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Santilli V, Mangone M, Diko A, Alviti F, Bernetti A, Agostini F, Palagi L, Servidio M, Paoloni M, Goffredo M, Infarinato F, Pournajaf S, Franceschini M, Fini M, Damiani C. The Use of Machine Learning for Inferencing the Effectiveness of a Rehabilitation Program for Orthopedic and Neurological Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085575. [PMID: 37107856 PMCID: PMC10139165 DOI: 10.3390/ijerph20085575] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023]
Abstract
Advance assessment of the potential functional improvement of patients undergoing a rehabilitation program is crucial in developing precision medicine tools and patient-oriented rehabilitation programs, as well as in better allocating resources in hospitals. In this work, we propose a novel approach to this problem using machine learning algorithms focused on assessing the modified Barthel index (mBI) as an indicator of functional ability. We build four tree-based ensemble machine learning models and train them on a private training cohort of orthopedic (OP) and neurological (NP) hospital discharges. Moreover, we evaluate the models using a validation set for each category of patients using root mean squared error (RMSE) as an absolute error indicator between the predicted mBI and the actual values. The best results obtained from the study are an RMSE of 6.58 for OP patients and 8.66 for NP patients, which shows the potential of artificial intelligence in predicting the functional improvement of patients undergoing rehabilitation.
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Affiliation(s)
- Valter Santilli
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Anxhelo Diko
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Federica Alviti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
- Correspondence:
| | - Laura Palagi
- Department of Computer, Control and Management Engineering Antonio Ruberti, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marila Servidio
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marco Paoloni
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
| | - Francesco Infarinato
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
| | - Sanaz Pournajaf
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy
| | - Massimo Fini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
| | - Carlo Damiani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Via della Pisana 235, 00163 Rome, Italy
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Huerta-Mareca R, De-Rosende-Celeiro I, Ares-Senra L, Gálvez-Bermejo C, Pérez-Hernández E. Evaluation of improvement of functional independence in a multicentre cohort of rehabilitation outpatients with neurological conditions. Disabil Rehabil 2022; 44:8332-8338. [PMID: 34889157 DOI: 10.1080/09638288.2021.2012840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The objectives were to examine: (1) the changes in independence in basic activities of daily living (ADL) following an outpatient occupational therapy (OT) intervention in people with neurological conditions; (2) the factors associated with good relative functional gain (RFG) and with good OT efficiency; (3) and the effects on instrumental activities of daily living (IADL) and caregiver assistance. MATERIALS AND METHODS A prospective observational study examining changes in a multicentre cohort (three urban hospitals). Ninety-eight adults were assessed on admission and after intervention. Barthel Index was the primary outcome (ADL). RESULTS Acquired brain damage (ABI) was the most frequent diagnosis (84.7%). There was an improvement in ADL (p < 0.001); the effect size (r) was large (r = 0.59). RFG was good for 88.8% of participants. A good RFG was significantly associated with ABI, a lower number of hours of caregiver assistance, and a greater intensity of OT. The OT efficiency was good for 43.9% of participants. Factors significantly associated with good efficiency were being young and male patients, and receiving fewer hours of caregiver assistance. Secondary measures were improved: IADL (p < 0.001) and hours of caregiver assistance (p < 0.001). CONCLUSIONS This study suggests that the intervention is an effective approach to improve functional independence.Implications for rehabilitationLittle is known about the outcomes of outpatient occupational therapy intervention in neurorehabilitation services for the adult population with neurological diseases.In a multicentre cohort of neurorehabilitation outpatients, the occupational therapy intervention can lead to improvements in the level of independence in basic and instrumental daily activities, as well as reducing the hours of caregiver assistance.A good relative functional gain is associated with acquired brain injury, a lower number of hours of assistance, and a greater intensity of occupational therapy.The factors associated with good efficiency are being younger, male patients, and receiving fewer hours of assistance.
