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Bruschke S, Zeh R, Baumann U, Helbig S, Stöver T. [Frankfurt concept of early inpatient rehabilitation after cochlear implant treatment : Feasibility for aftercare. German version]. HNO 2024:10.1007/s00106-024-01440-z. [PMID: 38358482 DOI: 10.1007/s00106-024-01440-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined. MATERIALS AND METHODS The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation. RESULTS Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1-0.85 dB SNR; 12 months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups. CONCLUSION A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.
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Affiliation(s)
- Stefanie Bruschke
- Klinik für HNO-Heilkunde, Goethe-Universität Frankfurt, Universitätsklinikum, Frankfurt a. M, Deutschland.
| | - Roland Zeh
- MEDIAN Kaiserberg-Klinik, Bad Nauheim, Deutschland
| | - Uwe Baumann
- Klinik für HNO-Heilkunde, Goethe-Universität Frankfurt, Universitätsklinikum, Frankfurt a. M, Deutschland.
| | - Silke Helbig
- Klinik für HNO-Heilkunde, Goethe-Universität Frankfurt, Universitätsklinikum, Frankfurt a. M, Deutschland
| | - Timo Stöver
- Klinik für HNO-Heilkunde, Goethe-Universität Frankfurt, Universitätsklinikum, Frankfurt a. M, Deutschland
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Pellicciari L, Basagni B, Paperini A, Campagnini S, Sodero A, Hakiki B, Castagnoli C, Politi AM, Avila L, Barilli M, Romano E, Pancani S, Mannini A, Sensoli F, Salvadori E, Poggesi A, Grippo A, Macchi C, Baccini M, Carrozza MC, Cecchi F. Trunk Control Test as a Main Predictor of the Modified Barthel Index Score at Discharge From Intensive Post-acute Stroke Rehabilitation: Results From a Multicenter Italian Study. Arch Phys Med Rehabil 2024; 105:326-334. [PMID: 37625531 DOI: 10.1016/j.apmr.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI. DESIGN Multicentric retrospective observational cohort study. SETTING Two Italian inpatient rehabilitation units. PARTICIPANTS A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes. RESULTS All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P<.001) independently predicted discharge mBI (adjusted R2=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R2 of 65.1%. On the other side, the model with the TCT only presented an R2 of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R2 increase up to 68.5%. CONCLUSIONS TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI.
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Affiliation(s)
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Lucia Avila
- Fondazione Don Carlo Gnocchi onlus, Marina di Massa, Italy
| | | | | | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Federico Sensoli
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
| | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; SOD Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Silva ALDS, Collange LA, Ferreira ADS. Hybrid maneuver for benign paroxysmal positional vertigo in individuals with limited neck mobility: Case series. J Bodyw Mov Ther 2024; 37:386-391. [PMID: 38432834 DOI: 10.1016/j.jbmt.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Mobility limitation of the cervical spine compromises the adequate execution of the canalith repositioning maneuver (CRM) in cases of posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV-GEO). Thus, novel therapeutic options are required for such individuals. OBJECTIVES This study describes the effects of a change in the biomechanical position for the execution of the CRM on symptoms of dizziness and mobility limitation regarding flexion-extension of the cervical spine in older people with unilateral PSC-BPPV-GEO. METHODS A quasi-experimental viability study was conducted with 15 older adults (11 women; mean age: 72.2 ± 8.1 years). Treatment consisted of a hybrid CRM. The participants were evaluated before and after the intervention using the modified Dix & Hallpike test, Dizziness Handicap Inventory (DHI) and a visual analog scale (VAS) for vertigo. RESULTS The modified Dix & Hallpike test was negative in all cases after the execution of the hybrid CRM. A significant reduction was found for dizziness measured using the DHI (mean difference: -39.3 ± 9.4, p < 0.001) and VAS (mean difference: -2.9 ± 0.8, p = 0.04) after the intervention. CONCLUSION The hybrid CRM proved executable and satisfactory for resolving symptoms of dizziness in older adults with PSC-BPPV. The present findings are promising and randomized controlled clinical trials should be conducted to evaluate the effectiveness of the hybrid CRM in this population.
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Affiliation(s)
- Andre Luís Dos Santos Silva
- Department of Vestibular Physiotherapy, Brazilian Institute of Vestibular Physiotherapy and Balance [IBRAFIVE], Rio de Janeiro, RJ, Brazil.
| | - Luanda Andre Collange
- Center of Pediatric Neurostimulation, Sao Paulo, Brazil. Human Movement Analysis Laboratory, University Center of Anápolis, Anápolis, Goiás, Brazil
| | - Arthur de Sá Ferreira
- Coordinator of the Postgraduate Program in Rehabilitation Sciences (UNISUAM), Rio de Janeiro, RJ, Brazil
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Lanotte F, O’Brien MK, Jayaraman A. AI in Rehabilitation Medicine: Opportunities and Challenges. Ann Rehabil Med 2023; 47:444-458. [PMID: 38093518 PMCID: PMC10767220 DOI: 10.5535/arm.23131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Artificial intelligence (AI) tools are increasingly able to learn from larger and more complex data, thus allowing clinicians and scientists to gain new insights from the information they collect about their patients every day. In rehabilitation medicine, AI can be used to find patterns in huge amounts of healthcare data. These patterns can then be leveraged at the individual level, to design personalized care strategies and interventions to optimize each patient's outcomes. However, building effective AI tools requires many careful considerations about how we collect and handle data, how we train the models, and how we interpret results. In this perspective, we discuss some of the current opportunities and challenges for AI in rehabilitation. We first review recent trends in AI for the screening, diagnosis, treatment, and continuous monitoring of disease or injury, with a special focus on the different types of healthcare data used for these applications. We then examine potential barriers to designing and integrating AI into the clinical workflow, and we propose an end-to-end framework to address these barriers and guide the development of effective AI for rehabilitation. Finally, we present ideas for future work to pave the way for AI implementation in real-world rehabilitation practices.
