Effectiveness of a Multidisciplinary Rehabilitation Program Following Shoulder Injury

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Andrea Bean

2017-07-01

Full Text Available Background: Shoulder injuries in working age adults result in a major cost to the health care system. The purpose of this study was to examine the effectiveness of a new multidisciplinary rehabilitation program and to explore factors that affected a successful return to work (RTW in injured workers with shoulder problems who received this program. Methods: This was a prospective longitudinal study. The patient-oriented outcome measures were the Numeric Pain Rating Scale (NPRS and the Disabilities of the Arm, Shoulder, and Hand (DASH. Range of motion (ROM in flexion, abduction, and external rotation and strength in lifting and push/pull were documented. All outcomes were measured before and at the completion of the program. Results: Data of 68 patients were used for analysis. All outcomes showed a statistically significant improvement over time. Conclusions: Multidisciplinary rehabilitation programs help to improve pain, disability, ROM, strength, and facilitate RTW. Higher stress and a fast-paced work environment increased the risk of not progressing in work status.

Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment

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Preuss UW

2012-05-01

Full Text Available Ulrich W Preuss,1 Jörg Zimmermann,2,3 Gabriele Schultz,2 Anna Watzke,2 Peggy Schmidt,4 Bärbel Löhnert,5 Michael Soyka2,61Department of Psychiatry, Psychotherapy and Psychosomatics, University of Halle-Wittenberg, Halle, Germany; 2Ev Krankenhaus Bethanien GmbH, Fachklinik Gristower Wiek, Johanna-Odebrecht-Stiftung, Germany; 3Karl-Jaspers-Klinik, Fachkrankenhaus für Psychiatrie und Psychotherapie, Psychiatrieverbund Oldenburger Land, Germany; 4Department of Psychiatry, Ludwig-Maximilians-Universität Munich, Germany; 5Klientenzentrierte Problemberatung, Dachau/Munich, Germany; 6Privatklinik Meiringen, Meiringen, Switzerland Background: Rehabilitation treatment noncompletion is considered a risk factor for long term relapse in alcohol-dependent individuals. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to identify social, mental, and somatic risk profiles for treatment noncompletion.Methods: A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (personality disorders, anxiety, depression, and impulsivity at treatment admission, with termination at 12 months follow-up. Participants were subdivided into treatment completers and noncompleters for any reason.Results: A total of 10.2% of inpatients and 16.1% of outpatients did not complete treatment. Compared with treatment completers, noncompleters had a significantly lower rate of continuous abstinence at 1-year follow-up, more recent alcohol consumption before admission, and a higher rate of borderline personality disorders. Among inpatients, an elevated rate of lifetime mental disorders, depression, and suicide attempts was found among treatment noncompleters; among outpatients, treatment noncompleters were more often than completers to be

Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

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Claudiu Avram

2010-12-01

Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 2. Impact of Multidisciplinary Rehabilitation and Psychosocial, Sexuality, and Return-to-Work Interventions.

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Hunter, Elizabeth G; Gibson, Robert W; Arbesman, Marian; D'Amico, Mariana

This article is the second part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the use of multidisciplinary rehabilitation and interventions that address psychosocial outcomes, sexuality, and return to work. Strong evidence indicates that multidisciplinary rehabilitation benefits cancer survivors and that psychosocial strategies can reduce anxiety and depression. Moderate evidence indicates that interventions can support survivors in returning to the level of sexuality desired and help with return to work. Part 1 of the review also appears in this issue. Copyright © 2017 by the American Occupational Therapy Association, Inc.

Roles and challenges of the multidisciplinary team involved in prosthetic rehabilitation, in a rural district in South Africa

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Ennion L

2016-10-01

Full Text Available Liezel Ennion, Anthea Rhoda Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa Background: Major lower limb amputations result in a significant sense of loss, psychological stress, and decrease in function and overall quality of life for the amputee. The holistic, patient-centered prosthetic rehabilitation of an amputee requires input from a team of dedicated health professionals from different disciplines commonly referred to as a multidisciplinary team (MDT. MDT rehabilitation is considered crucial in the reintegration of the amputee into the community, as well as for providing psychological support after limb loss. Multidisciplinary and interdisciplinary rehabilitation has been proven to be more successful than therapy provided by individual therapists in a number of different populations, regardless of the population studied. However, in most developing countries, there is a significant lack of multidisciplinary rehabilitation.Aim: To explore the roles and challenges of the members of the MDT involved in trans-tibial amputation rehabilitation in a rural community in South Africa (SA.Design: An explorative sequential qualitative descriptive study.Setting: A rural district in the KwaZulu Natal province in SA.Participants: Nine prosthetic users, three surgeons, three traditional healers, 17 therapists, four prosthetists, and four community health workers.Instruments for data collection: Semistructured interviews and focus group discussions.Results: The roles of the members of the MDT were clarified, and various members of the MDT highlighted specific challenges relating to their experiences and roles in the rehabilitation team. Lack of interdisciplinary rehabilitation and communication among team members, as well as lack of resources, and patient education negatively impact the rehabilitation of trans-tibial amputees.Conclusion: Aiming to address the limited resources

Effect of a Multidisciplinary Outpatient Model of Care on Health Outcomes in Older Patients with Multimorbidity: A Retrospective Case Control Study.

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Sepehr Shakib

Full Text Available To evaluate a holistic multidisciplinary outpatient model of care on hospital readmission, length of stay and mortality in older patients with multimorbidity following discharge from hospital.A pilot case-control study between March 2006 and June 2009 of patients referred on discharge to a multidisciplinary, integrated outpatient model of care that includes outpatient follow-up, timely GP communication and dial-in service compared with usual care following discharge, within a metropolitan, tertiary referral, public teaching hospital. Controls were matched in a 4:1 ratio with cases for age, gender, index admission diagnosis and length of stay.Non-elective readmission rates, total readmission length of stay and overall survival.A total of 252 cases and 1008 control patients were included in the study. Despite the patients referred to the multidisciplinary model of care had slightly more comorbid conditions, significantly higher total length of hospital stay in the previous 12 months and increased prevalence of diabetes and heart failure by comparison to those who received usual care, they had significantly improved survival (adjusted hazard ratio 0.70 95% CI 0.51-0.96, p = 0.029 and no excess in the number of hospitalisations observed.Following discharge from hospital, holistic multidisciplinary outpatient management is associated with improved survival in older patients with multimorbidity. The findings of this study warrant further examination in randomised and cost-effectiveness trials.

Engagement and learning: an exploratory study of situated practice in multi-disciplinary stroke rehabilitation.

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Horton, Simon; Howell, Alison; Humby, Kate; Ross, Alexandra

2011-01-01

Active participation is considered to be a key factor in stroke rehabilitation. Patient engagement in learning is an important part of this process. This study sets out to explore how active participation and engagement are 'produced' in the course of day-to-day multi-disciplinary stroke rehabilitation. Ethnographic observation, analytic concepts drawn from discourse analysis (DA) and the perspective and methods of conversation analysis (CA) were applied to videotaped data from three sessions of rehabilitation therapy each for two patients with communication impairments (dysarthria, aphasia). Engagement was facilitated (and hindered) through the interactional work of patients and healthcare professionals. An institutional ethos of 'right practice' was evidenced in the working practices of therapists and aligned with or resisted by patients; therapeutic activity type (impairment, activity or functional focus) impacted on the ways in which patient engagement was developed and sustained. This exploration of multi-disciplinary rehabilitation practice adds a new dimension to our understanding of the barriers and facilitators to patient engagement in the learning process and provides scope for further research. Harmonising the rehabilitation process across disciplines through more focused attention to ways in which patient participation is enhanced may help improve the consistency and quality of patient engagement.

Twenty years of multidisciplinary research and practice: the Journal of Occupational Rehabilitation then and now.

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Shaw, William S; Findley, Patricia A; Feuerstein, Michael

2011-12-01

Early research of work disability in the 1980s showed a complexity of factors influencing pain and health-related functional limitation at work; hence, multidisciplinary perspectives were necessary to understand the complex interplay between biomechanical, organizational, social, and psychological factors impacting work disability. To address this need, the Journal of Occupational Rehabilitation was founded in 1991 with the goal of providing a scientific, yet practical forum for presenting multidisciplinary research and practice in work disability. Now, the 20-year collection of articles in the Journal reflects important trends and directions in the field of occupational rehabilitation. We conducted a retrospective summary of the past 20 years of the Journal of Occupational Rehabilitation, including its inaugural goals and intent, rates of submission and acceptance, trends in the types of articles published, study topics, global distribution of authors, and future directions. The original goal of providing a multidisciplinary scientific and practical forum has been met, but current trends reflect a maturing scientific evidence base, with less representation of employer-based case studies and practical innovations. There has been a dramatic increase in the international representation of studies, authors, and peer reviewers outside of the US. Also, published studies now address work disability for a larger number of health concerns. Contributions to the Journal continue to reflect a multidisciplinary perspective, but the Journal has seen significant changes with respect to international representation, the expanding study of non-musculoskeletal sources of work disability, and the maturing scientific evidence base in the field of occupational rehabilitation. Future volumes of the Journal will likely reflect continuing changes in the global economy, workforce fitness, and job demands.

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis

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Kamper, S.J.; Apeldoorn, A.T.; Chiarotto, A.

2015-01-01

Objective To assess the long term effects of multidisciplinary biopsychosocial rehabilitation for patients with chronic low back pain. Design Systematic review and random effects meta-analysis of randomised controlled trials. Data sources Electronic searches of Cochrane Back Review Group Trials...... usual care (moderate quality evidence) and physical treatments (low quality evidence) in decreasing pain and disability in people with chronic low back pain. For work outcomes, multidisciplinary rehabilitation seems to be more effective than physical treatment but not more effective than usual care....... Register, CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to February 2014, supplemented by hand searching of reference lists and forward citation tracking of included trials. Study selection criteria Trials published in full; participants with low back pain for more than three months...

Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo).

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Vos-Vromans, Desirée C W M; Smeets, Rob J E M; Rijnders, Leonie J M; Gorrissen, René R M; Pont, Menno; Köke, Albère J A; Hitters, Minou W M G C; Evers, Silvia M A A; Knottnerus, André J

2012-05-30

Patients with chronic fatigue syndrome experience extreme fatigue, which often leads to substantial limitations of occupational, educational, social and personal activities. Currently, there is no consensus regarding the treatment. Patients try many different therapies to overcome their fatigue. Although there is no consensus, cognitive behavioural therapy is seen as one of the most effective treatments. Little is known about multidisciplinary rehabilitation treatment, a combination of cognitive behavioural therapy with principles of mindfulness, gradual increase of activities, body awareness therapy and pacing. The difference in effectiveness and cost-effectiveness between multidisciplinary rehabilitation treatment and cognitive behavioural therapy is as yet unknown. The FatiGo (Fatigue-Go) trial aims to compare the effects of both treatment approaches in outpatient rehabilitation on fatigue severity and quality of life in patients with chronic fatigue syndrome. One hundred twenty patients who meet the criteria of chronic fatigue syndrome, fulfil the inclusion criteria and sign the informed consent form will be recruited. Both treatments take 6 months to complete. The outcome will be assessed at 6 and 12 months after the start of treatment. Two weeks after the start of treatment, expectancy and credibility will be measured, and patients will be asked to write down their personal goals and score their current performance on these goals on a visual analogue scale. At 6 and 14 weeks after the start of treatment, the primary outcome and three potential mediators-self-efficacy, causal attributions and present-centred attention-awareness-will be measured. Primary outcomes are fatigue severity and quality of life. Secondary outcomes are physical activity, psychological symptoms, self-efficacy, causal attributions, impact of disease on emotional and physical functioning, present-centred attention-awareness, life satisfaction, patient personal goals, self-rated improvement

Improved work ability and return to work following vocational multidisciplinary rehabilitation of subjects on long-term sick leave

OpenAIRE

Braathen, Tore; Veiersted, Kaj Bo; Heggenes, Jan

2007-01-01

Objective: To evaluate a vocational multidisciplinary rehabilitation programme for patients on long-term sick leave with respect to their work ability and return to work. Methods: A multidisciplinary rehabilitation programme was administered to an intervention group of 183 patients on long-term sick leave (mean 12.2 months). Effects of the treatment were compared with a control group (n = 96) recruited from the national sickness insurance record of patients on sick leave of 6??2 month...

Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial.

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Aasdahl, Lene; Pape, Kristine; Vasseljen, Ottar; Johnsen, Roar; Gismervik, Sigmund; Halsteinli, Vidar; Fleten, Nils; Nielsen, Claus Vinther; Fimland, Marius Steiro

2018-03-01

Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18-60 years old on sick-leave for 2-12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48-1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program.

Symptoms versus neurocognition as predictors of change in life skills in schizophrenia after outpatient rehabilitation.

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Kurtz, Matthew M; Wexler, Bruce E; Fujimoto, Marco; Shagan, Dana S; Seltzer, James C

2008-07-01

A growing body of literature has shown that neurocognitive deficits in schizophrenia account for 20-60% of the variance in measures of outcome, and in many studies are more closely related to outcome than symptoms [Green, M.F., Kern, R.S., Braff, D.L., Mintz, J., 2000. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? Schizophr. Bull. 26(1), 119-136; Green, M.F., Kern, R.S., Heaton, R.K., 2004. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr. Res. 72(1), 41-51]. Most of these studies have been cross-sectional, few longitudinal studies have investigated the degree to which neurocognition and symptoms predict ability to benefit from outpatient rehabilitation, and no longitudinal studies use measures of everyday life skills that are performance-based. In the current study we investigated the relationship between five measures of neurocognitive function, crystallized verbal ability, visual sustained vigilance, verbal learning, problem-solving, and processing speed, and two measures of symptoms, total positive and negative symptoms, and change on a performance-based measure of everyday life skills after a year of outpatient rehabilitation. Rehabilitation consisted of both psychosocial and cognitive interventions. Forty-six patients with schizophrenia or schizoaffective disorder were studied. Results of a linear regression model revealed that verbal learning predicted a significant amount of the variance in change in performance-based measures of everyday life skills after outpatient rehabilitation, even when variance for all other variables in the model was accounted for. Measures of crystallized verbal ability, sustained visual vigilance, problem-solving, processing speed and symptoms were not linked to functional status change. These findings emphasize the importance of verbal learning for benefiting from psychosocial and cognitive rehabilitation

Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients.

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Croitoru, Alina; Ioniţă, Diana; Stroescu, Carmen; Pele, Irina; Gologanu, Daniela; Dumitrescu, Andreea; Marinescu, Lucia; Anghelescu, Dana; Alexandru, Miron; Bogdan

2013-01-01

Respiratory rehabilitation programs (RR) are essential tools in the management of COPD. We present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. The following parameters were evaluated before and after RR: dyspnea (mMRC scale), pulmonary function (FEVI, RV- residual volume), exercise tolerance (6MWT- 6 minutes walk test, CPET - cardiopulmonary exercise test), quality of life (SGROQ questionnaire). The RR program was outpatient, hospital based (7 weeks, 3 sessions/ week) and included: exercise training, therapeutic education, and psychological support. 25 patients, COPD stage II-IV GOLD (mean FEVI 44.5 +/-13% predicted), mean age 60.4 +/-12 years, 7 females, average BMI 27.14+/-4 kg/m2, average RV residual volume 221.55+/-86% predicted. Mean 6MWTdistance: 407.48 +/- 84 m and mean maximum power (Pmax) obtained on CPET: 75.67+/-30 Watts. All patients were symptomatic with significant dyspnea (3.06+/-0.7 on mMRC scale) and showed a significant impairment of quality of life: SGRO score 46.23+/- 14. At the end of RR program: dyspnea decreased with 0.67points on mMRC scale (p = 0.000), 6MWT distance increased with 58.5 m (p = 0.0071), Pmax obtained during CPET increased with 11.2 W, without reaching statistical significance (p> 0.05). SGRO score decreased by 5.59 points (p = 0.02). There were no significant improvements in FEV1 and RV values (p> 0.05). In our COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement ofsymptoms, exercise tolerance and quality of life.

Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments.

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Ilaria Clerici

Full Text Available to date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP. It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson's disease, including the use of robot-assisted walking training.to evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT conceived for Parkinsonian patients.we enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group. Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group. Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS score and its "limb" and "gait" sub-scores. Secondary outcomes were Berg Balance Scale (BBS, Six Minutes Walking test (6MWT and the number of falls.total PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively. The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002. A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047. No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups.Lokomat® training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal

[Cardiac rehabilitation: current status and future challenges].

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Hahmann, H W

2012-02-01

The goal of cardiac rehabilitation is to support heart patients using a multidisciplinary team in order to obtain the best possible physical and mental health and achieve long-term social reintegration. In addition to improving physical fitness, cardiac rehabilitation restores self-confidence, thus better equipping patients to deal with mental illness and improving their social reintegration ("participation"). Once the causes of disease have been identified and treated as effectively as possible, drug and lifestyle changes form the focus of cardiac rehabilitation measures. In particular diseases, rehabilitation offers the opportunity for targeted educational courses for diabetics or drug dose escalation, as well as special training for heart failure patients. A nationwide network of outpatient heart groups is available for targeted follow-up. Cardiac patients predominantly rehabilitated in follow-up rehabilitation are older and have greater morbidity than in the past; moreover, they generally come out of acute clinical care earlier and are discharged from hospital more quickly. The proportion of severely ill and multimorbid patients presents a diagnostic and therapeutic challenge in cardiac rehabilitation, although cardiac rehabilitation was not initially conceived for this patient group. The benefit of cardiac rehabilitation has been a well documented reduction in morbidity and mortality. However, hurdles remain, partly due to the patients themselves, partly due to the health insurers. Some insurance providers still refuse rehabilitation for non-ST-segment elevation infarction. In principle rehabilitation can be carried out in an inpatient or an outpatient setting. Specific allocation criteria have not yet been established, but the structure and process quality of outpatient rehabilitation should correspond to that of the inpatient setting. The choice between the two settings should be based on pragmatic criteria. Both settings should be possible for an individual

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

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Jia H

2017-03-01

Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

Systematic review of multidisciplinary rehabilitation in patients with multiple trauma.

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Khan, F; Amatya, B; Hoffman, K

2012-01-01

Multiple trauma is a cause of significant disability in adults of working age. Despite the implementation of trauma systems for improved coordination and organization of care, rehabilitation services are not yet routinely considered integral to trauma care processes. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Physiotherapy Evidence Database, Latin American and Caribbean Literature on Health Sciences and Cochrane Library databases were searched up to May 2011 for randomized clinical trials, as well as observational studies, reporting outcomes of injured patients following multidisciplinary rehabilitation that addressed functional restoration and societal reintegration based on the International Classification of Functioning, Disability and Health. No randomized and/or controlled clinical trials were identified. Fifteen observational studies involving 2386 participants with injuries were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach assessed methodological quality as 'poor' in all studies, with selection and observer bias. Although patients with low functional scores showed improvement after rehabilitation, they were unable to resume their pretrauma level of activity. Their functional ability was significantly associated with motor independence on admission and early acute rehabilitation, which contributed to a shorter hospital stay. Injury location, age, co-morbidity and education predicted long-term functional consequences. Trauma care systems were associated with reduced mortality. The gaps in evidence include: rehabilitation settings, components, intensity, duration and types of therapy, and long-term outcomes for survivors of multiple trauma. Rehabilitation is an expensive resource and the evidence to support its justification is needed urgently. The issues in study design and research methodology in rehabilitation are challenging. Opportunities

Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo

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Vos-Vromans Desirée CWM

2012-05-01

Full Text Available Abstract Background Patients with chronic fatigue syndrome experience extreme fatigue, which often leads to substantial limitations of occupational, educational, social and personal activities. Currently, there is no consensus regarding the treatment. Patients try many different therapies to overcome their fatigue. Although there is no consensus, cognitive behavioural therapy is seen as one of the most effective treatments. Little is known about multidisciplinary rehabilitation treatment, a combination of cognitive behavioural therapy with principles of mindfulness, gradual increase of activities, body awareness therapy and pacing. The difference in effectiveness and cost-effectiveness between multidisciplinary rehabilitation treatment and cognitive behavioural therapy is as yet unknown. The FatiGo (Fatigue-Go trial aims to compare the effects of both treatment approaches in outpatient rehabilitation on fatigue severity and quality of life in patients with chronic fatigue syndrome. Methods One hundred twenty patients who meet the criteria of chronic fatigue syndrome, fulfil the inclusion criteria and sign the informed consent form will be recruited. Both treatments take 6 months to complete. The outcome will be assessed at 6 and 12 months after the start of treatment. Two weeks after the start of treatment, expectancy and credibility will be measured, and patients will be asked to write down their personal goals and score their current performance on these goals on a visual analogue scale. At 6 and 14 weeks after the start of treatment, the primary outcome and three potential mediators—self-efficacy, causal attributions and present-centred attention-awareness—will be measured. Primary outcomes are fatigue severity and quality of life. Secondary outcomes are physical activity, psychological symptoms, self-efficacy, causal attributions, impact of disease on emotional and physical functioning, present-centred attention-awareness, life

Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation.

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Vugts, Miel A P; Joosen, Margot C W; Mert, Agali; Zedlitz, Aglaia; Vrijhoef, Hubertus J M

2017-06-08

Many individuals suffer from chronic pain or functional somatic syndromes and face boundaries for diminishing functional limitations by means of biopsychosocial interventions. Serious gaming could complement multidisciplinary interventions through enjoyment and independent accessibility. A study protocol is presented for studying whether, how, for which patients and under what circumstances, serious gaming improves patient health outcomes during regular multidisciplinary rehabilitation. A mixed-methods design is described that prioritises a two-armed naturalistic quasi-experiment. An experimental group is composed of patients who follow serious gaming during an outpatient multidisciplinary programme at two sites of a Dutch rehabilitation centre. Control group patients follow the same programme without serious gaming in two similar sites. Multivariate mixed-modelling analysis is planned for assessing how much variance in 250 patient records of routinely monitored pain intensity, pain coping and cognition, fatigue and psychopathology outcomes is attributable to serious gaming. Embedded qualitative methods include unobtrusive collection and analyses of stakeholder focus group interviews, participant feedback and semistructured patient interviews. Process analyses are carried out by a systematic approach of mixing qualitative and quantitative methods at various stages of the research. The Ethics Committee of the Tilburg School of Social and Behavioural Sciences approved the research after reviewing the protocol for the protection of patients' interests in conformity to the letter and rationale of the applicable laws and research practice (EC 2016.25t). Findings will be presented in research articles and international scientific conferences. A prospective research protocol for the naturalistic quasi-experimental outcome evaluation was entered in the Dutch trial register (registration number: NTR6020; Pre-results). © Article author(s) (or their employer(s) unless

Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

DEFF Research Database (Denmark)

Ringbaek, Thomas J.; Lavesen, Marie; Lange, Peter

2016-01-01

BACKGROUND: A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). OBJECTIVE: To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. METHODS: A total of 115 patients...... participated in a 7- to 10-week outpatient PR programme in groups of 10-12 individuals. Half of the groups were assigned to PR plus a tablet (tablet group) and the other groups were assigned to PR only (controls). Primary effect parameters were endurance shuttle walk time (ESWT) and disease-specific health...... status (COPD Assessment Test=CAT). RESULTS: The change in ESWT was significantly better in the control group (mean 167 sec) compared with the tablet group (mean 51 sec) (p

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study.

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Del Baño-Aledo, M Elena; Medina-Mirapeix, Francesc; Escolar-Reina, Pilar; Montilla-Herrador, Joaquina; Collins, Sean M

2014-03-01

To identify elements of the physiotherapist-patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings. A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach. Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain). Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. Patients based their evaluations of quality of care on their assessment of physiotherapists' willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist-patient interaction emerged under all these themes, except for friendly and respectful communication. This study identified which elements of the physiotherapist-patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients' experiences of the physiotherapist-patient interaction in rehabilitation services to provide empirical and quantitative evidence. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people.

Science.gov (United States)

Randström, Kerstin Björkman; Wengler, Yvonne; Asplund, Kenneth; Svedlund, Marianne

2014-03-01

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people. The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people. Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis. Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: 'giving 'hands-off' support' and 'being in a home environment'. The second main category, working across professional boundaries, consisted of the subcategories: 'coordinating resources' and 'learning from each other'. Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation. Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on 'hands-off' support in order to incorporate an individual's everyday activities as a part of their rehabilitation. © 2012 Blackwell Publishing Ltd.

Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty.

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Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J

2015-05-01

Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. Copyright © 2014 Elsevier Inc. All rights reserved.

How can group-based multidisciplinary rehabilitation for patients with fibromyalgia influence patients' self-efficacy and ability to cope with their illness: a grounded theory approach.

Science.gov (United States)

Rasmussen, Marianne Uggen; Amris, Kirstine; Rydahl-Hansen, Susan

2017-04-01

To describe how group-based multidisciplinary rehabilitation for patients with fibromyalgia can influence patients' self-efficacy and ability to cope with their illness. Multidisciplinary rehabilitation is recommended in the management of fibromyalgia. Self-efficacy is said to influence and predict adaptive coping behaviours and functioning. However, knowledge is lacking on how rehabilitation programmes may influence self-efficacy and ability to cope, from the patients' perspective. Grounded theory study of semi-structured focus group interviews. Participants (n = 17) were included in four focus groups that had completed a two-week multidisciplinary rehabilitation programme together. Interviews were conducted four weeks after each group had completed the programme. The analysis was conducted constant comparatively applying open, axial and selective coding. Categories (in italics) were derived from data in which the explanatory core category was identified: Learning to accept and live with pain as a life condition, and linked to three categories mutually influencing each other: Increased self-acceptance of living with the illness, experiencing acceptance from others and developing new coping strategies. Thus, patients benefitted from multidisciplinary rehabilitation with stronger self-efficacy and expectations to their future coping. However, limitations in the programme were identified, as the programme was short and intensive with no subsequent follow-up, and social welfare was not sufficiently addressed. Participants also found it difficult to maintain knowledge and were lacking individual sessions with the psychologist and had waited long to receive rehabilitation. Multidisciplinary rehabilitation may advantageously be offered to patients with fibromyalgia. However, earlier action with longer programmes, in which patients' social situation is addressed, comprising individual sessions with the psychologist, with multiple repetitions of the content and follow

Effects of a multidisciplinary group rehabilitation programme on participation of the visually impaired elderly : a pilot study

NARCIS (Netherlands)

Alma, Manna A.; Groothoff, Johan W.; Melis-Dankers, Bart J. M.; Post, Marcel W. M.; Suurmeijer, Theo P. B. M.; van der Mei, Sijrike F.

2012-01-01

Purpose: To pilot test the newly developed multidisciplinary group rehabilitation programme Visually Impaired elderly Persons Participating (VIPP). Method: A single group pretest-posttest design pilot study included 29 visually impaired persons (>= 55 years). The intervention (20 weekly meetings)

[Neuro-rehabilitation after stroke].

Science.gov (United States)

Murie-Fernández, M; Irimia, P; Martínez-Vila, E; John Meyer, M; Teasell, R

2010-04-01

the high incidence of stroke results in significant mortality and disability leading to immense health care costs. These costs lead to socioeconomic, budgetary, and staffing repercussions in developing countries. Improvements in stroke management focus mainly on acute neurological treatment, admission to stroke units, fibrinolytic treatment for ischaemic strokes and rehabilitation processes. Among these, rehabilitation has the longest therapeutic window, can be applied in both ischaemic and haemorrhagic strokes, and can improve functional outcomes months after stroke. Neurologists, because of their knowledge in neuroanatomy, physiopathology, neuro-pharmacology, and brain plasticity, are in an ideal position to actively participate in the neurorehabilitation process. Several processes have been shown to play a role in determining the efficacy of rehabilitation; time from stroke onset to rehabilitation admission and the duration and intensity of treatment. neurorehabilitation is a sub-speciality in which neurologists should be incorporated into multidisciplinary neurorehabilitation teams. Early time to rehabilitation admission and greater intensity and duration of treatment are associated with better functional outcomes, lower mortality/institutionalisation, and shorter length of stay. In order to be efficient, a concerted effort must be made to ensure patients receive neurorehabilitation treatment in a timely manner with appropriate intensity to maximize patient outcomes during both inpatient and outpatient rehabilitation. Published by Elservier España, S.L. All rights reserved.

Rehabilitation of a patient with stroke

Directory of Open Access Journals (Sweden)

Apurba Barman

2013-01-01

Full Text Available Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study.

Science.gov (United States)

Bertelsen, Merete; Broberg, Susse; Madsen, Ellen

2009-01-01

The aim of this study was to evaluate the outcome of physiotherapy as part of a multidisciplinary rehabilitation. Prospective uncontrolled intervention study. Fifty patients with late effects of polio, first time referred to physiotherapy at the Danish Society of Polio and Accident Victims (PTU) Rehabilitation Centre. The intervention was physiotherapy as an essential part of an individually planned multidisciplinary rehabilitation. The outcome measures Six-Minute Walk Test and Timed-Stands Test were used to assess the functional capacity. Quality of life was evaluated by Medical Outcome Survey Short Form (SF-36) and fatigue by Multidimensional Fatigue Inventory (MFI-20). Patients were tested at baseline; 3 months after the start of rehabilitation and at one-year follow-up. The patients showed significantly better functional capacity on all measurements 3 months after start of intervention and at one-year follow-up. The patients showed significant improvement in 3 of the SF-36 dimensions regarding quality of life, but only the improvement in "general health" remained after one year. This study shows that patients with late effects of polio, who experience new problems related to polio, can benefit from an individually planned multidisciplinary intervention with emphasis on physiotherapy, and the improvement in physical capacity and general health can remain at one-year follow-up.

Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery.

Science.gov (United States)

Spiroski, Dejan; Andjić, Mojsije; Stojanović, Olivera Ilić; Lazović, Milica; Dikić, Ana Djordjević; Ostojić, Miodrag; Beleslin, Branko; Kostić, Snežana; Zdravković, Marija; Lović, Dragan

2017-05-01

Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57.72 ± 7.61 years, left ventricular ejection fraction 55% ± 5.81%), who participated in a 3-week clinical and 6-month outpatient cardiac rehabilitation program. The Inpatient program consisted of cycling 7 times/week and daily walking for 45 minutes. The outpatient program consisted mainly of walking 5 times/week for 45 minutes and cycling 3 times/week. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute at the start, for 3 weeks, and for 6 months. After 3 weeks of an exercise-based cardiac rehabilitation program, exercise tolerance improved as compared to baseline, as well as peak respiratory exchange ratio. Most importantly, peak VO 2 (16.35 ± 3.83 vs 17.88 ± 4.25 mL/kg/min, respectively, P exercise training in patients with MI treated with CABG surgery is safe and improves functional capacity. © 2017 Wiley Periodicals, Inc.

