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Syed RIB, Hangody LR, Frischmann G, Kós P, Kopper B, Berkes I. Comparative Effectiveness of Supervised and Home-Based Rehabilitation after Anterior Cruciate Ligament Reconstruction in Competitive Athletes. J Clin Med 2024; 13:2245. [PMID: 38673520 PMCID: PMC11051221 DOI: 10.3390/jcm13082245] [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] [Received: 03/06/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: After the increasingly common anterior cruciate ligament reconstruction (ACLR) procedure in competitive athletes, rehabilitation is crucial for facilitating a timely return to sports (RTS) and preventing re-injury. This pilot study investigates the patient-reported outcomes of postoperative rehabilitation in competitive athletes, comparing supervised rehabilitation (SVR) and home-based rehabilitation (HBR). Methods: After ACLR, 60 (out of 74 screened) athletes were recruited and equally divided into HBR and SVR groups using non-probability convenience sampling, with each group comprising 15 males and 15 females. The rehabilitation outcomes in the respective groups were evaluated at 8 months using measures (Tegner Activity Scale [TAS], International Knee Documentation Committee subjective knee form [IKDC-SKF], ACL Return to Sport after Injury [ACL-RSI]) and objective parameters (isometric muscle strength, hamstring/quadricep asymmetry). RTS was evaluated at 9 months, with ACL re-injury rates recorded approximately 6 months post-RTS. Results: Both groups exhibited decreased TAS scores (HBR: 8 to 6, SVR: 8 to 7), with the SVR group demonstrating superior postoperative IKDC-SKF scores (81.82 vs. 68.43) and lower ACL-RSI scores (49.46 vs. 55.25). Isometric and isokinetic muscle strength, along with asymmetry values, was higher in the SVR group 8 months post-ACLR (p < 0.05). The SVR group showed a higher RTS rate to the same level (76.6% vs. 53.3%), while the re-injury rate was the same in both the rehabilitation groups (3.3%). Conclusions: Although both rehabilitation approaches yielded comparable outcomes, SVR may demonstrate some superior biomechanical improvements in athletes, resulting in a higher RTS rate. However, the psychological outcomes and re-injury rates did not significantly differ between the groups, emphasizing the need to address individual psychological needs during rehabilitation. Further investigation is recommended with a larger sample size to address the differences of gender among competitive athletes.
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Affiliation(s)
| | | | - Gergely Frischmann
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Petra Kós
- Biomechanics Lab, TSO Medical Hungary Kft., 1118 Budapest, Hungary; (G.F.); (P.K.)
| | - Bence Kopper
- Department of Biomechanics, Hungarian University of Sports Science, 1123 Budapest, Hungary;
| | - István Berkes
- Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Traumatology, Semmelweis University, 1085 Budapest, Hungary;
- Department of Health Sciences and Sport Medicine, Hungarian University of Sports Science, 1123 Budapest, Hungary
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Petrosyan H, Leonardi C, Thakral A, Roth J, Russoniello N, Goldin Y, Parikh S. Barriers and factors associated with adherence to a home exercise program of adults with musculoskeletal pain. J Back Musculoskelet Rehabil 2024; 37:473-485. [PMID: 38108342 DOI: 10.3233/bmr-230178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Home exercise programs (HEPs) are cost-effective and efficacious treatments for musculoskeletal pain conditions. Although HEPs are an important part of the continuum of care, non-adherence limits their effectiveness. OBJECTIVE The objective of this study was to examine adherence and specific barriers to clinician-prescribed HEPs in adults with musculoskeletal pain. METHODS A cross-sectional study was conducted with a total of 300 patients presenting to an outpatient pain clinic in an academic medical center. Participants' self-reported information, including HEP completion frequency and barriers, was collected through a survey. RESULTS The participants' mean age was 54.1 ± 15.8 years (females = 133 (65.5%)). Of 203 participants, 99 (48.8%) adhered to HEP, 56 (27.6%) partially adhered, and 48 (23.6%) did not adhere. One hundred eighty-seven (92.1%) participants reported receiving adequate instructions, and 175 (86.2%) reported receiving instructional materials. Age and "sufficient instructions" were found to be significant determinants of adherence (p< 0.05), while gender and handouts were not (p> 0.05). Pain in more than one body part was significantly (p< 0.05) associated with motivational barriers for non-adherence. CONCLUSION Age and participants' perception of sufficient instructions were significant factors for non-adherence. These results emphasize the importance of therapist-provided instructions to overcome barriers to adherence.
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Affiliation(s)
- Hayk Petrosyan
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher Leonardi
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aakash Thakral
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Jason Roth
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Nicholas Russoniello
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Yelena Goldin
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Sagar Parikh
- International Spine Pain and Performance Center, Washington, DC, USA
- Center for Interventional Pain and Spine, Wilmington, DE, USA
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Yang W, Du Y, Chen M, Li S, Zhang F, Yu P, Xu X. Effectiveness of Home-Based Telerehabilitation Interventions for Dysphagia in Patients With Head and Neck Cancer: Systematic Review. J Med Internet Res 2023; 25:e47324. [PMID: 37682589 PMCID: PMC10517384 DOI: 10.2196/47324] [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: 03/16/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Multimodal treatment-induced dysphagia has serious negative effects on survivors of head and neck cancer. Owing to advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing exercises, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation in the context of the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear. OBJECTIVE This systematic review aimed to examine the evidence regarding the efficacy of telerehabilitation for reducing physiological and functional impairments related to swallowing and for improving adherence and related influencing factors among head and neck cancer survivors. METHODS The PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases were systematically searched up to July 2023 to identify relevant articles. In total, 2 investigators independently extracted the data and assessed the methodological quality of the included studies using the quality assessment tool of the Joanna Briggs Institute. RESULTS A total of 1465 articles were initially identified; ultimately, 13 (0.89%) were included in the systematic review. The quality assessment indicated that the included studies were of moderate to good quality. The results showed that home-based telerehabilitation improved the safety of swallowing and oral feeding, nutritional status, and swallowing-related quality of life; reduced negative emotions; improved swallowing rehabilitation adherence; was rated by participants as highly satisfactory and supportive; and was cost-effective. In addition, this review investigated factors that influenced the efficacy of telerehabilitation, which included striking a balance among swallowing training strategy, intensity, frequency, duration, and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational, and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems. CONCLUSIONS Home-based telerehabilitation has shown great potential in reducing the safety risks of swallowing and oral feeding, improving quality of life and adherence, and meeting information needs for dysphagia among survivors of head and neck cancer. However, this review highlights limitations in the current literature, and the current research is in its infancy. In addition, owing to the diversity of patient sociodemographic, medical, physiological and functional swallowing, and behavioral factors, we recommend the development of tailored telemedicine interventions to achieve the best rehabilitation effects with the fewest and most precise interventions.
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Affiliation(s)
- Wenwen Yang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Yifei Du
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Mengran Chen
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Sufang Li
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Fan Zhang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Peiyang Yu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Xiaoxia Xu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
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Cunha B, Ferreira R, Sousa ASP. Home-Based Rehabilitation of the Shoulder Using Auxiliary Systems and Artificial Intelligence: An Overview. Sensors (Basel) 2023; 23:7100. [PMID: 37631637 PMCID: PMC10459225 DOI: 10.3390/s23167100] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.
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Affiliation(s)
- Bruno Cunha
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health-Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
| | - Ricardo Ferreira
- Institute for Systems and Computer Engineering, Technology and Science—Telecommunications and Multimedia Centre, FEUP, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health-Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
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Arntz A, Weber F, Handgraaf M, Lällä K, Korniloff K, Murtonen KP, Chichaeva J, Kidritsch A, Heller M, Sakellari E, Athanasopoulou C, Lagiou A, Tzonichaki I, Salinas-Bueno I, Martínez-Bueso P, Velasco-Roldán O, Schulz RJ, Grüneberg C. Technologies in Home-Based Digital Rehabilitation: Scoping Review. JMIR Rehabil Assist Technol 2023; 10:e43615. [PMID: 37253381 PMCID: PMC10415951 DOI: 10.2196/43615] [Citation(s) in RCA: 1] [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: 10/18/2022] [Revised: 03/10/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. METHODS The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. RESULTS A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. CONCLUSIONS Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.
