect different behaviors during UL cognitive-motor tasks. HRV parameters were not correlated with clinical functional assessment scales, likely meaning that they possible exploring different domains.

Background: Traumatic spinal cord injury impacts physical functioning, independence, and quality of life. The high incidence rate of 75.6 per million in South Africa indicate the crucial role of successful community reintegration. Despite South African's policy emphasizing comprehensive rehabilitation of persons with disabilities, community reintegration following spinal cord injury remains inadequate.

Objective: To develop a multidimensional model to improve community reintegration for individuals with traumatic spinal cord injuries in South Africa.

Methods: A 4-phase mixed methods study was employed. Phase 1 used a cross-sectional survey of 108 individuals with spinal cord injuries to investigate levels and factors influencing psychosocial and community reintegration. Phase 2 involved 28 qualitative interviews with different content experts, including individuals with spinal cord injuries, caregivers, rehabilitation professionals, and persons representing people with disabilities in the communities. Phase 3 reviewed existing community reintegration programs, while Phase 4 used a Delphi technique with 10 experts to design and refine program components and strategies.

Results: The study revealed low levels of psychosocial and community reintegration, influenced by employment and housing factors. Content experts highlighted barriers such as inaccessible environments, transportation challenges, and negative societal attitudes. Program components included technological support, employment assistance, mentorship, and recreational activities. The first 3 phases informed a development of a 3-level model addressing client, community, and legislative domains. In the fourth phase, experts reached consensus on components and strategies to achieve this multi-level community reintegration model.

Conclusion: The evidence-based community reintegration model offers a structured, multi-level framework to address reintegration challenges in South Africa. It emphasizes coordinated interventions at individual, community, and policy levels to improve outcomes for individuals with traumatic spinal cord injuries.

Objectives: This study examined whether community-dwelling older adults can independently capture wearable sensor data that can be used to classify frailty status.

Methods: Fifty-one older adults (age 77.5 ± 8.4 years, height 163.6 77.5 ± 8.4, weight 72.0 ± 13.5 kg, female 76%) took part in this investigation. Participants independently captured physical activity and physical function data at home using a smartwatch and a research-grade inertial sensor system for 48-hours. Machine learning classifiers were used to determine whether the data obtained can discriminate between frailty levels.

Results: Models incorporating variables from both the smartwatch and inertial sensor system were successful in the prediction of frailty status.

Discussion: This study has demonstrated the ability of older adults to collect data which can be used to indicate their frailty risk. This may enable earlier intervention and lessen the impact of frailty on the individual and society as a whole.

Background: Trauma systems provide comprehensive care across various settings, from prehospital services to rehabilitation, integrating clinical and social care aspects. Established in the 1970s, these systems are pivotal yet under-researched in their operational management. This study aims to fill this gap by focussing on the integration of operations management (OM) techniques to enhance the efficiency and effectiveness of trauma systems. By leveraging proven OM strategies from other healthcare sectors, we seek to improve patient outcomes and optimise system performance, addressing a crucial need for innovation in trauma care operations.

Methodology: A systematic literature review was conducted using the PICOTS framework to explore operational aspects of trauma systems across varied settings, from emergency departments to specialised centres. Searches were performed in 5 databases, focussing on articles published from 2006 to 2024. Keywords related to operational research and management targeted both trauma systems and emergency management services. Our method involved identifying, synthesising, and summarising studies to evaluate operational performance, with a specific emphasis on articles that applied operational research/management techniques in trauma care. All eligible articles were critically appraised using 2 quality assessment tools.

Results: Employing Donabedian's framework to analyse the quality of trauma systems through structure, process, and outcome dimensions, our systematic review included 160 studies. Of these, 5 studies discussed the application of the Donabedian evaluation framework to trauma systems, and 14 studies examined structural elements, focussing on the location of healthcare facilities, trauma resource management, and EMS logistics. The 63 studies on process indicators primarily assessed triage procedures, with some exploring the timeliness of trauma care. Meanwhile, the 78 outcome-oriented studies predominantly evaluated mortality rates, alongside a smaller number assessing functional outcomes.

Conclusion: Existing evaluation metrics primarily focussed on triage accuracy and mortality are inadequate. We propose expanding these metrics to include patient length of stay (LOS) and rehabilitation trajectory analyses. There is a critical gap in understanding patient flow management and long-term outcomes, necessitating focussed research on LOS modelling and improved rehabilitation data collection. Addressing these areas is essential for optimising trauma care and improving patient recovery outcomes.

