Pub Date : 2024-03-01DOI: 10.1016/j.arrct.2023.100310
Ursina Arnet PhD , Fransiska M. Bossuyt PhD , Benjamin J.H. Beirens MSc , Wiebe H.K. de Vries PhD
Objective
To investigate the association between propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia.
Design
Cross-sectional, observational study.
Setting
Non-university research institution.
Participants
16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7, with and without shoulder pain (age, 49.1±11.7 years; 94% men, 23.4±9.5 years past injury).
Interventions
Not applicable.
Main Outcome Measures
Force application and spatio-temporal characteristics of wheelchair propulsion on a treadmill (0.56 m/s, 10W and 0.83 m/s, 15W). Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index (WUSPI) score on the day of measurement.
Results
The mixed-effect multilevel analysis showed that wheelchair users with high levels of shoulder pain applied propulsion force more effectively (and with a lower medial component) and over a longer push angle, thus shortening the recovery time as compared with persons with low or moderate levels of shoulder pain.
Conclusions
In contrast with previous results from persons with a paraplegia, persons with tetraplegia and high levels of shoulder pain propel their wheelchair more optimal with regard to risk factors for shoulder pain. Our results therefore affirm that there is a different interaction of shoulder pain and propulsion biomechanics in persons with a tetraplegia which should be considered when further analyzing risk factors for shoulder pain in wheelchair users or applying literature results to different patient populations.
{"title":"Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion","authors":"Ursina Arnet PhD , Fransiska M. Bossuyt PhD , Benjamin J.H. Beirens MSc , Wiebe H.K. de Vries PhD","doi":"10.1016/j.arrct.2023.100310","DOIUrl":"https://doi.org/10.1016/j.arrct.2023.100310","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the association between propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia.</p></div><div><h3>Design</h3><p>Cross-sectional, observational study.</p></div><div><h3>Setting</h3><p>Non-university research institution.</p></div><div><h3>Participants</h3><p>16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7, with and without shoulder pain (age, 49.1±11.7 years; 94% men, 23.4±9.5 years past injury).</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Main Outcome Measures</h3><p>Force application and spatio-temporal characteristics of wheelchair propulsion on a treadmill (0.56 m/s, 10W and 0.83 m/s, 15W). Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index (WUSPI) score on the day of measurement.</p></div><div><h3>Results</h3><p>The mixed-effect multilevel analysis showed that wheelchair users with high levels of shoulder pain applied propulsion force more effectively (and with a lower medial component) and over a longer push angle, thus shortening the recovery time as compared with persons with low or moderate levels of shoulder pain.</p></div><div><h3>Conclusions</h3><p>In contrast with previous results from persons with a paraplegia, persons with tetraplegia and high levels of shoulder pain propel their wheelchair more optimal with regard to risk factors for shoulder pain. Our results therefore affirm that there is a different interaction of shoulder pain and propulsion biomechanics in persons with a tetraplegia which should be considered when further analyzing risk factors for shoulder pain in wheelchair users or applying literature results to different patient populations.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000721/pdfft?md5=ee61899426717f3a2bea20ec810a3087&pid=1-s2.0-S2590109523000721-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the effect of a reablement intervention (a person-centered, interdisciplinary rehabilitation approach) compared with usual care services in home-dwelling elderly experiencing functional declines in activities of daily living.
Design
A non-randomized controlled trial comparing a reablement intervention with usual care; outcomes were measured at baseline, after intervention, and at a 6-month from baseline in both groups.
Setting
Municipal public health service.
Participants
Sixty-five home-dwelling elderly with functional decline were assigned by the participants home care service zone to a reablement group (n=35), or a usual care group (n=30). The mean participant age was 80±11 years in the reablement group and 78±12 in the usual care group.
Intervention
The reablement group received a person-centered and tailored reablement program provided by an interdisciplinary team, consisting of a physiotherapist, an occupational therapist, and a nurse. The usual care group received standard home care services.
Main Outcome Measures
The dimension “Your health today” from the European Quality of Life-Visual Analog Scale (HRQOL), the patient-specific functional scale for goals in ADL (PSFS), the short physical performance battery (SPPB), and home care services in hours per week.