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Affiliation(s)
| | | | - Lucía Ares-Senra
- Rehabilitation Service, Lucus Augusti University Hospital, Lugo, Spain
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Htun HL, Wong LH, Lian W, Koh J, Lee LT, Lim JP, Leong I, Lim WY. Functional improvement after inpatient rehabilitation in community hospitals following acute hospital care. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:357-369. [PMID: 35786756 DOI: 10.47102/annals-acadmedsg.2021507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There are limited studies exploring functional improvement in relation to characteristics of patients who, following acute hospital care, receive inpatient rehabilitation in community hospitals. We evaluated the association of acute hospital admission-related factors with functional improvement on community hospital discharge. METHODS We conducted a retrospective cohort study among patients who were transferred to community hospitals within 14-day post-discharge from acute hospital between 2016 and 2018. Modified Barthel Index (MBI) on a 100-point ordinal scale was used to assess functional status on admission to and discharge from the community hospital. We categorised MBI into 6 bands: 0-24, 25-49, 50-74, 75-90, 91-99 and 100. Multivariable logistic regression models were constructed to determine factors associated with categorical improvement in functional status, defined as an increase in at least one MBI band between admission and discharge. RESULTS A total of 5,641 patients (median age 77 years, interquartile range 69-84; 44.2% men) were included for analysis. After adjusting for potential confounders, factors associated with functional improvement were younger age, a higher MBI on admission, and musculoskeletal diagnosis for the acute hospital admission episode. In contrast, a history of dementia or stroke; lower estimated glomerular filtration rate; abnormal serum albumin or anaemia measured during the acute hospital episode; and diagnoses of stroke, cardiac disease, malignancy, falls or pneumonia; and other chronic respiratory diseases were associated with lower odds of functional improvement. CONCLUSION Clinicians may want to take into account the presence of these high-risk factors in their patients when planning rehabilitation programmes, in order to maximise the likelihood of functional improvement.
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Affiliation(s)
- Htet Lin Htun
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
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Syros A, Kotlia P, Fotakopoulos G. Preliminary findings from an Acupuncture and experiential/traditional music therapy during the standard care of rehabilitation exercise program for Recovery on post-stroke upper limb dysfunction. Int J Neurosci 2021; 132:1110-1117. [PMID: 34143714 DOI: 10.1080/00207454.2020.1860972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Upper limb dysfunction is common damage after stroke posing an important challenge for post-stroke rehabilitation but little is known about the effects of combined therapy with acupuncture and experiential/traditional music during the standard care of rehabilitation exercise program. The aim of this study, therefore, was to systematically assess the effects of exercise rehabilitation program accompanied by experiential music or/+ acupuncture for clinical recovery on post-stroke upper limb dysfunction. This was a randomized controlled study with a total of 116 eligible subjects randomly divided into three groups, namely (1) MG group-(daily listening to experiential/traditional music), (2) AP/MG group (combined treatment with daily listening to experiential/traditional music and AP), and (3) CG group (with no experiential/traditional music therapy or AP (standard care only)), in a 1.3:1:1 ratio. The primary outcomes in this study were the changes between baseline score during the admission and after 6 months Fugl-Meyer Assessment for Upper Extremity (FMA/UE) and the recovery. The secondary outcomes are the mean change in the scores between baseline value during the admission and after 6 months on the Visual Analogue Scale, mini-mental test, Barthel index and Computer tomography Perfusion (CTP) findings- cerebral blood flow (CBF). The results of this study clarify the synergistic effects of AP and daily listening to experiential/traditional music during the standard care rehabilitation program on upper limb dysfunction after stroke.
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Affiliation(s)
- Apostolis Syros
- Department of Physiatria Scientific Director of Rehabilitation Center, Arwgi Thessalias S.A., Agnadero, Karditsa, Greece
| | - Polikceni Kotlia
- Department of Anesthesiology, General Hospital of Karditsa, Karditsa, Greece
| | - George Fotakopoulos
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, Larissa, Greece
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Chong WFW, Ng LH, Ho RMH, Koh GCH, Hoenig H, Matchar DB, Yap P, Venketasubramanian N, Tan KB, Ning C, Menon E, Chang HM, De Silva DA, Lee KE, Tan BY, Young SHY, Ng YS, Tu TM, Ang YH, Yeo TT, Merchant RA, Kong KH, Singh R, Ng YL, Cheong A. Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis. J Am Med Dir Assoc 2021; 22:2350-2357.e2. [PMID: 33812841 DOI: 10.1016/j.jamda.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates. DESIGN Latent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome. SETTING AND PARTICIPANTS A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study. METHODS Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates. RESULTS Two distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke. CONCLUSIONS AND IMPLICATIONS Whether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation.