DO PATIENTS WITH CHRONIC LOW BACK PAIN EXPERIENCE PAIN REDUCTION AND FUNCTIONAL IMPROVEMENT AFTER TREATMENT AT A MULTIDISCIPLINARY OUTPATIENT CLINIC?

Directory of Open Access Journals (Sweden)

Norbye Anja

2017-04-01

Full Text Available Background: Low back pain is the most common affliction of the musculoskeletal system. Patients with chronic low back pain cost the society great expenses in treatments and other social benefits; however, the effects of interventions are discussed. The purpose of this study was to determine whether patients with chronic low back pain experience pain reduction and functional improvement after treatment at a multidisciplinary outpatient clinic. Methods: A prospective study design was used, including 446 patients who participated in follow-up questionnaires with data collection at 6 and 12 months after treatment. The primary outcome was alterations in pain and function. Result: By 12 months after treatment, 71.3 % of the included patients had completed the follow-up questionnaires. Based on these questionnaires, we identified statistically significant changes from baseline at all end points, with clinically significant changes in approximately half of the participants (p = 0.000. Conclusion: Treatment of chronic low back pain at a multidisciplinary outpatient clinic resulted in clinically significant pain reduction and functional improvement within 12 months for approximately half of affected patients.

Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study.

Science.gov (United States)

Spruit, Martijn A; Janssen, Paul P; Willemsen, Sonja C P; Hochstenbag, Monique M H; Wouters, Emiel F M

2006-05-01

Although lung cancer is a highly prevalent type of cancer, the effects of an inpatient multidisciplinary rehabilitation program on pulmonary function and exercise capacity have never been studied in these patients. Pulmonary function, 6-min walking distance and peak exercise capacity of 10 patients with a severely impaired pulmonary function following treatment of lung cancer were assessed in this pilot study before and after an 8-week inpatient multidisciplinary rehabilitation program. At baseline, patients had a restrictive pulmonary function and an apparent exercise intolerance (median 6-min walking distance: 63.6% predicted; median peak cycling load: 58.5% predicted). Despite the lack of change in median pulmonary function [FEV1: -0.01L, p = 0.5469], functional exercise capacity [145 m; 43.2% of the initial values, p=0.0020] and peak exercise capacity [26 W; 34.4% of the initial values, p = 0.0078] improved significantly compared to baseline. Future trials have to corroborate the present findings. Nevertheless, patients with lung cancer have a clear indication to start a comprehensive rehabilitation program following intensive treatment of their disease. In fact, based on the results of the present pilot study it appears that these patients are good candidates for pulmonary rehabilitation programs.

Multidisciplinary team approach in the oral rehabilitation of patients with cleidocranial dysplasia to achieve a functional aesthetic outcome.

Science.gov (United States)

Patel, D; Patel, N; Brennan, P A; Kwok, J

2017-11-01

Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6. Successful treatment depends on multidisciplinary assessment and a comprehensive staged treatment plan. We present a case series of 12 patients who were managed with a specifically tailored combination of surgery, orthodontics, and prosthodontics to provide a functional dentition and restore their smile and facial contour. Successful dental rehabilitation can be challenging in this group because patients often have multiple dental anomalies and a reduced quantity and density of alveolar bone. Rehabilitation with early intervention and a carefully planned multidisciplinary approach has been successful in the long term. Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial.

Science.gov (United States)

Braverman, S E; Spector, J; Warden, D L; Wilson, B C; Ellis, T E; Bamdad, M J; Salazar, A M

1999-06-01

To design and describe an effective rehabilitation programme for use in an ongoing trial on the efficacy of multidisciplinary brain injury rehabilitation for moderately head injury military service members. Treatment arm of a randomized control trial. US military tertiary care hospital inpatient rehabilitation programme. Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. Eight week rehabilitation programme combining group and individual therapies with an inpatient milieu-oriented neuropsychological focus. Group therapies included fitness, planning and organization, cognitive skills, work skills, medication, and milieu groups, and community re-entry outings. Individual therapy included neuropsychology, work therapy, occupational therapy, and speech and language pathology. Successful return to work and return to duty. At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. The described rehabilitation programme demonstrates one successful effort to rehabilitate active duty military service members with TBI who have the potential to return to duty.

The Effectiveness of a Multidisciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People Who Are Visually Impaired

NARCIS (Netherlands)

Alma, Manna A.; Groothoff, Johan W.; Melis-Dankers, Bart J. M.; Suurmeijer, Theodorus; van der Mei, Sijrike F.

2013-01-01

Introduction: The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods: The single-group pretest-posttest pilot study included 29 persons with visual

How can group-based multidisciplinary rehabilitation for patients with fibromyalgia influence patients' self-efficacy and ability to cope with their illness: a grounded theory approach

DEFF Research Database (Denmark)

Uggen Rasmussen, Marianne; Amris, K; Rydahl-Hansen, Susan

2017-01-01

Aims and objectives: To describe how group-based multidisciplinary rehabilitation for patients with fibromyalgia can influence patients' self-efficacy and ability to cope with their illness. Background: Multidisciplinary rehabilitation is recommended in the management of fibromyalgia. Self...... coding. Results: Categories (in italics) were derived from data in which the explanatory core category was identified: Learning to accept and live with pain as a life condition, and linked to three categories mutually influencing each other: Increased self-acceptance of living with the illness...

Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer’s disease and cognitive impairment without dementia

Directory of Open Access Journals (Sweden)

Glenda Dias Santos

2015-12-01

Full Text Available Abstract Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD and cognitive impairment without dementia (CIND. Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54 or control (n = 16 groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13 or with CIND (n = 14 who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021 and quality of life (p = 0.003, along with a reduction in depressive symptoms (p < 0.001. As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005 and depressive symptoms (p = 0.011. No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

Science.gov (United States)

Wong, Eliza M L; Zhong, Xue Bing; Sit, Janet W H; Chair, Sek Ying; Leung, Doris Y P; Leung, Carmen; Leung, K C

2016-09-01

This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.

Science.gov (United States)

Lucchetti, Giancarlo; Lucchetti, Alessandra Granero; Badan-Neto, Antonio M; Peres, Patricia T; Peres, Mario F P; Moreira-Almeida, Alexander; Gomes, Cláudio; Koenig, Harold G

2011-03-01

To evaluate the relationship between religiousness and mental health, hospitalization, pain, disability and quality of life in older adults from an outpatient rehabilitation setting in Sao Paulo, Brazil. Cross-sectional study. A total of 110 patients aged 60 years or older were interviewed during attendance at an outpatient rehabilitation service. Researchers administered a standardized questionnaire that assessed socio-demographic data, religiousness, self-reported quality of life, anxiety, physical activity limitation, depression, pain and cognition. Predictors were included in each model analysis, and a backward conditional method was used for variable selection using logistic regression (categorical outcomes) or linear regression (continuous outcomes). Thirty-one patients (28.2%) fulfilled criteria for significant depressive symptoms, 27 (24.5%) for anxiety, and 10 (9.6%) for cognitive impairment. Pain was present in 89 (80.7%) patients. Limited depressive symptoms (as assessed by the Geriatric Depression Scale), and greater self-reported quality of life were related to greater self-reported religiousness, as were scores on the Mini-Mental State Examination (less cognitive impairment), and lower ratings of pain. Religiousness is related to significantly less depressive symptoms, better quality of life, less cognitive impairment, and less perceived pain. Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings.

Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines.

Science.gov (United States)

Butterworth, C; McCaul, L; Barclay, C

2016-05-01

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation. Recommendations • Preventative oral care must be delivered to patients whose cancer treatment will affect the oral cavity, jaws, salivary glands and oral accessibility. (G) • Close working and communication between the surgeons, oncologists and restorative dental specialists is important in ensuring optimal oral health outcomes. (G) • Intensity-modulated radiotherapy has been shown to reduce long-term xerostomia and should be offered to all appropriate patients. (R) • If patients are deemed at risk of trismus they should be warned and its progressive and potentially irreversible nature explained. (G) • Where it is known that adjuvant radiotherapy will be given, extractions should take place at primary surgery to maximise the time for healing and minimise the number of surgical events for patients. (G) • Osseointegrated implants should be considered for all patients having resection for head and neck cancer. (G).

Rapid sideline performance meets outpatient clinic: Results from a multidisciplinary concussion center registry.

Science.gov (United States)

Kyle Harrold, G; Hasanaj, Lisena; Moehringer, Nicholas; Zhang, Isis; Nolan, Rachel; Serrano, Liliana; Raynowska, Jenelle; Rucker, Janet C; Flanagan, Steven R; Cardone, Dennis; Galetta, Steven L; Balcer, Laura J

2017-08-15

This study investigated the utility of sideline concussion tests, including components of the Sports Concussion Assessment Tool, 3rd Edition (SCAT3) and the King-Devick (K-D), a vision-based test of rapid number naming, in an outpatient, multidisciplinary concussion center treating patients with both sports-related and non-sports related concussions. The ability of these tests to predict clinical outcomes based on the scores at the initial visit was evaluated. Scores for components of the SCAT3 and the K-D were fit into regression models accounting for age, gender, and sport/non-sport etiology in order to predict clinical outcome measures including total number of visits to the concussion center, whether the patient reached a SCAT3 symptom severity score≤7, and the total types of referrals each patient received over their course. Patient characteristics, differences between those with sport and non-sport etiologies, and correlations between the tests were also analyzed. Among 426 patients with concussion, SCAT3 total symptom score and symptom severity score at the initial visit predicted each of the clinical outcome variables. K-D score at the initial visit predicted the total number of visits and the total number of referrals. Those with sports-related concussions were younger, had less severely-affected test scores, had fewer visits and types of referrals, and were more likely to have clinical resolution of their concussion and to reach a symptom severity score≤7. This large-scale study of concussion patients supports the use of sideline concussion tests as part of outpatient concussion assessment, especially the total symptom and symptom severity score portions of the SCAT3 and the K-D. Women in this cohort had higher total symptom and symptom severity scores compared to men. Our data also suggest that those with non-sports-related concussions have longer lasting symptoms than those with sports-related concussions, and that these two groups should perhaps be

Rehabilitation activities, out-patient visits and employment in patients and partners the first year after ICU

DEFF Research Database (Denmark)

Ågård, Anne Sophie; Lomborg, K; Tønnesen, E

2014-01-01

) 52 (15–174) days (n = 10). Community-based training was 12 (3–34) weeks (n = 15). Neuropsychological rehabilitation following brain damage was 13–20 weeks (n = 3). Number of out-patient visits 1 year before and 1 year after were mean 3 versus 8, and General Practitioner visits were 12 versus 18......Summary Objectives To describe the influence of critical illness on patients and their partners in relation to rehabilitation, healthcare consumption and employment during the first year after Intensive Care Unit discharge. Design Longitudinal, observational and descriptive. Setting Five Danish...... Intensive Care Units. Methods Data were collected from hospital charts, population registers and interviews with 18 patients and their partners at 3 and 12 months after intensive care discharge. Descriptive statistical analysis was performed. Results Post-discharge inpatient rehabilitation was median (range...

Rehabilitation service models for people with physical and/or mental disability living in low- and middle-income countries: A systematic review.

Science.gov (United States)

Furlan, Andréa D; Irvin, Emma; Munhall, Claire; Giraldo-Prieto, Mario; Fullerton, Laura; McMaster, Robert; Danak, Shivang; Costante, Alicia; Pitzul, Kristen B; Bhide, Rohit P; Marchenko, Stanislav; Mahood, Quenby; David, Judy A; Flannery, John F; Bayley, Mark

2018-04-03

To compare models of rehabilitation services for people with mental and/or physical disability in order to determine optimal models for therapy and interventions in low- to middle-income countries. CINAHL, EMBASE, MEDLINE, CENTRAL, PsycINFO, Business Source Premier, HINARI, CEBHA and PubMed. Systematic reviews, randomized control trials and observational studies comparing >2 models of rehabilitation care in any language. Date extraction: Standardized forms were used. Methodological quality was assessed using AMSTAR and quality of evidence was assessed using GRADE. Twenty-four systematic reviews which included 578 studies and 202,307 participants were selected. In addition, four primary studies were included to complement the gaps in the systematic reviews. The studies were all done at various countries. Moderate- to high-quality evidence supports the following models of rehabilitation services: psychological intervention in primary care settings for people with major depression, admission into an inpatient, multidisciplinary, specialized rehabilitation unit for those with recent onset of a severe disabling condition; outpatient rehabilitation with multidisciplinary care in the community, hospital or home is recommended for less severe conditions; However, a model of rehabilitation service that includes early discharge is not recommended for elderly patients with severe stroke, chronic obstructive pulmonary disease, hip fracture and total joints. Models of rehabilitation care in inpatient, multidisciplinary and specialized rehabilitation units are recommended for the treatment of severe conditions with recent onset, as they reduce mortality and the need for institutionalized care, especially among elderly patients, stroke patients, or those with chronic back pain. Results are expected to be generalizable for brain/spinal cord injury and complex fractures.

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

NARCIS (Netherlands)

Melick, N. van; Cingel, R.E. van; Brooijmans, F.; Neeter, C.; Tienen, T. van; Hullegie, W.; Sanden, M.W. van der

2016-01-01

AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and

Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation.

Science.gov (United States)

Gison, Annalisa; Rizza, Federica; Bonassi, Stefano; Donati, Valentina; Giaquinto, Salvatore

2015-01-01

This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson's disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson's Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO di not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances.

A Surgical Perspective of the Outcome of a Multidisciplinary Intestinal Rehabilitation Program for Children With Short Bowel Syndrome in the Netherlands

NARCIS (Netherlands)

Schurink, M.; Hulscher, J. B. F.; Nieuwenhuijs, V. B.; Heineman, E.; Rings, E. H. H. M.

2014-01-01

Aim. In 2001, a multidisciplinary intestinal rehabilitation program, prompted by a nationwide collaboration on intestinal failure (Dutch Registry for Intestinal Failure and Intestinal Transplantation), was started for children who have short bowel syndrome (SBS). This study evaluates this program,

Stochastic integer programming for multi-disciplinary outpatient clinic planning

NARCIS (Netherlands)

Leeftink, A. G.; Vliegen, I. M.H.; Hans, E. W.

2017-01-01

Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are

Health-Related Quality-of-Life in patients with chronic rheumatic disease after a multidisciplinary rehabilitation regimen

DEFF Research Database (Denmark)

Couppé, C; Comins, J.; Beyer, N.

2017-01-01

-, and 12-month follow-ups. Multivariable linear regression models using generalized estimating equations to account for repeated measurement were employed. A weighting procedure to account for differential dropouts was applied. Results: Three hundred fifty-six women and 74 men with chronic rheumatic......Introduction: Multidisciplinary rehabilitation has beneficial effects on health-related quality of life (HRQoL) in patients with chronic rheumatic diseases. However, whether this intervention benefits different age groups in women or men is largely unknown. Purpose: To investigate HRQoL in patients...