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Affiliation(s)
- Francesco Lanotte
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Megan K. O’Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
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Tsoy N, Langewitz W, Müri S, Notter S, Pannek J, Post MWM, Rednic LN, Rubinelli S, Scheel-Sailer A. Quality of life from the patient perspective at the end of the first rehabilitation after the onset of spinal cord injury/disorder - A qualitative interview-based study. J Spinal Cord Med 2023:1-12. [PMID: 37819653 DOI: 10.1080/10790268.2023.2263235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
CONTEXT At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D). OBJECTIVE To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D. METHODS Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set. RESULTS The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL. CONCLUSION Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.
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Affiliation(s)
| | - Wolf Langewitz
- Basel University Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | - Selina Müri
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Seraina Notter
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jürgen Pannek
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel W M Post
- University of Groningen, University Medical Centre Groningen, Department of rehabilitation medicine, Groningen, the Netherlands
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | - Sara Rubinelli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Suzuki T, Tsuji O, Ichikawa M, Ishii R, Nagoshi N, Kawakami M, Watanabe K, Matsumoto M, Tsuji T, Fujiwara T, Nakamura M. Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery. Asian Spine J 2023; 17:355-364. [PMID: 36625019 PMCID: PMC10151637 DOI: 10.31616/asj.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023] Open
Abstract
Study Design This is a single-center retrospective cohort study with a university hospital setting. Purpose This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery. Overview of Literature Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage. Methods A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery. Results In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93-1.00). Conclusions The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.
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Affiliation(s)
- Tetsuya Suzuki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiko Ichikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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O'Neil-Pirozzi TM, Pinto SM, Sevigny M, Hammond FM, Juengst SB, Bombardier CH. Factors Associated With High and Low Life Satisfaction 10 Years After Traumatic Brain Injury. Arch Phys Med Rehabil 2022; 103:2164-2173. [PMID: 35202582 PMCID: PMC9484051 DOI: 10.1016/j.apmr.2022.01.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify correlates of life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. DESIGN Effect sizes were calculated in this observational cohort study to estimate relationships of 10-year postinjury extremely high, extremely low, and moderate life satisfaction with (1) pre-injury demographics, injury-related factors, and functional characteristics at inpatient rehabilitation admission and discharge; and (2) postinjury demographics and clinical and functional measures at 10 years postinjury. SETTING Multicenter longitudinal database study. PARTICIPANTS People identified from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Database with life satisfaction data at 10 years post TBI (N=4800). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Satisfaction With Life Scale. RESULTS Although few pre-injury factors or clinical and functional factors shortly after injury were associated with 10-year life satisfaction groups, the following 10-year postinjury factors were associated with extremely high vs extremely low life satisfaction group membership: greater independent functioning, less disability, more frequent community participation, being employed, and having fewer depressive and anxiety symptoms. Those with extremely high life satisfaction were distinctly different from those with moderate and extremely low satisfaction. Extremely high life satisfaction was underrepresented among non-Hispanic Black persons relative to non-Hispanic White persons. Relationships between life satisfaction and independent functioning, disability, and participation were attenuated among non-Hispanic Black persons. CONCLUSIONS Extreme phenotyping analysis complements existing knowledge regarding life satisfaction after moderate to severe TBI and may inform acute and postacute clinical service delivery by comparing extremely high and extremely low life satisfaction subgroups. Findings suggest little association among personal, clinical, and functional characteristics early post TBI and life satisfaction 10 years later. Contemporaneous correlates of extremely high life satisfaction exist at 10 years post TBI, although the positive relationship of these variables to life satisfaction may be attenuated for non-Hispanic Black persons.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA.
| | - Shanti M Pinto
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC
| | | | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN; Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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Campagnini S, Arienti C, Patrini M, Liuzzi P, Mannini A, Carrozza MC. Machine learning methods for functional recovery prediction and prognosis in post-stroke rehabilitation: a systematic review. J Neuroeng Rehabil 2022; 19:54. [PMID: 35659246 PMCID: PMC9166382 DOI: 10.1186/s12984-022-01032-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Rehabilitation medicine is facing a new development phase thanks to a recent wave of rigorous clinical trials aimed at improving the scientific evidence of protocols. This phenomenon, combined with new trends in personalised medical therapies, is expected to change clinical practice dramatically. The emerging field of Rehabilomics is only possible if methodologies are based on biomedical data collection and analysis. In this framework, the objective of this work is to develop a systematic review of machine learning algorithms as solutions to predict motor functional recovery of post-stroke patients after treatment. METHODS We conducted a comprehensive search of five electronic databases using the Patient, Intervention, Comparison and Outcome (PICO) format. We extracted health conditions, population characteristics, outcome assessed, the method for feature extraction and selection, the algorithm used, and the validation approach. The methodological quality of included studies was assessed using the prediction model risk of bias assessment tool (PROBAST). A qualitative description of the characteristics of the included studies as well as a narrative data synthesis was performed. RESULTS A total of 19 primary studies were included. The predictors most frequently used belonged to the areas of demographic characteristics and stroke assessment through clinical examination. Regarding the methods, linear and logistic regressions were the most frequently used and cross-validation was the preferred validation approach. CONCLUSIONS We identified several methodological limitations: small sample sizes, a limited number of external validation approaches, and high heterogeneity among input and output variables. Although these elements prevented a quantitative comparison across models, we defined the most frequently used models given a specific outcome, providing useful indications for the application of more complex machine learning algorithms in rehabilitation medicine.
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Affiliation(s)
- Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via di Scandicci 269, 50143, Firenze, Italy.,Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Chiara Arienti
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via di Scandicci 269, 50143, Firenze, Italy
| | - Michele Patrini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via di Scandicci 269, 50143, Firenze, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via di Scandicci 269, 50143, Firenze, Italy.,Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Via di Scandicci 269, 50143, Firenze, Italy.