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Affiliation(s)
- Angela Arntz
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
- Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
- Department of Rehabilitation, Physiotherapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marietta Handgraaf
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
| | - Kaisa Lällä
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Katariina Korniloff
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Kari-Pekka Murtonen
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Julija Chichaeva
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Anita Kidritsch
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Mario Heller
- Department of Media & Digital Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Evanthia Sakellari
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | | | - Areti Lagiou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | - Ioanna Tzonichaki
- Department of Occupational Therapy, University of West Attica, Athens, Greece
| | - Iosune Salinas-Bueno
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pau Martínez-Bueso
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Olga Velasco-Roldán
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
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Moita Gonçalves E, Alves B, Antunes F, Vítor Gonçalves J, Aleixo C, Vilaverde D, Maçães F, Correia R, Andrade I, Ferreira A. Home-Based Rehabilitation Following Subtalar Dislocation: A Case Report. Cureus 2023; 15:e41348. [PMID: 37408937 PMCID: PMC10318596 DOI: 10.7759/cureus.41348] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 07/07/2023] Open
Abstract
The demand for physical medicine and rehabilitation services has risen significantly. Immediate rehabilitation is not always readily available which may compromise patients' functional recovery. Here, we describe a rare subtalar dislocation case and how an unsupervised home-based rehabilitation program allowed functional recovery. A 49-year-old male presented to the emergency department with an injury to the right ankle which resulted from a 3-meter height fall with his foot in plantar flexion and inversion. Clinical and imaging findings confirmed a diagnosis of a rare case of subtalar dislocation. The post-injury AOFAS Ankle-Hindfoot Scale score was 24/100 points. After six weeks of immobilization, a patient-tailored home-based rehabilitation program was prescribed. Adherence to our home-based rehabilitation program was critical to allow a range-of-motion improvement and functional recovery. Delaying rehabilitation may lead to long-term functional impairments. Thus, acknowledging the post-acute period as critical to initiate rehabilitation is mandatory. When outpatient rehabilitation settings are not readily available due to high demand, comprehensive patient education, and home-based rehabilitation programs may constitute effective alternative interventions. We demonstrate the significant improvement obtained with an early patient-tailored home-based rehabilitation program in range-of-motion and functional outcomes in a case of medial subtalar dislocation.
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Affiliation(s)
- Eugénio Moita Gonçalves
- Physical Medicine and Rehabilitation, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
- Research, Faculty of Medicine, University of Porto, Porto, PRT
- Research, Egas Moniz Health Alliance Clinical Academic Center, Aveiro, PRT
| | - Belmiro Alves
- Orthopedics and Traumatology, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - Francisco Antunes
- Medical Imaging, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - José Vítor Gonçalves
- Physical Medicine and Rehabilitation, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - Catarina Aleixo
- Orthopedics and Traumatology, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - Daniel Vilaverde
- Orthopedics and Traumatology, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - Filipe Maçães
- Orthopedics and Traumatology, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
| | - Rodrigo Correia
- Physical Medicine and Rehabilitation, Vila Nova de Gaia/Espinho Hospital Center, North Rehabilitation Center, Gaia, PRT
| | - Inês Andrade
- Physical Medicine and Rehabilitation, Alcoitão Rehabilitation Medicine Center, Lisbon, PRT
| | - Andreia Ferreira
- Orthopedics and Traumatology, Vila Nova de Gaia/Espinho Hospital Center, Porto, PRT
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Choi JY, Yi SH, Shim D, Yoo B, Park ES, Rha DW. Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial. Front Pediatr 2023; 11:1131573. [PMID: 37274815 PMCID: PMC10233002 DOI: 10.3389/fped.2023.1131573] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration CRIS.nih.go.kr: identifier KCT0003172.
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Affiliation(s)
- Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sook-hee Yi
- Department of Physical and Rehabilitation Medicine, Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Morgan S, Visovsky C, Thomas B, Klein AB, Ji M, Schwab L, Coury J. Home-Based Pilot Pulmonary Program for Dyspneic Patients Post-COVID-19. Clin Nurs Res 2023; 32:895-901. [PMID: 37132243 PMCID: PMC10158807 DOI: 10.1177/10547738231170496] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
It is estimated that at least 10% of people who have had COVID-19 will experience ongoing symptoms such as shortness of breath, fatigue, and cognitive disturbances. Pulmonary exercise has demonstrated improved dyspnea outcomes in other respiratory conditions. Thus, the purpose of this study was to assess the efficacy of a home-based pulmonary rehabilitation program in post-COVID-19 survivors who continue to experience dyspnea. This was a longitudinal, single group pilot study in which 19 patients received a home-based expiratory muscle strength training program over 12 weeks. Outcomes measured at baseline, 6 weeks, and 12 weeks included pulmonary symptoms, functional performance, thoracic expansion, forced expiratory volume, and expiratory resistance measures. Significant improvements were found in pulmonary symptoms (p < .001), functional performance (p = .014), and progressive expiratory resistance capabilities (p < .001). A home-based pulmonary program may be an inexpensive strategy for post-COVID-19 survivors who continue to experience dyspnea.
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Affiliation(s)
| | | | | | | | - Ming Ji
- University of South Florida, Tampa, USA
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Krkoska P, Vlazna D, Sladeckova M, Minarikova J, Barusova T, Batalik L, Dosbaba F, Vohanka S, Adamova B. Adherence and Effect of Home-Based Rehabilitation with Telemonitoring Support in Patients with Chronic Non-Specific Low Back Pain: A Pilot Study. Int J Environ Res Public Health 2023; 20:1504. [PMID: 36674258 PMCID: PMC9860722 DOI: 10.3390/ijerph20021504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Home-based exercises have been on the rise recently. This pilot study aimed to assess the adherence and effect of a home-based rehabilitation programme using telemonitoring in patients with chronic non-specific low back pain (CNLBP). Twenty-seven patients with CNLBP were enrolled in the study, each of whom underwent a neurological assessment, including patient-oriented measures and a functional assessment-a battery of tests that comprehensively evaluated trunk muscle function. The rehabilitation programme lasted 18 weeks and included daily home-based exercises. A mobile application or an exercise diary was used to monitor compliance. Adherence to the programme was excellent for both the diary and mobile application groups, with 82.3% in the diary group exercising at least once a day and 72.9% twice a day, and 94.8% in the mobile application group exercising at least once a day and 86.6% twice a day. Both patient-oriented and functional outcomes improved significantly; however, the relative changes of the parameters in these two groups did not correlate, which supports the idea that trunk muscle function does not directly relate to patient complaints and that CNLBP is a multifactorial issue. This model of rehabilitation programme should be used in clinical practice, as its adherence and effectiveness seem noticeable.
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Affiliation(s)
- Peter Krkoska
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Daniela Vlazna
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Michaela Sladeckova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Jitka Minarikova
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Tamara Barusova
- Institute of Biostatistics and Analysis Ltd., 602 00 Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Stanislav Vohanka
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Blanka Adamova
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, 625 00 Brno, Czech Republic
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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10
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Kim GJ, Lebovich S, Rand D. Perceived Facilitators and Barriers for Actual Arm Use during Everyday Activities in Community Dwelling Individuals with Chronic Stroke. Int J Environ Res Public Health 2022; 19:11707. [PMID: 36141980 PMCID: PMC9516989 DOI: 10.3390/ijerph191811707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. METHODS Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis. RESULTS Six participants 5-18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence, and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents). CONCLUSION Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of ac-cidents. Social support was both a facilitator and a barrier. Our results support the growing call to adopt a broader biopsychosocial framework into rehabilitation delivery.