EVALUATING PATIENTS’ NEEDS AMONG REHABILITATION SETTING

Directory of Open Access Journals (Sweden)

Mohammed M. J. Alqahtani

2015-09-01

Full Text Available Patient’ needs have been found to be crucial to the success of rehabilitation and recovery. To understand what patients want from their rehabilitation services should be addressed in the rehabilitation intervention. This study aims to examine patients’ needs for rehabilitation services as well as to examine the validity of a self-report questionnaire that developed to measure what patient needs from rehabilitation services in Saudi Arabia. Tow hundreds-eighty patients, from inpatients and outpatients, with stroke, spinal cord and brain injury completed the Patient’s Needs Questionnaire (PNQ. In general, the result showed that patients are in highly needs for Psychological Interventions, even before Rehabilitation and Treatment component. In detail, Psychological Intervention and Emotional Support were significantly greater in inpatients than in outpatients. Outpatients, in contrast, affirmed the Religious Support component significantly more than inpatients did. The statistical analysis of PNQ yielded four components: psychological interventions, rehabilitation and treatment, religious support, and explanation/reassurance. These components accounted for 48.71% of the total variances. Rehabilitation services is not only the component of rehabilitation intervention and medical treatments, indeed, it is a holistic intervention that understand the psychological, religious, and reassurance demands. The health provider in Saudi Arabia should develop a rehabilitation goal menu based on patient-centred care needs. The PNQ is a valuable and practical tool for the identification of patients’ needs from rehabilitation services.

[A nationwide investigation needs for rehabilitation of schizophrenic outpatients--the patients' attribute and actual conditions of living].

Science.gov (United States)

Yamashita, T; Kuroda, K; Hirano, W; Ueno, M; Yoshizumi, A; Inomata, Y; Komine, K

1996-01-01

In Japan we are very short of community resources for persons with mental disability. The authors, a board of resettlement, thought patients' actual conditions of living and needs for rehabilitation to let them live in the community had to be evaluated. Then in March 1993 the actual conditions of living and needs for rehabilitation of schizophrenic outpatients were investigated nationally. This article is the report on the patients' actual conditions of living. Investigation papers were sent to 358 institutions (286 hospitals and 72 clinics) which agreed to cooperate with the investigation. The 5186 investigation papers were received from 313 institutions. All of the papers except 18, which were lack of their ages, were analyzed. All of the schizophrenic outpatients, who consulted psychiatrists on one day during investigation, were considered objects of this research. Those who consented were included the research and psychiatrists filled in investigation papers. These institutions had a policy of intensive social resettlement activities and so on. Male patients were 55% and females were 45%. There were patients in the forties and females were older than males. Thirty-nine percent of them had been hospitalized once or twice. Thirty-four percent of them had been hospitalized for less than one year. Eighteen percent of them had not been hospitalized. Fifty percent of patients answered there was no friend and acquaintance, and had a tendency to stand alone. Fifty-three percent of patients lived with their parents, 21% with their spouses, and 17% alone. But 32% of females lived with their husbands. Sixteen percent worked for full-time jobs, 8% worked part-time jobs, 12% attended day care center 4% went to sheltered-workshops and only 1% went to rehabilitation-workshops for outpatients. While 13% didn't have a right to receive disability pension, the sources of income were job (30%), disability pension (30%), and welfare benefits (12%). Regarding the ability for living

Multidisciplinary Team Contributions Within a Dedicated Outpatient Palliative Radiotherapy Clinic: A Prospective Descriptive Study

International Nuclear Information System (INIS)

Pituskin, Edith; Fairchild, Alysa; Dutka, Jennifer; Gagnon, Lori; Driga, Amy; Tachynski, Patty; Borschneck, Jo-Ann; Ghosh, Sunita

2010-01-01

Purpose: Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic. Methods and Materials: Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes. Results: A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks. Conclusions: Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.

Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation.

Science.gov (United States)

Monaghan, J; Channell, K; McDowell, D; Sharma, A K

2005-03-01

To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.

Evaluation of a multidisciplinary rehabilitation programme for elderly patients with hip fracture: A prospective cohort study

Directory of Open Access Journals (Sweden)

Wing-Hoi Cheung

2017-12-01

Full Text Available Objective: To investigate the effectiveness and cost of an 18-month multi-disciplinary Comprehensive Fragility Fracture Management Program (CFFMP for fragility hip fracture patients. Design: Prospective cohort study. Patients: Elderly patients with hip fracture were recruited at their first postoperative follow-up in 2 district hospitals. The intervention group comprised patients from the hospital undergoing CFFMP, and the control group comprised patients from another hospital undergoing conventional care. CFFMP provided geri-orthopaedic co-management, physician consultations, group-exercise and vibration-therapy. Timed-up-and-go test (TUG, Elderly Mobility Scale (EMS, Berg Balance Scale (BBS and fall risk screening (FS were used to assess functional performance. Incidences of falls and secondary fractures, the cost of the programme and related healthcare resources were recorded. Results: A total of 76 patients were included in the intervention group (mean age 77.9 years ((standard deviation; SD 6.1 and 77 in the control group (79.9 (SD 7.2, respectively. The re-fracture rate in the control group (10.39% was significantly higher than in the intervention group (1.32% (p = 0.034. The intervention group improved significantly in TUG, EMS and FS after a 1-year programme. The overall healthcare costs per patient in the intervention and control groups were US$22,450 and US$25,313, respectively. Conclusion: Multi-disciplinary CFFMP is effective, with reduced overall cost, reduced length of hospital stay and reduced secondary fracture rate. The rehabilitation community service favours rehabilitation and improved quality of life of hip fracture patients.

A MULTIDISCIPLINARY APPROACH TO THE REHABILITATION OF A COLLEGIATE FOOTBALL PLAYER FOLLOWING ANKLE FRACTURE: A CASE REPORT.

Science.gov (United States)

Feigenbaum, Luis A; Kaplan, Lee D; Musto, Tony; Gaunaurd, Ignacio A; Gailey, Robert S; Kelley, William P; Alemi, Timothy J; Espinosa, Braulio; Mandler, Eli; Scavo, Vincent A; West, Dustin C

2016-06-01

Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling. A 21 year-old running back fractured his lateral malleolus due to a mechanism of injury of excessive eversion with external rotation of the ankle. Surgical intervention included an open reduction internal fixation (ORIF) of the fibula and syndesmosis. In addition to six months of rehabilitation, the patient received consultations from the team sports nutritionist specialist to provide dietary counseling and body composition testing. The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S), a performance-based outcome measure, self-report on the Foot and Ankle Disability Index (FADI-ADL, FADI-S), and body composition testing using whole body densitometry (BOD POD®), were administered throughout rehabilitation. The subject was successfully rehabilitated, returned to his starting role, and subsequently was drafted by a National Football League (NFL) franchise. High-level mobility returned to above pre-injury values, achieving 105% of his preseason CHAMP-S score at discharge. Self-reported function on the FADI-ADL and FADI-Sport improved to 100% at discharge. Body fat percentages decreased (13.3% to 11.9%) and fat mass decreased (12.0 kg to 11.0kg). Lean body mass (78.1 kg to 81.5 kg) and lbm/in increased (1.14 kg/in to 1.19 kg/in). His BMI changed from 29.8 kg/m(2) to 30.6 kg/m(2). This case report illustrates the positive effects of a multidisciplinary approach where combining physical therapy and

Rehabilitation interventions in multiple sclerosis: an overview.

Science.gov (United States)

Beer, Serafin; Khan, Fary; Kesselring, Jürg

2012-09-01

Multiple sclerosis is a complex, heterogeneous disease associated with long-term disability. Despite the availability of advanced disease-modifying and symptomatic therapies that may decrease activity and progression of disease and alleviate complaints to a certain extent, there is still a need for comprehensive rehabilitation interventions in order to reduce sequels and symptoms of the disease on personal activities and social participation to achieve the highest possible independence and the best quality of life. Timing and setting of rehabilitation interventions should be selected individually depending on disease phase, functional deficits, personal requirements, as well as specific goals. In addition, limitations and disease-specific characteristics that may influence rehabilitation outcome should be noted. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing risk for losing important abilities or independence. Due to gradual failure of adaptive compensatory mechanisms along the course of disease, benefits of rehabilitation interventions are generally higher in earlier phases of MS. Inpatient and outpatient multidisciplinary rehabilitation has been shown to be beneficial in improving disability, participation and quality of life despite progression of the disease. Good evidence exists for different specific interventions improving physical and cognitive performance. Other important issues responsible for beneficial effects of comprehensive rehabilitation in MS include education, instruction, and information of patients and caregivers. Comprehensive assessment of health domains in MS patients using standardized framework and common language for describing the impact of disease at different levels, using International Classification of Functioning, Disability and Health (ICF) core sets may increase the knowledge of needs of these patients for more efficient and adapted rehabilitation interventions meeting these

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

Directory of Open Access Journals (Sweden)

Anema Johannes R

2007-09-01

Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

Directory of Open Access Journals (Sweden)

Francis Rebecca

2010-01-01

Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

DEFF Research Database (Denmark)

Corrà, Ugo; Piepoli, Massimo F; Carré, François

2010-01-01

of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction...... and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention...... and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling...

Cancer rehabilitation in Austria--aspects of Physical Medicine and Rehabilitation.

Science.gov (United States)

Maehr, Bruno; Keilani, Mohammad; Wiltschke, Christoph; Hassler, Marco; Licht, Thomas; Marosi, Christine; Huetterer, Elisabeth; Cenik, Fadime; Crevenna, Richard

2016-02-01

In Austria, cancer rehabilitation is an important issue in the management of cancer patients. Survival rates and survival time of cancer patients are increasing, and cancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and (social) participation. Today, in Austria there are approximately 600 beds for inpatient rehabilitation. The field of outpatient rehabilitation will maybe be expanded after evaluating the existing pilot projects. Beside other specialities, the field of Physical Medicine and Rehabilitation (PM&R) plays an important role in cancer rehabilitation. In cancer rehabilitation, especially activating modalities from PM&R such as exercise are very important and well-accepted parts to improve functional status, quality of life, and participation of patients.

A MULTIDISCIPLINARY APPROACH TO THE REHABILITATION OF A COLLEGIATE FOOTBALL PLAYER FOLLOWING ANKLE FRACTURE: A CASE REPORT

Science.gov (United States)

Kaplan, Lee D.; Musto, Tony; Gaunaurd, Ignacio A.; Gailey, Robert S.; Kelley, William P.; Alemi, Timothy J.; Espinosa, Braulio; Mandler, Eli; Scavo, Vincent A.; West, Dustin C.

2016-01-01

ABSTRACT Background and Purpose Multiple rehabilitation factors including overall wellness need to be considered when an athlete returns to sport after an injury. The purpose of this case report is to describe a multidisciplinary approach for return to sport of a Division I collegiate football player following a traumatic ankle fracture requiring surgical repair. The assessment and treatment approach included the use of a performance-based physical therapy outcome measure, self-reported functional abilities, body composition assessments, and nutritional counseling. Case Description A 21 year-old running back fractured his lateral malleolus due to a mechanism of injury of excessive eversion with external rotation of the ankle. Surgical intervention included an open reduction internal fixation (ORIF) of the fibula and syndesmosis. In addition to six months of rehabilitation, the patient received consultations from the team sports nutritionist specialist to provide dietary counseling and body composition testing. The Comprehensive High-level Activity Mobility Predictor-Sport (CHAMP-S), a performance-based outcome measure, self-report on the Foot and Ankle Disability Index (FADI-ADL, FADI-S), and body composition testing using whole body densitometry (BOD POD®), were administered throughout rehabilitation. Outcomes The subject was successfully rehabilitated, returned to his starting role, and subsequently was drafted by a National Football League (NFL) franchise. High-level mobility returned to above pre-injury values, achieving 105% of his preseason CHAMP-S score at discharge. Self-reported function on the FADI-ADL and FADI-Sport improved to 100% at discharge. Body fat percentages decreased (13.3% to 11.9%) and fat mass decreased (12.0 kg to 11.0kg). Lean body mass (78.1 kg to 81.5 kg) and lbm/in increased (1.14 kg/in to 1.19 kg/in). His BMI changed from 29.8 kg/m2 to 30.6 kg/m2. Discussion This case report illustrates the positive effects of a

Are there meaningful longitudinal changes in health related quality of life--SF36, in cardiac rehabilitation patients?

LENUS (Irish Health Repository)

McKee, Gabrielle

2012-02-01

BACKGROUND: This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data. METHODS: In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme. RESULTS: There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase. CONCLUSIONS: These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.

Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: a review.

Science.gov (United States)

Rivas-Perez, Hiram; Nana-Sinkam, Patrick

2015-04-01

Lung cancer is the number one cause of cancer related deaths. It is increasingly recognized that a multidisciplinary approach to the diagnosis and management of patients with lung cancer represents the ideal model for health care delivery. Given the high incidence of comorbid lung disease in lung cancer patients, strategies targeted at improving or optimizing these conditions may improve outcomes. Pulmonary rehabilitation (PR) has proven to be a useful management strategy for patients with chronic lung diseases including chronic obstructive pulmonary disease, interstitial lung disease and pulmonary hypertension. PR improves both exercise capacity and dyspnea. The effects of PR have also been studied in patients with lung cancer prior to and following surgical resection. Investigators have demonstrated significant improvements in six minute walk distance and lower extremity strength. In addition, patient recovery time is shorter when inpatient pulmonary rehabilitation is integrated prior to or following surgery. There are also positive reports regarding the benefits of exercise training in lung cancer patients receiving definite chemotherapy and radiotherapy. Pilot studies have demonstrated improvement in dyspnea scores as well as exercise capacity objectively measured by six minute walk distance. PR also offers an educational component in which patients have the opportunity to be educated regarding management of their disease as well as discuss goals of care. PR can be included as the standard of care for patients with advanced lung cancer with the goal of optimizing quality of life. Here, we provide a review of the current knowledge regarding PR in the management of patients with lung cancer. Published by Elsevier Ltd.

COPD online-rehabilitation versus conventional COPD rehabilitation

DEFF Research Database (Denmark)

Hansen, Henrik; Bieler, Theresa; Beyer, Nina

2017-01-01

BACKGROUND: Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program......, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline assessments. DISCUSSION: The study will likely contribute to knowledge regarding COPD tele...... accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). METHODS: This study is a randomized assessor- and statistician blinded superiority multicenter...

Stroke Care 2: Stroke rehabilitation

NARCIS (Netherlands)

Langhorne, P.; Bernhardt, J.; Kwakkel, G.

2011-01-01

Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially

Effect of a web-based audit and feedback intervention with outreach visits on the clinical performance of multidisciplinary teams: a cluster-randomized trial in cardiac rehabilitation

NARCIS (Netherlands)

Gude, Wouter T.; van Engen-Verheul, Mariëtte M.; van der Veer, Sabine N.; Kemps, Hareld M. C.; Jaspers, Monique W. M.; de Keizer, Nicolette F.; Peek, Niels

2016-01-01

The objective of this study was to assess the effect of a web-based audit and feedback (A&F) intervention with outreach visits to support decision-making by multidisciplinary teams. We performed a multicentre cluster-randomized trial within the field of comprehensive cardiac rehabilitation (CR) in

[Psychosocial rehabilitation at the dawn of the 21st century: II: Therapeutic or rehabilitative modalities and institutional disposition].

Science.gov (United States)

Gasset, François; Orita, Alina; Spagnoli, Dany; Pomini, Valentino; Rabia, Sophie; Ducret, Michel; Veillon, Henri; Cucchia, Anne-Therèse

2004-04-01

The main goal of psychosocial rehabilitation is to compensate the vulnerability underlying psychiatric disorders through intermediate institutions when the persistence and recurrence of these disorders have led to social and professional exclusion. Intermediate institutions refer to services which allow transition between the state of dependence on the hospital to the state of relative autonomy in social community. Psychosocial rehabilitation is a comprehensive approach which link the type of interventions: treatment, rehabilitation and support integrated in multimodal and individualized programs. A study of the out-patients followed by the rehabilitation unit of the psychiatric department in Lausanne has shown that provision of services is divided into 60% for rehabilitation, 20% for treatment and 20% for support independently of the psychiatric disorders. The implementation of these programs necessitates institutional support from psychiatric hospital to outpatient clinics through different types of facilities in order to offer a medical and psychosocial device of rehabilitation into the community.

