Prehabilitation and heart failure: perspective in primary outcomes, a randomized controlled trial

OBJECTIVE

Prehabilitation, intended as a multidisciplinary approach where physical training is combined with educational and counselling training, in cardiology could optimizing care, and has been shown to be able to reduce morbidity and mortality in several diseases. The present study aims to assess the effectiveness of a prehabilitation program in elderly patients (over 65) with chronic heart failure and to evaluate functional and quality indices of life.

PATIENTS AND METHODS

This is randomized, single blind controlled trial. Fourteen older adult patients diagnosed with chronic heart failure were enrolled. Patients were randomly assigned into the study or the control group. Patients in the study group underwent physical training organized into 10 twice-weekly meetings, nutritional and lifestyle counseling.

RESULTS

In the Study Group, the quality of life improved significantly (EQoL-5D), and between the two groups there is a statistically significant difference in the motor dimension of SF-36.

CONCLUSIONS

Because of our preliminary results, prehabilitation program should be included among the management strategies of in elderly patients with chronic heart failure to better manage their disease and to improve their Quality of Life.

Functional outcome and multidimensional evaluation of patients with Mutars® reconstructions post lower limb tumor resection and rehabilitation: preliminary results

Modular prostheses are commonly used to reconstruct defects of the distal femur and proximal tibia after bone tumor resection. Improving patient's autonomy and giving them a better quality of life are the main goals. Post-surgical rehabilitation is very relevant after surgery. The aim of this paper is to study the short and mean time functional outcomes in patients treated with Mutars® reconstructions after proximal and distal lower limb tumor resection with a multidimensional analysis and a standardized stabilometric examination. Twenty-one patients (7 male and 14 women, mean age and standard deviation: 61.76±14.68) affected by primitive bone tumor (28.6%) or metastatic bone tumor (71.4%), treated with MUTARS® reconstructions after proximal (71%) , distal(23.8%) and both (4.8%) lower limb tumor resections, accepted to take part to the study. They were evaluated after one week (T0), one month (T1), three months (T2), six months (T3) and one year (T4) after surgery with standardized clinic evaluation and with multidimensional validated scales. Visual Analogic Scale (VAS during active movement), Short Physical Performance Battery (SPPB), Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Status (KPS), MusculoSkeletal Tumor So¬ciety rating (MSTS), Toronto Extremity Salvage Score scale (TESS). Patients underwent to an instrumental standardized stabilometric test after one month from surgery and in following evaluations to measure stand¬ing balance. Patients underwent to a rehabilitation program during three months after surgery. There was a significant improvement of hip flexion range of movement (p level: 0.008), and gait modalities (without aids) after three months from surgery (p level 0.02). There was a significant reduction in VAS after one month of surgery (p level 0.00). It was observed an increase of the SPPB value at T3 (p level 0.01), of MSTS and TESS at T2. Balance stabilometric evaluation did not showed significant increase at each timing also if Romberg perimeter decrease progressively. These preliminary results showed that, oncological patients, affected by bone tumors or metastasis, surgical treated with MUTARS® implant and admitted to the rehabilitation programs, can improve their gait modalities and functional daily life outcomes, until three months from surgery. A large sample will allow, necessary to define standardized rehabilitation protocols after oncological orthopedic sur¬gery, in order to introduce guidelines that can be applied routinely.

Role of spiritual beliefs on disability and health-related quality of life in acute inpatient rehabilitation unit

BACKGROUND

The influence of spirituality and religious beliefs on health-related quality of life and disability in the rehabilitation field is discussed in literature.

AIM

To describe the role of spiritual belief on functional recovery and health-related quality of life in acute inpatient rehabilitation ward.

DESIGN

Observational cross sectional study.

SETTING

Inpatients clinic of Physical Medicine and Rehabilitation Department, University Hospital.

POPULATION

One hundred and four patients admitted to an inpatient acute rehabilitation ward, after a neurological or orthopedic disease.

METHODS

Anamnestic and demographic data were reported on a standardized form. The Royal Free Interview for Spiritual and Religious Beliefs (RFI) and Cumulative Illness Rating Scale (CIRS) were performed on admission (T0). SF-36 item Short Form Health Survey Questionnaire (SF36) and the Barthel index (BI) were performed on admission (T0) and on discharge (T1).

RESULTS

Statistical analysis was performed on 102 patients with spiritual belief divided in strong (55 cases) and weak (47 cases) spiritual belief. Change from baseline (T1-T0) of SF36 domains between groups showed a significant higher improvement in Physical Role and Physical Composite Score in the weak belief group than in the strong belief group. The latter presented an improvement (without statistical significance) in almost every emotional score. We found no significant difference in change from baseline of Barthel index between the groups.

CONCLUSION

Strength of spiritual belief seems to influence some aspects of quality of life of acute inpatient in the rehabilitation setting. It seems that patients with less spiritual belief showed more improvement in physical role, after acute rehabilitation.

[The role of occupational therapy in rehabilitating injured at work]

The evolution of social and health setting in its demographic, productive and welfare elements make work as a finalized activity oriented to different tasks, from individual indepencence to social integration. In this context, the word "re-habilitation" has a double value; on one hand consideration of lifetime acquired abilities; on the other hand recovery of residual activities, consistent with the disablement. In Italy, for years, rehabilitation activities were performed by physiotherapists, who had inadequate occupational knowledge and preferred technical skills of non-finalized function recovery. The acknowledgment of Occupational Therapist took place in the end of the '90s, so that the few organizations sensitive to Occupational Therapy, as "Fondazione Maugeri" and "Fondazione Don Gnocchi", found "prepared ad hoc" personnel only abroad, above all in Spain and Switzerland. Nowadays we have specific first degree courses, but what really obstacles the development of this field is the economic crisis which afflicts healthcare services and avoids the growth of new sectors.