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Affiliation(s)
- Wayne F W Chong
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore; GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore.
| | - Leong Hwee Ng
- GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore
| | - Ringo M-H Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Gerald C H Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; Office of Healthcare Transformation, Ministry of Health, Singapore, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Science, Durham Veterans Administration Medical Center, Durham, NC, USA; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David B Matchar
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Singapore; Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | | | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; InfoComm, Technology and Data Group, Ministry of Health, Singapore, Singapore, Singapore
| | - Chou Ning
- CHOU Neuroscience Clinic, Farrer Park Hospital, Singapore, Singapore, Singapore; Chou Neurosurgery Pte Ltd, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore, Singapore
| | | | - Sherry H Y Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University of Singapore, Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Department of Medicine (Division of Geriatric Medicine), National University Hospital, Singapore, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yu Li Ng
- Manpower Planning and Strategy, Ministry of Health, Singapore, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore
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Vadas D, Kalichman L. The impact of availability and identity of the caregiver on the post-stroke patient. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background After having a stroke, most patients are helped by a caregiver with activities that they cannot perform by themselves. The caregiver presence and actions are an important variable that may affect rehabilitation in many ways. The aim of this review study was to evaluate the impact of caregiver presence (or absence) and identity (spouse, family, or foreign domestic worker) on therapeutic exercise performance, depression symptoms, patient–spouse relations and total functional outcomes of stroke patients. Assessing these effects may help health care professionals and families to prioritise/choose the caregiver for their patient/family member. Methods A narrative literature review was conducted, focusing on one-direction effects (caregiver on patient effects) on the topics of interest mentioned, in a post-stroke population. PubMed, CINAHL, PEDro, Trip database, and Google Scholar were searched, and included studies of most designs and research qualities. The search strategy had not been specified before commencing the review. Each study was analysed individually with the purpose of synthesising the available evidence to achieve a greater understanding of this topic. Results A total of 17 relevant papers were included: six randomised controlled trials, six observational studies, two systematic reviews, two survey-based studies, and one case series. Trials were consistent with the positive effect that caregivers have on therapeutic exercise performance. Studies have shown a positive effect of caregivers on the patient's depressive symptoms, but only at the chronic phase after stroke. A spouse caregiver seems to more positively affect the patient–spouse relations in the acute phase of rehabilitation, while foreign domestic workers can improve these relations at more chronic phases. The presence of a caregiver is shown to decrease functional outcomes within institutionalised rehabilitation centres, while it is necessary and positively affects functionality at more chronic phases within community settings. Conclusions The advantages and disadvantages of employing a caregiver depend in many cases on the rehabilitation phase. The caregiver might be beneficial or harmful to the patient's functional progress, depressive symptoms and marital relationship depending on the rehabilitation phase. More studies are needed to assess the caregiver effects on post-stroke patients' rehabilitation and quality of life.
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Affiliation(s)
- Dor Vadas
- The Israel Rehabilitation Center for Stroke and Brain Injury, Rehovot, Israel; Oxford University, Oxford, UK
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Tyagi S, Koh GCH, Luo N, Tan KB, Hoenig H, Matchar DB, Yoong J, Chan A, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Tan CS. Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study. BMJ Open 2020; 10:e036631. [PMID: 32332008 PMCID: PMC7204848 DOI: 10.1136/bmjopen-2019-036631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting. DESIGN Prospective cohort study. SETTING Community setting. PARTICIPANTS We recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke. OUTCOME MEASURES SCR participation over the first 3 months and subsequent 3 to 12 months post-stroke RESULTS: 251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor's disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver's positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068). CONCLUSION We established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research and Evaluation Division, Ministry of Health, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina, USA
| | - David Bruce Matchar
- Internal Medicine, Duke University, Durham, North Carolina, USA
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Graduate Medical School, Singapore
| | | | | | | | - Kin Ming Chan
- Geriatric Medicine, Mount Alvernia Hospital, Singapore
| | | | - Philip Yap
