Rehabilitation Process and Outcome最新文献

{"title":"Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study.","authors":"Helen L Graham,&nbsp;Andrew Lac,&nbsp;Haeok Lee,&nbsp;Melissa J Benton","doi":"10.1177/1179572719827610","DOIUrl":"https://doi.org/10.1177/1179572719827610","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates.</p><p><strong>Objective: </strong>To predict LT mortality, readmission, and survival benefits associated with CR participation in a nationally certified program.</p><p><strong>Methods: </strong>Investigators collected mortality and hospital readmission data in a retrospective study to examine a cohort of cardiac patients following a myocardial infarction (MI), MI/percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) up to 14 years ago. Hospital electronic medical record (EMR; n = 207) were used to measure hospital readmission outcome and State Health Department records (n = 361) for mortality and survival outcomes. Participation in CR, age, gender prior history of cardiac event, and diagnosis were used to predict readmission, mortality, and survival.</p><p><strong>Results: </strong>Approximately half (52.1%) the sample participated in CR. Participants included 72% males, average age 68 years (38-91 years), and were predominantly Non-Hispanic white. CR participants attended an average of 20 sessions. CR group differed in diagnoses MI (58.5%), CABG (57.4%) and in prior history of heart disease (25.4%) from the non-cardiac rehabilitation (NCR) group (83.2%, 25.4%, 42.2%, respectively) (<i>P</i> < .05). After controlling for the covariates in logistic regression analyses, the CR group independently predicted lower all-cause mortality (odds ratio, OR = 0.22, 95% CI 0.12 to 0.39) and decreased hospital readmissions (OR = 0.48, 95% CI 0.24 to 0.96). After controlling for the covariates in survival analysis, the CR group significantly contributed to decreased likelihood of death hazard (hazard ratio = 0.36, 95% CI 0.24 to 0.54). Median survivor time for the participants was 5.91 years, SD = 3.81 years.</p><p><strong>Conclusions: </strong>Participation in CR for middle age and elderly patients is associated with increased survival, a marked decrease in all-cause mortality, and a decrease in cardiovascular-related hospital readmission. A referral to a nationally certified outpatient CR program prior to hospital discharge and early enrollment may improve LT outcomes.</p>","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":"8 ","pages":"1179572719827610"},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572719827610","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Multiple Sclerosis Spasticity Scale 88: A Short Report.","authors":"Jenny Freeman,&nbsp;Terry Gorst,&nbsp;Jodielin Ofori,&nbsp;Jonathan Marsden","doi":"10.1177/1179572718823510","DOIUrl":"https://doi.org/10.1177/1179572718823510","url":null,"abstract":"<p><strong>Background: </strong>The Multiple Sclerosis Spasticity Scale 88 (MSSS-88) is designed to capture the patient experience and impact of spasticity, but there is limited evaluation against clinician-rated measures of spasticity.</p><p><strong>Objective: </strong>To evaluate the convergent validity and responsiveness of the MSSS-88.</p><p><strong>Design: </strong>Longitudinal study.</p><p><strong>Setting: </strong>University Laboratory.</p><p><strong>Subjects: </strong>Thirty-four people with multiple sclerosis.</p><p><strong>Methods: </strong>People with multiple sclerosis (MS; n = 34) completed the self-reported 12-item Multiple Sclerosis Walking Scale, Multiple Sclerosis Spasticity Scale, Barthel Index alongside the clinician-rated Ashworth Scale, and a laboratory-based measure of ankle spasticity. Spasticity measure responsiveness was evaluated in 20 participants at two time points, an average of 8.75 ± 3.8 months apart.</p><p><strong>Results: </strong>In people with MS (mean age 55.1 ± 8.1 years; Expanded Disability Scale range 4.5-7.0), spasticity symptom specific subscales of the MSSS-88 (stiffness and spasms) showed strong and significant correlations with the clinician-rated Ashworth Scale (<i>r</i> = 0.52-0.53; <i>P</i> < .01). Responsiveness of the MSSS-88 was comparable to a laboratory-based measure of ankle spasticity.</p><p><strong>Conclusions: </strong>Our findings lend additional support to the convergent validity of this measure.</p>","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":"8 ","pages":"1179572718823510"},"PeriodicalIF":0.0,"publicationDate":"2019-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718823510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39396742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Home Rehabilitation Resources and Avoidable Admissions to Inpatient Rehabilitation after Stroke: An Ecological Study","authors":"M. Meyer, R. Teasell, A. Thind, J. Koval, M. Speechley","doi":"10.1177/1179572718820543","DOIUrl":"https://doi.org/10.1177/1179572718820543","url":null,"abstract":"Background and purpose: In Ontario (Canada’s most populous province), it has been suggested that mildly impaired stroke patients are being admitted to inpatient rehabilitation unnecessarily due to a lack of alternative options in the community. This ecological study aimed to formally test this hypothesis. Methods: Patients admitted to an inpatient rehabilitation bed in Ontario’s most highly functioning patient classification group (Rehabilitation Patient Group 1160) were retrospectively identified as potentially avoidable admissions, and the proportion of such patients was calculated for each Local Health Integration Network every year between 2006/2007 and 2010/2011. Five indicators of community-based rehabilitation availability were used to test the relationships between avoidable admissions and resource indicators. Results: Of the 25 correlations tested, 21 agreed with the hypothesized direction of effect and 4 reached statistical significance. Logistic-linear regressions on combined data from each of the 5 years demonstrated statistically significant associations between all 5 resource indicators and the proportion of potentially avoidable admissions. Conclusions: This study confirms the suggestion of variation in the proportion of mildly impaired patients admitted to inpatient rehabilitation across Ontario’s Local Health Integration Networks. It also adds evidence to support the concern that a lack of community-based rehabilitation is contributing to these potentially avoidable admissions.