To explore experiences of a 6-week Fatigue Management course (FMC) in adults with cerebral palsy (CP).
Design
A qualitative study using semi-structured interviews. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Setting
The study was conducted in southeastern Sweden in an out-patient setting.
Participants
Adults (N=8) with CP who had participated in FMC.
Interventions
Not applicable.
Main Outcome Measure
Qualitative content analysis of the transcribed interviews led to identification of a main category, categories, and subcategories, describing the participants’ experiences of FMC.
Results
The analysis identified 2 categories: Awareness regarding fatigue, with the 2 subcategories: A better understanding, and The feeling of not being alone; and Perceive opportunities for changes, with the 3 subcategories: Understanding the need for changes, Demanding process, and Taking steps toward change. These categories were summed up in the main category describing the participants’ experiences of FMC: A challenging and eye-opening course that gave deeper self-understanding and thoughts about making changes.
Conclusions
Overall, the participants described positive experiences of FMC, with increased awareness regarding fatigue and insight regarding the possibilities for change. Nevertheless, there were challenges in coping with the extensive information and with the home assignments. This study gives promising results regarding the applicability of FMC for adults with CP. However, there is a need for course modifications with more targeted and differentiated content that is manageable and does not overload the participants. The modifications should include extended time, the addition of individual support, and follow-up between sessions, to increase participants’ opportunities to implement new strategies and initiate behavioral change.
{"title":"Managing Fatigue: Experiences From a 6-week Course for Adults With Cerebral Palsy","authors":"Ellinor Nilsson MSc , Séverine Hedberg Dubuc PhD , Nazdar Ghafouri PhD , Anne Söderlund Schaller PhD","doi":"10.1016/j.arrct.2023.100300","DOIUrl":"10.1016/j.arrct.2023.100300","url":null,"abstract":"<div><h3>Objective</h3><p>To explore experiences of a 6-week Fatigue Management course (FMC) in adults with cerebral palsy (CP).</p></div><div><h3>Design</h3><p>A qualitative study using semi-structured interviews. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).</p></div><div><h3>Setting</h3><p>The study was conducted in southeastern Sweden in an out-patient setting.</p></div><div><h3>Participants</h3><p>Adults (N=8) with CP who had participated in FMC.</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Main Outcome Measure</h3><p>Qualitative content analysis of the transcribed interviews led to identification of a main category, categories, and subcategories, describing the participants’ experiences of FMC.</p></div><div><h3>Results</h3><p>The analysis identified 2 categories: Awareness regarding fatigue, with the 2 subcategories: A better understanding, and The feeling of not being alone; and Perceive opportunities for changes, with the 3 subcategories: Understanding the need for changes, Demanding process, and Taking steps toward change. These categories were summed up in the main category describing the participants’ experiences of FMC: A challenging and eye-opening course that gave deeper self-understanding and thoughts about making changes.</p></div><div><h3>Conclusions</h3><p>Overall, the participants described positive experiences of FMC, with increased awareness regarding fatigue and insight regarding the possibilities for change. Nevertheless, there were challenges in coping with the extensive information and with the home assignments. This study gives promising results regarding the applicability of FMC for adults with CP. However, there is a need for course modifications with more targeted and differentiated content that is manageable and does not overload the participants. The modifications should include extended time, the addition of individual support, and follow-up between sessions, to increase participants’ opportunities to implement new strategies and initiate behavioral change.</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/S2590109523000629/pdfft?md5=cd2d33c561dbc4b11a6a0ce0a5acfa9f&pid=1-s2.0-S2590109523000629-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135458951","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.2023.100298
David Godley MD, John Csongradi MD
The purpose of this report is to remind providers of the potential risks of Whole Body Vibration Therapy (WBVT) for children with disabilities. We reviewed the current state of knowledge and learned that WBVT may have potential risk of injury for some children. To the best of our knowledge this review is the first to clarify WBVT risks. We believe WBVT may have therapeutic value but we recommend caution and offer suggestions for future research.