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Affiliation(s)
- Grace J. Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA
| | - Shir Lebovich
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Occupational Therapy Services, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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11
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Voorn MJJ, Bongers BC, van Kampen-van den Boogaart VEM, Driessen EJM, Janssen-Heijnen MLG. Feasibility of Rehabilitation during Chemoradiotherapy among Patients with Stage III Non-Small Cell Lung Cancer: A Proof-of-Concept Study. Cancers (Basel) 2022; 14:cancers14102387. [PMID: 35625990 PMCID: PMC9139205 DOI: 10.3390/cancers14102387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/28/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Rehabilitation during chemoradiotherapy (CHRT) might (partly) prevent reduction in physical fitness and nutritional status and could improve treatment tolerance in patients with stage III non-small cell lung cancer (NSCLC). The aim of this proof-of-concept study was to investigate the feasibility of a multimodal program for rehabilitation during CHRT. A home-based multimodal rehabilitation program (partly supervised moderate-intensity physical exercise training and nutritional support) during CHRT was developed in collaboration with patients with stage III NSCLC and specialized healthcare professionals. A predetermined number of six patients with stage III NSCLC (aged > 50 years) who underwent CHRT and participated in this program were monitored in detail to assess its feasibility for further development and optimization of the program. The patient’s level of physical functioning (e.g., cardiopulmonary exercise test, six-minute walking test, handgrip strength, body mass index, fat free mass index, energy and protein intake) was evaluated in order to provide personalized advice regarding physical exercise training and nutrition. The program appeared feasible and well-tolerated. All six included patients managed to perform the assessments. Exercise session adherence was high in five patients and low in one patient. The performed exercise intensity was lower than prescribed for all patients. Patients were motivated to complete the home-based rehabilitation program during CHRT. Preliminary effects on physical and nutritional parameters revealed relatively stable values throughout CHRT, with inter-individual variation. Supervised and personalized rehabilitation in patients with stage III NSCLC undergoing CHRT seems feasible when the intensity of the physical exercise training was adjusted to the possibilities and preferences of the patients. Future research should investigate the feasibility of a supervised and personalized rehabilitation program during CHRT with a low-to-moderate exercise intensity with the aim to prevent physical decline during CHRT.
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Affiliation(s)
- Melissa J. J. Voorn
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (E.J.M.D.); (M.L.G.J.-H.)
- Adelante Rehabilitation Centre, 5912 BL Venlo, The Netherlands
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-77-320-6905
| | - Bart C. Bongers
- Department of Nutrition and Movement Sciences, (NUTRIM) School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands;
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Elisabeth J. M. Driessen
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (E.J.M.D.); (M.L.G.J.-H.)
| | - Maryska L. G. Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands; (E.J.M.D.); (M.L.G.J.-H.)
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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12
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Holthe IL, Rohrer-Baumgartner N, Svendsen EJ, Hauger SL, Forslund MV, Borgen IMH, Øra HP, Kleffelgård I, Strand-Saugnes AP, Egeland J, Røe C, Wade SL, Løvstad M. Feasibility and Acceptability of a Complex Telerehabilitation Intervention for Pediatric Acquired Brain Injury: The Child in Context Intervention (CICI). J Clin Med 2022; 11:2564. [PMID: 35566690 DOI: 10.3390/jcm11092564] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 03/29/2022] [Revised: 04/23/2022] [Accepted: 04/30/2022] [Indexed: 12/14/2022] Open
Abstract
The current study is a feasibility study of a randomized controlled trial (RCT): the Child in Context Intervention (CICI). The CICI study is an individualized, goal-oriented and home-based intervention conducted mainly through videoconference. It targets children with ongoing challenges (physical, cognitive, behavioral, social and/or psychological) after acquired brain injury (ABI) and their families at least one year post injury. The CICI feasibility study included six children aged 11–16 years with verified ABI-diagnosis, their families and their schools. The aim was to evaluate the feasibility of the intervention components, child and parent perceptions of usefulness and relevance of the intervention as well as the assessment protocol through a priori defined criteria. Overall, the families and therapists rated the intervention as feasible and acceptable, including the videoconference treatment delivery. However, the burden of assessment was too high. The SMART-goal approach was rated as useful, and goal attainment was high. The parents’ ratings of acceptability of the intervention were somewhat higher than the children’s. In conclusion, the CICI protocol proved feasible and acceptable to families, schools and therapists. The assessment burden was reduced, and adjustments in primary outcomes were made for the definitive RCT.
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13
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Wang H, Ghazi M, Chandrashekhar R, Rippetoe J, Duginski GA, Lepak LV, Milhan LR, James SA. User Participatory Design of a Wearable Focal Vibration Device for Home-Based Stroke Rehabilitation. Sensors (Basel) 2022; 22:3308. [PMID: 35590997 PMCID: PMC9105527 DOI: 10.3390/s22093308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Stroke often leads to the significant impairment of upper limb function and is associated with a decreased quality of life. Despite study results from several interventions for muscle activation and motor coordination, wide-scale adoption remains largely elusive due to under-doses and low user compliance and participation. Recent studies have shown that focal vibration has a greater potential to increase and coordinate muscle recruitment and build muscle strength and endurance. This form of treatment could widely benefit stroke survivors and therapists. Thus, this study aimed to design and develop a novel wearable focal vibration device for upper limb rehabilitation in stroke survivors. A user participatory design approach was used for the design and development. Five stroke survivors, three physical therapists, and two occupational therapists were recruited and participated. This pilot study may help to develop a novel sustainable wearable system providing vibration-based muscle activation for upper limb function rehabilitation. It may allow users to apply the prescribed vibratory stimuli in-home and/or in community settings. It may also allow therapists to monitor treatment usage and user performance and adjust the treatment doses based on progression.
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Affiliation(s)
- Hongwu Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32603, USA
| | - Mustafa Ghazi
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | | | - Josiah Rippetoe
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Grace A Duginski
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Louis V Lepak
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Lisa R Milhan
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
| | - Shirley A James
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA
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14
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Lee H, Lee SH. Effectiveness of Multicomponent Home-Based Rehabilitation in Elderly Patients after Hip Fracture Surgery: A Randomized Controlled Trial. J Pers Med 2022; 12:jpm12040649. [PMID: 35455765 PMCID: PMC9027847 DOI: 10.3390/jpm12040649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022] Open
Abstract
This randomized controlled study aimed to assess the clinical effectiveness of an 8-week personalized multicomponent home-based rehabilitation (MHR) program by comparing it with a home exercise program after discharge. Forty patients (≥60 years old) who underwent hip surgery were randomly assigned to multicomponent home-based rehabilitation (MHR) and home exercise groups. The MHR program included strength, endurance, balance, and breathing exercises; modifications to the home environment; education on assistive device use; pressure ulcer care; nutrition management; and motivational counseling. The MHR group received 24 visits from rehabilitation staff for 8 weeks (3 times a week), while the home exercise group received home exercises focusing on strengthening described in the leaflet. The rehabilitation staff prescribed the intensity of exercise at the first visit, and the home exercise group exercised without supervision after that for 8 weeks. Both groups received a 10-min phone call once a week for overall counseling to ensure high adherence to home exercises. Among the 40 participants, 29 (72.5%) completed the trial. The primary outcomes were balance and mobility. Balance was assessed using the functional reach test (FRT), and the timed up-and-go test (TUG) was used to assess balance and mobility. Data were analyzed using the intention-to-treat principle. The MHR group showed significant improvement compared to the home exercise group for FRT (mean difference (MD) 4.4 cm; 95% confidence interval (CI) 1.0 to 7.8) and TUG (MD: −4.2 s; 95% CI −8.0 to −0.3) after 8 weeks of intervention. Subjective pain and physical components of general health-related quality of life also improved significantly in the MHR group. No serious adverse events related to the interventions were observed. The eight-week of MHR program can effectively improve balance and mobility.