Results
There were significant differences over time in favor of the reablement group with between-group effect sizes of Cohen h2=0.36 (P=.001) for HRQOL, h2=0.60 (P=.001) for PSFS, h2=0.30 (P=.001) for SPPB, and h2=0.10 (P=.013) for hours of home care services per week. The within-group effect size for PSFS was h2=0.15 (P=.010) in favor of the reablement group. The mean number of hours of home care services per week was mean 0.38±1.07 (P=.001) in the reablement group and mean 30.38±64.13 (P=.023) in the usual care group.
Conclusions
The participants in the reablement group achieved and maintained better physical function, a higher HRQOL and needed considerably less home care services than the usual care group participants. Thus, reablement appears to be a more beneficial and sustainable approach than the usual care services for the home-dwelling elderly with functional decline.
{"title":"A Prospective Intervention Study With 6 Months Follow-up of the Effect of Reablement in Home Dwelling Elderly: Patient-reported and Observed Outcomes","authors":"Jeanette Kjernsholen MD , Inger Schou-Bredal PhD, RN, OUS , Rolf Kaaresen MD, PhD, OUS , Helene Lundgaard Soberg PhD , Aase Sagen PhD","doi":"10.1016/j.arrct.2023.100311","DOIUrl":"10.1016/j.arrct.2023.100311","url":null,"abstract":"<div><h3>Objectives</h3><p>To investigate the effect of a reablement intervention (a person-centered, interdisciplinary rehabilitation approach) compared with usual care services in home-dwelling elderly experiencing functional declines in activities of daily living.</p></div><div><h3>Design</h3><p>A non-randomized controlled trial comparing a reablement intervention with usual care; outcomes were measured at baseline, after intervention, and at a 6-month from baseline in both groups.</p></div><div><h3>Setting</h3><p>Municipal public health service.</p></div><div><h3>Participants</h3><p>Sixty-five home-dwelling elderly with functional decline were assigned by the participants home care service zone to a reablement group (n=35), or a usual care group (n=30). The mean participant age was 80±11 years in the reablement group and 78±12 in the usual care group.</p></div><div><h3>Intervention</h3><p>The reablement group received a person-centered and tailored reablement program provided by an interdisciplinary team, consisting of a physiotherapist, an occupational therapist, and a nurse. The usual care group received standard home care services.</p></div><div><h3>Main Outcome Measures</h3><p>The dimension “Your health today” from the European Quality of Life-Visual Analog Scale (HRQOL), the patient-specific functional scale for goals in ADL (PSFS), the short physical performance battery (SPPB), and home care services in hours per week.</p></div><div><h3>Results</h3><p>There were significant differences over time in favor of the reablement group with between-group effect sizes of Cohen h<sup>2</sup>=0.36 (<em>P</em>=.001) for HRQOL, h<sup>2</sup>=0.60 (<em>P</em>=.001) for PSFS, h<sup>2</sup>=0.30 (<em>P</em>=.001) for SPPB, and h<sup>2</sup>=0.10 (<em>P=</em>.013) for hours of home care services per week. The within-group effect size for PSFS was h<sup>2</sup>=0.15 (<em>P=</em>.010) in favor of the reablement group. The mean number of hours of home care services per week was mean 0.38±1.07 (<em>P</em>=.001) in the reablement group and mean 30.38±64.13 (<em>P</em>=.023) in the usual care group.</p></div><div><h3>Conclusions</h3><p>The participants in the reablement group achieved and maintained better physical function, a higher HRQOL and needed considerably less home care services than the usual care group participants. Thus, reablement appears to be a more beneficial and sustainable approach than the usual care services for the home-dwelling elderly with functional decline.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000733/pdfft?md5=f307fb070aae2676db1f261e9d5ca0e2&pid=1-s2.0-S2590109523000733-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.arrct.2023.100313
Katherine Hu MD , Maree Cassimatis BAppSc(ExPhys) , Christian Girgis MD
Objective
This systematic review aims to determine the effects of exercise on bone and muscle health in men with low bone density.