{"title":"Whole Body Vibration Therapy for Children with Disabilities: A Survey of Potential Risks and Benefits","authors":"David Godley MD, John Csongradi MD","doi":"10.1016/j.arrct.2023.100298","DOIUrl":"10.1016/j.arrct.2023.100298","url":null,"abstract":"<div><p>The purpose of this report is to remind providers of the potential risks of Whole Body Vibration Therapy (WBVT) for children with disabilities. We reviewed the current state of knowledge and learned that WBVT may have potential risk of injury for some children. To the best of our knowledge this review is the first to clarify WBVT risks. We believe WBVT may have therapeutic value but we recommend caution and offer suggestions for future research.</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/S2590109523000605/pdfft?md5=58cb5ad36d54882eacaa13cf16d0597f&pid=1-s2.0-S2590109523000605-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588000","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.2023.100309
Mayank Seth PhD , John Robert Horne CPO , Ryan Todd Pohlig PhD , Jaclyn Megan Sions PhD
Objective
The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation.
Design
Cross-sectional study.
Setting
Research laboratory.
Participants
Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83).
Intervention
Not applicable.
Main Outcome Measures
Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained.
Results
After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively.
Conclusions
Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.
{"title":"Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation","authors":"Mayank Seth PhD , John Robert Horne CPO , Ryan Todd Pohlig PhD , Jaclyn Megan Sions PhD","doi":"10.1016/j.arrct.2023.100309","DOIUrl":"10.1016/j.arrct.2023.100309","url":null,"abstract":"<div><h3>Objective</h3><p>The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Setting</h3><p>Research laboratory.</p></div><div><h3>Participants</h3><p>Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83).</p></div><div><h3>Intervention</h3><p>Not applicable.</p></div><div><h3>Main Outcome Measures</h3><p>Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained.</p></div><div><h3>Results</h3><p>After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively.</p></div><div><h3>Conclusions</h3><p>Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.</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/S259010952300071X/pdfft?md5=c4c0c4562ebf9a0f989a6fdb693e1062&pid=1-s2.0-S259010952300071X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509543","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.2023.100299
Stephen A. Ashford PhD , Gary Morris MSc , Michael J. Smith PhD
Objective
To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity
Design
Delphi study
Setting
International, web-based survey
Participants
A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15).
Interventions
In round 1, open-ended questions were posed relating to potential scope of practice for ‘ultrasound imaging in spasticity management’; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated.
Outcome measures
5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above.
Results
Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated.
Conclusion
Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.
{"title":"Ultrasound image guided injection of botulinum toxin for the management of spasticity: A Delphi study to develop recommendations for a scope of practice, competency, and governance framework","authors":"Stephen A. Ashford PhD , Gary Morris MSc , Michael J. Smith PhD","doi":"10.1016/j.arrct.2023.100299","DOIUrl":"10.1016/j.arrct.2023.100299","url":null,"abstract":"<div><h3>Objective</h3><p>To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity</p></div><div><h3>Design</h3><p>Delphi study</p></div><div><h3>Setting</h3><p>International, web-based survey</p></div><div><h3>Participants</h3><p>A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) in the use of ultrasound image guided injection of botulinum toxin for management of spasticity. Panel members were predominantly based in the UK (11/15).</p></div><div><h3>Interventions</h3><p>In round 1, open-ended questions were posed relating to potential scope of practice for ‘ultrasound imaging in spasticity management’; (specifically relating to ultrasound image guided injection of Botulinum Toxin) education/competency and governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated.</p></div><div><h3>Outcome measures</h3><p>5-point Likert scale used for rating the statements. Threshold for consensus agreement was set at 70% or above.</p></div><div><h3>Results</h3><p>Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, 7 competency requirements were agreed relating to areas including image optimization and interpretation, needle visualization and safety. A singular, broad governance statement was generated.</p></div><div><h3>Conclusion</h3><p>Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance framework. These are integrated within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.</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/S2590109523000617/pdfft?md5=0db6c94f6f7dff09c360363cbd146470&pid=1-s2.0-S2590109523000617-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134994569","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.2023.100297
Elin Uzunel MD , Ann-Charlotte Grahn Kronhed RPT, PhD , Christina Kaijser Alin RPT, PhD , Aisha Siddiqah Ahmed PhD , Per Wändell MD, PhD , Helena Salminen MD, PhD
Objective
Primary purpose was to examine the effects of exercise and use of a spinal orthosis on quality of life (QoL). Secondary, to explore the effects of above-mentioned interventions on plasma levels of potential markers of pain: substance P (SP), calcitonin gene-related peptide (CGRP), and interleukin-6 (IL-6).