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Nanjayya VB, Doherty Z, Gupta N, Alexander T, Chavan S, Pilcher D, Bray J. Rehabilitation outcomes of survivors of cardiac arrest admitted to ICUs in Australia and New Zealand (ROSC ANZ): A data linkage study. Resuscitation 2021; 169:156-164. [PMID: 34536560 DOI: 10.1016/j.resuscitation.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rehabilitation outcomes in cardiac arrest survivors are largely unknown, with no data comparing out-of-hospital cardiac arrests (OHCA) and in-hospital cardiac arrests (IHCA). This study aimed to describe and compare inpatient rehabilitation outcomes in these patients who were admitted from intensive care units (ICU). METHODS A retrospective linkage and analysis of cardiac arrest patients in the Australian and New Zealand Intensive Care Society Adult Patient Database and the Australasian Rehabilitation Outcomes Centre inpatient dataset discharged to inpatient rehabilitation between January 2017 and June 2018. Primary outcome was the functional improvement during rehabilitation (difference between the Functional Independence Measurement (FIM) score on admission and discharge). Multivariate regression analyses were performed to determine factors associated with functional improvement. RESULTS In the 240 (84 OHCA and 156 IHCA) patients included, the median length of inpatient rehabilitation was 15 days [1st-3rd quartile (Q1-Q3): 9-24]. OHCA patients were more likely to be admitted to rehabilitation for neurological issues (41.7%) and IHCA for medical reasons (51.9%). Median (Q1-Q3) change in total FIM scores was similar between the two groups (24.5[10-37]) vs 21[11-31], adjusted p = 0.20), with most of the FIM change seen in the motor items, and this was only associated with a lower admission FIM score. The majority of OHCA and IHCA patients were discharged home (91.5% and 89.7%, respectively), although with an increased need for a carer at home compared to baseline (27.2% to 55.6%). CONCLUSION Patients discharged from ICU following OHCA and IHCA achieved reasonable and similar functional improvement during inpatient rehabilitation.
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Affiliation(s)
- Vinodh Bhagyalakshmi Nanjayya
- Intensive Care Unit, Alfred Hospital, Melbourne 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - Zakary Doherty
- School of Rural Health, Monash University, Melbourne, Australia
| | - Namankit Gupta
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Tara Alexander
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Shaila Chavan
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Victoria 3124, Australia
| | - David Pilcher
- Intensive Care Unit, Alfred Hospital, Melbourne 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Victoria 3124, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Australia
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Arcolin I, Godi M, Giardini M, Guglielmetti S, Corna S. Does the type of hip fracture affect functional recovery in elderly patients undergoing inpatient rehabilitation? Injury 2021; 52:2373-2378. [PMID: 33879338 DOI: 10.1016/j.injury.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fractures should not be considered as a single, homogeneous condition. Various determinants of functional recovery of patients with hip fracture have been proposed, such as age or type of fracture. The aim of this study was to determine if patients with an intertrochanteric fracture (ITF) had lower functional recovery characteristics with respect to those with a femoral neck fracture (FNF). METHODS A retrospective study was carried out on 531 elderly patients with hip fracture, surgically treated, admitted to a rehabilitation institute between December 1, 2014, and December 31, 2017. Patients underwent an individualized rehabilitation program for improving their physical function. The outcome measures of this study were the length of stay (LOS) in the rehabilitation institute, the Functional Independence Measure (FIM) gain, i.e. the difference in FIM score between discharge and admission, and the FIM efficiency, which represents the daily gain. Patients were also stratified by age categories and by different levels of functional independence, as evaluated with the FIM total score at baseline. RESULTS Age (p<0.05), LOS (p<0.005) and rehabilitation outcomes (FIM score and efficiency; p<0.05) differed significantly between patients with FNF and ITF. In particular, patients with ITF were older and more dependent at baseline. Moreover, they showed a lower FIM efficiency with respect to patients with FNF (p<0.05), which obtained a similar improvement in FIM total score of about 26 points but were discharged on average 3 days before. With aging, FIM efficiency decreased, while LOS increased. Patients highly dependent at baseline (FIM total score <40) had the lowest FIM gain and efficiency and the longest LOS respect to the more independent patients. Moreover, in older (85+ years) and in higher dependent patients the differences in the outcome measures between ITF and FNF were reduced. CONCLUSIONS The type of hip fracture could affect the LOS and FIM efficiency of younger and more independent patients with hip fracture during inpatient rehabilitation. In particular, patients with ITF require a longer rehabilitation period to achieve a similar functional gain as those with FNF.
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Affiliation(s)
- Ilaria Arcolin
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Marco Godi
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Marica Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Simone Guglielmetti
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
| | - Stefano Corna
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Veruno, 28013 Gattico-Veruno (NO), . Division of Physical Medicine and Rehabilitation, Italy.