The effects of multidisciplinary rehabilitation: RePCa-a randomised study among primary prostate cancer patients

DEFF Research Database (Denmark)

Dieperink, K B; Johansen, C; Hansen, Steinbjørn

2013-01-01

Background:The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa).Methods:In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated...... with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum......-score.Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified...

A systematic review of economic evaluations of cardiac rehabilitation

Directory of Open Access Journals (Sweden)

Wong Wai

2012-08-01

Full Text Available Abstract Background Cardiac rehabilitation (CR, a multidisciplinary program consisting of exercise, risk factor modification and psychosocial intervention, forms an integral part of managing patients after myocardial infarction (MI, revascularization surgery and percutaneous coronary interventions, as well as patients with heart failure (HF. This systematic review seeks to examine the cost-effectiveness of CR for patients with MI or HF and inform policy makers in Singapore on published cost-effectiveness studies on CR. Methods Electronic databases (EMBASE, MEDLINE, NHS EED, PEDro, CINAHL were searched from inception to May 2010 for published economic studies. Additional references were identified through searching bibliographies of included studies. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using Drummond’s checklist. Results A total of 22 articles were selected for review. However five articles were further excluded because they were cost-minimization analyses, whilst one included patients with stroke. Of the final 16 articles, one article addressed both centre-based cardiac rehabilitation versus no rehabilitation, as well as home-based cardiac rehabilitation versus no rehabilitation. Therefore, nine studies compared cost-effectiveness between centre-based supervised CR and no CR; three studies examined that between centre- and home based CR; one between inpatient and outpatient CR; and four between home-based CR and no CR. These studies were characterized by differences in the study perspectives, economic study designs and time frames, as well as variability in clinical data and assumptions made on costs. Overall, the studies suggested that: (1 supervised centre-based CR was highly cost-effective and the dominant strategy when compared to no CR; (2 home-based CR was no different from centre-based CR; (3 no difference existed

Rasch Analysis of the Activities-specific Balance Confidence (ABC) Scale in Older Adults Seeking Outpatient Rehabilitation Services.

Science.gov (United States)

Wang, Ying-Chih; Sindhu, Bhagwant; Lehman, Leigh; Li, Xiaoyan; Yen, Sheng-Che; Kapellusch, Jay

2018-03-30

Study Design Cross-sectional study of 5,012 older patients seeking outpatient rehabilitation therapy in 123 clinics. Background The Activities-Specific Balance Confidence (ABC) Scale measures confidence in performing various ambulatory activities without falling or experiencing a sense of unsteadiness. Objectives Our purposes were to: (1) examine the ABC Scale (0-100) using the Rasch analysis, (2) assess statistically reliable change, and (3) develop a functional staging to guide clinical interpretation of the patient's improvement. Methods We examined rating scale structure, item difficulty hierarchy, item fit, person-item match, separation index, differential item functioning (DIF), test precision, and unidimensionality. Additionally, we estimated the minimal detectable change (MDC) and developed a functional staging. Results Item 'walking outside on icy sidewalks' was the most difficult item, while 'reach for a small can off a shelf at eye level' was the easiest item. Overall, average patient ability estimates of 56.2 (20.3) was slightly higher than the average item difficulty estimates of 45.9 (7.8). With a separation index equaled to 3.65, the ABC items can differentiate persons into 5.2 statistically distinct strata. Most ABC items were free of DIF. For example, 'walk outside on icy sidewalks' was easier for patients who was underweight. Results supported unidimensionality of the ABC Scale, with the first factor explained 77% of the total variance. The estimated MDC was 15 points. We provided an example of functional staging application. Conclusion Results supported sound psychometric properties and clinical usage of the ABC Scale for older adults seeking outpatient rehabilitation therapy. Level of Evidence 2c. J Orthop Sports Phys Ther, Epub 30 Mar 2018. doi:10.2519/jospt.2018.8023.

Coping, problem solving, depression, and health-related quality of life in patients receiving outpatient stroke rehabilitation.

Science.gov (United States)

Visser, Marieke M; Heijenbrok-Kal, Majanka H; Spijker, Adriaan Van't; Oostra, Kristine M; Busschbach, Jan J; Ribbers, Gerard M

2015-08-01

To investigate whether patients with high and low depression scores after stroke use different coping strategies and problem-solving skills and whether these variables are related to psychosocial health-related quality of life (HRQOL) independent of depression. Cross-sectional study. Two rehabilitation centers. Patients participating in outpatient stroke rehabilitation (N=166; mean age, 53.06±10.19y; 53% men; median time poststroke, 7.29mo). Not applicable. Coping strategy was measured using the Coping Inventory for Stressful Situations; problem-solving skills were measured using the Social Problem Solving Inventory-Revised: Short Form; depression was assessed using the Center for Epidemiologic Studies Depression Scale; and HRQOL was measured using the five-level EuroQol five-dimensional questionnaire and the Stroke-Specific Quality of Life Scale. Independent samples t tests and multivariable regression analyses, adjusted for patient characteristics, were performed. Compared with patients with low depression scores, patients with high depression scores used less positive problem orientation (P=.002) and emotion-oriented coping (Pproblem orientation (Pproblem orientation was independently related to psychosocial HRQOL (β=.086; P=.018) and total HRQOL (β=.058; P=.031). Patients with high depression scores use different coping strategies and problem-solving skills than do patients with low depression scores. Independent of depression, positive problem-solving skills appear to be most significantly related to better HRQOL. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

Directory of Open Access Journals (Sweden)

Artner J

2012-07-01

Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

Noninvasive and Multidisciplinary Approach to the Functional and Esthetic Rehabilitation of Amelogenesis Imperfecta: A Pediatric Case Report

Directory of Open Access Journals (Sweden)

Juliana Feltrin de Souza

2014-01-01

Full Text Available Case Report. An 8-year-old girl with amelogenesis imperfecta (AI reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.

Noninvasive and multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta: a pediatric case report.

Science.gov (United States)

de Souza, Juliana Feltrin; Fragelli, Camila Maria Bullio; Paschoal, Marco Aurélio Benini; Campos, Edson Alves; Cunha, Leonardo Fernandes; Losso, Estela Maris; Cordeiro, Rita de Cássia Loiola

2014-01-01

Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.

MORE Resiliency in the Rehabilitation of Active Duty Service Members

Science.gov (United States)

2017-10-01

leverage the infrastructure of the Maximizing Outpatient Rehabilitation Effectiveness (MORE) study that is currently being conducted at Brooke Army Medical...Unclassified c. THIS PAGE Unclassified Unclassified 9 19b. TELEPHONE NUMBER (include area code ) Standard Form 298 (Rev. 8- TABLE OF CONTENTS... infrastructure of the Maximizing Outpatient Rehabilitation Effectiveness (MORE) study that is currently being funded by the Bridging Advanced Developments for

Multidisciplinary team-based approach for comprehensive preoperative pulmonary rehabilitation including intensive nutritional support for lung cancer patients.

Science.gov (United States)

Harada, Hiroaki; Yamashita, Yoshinori; Misumi, Keizo; Tsubokawa, Norifumi; Nakao, Junichi; Matsutani, Junko; Yamasaki, Miyako; Ohkawachi, Tomomi; Taniyama, Kiyomi

2013-01-01

To decrease the risk of postoperative complication, improving general and pulmonary conditioning preoperatively should be considered essential for patients scheduled to undergo lung surgery. The aim of this study is to develop a short-term beneficial program of preoperative pulmonary rehabilitation for lung cancer patients. From June 2009, comprehensive preoperative pulmonary rehabilitation (CHPR) including intensive nutritional support was performed prospectively using a multidisciplinary team-based approach. Postoperative complication rate and the transitions of pulmonary function in CHPR were compared with historical data of conventional preoperative pulmonary rehabilitation (CVPR) conducted since June 2006. The study population was limited to patients who underwent standard lobectomy. Postoperative complication rate in the CVPR (n = 29) and CHPR (n = 21) were 48.3% and 28.6% (p = 0.2428), respectively. Those in patients with Charlson Comorbidity Index scores ≥2 were 68.8% (n = 16) and 27.3% (n = 11), respectively (p = 0.0341) and those in patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress scores >0.3 were 57.9% (n = 19) and 21.4% (n = 14), respectively (p = 0.0362). Vital capacities of pre- and post intervention before surgery in the CHPR group were 2.63±0.65 L and 2.75±0.63 L (p = 0.0043), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6815). Forced expiratory volumes in one second of pre- and post intervention before surgery in the CHPR group were 1.73±0.46 L and 1.87±0.46 L (p = 0.0012), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6424). CHPR appeared to be a beneficial and effective short-term preoperative rehabilitation protocol, especially in patients with poor preoperative conditions.

Multidisciplinary Approach for Full-Mouth Rehabilitation of an Adult Patient with Collapsed Occlusal Plane and Several Missing Teeth: A Clinical Report.

Science.gov (United States)

Cheong, Jieun; Hwang, Yu-Sun; Jung, Bock-Yung

2018-03-13

In the full-mouth rehabilitation of a patient with severely collapsed occlusion, a multidisciplinary approach including prosthodontics, orthodontics, endodontics, and surgery could provide better esthetic and functional results. Orthodontic treatment aiming for stable occlusion that meets the standard requirement of functional occlusion, enables the maintenance of occlusal function, and guarantees long-term stability on the basis of periodontal health was attempted. The essential element of this protocol is careful treatment planning based on the optimal sequence pursuing functional occlusion. © 2018 by the American College of Prosthodontists.

Lifestyle intervention for type 2 diabetes patients: trial protocol of The Copenhagen Type 2 Diabetes Rehabilitation Project

DEFF Research Database (Denmark)

Vadstrup, Eva S; Frølich, Anne; Perrild, Hans

2009-01-01

BACKGROUND: Current guidelines recommend education, physical activity and changes in diet for type 2 diabetes patients, yet the composition and organization of non-pharmacological care are still controversial. Therefore, it is very important that programmes aiming to improve non-pharmacological t......BACKGROUND: Current guidelines recommend education, physical activity and changes in diet for type 2 diabetes patients, yet the composition and organization of non-pharmacological care are still controversial. Therefore, it is very important that programmes aiming to improve non...... and physical fitness will be examined after 6, 12 and 24 months. DISCUSSION: The Copenhagen Type 2 Diabetes Rehabilitation Project evaluates a multi-disciplinary non-pharmacological intervention programme in a primary care setting and provides important information about how to organize non...... programme consists of empowerment-based education, supervised exercise and dietary intervention. The effectiveness of this multi-disciplinary intervention is compared with conventional individual counselling in a Diabetes Outpatient Clinic and evaluated in a prospective and randomized controlled trial...

Prevalence and predictors of depressive symptoms and wellbeing during and up to nine years after outpatient cardiac rehabilitation.

Science.gov (United States)

Koçer, O; Wachter, M; Zellweger, M; Piazzalonga, S; Hoffmann, A

2011-07-30

Depression is an important independent prognostic variable in cardiac patients. The prevalence and predictors of depressive symptoms up to nine years after cardiac rehabilitation were studied. Follow-up questionnaires were sent to 2199 patients who had completed a 12-week exercise-based outpatient cardiac rehabilitation (OCR) programme between June 1999 and March 2006. Medical outcome, general wellbeing, and depressive symptoms were assessed, the latter by using two screening questions according to Arrol. Patients with incomplete data due to language problems, lack of compliance and non-response were excluded. Complete data for analysis was available for 710 patients. The median follow up period was 46 months (Interquartile range (IQR) 22-71, min. 6 months). At follow-up, 132 patients (19%) indicated low wellbeing, whereas 81 (11%) were having depressive symptoms. Multivariate analyses revealed impaired quality of life (p wellbeing at follow-up. Persistent smoking (p = 0.045) as well as negative mood (p = 0.022) at the end of OCR were independent predictors of depressive symptoms at follow-up. In a selected patient population a mean of four years after OCR, persistent smoking, diabetes, low exercise capacity and impaired quality of life at the end of OCR were independent long term predictors of low wellbeing and depressive symptoms, rather than specific cardiac variables. This highlights the need for close cooperation between cardiovascular and psychological specialists in cardiac rehabilitation.

Does an interdisciplinary outpatient atrial fibrillation (AF) clinic affect the number of acute AF admissions?

DEFF Research Database (Denmark)

Frydensberg, Vivi Skibdal; Brandes, Axel

2018-01-01

AIMS AND OBJECTIVES: To investigate the impact of a multidisciplinary outpatient clinic for patients with atrial fibrillation (AF-clinic) on the number of acute hospitalizations for atrial fibrillation compared with usual outpatient care for this condition before the establishment of the AF-clinic....... BACKGROUND: Guidelines recommend a structured outpatient clinic follow-up in multidisciplinary teams for patients with atrial fibrillation due to fewer hospitalizations and death. However the evidence base is weak. DESIGN: The study is a retrospective cohort study including a total of 129 patients from...... the cardiac outpatient clinic at a large Danish University Hospital. The study population consisted of two groups: a usual care group before a dedicated AF-clinic was established (n=73) and the AF-clinic group (n=56). The primary endpoint was acute hospitalization for AF. METHODS: Cox regression was used...

Low Vision Rehabilitation Plans Comparing Two Intake Methods

NARCIS (Netherlands)

Bruijning, J.E.; van Nispen, R.M.A.; Knol, D.L.; van Rens, G.H.M.B.

2012-01-01

Purpose. This qualitative study investigates possible differences in identified rehabilitation needs indicated by the usual intake procedures at a Multidisciplinary Rehabilitation Center (MRC) for visually impaired persons compared with those indicated by the use of a structured Dutch version [based

Problem-Solving Therapy During Outpatient Stroke Rehabilitation Improves Coping and Health-Related Quality of Life: Randomized Controlled Trial.

Science.gov (United States)

Visser, Marieke M; Heijenbrok-Kal, Majanka H; Van't Spijker, Adriaan; Lannoo, Engelien; Busschbach, Jan J V; Ribbers, Gerard M

2016-01-01

This study investigated whether problem-solving therapy (PST) is an effective group intervention for improving coping strategy and health-related quality of life (HRQoL) in patients with stroke. In this multicenter randomized controlled trial, the intervention group received PST as add-on to standard outpatient rehabilitation, the control group received outpatient rehabilitation only. Measurements were performed at baseline, directly after the intervention, and 6 and 12 months later. Data were analyzed using linear-mixed models. Primary outcomes were task-oriented coping as measured by the Coping Inventory for Stressful Situations and psychosocial HRQoL as measured by the Stroke-Specific Quality of Life Scale. Secondary outcomes were the EuroQol EQ-5D-5L utility score, emotion-oriented and avoidant coping as measured by the Coping Inventory for Stressful Situations, problem-solving skills as measured by the Social Problem Solving Inventory-Revised, and depression as measured by the Center for Epidemiological Studies Depression Scale. Included were 166 patients with stroke, mean age 53.06 years (SD, 10.19), 53% men, median time poststroke 7.29 months (interquartile range, 4.90-10.61 months). Six months post intervention, the PST group showed significant improvement when compared with the control group in task-oriented coping (P=0.008), but not stroke-specific psychosocial HRQoL. Furthermore, avoidant coping (P=0.039) and the utility value for general HRQoL (P=0.034) improved more in the PST group than in the control after 6 months. PST seems to improve task-oriented coping but not disease-specific psychosocial HRQoL after stroke >6-month follow-up. Furthermore, we found indications that PST may improve generic HRQoL recovery and avoidant coping. URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2509. Unique identifier: CNTR2509. © 2015 American Heart Association, Inc.