Design
Randomized controlled trial.
Setting
Community-dwelling women in Stockholm.
Participants
A total of 113 women aged 60-93 years suffering from back pain and self-reported osteoporosis (n=113).
Interventions
The randomized controlled trial was 3-armed: participation in an equipment exercise group, treatment with an activating spinal orthosis or controls. The intervention time was 6 months.
Main Outcome Measure(s)
QoL (QUALEFFO-41 and SF-36), plasma levels of SP, CGRP, and IL-6 measured at baseline and after 6 months in all 3 arms.
Results
No improvement of QoL was found. Comparing change in mobility (QUALEFFO-41), the effect in least squares means was lower in the spinal orthosis group compared with controls. In the exercise group, the role emotional score (SF-36) deteriorated during the intervention. Effect size varied between 0.02 and 0.6. There was no change in the levels of CGRP or SP, while IL-6 levels were lower at 6 months in the spinal orthosis group compared with the other groups. At least 1 previous vertebral fracture was verified by X-ray in 46 women.
Conclusion
The interventions showed none or negative effect on QoL, which was unexpected. The modest effect size may prompt a cautious interpretation. We found a lowering of IL-6 levels in the spinal orthosis group, but more studies are needed.
目的主要研究运动和使用脊柱矫形器对生活质量(QoL)的影响。其次,探讨上述干预措施对疼痛潜在标志物血浆水平的影响:P 物质(SP)、降钙素基因相关肽(CGRP)和白细胞介素-6(IL-6)。干预措施随机对照试验分为三组:参加器械锻炼组、使用激活脊柱矫形器治疗或对照组。干预时间为6个月。主要结果测量QoL(QUALEFFO-41和SF-36)、血浆中SP、CGRP和IL-6的水平,在基线时和6个月后在所有3组中进行测量。比较活动能力(QUALEFFO-41)的变化,脊柱矫形器组的最小二乘法效应低于对照组。在干预期间,锻炼组的角色情感评分(SF-36)有所下降。效应大小介于 0.02 和 0.6 之间。CGRP或SP的水平没有变化,而脊柱矫形器组的IL-6水平在6个月时低于其他组。46名女性中至少有1人通过X光检查证实曾发生过椎体骨折。干预措施对 QoL 没有影响或有负面影响,这出乎我们的意料。我们发现脊柱矫形器组的 IL-6 水平有所降低,但还需要更多的研究。
{"title":"The Effect of Group Training or Spinal Orthosis on Quality of Life and Potential Plasma Markers of Pain in Older Women With Osteoporosis. A Randomized Controlled Trial","authors":"Elin Uzunel MD , Ann-Charlotte Grahn Kronhed RPT, PhD , Christina Kaijser Alin RPT, PhD , Aisha Siddiqah Ahmed PhD , Per Wändell MD, PhD , Helena Salminen MD, PhD","doi":"10.1016/j.arrct.2023.100297","DOIUrl":"10.1016/j.arrct.2023.100297","url":null,"abstract":"<div><h3>Objective</h3><p>Primary purpose was to examine the effects of exercise and use of a spinal orthosis on quality of life (QoL). Secondary, to explore the effects of above-mentioned interventions on plasma levels of potential markers of pain: substance P (SP), calcitonin gene-related peptide (CGRP), and interleukin-6 (IL-6).</p></div><div><h3>Design</h3><p>Randomized controlled trial.</p></div><div><h3>Setting</h3><p>Community-dwelling women in Stockholm.</p></div><div><h3>Participants</h3><p>A total of 113 women aged 60-93 years suffering from back pain and self-reported osteoporosis (n=113).</p></div><div><h3>Interventions</h3><p>The randomized controlled trial was 3-armed: participation in an equipment exercise group, treatment with an activating spinal orthosis or controls. The intervention time was 6 months.</p></div><div><h3>Main Outcome Measure(s)</h3><p>QoL (QUALEFFO-41 and SF-36), plasma levels of SP, CGRP, and IL-6 measured at baseline and after 6 months in all 3 arms.</p></div><div><h3>Results</h3><p>No improvement of QoL was found. Comparing change in mobility (QUALEFFO-41), the effect in least squares means was lower in the spinal orthosis group compared with controls. In the exercise group, the role emotional score (SF-36) deteriorated during the intervention. Effect size varied between 0.02 and 0.6. There was no change in the levels of CGRP or SP, while IL-6 levels were lower at 6 months in the spinal orthosis group compared with the other groups. At least 1 previous vertebral fracture was verified by X-ray in 46 women.</p></div><div><h3>Conclusion</h3><p>The interventions showed none or negative effect on QoL, which was unexpected. The modest effect size may prompt a cautious interpretation. We found a lowering of IL-6 levels in the spinal orthosis group, but more studies are needed.</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/S2590109523000599/pdfft?md5=8b282daf529f4da8021983f302c4b7f4&pid=1-s2.0-S2590109523000599-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135248654","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 determine the ability of Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Inventory (Section GG)’s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation.