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Affiliation(s)
- Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea;
| | - Seon-Heui Lee
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-42301; Fax: +82-32-820-4201
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15
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Lencioni T, Meloni M, Bowman T, Marzegan A, Caronni A, Carpinella I, Castagna A, Gower V, Ferrarin M, Pelosin E. Events Detection of Anticipatory Postural Adjustments through a Wearable Accelerometer Sensor Is Comparable to That Measured by the Force Platform in Subjects with Parkinson's Disease. Sensors (Basel) 2022; 22. [PMID: 35408282 DOI: 10.3390/s22072668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023]
Abstract
Out-of-the-lab instrumented gait testing focuses on steady-state gait and usually does not include gait initiation (GI) measures. GI involves Anticipatory Postural Adjustments (APAs), which propel the center of mass (COM) forward and laterally before the first step. These movements are impaired in persons with Parkinson’s disease (PD), contributing to their pathological gait. The use of a simple GI testing system, outside the lab, would allow improving gait rehabilitation of PD patients. Here, we evaluated the metrological quality of using a single inertial measurement unit for APA detection as compared with the use of a gold-standard system, i.e., the force platforms. Twenty-five PD and eight elderly subjects (ELD) were asked to initiate gait in response to auditory stimuli while wearing an IMU on the trunk. Temporal parameters (APA-Onset, Time-to-Toe-Off, Time-to-Heel-Strike, APA-Duration, Swing-Duration) extracted from the accelerometric data and force platforms were significantly correlated (mean(SD), r: 0.99(0.01), slope: 0.97(0.02)) showing a good level of agreement (LOA [s]: 0.04(0.01), CV [%]: 2.9(1.7)). PD showed longer APA-Duration compared to ELD ([s] 0.81(0.17) vs. 0.59(0.09) p < 0.01). APA parameters showed moderate correlation with the MDS-UPDRS Rigidity, Characterizing-FOG questionnaire and FAB-2 planning. The single IMU-based reconstruction algorithm was effective in measuring APAs timings in PD. The current work sets the stage for future developments of tele-rehabilitation and home-based exercises.
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16
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Cho K, Kang A. Home-based rehabilitation in patients over 60 with stabilized ankylosing spondylitis during the COVID-19 pandemic. J Back Musculoskelet Rehabil 2022; 35:261-269. [PMID: 34806597 DOI: 10.3233/bmr-210153] [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: 02/04/2023]
Abstract
BACKGROUND COVID-19 has become a significant healthcare issue, particularly challenging for patients with ankylosing spondylitis (AS), because immune-related diseases and their treatments could adversely affect the susceptibility to or severity of a viral infection. OBJECTIVE This study is conducted to present an exercise rehabilitation program that patients older than 60 years with AS can do at home during the COVID-19 pandemic. METHODS Three Delphi surveys were conducted to reach a consensus on home-based rehabilitation programs. This study recruited ten experts and performed three Delphi rounds for a month. RESULTS The expert panel suggested that home-based rehabilitation for the patients should be carried out with a clear rehabilitation goal. Their final recommendations are to institute a program aimed to ease symptoms, such as pain and stiffness; encourage patients to consult with experts regularly to ensure that they perform exercise rehabilitation properly at home; add fast walking and stretching to the rehabilitation program; and see if indoor cycling, Pilates, or yoga could be appropriate. CONCLUSIONS This study suggests that patients with AS over 60 should repeat low-intensity exercises, such as stretching, for an hour a day, four to six times a week during the COVID-19 pandemic.
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Affiliation(s)
- Kyunghwan Cho
- Department of Health Rehabilitation, Hanshin University, Korea
| | - Austin Kang
- Department of Forensic Medicine, Seoul National University, Korea
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17
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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18
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Polgar O, Patel S, Walsh JA, Barker RE, Ingram KA, Kon SS, Man WD, Nolan CM. Digital habits of pulmonary rehabilitation service-users following the COVID-19 pandemic. Chron Respir Dis 2022; 19:14799731221075647. [PMID: 35195025 PMCID: PMC8872816 DOI: 10.1177/14799731221075647] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We previously demonstrated low levels of digital literacy amongst pulmonary rehabilitation service-users prior to the COVID-19 pandemic. We aimed to identify whether the pandemic accelerated digital literacy in this population, resulting in greater acceptance of remote web-based pulmonary rehabilitation programme models. METHODS We surveyed digital access and behaviours and pulmonary rehabilitation delivery preferences of service-users referred to pulmonary rehabilitation in 2021 (cohort 2021) and propensity score-matched them to a cohort who completed the survey in 2020 (cohort 2020). RESULTS There were indicators that digital access and confidence were better amongst the Cohort 2021 but no difference was seen in the proportion of patients choosing remote web-based pulmonary rehabilitation as an acceptable method of receiving pulmonary rehabilitation. CONCLUSION In an unselected cohort of service-users, remote web-based pulmonary rehabilitation was considered acceptable in only a minority of patients which has implications on healthcare commissioning and delivery of pulmonary rehabilitation.
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Affiliation(s)
- Oliver Polgar
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, 4615Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, 4615Imperial College London, London, UK.,586157Wessex Academic Health Science Network, Southampton, UK
| | - Karen A Ingram
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, 8945Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Samantha Sc Kon
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK.,Hillingdon Integrated Respiratory Service, London, UK
| | - William Dc Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK.,National Heart and Lung Institute, 4615Imperial College London, London, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, 8945Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, 8945Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Health Sciences, College of Health, Medicine and Life Sciences, 3890Brunel University London, Uxbridge, UK
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19
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Li C, Song X, Chen S, Wang C, He J, Zhang Y, Xu S, Yan Z, Jia J, Shull P. Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial. JMIR Serious Games 2021; 9:e30184. [PMID: 34817390 PMCID: PMC8663710 DOI: 10.2196/30184] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/15/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background A serious game–based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient’s acceptance of the proposed system. Methods A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients’ adoption of the system in the experimental group after the final intervention. Results All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group’s FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz
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Affiliation(s)
- Chong Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinyu Song
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuankai Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jieying He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongli Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuo Xu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhijie Yan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
| | - Peter Shull
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
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20
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Lee H, Lee SH. Analysis of Home-Based Rehabilitation Awareness, Needs and Preferred Components of Elderly Patients with Hip Fracture Surgery in South Korea. Int J Environ Res Public Health 2021; 18:ijerph18147632. [PMID: 34300083 PMCID: PMC8306015 DOI: 10.3390/ijerph18147632] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
The importance and necessity of home-based rehabilitation with professional and systematic interventions should be considered since home-based rehabilitation has been institutionalized as it is more feasible, cost effective, and even safer than in-hospital rehabilitation in most countries—though not in South Korea. In addition, the need for home-based rehabilitation is increasing due to the increasing number of hip fracture patients and limited capacity of acute hospital rehabilitation. Therefore, the purpose of this study was to investigate the awareness, needs, and preferred components of home-based rehabilitation services after discharge for elderly patients with hip fracture surgery in South Korea. A survey of 98 elderly patients who recently underwent hip fracture surgery was performed using a questionnaire. More than 75% of patients agreed on the need for home-based rehabilitation, even though most had never heard of it. The reason for the need for home-based rehabilitation was that it is possible to receive continuously ongoing treatment (53.0%), and it alleviates the inconvenience of visiting hospitals (27.7%). In addition to this, about 15.7% of patients responded that they could achieve mental comfort. In other words, patients can recover in an emotionally stable environment without the psychological anxiety they might experience in hospital. Thus, in order to maximize the effectiveness of home-based rehabilitation and provide comprehensive guidance including exercise, education, motivational support, and environmental modification, to patients undergoing hip fracture surgery, the component of the rehabilitation program must be developed based upon rehabilitation experts’ knowledge and patients’ value. Additionally, corresponding policies should be established.