Spasticity affects up to 80% of individuals with cerebral palsy and can lead to pain and difficulties with performing activities of daily living. If left untreated, spasticity can progress to contracture and neuro-orthopedic deformities. Cryoneurolysis is an emerging and mini-invasive ultrasound-guided technique that causes secondary axonotmesis of peripheral nerves through the formation of an ice ball and may result in months to years of improved range of motion and reduced pain in patients with spasticity. However, the safety of cryoneurolysis has not yet been established in patients with an increased bleeding risk secondary to Hemophilia A. We present a case of cryoneurolysis for cerebral palsy-related spasticity in a 14-year-old male with hemophilia A who previously had minimal benefit from botulinum toxin for increased elbow and wrist flexor tone with contracture. Fifteen minutes prior to cryoneurolysis, an IV infusion of 2000 IU of recombinant antihemophilic factor (FVIII) was administered for bleeding prophylaxis. Targets were identified with ultrasound guidance and nerve stimulation and cryoneurolysis was performed without bleeding complications or adverse events. There was an immediate improvement in tone and range of motion that was maintained at 3- and 8-month follow-ups with reported increased left arm function. This case suggests that cryoneurolysis is an effective mini-invasive procedure for spasticity that improves tone and range of motion and is safe for use in patients with Hemophilia A who receive adequate Factor VIII prophylaxis.

Background: Nearly half of subjects after COVID-19 still experience symptoms after 12 weeks, as described in the Post-Covid Syndrome (PCS). Other than the physical alterations perceived, mental health disorders have been frequently reported. Mindfulness-Based Interventions (MBIs) showed beneficial effects on psychological well-being in patients with respiratory dysfunctions, but they have been rarely tested in severe COVID-19 survivors.

Objective: In a quasi-experimental study, test the clinical and psychological effects of a 12-week Tele-MBI in previously hospitalized COVID-19 patients and analyze the feasibility of the intervention.

Methods: Subjects earlier hospitalized due to COVID-19 were enrolled 12 weeks after the infection onset, they were assigned to the intervention group (TG) or to the control one (n-TG). Subjects enrolled in the TG attended a 12-week home-based T-MBI and patients of both groups received multimodal rehabilitation interventions according to their own therapeutic needs. Mental health (anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, sleep quality, self-efficacy, and resilience) and quality of life were detected before and after treatment. The feasibility of the T-MBI applied was also investigated.

Results: A total of 88 subjects were included (44 in the TG and 44 in the n-TG; 63.6% males, mean age 64.4 ± 10.6). Most characteristics were similar between groups at the baseline; TG patients showed greater improvements in different psychological metrics (anxiety, depression, PTSD, resilience, and self-efficacy) compared to n-TG while no differences were found for perceived quality of life. T-MBI was well-accepted by patients.

Conclusion: Tele-Mindfulness program seems effective in reducing anxiety, depression, and post-traumatic stress disorder symptoms and increasing resilience and self-efficacy in subjects who required hospitalization due to COVID-19.

Objective: To report practice based evidence built on clinical findings where an intensive therapeutic approach called ACQUIRE Therapy was used as a rehabilitation/habilitation tool for children diagnosed with CASK mutations. ACQUIRE Therapy delivery is based on principles of learning and guided by a therapeutic framework often used in the delivery of intensive therapy.

Design: Clinical Cohort.

Setting: Natural environments (eg, home-like environment).

Participants: A total of 20 females, 12 to 128 months, mean age = 44.75 (SD = 31.64).

Intervention: Trained Occupational therapists delivered high-dosage rehabilitation for an average of 64.06 hours (SD = 12.91) across 4 weeks. ACQUIRE Therapy targeted cross-domain intervention targets often associated with executive control and praxis.

Main outcome measures: Clinical data was examined from the following sources; therapist daily treatment documentation (eg, therapy goals, video recordings, daily therapy logs, and discharge documentation).

Results: Receptive communication improved in all children. The most common motor skill improvements occurred in trunk control occurring in 33% of children; followed by, gross reaching abilities in 21% of children; fine-motor skills in 19%; head control in 15%; and mobility in 12%. Documentation of cognitive-motor pairing of skills was documented in all children.

Conclusions: Diagnosis specific intervention targets (eg, attention and cognitive-pairing skills) need to be considered when providing therapeutic services to children with CASK-gene mutations and other forms of Global Developmental Delay.Clinicaltrials.gov registration number is NCT03325946. Date of registration: 1 May 2013. Trial Dates: December 2014 and October 2023. https://clinicaltrials.gov/study/NCT03325946?locStr=Roanoke,%20VA&country=United%20States&state=Virginia&city=Roanoke&cond=Cerebral%20Palsy&intr=Intensive%20therapy&rank=2.