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Fatone S, Caldwell R, Angelico J, Stine R, Kim KY, Gard S, Oros M. Comparison of Ischial Containment and Subischial Sockets on Comfort, Function, Quality of Life, and Satisfaction With Device in Persons With Unilateral Transfemoral Amputation: A Randomized Crossover Trial. Arch Phys Med Rehabil 2021; 102:2063-2073.e2. [PMID: 34214499 DOI: 10.1016/j.apmr.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare comfort and functional performance of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket with the ischial containment (IC) socket in persons with unilateral transfemoral amputation. DESIGN Randomized crossover trial with two 7-week periods. SETTING Private prosthetic clinics and university research laboratory. PARTICIPANTS A total of 30 enrolled (N=30); 25 participants completed the study with full (n=18) or partial data (n=7). INTERVENTIONS Two custom-fabricated sockets (IC and NU-FlexSIV), worn full-time for 7 weeks, with testing at 1, 4, and 7 weeks after socket delivery. MAIN OUTCOME MEASURES The primary outcome was change in Socket Comfort Score (SCS) at 7 weeks. Secondary outcomes at 7 weeks included the Orthotic and Prosthetic Users' Survey (OPUS) to assess lower extremity functional status, health-related quality of life, and satisfaction with device, as well as the 5-Times Rapid Sit-to-Stand Test, Four Square Step Test, and T-Test of Agility to assess functional performance. RESULTS At 7 weeks, the mean SCS for IC (7.0±1.7) and NU-FlexSIV (8.4±1.1) Sockets were significantly different (P<.001; 95% confidence interval, 0.8-2.3). Results from a linear mixed-effects model, accounting for data from all time points, indicated that the SCS was 1.7 (SE=0.45) points higher for the NU-FlexSIV Socket (P<.001). For the secondary outcomes, only OPUS satisfaction with device was significantly better in the NU-FlexSIV Socket after accounting for all data points. CONCLUSIONS The results suggest that after 7 weeks' accommodation, the NU-FlexSIV Socket was more comfortable and led to greater satisfaction with device than the IC socket in persons with unilateral transfemoral amputation and K3/K4 mobility. Other patient-reported outcomes and function were no different between sockets.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Ryan Caldwell
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | - John Angelico
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | | | - Kwang-Youn Kim
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Steven Gard
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Jesse Brown VA Medical Center, Chicago, IL
| | - Michael Oros
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
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12
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Wan RCW, Fan JCH, Hung YW, Kwok KB, Lo CKM, Chung KY. Cost, safety, and rehabilitation of same-stage, bilateral total knee replacements compared to two-stage total knee replacements. Knee Surg Relat Res 2021; 33:17. [PMID: 34118996 PMCID: PMC8196524 DOI: 10.1186/s43019-021-00098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background Many patients experience bilateral knee osteoarthritis and require bilateral total knee replacement (TKR). Same-stage, bilateral TKR is proposed to be a cost-effective and safe solution compared to two-stage, but conflicting results in the literature are reported. We aim to compare the costs, safety, and rehabilitation performance of patients in same-stage versus two-stage, bilateral TKR with our centre’s perioperative protocol. Materials and methods We retrospectively reviewed 175 patients (95 same-stage, 80 two-stage) who had undergone bilateral TKR in our centre. Patient selection for same-stage, bilateral TKR was strictly protocol-driven and required fulfilment of all criteria, including age < 75 years, American Society of Anesthesiologists (ASA) grade 1 or 2, body mass index (BMI) < 40, and having non-complex arthritis. All patients followed a standardised pre-operative, intra-operative, and post-operative Enhanced Recovery After Surgery (ERAS) protocol. The cost, safety profiles, and rehabilitation outcomes were compared between the same-stage and two-stage groups. Results The same-stage, bilateral TKR reduced the length of hospital stays by 5.71 days per patient, decreased the operation time by 27.4 min, saved 3.34 (18.6%) physiotherapy sessions, and 3.78 (51.5%) occupational therapy sessions. The same-stage group experienced a higher haemoglobin drop but no significant difference in transfusion percentage, transfusion volume, complication rate, and readmission rate. The two-stage subgroup with anaesthetic risk, age, and BMI similar to the same-stage group showed the same results. Same-stage, bilateral TKR patients experienced no significant difference in final post-operative pain levels and rehabilitation outcomes as two-stage TKR patients. Conclusion This study showed that same-stage, bilateral TKR can reduce costs, with similar safety profiles and rehabilitation outcomes compared to the two-stage, bilateral TKR.
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Affiliation(s)
- Raymond C W Wan
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | - Jason C H Fan
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China.
| | - Yuk-Wah Hung
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Ka-Bon Kwok
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Carmen K M Lo
- Present address: Department of Orthopedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China
| | - Kwong-Yin Chung
- Department of Orthopedics & Traumatology, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
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Zoch-Lesniak B, Dobberke J, Schlitt A, Bongarth C, Glatz J, Spörl-Dönch S, Koran I, Völler H, Salzwedel A. Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe. Arch Rehabil Res Clin Transl 2020; 2:100043. [PMID: 33543072 DOI: 10.1016/j.arrct.2020.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting Comprehensive 3-week CR. Participants Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). Interventions Not applicable. Main Outcome Measures Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). Results Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. Conclusions We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.
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Key Words
- 6MWD, 6-minute walking distance
- 95% CI, 95% confidence interval
- ACS, acute coronary syndrome
- BMI, body mass index
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardiovascular diseases
- EDC, electronic data capture
- HAF-17, Herzangstfragebogen (German version of the Cardiac Anxiety Questionnaire)
- IRES-24, indicators of rehabilitation status-24
- KMO, Kaiser-Meyer-Olkin
- LDL, low-density lipoprotein
- OutCaRe, Outcome of Cardiac Rehabilitation
- Outcome measures
- PAD, peripheral artery disease
- PCS, physical component summary
- PHQ-9, Patient Health Questionnaire-9
- Quality indicators
- Rehabilitation
- Rehabilitation outcome
- SES, standardized effect size
- SF-12, Medical Outcomes Study 12-Item Short-Form Health Survey
- Secondary prevention
- WHO-5, 5-item World Health Organization Well-Being Index
- health care
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Zuccarino S, Fattore G, Vitali S, Antronaco G, Frigerio S, Colombo M. The Association between Education and Rehabilitation Outcomes: a Population Retrospective Observational Study. Arch Gerontol Geriatr 2020; 91:104218. [PMID: 32784079 DOI: 10.1016/j.archger.2020.104218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Retrospective observational study aiming at testing whether different education levels in older adults are associated with the rehabilitation outcome. STUDY DESIGN The study planned to cover all patients of over 65 rehabilitated from 2015 to 2017 at Golgi-Redaelli, a large government-funded rehabilitation Institute in Northern Italy comprising of three centers. Different administrative datasets were linked to investigate the factors associated with the functional outcome. The cohort resulted in 2,486 older adults for whom information on education and rehabilitation outcome was available. MAIN OUTCOME MEASURES Rehabilitation outcome was measured with the Barthel Index testing the ability in basic activities of daily living and the Tinetti Performance Oriented Mobility Assessment measuring stability and walking. Multiple linear and logistic regression models were run controlling for rehabilitation setting and center of care, age, gender, cognitive functioning and comorbidity. RESULTS Education resulted negatively associated with functional recovery. Patients with at least 8 years of education improved 2.24 point less in Barthel Index (out of100) and 0.70 points less in Tinetti Performance Oriented Mobility Assessment (out of 28) than the less educated patients. Results confirmed the importance of cognitive functioning in predicting rehabilitation outcome in older patients. CONCLUSIONS Different mechanisms can explain an unexpected negative association between education and rehabilitation outcome, when possible inequalities in access to care are controlled for by study design (the cohort was admitted to a NHS-funded institute). Additional studies are needed to confirm our results and to test more specific hypotheses about the degree of effectiveness of rehabilitation across socio-economic groups.