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Affiliation(s)
- Haneul Lee
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea;
| | - Seon-Heui Lee
- Department of Nursing, College of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4230
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Rhim HC, Lee JH, Lee SJ, Jeon JS, Kim G, Lee KY, Jang KM. Supervised Rehabilitation May Lead to Better Outcome than Home-Based Rehabilitation Up to 1 Year after Anterior Cruciate Ligament Reconstruction. ACTA ACUST UNITED AC 2020; 57:medicina57010019. [PMID: 33379403 PMCID: PMC7824668 DOI: 10.3390/medicina57010019] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/12/2023]
Abstract
Background and objectives: Previous studies consistently found no significant difference between supervised and home-based rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the function of the nonoperative knee, hamstring strength at deep flexion, and neuromuscular control have been overlooked. This prospective observational study was performed to investigate the outcomes after ACLR in operative and nonoperative knees between supervised and home-based rehabilitations. Materials and Methods: After surgery, instructional videos demonstrating the rehabilitation process and exercises were provided for the home-based rehabilitation group. The supervised rehabilitation group visited our sports medicine center and physical therapists followed up all patients during the entire duration of the study. Isokinetic muscle strength and neuromuscular control (acceleration time (AT) and overall stability index (OSI)) of both operative and nonoperative knees, as well as patient-reported knee function (Lysholm score), were measured and compared between the two groups 6 months and 1 year postoperatively. Results: The supervised rehabilitation group showed higher muscle strength of hamstring and quadriceps in nonoperative knees at 6 months (hamstring, p = 0.033; quadriceps, p = 0.045) and higher hamstring strength in operative and nonoperative knees at 1 year (operative knees, p = 0.035; nonoperative knees, p = 0.010) than the home-based rehabilitation group. At 6 months and 1 year, OSIs in operative and nonoperative knees were significantly better in the supervised rehabilitation group than in the home-based rehabilitation group (operative knees, p < 0.001, p < 0.001; nonoperative knees, p < 0.001, p < 0.001, at 6 months and 1 year, respectively). At 1 year, the supervised rehabilitation group also demonstrated faster AT of the hamstrings (operative knees, p = 0.016; nonoperative knees, p = 0.036). Lysholm scores gradually improved in both groups over 1 year; however, the supervised rehabilitation group showed higher scores at 1 year (87.3 ± 5.8 vs. 75.6 ± 15.1, p = 0.016). Conclusions: This study demonstrated that supervised rehabilitation may offer additional benefits in improving muscle strength, neuromuscular control, and patient-reported knee function compared with home-based rehabilitation up to 1 year after ACLR.
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Affiliation(s)
- Hye Chang Rhim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
| | - Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Seo Jun Lee
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
| | - Jin Sung Jeon
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
| | - Geun Kim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
| | - Kwang Yeol Lee
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (H.C.R.); (S.J.L.); (J.S.J.); (G.K.); (K.Y.L.)
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
- Correspondence: ; Tel.: +82-2-920-6406
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Vourganas I, Stankovic V, Stankovic L. Individualised Responsible Artificial Intelligence for Home-Based Rehabilitation. Sensors (Basel) 2020; 21:E2. [PMID: 33374913 PMCID: PMC7792599 DOI: 10.3390/s21010002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Socioeconomic reasons post-COVID-19 demand unsupervised home-based rehabilitation and, specifically, artificial ambient intelligence with individualisation to support engagement and motivation. Artificial intelligence must also comply with accountability, responsibility, and transparency (ART) requirements for wider acceptability. This paper presents such a patient-centric individualised home-based rehabilitation support system. To this end, the Timed Up and Go (TUG) and Five Time Sit To Stand (FTSTS) tests evaluate daily living activity performance in the presence or development of comorbidities. We present a method for generating synthetic datasets complementing experimental observations and mitigating bias. We present an incremental hybrid machine learning algorithm combining ensemble learning and hybrid stacking using extreme gradient boosted decision trees and k-nearest neighbours to meet individualisation, interpretability, and ART design requirements while maintaining low computation footprint. The model reaches up to 100% accuracy for both FTSTS and TUG in predicting associated patient medical condition, and 100% or 83.13%, respectively, in predicting area of difficulty in the segments of the test. Our results show an improvement of 5% and 15% for FTSTS and TUG tests, respectively, over previous approaches that use intrusive means of monitoring such as cameras.
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Affiliation(s)
- Ioannis Vourganas
- Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow G1 1XW, UK; (V.S.); (L.S.)
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Abstract
BACKGROUND Reablement is a shift from reactive home care to a more preventive model based on active engagement. In this shift, it is interesting to uncover and understand potential discourses that may exist amongst service providers regarding their views of service recipients. AIM to explore and describe discourses of the view of service recipients in the context of reablement, from the service providers' perspective. METHOD Participants were service providers working in reablement, with the analysis being retrieved from 13 focus groups. A critical discourse analysis was used in order to gain a broader understanding and to capture service providers' views. FINDINGS Five discourses were constructed. Three discourses indicated the way participants perceived service recipients included in reablement, namely the competent service recipient, the conventional service recipient, and the perfect service recipient. Two discourses categorised recipients related to whether or not they were included in reablement: the suitable service recipient who was excluded and the unsuitable service recipient who was included. CONCLUSION Service providers use a variety of different discourses when they talk about service recipients. SIGNIFICANCE Service providers, including occupational therapists, must be aware of how unconscious discourses can affect those to whom they provide services.
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Affiliation(s)
- Maria Ranner
- Faculty of Medicine and Health Sciences, Norwegian University of Science Technology, Trondheim, Norway
| | - Kjersti Vik
- Faculty of Medicine and Health Sciences, Norwegian University of Science Technology, Trondheim, Norway
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Chae SH, Kim Y, Lee KS, Park HS. Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study. JMIR Mhealth Uhealth 2020; 8:e17216. [PMID: 32480361 PMCID: PMC7380903 DOI: 10.2196/17216] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/22/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. Objective This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. Methods The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. Results The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80%) was the most accurate compared with accelerometer (5496/5601, 98.13%) or gyroscope data (5381/5601, 96.07%). In the comparative study, the drop-out rates in the control and HBR groups were 40% (4/10) and 22% (5/22) at 12 weeks and 100% (10/10) and 45% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (P=.02) and ROM of flexion (P=.004) and internal rotation (P=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (P=.03). Conclusions This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. Trial Registration Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t
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Affiliation(s)
- Sang Hoon Chae
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Yushin Kim
- Major of Sports Health Rehabilitation, Cheongju University, Cheongju, Republic of Korea
| | - Kyoung-Soub Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hyung-Soon Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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Zhang X, Tang X, Zhu X, Gao X, Chen X, Chen X. A Regression-Based Framework for Quantitative Assessment of Muscle Spasticity Using Combined EMG and Inertial Data From Wearable Sensors. Front Neurosci 2019; 13:398. [PMID: 31130834 PMCID: PMC6509177 DOI: 10.3389/fnins.2019.00398] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/19/2018] [Accepted: 04/08/2019] [Indexed: 01/27/2023] Open
Abstract
There have always been practical demands for objective and accurate assessment of muscle spasticity beyond its clinical routine. A novel regression-based framework for quantitative assessment of muscle spasticity is proposed in this paper using wearable surface electromyogram (EMG) and inertial sensors combined with a simple examination procedure. Sixteen subjects with elbow flexor or extensor (i.e., biceps brachii muscle or triceps brachii muscle) spasticity and eight healthy subjects were recruited for the study. The EMG and inertial data were recorded from each subject when a series of passive elbow stretches with different stretch velocities were conducted. In the proposed framework, both lambda model and kinematic model were constructed from the recorded data, and biomarkers were extracted respectively from the two models to describe the neurogenic component and biomechanical component of the muscle spasticity, respectively. Subsequently, three evaluation methods using supervised machine learning algorithms including single-/multi-variable linear regression and support vector regression (SVR) were applied to calibrate biomarkers from each single model or combination of two models into evaluation scores. Each of these evaluation scores can be regarded as a prediction of the modified Ashworth scale (MAS) grade for spasticity assessment with the same meaning and clinical interpretation. In order to validate performance of three proposed methods within the framework, a 24-fold leave-one-out cross validation was conducted for all subjects. Both methods with each individual model achieved satisfactory performance, with low mean square error (MSE, 0.14 and 0.47) between the resultant evaluation score and the MAS. By contrast, the method using SVR to fuse biomarkers from both models outperformed other two methods with the lowest MSE at 0.059. The experimental results demonstrated the usability and feasibility of the proposed framework, and it provides an objective, quantitative and convenient solution to spasticity assessment, suitable for clinical, community, and home-based rehabilitation.
