Archives of rehabilitation research and clinical translation最新文献

Objective

To compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals.

Design

Retrospective cohort study.

Setting

TTertiary hospitals in Shenzhen, China.

Participants

We assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services.

Interventions

Not applicable.

Main Outcome Measures

The outcome variable was the patients’ rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost.

Results

The results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was −1269 RMB (−193 USD). This difference in 2019, 2020, 2021, and 2022 was −1419 RMB (−228 USD), −1088 RMB (−158 USD), −1585 RMB (−246 USD), and −1034 RMB (−154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients’ age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization.

Conclusions

The findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Objective

To evaluate how the distribution of patients in groups (based on subjective health experience) changes over time and to investigate differences in physical functioning and mental health between these patient groups.

Design

An observational cohort study.

Setting

University medical center.

Participants

Patients who underwent gastrointestinal or bladder oncological surgery (N=98).

Interventions

Not applicable.

Main Outcome Measures

The classification of patients into different groups based on the subjective health experience model (acceptance and perceived control), preoperatively and 1 and 3 months after discharge.

Results

In total, 98 patients were included. Preoperatively, 31% of the patients were classified as having low acceptance and perceived control (group 4), and this proportion increased to 47% and 45% 1 and 3 months after discharge, respectively. These patients had significantly lower levels of physical functioning (preoperatively, 55 vs 61; P=.030; 1 month, 47 vs 57; P=.002; 3 months, 52 vs 62; P=.006) and higher levels of anxiety and depression (preoperatively, 14 vs 9; P<.001; 1 month, 11 vs 3; P=.001; 3 months, 10 vs 3; P=.009) than patients with high acceptance and perceived control (group 1).

Conclusions

The classification of patients to different groups provides insight in different levels of physical and mental health. However, frequent evaluation is important because of changes in patient groups over time.

Objective

To investigate the feasibility of poststroke interventions using a motivational instructional design model with occupational therapy (OT) and swallowing therapy (ST) and the model's potential physical and mental health effects.

Design

An open-label, single-arm, feasibility study on the Attention, Relevance, Confidence, and Satisfaction model.

Setting

Two convalescent rehabilitation wards.

Participants

Twenty-five patients with stroke (N=25) (19 men; mean age, 62.4±11.9y; 61.9±36.8d from the first stroke) were recruited.

Interventions

Twelve participants received a motivational approach based on the Attention, Relevance, Confidence, and Satisfaction model during OT (OT group), and 13 received it during ST (ST group). The intervention lasted 40-60 minutes daily, 5 days weekly, for 4 weeks.

Main Outcome Measures

The primary outcomes included the dropout rate, an adverse event, and the participants’ acceptability of the intervention. Paretic arm function was assessed in the OT group; swallowing ability was assessed in the ST group; and activities of daily living, depressive symptoms, and apathy were assessed in both groups.

Results

No participants dropped out of the intervention or experienced an adverse event. Twenty-one participants (84%) were satisfied with the intervention, and 19 (76%) hoped to continue receiving it. The OT group showed statistically significant improvements in paretic arm function and activities of daily living (Cohen's r=0.68-0.77), whereas the ST group improved in swallowing ability, activities of daily living, and depressive symptoms (Cohen's r=0.62-0.85).

Conclusions

The interventions using the motivational instructional model with OT and ST were feasible and could improve poststroke paretic arm function, swallowing ability, and activities of daily living after stroke.

The present study aims to describe the chair, bed, and toilet heights in rehabilitation hospitals and home environments to challenge rehabilitation clinicians to better prepare stroke survivors for discharge home. This study uses analysis of secondary outcomes from a multicentre, phase II randomized controlled trial (HOME Rehab trial) and additional observation of hospital environment. Data were collected from six rehabilitation hospitals and the homes of two hundred first-time stroke survivors who were aged >45 years. Chair, bed and toilet heights were measured; we measured 936 chairs and beds in hospital (17%) and home (83%) environments. Mean chair height at home was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym. Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI, 2-4) lower than in the hospital. Study findings suggest a disparity in heights between hospitals and home. Although clinicians may be aware of this disparity, they need to ensure that chair and bed heights within the hospital environment are progressively made lower to better prepare stroke survivors for discharge home.