Strengthened General Self-Efficacy with Multidisciplinary Vocational Rehabilitation in Women on Long-Term Sick Leave: A Randomised Controlled Trial.

Science.gov (United States)

Andersén, Åsa; Larsson, Kjerstin; Lytsy, Per; Berglund, Erik; Kristiansson, Per; Anderzén, Ingrid

2018-01-09

Purpose To investigate the effects of two vocational rehabilitation interventions on self-efficacy, for women on long-term sick leave ≥ 1 year due to chronic pain and/or mental illness. Methods This study uses data from a randomised controlled trial consisting of two phases and comprising 401 women on long-term sick leave. They were allocated to either (1) a multidisciplinary team assessment and multimodal intervention (TEAM), (2) acceptance and commitment therapy (ACT), or (3) control group. Data were collected through repeated measurements from self-reported questionnaires before intervention, 6 and 12 months later and registry data. Data from measurements of general self-efficacy, sociodemographics, anxiety and depression were analysed with linear regression analyses. Results During the intervention period, the women in the TEAM group's self-efficacy mean increased from 2.29 to 2.74. The adjusted linear regression model, which included group allocation, sociodemographics, self-efficacy pre-treatment, anxiety and depression showed increased self-efficacy for those in the TEAM intervention at 12 months (B = 0.25, 95% CI 0.10-0.41). ACT intervention had no effect on self-efficacy at 12 months (B = 0.02, 95% CI - 0.16 to 0.19). The results in the adjusted model also showed that higher self-efficacy at pre-treatment was associated with a higher level of self-efficacy at 12 months (B = 0.68, 95% CI 0.54-0.81). Conclusion A multidisciplinary team assessment and multimodal intervention increased self-efficacy in women on sick leave for an extremely long time (mean 7.8 years) who had a low mean level of self-efficacy prior to inclusion. Thus, self-efficacy needs to be addressed in vocational rehabilitation.

Multidisciplinary team-based approach for comprehensive preoperative pulmonary rehabilitation including intensive nutritional support for lung cancer patients.

Directory of Open Access Journals (Sweden)

Hiroaki Harada

Full Text Available BACKGROUND: To decrease the risk of postoperative complication, improving general and pulmonary conditioning preoperatively should be considered essential for patients scheduled to undergo lung surgery. OBJECTIVE: The aim of this study is to develop a short-term beneficial program of preoperative pulmonary rehabilitation for lung cancer patients. METHODS: From June 2009, comprehensive preoperative pulmonary rehabilitation (CHPR including intensive nutritional support was performed prospectively using a multidisciplinary team-based approach. Postoperative complication rate and the transitions of pulmonary function in CHPR were compared with historical data of conventional preoperative pulmonary rehabilitation (CVPR conducted since June 2006. The study population was limited to patients who underwent standard lobectomy. RESULTS: Postoperative complication rate in the CVPR (n = 29 and CHPR (n = 21 were 48.3% and 28.6% (p = 0.2428, respectively. Those in patients with Charlson Comorbidity Index scores ≥2 were 68.8% (n = 16 and 27.3% (n = 11, respectively (p = 0.0341 and those in patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress scores >0.3 were 57.9% (n = 19 and 21.4% (n = 14, respectively (p = 0.0362. Vital capacities of pre- and post intervention before surgery in the CHPR group were 2.63±0.65 L and 2.75±0.63 L (p = 0.0043, respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6815. Forced expiratory volumes in one second of pre- and post intervention before surgery in the CHPR group were 1.73±0.46 L and 1.87±0.46 L (p = 0.0012, respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6424. CONCLUSIONS: CHPR appeared to be a beneficial and effective short-term preoperative rehabilitation protocol, especially in patients with poor preoperative conditions.

Participation in leisure activities during brain injury rehabilitation.

Science.gov (United States)

Fleming, Jennifer; Braithwaite, Helen; Gustafsson, Louise; Griffin, Janelle; Collier, Ann Maree; Fletcher, Stephanie

2011-01-01

To describe and compare pre- and post-injury leisure activities of individuals receiving brain injury rehabilitation and explore levels of leisure participation and satisfaction. Cross-sectional descriptive study incorporating a survey of current and past leisure activities. Questionnaires were completed by 40 individuals with an acquired brain injury receiving inpatient or outpatient rehabilitation. Shortened Version of the Nottingham Leisure Questionnaire and Changes in Leisure Questionnaire (developed for this study). Leisure participation declined following injury, particularly in social leisure activities. Pre-injury activities with high rates of discontinued or decreased participation were driving, going to pubs and parties, do-it-yourself activities and attending sports events. Inpatient participants generally attributed decreased participation to the hospital environment, whereas outpatient participants reported this predominantly as a result of disability. Post-injury levels of perceived leisure satisfaction were significantly lower for the inpatient group compared to pre-injury, but not for the outpatient group. Uptake of some new leisure activities was reported post-injury, however not at the rate to which participation declined. Leisure participation decreases during brain injury rehabilitation compared to pre-injury levels. Re-engagement in relevant, age-appropriate leisure activities needs to be addressed during rehabilitation to improve participation in this domain.

Stroke rehabilitation.

Science.gov (United States)

Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

2011-05-14

Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

SATISFACTION OF PATIENTS WITH ARTHROSIS FROM MULTIDISCIPLINARY COOPERATION

Directory of Open Access Journals (Sweden)

Gergana Nenova

2016-10-01

Full Text Available INTRODUCTION: The research of patient satisfaction with arthrosis from multidisciplinary cooperation is related to clarifying the position and the role of the physiotherapist in public health and in the development of integrated care. AIM OF THE STUDY: To investigate the satisfaction of patients with arthrosis from multidisciplinary cooperation. MATERIAL AND METHODS: In this research study participated 30 patients of the Department of Orthopedics and Traumatology of University Hospital "St. Marina" EAD - Varna for the period 2012-2016 of which 13 were men and 17 women. A feedback from these patients was sought based on the 5-point Likert scale regarding their satisfaction after the completion of the work of the multidisciplinary task team that provides integrated care at home. The questionnaire includes 12 questions, grouped in the following areas: awareness, attitude / communication, time, physical activity, professionalism and benefit / effectiveness. The data were compared with the results from a study of the satisfaction of a control group of 30 patients who were treated in the same ward, but chose to continue their rehabilitation with NHIF. RESULTS: The respondents from the test group are highly satisfied in the "awareness" area (respectively 4.80 and 4.90. They say that they have more freedom in daily activities after the procedure conducted by physiotherapist (4.93 and would seek the same physiotherapist if they need rehabilitation in the future. Patients appreciate the quality behavior/approach and communication skills displayed by the physiotherapist during the rehabilitation process (5.00, which enables them to better understand their illness (4.93. The respondents from the test group felt much better after each procedure performed by the physiotherapist (5.00 and would recommend him/her to other patients who have the same need (5.00. The satisfaction from the work of the physiotherapist is appreciated by patients extremely high, but

[The rehabilitation treatment of patients with motor and cognitive disorders after stroke].

Science.gov (United States)

Sakharov, V Iu; Isanova, V A

2014-01-01

Objective. To study the possibility of using the rehabilitative pneumatic suit "Atlant" in stroke outpatients. Material and methods. We studied 11 stroke patients who wore the pneumatic suit in the early rehabilitation period. A comparison group included 13 patients. The high effectiveness of complex treatment with using the suit "Atlant" was shown. The motor activity was improved in 71.4% of patients, the recovery of speech was found in 33.3% patients. Conclusion. Continuity of rehabilitation in outpatients with stroke promotes the recovery of functional activity, motor, cognitive and speech functions and positively impacts on the emotional state of the patient.

COMPARATIVE ANALYSIS OF RUSSIAN AND BRITISH APPROACHES TO NEUROPSYCHOLOGICAL DIAGNOSTICS AND NEUROPSYCHOLOGICAL REHABILITATION

Directory of Open Access Journals (Sweden)

Yu. V. Mukhitova

2017-01-01

Full Text Available Introduction. This article is devoted to the comparative analysis of the Russian and British approaches to restoration of the highest mental functions in patients with neurological disorders.The applicability of development of effective programs for neuropsychological rehabilitation of neurological patients is represented, where one of the main directions is the reconstruction of higher mental functions.Results. This article shows the importance of cooperation and understanding of specialists among the multidisciplinary team in medical rehabilitation system. The history of origin of the concept «multidisciplinary approach» is cited, it was spoken about by V. M. Bekhterev for the first time, emphasizing the necessity of multidisciplinary study of neuropsychic system of a healthy and ill person. Special aspects of rehabilitation process in Russia and in England were considered. Results of the comparison of neuropsychological rehabilitation models of two countries were presented. Conclusions. Further guidelines of cooperation between Russian and foreign neuropsychologists were identified. The attention is focused on determination of rehabilitation potential and inclusion of the patient and his family in rehabilitation process as it allows to solve problems of insufficiency of motivation, a self-assessment and to prevent emotional violations, increasing quality of life of patients. 

MULTIDISCIPLINARY APPROACH TO SUPPORTING TREATMENT COMPLIANCE IN TUBERCULOSIS PATIENTS

Directory of Open Access Journals (Sweden)

T. V. Sherstneva

2017-01-01

Full Text Available The article presents the algorithm for working with tuberculosis patients in TB hospital, providing implementation of multidisciplinary patient-centered activities for early diagnostics of psychiatric and social disorders, therapy and rehabilitation of concurrent psychiatric disorders and addictions. Multidisciplinary approach to activities within TB unit is aimed at improvement of treatment compliance of tuberculosis patients. The training programme has been developed in order to improve competency of medical personnel on the issue of treatment interruption prevention and motivating patients to undergo the continuous treatment.

[Role of clinical pharmacist in the therapeutical optimization in geriatric outpatient hospital].

Science.gov (United States)

Jean-Bart, E; Faure, R; Omrani, S; Guilli, T; Roubaud, C; Krolak-Salmon, P; Mouchoux, C

2014-05-01

Cares in outpatient hospital for elderly patients is a period of interest for multidisciplinary reassessment and pharmaceutical care of the prescription. The objective is to present the implementation of the pharmaceutical care activity at the outpatient hospital. Between August and October 2011, elderly patients hospitalized in the outpatient hospital for a brief appraisal had a pharmaceutical care. The clinician introduced pharmaceutical reviews in the synthesis letter for general practitioner. An analysis of the activity was carried out over 3 months. A pharmaceutical care had been realized for 67 patients, mean age of 81.7 years. Among medical related problems identified, 39.6% were for potentially unnecessary medication. A stop was proposed for 44% of pharmaceutical interventions. A total of 91 pharmaceutical interventions and 13 recommendations were made and 34% of patients had potentially inappropriate medication. According to the objective to reduce the therapeutics contributing to the iatrogenesis, this approach allowed us to undertake a multidisciplinary collaboration oriented toward the relay between hospital and city cares. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

Science.gov (United States)

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care

Achieving a holistic perspective in stroke rehabilitation

DEFF Research Database (Denmark)

Kristensen, Hanne Kaae; Lund, Hans; Jones, Dorrie

2015-01-01

Background/Aims: Holistic, multidisciplinary rehabilitation is often the most appropriate for stroke patients. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) provides a comprehensive conceptual framework and systematic terminology used...... to a holistic approach in stroke rehabilitation, including an understanding of functioning and the ability to participate in everyday life. Using this approach to rehabilitation, disability is not only perceived as a consequence of stroke but also in the context of the individual person, where interactions...... the holistic approach....

Regenerative rehabilitation: a new future?

Science.gov (United States)

Perez-Terzic, Carmen; Childers, Martin K

2014-11-01

Modern rehabilitation medicine is propelled by newfound knowledge aimed at offering solutions for an increasingly aging population afflicted by chronic debilitating conditions. Considered a core component of future health care, the rollout of regenerative medicine underscores a paradigm shift in patient management targeted at restoring physiologic function and restituting normative impact. Nascent regenerative technologies offer unprecedented prospects in achieving repair of degenerated, diseased, or damaged tissues. In this context, principles of regenerative science are increasingly integrated in rehabilitation practices as illustrated in the present Supplement. Encompassing a growing multidisciplinary domain, the emergent era of "regenerative rehabilitation" brings radical innovations at the forefront of healthcare blueprints.

[Mobile geriatric rehabilitation in statutory health insurance: Conceptual strategy and results of a nationwide treatment documentation (Part 1)].

Science.gov (United States)

Meinck, Matthias; Pippel, K; Lübke, N

2017-04-01

Insurants have a statutory right to mobile rehabilitation in which a multidisciplinary team carries out treatment in the familiar home environment. Framework recommendations in geriatric medicine were presented by the statutory health insurance (SHI) and a standardized treatment documentation was implemented nationwide. This article presents the conceptual design and selected results from this treatment documentation and reports on the established practice. A total of 1879 anonymized cases of mobile geriatric rehabilitation carried out between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient and process-related features. The patients were on average 81 years old and 61 % were female. The mobile rehabilitation was provided on average over 22 treatment days over a period of 8 weeks and in 84 % of cases following hospital treatment. Of the rehabilitation patients 27 % lived in a care home prior to treatment and 73 % were already allocated to a care level. The statistically significant gain in capacity for self-sufficiency was 18 points on the Barthel index at the end of the rehabilitation. The majority of treatment was provided by physiotherapists and occupational therapists followed by speech therapists and nursing personnel. Relevant differences were detected between the institutions regarding the indications, access route, therapy combinations, treatment frequency, scope and duration. At the same time individual requirements from the framework recommendations were sometimes not met. Even though the treatment documentation does not replace any external mobile rehabilitation quality assurance, it provides transparency in a still very limited range of services that are sometimes differently implemented at institutions. It therefore provides the basis for further development of mobile out-patient rehabilitation in SHI.

Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR): a phase II randomised feasibility study of a multidisciplinary rehabilitation package following hip fracture.