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Affiliation(s)
- Xu Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiao Tang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaofei Zhu
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaoping Gao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiang Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xun Chen
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
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26
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Hoogland J, Wijnen A, Munsterman T, Gerritsma CLE, Dijkstra B, Zijlstra WP, Annegarn J, Ibarra F, Zijlstra W, Stevens M. Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty. JMIR Mhealth Uhealth 2019; 7:e10342. [PMID: 30702438 PMCID: PMC6374724 DOI: 10.2196/10342] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Recent developments in technology are promising for providing home-based exercise programs. Objective The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. Methods We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). Results Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25% (33/134) and work 15% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale “coaching” and the lowest for the subscale “sensor.” Conclusions A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed.
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Affiliation(s)
- Jildou Hoogland
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Annet Wijnen
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tjerk Munsterman
- Department of Physiotherapy, Martini Hospital Groningen, Groningen, Netherlands
| | - Carina LE Gerritsma
- Department of Orthopedics, Martini Hospital Groningen, Groningen, Netherlands
| | - Baukje Dijkstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Wierd P Zijlstra
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Janneke Annegarn
- Department of Personal Health, Philips Research, Eindhoven, Netherlands
| | | | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Liu X, Li P, Xiao L, Lu Y, Li N, Wang Z, Duan H, Li J, Wu W. Effects of home-based prescribed pulmonary exercise by patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial. Trials 2019; 20:41. [PMID: 30635038 DOI: 10.1186/s13063-018-3149-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Received: 08/29/2018] [Accepted: 12/18/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) not only affects pulmonary function but also leads to skeletal muscle dysfunction. The various characteristics of different forms of traditional Chinese exercise lead to inconsistent clinical effects in COPD patients. Hence, the present study carefully combined and rearranged liuzijue, wuqinxi, baduanjin, and yijinjing into a pulmonary exercise program targeting COPD patients. METHODS/DESIGN This study is a single-blind, randomized controlled trial. A random number table will be generated by an independent person. Each number will be placed in a sealed opaque envelop to blind assignment. All outcome assessors will be blinded to group assignment. COPD patients between 40 and 80 years of age, with stable medical treatment and no regular participation in regular exercise in the last 6 months will be included. All participants will be recruited from the Respiratory Medicine Department of Yue-Yang Integrative Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. All participants will continue to follow their medical treatment. They will be randomly assigned to one of four groups in a 1:1:1:1 ratio: (1) usual care (control group, CG), (2) pulmonary exercise group (PG), (3) resistance exercise group (RG), or (4) combined pulmonary exercise and resistance exercise group (PRG). CG participants will receive medical treatment only. PG participants will perform 60 min of exercise twice a day 7 days a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. RG participants will perform 60 min of resistance exercise once a day, three times a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. PRG participants will perform 60 min of prescribed pulmonary exercise combined with resistance exercise for 3 months. The outcomes include the isokinetic strength of peripheral skeletal muscle, surface electromyography, 6-min walking distance, 30-s arm curl test, pulmonary function, respiratory muscle strength, dyspnea, body composition, physical activity, quality of life, and Chronic Disease Self-Efficacy Scale. DISCUSSION The results of this study will compensate for the current inadequate understanding of prescribed pulmonary exercise and may provide a new, simple, convenient, and effective home-based exercise intervention for COPD patients. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-1800017405 . Registered on 28 July 2018.
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Panerai S, Catania V, Rundo F, Ferri R. Remote Home-Based Virtual Training of Functional Living Skills for Adolescents and Young Adults With Intellectual Disability: Feasibility and Preliminary Results. Front Psychol 2018; 9:1730. [PMID: 30283382 PMCID: PMC6156546 DOI: 10.3389/fpsyg.2018.01730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/29/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Virtual Reality (VR) is acquiring increasing credibility as a tool for teaching independent living skills to people with Intellectual Disability (ID). Generalization of skills acquired during VR training into real environment seems to be feasible. Objective: To assess feasibility and verify effectiveness of a remote home-based rehabilitation, focused on functional living skills, for adolescents and young adults with ID, by using virtual apps installed on tablets. In particular, to assess if this tool can be managed independently, if it is enjoyable and simple to be used, and if the acquired skills can be generalized to the real environment of everyday life. Subjects and method: A single group, pre- and post-test research design was used. Sixteen participants with ID were included. A digital system was arranged, with a server managing communication between the database and the apps installed on tablets. In vivo tests were performed before and after the eleven sessions of VR training. Satisfaction questionnaires were also administered. Results: Statistically significant improvements were found between the pre- and post-in vivo tests, as well as between the VR training sessions, in almost all the parameters taken into account, for each app. Final questionnaires showed a good satisfaction level for both the participants and their families. Conclusion: The highly technological system was managed independently by participants with ID, who found it simple to be used, useful and even fun; generalization across settings was obtained. Results obtained require to be confirmed by future controlled studies, with larger samples.
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Affiliation(s)
| | | | - Francesco Rundo
- Unit of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
| | - Raffaele Ferri
- Unit of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
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29
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de Souza Y, da Silva KM, Condesso D, Figueira B, Noronha Filho AJ, Rufino R, Gosselink R, da Costa CH. Use of a Home-Based Manual as Part of a Pulmonary Rehabilitation Program. Respir Care 2018; 63:1485-1491. [PMID: 30087196 DOI: 10.4187/respcare.05656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/05/2022]
Abstract
BACKGROUND Pulmonary rehabilitation programs improve exercise capacity and quality of life in patients with COPD. Domiciliary strategies to maintain these benefits have been proposed. OBJECTIVE This study aimed to determine whether a rehabilitation manual would facilitate the maintenance of the benefits acquired during out-patient pulmonary rehabilitation. METHODS Fifty subjects with stable COPD were included (26 women and 24 men). All the subjects were evaluated during screening and after 12 wk of out-patient rehabilitation, and then were randomly divided into 2 groups, with one group that received the rehabilitation manual for home use (manual group) and the other group only received verbal recommendations (control group). At this point, the 2 groups were similar. After 12 wk at home, both groups were evaluated a third time. All evaluations included a 6-min walk test (6MWT), 6-min step test, COPD Assessment Test, and measurement of dyspnea by using the modified Medical Research Council dyspnea scale. RESULTS When comparing the results of the 6MWT and 6-min step test done at out-patient discharge and after 12 wk at home, the manual group presented no differences (6MWT, 0 ± 25 m; 6-min step test, 1 ± 32 steps), whereas the control subjects lost part of the gain obtained during rehabilitation (6MWT -46 ± 36 m; 6-min step test -39 ± 33 steps). There was a significant difference between the groups (P < .05). When comparing the same time points, the change in the COPD Assessment Test score was -1 ± 1 for the manual group and 1 ± 2 for the control group (P = .01). For the modified Medical Research Council dyspnea scale, the change in score was 0 ± 1 for the manual group and 1 ± 1 for the control group (P = .01). CONCLUSIONS The use of a simple, well-illustrated manual facilitated the maintenance of the benefits acquired in out-patient pulmonary rehabilitation over a period of 3 months after study termination.
