Parents' and Therapists' Satisfaction with Four Early Childhood Power Mobility Devices

Background. Little is known about satisfaction with power mobility devices used by young children. Purpose. Parents' and therapists' satisfaction with four early childhood power mobility devices were examined. Method. A two-phased study, comprising Trial Phase cross-sectional design and Loan Phase one-group pretest-posttest design. Parents and therapists of children 9 months to 6 years with mobility limitations completed the Quebec User Evaluation of Satisfaction of Assistive Technology 2.0 Device Subscale (QUEST8) plus an additional device Aesthetics rating. Findings. Seventy-four parents and 42 therapists from 18 child development and rehabilitation centres participated. Parent and therapist median QUEST8 and Aesthetics scores varied across devices when trialled and over the six-month loan. Favourable median ratings had no statistically significant differences between parents and therapists. Parent ratings decreased statistically over loan period although therapists' ratings did not. Device dimensions, safety, and aesthetics were highly rated. Implications. Similarities and differences exist among parent and therapist ratings.

Adaptive Eating Device: Performance and Satisfaction of a Person with Parkinson's Disease

BACKGROUND.

Individuals with Parkinson's disease (PD) can experience motor impairments related to their hand-use that restrict participation in daily activities. Feeding is one activity impacted by this health condition. The use of adapted utensils can improve performance and independence in this activity.

PURPOSE.

To investigate if a locally designed and made eating-adaptive device helps a person with PD to improve their feeding performance.

METHOD.

Single-case ABC-type experimental design. Performance and satisfaction of a 60-year-old man with PD were assessed during feeding tasks in 70 sequential days in three phases. Celeration Line, Two-Standard Deviation Band, and Visual Analysis were the methods used for data analysis.

FINDINGS.

Performance and satisfaction increased significantly after the introduction of the adaptive eating device. The addition of weight also contributed to the increase in the participant's performance.

IMPLICATIONS.

Adaptive eating device with low production costs and possibility of customized adjustments improves performance of people with PD.

The Engaged Child in Occupational Therapy

BACKGROUND.

Achieving optimal outcomes for children in occupational therapy settings is influenced, in part, by their engagement. The nature of child engagement from the occupational therapy perspective remains relatively unexplored.

METHOD.

A qualitative research methodology was adopted, using an interpretive description approach. Thirty-two occupational therapists participated in five focus groups and six individual interviews that were thematically analyzed.

FINDINGS.

Four themes emerged from the data: (i) signs of child engagement and disengagement; (ii) it's about the child feeling safe; (iii) a sense of meaning and purpose; and (iv) service and therapist factors influencing child engagement.

IMPLICATIONS.

Helping the child feel safe; providing meaningful experiences; and being flexible and responsive were key means of connecting with, and supporting, child engagement. Strategies occupational therapists reportedly used to engage the child aligned with the tenets of self-determination theory (autonomy, relatedness, and competence).

[Cardiac rehabilitation in elderly patient]

According to "OMS" we are old at age 65. Because of the ageing population (life expectancy has increased in Europe) and medical progress, more and more old patients are addressed to cardiac rehabilitation centers. Ageing is a physiological process which varies between individuals, and in the same person organ ageing also differs. Old patient has usually several pathological diseases. Because old patient has restricted functional reserve, acute illness could get him closer to the decompensation area. Complications are more frequent in ageing people, and often need a specific initial treatment which delays rehabilitation. Rehabilitation program of old non-disabled patient is not different from that addressed to youngers. The main objective for dependent people is to restore the ability to perform activities of daily living. Correction of vascular risk factors and therapeutic education are also valuable in elderly. For patients with difficulty to remember or to understand instructions, family help is valuable when possible. The benefit of the rehabilitation in the elderly is demonstrated by several studies.