Design
Retrospective, observational cohort study.
Setting
150-bed inpatient rehabilitation facility within a metropolitan health system.
Participants
Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19.
Intervention
None.
Main Outcome Measures
Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons.
Results
Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (P<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility.
Conclusion
Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.
{"title":"Prediction of Discharge Destination After Inpatient Rehabilitation for Stroke Using Mobility and Self-Care Assessment in Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Instrument","authors":"Janet Herbold PT, PhD, MPH , Ebrahim Elmohsen PT, DPT , Gino Gutierrez PT, DPT , Michael Helgesen DPT , Suzanne Babyar PT, PhD","doi":"10.1016/j.arrct.2023.100292","DOIUrl":"10.1016/j.arrct.2023.100292","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the ability of Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Inventory (Section GG)’s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation.</p></div><div><h3>Design</h3><p>Retrospective, observational cohort study.</p></div><div><h3>Setting</h3><p>150-bed inpatient rehabilitation facility within a metropolitan health system.</p></div><div><h3>Participants</h3><p>Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19.</p></div><div><h3>Intervention</h3><p>None.</p></div><div><h3>Main Outcome Measures</h3><p>Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons.</p></div><div><h3>Results</h3><p>Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (<em>P</em><.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility.</p></div><div><h3>Conclusion</h3><p>Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.</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/S2590109523000484/pdfft?md5=4077b69b6840cad1b336e322f5f5f87d&pid=1-s2.0-S2590109523000484-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45545849","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 assess whether patients undergoing outpatient cardiac rehabilitation who have frailty and depressive symptoms at discharge are less likely than those without these condition to establish positive exercise habits.
Design
A retrospective cohort study that involved the assessment of frailty and depressive symptoms at the end of a 3-month course of cardiac rehabilitation. Frailty was defined as the patient noting 3 or more items using the criteria of Fried et al, while depressive symptoms were delineated by Patient Health Questionnaire-9 (PHQ-9) scores of 10 or greater.
Setting
General hospital (1048 beds) with outpatient cardiac rehabilitation in a suburb location in Japan.
Participants
344 individuals underwent outpatient cardiac rehabilitation during the January 1, 2019-June 1, 2022, study period. Of these, 48 individuals were excluded because they did not complete the course and 54 were excluded because they lacked outcome data. Finaly, 242 individuals (mean age: 68.2±11.1 years) were analyzed.
Interventions
Not applicable.
Main Outcome Variable
The establishment of an exercise habit defined as exercising at least 2 days per week and 30 minutes per day.
Results
Participants were divided into 4 groups depending upon the presence or absence of frailty and depressive symptoms: non-frail with no reported depressive symptoms (173 subjects), frailty-only (21 subjects), depressive symptoms-only (38 subjects), and frailty and depressive symptoms (10 subjects). Compared with patients who were not depressed and not frail, those with frailty only (odds ratio [OR]: 0.43, 95% confidence interval: 0.21-0.88, P=.02) and those with frailty and depressive symptoms (OR: 0.21, 95% confidence interval: 0.05-0.82, P=.025) had significantly lower ORs for establishing exercise habits. After multivariate adjustment, the OR of establishing an exercise habit was significantly lower in those with only frailty (OR: 0.35, 95% confidence interval: 0.14-0.85, P=.005).