Data Sources
An electronic search in the following databases was performed: Medline, AMED, Embase, Scopus, and SPORTDiscus between January 1940 and September 2021.
Study Selection
Randomized or non-randomized trials involving any form of exercise in adult men with a densitometric diagnosis of osteoporosis or osteopenia and reported outcomes relating to bone or muscle health. Two independent reviewers screened 12,018 records, resulting in 13 eligible articles.
Data Extraction
One reviewer extracted data into a pre-formed table, including characteristics of the exercise intervention, population examined, and primary and secondary outcomes. Study quality was assessed by 2 independent reviewers using the Tool for assEssment of Study qualiTy and reporting in Exercise (TESTEX).
Data Synthesis
Thirteen publications, originating from 6 unique trials, were eligible for inclusion, which assessed the effect of resistance training, impact training, whole body vibration, and traditional Chinese exercises. Resistance training was the most effective: it stimulates the replacement of adipose tissue with muscle, and in some cases, improved bone density.
Conclusions
Exercise, especially resistance training, slowed down the natural progression of osteoporosis and sarcopenia in men. These benefits are reflected in enhancements to function, such as improved mobility and balance. Other exercise modalities, such as whole body vibration and traditional Chinese exercises, generated minimal improvements to bone health, strength, and balance.
{"title":"Exercise and Musculoskeletal Health in Men With Low Bone Mineral Density: A Systematic Review","authors":"Katherine Hu MD , Maree Cassimatis BAppSc(ExPhys) , Christian Girgis MD","doi":"10.1016/j.arrct.2023.100313","DOIUrl":"10.1016/j.arrct.2023.100313","url":null,"abstract":"<div><h3>Objective</h3><p>This systematic review aims to determine the effects of exercise on bone and muscle health in men with low bone density.</p></div><div><h3>Data Sources</h3><p>An electronic search in the following databases was performed: Medline, AMED, Embase, Scopus, and SPORTDiscus between January 1940 and September 2021.</p></div><div><h3>Study Selection</h3><p>Randomized or non-randomized trials involving any form of exercise in adult men with a densitometric diagnosis of osteoporosis or osteopenia and reported outcomes relating to bone or muscle health. Two independent reviewers screened 12,018 records, resulting in 13 eligible articles.</p></div><div><h3>Data Extraction</h3><p>One reviewer extracted data into a pre-formed table, including characteristics of the exercise intervention, population examined, and primary and secondary outcomes. Study quality was assessed by 2 independent reviewers using the Tool for assEssment of Study qualiTy and reporting in Exercise (TESTEX).</p></div><div><h3>Data Synthesis</h3><p>Thirteen publications, originating from 6 unique trials, were eligible for inclusion, which assessed the effect of resistance training, impact training, whole body vibration, and traditional Chinese exercises. Resistance training was the most effective: it stimulates the replacement of adipose tissue with muscle, and in some cases, improved bone density.</p></div><div><h3>Conclusions</h3><p>Exercise, especially resistance training, slowed down the natural progression of osteoporosis and sarcopenia in men. These benefits are reflected in enhancements to function, such as improved mobility and balance. Other exercise modalities, such as whole body vibration and traditional Chinese exercises, generated minimal improvements to bone health, strength, and balance.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000800/pdfft?md5=544a4523bcf6f0747f34a33589d79934&pid=1-s2.0-S2590109523000800-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138627045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.arrct.2023.100316
Grace J. Kim PhD , Amanda Gahlot MS , Camile Magsombol OTD , Margaret Waskiewicz OTD , Nettie Capasso MS , Stephen Van Lew PhD , Hayejin Kim MS , Avinash Parnandi PhD , Victoria Vaughan Dickson PhD , Yael Goverover PhD
Objective
To determine the feasibility of a self-directed training protocol to promote actual arm use in everyday life. The secondary aim was to explore the initial efficacy on upper extremity (UE) outcome measures.
Design
Feasibility study using multiple methods.
Setting
Home and outpatient research lab.