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Affiliation(s)
- Yves de Souza
- Department of Physical Therapy, Veiga de Almeida University, Rio de Janeiro, Rio de Janeiro, Brazil. .,Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kenia Maynard da Silva
- Department of Physical Therapy, Veiga de Almeida University, Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Condesso
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Figueira
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arnaldo J Noronha Filho
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Cláudia H da Costa
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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30
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Abstract
Background: Reablement aims to improve the self-dependence of people with or at risk of functional decline. Physiotherapists (PTs) are responsible for assessments, developing interventions and supervising home trainers (HTs), who mostly conduct the reablement training. The content of reablement practice is not clearly described. This study explores how physiotherapy practice is performed in reablement settings and the content of the service provided to reablement users. Methods: Fieldwork was performed in seven Norwegian reablement teams. We conducted observations of seven triads, including PTs, HTs, and reablement users, followed by interviews with the PTs and HTs. We then conducted a systematic content analysis. Results: Three themes emerged from the analysis: 1) division of labor; 2) assessment; and 3) intervention. Different practices within these three characteristics of practice revealed two typologies of reablement teams. Teams with a fixed division of labor provided limited assessments and a nonspecific approach. Teams with a flexible division of labor were characterized by interdisciplinary collaboration, thorough assessments, and user-tailored interventions. Discussion: Values emphasizing responsivity enable a flexible and individually tailored reablement approach, in contrast to values emphasizing efficiency, which facilitate a nonspecific approach.
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Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nils O Henriksen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siri Moe
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Asiri FY, Marchetti GF, Ellis JL, Otis L, Sparto PJ, Watzlaf V, Whitney SL. Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study. Physiother Theory Pract 2017; 33:943-953. [PMID: 28825517 DOI: 10.1080/09593985.2017.1360422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. METHODS A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. RESULTS Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R2 = 42%). CONCLUSIONS Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.
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Affiliation(s)
- Faisal Y Asiri
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA.,b Department of Rehabilitation Sciences, King Khalid University , Abha , Saudi Arabia
| | - Gregory F Marchetti
- c Department of Physical Therapy, Duquesne University , Pittsburgh , PA , USA
| | | | - Laurie Otis
- d Gentiva Health Services Inc , Atlanta , GA , USA
| | - Patrick J Sparto
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA
| | - Valerie Watzlaf
- e Department of Health Information Management, University of Pittsburgh , Pittsburgh , PA , USA
| | - Susan L Whitney
- a Department of Physical Therapy, University of Pittsburgh , Pittsburgh , PA , USA.,f King Saud University, Rehabilitation Research Chair , Riyadh , Saudi Arabia
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Cobbing S, Chetty V, Hanass-Hancock J, Myezwa H. "Knowing I can be helpful makes me feel good inside, it makes me feel essential": community health care workers' experiences of conducting a home-based rehabilitation intervention for people living with HIV in KwaZulu-Natal, South Africa. AIDS Care 2017; 29:1260-1264. [PMID: 28278572 DOI: 10.1080/09540121.2017.1290208] [Citation(s) in RCA: 5] [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] [Indexed: 10/20/2022]
Abstract
People living with HIV (PLHIV) are living longer lives on antiretroviral therapy and are prone to a wide range of disabilities. Innovative strategies are required to meet the rehabilitation needs of PLHIV, particularly in resource-poor communities where HIV is endemic and access to institution-based rehabilitation is limited. Home-based rehabilitation (HBR) is one such approach, but there is a paucity of research related to HBR programmes for PLHIV or the experiences of community care workers (CCWs) involved in these programmes. Following a four month randomised controlled trial of a HBR intervention designed specifically for PLHIV in KwaZulu-Natal, South Africa; four CCWs were interviewed. This study employed a qualitative research design, using semi-structured interviews to explore these workers' experiences of being involved in carrying out this intervention. Participants reported how their personal development, improvement in their own health and increased feelings of self-worth enabled them to successfully implement the intervention. Participants also described a number of inhibitors, including stigma and environmental challenges related to the distances between patients' homes, the steep terrain and the hot climate. Despite this, the participants felt empowered by acquiring knowledge and skills that enabled them to shift roles beyond rehabilitation provision. The findings of this study should be considered when employing a task shifting approach in the development and implementation of HBR interventions for PLHIV. By employing a less specialised cadre of community workers to conduct basic HBR interventions, both the relative lack of qualified rehabilitation professionals and the high levels of disability in HIV-epidemic communities can be simultaneously addressed.
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Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Verusia Chetty
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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Shelly AG, Prabhu NS, Jirange P, Kamath A, Vaishali K. Quality of Life Improves with Individualized Home-based Exercises in Critical Care Survivors. Indian J Crit Care Med 2017; 21:89-93. [PMID: 28250604 PMCID: PMC5330060 DOI: 10.4103/ijccm.ijccm_433_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/29/2022] Open
Abstract
The Aim of the Study: This study aims to determine the effect of individualized home-based exercise on the quality of life post-Intensive Care Unit (ICU) discharge. Subjects: Adult patients invasively mechanically ventilated for more than 48 h in medical ICU. Methodology: Thirty-five patients were enrolled prospectively in this study. They were interviewed to complete short form 36 (SF-36) version 2 questionnaire and were randomly allocated to control and experimental group by block randomization. The experimental group received individualized exercise information sheet and control group was asked to continue routine exercises done during their hospital stay. The experimental group also received a log book and weekly telephonic reminders. Patients were interviewed to complete the SF-36 through the telephone 4 weeks after hospital discharge. Results: Physical and mental components of the quality of life as measured by the SF-36 at the end of 4 weeks after hospital discharge showed a statistically significant difference (P < 0.05) in the experimental group. Conclusion: A well-structured individualized exercise program improves the quality of life of critically ill patients after discharge.
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Affiliation(s)
- Aayushi G Shelly
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Udupi, Karnataka, India
| | - Nivedita S Prabhu
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Udupi, Karnataka, India
| | - Priyanka Jirange
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Udupi, Karnataka, India
| | - Asha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka, India
| | - K Vaishali
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Udupi, Karnataka, India
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Tuntland H, Kjeken I, Langeland E, Folkestad B, Espehaug B, Førland O, Aaslund MK. Predictors of outcomes following reablement in community-dwelling older adults. Clin Interv Aging 2016; 12:55-63. [PMID: 28096664 PMCID: PMC5207334 DOI: 10.2147/cia.s125762] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. OBJECTIVE The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up. METHODS The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM). RESULTS The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. CONCLUSION The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement.
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Affiliation(s)
- Hanne Tuntland
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen; Centre for Care Research Western Norway, Bergen University College, Bergen
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Eva Langeland
- Centre for Care Research Western Norway, Bergen University College, Bergen; Department of Nursing, Faculty of Health and Social Sciences, Bergen University College
| | - Bjarte Folkestad
- Centre for Care Research Western Norway, Bergen University College, Bergen; Uni Research Rokkan Centre
| | | | - Oddvar Førland
- Centre for Care Research Western Norway, Bergen University College, Bergen; Faculty of Health Studies, VID Specialized University, Campus Bergen, Bergen, Norway
| | - Mona Kristin Aaslund
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen
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Abstract
Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most.
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Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
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Aspinal F, Glasby J, Rostgaard T, Tuntland H, Westendorp RGJ. New horizons: Reablement - supporting older people towards independence. Age Ageing 2016; 45:572-6. [PMID: 27209329 DOI: 10.1093/ageing/afw094] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [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: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 11/13/2022] Open
Abstract
As the overwhelming majority of older people prefer to remain in their own homes and communities, innovative service provision aims to promote independence of older people despite incremental age associated frailty. Reablement is one such service intervention that is rapidly being adopted across high-income countries and projected to result in significant cost-savings in public health expenditure by decreasing premature admission to acute care settings and long-term institutionalisation. It is an intensive, time-limited intervention provided in people's homes or in community settings, often multi-disciplinary in nature, focussing on supporting people to regain skills around daily activities. It is goal-orientated, holistic and person-centred irrespective of diagnosis, age and individual capacities. Reablement is an inclusive approach that seeks to work with all kinds of frail people but requires skilled professionals who are willing to adapt their practise, as well as receptive older people, families and care staff. Although reablement may just seem the right thing to do, studies on the outcomes of this knowledge-based practice are inconsistent-yet there is an emerging evidence and practice base that suggests that reablement improves performance in daily activities. This innovative service however may lead to hidden side effects such as social isolation and a paradoxical increase in hospital admissions. Some of the necessary evaluative research is already underway, the results of which will help fill some of the evidence gaps outlined here.