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Affiliation(s)
- Sara Zuccarino
- Institute of Management and Department EMbeDS, Management and Health Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Giovanni Fattore
- Social and Political Sciences Department, Università Bocconi, Milan, Italy; CERGAS-SDA, Università Bocconi, Milan, Italy
| | - Silvia Vitali
- Geriatric Institute "Camillo Golgi", ASP Golgi Redaelli, Abbiategrasso, Milan, Italy; Golgi Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Gino Antronaco
- Geriatric Institute "Camillo Golgi", ASP Golgi Redaelli, Abbiategrasso, Milan, Italy
| | - Simona Frigerio
- Geriatric Institute "Camillo Golgi", ASP Golgi Redaelli, Abbiategrasso, Milan, Italy
| | - Mauro Colombo
- Geriatric Institute "Camillo Golgi", ASP Golgi Redaelli, Abbiategrasso, Milan, Italy; Golgi Cenci Foundation, Abbiategrasso, Milan, Italy
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Zhao S, Zhang T, Li B, Wu Z, Zhao J. What Determines Good Rehabilitation Recovery in Stroke Patients with very Severe Disability? A Retrospective Cohort Study. J Stroke Cerebrovasc Dis 2020; 29:105130. [PMID: 32912513 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate predictors of good recovery after rehabilitation in stroke patients with very severe disability. METHODS 168 Eligible patients were enrolled. Fugl-Meyer of motor score (FMM), National Institute of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) were used to measure the motor and degree of disability. Logistic regressions were used to investigate the effect of 21 pre-existing conditions on efficacy outcomes after 4 weeks rehabilitation. RESULTS The results indicated the following: 1) FMM (r = 0.2, P=0.02) and NIHSS (r = -0.2, P=0.00) were significantly correlated (positively and negatively, respectively) with fat-free mass index (FFMI); 2)FFMI (odds ratio [OR],1.9; 95% CI, 1.1 to 3.3; P=0.02), OAI (OR, 0.9; 95% CI, 0.9 to 1.0; P=0.00), and FMM (OR, 1.0; 95% CI, 1.0 to 1.1; P=0.00) were revealed as predictors of good recovery after 4 weeks rehabilitation; 3) The model could predict the possibility of good recovery in stroke patients with very severe disability with excellent sensitivity and specificity(80.0% and 67.1%, respectively). CONCLUSIONS The results could enable clinicians to predict good recovery after rehabilitation in patients with very severe post-stroke disability.
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Bae SH, Kim WJ, Seo YJ, Kim J, Jeon JY. Bioimpedance Analysis for Predicting Outcomes of Complex Decongestive Therapy for Gynecological Cancer Related Lymphedema: A Feasibility Study. Ann Rehabil Med 2020; 44:238-245. [PMID: 32640783 PMCID: PMC7349036 DOI: 10.5535/arm.19102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To determine whether the bioimpedance analysis (BIA) ratios of upper to lower extremities could predict treatment outcomes after complex decongestive therapy (CDT) for gynecological cancer related lymphedema (GCRL). Methods A retrospective study, from March 2015 to December 2018, was conducted. The study sample comprised patients receiving CDT, 30 minutes per day, for 10 days. Bioimpedance was measured pre- and post-CDT. Circumference measurements were obtained at 20 and 10 cm above the knee (AK) and 10 cm below the knee (BK). We calculated the expected impedance at 0 Hz (R0) of extremities and upper/lower extremity R0 ratios (R0U/L). We evaluated the relationship between R0U/L and changes in R0U/L and circumferences, pre- and post-CDT. Results Overall, 59 patients were included in this study. Thirty-one lower extremities in 26 patients comprised the acute group, and 38 lower extremities in 33 patients comprised the chronic group. Pre-treatment R0U/L was significantly correlated with R0U/L change after adjusting for age and BMI (acute: R=0.513, p<0.01; chronic: R=0.423, p<0.01). In the acute group, pre-treatment R0U/L showed a tendency to be correlated with circumference change (AK 20 cm: R=0.427, p=0.02; AK 10 cm: R=0.399, p=0.03). Conclusion Our study results suggested that pre-treatment BIA could predict volume reductions after CDT in the early stages of GCRL. These findings implied that BIA value could be one possible parameter to apply in treatment outcomes prediction, during the early stage of GCRL. Therefore, further large-scale prospective studies will be beneficial.