Conclusions
This study, while limited by the small number of subjects with both frailty and depressive symptoms, indicates that interventions to prevent frailty during hospitalization and cardiac rehabilitation may be essential for cardiovascular disease patients with frailty whether or not associated with depressive symptoms.
{"title":"Association of Frailty and Depressive Symptoms With the Establishment of Exercise Habits in Patients Undergoing Outpatient Cardiac Rehabilitation","authors":"Tsubasa Yokote PT, MA , Takatoshi Nishimura PT , Shoichiro Furukawa MD , Shujiro Inoue MD, PhD","doi":"10.1016/j.arrct.2023.100290","DOIUrl":"10.1016/j.arrct.2023.100290","url":null,"abstract":"<div><h3>Objective</h3><p>To assess whether patients undergoing outpatient cardiac rehabilitation who have frailty and depressive symptoms at discharge are less likely than those without these condition to establish positive exercise habits.</p></div><div><h3>Design</h3><p>A retrospective cohort study that involved the assessment of frailty and depressive symptoms at the end of a 3-month course of cardiac rehabilitation. Frailty was defined as the patient noting 3 or more items using the criteria of Fried et al, while depressive symptoms were delineated by Patient Health Questionnaire-9 (PHQ-9) scores of 10 or greater.</p></div><div><h3>Setting</h3><p>General hospital (1048 beds) with outpatient cardiac rehabilitation in a suburb location in Japan.</p></div><div><h3>Participants</h3><p>344 individuals underwent outpatient cardiac rehabilitation during the January 1, 2019-June 1, 2022, study period. Of these, 48 individuals were excluded because they did not complete the course and 54 were excluded because they lacked outcome data. Finaly, 242 individuals (mean age: 68.2±11.1 years) were analyzed.</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Main Outcome Variable</h3><p>The establishment of an exercise habit defined as exercising at least 2 days per week and 30 minutes per day.</p></div><div><h3>Results</h3><p>Participants were divided into 4 groups depending upon the presence or absence of frailty and depressive symptoms: non-frail with no reported depressive symptoms (173 subjects), frailty-only (21 subjects), depressive symptoms-only (38 subjects), and frailty and depressive symptoms (10 subjects). Compared with patients who were not depressed and not frail, those with frailty only (odds ratio [OR]: 0.43, 95% confidence interval: 0.21-0.88, <em>P</em>=.02) and those with frailty and depressive symptoms (OR: 0.21, 95% confidence interval: 0.05-0.82, <em>P</em>=.025) had significantly lower ORs for establishing exercise habits. After multivariate adjustment, the OR of establishing an exercise habit was significantly lower in those with only frailty (OR: 0.35, 95% confidence interval: 0.14-0.85, <em>P</em>=.005).</p></div><div><h3>Conclusions</h3><p>This study, while limited by the small number of subjects with both frailty and depressive symptoms, indicates that interventions to prevent frailty during hospitalization and cardiac rehabilitation may be essential for cardiovascular disease patients with frailty whether or not associated with depressive symptoms.</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/S2590109523000460/pdfft?md5=8a3cfde3d832d580051c25bfcb90aceb&pid=1-s2.0-S2590109523000460-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48029494","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.2023.100306
Vivek Yedavalli MD, MS , Manisha Koneru MS , Meisam Hoseinyazdi MD , Karen Copeland PhD , Risheng Xu MD, PhD , Licia Luna MD, PhD , Justin Caplan MD , Adam Dmytriw MD, MPH, MSc , Adrien Guenego MD, PhD , Jeremy Heit MD, PhD , Gregory Albers MD , Max Wintermark MD, MS, MBA , Fernando Gonzalez MD , Victor Urrutia MD , Judy Huang MD , Richard Leigh MD , Elisabeth Marsh MD , Rafael Llinas MD , Marlis Gonzalez Hernandez MD, PhD , Argye Hillis MD
Objective
To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning.
Design
In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant.
Setting
Hospitalized care.
Participants
In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores.
Interventions
None.
Main Outcome Measures
Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17.
Results
Patients with favorable AM-PAC were younger (61.3 vs 70.7, P<.001), had lower admission glucose (mean, 124 vs 136, P=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, P<.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, P<.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (P<.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86).