Science.gov (United States)

Williams, Nefyn H; Roberts, Jessica L; Din, Nafees Ud; Totton, Nicola; Charles, Joanna M; Hawkes, Claire A; Morrison, Val; Hoare, Zoe; Williams, Michelle; Pritchard, Aaron W; Alexander, Swapna; Lemmey, Andrew; Woods, Robert T; Sackley, Catherine; Logan, Pip; Edwards, Rhiannon T; Wilkinson, Clare

2016-10-05

To conduct a rigorous feasibility study for a future definitive parallel-group randomised controlled trial (RCT) and economic evaluation of an enhanced rehabilitation package for hip fracture. Recruitment from 3 acute hospitals in North Wales. Intervention delivery in the community. Older adults (aged ≥65) who received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by clinical team) and received rehabilitation in the North Wales area. Remote randomisation to usual care (control) or usual care+enhanced rehabilitation package (intervention), including six additional home-based physiotherapy sessions delivered by a physiotherapist or technical instructor, novel information workbook and goal-setting diary. Primary: Barthel Activities of Daily Living (BADL). Secondary measures included Nottingham Extended Activities of Daily Living scale (NEADL), EQ-5D, ICECAP capability, a suite of self-efficacy, psychosocial and service-use measures and costs. Outcome measures were assessed at baseline and 3-month follow-up by blinded researchers. 62 participants were recruited, 61 randomised (control 32; intervention 29) and 49 (79%) completed 3-month follow-up. Minimal differences occurred between the 2 groups for most outcomes, including BADL (adjusted mean difference 0.5). The intervention group showed a medium-sized improvement in the NEADL relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d 0.63), and a trend for greater improvement in self-efficacy and mental health, but with small effect sizes. The mean cost of delivering the intervention was £231 per patient. There was a small relative improvement in quality-adjusted life year in the intervention group. No serious adverse events relating to the intervention were reported. The trial methods were feasible in terms of eligibility, recruitment and retention. The effectiveness and cost-effectiveness of the rehabilitation

A Danish national strategy for treatment and rehabilitation after acquired brain injury

DEFF Research Database (Denmark)

Engberg, Aase W

2007-01-01

This study describes the establishment of a Danish national strategy for treatment and rehabilitation of acquired brain injury, particularly traumatic brain injury, in 1997. The vision was to create a system of tax-financed continuous treatment, restoration of function, and outpatient rehabilitat......This study describes the establishment of a Danish national strategy for treatment and rehabilitation of acquired brain injury, particularly traumatic brain injury, in 1997. The vision was to create a system of tax-financed continuous treatment, restoration of function, and outpatient...

42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

Science.gov (United States)

2010-10-01

... of the items and services furnished under the plan. (iii) The goals set for the individual under the... prescribed exercise, cardiac risk factor modification, psychosocial assessment, and outcomes assessment... section. Intensive cardiac rehabilitation site means a hospital outpatient setting or physician's office...

Cognitive-linguistic effort in multidisciplinary stroke rehabilitation: Decreasing vs. increasing cues for word retrieval.

Science.gov (United States)

Choe, Yu-Kyong; Foster, Tammie; Asselin, Abigail; LeVander, Meagan; Baird, Jennifer

2017-04-01

Approximately 24% of stroke survivors experience co-occurring aphasia and hemiparesis. These individuals typically attend back-to-back therapy sessions. However, sequentially scheduled therapy may trigger physical and mental fatigue and have an adverse impact on treatment outcomes. The current study tested a hypothesis that exerting less effort during a therapy session would reduce overall fatigue and enhance functional recovery. Two stroke survivors chronically challenged by non-fluent aphasia and right hemiparesis sequentially completed verbal naming and upper-limb tasks on their home computers. The level of cognitive-linguistic effort in speech/language practice was manipulated by presenting verbal naming tasks in two conditions: Decreasing cues (i.e., most-to-least support for word retrieval), and Increasing cues (i.e., least-to-most support). The participants completed the same upper-limb exercises throughout the study periods. Both individuals showed a statistically significant advantage of decreasing cues over increasing cues in word retrieval during the practice period, but not at the end of the practice period or thereafter. The participant with moderate aphasia and hemiparesis achieved clinically meaningful gains in upper-limb functions following the decreasing cues condition, but not after the increasing cues condition. Preliminary findings from the current study suggest a positive impact of decreasing cues in the context of multidisciplinary stroke rehabilitation.

Multidisciplinary approach on rehabilitation of primary teeth traumatism repercussion on the permanent successor: 6-year follow-up case report

Directory of Open Access Journals (Sweden)

Mello-Moura ACV

2009-06-01

Full Text Available Traumatic lesions in primary teeth are frequent in pediatric patients and can cause problems both to the deciduous tooth and permanent successor. The impact strength on deciduous tooth can reach the growing permanent tooth, affecting its morphology, structure and position, or even hampering its proper development. This report describes an aesthetic-functional rehabilitation process in an 8 year 10 month old boy during a multidisciplinary treatment held at the Clinical Center of Dental Trauma in Primary Teeth of the Pediatric Dentistry of Dental College of University of São Paulo, Brazil. The patient presented bilateral posterior cross bite and the permanent left upper central incisor with ectopic eruption and enamel hypoplasy, preceded by avulsion of element 61, occurred when the patient was 1.6 years old. After diagnosis and treatment planning, a quick expansion of jaws was recommended with Hass-type rapid expander and orthodontic leveling with fixed braces. Due to the ectopic eruption, the gingival contour had been altered and hypertrophia was found, compromising aesthetics and avoiding local hygienic procedures. Gingivoplasty was carried out with high-intensity Diode Laser, followed by aesthetic restoration with compound resin. It was concluded that after deciduous teeth traumatism it is important that the patient undergoes clinic and radiographic assistance until the permanent teeth erupt so that an adequate multidisciplinary treatment can be offered to the patient.

Summary of comprehensive systematic review: Rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.

Science.gov (United States)

Haselkorn, Jodie K; Hughes, Christina; Rae-Grant, Alex; Henson, Lily Jung; Bever, Christopher T; Lo, Albert C; Brown, Theodore R; Kraft, George H; Getchius, Thomas; Gronseth, Gary; Armstrong, Melissa J; Narayanaswami, Pushpa

2015-11-24

To systematically review the evidence regarding rehabilitation treatments in multiple sclerosis (MS). We systematically searched the literature (1970-2013) and classified articles using 2004 American Academy of Neurology criteria. This systematic review highlights the paucity of well-designed studies, which are needed to evaluate the available MS rehabilitative therapies. Weekly home/outpatient physical therapy (8 weeks) probably is effective for improving balance, disability, and gait (MS type unspecified, participants able to walk ≥5 meters) but probably is ineffective for improving upper extremity dexterity (1 Class I). Inpatient exercises (3 weeks) followed by home exercises (15 weeks) possibly are effective for improving disability (relapsing-remitting MS [RRMS], primary progressive MS [PPMS], secondary progressive MS [SPMS], Expanded Disability Status Scale [EDSS] 3.0-6.5) (1 Class II). Six weeks' worth of comprehensive multidisciplinary outpatient rehabilitation possibly is effective for improving disability/function (PPMS, SPMS, EDSS 4.0-8.0) (1 Class II). Motor and sensory balance training or motor balance training (3 weeks) possibly is effective for improving static and dynamic balance, and motor balance training (3 weeks) possibly is effective for improving static balance (RRMS, SPMS, PPMS) (1 Class II). Breathing-enhanced upper extremity exercises (6 weeks) possibly are effective for improving timed gait and forced expiratory volume in 1 second (RRMS, SPMS, PPMS, mean EDSS 4.5); this change is of unclear clinical significance. This technique possibly is ineffective for improving disability (1 Class II). Inspiratory muscle training (10 weeks) possibly improves maximal inspiratory pressure (RRMS, SPMS, PPMS, EDSS 2-6.5) (1 Class II). © 2015 American Academy of Neurology.

Spinal deformities rehabilitation - state of the art review

Directory of Open Access Journals (Sweden)

Weiss Hans-Rudolf

2010-12-01

Full Text Available Abstract Background Medical rehabilitation aims at an improvement in function, capacity and participation. For the rehabilitation of spinal deformities, the goal is to maintain function and prevent secondary symptoms in the short- and long-term. In patients with scoliosis, predictable signs and symptoms include pain and reduced pulmonary function. Materials and methods A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation. Discussion Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term. Conclusion Outpatient treatment/rehabilitation is sufficient for adolescents with spinal deformities. Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.

Rehabilitering og palliation af patienter med svær KOL bør integreres

DEFF Research Database (Denmark)

Ringbæk, Thomas; Wilcke, Jon Torgny Rostrup

2013-01-01

Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy, occupatio......Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy...

Update on rehabilitation in multiple sclerosis.

Science.gov (United States)

Donzé, Cécile

2015-04-01

Given that mobility impairment is a hallmark of multiple sclerosis, people with this disease are likely to benefit from rehabilitation therapy throughout the course of their illness. The review provides an update on rehabilitation focused on balance and walking impairment. Classical rehabilitation focusing on muscle rehabilitation, neurotherapeutic facilitation is effective and recommended. Other techniques did not prove their superiority: transcutaneal neurostimulation, repetitive magnetic stimulation, electromagnetic therapy, whole body vibration and robot-assisted gait rehabilitation and need more studies to conclude. Cooling therapy, hydrotherapy, orthoses and textured insoles could represent a complementary service to other techniques in specific conditions. Multidisciplinary rehabilitation program provides positive effects and high satisfaction for patients with multiple sclerosis but needs more evaluation. New technologies using serious game and telerehabilitation seem to be an interesting technique to promote physical activity, self-management and quality of life. Rehabilitation like other therapy needs regular clinical evaluation to adapt the program and propose appropriate techniques. Moreover, the objective of rehabilitation needs to be decided with the patient with realistic expectation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Benchmarking Outpatient Rehabilitation Clinics Using Functional Status Outcomes.

Science.gov (United States)

Gozalo, Pedro L; Resnik, Linda J; Silver, Benjamin

2016-04-01

To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics. Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments. Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-June 2008. FS at discharge was modeled using hierarchical regression methods with patients nested within therapists within clinics. Separate models were estimated for all patients, for those with lumbar, and for those with shoulder impairments. All models risk-adjusted for intake FS, age, gender, onset, surgery count, functional comorbidity index, fear-avoidance level, and payer type. Inverse probability weighting adjusted for censoring. Functional status was captured using computer adaptive testing at intake and at discharge. Clinic and therapist effects explained 11.6 percent of variation in FS. Clinics ranked in the lowest quartile had significantly different outcomes than those in the highest quartile (p < .01). Clinics ranked similarly in lumbar and shoulder impairments (correlation = 0.54), but some clinics ranked in the highest quintile for one condition and in the lowest for the other. Benchmarking models based on validated FS measures clearly separated high-quality from low-quality clinics, and they could be used to inform value-based-payment policies. © Health Research and Educational Trust.

Rehabilitation after traumatic brain injury.

Science.gov (United States)

Barnes, M P

1999-01-01

Head injury is a common disabling condition but regrettably facilities for rehabilitation are sparse. There is now increasing evidence of the efficacy of a comprehensive multidisciplinary rehabilitation team compared to natural recovery following brain injury. This chapter outlines some basic concepts of rehabilitation and emphasises the importance of valid and reliable outcome measures. The evidence of the efficacy of a rehabilitation programme is discussed in some detail. A number of specific rehabilitation problems are outlined including the management of spasticity, nutrition, pressure sores and urinary continence. The increasingly important role of assistive technology is illustrated, particularly in terms of communication aids and environmental control equipment. However, the major long-term difficulties after head injury focus around the cognitive, intellectual, behavioural and emotional problems. The complex management of these disorders is briefly addressed and the evidence of the efficacy of some techniques discussed. The importance of recognition of the vegetative stage and avoidance of misdiagnosis is emphasised. Finally, the important, but often neglected, area of employment rehabilitation is covered.

Rehabilitering og palliation af patienter med svær KOL bør integreres

DEFF Research Database (Denmark)

Ringbæk, Thomas; Wilcke, Jon Torgny Rostrup

2013-01-01

Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy, occupatio......Treatment elements of rehabilitation and palliative care are described in relation to the main clinical manifestations of severe and very severe chronic obstructive pulmonary disease (COPD). With increasing loss of function the need for multidisciplinary effort increases. Physiotherapy...... especially for patients with frequent exacerbations....

Male coping through a long-term cancer trajectory. Secondary outcomes from a RTC examining the effect of a multidisciplinary rehabilitation program (RePCa) among radiated men with prostate cancer

DEFF Research Database (Denmark)

Dieperink, Karin B; Johansen, Christoffer; Hansen, Steinbjørn

2017-01-01

patients treated with radiotherapy and androgen deprivation therapy were included in a randomized controlled trial from 2010 to 2012. The trial examined the effect of a multidisciplinary rehabilitation program within six months of treatment consisting of two nursing counseling sessions and two instructive...... sessions with a physical therapist (n = 79), or standard care (n = 82). As secondary outcomes coping was measured before radiotherapy, one month after radiotherapy (baseline), six month post-intervention (assessment) and three years after radiotherapy (follow-up) by the Mini-mental adjustment to cancer.......025) compared with controls, but after three years this difference evened out. After three years the intervention group had lower Cognitive Avoidance (p = 0.044) than the controls. Factors as educational level, and depression influenced the use of coping styles after three years. CONCLUSION: Multidisciplinary...

Initial Efficacy of a Cardiac Rehabilitation Transition Program: Cardiac TRUST

Science.gov (United States)

Zullo, Melissa; Boxer, Rebecca; Moore, Shirley M.

2012-01-01

Patients recovering from cardiac events are increasingly using postacute care, such as home health care and skilled nursing facility services. The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self- Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation program were compared in a sample of 38 older adults; 17 who received the Cardiac TRUST program and 21 who received usual care only. At discharge from postacute care, the intervention group had a trend for higher levels of self-efficacy for exercise outcomes (X=39.1, SD=7.4) than the usual care group (X=34.5; SD=7.0) (t-test 1.9, p=.06). During the 6 weeks following discharge, compared with the usual care group, the intervention group had more attendance in out-patient cardiac rehabilitation (33% compared to 11.8%, F=7.1, p=.03) and a trend toward more steps walked during the first week (X=1,307, SD=652 compared to X=782, SD=544, t-test 1.8, p=.07). The feasibility of the intervention was better for the home health participants than for those in the skilled nursing facility and there were no safety concerns. The provision of cardiac-focused rehabilitation during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient cardiac rehabilitation for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted. PMID:22084960

Intensive Outpatient Cognitive Behaviour Therapy for Eating Disorder

Directory of Open Access Journals (Sweden)

Riccardo Dalle Grave

2008-12-01

Full Text Available The aim of this paper is to describe a novel model of intensive outpatient cognitive-behaviour therapy (CBT indicated for eating disorder patients who are having difficulty modifying their eating habits in response to conventional outpatient CBT. Intensive outpatient CBT is a manual based treatment derived by the CBT-Enhanced (CBT-E for eating disorders. The treatment has four features that distinguish it from the conventional outpatient CBT-E: (1 it is designed to be suitable for both adult and adolescent patients, (2 it is delivered by a multidisciplinary non-eclectic team trained in CBT, (3 there is assistance with eating, (4 there is a family therapy module for patients under the age of 18 years. Preliminary outcome of intensive outpatient CBT-E are encouraging. The treatment has been applied to 20 consecutive underweight eating disorder patients (age 18.2 ± 6.5 years; BMI 14.6 ± 1.5 kg/m2. Thirteen patients (65% concluded the treatment, five (25% were admitted at an eating disorder inpatient unit, and two (10% prematurely interrupted the treatment. Completers obtained significant weight regain and improvement of eating disorder and general psychopathology. Most of the improvements were maintained at six-month follow-up.

Case Study: Caregiver Perception of Pediatric Multidisciplinary Feeding Outpatient Clinic

Directory of Open Access Journals (Sweden)

Thomas F. Fisher PhD, OT, FAOTA

2014-01-01

Full Text Available This study explores the perception of satisfaction of caregivers who attended a feeding clinic at a large pediatric hospital in the midwest. The clinic is designed for a multidisciplinary team to meet with the child and the caregiver. Thirty-five participants were involved in the study. Results indicated that most participants were satisfied with the clinic experience. However, there were areas of care not covered by the members of the feeding team, which indicates a need. It is suggested that this need could be filled by occupational therapists.