[Knowledge assessment of the coding using CSARR nomenclature, two years after its establishment]

BACKGROUND

French post-acute care and rehabilitation facilities describe and code their activity through the Program for Medicalization of Information Systems (PMSI). A new specific catalogue of rehabilitation procedures (CSARR) has been implemented to code rehabilitation acts since 2013. This study aimed to assess the coherence of the coding of the rehabilitation acts using the CSARR two years after its establishment through the analyze of 3 main items regarding patients and therapists.

METHODS

We analyzed the use of CSARR for coding rehabilitation acts from the PMSI national database for post-acute care and rehabilitation, in 2015. Analyses were made on specific items characterizing rehabilitation acts: "number of patients", "type of therapists" and "number of therapists".

RESULTS

There were 72,014,731 rehabilitation acts coded in 2015 using CSARR nomenclature; 86% were individual rehabilitation acts. All acts of CSARR, except one, were used to describe rehabilitation activities. Physiotherapists coded the majority of rehabilitation acts (47%), then nurses (14%). Coding errors were identified as the "number of patients", coded with more than one patient for individual acts (13% of the acts) or with less than 2 patients for groups (6% of the acts), or the "number of therapists" coded with only one therapist for rehabilitation acts requiring several professionals.

CONCLUSION

This first assessment indicated a good level of appropriation of the CSARR coding rules in the national PMSI database by post-acute care and rehabilitation facilities. However, a simplification of this catalogue and therapist training could increase the quality of the rehabilitation data.

Contribution of patient-advisors during rehabilitation for replantation of digits improves patient-reported functional outcomes: A presentation of concept

Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of "patient-advisors". Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient-reported outcomes in individuals enrolled in a Patient-Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6-8weeks and 4-6months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient-advisors group and 43 in the control group. Patients from the patient-advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4-6months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4-6months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.

A video-game group intervention: Experiences and perceptions of adults with chronic stroke and their therapists: Intervention de groupe à l'aide de jeux vidéo : Expériences et perceptions d'adultes en phase chronique d'un accident vasculaire cérébral et de leurs ergothérapeutes

BACKGROUND

Ongoing physical activity is important for maintaining the functional level of individuals with chronic stroke. Video games in a group setting might be a cost-effective way for providing mobility and preventing physical inactivity.

PURPOSE

This study explores the experiences and perceptions of individuals with chronic stroke who participated in a novel community-based video-game group intervention and their therapists.

METHOD

A qualitative study, nested in a randomized controlled trial, was conducted using semistructured interviews with eight individuals with chronic stroke (four men and four women) ages 29 to 69 and a focus group of their three occupational therapists, following a video-game intervention. Data were analyzed using content analysis.

FINDINGS

Three main categories were identified by the study participants: (a) using video games, (b) the group/team experience, and (c) intervention outcomes/evolving understandings following the intervention.

IMPLICATIONS

Playing video games was perceived not as treatment but as a motivating tool to facilitate whole-body movement. Therefore, this intervention might be suitable to be used in the community for ongoing intervention.

Clinical outcomes in myocardial infarction and multivessel disease after a cardiac rehabilitation programme: Partial versus complete revascularization

BACKGROUND

Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI.

AIM

To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme.

METHODS

We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups.

RESULTS

Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years; P=0.02), diabetes mellitus prevalence (34.3% vs. 20.1%; P=0.01) and number of arteries with stenosis (2.6 vs. 2.3; P=0.001). During the mean follow-up of 48.0±25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19-1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62-3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk.

CONCLUSIONS

There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation.

[Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: a randomized controlled trial]

AIM

This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation.

PATIENTS AND METHODS

Inclusion criteria were EDSS score<7 and presence of lower urinary tract symptoms. Exclusion criteria were multiple sclerosis relapse during the study, active urinary tract infection and pregnancy. The primary outcome was quality of life (SF-Qualiveen questionnaire). Secondary outcomes included overactive bladder (USP questionnaire) score and frequency of urgency episodes (3-day bladder diary). Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30 minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency).

RESULTS

A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031).

CONCLUSIONS

Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability.

LEVEL OF EVIDENCE

2.