- Geriatric Centre, Khoo Teck Puat Hospital, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital Campus, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Fotakopoulos G, Kotlia P. The Value of Exercise Rehabilitation Program Accompanied by Experiential Music for Recovery of Cognitive and Motor Skills in Stroke Patients. J Stroke Cerebrovasc Dis 2018; 27:2932-2939. [PMID: 30072173 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/17/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically assess the effects of exercise rehabilitation program accompanied by experiential music for clinical recovery. METHODS This was a prospective randomized study with 65 stroke survivor patients. All cases underwent a neuropsychological assessment first as a prescreening test, during the admission at the Rehabilitation center (baseline), and 6 months poststroke. All patients received standard treatment for stroke in terms of medical care and rehabilitation. Additionally, all patients were separated into 2 Groups: a music Group (daily listening to experiential/traditional music), and a control Group (CG) with no experiential/traditional music therapy (standard care only). Computed tomography perfusion and full neurological examination including GCS were assessment. As Recovery was defined the improvement of cognitive and motor skills of the limb in the affected site, with an increase of muscle strength at least by 1/5 and with emotional progress. RESULTS Statistically significant differences were found between the Group CG and the rest of the patients in respect of Lesion size (P = .001) and CBF in affected area (P = .001). Μultivariate analysis revealed that only Group and Lesion size were independent predictors for Recovery (odd ratio [OR][95%confidence interval]) .11(.001-.133) and .798(.668-.954) respectively. CONCLUSION The findings of this study suggest that the music-based exercise program has a positive effect on mood profile in stroke patients and Recovery rate is higher when exercise rehabilitation program was accompanied by an enriched sound environment with experiential music.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, University Hospital of Patras, Patra, Greece; Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Biopolis, 41110 Larissa, Thessaly, Greece
| | - Polikceni Kotlia
- Department of Head of Critical Care, University of Thessaly, University Hospital of Larissa, Biopolis, 41110, Larissa, Thessaly, Greece
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Kawada S, Goto R. Relationship between psychophysiological factors and prognosis for activities of daily living in patients with stroke in a recovery rehabilitation unit: a preliminary study. J Phys Ther Sci 2018; 29:2206-2209. [PMID: 29643606 PMCID: PMC5890232 DOI: 10.1589/jpts.29.2206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of the present study was to examine the factors, including physical and mental functions, that are associated with the prognosis for activities of daily living in patients with stroke in a recovery rehabilitation unit. [Subjects and Methods] The subjects were 13 patients with stroke who were admitted to the recovery rehabilitation unit of Tokai Memorial Hospital between March and October 2014 and followed up for 2 months. Their physical and mental functions were evaluated at the time of admission and the relationship between these functions and activities of daily living was assessed 2 months later. [Results] The activities of daily living at 2 months after admission showed a significant correlation not only with the severity of motor paralysis (R=-0.80) but mental function (R=-0.69) at the time of admission. No significant correlation was noted between the severity of motor paralysis and the mental function. [Conclusion] It is important to evaluate both mental function and severity of motor paralysis immediately after patients' admission to the recovery rehabilitation unit. Mental health intervention should be considered in the future to effectively improve subsequent activities of daily living.
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Affiliation(s)
- Shogo Kawada
- Department of Rehabilitation, Orange Home Care Clinic: 1-2-20 Tawara, Fukui, Fukui 910-0018, Japan
| | - Ryohei Goto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
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Ong PH, Tai BC, Wong WP, Wee LE, Chen C, Cheong A, Fong NP, Chan KM, Tan BY, Menon E, Lee KK, Ee CH, Petrella R, Thind A, Koh GCH. Caregivers: Do They Make a Difference to Patient Recovery in Subacute Stroke? Arch Phys Med Rehabil 2017; 98:2009-2020. [PMID: 28363700 DOI: 10.1016/j.apmr.2017.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke. DESIGN Retrospective cohort study. SETTING Four community rehabilitation hospitals. PARTICIPANTS Patients with subacute, first-time stroke (N=4042; 48.5% men; mean age ± SD, 70.12±10.4y; 51.5% women; mean age ± SD, 72.54 ±10.0y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Rehabilitation effectiveness, defined as the percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency, defined as the rate of functional improvement during rehabilitation. RESULTS In our cohort, 96.7% had available caregiver(s), of which 42.0% were primarily supported by foreign domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8% by other relatives, and 5.1% by other caregivers. Using quantile regression, we found that having a caregiver was independently associated with rehabilitation efficiency (β=-3.83; 95% confidence interval [CI], -6.99 to -0.66; P=.018). The relationship between caregiver availability and rehabilitation effectiveness was modified by patient sex in that the negative association was significantly greater in men (β=-22.81; 95% CI, -32.70 to -12.94; P<.001) than women (β=-5.64; 95% CI, -14.72 to 3.44; P=.223). Having a FDW as a caregiver compared with a spousal caregiver was negatively associated with rehabilitation effectiveness (β=-3.95; 95% CI, -6.94 to -0.95; P=.01) and rehabilitation efficiency (β=-1.83; 95% CI, -3.14 to -0.53; P=.006). The number of potential caregivers was only significantly associated with rehabilitation effectiveness at the bivariate level (P=.006). CONCLUSIONS Caregiver identity, and possibly availability, appears to negatively affect rehabilitation outcomes in subacute stroke. A better understanding of these relationships has potential implications on clinical practice and policy directions.