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718820543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43665495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent, Child and Physiotherapist Perceptions of Effectiveness of Parent Performed Manually Assisted Cough on Children With Neuromuscular Disease","authors":"Ashley N Pitcher, M. Doumit, M. Hutchence, J. Widger, K. Jones, J. Butler","doi":"10.1177/1179572718803350","DOIUrl":"https://doi.org/10.1177/1179572718803350","url":null,"abstract":"Published research exploring confidence and perceptions of effectiveness in performing a manually assisted cough on children with neuromuscular disease is not available. This descriptive study aimed to describe confidence and perceived effectiveness of parents, children, and therapists in parent performed manually assisted cough. A total of 28 children with neuromuscular disease, one of their parents, and physiotherapist participated. Overall, 40% of parents, 52% of children, and 46% of therapists were very confident in parents’ ability to perform effective manually assisted coughs. Parents, children, and therapists largely perceived the parental manually assisted coughs as somewhat effective (68%, 60%, and 57%, respectively). Approximately, half of parents (48%), children (52%), and therapists (50%) felt very confident in parents’ ability to retain the technique between clinic visits. Interestingly, percentage agreement statistics indicate that a reasonable proportion (30%) of pairs of respondents did not agree in their ratings. Overall, high percentages of favourable ratings were noted for all questions.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718803350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44927518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative","authors":"M. Ibrahim, Garnet J. Lau, N. Smirnow, Anna T. Buono, A. Cooke, Kimberley Gartshore, C. Loiselle, K. Johnson","doi":"10.1177/1179572718790937","DOIUrl":"https://doi.org/10.1177/1179572718790937","url":null,"abstract":"Purpose: Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative. Methods: Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback. Results: A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery. Conclusions: Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points. Implications for cancer survivors: Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718790937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47197188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relations Between Exercise Habit and Visual Attentional Ability in Older Adult Community Dwellers: Evidences From the Yakumo Study","authors":"Takeshi Hatta, Kimiko Kato, A. Iwahara, Taketoshi Hatta, Kazumi Fujiwara, Emi Ito, Y. Hasegawa","doi":"10.1177/1179572718773071","DOIUrl":"https://doi.org/10.1177/1179572718773071","url":null,"abstract":"Objective: The relation between mild everyday exercise and cognitive ability in healthy older people was examined using cohort study database. Methods: Individually calculated linear regression coefficients in digit cancelation task performances for 11 years age from 65 to 75 years were compared between mild exercise habit holders and non-holders. Results: Exercise habit holders showed significantly smaller age-related decline than non-holders, irrespective of task difficulty. Discussion: The results suggested that even mild exercise habit for long years possesses benefits on sustaining cognitive function in older people as well as the physical activities such as programmed in a sport gym. It also becomes clear that it is difficult for ordinary older adult to continue exercising habits for many years. Therefore, more substantial ways are required for local health officials to advertise the effectiveness of mild exercise habits and to devise the necessary work to become a habit.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718773071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48800431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Protein or Essential Amino Acid Supplementation During Prolonged Resistance Exercise Training in Older Adults on Body Composition, Muscle Strength, and Physical Performance Parameters: A Systematic Review","authors":"J. Gade, R. J. Pedersen, A. Beck","doi":"10.1177/1179572718765760","DOIUrl":"https://doi.org/10.1177/1179572718765760","url":null,"abstract":"Objectives: Loss of muscle mass and strength with aging, sarcopenia, burdens many older adults, making identification of strategies on how to counteract it very relevant—especially to health care providers working in rehabilitation. The aim of this systematic review was to determine the effect of protein or essential amino acid (EAA) supplementation during prolonged resistance exercise training (RT) in older adults. No known stimulants of muscle protein synthesis, or ingredients with an effect on muscle strength/physical function, were allowed with the supplementation, differentiating this systematic review from others. Data sources and methods: In January 2017, 4 electronic databases and reference lists were searched for randomized controlled trials investigating the effect of protein or EAA supplementation during RT in older adults (mean age >60 years) on outcomes of body composition, muscle strength, and physical performance. Study selection and data extraction were performed by 2 independent reviewers. Results Sixteen studies (1107 participants) fulfilled the eligibility criteria. Methodologic differences between the studies disallowed a meta-analysis. Of the 16 studies, 6 found significant effects on body composition (3 studies), muscle strength (3 studies), and physical performance (2 studies) measures. Conclusions The evidence is weak and inconsistent, as benefit of protein or EAA supplementation during RT in older adults is only shown in some studies. The findings indicate that frail/sarcopenic older adults might benefit more than healthy older adults. Further research is needed to allow an interpretation on the importance of study population and design. Trial registration: PROSPERO, Reg. no.: CRD42017063808. Registered April 14, 2017.