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Affiliation(s)
- Su Hwan Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Jun Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Jin Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - JaYoung Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cecchi F, Pancani S, Antonioli D, Avila L, Barilli M, Gambini M, Landucci Pellegrini L, Romano E, Sarti C, Zingoni M, Gabrielli MA, Vannetti F, Pasquini G, Macchi C. Predictors of recovering ambulation after hip fracture inpatient rehabilitation. BMC Geriatr 2018; 18:201. [PMID: 30170554 PMCID: PMC6117966 DOI: 10.1186/s12877-018-0884-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Despite progress in surgery and care, hip fracture (HF) remains a catastrophic event, burdened with high risk of mortality and disability. This study aims at identifying predictors of recovering ambulation after intensive inpatient rehabilitation within the Tuscany Region HF rehabilitation pathway. Methods All HF patients referred from acute care to the two Massa-Carrara Rehabilitation facilities January 2015–June 2017 were enrolled. Comorbidity Total Score (CIRS) defined high- or low-care setting referral. Recovery of ambulation, with or without aid, (assessed by SAHFE) was the primary outcome. Personal data, comorbidity, cognitive (MMSe) and pre-fracture function (mRANKIN) were recorded on admission. Outcomes included hospital readmission, length of stay (LOS) and home discharge. Urinary catheter, bedsores, disability (modified Barthel Index-mBI), communication disability (CDS), trunk control (TCT), pain (NRS), and ambulation were recorded (admission-discharge). Results Of 352 patients enrolled (age 83.9 ± 7.1; 80% women), 1 died and 6 were readmitted to acute-care hospital; 97% patients referred to high-care, and 64% referred to low-care, presented moderate-high comorbidity on admission. Median LOS was 22 days; 95% patients were discharged back home; daily functional gain (mBIscore/LOS) was 1.3 ± 0.7. Patients who recovered ambulation on discharge were 84%. Older age, higher comorbidity, bladder catheter, impaired trunk control, worse cognitive and functional status on admission, and pre-fracture disability were associated to poor outcome, but only higher comorbidity and impaired communication on admission predicted failure to recover ambulation on discharge. Conclusion In HF patients entitled to intensive inpatient rehabilitation, moderate-high comorbidity and impaired communication are frequent findings and predict rehabilitation failure.
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Affiliation(s)
- Francesca Cecchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Silvia Pancani
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Desiderio Antonioli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Lucia Avila
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Manuele Barilli
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Massimo Gambini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | | | - Emanuela Romano
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Chiara Sarti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Margherita Zingoni
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | | | - Federica Vannetti
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Guido Pasquini
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy
| | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Via di Scandicci, 269, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Hong SE, Kim CH, Kim EJ, Joa KL, Kim TH, Kim SK, Han HJ, Lee EC, Jung HY. Effect of a Caregiver's Education Program on Stroke Rehabilitation. Ann Rehabil Med 2017; 41:16-24. [PMID: 28289631 PMCID: PMC5344819 DOI: 10.5535/arm.2017.41.1.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/05/2016] [Indexed: 01/14/2023] Open
Abstract
Objective To evaluate effects of caregiver's education program on their satisfaction, as well as patient functional recovery, performed in addition to daily conventional rehabilitation treatment. Methods Three hundred eleven subjects diagnosed with first-onset stroke and transferred to the Department of Physical Medicine and Rehabilitation of Inha University Hospital were surveyed. In 2015, caregivers attended an education program for acute and subacute stroke patients. Patients who received an additional rehabilitation therapy were assigned to the experimental group (n=81), whereas the control group (n=100) consisted of transfer cases in 2014 with only conventional treatment. The experimental group was classified by severity using the Korean version of the National Institutes of Health Stroke Scale (K-NIHSS), which was administered to all 181 subjects, in addition to, the Korean version of the Mini Mental Status Examination (K-MMSE), a Modified Barthel Index (K-MBI), and the Berg Balance Scale (K-BBS). Caregiver satisfaction and burden before and after education programs were assessed using the Canadian Occupational Performance Measure (COPM), as well as family burden and caregiver burnout scales. Results No significant intergroup difference was observed between initial K-NIHSS, K-MMSE, K-BBS, K-MBI scores, and times from admission to transfer. Those with moderate or severe strokes under the experimental condition showed a more significant improvement than the control group as determined by the K-NIHSS and K-BBS, as well as tendential K-MMSE and K-MBI score increases. Satisfaction was significantly greater for family members and formal caregivers of patients with strokes of moderate severity in the experimental group. Conclusion The caregiver's education program for stroke subjects had a positive outcome on patients' functional improvement and caregiver satisfaction. The authors believe that the additional rehabilitation therapy with the education program aids patients to achieve functional improvements for an optimal return to social life.
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Affiliation(s)
- Sang-Eun Hong
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Chang-Hwan Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ee-Jin Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kyung-Lim Joa
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Tae-Hyun Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang-Keun Kim
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hee-Jun Han
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Eui-Chang Lee
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Han-Young Jung
- Department of Physical and Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
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Abstract
The majority of dislocated, intra-articular fractures are treated with an open reduction and internal fixation. In this paper we describe a variety of dorsal approaches to the distal humerus. Beside the dorsal approach through an olecranon osteotomy we also discuss the alternative dorsal approaches without osteotomy and their advantages and drawbacks. Moreover we discuss the preoperative planning and operative procedure. Early functional rehabilitation, without weight bearing, is important to achieve an optimal outcome. Finally we present the results of the last 6 years of patients treated operatively in our clinic with distal humeral fractures.
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Affiliation(s)
- F J P Beeres
- Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6016, Luzern, Schweiz.
| | - F Oehme
- Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6016, Luzern, Schweiz
| | - R Babst
- Klinik Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6016, Luzern, Schweiz
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Field DA, Miller WC, Ryan SE, Jarus T, Roxborough L. Exploring suitable participation tools for children who need or use power mobility: A modified Delphi survey. Dev Neurorehabil 2016; 19:365-379. [PMID: 25825804 DOI: 10.3109/17518423.2015.1004763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify suitable tools for measuring important elements of participation for children, aged 18 months to 12 years, who need or use power mobility, and to indicate which tools should be considered for inclusion in a measurement toolkit. METHODS Parents, therapists and researchers with expertise in paediatric power mobility and participation (n = 70) completed an online modified Delphi survey, with consensus set a priori >80% agreement. Existing tools were matched against participation elements ranked most important for those in early childhood (18 months-5 years) and of school-age (6-12 years) by the panel. RESULTS Six out of 13 tools demonstrated potential, meeting at least three elements each, although none addressed all elements deemed important to measure by the panel. Only the Participation and Environment Measure for Children and Youth (PEM-CY) reached consensus for inclusion in a participation measure toolkit. CONCLUSION Further evaluation of these tools with this population is warranted.