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Affiliation(s)
- Peck-Hoon Ong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | - Liang En Wee
- Singhealth Internal Medicine Residency, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | | | - Kok Keng Lee
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Robert Petrella
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Amardeep Thind
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
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Goto R, Watanabe H, Tsutsumi M, Kanamori T, Maeno T, Yanagi H. Factors associated with the recovery of activities of daily living after hospitalization for acute medical illness: a prospective cohort study. J Phys Ther Sci 2016; 28:2763-2768. [PMID: 27821931 PMCID: PMC5088122 DOI: 10.1589/jpts.28.2763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022] Open
Abstract
[Purpose] This study investigated the factors associated with the recovery rate of
activities of daily living of elderly patients hospitalized for acute medical illness.
[Subjects and Methods] A total of 238 elderly patients were enrolled in this study. The
main outcome measure was the functional independence measure score which was used as an
assessment of activities of daily living. The participants were divided into 2 groups
based on their activities of daily living before onset: the independent group and the
partially dependent group. The participants of each group were further divided into 2
subgroups based on recovery rates of activities of daily living: the high-recovery group
(80%) and the low-recovery group (<80%). The factors associated with the recovery rate
were examined using multivariate logistic regression analysis. [Results] The factors
associated with the recovery rate were: days of inactivity and cognitive status at the
start of rehabilitation for the independent group, and days of inactivity and nutritional
status at the start of rehabilitation for the partially dependent group. [Conclusion] The
results of this study suggest that the important factors for return to normal activities
of daily living are: days of inactivity and cognitive status for the independent group;
and days of inactivity and management of nutrition for the partially dependent group.
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Affiliation(s)
- Ryohei Goto
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Hiroki Watanabe
- Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | | | | | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Hisako Yanagi
- Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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Caregiver Factors in Stroke: Are They the Missing Piece of the Puzzle? Arch Phys Med Rehabil 2016; 97:1223-5. [DOI: 10.1016/j.apmr.2016.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
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Tse T, Carey L, Cadilhac D, Koh GCH, Baum C. Application of the World Stroke Organization health system indicators and performance in Australia, Singapore, and the USA. Int J Stroke 2016; 11:852-859. [DOI: 10.1177/1747493016660104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim To examine how Australia, Singapore and the United States of America (USA) match to the World Stroke Organization Global Stroke Services health system monitoring indicators (HSI). Design Descriptive comparative study Participants The health systems of Australia, Singapore, the USA. Outcome measures Published data available from each country were mapped to the 10 health system monitoring indicators proposed by the World Stroke Organization. Results Most health system monitoring indicators were at least partially met in each country. Thrombolytic agents were available for use in acute stroke. Stroke guidelines and stroke registry data were available in all three countries. Stroke incidence, prevalence, and mortality rates were available but at non-uniform times post-stroke. The International Classification of Disease 9 or 10 coding systems are used in all three countries. Standardized clinical audits are routine in Australia and the USA, but not in Singapore. The use of the modified Rankin Scale is collected sub-acutely but not at one year post-stroke in all three countries. Conclusions The three developed countries are performing well against the World Stroke Organization health system monitoring indicators for acute and sub-acute stroke care. However, improvements in stroke risk assessment and at one-year post-stroke outcome measurement are needed.
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Affiliation(s)
- Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health Heidelberg, Victoria, Australia
| | - Leeanne Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health Heidelberg, Victoria, Australia
| | - Dominique Cadilhac
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Victoria, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System
| | - Carolyn Baum
- Washington University in St Louis, St Louis, MO, USA
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Venkataraman K, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh GCH. Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes. Arch Phys Med Rehabil 2016; 97:1473-1480. [PMID: 27178094 DOI: 10.1016/j.apmr.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. DESIGN Retrospective medical records review. SETTING All community hospitals. PARTICIPANTS Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. RESULTS Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. CONCLUSIONS Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.