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718765760","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46521486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Shock Wave Therapy in Acute Injury Care: A Systematic Review","authors":"A. Zissler, W. Stoiber, S. Pittner, A. Sänger","doi":"10.1177/1179572718765138","DOIUrl":"https://doi.org/10.1177/1179572718765138","url":null,"abstract":"Objectives: We provide a systematic review of the literature to identify clinical studies assessing the effects of extracorporeal shock wave therapy (ESWT) on acutely injured tissues of human subjects, also highlighting the biological mechanisms by which the technique is proposed to promote the processes of early tissue repair. Special attention is also paid to the progress of research in animal models. Method: A systematic review of the literature on ESWT of acute injuries of bone and soft tissue as available in the PubMed/MEDLINE, Cochrane CENTRAL, SPORTDiscus, and CINAHL databases up to December 2017 was conducted. Results: A total of 10 studies were included. There is some evidence for the application of ESWT in an early postacute injury phase. Most studies report benefits with no or minimal side effects. However, different types of treated tissues and wounds (varying cause and severity) and resulting heterogeneity in study design and outcome measurement make it difficult to compare studies. The picture of knowledge remains limited by an apparent lack of data on optimal treatment timing and on tissue- and injury-specific parameters. Conclusions: Although the amount of studies to date is still limited, recent clinical research has presented first successful steps to introduce ESWT as a means of treatment in acute injury care. Therefore, on the basis of the analyzed data, further testing is encouraged to validate optimal timing, physical settings, and possible long-term effects to exclude potential risks.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718765138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43514014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding Events in Thrombocytopenic Patients With Cancer Undergoing Acute Rehabilitation","authors":"J. Neal, Samman Shahpar, G. Spill, P. Semik, C. Marciniak","doi":"10.1177/1179572718761379","DOIUrl":"https://doi.org/10.1177/1179572718761379","url":null,"abstract":"Objectives: To determine incidence of bleeding in thrombocytopenic patients with cancer undergoing acute inpatient rehabilitation. Design: This is an observational cross-sectional retrospective study. Setting: Acute inpatient academic rehabilitation facility. Participants: Adult patients admitted to acute inpatient rehabilitation with functional impairments secondary to cancer. Methods: Electronic records were reviewed for thrombocytopenic patients with cancer to determine platelet counts, bleeding events during rehabilitation, and anticoagulant medications prescribed. Main outcomes measurements: Type and number of bleeding events, severity of bleeding by World Health Organization criteria. Results: Of the 278 patients with cancer admitted to acute rehabilitation over a 27-month time frame, 119 had at least one platelet count <150 000/µL. In all, 37 (31.1%) had a history of a bleeding event prior to the rehabilitation admission and 34 (28.6%) had at least one bleeding complication during their stay. Most events (87.5%) were of low grade (Grade 1 and 2 World Health Organization criteria). There was no association between platelet counts <11 000 or counts 11 000 to 20 000/µL and the occurrence of bleeding (P = .106 and P = .319, respectively). Although anticoagulants were common, there was no association found with a bleeding event and either anticoagulation status (receiving or not on such agents), specific anticoagulant or antiplatelet agents, or a combination. Conclusions: Bleeding events in patients with cancer with thrombocytopenia during acute rehabilitation stay are not uncommon but are typically mild in severity and not associated with the degree of thrombocytopenia. Patients taking anticoagulants when platelet levels rose did experience bleeding events, but not at a statistically greater rate than those not taking such medications.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572718761379","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41330368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury","authors":"D. Lala, P. Houghton, P. Holyoke, D. Wolfe","doi":"10.1177/1179572717745836","DOIUrl":"https://doi.org/10.1177/1179572717745836","url":null,"abstract":"Objectives: To apply a modified ADAPTE process to adapt best practices to a local context for successful implementation of electrical stimulation therapy (EST) for treating pressure injuries in persons with spinal cord injury (SCI). Participants: An expert team of health care professionals and a consumer participated in a 2-day workshop to assist in the development of the locally adapted EST document in Southwest Ontario, Canada. Results: A process map illustrating the flow of activities to initiate EST for treating pressure injuries in persons with SCI based on the challenges and opportunities existing within this region was created. The team also developed a summary of roles and responsibilities delineating tasks specific to providing EST and identified a set of challenges likely to be encountered. Conclusions: The modified ADAPTE process provided a clear and flexible structure to adaptation when used for implementation planning. This article shares some challenges associated with using this process for local adaptation and shares strategies of improvement for future studies aimed at adapting a practice to their local environment.","PeriodicalId":41347,"journal":{"name":"Rehabilitation Process and Outcome","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179572717745836","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47737467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}