Conclusion
Excellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.
{"title":"Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion","authors":"Vivek Yedavalli MD, MS , Manisha Koneru MS , Meisam Hoseinyazdi MD , Karen Copeland PhD , Risheng Xu MD, PhD , Licia Luna MD, PhD , Justin Caplan MD , Adam Dmytriw MD, MPH, MSc , Adrien Guenego MD, PhD , Jeremy Heit MD, PhD , Gregory Albers MD , Max Wintermark MD, MS, MBA , Fernando Gonzalez MD , Victor Urrutia MD , Judy Huang MD , Richard Leigh MD , Elisabeth Marsh MD , Rafael Llinas MD , Marlis Gonzalez Hernandez MD, PhD , Argye Hillis MD","doi":"10.1016/j.arrct.2023.100306","DOIUrl":"10.1016/j.arrct.2023.100306","url":null,"abstract":"<div><h3>Objective</h3><p>To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning.</p></div><div><h3>Design</h3><p>In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A <em>P</em> value of ≤.05 was significant.</p></div><div><h3>Setting</h3><p>Hospitalized care.</p></div><div><h3>Participants</h3><p>In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main Outcome Measures</h3><p>Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17.</p></div><div><h3>Results</h3><p>Patients with favorable AM-PAC were younger (61.3 vs 70.7, <em>P</em><.001), had lower admission glucose (mean, 124 vs 136, <em>P</em>=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, <em>P</em><.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, <em>P</em><.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (<em>P</em><.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86).</p></div><div><h3>Conclusion</h3><p>Excellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.</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/S259010952300068X/pdfft?md5=bfbc60035a9b43e1bce9b4aa45304dd7&pid=1-s2.0-S259010952300068X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093596","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.2023.100294
Jonas Stenberg PhD , Stina Hedström MSc , Gabriela Markovic PhD , Kristian Borg PhD , Monika Löfgren PhD , Marika C. Möller PhD
Objective
To investigate cognitive functioning in patients with higher education having post COVID-19 condition.
Design
Prospective cohort study.
Setting
Outpatient rehabilitation clinic.
Participants
Patients (N=38; mean age, 48.5y; 71% women) at the Cognitive Post COVID-19 Clinic at Danderyd University Hospital in Stockholm, Sweden, who sought health care because of self-experienced cognitive problems. All had at least 4 years of university education and an initially mild infection (ie, most were not hospital admitted, none were admitted to intensive care).
Interventions
Not applicable.
Main Outcome Measures
Cognitive test performance assessed with a comprehensive neuropsychological test battery including Information, Matrix Reasoning, Coding, and Digit Span from Wechsler's Adult Intelligence Scale-IV, Buschke Selective Reminding Test, Rey Complex Figure Test, Ruff 2&7, Color-Word Interference Test, Verbal Fluency, and Trail Making Test. The mean time between the infection and the assessment was 18 months.
Results
Cognitive deficits were evident on tests of verbal learning and memory (Buschke Selective Reminding Test) and selective attention (Ruff 2&7). Approximately 50% of the participants had scores lower than 1 SD below the mean in the norm group on the measures of verbal learning and memory. When estimated premorbid cognitive functioning was accounted for, deficits were suggested in most cognitive domains.
Conclusions
Post COVID-19 condition seems to be associated with cognitive deficits, even in patients with high education and an initially mild infection.