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Affiliation(s)
- Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kin Ming Chan
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore
| | | | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore
| | - Chye Hua Ee
- Elder Care and Health Consultancy, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Kuptniratsaikul V, Wattanapan P, Wathanadilokul U, Sukonthamarn K, Lukkanapichonchut P, Ingkasuthi K, Massakulpan P, Klaphajone J, Suethanapornkul S, Tunwattanapong P, Laksanakorn W, Thamronglaohaphan P, Leelasamran W, Wangno W. The Effectiveness and Efficiency of Inpatient Rehabilitation Services in Thailand: A Prospective Multicenter Study. Rehabil Process Outcome 2016. [DOI: 10.4137/rpo.s34816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the effectiveness and efficiency of inpatient rehabilitation. Methods A total of 2,081 patients across 14 hospitals were recruited in this prospective, multicenter cohort study. Data on the diagnoses, types of admission, length of stay (LOS), and functional ability score based on a modified Barthel index (BI) at admission (BIa) and at discharge (BId) were collected. Effectiveness was defined as the difference of BI (ΔBI) and efficiency as ΔBI divided by LOS. Results The majority of patients were diagnosed with spinal cord injury and stroke (41.8% and 37.5%, respectively). The mean age was 52.4 ± 18.6 years with a mean LOS of 23.9 ± 19.9 days, BIa of 9.4 ± 6.1, and BId of 12.3 ± 5.7. The overall effectiveness and efficiency were 2.9 ± 3.4 and 0.16 ± 0.30 scores/day, respectively; stroke rehabilitation provided the most effective and efficient BI improvement compared with rehabilitation for other diseases. Most patients (54.5%) received intensive functional rehabilitation, which was the most effective and efficient program (4.4 ± 3.6 and 0.23 ± 0.32 scores/day, respectively); the efficiency of the intensive program was not different among various diseases (P = 0.726). Conclusion Stroke rehabilitation had the highest efficiency compared with rehabilitation for other neurological diseases. The most efficient type of admission was intensive rehabilitation, regardless of the disease being treated.
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Affiliation(s)
- Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattra Wattanapan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ubonwon Wathanadilokul
- Department of Medical Services, Ministry of Public Health, Sirindhorn National Medical Rehabilitation Centre (SNMRC), Nonthaburi, Thailand
| | - Kwanyupa Sukonthamarn
- Thai Red Cross Rehabilitation Center, The Thai Red Cross Society, Sumut Prakan, Thailand
| | - Pranee Lukkanapichonchut
- Department of Rehabilitation Medicine, Ratchaburi Hospital, Ministry of Public Health, Ratchaburi, Thailand
| | - Kanlaya Ingkasuthi
- Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, Ministry of Public Health, Nakhon Ratchasima, Thailand
| | - Pornpimon Massakulpan
- Department of Rehabilitation Medicine, Prasat Neurological Institute, Ministry of Public Health, Bangkok, Thailand
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sumalee Suethanapornkul
- Department of Rehabilitation Medicine Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Punjama Tunwattanapong
- Department of Rehabilitation Medicine, Sunpasitthiprasong Hospital, Ministry of Public Health, Ubonratchatanee, Thailand
| | | | - Pitagorn Thamronglaohaphan
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wipawan Leelasamran
- Department of Orthopedics and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Chow P, Chen C, Cheong A, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh D, Koh GC. Factors and Trade-Offs With Rehabilitation Effectiveness and Efficiency in Newly Disabled Older Persons. Arch Phys Med Rehabil 2014; 95:1510-20.e4. [DOI: 10.1016/j.apmr.2014.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
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[Subacute care of stroke-affected patients. Satisfaction and results]. ACTA ACUST UNITED AC 2014; 29:150-7. [PMID: 24745872 DOI: 10.1016/j.cali.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/28/2013] [Accepted: 01/07/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.
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Tan AKH, Taiju R, Menon EB, Koh GCH. Postoperated Hip Fracture Rehabilitation Effectiveness and Efficiency in a Community Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2014. [DOI: 10.47102/annals-acadmedsg.v43n4p209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: This study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later. Materials and Methods: A retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy. Results: The mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later. Conclusion: CH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.