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Affiliation(s)
- Debra A Field
- a Graduate Programs in Rehabilitation Sciences, University of British Columbia (UBC) , Vancouver , British Columbia , Canada.,b Rehabilitation Research Program, GF Strong Rehabilitation Centre , Vancouver , British Columbia , Canada.,c Sunny Hill Health Centre for Children , Therapy , Vancouver , British Columbia , Canada
| | - William C Miller
- a Graduate Programs in Rehabilitation Sciences, University of British Columbia (UBC) , Vancouver , British Columbia , Canada.,b Rehabilitation Research Program, GF Strong Rehabilitation Centre , Vancouver , British Columbia , Canada.,d Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada
| | - Stephen E Ryan
- e Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute , Toronto , Ontario , Canada.,f Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada , and.,g Graduate Department of Rehabilitation Sciences , University of Toronto , Toronto , Ontario , Canada
| | - Tal Jarus
- a Graduate Programs in Rehabilitation Sciences, University of British Columbia (UBC) , Vancouver , British Columbia , Canada.,d Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada
| | - Lori Roxborough
- c Sunny Hill Health Centre for Children , Therapy , Vancouver , British Columbia , Canada
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Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Platz J, Seifert V. Non-aneurysmal non-perimesencephalic subarachnoid hemorrhage: effect of rehabilitation at short-term and in a prospective study of long-term follow-up. Top Stroke Rehabil 2016; 23:261-8. [PMID: 26916565 DOI: 10.1080/10749357.2016.1149982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A recently published prospective study identified an impaired outcome of patients with non-perimesencephalic (NPM) subarachnoid hemorrhage (SAH). Our objective was to analyze the long-term outcome of patients with subsequent rehabilitation after NPM SAH. METHODS A comparison of patients with NPM SAH receiving subsequent in-patient rehabilitation was done at discharge (using the modified Rankin scale (mRS)), short-term outcome after 6 months (mRS), and prospectively using a questionnaire (short-form health survey with 36 questions (SF-36)), which was sent to 66 patients. RESULTS Thirty-seven patients answered the SF-36, on average 6.3 years after ictus (range 1.5-14 years). After NPM SAH, the mRS is impaired. Patients with subsequent rehabilitation had a significant better improvement until short-term follow-up. Until long-term outcome, the psychological items were non-significantly reduced, whereas all physical items (physical functioning, role limitations because of physical health problems, bodily pain, and general health perceptions) were significantly decreased compared to the standard population. In patients with subsequent rehabilitation, all items were only non-significantly reduced. About 16% of the patients developed secondary neurological and/or psychiatric diseases. CONCLUSIONS The quality of life (QoL) is decreased after NPM SAH. In the long-term follow-up, a significant reduction in physical items was identified. Due to subsequent in-patient rehabilitation after NPM SAH, the impairment can be improved significantly until short-term follow-up. Whereas patients with NPM SAH had a significantly decreased QoL at long-term follow-up, for patients with rehabilitation, the QoL was only slightly (non-significantly) reduced. Therefore, patients should receive subsequent rehabilitation after NPM SAH to improve the functional short-term outcome (mRS) and long-term QoL. www.clinicaltrials.gov (Identifier No. NCT02334657).
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Affiliation(s)
- Juergen Konczalla
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Jens Schmitz
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Sepide Kashefiolasl
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Christian Senft
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Johannes Platz
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
| | - Volker Seifert
- a Department of Neurosurgery , Goethe-University Hospital , Frankfurt am Main , Germany
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Luvizutto GJ, Gameiro MDOO, Schelp AO, Braga GP, Ribeiro PW, Bazan R. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital. J Phys Ther Sci 2015; 27:2533-6. [PMID: 26355915 PMCID: PMC4563308 DOI: 10.1589/jpts.27.2533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/15/2015] [Indexed: 01/19/2023] Open
Abstract
[Purpose] The study aimed to characterize patients treated by rehabilitation section
after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation
records of individuals with ischemic stroke were studied retrospectively, excluding
individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1,
prior stroke, structural bone deformities, associated neurological disease, and prior
cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment
received, ictus onset, hospitalization time, discharge date, and date of first evaluation
at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was
utilized to measure functional incapacity with the individuals divided into two groups,
before and after acute stroke unit implementation (2010). Functional incapacity was
compared between before and after acute stroke unit implementation by the Mann-Whitney
test, χ2 test and Fisher’s exact test. [Results] The medical records of 170
patients were evaluated. In the group evaluated after 2010, the patients were
significantly older and presented a shorter time between hospitalization and discharge,
shorter time until the first evaluation in rehabilitation, and increased percentage of
mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit
implementation, the patients treated in the rehabilitation section presented a shorter
hospitalization time and rehabilitation delay and less functional incapacity.
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Affiliation(s)
| | | | - Arthur Oscar Schelp
- Botucatu School of Medicine, Neurology Service, University Estadual Paulista, Brazil
| | | | | | - Rodrigo Bazan
- Botucatu School of Medicine, Neurology Service, University Estadual Paulista, Brazil
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Roffman CE, Buchanan J, Allison GT. Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules. J Physiother 2014; 60:224-31. [PMID: 25450484 DOI: 10.1016/j.jphys.2014.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/02/2014] [Accepted: 09/10/2014] [Indexed: 11/17/2022] Open
Abstract
QUESTIONS Can rules be developed to predict the risk of non-use of prostheses by people with lower limb amputation following discharge from rehabilitation? Are these clinical prediction rules valid? DESIGN Retrospective and prospective cohort study designs. PARTICIPANTS Consecutive tertiary rehabilitation patients: 135 retrospective (103 males, mean age = 56 years, SD 15) and 66 prospective (58 males, mean age = 54 years, SD 16). METHOD Medical records were audited for potential predictor variables. Retrospective participants were interviewed at a median of 1.9 years after discharge (IQR 1.4 to 2.5) and prospective participants at a median of 1.3 years (IQR 1.1 to 1.4). RESULTS Clinical prediction rules were identified at 4, 8 and 12 months after discharge, and validated. Amputation levels above transtibial and mobility-aid use were common predictors for all three time frames. At 4 months, if four out of five predictor variables were present (LR+ = 43.9, 95% CI 2.73 to 999+), the probability of non-use increased from 12 to 86% (p<0.001). At 8 months, if all three predictor variables were present (LR+ = 33.9, 95% CI 2.1 to 999+), the probability of non-use increased from 15 to 86% (p<0.001). At 12 months, if two out of three predictor variables were present (LR+=2.8, 95% CI 0.9 to 6.6), the probability of non-use increased from 17 to 36% (p<0.031). CONCLUSIONS These validated clinical prediction rules have implications for rehabilitation and service model development. [Roffman CE, Buchanan J, Allison GT (2014) Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules.Journal of Physiotherapy60: 224-231].