Objective

To evaluate the feasibility, safety, and potential health benefits of an 8-week home-based neurofeedback intervention.

Design

Single-group preliminary study.

Setting

Community-based.

Participants

Nine community dwelling adults with chronic neuropathic pain, 6 women and 3 men, with an average age of 51.9 years (range, 19-78 years) and with a 7-day average minimum pain score of 4 of 10 on the visual analog pain scale.

Interventions

A minimum of 5 neurofeedback sessions per week (40min/session) for 8 consecutive weeks was undertaken with a 12-week follow-up baseline electroencephalography recording period.

Main Outcome Measures

Primary feasibility outcomes: accessibility, tolerability, safety (adverse events and resolution), and human and information technology (IT) resources required. Secondary outcomes: pain, sensitization, catastrophization, anxiety, depression, sleep, health-related quality of life, electroencephalographic activity, and simple participant feedback.

Results

Of the 23 people screened, 11 were eligible for recruitment. One withdrew and another completed insufficient sessions for analysis, which resulted in 9 datasets analyzed. Three participants withdrew from the follow-up baselines, leaving 6 who completed the entire trial protocol. Thirteen adverse events were recorded and resolved: 1 was treatment-related, 4 were equipment-related, and 8 were administrative-related (eg, courier communication issues). The human and IT resources necessary for trial implementation were identified. There were also significant improvements in pain levels, depression, and anxiety. Six of 9 participants perceived minimal improvement or no change in symptoms after the trial, and 5 of 9 participants were satisfied with the treatment received.

Conclusions

It is feasible and safe to conduct a home-based trial of a neurofeedback intervention for people with chronic neuropathic pain, when the human and IT resources are provided and relevant governance processes are followed. Improvements in secondary outcomes merit investigation with a randomized controlled trial.

Objective

To identify potential barriers and obstacles preventing clinicians from adopting ultrasound for spasticity management.

Design

A prospective, cross-sectional national survey.

Setting

Web-based platform.

Participants

Thirty-six physicians and surgeons from across Canada.

Interventions

Survey completion.

Main Outcome Measures

The use of ultrasound in clinical spasticity practice, perceived barriers, and risks associated with its implementation.

Results

In total, 36 Canadian physicians and surgeons responded. A total of 91% reported using the US in their practice. Nearly all of them used ultrasonography (US) to guide injections and reported using more than 1 guidance technique for their injections. Less than half of the survey respondents reported using the US for muscle architecture assessment or longitudinal evaluation of muscle echo intensity. A total of 47% of survey respondents reported that they believe there are disadvantages associated with US use in spasticity practice. Disadvantages included increased time requirements resulting in discomfort for the injector and patient, the risk of infection after the procedure, and the risk of needle-stick injury. The most important barrier identified was the increased time demands of US compared with other guidance techniques. Other barriers included a lack of feedback on identifying a spastic muscle compared with electrical guidance techniques, a lack of additional remuneration to complete injections under ultrasound guidance, and a lack of adequate training.

Conclusions

Future educational efforts should address clinicians’ lack of familiarity with US purposes outside of injection guidance. This survey has highlighted the need for a curriculum shift in spasticity education to improve physician's scanning and injection technique, to address concerns about increased time requirements for injecting under ultrasound guidance and to address perceived disadvantages from clinicians.

Social determinants are nonmedical factors frequently used to study disparities in health outcomes but have not been widely explored in regard to rehabilitation service utilization. In our National Institutes of Child Health and Human Development-funded study, Access to and Effectiveness of Community-Based Rehabilitation After Stroke, we reviewed several conceptual models and frameworks for the study of social determinants to inform our work. The overall objective of this special communication is to describe our approach to identifying, selecting, and using area-level measures of social determinants to explore the relationship between social determinants and rehabilitation use. We present our methods for developing a conceptual model and a methodologic framework for the selection of social determinant measures relevant to rehabilitation use, as well as an overview of publicly available data on social determinants. We then discuss the methodologic challenges encountered and future directions for this work.