Participants
Fifteen adults (6 women, 9 men, mean age=53.08 years) with chronic stroke living in the community. There was wide range of UE functional levels, ranging from dependent stabilizer (limited function) to functional assist (high function).
Intervention
Use My Arm-Remote protocol. Phase 1 consisted of clinician training on motivational interviewing (MI). Phase 2 consisted of MI sessions with participants to determine participant generated goals, training activities, and training schedules. Phase 3 consisted of UE task-oriented training (60 minutes/day, 5 days/week, for 4 weeks). Participants received daily surveys through an app to monitor arm training behavior and weekly virtual check-ins with clinicians to problem-solve challenges and adjust treatment plans.
Outcome Measures
Primary outcome measures were feasibility domains after intervention, measured by quantitative study data and qualitative semi-structured interviews. Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), Fugl-Meyer Assessment (FMA), and accelerometry-based duration of use metric measured at baseline, discharge, and 4-week follow-up.
Results
The UMA-R was feasible in the following domains: recruitment rate, retention rate, intervention acceptance, intervention delivery, adherence frequency, and safety. Adherence to duration of daily practice did not meet our criteria. Improvements in UE outcomes were achieved at discharge and maintained at follow-up as measured by COPM-Performance subscale (F[1.42, 19.83]=17.72, P<.001) and COPM-Satisfaction subscale (F[2, 28]=14.73, P<.001), MAL (F[1.31, 18.30]=12.05, P<.01) and the FMA (F[2, 28]=16.62, P<.001).
Conclusion
The UMA-R was feasible and safe to implement for individuals living in the community with chronic stroke. Adherence duration was identified as area of refinement. Participants demonstrated improvements in standardized UE outcomes to support initial efficacy of the UMA-R. Shared decision-making and behavior change frameworks can support the implementation of UE self-directed rehabilitation. Our results warrant the refinement and further testing of the UMA-R.
{"title":"Feasibility of a Self-directed Upper Extremity Training Program to Promote Actual Arm Use for Individuals Living in the Community With Chronic Stroke","authors":"Grace J. Kim PhD , Amanda Gahlot MS , Camile Magsombol OTD , Margaret Waskiewicz OTD , Nettie Capasso MS , Stephen Van Lew PhD , Hayejin Kim MS , Avinash Parnandi PhD , Victoria Vaughan Dickson PhD , Yael Goverover PhD","doi":"10.1016/j.arrct.2023.100316","DOIUrl":"10.1016/j.arrct.2023.100316","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the feasibility of a self-directed training protocol to promote actual arm use in everyday life. The secondary aim was to explore the initial efficacy on upper extremity (UE) outcome measures.</p></div><div><h3>Design</h3><p>Feasibility study using multiple methods.</p></div><div><h3>Setting</h3><p>Home and outpatient research lab.</p></div><div><h3>Participants</h3><p>Fifteen adults (6 women, 9 men, mean age=53.08 years) with chronic stroke living in the community. There was wide range of UE functional levels, ranging from dependent stabilizer (limited function) to functional assist (high function).</p></div><div><h3>Intervention</h3><p>Use My Arm-Remote protocol. Phase 1 consisted of clinician training on motivational interviewing (MI). Phase 2 consisted of MI sessions with participants to determine participant generated goals, training activities, and training schedules. Phase 3 consisted of UE task-oriented training (60 minutes/day, 5 days/week, for 4 weeks). Participants received daily surveys through an app to monitor arm training behavior and weekly virtual check-ins with clinicians to problem-solve challenges and adjust treatment plans.</p></div><div><h3>Outcome Measures</h3><p>Primary outcome measures were feasibility domains after intervention, measured by quantitative study data and qualitative semi-structured interviews. Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), Fugl-Meyer Assessment (FMA), and accelerometry-based duration of use metric measured at baseline, discharge, and 4-week follow-up.