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Affiliation(s)
- Caroline E Roffman
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University and Royal Perth Hospital, Perth, Australia
| | - John Buchanan
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University and Royal Perth Hospital, Perth, Australia
| | - Garry T Allison
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University and Royal Perth Hospital, Perth, Australia
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Evans JJ, Gast DL, Perdices M, Manolov R. Single case experimental designs: introduction to a special issue of Neuropsychological Rehabilitation. Neuropsychol Rehabil 2014; 24:305-14. [PMID: 24766415 DOI: 10.1080/09602011.2014.903198] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper introduces the Special Issue of Neuropsychological Rehabilitation on Single Case Experimental Design (SCED) methodology. SCED studies have a long history of use in evaluating behavioural and psychological interventions, but in recent years there has been a resurgence of interest in SCED methodology, driven in part by the development of standards for conducting and reporting SCED studies. Although there is consensus on some aspects of SCED methodology, the question of how SCED data should be analysed remains unresolved. This Special Issues includes two papers discussing aspects of conducting SCED studies, five papers illustrating use of SCED methodology in clinical practice, and nine papers that present different methods of SCED data analysis. A final Discussion paper summarises points of agreement, highlights areas where further clarity is needed, and ends with a set of resources that will assist researchers conduct and analyse SCED studies.
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Affiliation(s)
- Jonathan J Evans
- a Institute of Health and Wellbeing , University of Glasgow , Scotland , UK
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Pretz CR, Malec JF, Hammond FM. Longitudinal description of the disability rating scale for individuals in the National Institute on Disability and Rehabilitation Research traumatic brain injury model systems national database. Arch Phys Med Rehabil 2013; 94:2478-2485. [PMID: 23827348 DOI: 10.1016/j.apmr.2013.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/01/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To develop a detailed understanding of temporal change (ie, estimated trajectories) at the individual level as measured by the Disability Rating Scale (DRS). DESIGN Individual growth curve (IGC) analysis of retrospective data obtained from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury (TBI) Model Systems National Database. SETTING Multicenter longitudinal database study. PARTICIPANTS Individuals with TBI (N=8816) participating in the TBI Model Systems National Database project. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE DRS RESULTS The negative exponential consisting of 3 growth parameters (pseudointercept, asymptote, rate) was successfully used to predict trajectory of recovery on the DRS qualified by the following covariates: race, sex, level of education and age at admission, rehabilitation length of stay, and cognitive and motor FIM scores at rehabilitation admission. Based on these results, an interactive tool was developed to allow prediction of the trajectory of recovery for individuals and subgroups with specified characteristics on the selected covariates. CONCLUSIONS With the use of IGC analysis, the longitudinal trajectory of recovery on the DRS for individuals sharing common characteristics and traits can be described. This methodology allows researchers and clinicians to predict numerous individual-level trajectories through use of a web-based computer automated interactive tool.
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Affiliation(s)
- Christopher R Pretz
- Craig Hospital, Englewood, CO; Traumatic Brain Injury National Statistical and Data Center, Englewood, CO.
| | - James F Malec
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
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Dawson DR, Binns MA, Hunt A, Lemsky C, Polatajko HJ. Occupation-based strategy training for adults with traumatic brain injury: a pilot study. Arch Phys Med Rehabil 2013; 94:1959-63. [PMID: 23796683 DOI: 10.1016/j.apmr.2013.05.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate, before undertaking a larger trial, feasibility of the study processes to determine the effectiveness of occupation-based strategy training for producing changes on trained real-world behaviors, and to determine whether far transfer of training effects to measures of real-world impact, including participation in everyday life, could be achieved. DESIGN Partially randomized controlled trial with pre- and postintervention assessments done by assessors masked to the treatment arm. SETTING Testing occurred at a research institute, interventions at participants' homes. PARTICIPANTS People (N=13) with chronic traumatic brain injury (TBI), 7 in the experimental group (mean age, 42.6y; mean time post-TBI, 9.8y; 4 men) and 6 in the control arm (mean age, 40.5y; mean time post-TBI, 10.8y; 3 men), were assessed immediately before and after the intervention phase. INTERVENTION Occupation-based strategy training, an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP), was provided in two 1-hour sessions per week for 10 weeks. MAIN OUTCOME MEASURES Canadian Occupational Performance Measure, Dysexecutive Questionnaire, Mayo-Portland Adaptability Inventory-4 Participation Index, and Assessment of Motor and Process Skills. RESULTS The study processes (testing and intervention) were acceptable to all participants. Evidence of far transfer was found as the experimental group improved significantly more than the control group on performance and satisfaction with performance ratings on untrained goals (P<.05), and reported increased levels of participation (P<.01). CONCLUSIONS Findings must be interpreted with caution since the sample is small and comparisons are made with a no-treatment control. Nevertheless, they suggest that the training is feasible and a larger trial warranted.
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Whyte J, Nakase-Richardson R, Hammond FM, McNamee S, Giacino JT, Kalmar K, Greenwald BD, Yablon SA, Horn LJ. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil 2013; 94:1855-60. [PMID: 23732164 DOI: 10.1016/j.apmr.2012.10.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/05/2012] [Accepted: 10/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation. DESIGN Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems (TBIMS). SETTING Inpatient rehabilitation hospitals participating in the TBIMS program. PARTICIPANTS Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM items. RESULTS For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years. CONCLUSIONS Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.
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Affiliation(s)
- John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA.
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