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Affiliation(s)
- Fiona Aspinal
- Social Policy Research Unit, University of York, Heslington, York YO10 5DD, UK
| | - Jon Glasby
- School of Social Policy, Muirhead Tower, Room 829, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Tine Rostgaard
- KORA - Danish Institute for Local and Regional Government Research, 1150 København K, Denmark
| | - Hanne Tuntland
- Centre for Care Research Western Norway and Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, 5020 Bergen, Norway
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, 1123 Copenhagen K, Denmark
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Abstract
SETTING AND OBJECTIVE The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities. DESIGN AND SUBJECTS In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees--service providers and managers--in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. RESULTS The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. CONCLUSION AND IMPLICATIONS A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. KEY POINTS Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law. The purchaser-provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work. Healthcare providers find themselves squeezed between the health authorities' overarching guidelines and requirements and the possibilities of achieving them. Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.
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Affiliation(s)
- Sissel Steihaug
- SINTEF Technology and Society, Department of Health Research, Blindern, Oslo, Norway
- CONTACT Sissel Steihaug Ekornveien 4, N-0777 Oslo, Norway
| | - Jan-W. Lippestad
- SINTEF Technology and Society, Department of Health Research, Blindern, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Abstract
Stroke is a leading cause of death and disability in adults in sub-Saharan Africa (SSA). Despite its considerable burden, there has been limited progress to properly cater for and rehabilitate stroke survivors. Scarcity of rehabilitation services and grossly inadequate skilled personnel for post stroke care are distressing realities for stroke victims in SSA. There is growing evidence suggesting that home-based rehabilitation for stroke can have functional outcomes similar to patients who receive inpatient neuro-rehabilitation. The acute phase of treatment during hospitalization could be an opportunity to educate families and caregivers on how to care for stroke victims at home and provide home-based rehabilitation and care tailored to their disability. Interventions to vulgarize home-based post-stroke care could be more acceptable, affordable and accessible for victims and families. This could go a long way to palliate to the scarcity of rehabilitation services and reduce stroke related morbidity. We suggest that further research be carried out to ascertain the feasibility of this model in SSA settings, with greater emphasis on the cost effectiveness and sustainability arms of such an intervention.
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Affiliation(s)
- Clovis Nkoke
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde 1, Cameroon ; 2 Department of Military Health, Ministry of Defense, Cameroon and Centre for Population Studies and Health Promotion, Yaounde, Cameroon
| | - Engelbert Bain Luchuo
- 1 Faculty of Medicine and Biomedical Sciences, Department of Internal medicine, University of Yaounde 1, Cameroon ; 2 Department of Military Health, Ministry of Defense, Cameroon and Centre for Population Studies and Health Promotion, Yaounde, Cameroon
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Nasr N, Leon B, Mountain G, Nijenhuis SM, Prange G, Sale P, Amirabdollahian F. The experience of living with stroke and using technology: opportunities to engage and co-design with end users. Disabil Rehabil Assist Technol 2015; 11:653-60. [PMID: 25879304 DOI: 10.3109/17483107.2015.1036469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE We drew on an interdisciplinary research design to examine stroke survivors' experiences of living with stroke and with technology in order to provide technology developers with insight into values, thoughts and feelings of the potential users of a to-be-designed robotic technology for home-based rehabilitation of the hand and wrist. METHOD Ten stroke survivors and their family carers were purposefully selected. On the first home visit, they were introduced to cultural probe. On the second visit, the content of the probe packs were used as prompt to conduct one-to-one interviews with them. The data generated was analysed using thematic analysis. A third home visit was conducted to evaluate the early prototype. RESULTS User requirements were categorised into their network of relationships, their attitude towards technology, their skills, their goals and motivations. The user requirements were used to envision the requirements of the system including providing feedback on performance, motivational aspects and usability of the system. Participants' views on the system requirements were obtained during a participatory evaluation. CONCLUSION This study showed that prior to the development of technology, it is important to engage with potential users to identify user requirements and subsequently envision system requirements based on users' views. Implications for Rehabilitation An understanding of how stroke survivors make sense of their experiences of living with stroke is needed to design home-based rehabilitation technologies. Linking stroke survivors' goals, motivations, behaviour, feelings and attitude to user requirements prior to technology development has a significant impact on improving the design.
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Affiliation(s)
- Nasrin Nasr
- a Rehabilitation and Assistive Technology Group, School of Health and Related Research, University of Sheffield , Sheffield , UK
| | - Beatriz Leon
- b Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire , Hatfield , UK
| | - Gail Mountain
- c Rehabilitation and Assistive Technologies Group, School of Health and Related Research, University of Sheffield , Sheffield , UK
| | | | - Gerdienke Prange
- e Department of Mechanical Engineering , University of Twente , Enschede , the Netherlands
| | | | - Farshid Amirabdollahian
- g Adaptive Systems: Assistive and Rehabilitation Robotics Laboratory, School of Computer Science, University of Hertfordshire , Hatfield , UK
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Kraut JC, Singer BJ, Singer KP. Referrer and service provider beliefs and attitudes towards rehabilitation in the home; factors related to utilisation of Early Supported Discharge. Disabil Rehabil 2014; 36:2178-86. [PMID: 24588069 DOI: 10.3109/09638288.2014.893373] [Citation(s) in RCA: 3] [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] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the attitudes and beliefs held by referrers and service providers of an Australian Early Supported Discharge (ESD) service called "Rehabilitation in the Home" (RITH); with particular consideration of factors that may influence referral to RITH. METHODS A cross-sectional online survey based on the Theory of Planned Behaviour was undertaken. RESULTS There were 113 respondents; 90 referrers and 23 service providers. Referrers and RITH staff had a moderately favourable attitude towards RITH. The majority of referrers, and, to a greater degree, RITH staff members, understood and appreciated the advantages ascribed to ESD. However, views varied with regard to some of the factors upon which the decision to refer to RITH rests. Two-fifths of referrers did not think that RITH provided hospital equivalent therapy intensity and over one-fifth of referrers had concerns about the capability of the RITH service to provide specialist stroke rehabilitation. Opinion of RITH staff was also varied on these topics. CONCLUSIONS This study provides evidence that there was a level of uncertainty amongst referrers and RITH service providers regarding issues directly and indirectly related to patient eligibility and RITH service capability. This uncertainty needs to be explored in future research. IMPLICATIONS FOR REHABILITATION Differences in views held by referrers and ESD service providers were identified in this study that could lead to inconsistencies in patient selection for, and under-utilization of, ESD services. Improved communication between referrers and ESD service providers, for instance attendance of RITH staff at inpatient team meetings, could ameliorate some of these misconceptions. On-going education of referrers about service capability is essential to ensure timely transfer of appropriate clients to ESD services.
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Affiliation(s)
- J C Kraut
- The Centre for Musculoskeletal Studies, School of Surgery, Faculty of Medicine, Dentistry and Health Science, The University of Western Australia , Perth, Western Australia , Australia and
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Li X, Deng L, Ye B. Functional outcomes after home-based rehabilitation for heroin-induced spongiform leukoencephalopathy. Neural Regen Res 2012; 7:534-8. [PMID: 25745441 PMCID: PMC4349001 DOI: 10.3969/j.issn.1673-5374.2012.07.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/08/2012] [Indexed: 11/24/2022] Open
Abstract
A 22-year-old man with a 2-year history of heroin vapor inhalation developed spongiform leukoencephalopathy and underwent clinical and home-based rehabilitative treatments. Activities of daily living were measured using the Functional Independence Measure at discharge and at 6, 12, and 24 months after discharge. His neurological symptoms gradually disappeared with rehabilitative treatment, and the functional scale scores increased from 55 on admission to 105 at 24 months after discharge. These results suggest that home-based rehabilitation was effective in ameliorating the pathology and improving activities of daily living in this patient with heroin-induced spongiform leukoencephalopathy.
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Affiliation(s)
- Xuhong Li
- Department of Rehabilitation, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Liming Deng
- Department of Rehabilitation, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Bin Ye
- Department of Radiology, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
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