{"title":"Preliminary Findings on Cognitive Dysfunction in University-Educated Patients After Mild COVID-19 Disease","authors":"Jonas Stenberg PhD , Stina Hedström MSc , Gabriela Markovic PhD , Kristian Borg PhD , Monika Löfgren PhD , Marika C. Möller PhD","doi":"10.1016/j.arrct.2023.100294","DOIUrl":"10.1016/j.arrct.2023.100294","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate cognitive functioning in patients with higher education having post COVID-19 condition.</p></div><div><h3>Design</h3><p>Prospective cohort study.</p></div><div><h3>Setting</h3><p>Outpatient rehabilitation clinic.</p></div><div><h3>Participants</h3><p>Patients (N=38; mean age, 48.5y; 71% women) at the Cognitive Post COVID-19 Clinic at Danderyd University Hospital in Stockholm, Sweden, who sought health care because of self-experienced cognitive problems. All had at least 4 years of university education and an initially mild infection (ie, most were not hospital admitted, none were admitted to intensive care).</p></div><div><h3>Interventions</h3><p>Not applicable.</p></div><div><h3>Main Outcome Measures</h3><p>Cognitive test performance assessed with a comprehensive neuropsychological test battery including Information, Matrix Reasoning, Coding, and Digit Span from Wechsler's Adult Intelligence Scale-IV, Buschke Selective Reminding Test, Rey Complex Figure Test, Ruff 2&7, Color-Word Interference Test, Verbal Fluency, and Trail Making Test. The mean time between the infection and the assessment was 18 months.</p></div><div><h3>Results</h3><p>Cognitive deficits were evident on tests of verbal learning and memory (Buschke Selective Reminding Test) and selective attention (Ruff 2&7). Approximately 50% of the participants had scores lower than 1 SD below the mean in the norm group on the measures of verbal learning and memory. When estimated premorbid cognitive functioning was accounted for, deficits were suggested in most cognitive domains.</p></div><div><h3>Conclusions</h3><p>Post COVID-19 condition seems to be associated with cognitive deficits, even in patients with high education and an initially mild infection.</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/S2590109523000563/pdfft?md5=6252b8edd1c17c5ed96d891a8ef4f60d&pid=1-s2.0-S2590109523000563-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134994571","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.2023.100289
Bettina Sommer MSc , Michelle Haas MSc , Samuel Karrer MSc , Matthias Jörger MSc , Eveline Graf PhD , Martin Huber MSc , Daniel Baumgartner PhD , Jens Bansi PhD , Jan Kool PhD , Christoph Bauer PhD
Objective
This pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls.
Design
Observational pilot study.
Setting
This study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants.
Participants
A total of eleven people after stroke and fifteen healthy people (N=26) took part.
Interventions
Lateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat.
Main Outcome Measure
Muscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group.
Results
A seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat.
Conclusions
Mobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.
{"title":"The Effect on Muscle Activity of Reaching Beyond Arm's Length on a Mobile Seat: A Pilot Study for Trunk Control Training for People After Stroke","authors":"Bettina Sommer MSc , Michelle Haas MSc , Samuel Karrer MSc , Matthias Jörger MSc , Eveline Graf PhD , Martin Huber MSc , Daniel Baumgartner PhD , Jens Bansi PhD , Jan Kool PhD , Christoph Bauer PhD","doi":"10.1016/j.arrct.2023.100289","DOIUrl":"10.1016/j.arrct.2023.100289","url":null,"abstract":"<div><h3>Objective</h3><p>This pilot study compared muscle activity during lateral reaching tasks between mobile and stable sitting using a novel therapy chair in people after stroke and healthy controls.</p></div><div><h3>Design</h3><p>Observational pilot study.</p></div><div><h3>Setting</h3><p>This study was conducted in a rehabilitation center for people after stroke and at the university's movement laboratory for healthy participants.</p></div><div><h3>Participants</h3><p>A total of eleven people after stroke and fifteen healthy people (N=26) took part.</p></div><div><h3>Interventions</h3><p>Lateral reaching exercises to the ipsilateral and contralateral sides were performed on a mobile and a stable seat.</p></div><div><h3>Main Outcome Measure</h3><p>Muscular activity of the multifidus, erector spinae and external oblique was measured bilaterally. A within-subject linear mixed model was applied to analyze the effects of seat condition, task, muscle side, and group.</p></div><div><h3>Results</h3><p>A seat condition effect was found for the multifidus and external oblique that was dependent on the muscle side and task. During ipsilateral reaching, the activity of the multifidi decreased for people after stroke on the mobile seat, while increasing for healthy participants. The erector spinae showed no condition effect. Decreased activity of the external oblique was found for both groups on the mobile seat.</p></div><div><h3>Conclusions</h3><p>Mobile sitting influences muscular activity. However, these preliminary results should be further investigated in order to generate recommendations for rehabilitation.</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/S2590109523000459/pdfft?md5=c4f0ed79994eb206c9fb5926eec8a98c&pid=1-s2.0-S2590109523000459-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49352929","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}