</p></div><div><h3>Results</h3><p>The UMA-R was feasible in the following domains: recruitment rate, retention rate, intervention acceptance, intervention delivery, adherence frequency, and safety. Adherence to duration of daily practice did not meet our criteria. Improvements in UE outcomes were achieved at discharge and maintained at follow-up as measured by COPM-Performance subscale (F[1.42, 19.83]=17.72, <em>P</em><.001) and COPM-Satisfaction subscale (F[2, 28]=14.73, <em>P</em><.001), MAL (F[1.31, 18.30]=12.05, <em>P</em><.01) and the FMA (F[2, 28]=16.62, <em>P</em><.001).</p></div><div><h3>Conclusion</h3><p>The UMA-R was feasible and safe to implement for individuals living in the community with chronic stroke. Adherence duration was identified as area of refinement. Participants demonstrated improvements in standardized UE outcomes to support initial efficacy of the UMA-R. Shared decision-making and behavior change frameworks can support the implementation of UE self-directed rehabilitation. Our results warrant the refinement and further testing of the UMA-R.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000836/pdfft?md5=0820b37c0308f78548d0cb7acdc91cdc&pid=1-s2.0-S2590109523000836-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.arrct.2024.100324
Lisa Engel, Roheema Ewesesan, Ibiyemi Arowolo, Celine Latulipe, Jane V. Karpa, Mohammad N. Khan
{"title":"Financial capability and financial well-being challenges and vulnerabilities of adults living with acquired brain injury: A pilot survey","authors":"Lisa Engel, Roheema Ewesesan, Ibiyemi Arowolo, Celine Latulipe, Jane V. Karpa, Mohammad N. Khan","doi":"10.1016/j.arrct.2024.100324","DOIUrl":"https://doi.org/10.1016/j.arrct.2024.100324","url":null,"abstract":"","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139831705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.arrct.2024.100326
M. J. Sobrepera, Julie Elfishawy, Anh T. Nguyen, Laura P. Prosser, Michelle J. Johnson
{"title":"Insights on Telecommunication Use by Rehabilitation Therapists Before, During, and Beyond COVID-19","authors":"M. J. Sobrepera, Julie Elfishawy, Anh T. Nguyen, Laura P. Prosser, Michelle J. Johnson","doi":"10.1016/j.arrct.2024.100326","DOIUrl":"https://doi.org/10.1016/j.arrct.2024.100326","url":null,"abstract":"","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139881497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-01DOI: 10.1016/j.arrct.2024.100325
Rebekah Harris, Elisa Ogawa, Rachel E. Ward, Emma Fitzelle-Jones, Thomas Travison, J. Brach, Jonathan F Bean
{"title":"Feasibility and Preliminary Efficacy of Virtual Rehabilitation for Middle and Older Aged Veterans with Mobility Limitations: a Pilot Study","authors":"Rebekah Harris, Elisa Ogawa, Rachel E. Ward, Emma Fitzelle-Jones, Thomas Travison, J. Brach, Jonathan F Bean","doi":"10.1016/j.arrct.2024.100325","DOIUrl":"https://doi.org/10.1016/j.arrct.2024.100325","url":null,"abstract":"","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139830131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the prevalence of post-stroke depression in a rehabilitation ward and elucidate its effect on functional improvement and outcomes.
Design
Retrospective cohort study.
Setting
A convalescent rehabilitation ward at a University Hospital.
Participants
A total of 114 patients with stroke (mean [SD] age, 67.2 [13.5] years; men, 76) assessed at 2 weeks after admission using the Mini-International Neuropsychiatric Interview were enrolled.
Main Outcome Measure
Functional independence measure (FIM) efficiency during hospitalization in the ward.
Results
Eleven patients (9.6%) had depression based on the Mini-International Neuropsychiatric Interview. Total FIM efficiency and FIM efficiency in the subtotal of motor items were significantly higher in the non-depression group than in the depression group (median [interquartile range]: 0.69 [0.39-0.95] vs 0.41 [0.24-0.63], P=.027; and 0.56 [0.38-0.80] vs 0.42 [0.18-0.49], P=.023, respectively). Patients in the non-depression group had higher FIM scores at discharge (median [interquartile range]: 116.0 [104.5-123.0] vs 104.0 [82.5-112.0], P=.013, respectively), and were more likely to be discharged home (80.6% vs 36.4%, P=.003). Furthermore, patients in the depression group also stayed significantly longer in the ward (71.0 [36.1] vs 106.1 [43.3], P=.010).