A 65-year-old woman presenting with a sensory ganglionopathy complicated with COVID-19 is limited in her rehabilitation due to pain from lateral compartment knee osteoarthritis. To increase participation in rehabilitation, cryoneurolysis of the medial and lateral anterior femoral cutaneous nerve and infrapatellar branches of the saphenous nerve was provided to manage pain associated with knee osteoarthritis. The patient reported immediate relief from pain. Physiotherapy noted improvement immediately after the procedure. Follow-ups at 7- and 11-days post-treatment revealed ongoing increases in mobility and reduction in pain. The patient was discharged to live independently shortly after cryoneurolysis. Cryoneurolysis for knee osteoarthritis could be considered as a treatment option to increase participation in rehabilitation for hospital inpatients who are stalled in their rehabilitation due to pain and poor mobility from knee osteoarthritis.

Objective

To determine whether chronic pain persists after complete spinal cord injury (SCI).

Design

Prospective observational study regarding the outcome of pre-existent chronic pain of inpatients admitted with new clinically diagnosed complete cervical SCI. For patients who acknowledged chronic pain of ≥3 years duration before the SCI, further questions explored whether they still experienced that pain, whether they were experiencing current posttraumatic pain, and whether they had any past exposure to opioids. The included patients were identified during the initial consultation in the trauma center for treatment of the SCI.

Setting

Level I trauma center.

Participants

From a total of 49 participants with acute cervical SCI with clinically diagnosed complete motor and sensory tetraplegia admitted between 2018 and 2020, 7 were selected on the basis of a history of chronic pain.

Intervention

Collected complete history and performed physical examination with serial follow-ups during the acute hospital stay until death or discharge.

Main Outcome Measures

The primary outcome was a finding of chronic pain experienced before new clinical diagnosis of complete SCI, compared with whether or not that pain continued after the SCI injury. The secondary outcome was the relation of persistent pain with opioid use; it was formulated after data collection.

Results

Among 49 patients with clinically diagnosed complete cervical SCIs, 7 had experienced prior chronic pain. Four participants experienced a continuation of the prior pain after their complete tetraplegia (4/7), whereas 3 participants did not (3/7). All the participants with continued pain had been previously treated with opioids, whereas those whose pain ceased had not received chronic opioid therapy.

Conclusions

There may be a unique form of chronic pain that is based in the brain, irrespective of peripheral pain or spinal mechanisms. Otherwise healthy people with longstanding antecedent chronic pain whose pain persists after acute clinically complete SCI with tetraplegia may provide a new model for evaluation of brain-based pain. Opioids may be requisite for this type of pain.

Survivors of neurologic injury (most commonly stroke or traumatic brain injury) frequently experience a disorder in which contralesionally positioned objects or the contralesional features of individual objects are often left unattended or underappreciated. The disorder is known by >200 unique labels in the literature, which potentially causes confusion for patients and their families, complicates literature searches for researchers and clinicians, and promotes a fractionated conceptualization of the disorder. The objective of this Delphi was to determine if consensus (≥75% agreement) could be reached by an international and multidisciplinary panel of researchers and clinicians with expertise on the topic.

To accomplish this aim, we used a modified Delphi method in which 66 researchers and/or clinicians with expertise on the topic completed at least 1 of 4 iterative rounds of surveys. Per the Delphi method, panelists were provided with results from each round prior to responding to the survey in the subsequent round with the explicit intention of achieving consensus. The panel ultimately reached consensus that the disorder should be consistently labeled spatial neglect. Based on the consensus reached by our expert panel, we recommend that researchers and clinicians use the label spatial neglect when describing the disorder in general and more specific labels pertaining to subtypes of the disorder when appropriate.