Key words: Modified Barthel Index, Length of stay, Length of weight bearing
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Lynch E, Hillier S, Cadilhac D. When Should Physical Rehabilitation Commence after Stroke: A Systematic Review. Int J Stroke 2014; 9:468-78. [DOI: 10.1111/ijs.12262] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/16/2013] [Indexed: 12/01/2022]
Abstract
Background Knowing when to commence physical rehabilitation after stroke is important to ensure optimal benefit for stroke survivors and efficient health care. The aims of this review were to: determine the effects on mortality, function and complications when physical rehabilitation commences ‘early’ (within seven days of stroke); and describe the effects of early transfer to rehabilitation wards/hospitals when sustained rehabilitation is unavailable in acute stroke units. Review summary From 3751 potential articles we included 5 randomized controlled trials and 38 cohort studies. Meta-analysis was performed with 3 randomized controlled trials involving 159 people to investigate the effects of commencing physical rehabilitation within 24 h of stroke compared to 48 h. Commencing physical rehabilitation within 24 h trended towards greater mortality (Mantel-Haenszel odds ratio 2·58; 95% confidence interval 0·98 to 6·79, P = 0·06), with no differences in complications or health outcomes. The cohort studies provided evidence of benefits when physical rehabilitation was commenced on the day of admission ( n = 1), within 3 days of stroke ( n = 3), or ‘sooner rather than later’ (3 of 4 studies). The effect of earlier transfer to rehabilitation was reported in 32 cohort studies. In 23/26 (88%) cohort studies that accounted for age and stroke severity, results favored earlier transfer for improving post-stroke function, with no consensus on timeframes. Conclusion In summary, the benefits of commencing physical rehabilitation within 24 h of stroke remain unclear from the current literature. Commencing physical rehabilitation or transferring to rehabilitation services ‘early’ may provide better functional outcomes.
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Affiliation(s)
- Elizabeth Lynch
- International Centre for Allied Health Evidence, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Susan Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Dominique Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
- Stroke and Ageing Research Centre, Department of Medicine, Monash University, Clayton, Vic., Australia
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Chen C, Naidoo N, Er B, Cheong A, Fong NP, Tay CY, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Ng YS, Teo YY, Koh GCH. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis. PLoS One 2013; 8:e82697. [PMID: 24376567 PMCID: PMC3871833 DOI: 10.1371/journal.pone.0082697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To (1) identify social and rehabilitation predictors of nursing home placement, (2) investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN National data were retrospectively extracted from medical records of community hospital. DATA SOURCES There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3%) patients were discharged home and 924 (9.7%) patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37), other community hospital (n = 31), death in community hospital (n = 12), acute hospital (n = 1,182) and discharge against doctor's advice (n = 24) were excluded. OUTCOME MEASURE Nursing home placement. RESULTS Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years), had lower mean Bathel Index scores (40 vs. 48), a longer median length of stay (40 vs. 33 days) and a longer time to rehabilitation (19 vs. 15 days), had a higher proportion without a caregiver (28 vs. 7%), being single (21 vs. 7%) and had dementia (23 vs. 10%). Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001) and 65% (p = 0.043) respectively compared to stroke patients. CONCLUSIONS In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such as fractures, lower limb amputation and falls in comparison to strokes.
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Affiliation(s)
- Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Nasheen Naidoo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Benjamin Er
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Choo Yian Tay
- Planning Division, Agency for Integrated Care, Singapore, Singapore
| | - Kin Ming Chan
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore, Singapore
| | - Boon Yeow Tan
- Medical Services, St Luke’s Hospital, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew’s Community Hospital, Singapore, Singapore
| | - Chye Hua Ee
- Bright Vision Hospital, Singapore, Singapore
| | | | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore, Singapore
- Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Gerald C. H. Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- * E-mail:
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Koh GCH, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3:e003483. [PMID: 24068767 PMCID: PMC3787469 DOI: 10.1136/bmjopen-2013-003483] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs. DESIGN Systematic review. DATA SOURCES PubMed and references in primary articles. STUDY SELECTION First, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case-control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed. RESULTS The five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy. CONCLUSIONS 5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.
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Affiliation(s)
- Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
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