Conclusions
Patients with post-stroke depression showed poorer efficiency of functional recovery than those without depression. A future multicenter study with a larger sample size is needed to verify these findings.
目的调查康复病房中脑卒中后抑郁症的患病率，并阐明其对功能改善和预后的影响.设计回顾性队列研究.设置一所大学医院的疗养康复病房.参与者共有 114 名脑卒中患者（平均 [SD] 年龄为 67.2 [13.主要结果测量在病房住院期间的功能独立性测量（FIM）效率。结果根据迷你国际神经精神访谈，有7名患者（9.6%）患有抑郁症。非抑郁组的 FIM 总效率和运动项目小计的 FIM 效率明显高于抑郁组（中位数[四分位间范围]：0.69 [0.39-0.40]] ：分别为 0.69 [0.39-0.95] vs 0.41 [0.24-0.63]，P=.027；0.56 [0.38-0.80] vs 0.42 [0.18-0.49]，P=.023）。非抑郁组患者出院时的 FIM 评分较高（中位数[四分位数间距]：116.0 [104.5-111.0]; 中位数[四分位数间距分别为 116.0 [104.5-123.0] vs 104.0 [82.5-112.0]，P=.013），并且更有可能出院回家（80.6% vs 36.4%，P=.003）。此外，抑郁组患者在病房的逗留时间也明显更长（71.0 [36.1] vs 106.1 [43.3]，P=.010）。结论卒中后抑郁患者的功能恢复效率低于无抑郁患者，需要今后开展样本量更大的多中心研究来验证这些发现。
{"title":"Effect of Post-stroke Depression on Functional Outcomes of Patients With Stroke in the Rehabilitation Ward: A Retrospective Cohort Study","authors":"Yoshitaka Wada MD, PhD , Yohei Otaka MD, PhD , Taiki Yoshida OTR, PhD , Kanako Takekoshi RN , Raku Takenaka MD , Yuki Senju MD, PhD , Hirofumi Maeda MD, PhD , Seiko Shibata MD, PhD , Taro Kishi MD, PhD , Satoshi Hirano MD, PhD","doi":"10.1016/j.arrct.2023.100287","DOIUrl":"10.1016/j.arrct.2023.100287","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the prevalence of post-stroke depression in a rehabilitation ward and elucidate its effect on functional improvement and outcomes.</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting</h3><p>A convalescent rehabilitation ward at a University Hospital.</p></div><div><h3>Participants</h3><p>A total of 114 patients with stroke (mean [SD] age, 67.2 [13.5] years; men, 76) assessed at 2 weeks after admission using the Mini-International Neuropsychiatric Interview were enrolled.</p></div><div><h3>Main Outcome Measure</h3><p>Functional independence measure (FIM) efficiency during hospitalization in the ward.</p></div><div><h3>Results</h3><p>Eleven patients (9.6%) had depression based on the Mini-International Neuropsychiatric Interview. Total FIM efficiency and FIM efficiency in the subtotal of motor items were significantly higher in the non-depression group than in the depression group (median [interquartile range]: 0.69 [0.39-0.95] vs 0.41 [0.24-0.63], <em>P</em>=.027; and 0.56 [0.38-0.80] vs 0.42 [0.18-0.49], <em>P</em>=.023, respectively). Patients in the non-depression group had higher FIM scores at discharge (median [interquartile range]: 116.0 [104.5-123.0] vs 104.0 [82.5-112.0], <em>P</em>=.013, respectively), and were more likely to be discharged home (80.6% vs 36.4%, <em>P</em>=.003). Furthermore, patients in the depression group also stayed significantly longer in the ward (71.0 [36.1] vs 106.1 [43.3], <em>P</em>=.010).</p></div><div><h3>Conclusions</h3><p>Patients with post-stroke depression showed poorer efficiency of functional recovery than those without depression. A future multicenter study with a larger sample size is needed to verify these findings.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000435/pdfft?md5=ccc69e29e3536f322048fe7bcd204db7&pid=1-s2.0-S2590109523000435-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43914197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the occurrence of incidents and sudden deteriorations during rehabilitation in an acute care setting by disease category based on the International Classification of Diseases and Related Health Problems, 10th Revision.
Design
Retrospective cohort study.
Setting
University hospital in Japan with 1376 beds.
Participants
A total of 49,927 patients who were admitted to the acute care wards and underwent rehabilitation over 8 years, from April 1, 2013, to March 31, 2021.
Interventions
Rehabilitation in an acute care setting.
Main Outcome Measures
Incidents and sudden deteriorations reported in medical charts.
Results
Among 49,927 admissions, 455 incidents and 683 sudden deteriorations occurred during rehabilitation. The incidents and sudden deteriorations occurred at rates of 0.009/person (0.50 case/1000 h) and 0.012/person (0.75 case/1000 h), respectively. The 3 most frequent incidents were “route-related incidents” (178 cases, 39.1%), followed by “bleeding/abrasions” (131 cases, 28.8%) and “falls” (125 cases, 27.5%). Among 12 disease categories with over 500 admissions and 10,000 rehabilitation hours, the highest incident rate occurred in “certain infectious and parasitic diseases” (0.81 case/1000 h), followed by “diseases of the musculoskeletal system and connective tissue” (0.67 case/1000 h) and “diseases of the genitourinary system” (0.66 case/1000 h). The commonest sudden deterioration was “vomiting” (460 cases, 67.3%), followed by “decreased level of consciousness (with reduced blood pressure)” (42 cases, 6.1%) and “seizure” (39 cases, 5.7%). Furthermore, the highest sudden deterioration rate was in the “endocrine, nutritional, and metabolic diseases” (1.19 case/1000 h) category, followed by “neoplasms” (1.04 case/1000 h) and “certain infectious and parasitic diseases” (0.99 case/1000 h).
Conclusions
An incident and sudden deterioration occurred every 2000 and 1333 h, respectively, during rehabilitation. Therefore, understanding the actual occurrence of incidents and sudden deteriorations during rehabilitation may provide valuable insights into preventing incidents and emergencies.
{"title":"Incidents and Sudden Patient Deteriorations Occurring During Their Rehabilitation Sessions in an Acute Care Hospital: A Retrospective Cohort Study","authors":"Koji Mizutani PT, MSc , Yohei Otaka MD, PhD , Masaki Kato PT , Miwako Hayakawa PT, MSc , Yoshitaka Wada MD, PhD , Takamichi Tohyama MD, PhD , Megumi Ozeki MD, PhD , Hirofumi Maeda MD, PhD , Satoshi Hirano MD, PhD , Seiko Shibata MD, PhD","doi":"10.1016/j.arrct.2023.100307","DOIUrl":"10.1016/j.arrct.2023.100307","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the occurrence of incidents and sudden deteriorations during rehabilitation in an acute care setting by disease category based on the International Classification of Diseases and Related Health Problems, 10th Revision.</p></div><div><h3>Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting</h3><p>University hospital in Japan with 1376 beds.</p></div><div><h3>Participants</h3><p>A total of 49,927 patients who were admitted to the acute care wards and underwent rehabilitation over 8 years, from April 1, 2013, to March 31, 2021.</p></div><div><h3>Interventions</h3><p>Rehabilitation in an acute care setting.</p></div><div><h3>Main Outcome Measures</h3><p>Incidents and sudden deteriorations reported in medical charts.</p></div><div><h3>Results</h3><p>Among 49,927 admissions, 455 incidents and 683 sudden deteriorations occurred during rehabilitation. The incidents and sudden deteriorations occurred at rates of 0.009/person (0.50 case/1000 h) and 0.012/person (0.75 case/1000 h), respectively. The 3 most frequent incidents were “route-related incidents” (178 cases, 39.1%), followed by “bleeding/abrasions” (131 cases, 28.8%) and “falls” (125 cases, 27.5%). Among 12 disease categories with over 500 admissions and 10,000 rehabilitation hours, the highest incident rate occurred in “certain infectious and parasitic diseases” (0.81 case/1000 h), followed by “diseases of the musculoskeletal system and connective tissue” (0.67 case/1000 h) and “diseases of the genitourinary system” (0.66 case/1000 h). The commonest sudden deterioration was “vomiting” (460 cases, 67.3%), followed by “decreased level of consciousness (with reduced blood pressure)” (42 cases, 6.1%) and “seizure” (39 cases, 5.7%). Furthermore, the highest sudden deterioration rate was in the “endocrine, nutritional, and metabolic diseases” (1.19 case/1000 h) category, followed by “neoplasms” (1.04 case/1000 h) and “certain infectious and parasitic diseases” (0.99 case/1000 h).</p></div><div><h3>Conclusions</h3><p>An incident and sudden deterioration occurred every 2000 and 1333 h, respectively, during rehabilitation. Therefore, understanding the actual occurrence of incidents and sudden deteriorations during rehabilitation may provide valuable insights into preventing incidents and emergencies.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000691/pdfft?md5=4bca478d4eab7cc14bafefa686ccd9fc&pid=1-s2.0-S2590109523000691-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.arrct.2023.100305
Kirby P. Mayer PT, PhD , Susan Silva PhD , Amanda Beaty PT , Anne Davenport PT , Melissa Minniti PT , Sara Uribe Dorn PT , Lane S. White PT , Valerie K. Sabol PhD, MBA , Amy M. Pastva PT, MA, PhD
Objective
To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.
Design
Retrospective, observational cohort study.
Setting
Medical Intensive Care Unit (MICU).
Participants
Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.
Interventions
Not applicable.
Measurements and Main Results
Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03).
Conclusion
Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.
目的确定重症患者的年龄、活动能力水平以及前 3 次物理康复治疗中活动能力水平的变化是否与临床预后有关。干预措施不适用。测量和主要结果样本包括 132 名患者，其中 60 人（45%）年龄较小（18-59 岁），72 人（55%）年龄较大（60 岁以上）。最常见的诊断是败血症/败血症（32.6%）。与年轻患者相比，老年患者在各康复疗程中的重症监护室移动量表（IMS）评分改善速度明显较慢（平均斜率系数为0.3分 vs 0.6分，P<.001），出院回家的可能性较低（30.6% vs 55.0%，P=.005），并且更有可能在12个月内死亡（41.7% vs 25.0%，P=.046）。协变量调整模型显示，IMS评分的早期改善幅度越大，出院回家的可能性越大（P=.005）。首次康复治疗时间较长、初始IMS评分较低以及IMS评分改善较慢与ICU天数增加有关（所有P< .03）。我们的研究结果表明，年龄和活动能力水平有助于预后，并有助于临床表型和康复服务的分配。
{"title":"Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness","authors":"Kirby P. Mayer PT, PhD , Susan Silva PhD , Amanda Beaty PT , Anne Davenport PT , Melissa Minniti PT , Sara Uribe Dorn PT , Lane S. White PT , Valerie K. Sabol PhD, MBA , Amy M. Pastva PT, MA, PhD","doi":"10.1016/j.arrct.2023.100305","DOIUrl":"10.1016/j.arrct.2023.100305","url":null,"abstract":"<div><h3>Objective</h3><p>To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.</p></div><div><h3>Design</h3><p>Retrospective, observational cohort study.</p></div><div><h3>Setting</h3><p>Medical Intensive Care Unit (MICU).</p></div><div><h3>Participants</h3><p>Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Measurements and Main Results</h3><p>Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, <em>P</em><.001), were less likely to be discharged to home (30.6% vs 55.0%, <em>P</em>=.005), and were more likely to die within 12 months (41.7% vs 25.0%, <em>P</em>=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (<em>P</em>=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all <em>P</em><.03).</p></div><div><h3>Conclusion</h3><p>Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.</p></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590109523000678/pdfft?md5=4ee695cd17194771a3475e0fae5bb07e&pid=1-s2.0-S2590109523000678-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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