METHODS OF PSYCHOSOCIAL REHABILITATION IN PSYCHIATRIC INSTITUTIONS OF THE ORYOL REGION AT THE MODERN STAGE OF ORGANIZATION OF PSYCHIATRIC CARE

Directory of Open Access Journals (Sweden)

G. R. Gardanova

2015-01-01

Full Text Available The article considers actual issues of psychosocial rehabilitation at the present stage of psychiatric care to the population of the Oryol region.The purpose. Study and generalize the experience of the use of methods of psychosocial rehabilitation in several psychiatric institutions of the Oryol region.Materials and methods. 1. The analysis of activity of out-patient departments, where we developed a new "development Program of sociorehabilitation service in regional psychoneurologic dispensary". 2. Analysis of the activity of hospital services, where the main role is played by psycho-social rehabilitation. 3. The analysis of new forms of psychosocial rehabilitation: in terms of the specifics of Oryol oblast psychiatric hospital of specialized type with intensive supervision (OPHSTIO.Results. As a result of the analysis we identified the most effective methods of sociorehabilitation: outpatient: "Social card of the outpatient" is intended for persons in need of social, psychological, legal and other professional assistance, that allows to plan and control the types of assistance provided. The organization of a hostel for patients at the outpatient stage, which allowed to introduce a "full" recovery cycle. In OPHSTIO — implementation of multiprofessional teams and "sick tips" and the opening of an Orthodox chapel of the Mother of God icon "All grieving pleasures".Conclusions. Methods of psychosocial rehabilitation allowed to optimize the work of the main stages of treatment and rehabilitation processes, to provide in a timely manner the necessary comprehensive care to patients based on individual needs of the mentally ill in the outpatient and inpatient therapy in the Oryol region.

[Application of digital design of orthodontic-prosthodontic multidisciplinary treatment plan in esthetic rehabilitation of anterior teeth].

Science.gov (United States)

Liu, Y S; Li, Z; Zhao, Y J; Ye, H Q; Zhou, Y Q; Hu, W J; Liu, Y S; Xun, C L; Zhou, Y S

2018-02-18

To develop a digital workflow of orthodontic-prosthodontic multidisciplinary treatment plan which can be applied in complicated anterior teeth esthetic rehabilitation, in order to enhance the efficiency of communication between dentists and patients, and improve the predictability of treatment outcome. Twenty patients with the potential needs of orthodontic-prosthodontic multidisciplinary treatment to solve their complicated esthetic problems in anterior teeth were recruited in this study. Digital models of patients' both dental arches and soft tissues were captured using intra oral scanner. Direct prosthodontic (DP) treatment plan and orthodontic-prosthodontic (OP) treatment plan were carried out for each patient. For DP treatment plans, digital wax-up models were directly designed on original digital models using prosthodontic design system. For OP treatment plans, virtual-setups were performed using orthodontic analyze system according to orthodontic and esthetic criteria and imported to prosthodontic design system to finalize the digital wax-up models. These two treatment plans were shown to the patients and demonstrated elaborately. Each patient rated two treatment plans using visual analogue scales and the medians of scores of two treatment plans were analyzed using signed Wilcoxon test. Having taken into consideration various related factors, including time, costs of treatment, each patient chose a specific treatment plan. For the patients chose DP treatment plans, digital wax-up models were exported and printed into resin diagnostic models which would be utilized in the prosthodontic treatment process. For the patients chose OP treatment plans, virtual-setups were used to fabricate aligners or indirect bonding templates and digital wax-up models were also exported and printed into resin diagnostic models for prosthodontic treatment after orthodontic treatment completed. The medians of scores of DP treatment plan and OP treatment plan were calculated and

Multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: a randomized controlled trial.

Science.gov (United States)

Vos-Vromans, D C W M; Smeets, R J E M; Huijnen, I P J; Köke, A J A; Hitters, W M G C; Rijnders, L J M; Pont, M; Winkens, B; Knottnerus, J A

2016-03-01

The aim of this trial was to evaluate the difference in treatment effect, at 26 and 52 weeks after the start of treatment, between cognitive behavioural therapy (CBT) and multidisciplinary rehabilitation treatment (MRT) for patients with chronic fatigue syndrome (CFS). Multicentre, randomized controlled trial of patients with CFS. Participants were randomly assigned to MRT or CBT. Four rehabilitation centres in the Netherlands. A total of 122 patients participated in the trial. Primary outcomes were fatigue measured by the fatigue subscale of the Checklist Individual Strength and health-related quality of life measured by the Short-Form 36. Outcomes were assessed prior to treatment and at 26 and 52 weeks after treatment initiation. A total of 114 participants completed the assessment at 26 weeks, and 112 completed the assessment at 52 weeks. MRT was significantly more effective than CBT in reducing fatigue at 52 weeks. The estimated difference in fatigue between the two treatments was -3.02 [95% confidence interval (CI) -8.07 to 2.03; P = 0.24] at 26 weeks and -5.69 (95% CI -10.62 to -0.76; P = 0.02) at 52 weeks. Patients showed an improvement in quality of life over time, but between-group differences were not significant. This study provides evidence that MRT is more effective in reducing long-term fatigue severity than CBT in patients with CFS. Although implementation in comparable populations can be recommended based on clinical effectiveness, it is advisable to analyse the cost-effectiveness and replicate these findings in another multicentre trial. © 2015 The Association for the Publication of the Journal of Internal Medicine.

REHABILITATION SERVICES FOR PERSONS AFFECTED BY STROKE IN JORDAN

Directory of Open Access Journals (Sweden)

Ann Moore

2011-05-01

Full Text Available The purpose of this study was to explore the perceptions stroke survivors have of the rehabilitation services received by them in the Jordanian community. A secondary aim was to explore the impact of culture on providing appropriate services for stroke survivors.Eighteen stroke survivors were recruited from an outpatient stroke rehabilitation programme. All 18 participants had been discharged from hospital for between one and six months. Semi-structured interviews were performed, either in the physiotherapy outpatient clinic where the affected person was attending a clinic or in their homes. Transcription of interviews carried out in Arabic and thematic analysis was also carried out in that language by transcribers who were fluent in Arabic and English, using a back-translation method. Necessary measures were taken to ensure the accuracy, reliability and validity of the data collection and analysis. Following thematic analysis, themes arising out of the data included physiotherapy and occupational therapy support in the community, out-patient rehabilitation clinic services, community clinic services and support from families, friends and neighbours. Participants expressed satisfaction with their therapists, but there were large areas of unmet rehabilitation need for stroke survivors in the Jordanian community such as a limited availability of occupational therapy services, insufficient amount of therapy services and poor medical support.   This study presents a unique contribution to knowledge relating to the experiences of stroke survivors in a developing country, and also shows how care systems are very dependent on cultural contexts, cultural beliefs and practises.DOI 10.5463/DCID.v22i1.18

Stroke Rehabilitation.

Science.gov (United States)

Belagaje, Samir R

2017-02-01

Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

Nurse-led rehabilitation after gynaecological cancer surgery

DEFF Research Database (Denmark)

Seibæk, Lene

2009-01-01

  Abstract This article presents the preliminary results and experiences from an ongoing study aiming to: Develop and test a nurse-led multidisciplinary rehabilitation programme for women who undergo surgery for localised gynaecological cancers.Evaluate the effect of the programme prospectively o...

[Geriatric rehabilitation care: Doing the right things right].

Science.gov (United States)

de Vos, A J B M; van Balen, R; Gobbens, R J J; Bakker, T J E M

2018-02-01

Geriatric rehabilitation concerns short-term integrated multidisciplinary care aimed at functional recovery and social participation for relatively frail elderly. Given the geriatric clients' complex care issues, nurses should possess sufficient and appropriate competencies in order to identify and assess the relevant symptoms and intervene effectively. Yet, nurses experience a certain apprehensiveness to perform their tasks and express difficulties in multidisciplinary communication and collaboration in a constructive manner. In addition to the client's and informal care giver's perception of their input in the geriatric rehabilitation process, this study provides an in-depth understanding of the way nurses perceive their role in geriatric rehabilitation. This descriptive study entails a quantitative and a qualitative component. The quantitative component concerns questionnaires for clients, informal care givers, nurses, and team leaders. The qualitative component aims to obtain in-depth information (i. e. opinions, meanings, and reflections) with regard to the decision making process and the performance of the rehabilitation care by means of open-ended questions (in the questionnaire) and semi-structured interviews. Clients and informal care givers rate specific themes in geriatric rehabilitation in a more negative light than nurses and team leaders do. These themes concern the provision of information in the hospital (prior to admission in the rehabilitation facility), involvement in the draw-up of the treatment plan and rehabilitation goals, geriatric rehabilitation as a 24/7 activity, and taking into account the client's other life events. The latter three findings in particular, are caused by nurses' apprehensiveness to perform their tasks adequately. Nurses working in geriatric rehabilitation, experience apprehensiveness to perform their tasks adequately. Uncertainty about the client's reaction or fear of damaging the relationship of trust, results

Characteristics of successful and unsuccessful completers of 3 postacute brain injury rehabilitation pathways.

Science.gov (United States)

Malec, James F; Degiorgio, Lisa

2002-12-01

To determine whether successful participants along different postacute brain injury rehabilitation pathways differ on demographic, injury-related, disability, and outcome variables. Secondary analysis of pre- and posttreatment, and 1-year follow-up data obtained in a previous study of specialized vocational services (SVS) for persons with brain injury. Outpatient brain injury rehabilitation clinic. One hundred fourteen persons with acquired brain injury. Participants in 3 distinct rehabilitation pathways were studied: SVS only; SVS and a 3-h/wk community reintegration outpatient group; and SVS and 6-h/d comprehensive day treatment (CDT). Mayo-Portland Adaptability Inventory (MPAI); Vocational Independence Scale; and "success," as defined by community-based employment (CBE) at 1-year follow-up. The percentage (77%-85%) of participants in CBE at 1-year follow-up did not differ among the 3 pathways. CDT participants had more limited educational backgrounds, were less recently injured, and showed greater disability and more impaired self-awareness than those receiving limited intervention (ie, SVS or community reintegration outpatient group). MPAI scores for limited-intervention participants who were unsuccessful were similar in level to successful participants in CDT. Logistic regression models were developed to predict the probability of success with limited intervention and CDT. Different rehabilitation pathways result in CBE for a large percentage of persons with brain injury if the intensity of service is appropriately matched to the severity of the disability, the time since injury, and other participant characteristics. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Waiting Time for Start of Outpatient Cardiac Rehabilitation: Correlations of Non Compliance to Systematic Referral After Coronary Artery Bypass Surgery

Directory of Open Access Journals (Sweden)

Ali Soroush

2016-04-01

Full Text Available Objectives To assess the waiting time, number of delays, and correlations of non-commitment to the systematic referral to the outpatient cardiac rehabilitation (CR among coronary artery bypass surgery (CABG patients. Methods The cross-sectional study data were gathered through evaluations related to 1,187 CABG patients who were referred to the outpatient CR of 1 hospital in western Iran during 2010 to 2014. The instruments included were demographics and actual risk factors checklist, single item of perceived risk factors, and Beck depression inventory (BDI. Data was analyzed via chi-square test, ANOVA, Bonferroni post hoc test, and binary logistic regression analysis. Results Among 1 187 patients (830 male, 27% had delayed referral, and the number of delays decreased from 2010 (49.3% to 2014 (7.6% (P < 0.001. The mean of the waiting time to receive outpatient CR in western Iran was an estimated 59 days. This mean has been reduced from 66 days (2010 to 53 days (2014 (P < 0.001. After adjustment for all demographics, the results indicated that diabetic patients (P = 0.002 and patients with biological (P = 0.002, behavioral (P = 0.003, or psychological (P = 0.002 perceived risk factors have less commitment. In addition, a family history of cardiac increases the possibility of commitment as 2.41 times (P < 0.001. Conclusions Despite the progressive process of patients’ admittance and acceptability of the present waiting time, especially after 2014, it seems that more attention to diabetic patients and patients without a family history of cardiac, and modification of attitudes about multiple risk factors can associate the self-care with more responsibility and it may also be affective in the control of harm consequences through commitment to the systematic referral.

Effectiveness of a home-based pulmonary rehabilitation programme ...

African Journals Online (AJOL)

week home-based pulmonary rehabilitation programme (PRP) improved the baseline measurements of lung function, exercise tolerance and health-related quality of life (HRQoL) in patients receiving out-patient treatment for PTB. Method: A single ...

PENGARUH DOCOSAHEXAENOIC ACID (DHA PADA TUMBUH KEMBANG ANAK BALITA GIZI BURUK YANG DIRAWAT JALAN [The effect of DocosaHexaenoic Acid (DHA on growth and development of outpatient rehabilitation of children under-five with severe malnutrition

Directory of Open Access Journals (Sweden)

Astuti Lamid1, , , , dan

2002-12-01

Full Text Available The study examined the effect of DocosaHexaenoic Acid (DHA on growth and development of outpatient rehabilitation of children under five with severe malnutrition. Sample was children whose age from 6 to 24 months suffering from severe malnutrition with weight /age index of WHO standard of Z score 0,05.

Multidisciplinary approach for the rehabilitation of central giant cell ...

African Journals Online (AJOL)

2013-09-16

Sep 16, 2013 ... of treatment inclination of mandibular right first molar teeth will be altered by fixed orthodontic therapy and the resultant space will restore with a dental implant. At the end of pubertal growth period anterior segment of mandible will be rehabilitated with implant supported metal‑ceramic fixed partial dentures.

Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation.

Science.gov (United States)

Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-08-09

This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p < 0.01), and at the end of observational study as assessed by GOHAI (p < 0.05) than those in the COHCP. Participants in the AOHCP group had significantly better HRQoL as assessed by physical component summary score (PCS) the end of both 3 and 6 months (both p < 0.05). This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health.

A description of a cognitive rehabilitation programme evaluated in brain tumour patients with mild to moderate cognitive deficits

NARCIS (Netherlands)

Gehring, K.; Aaronson, N.K.; Taphoorn, M.J.B.; Sitskoorn, M.M.

2011-01-01

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is cognitive rehabilitation.Background: There

The Danish Cardiac Rehabilitation Database

DEFF Research Database (Denmark)

Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne

2016-01-01

hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. CONCLUSION: The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD......AIM OF DATABASE: The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). STUDY POPULATION: Hospitalized patients with CHD with stenosis on coronary angiography treated...... with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date...

Use of the International Classification of Functioning, Disability and Health Generic-30 Set for the characterization of outpatients: Italian Society of Physical and Rehabilitative Medicine Residents Section Project.

Science.gov (United States)

Gimigliano, Francesca; De Sire, Alessandro; Gastaldo, Marco; Maghini, Irene; Paoletta, Marco; Pasquini, Andrea; Boldrini, Paolo; Selb, Melissa; Prodinger, Birgit

2018-06-11

The International Classification of Functioning, Disability and Health (ICF) Generic- 30 Set (previously referred to as Rehabilitation Set) is a minimal set of ICF categories for reporting and assessing functioning and disability in clinical populations with different health conditions along the continuum of care. Recently, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) developed an Italian modification of the simple and intuitive descriptions (SID) of these categories. This study was the first one to implement the use of the SID in practice. 1) To implement the use of the ICF in clinical practice and research among Italian Residents in PRM. 2) To verify if the SID made the application of ICF Generic 30 Set more user-friendly than the original descriptions. 3) To examine the prevalence of functioning problems of patients accessing Rehabilitation Services to serve as reference for the development of an ICF-based clinical data collection tool. Multicenter cross-sectional study. Italian Physical Medicine and Rehabilitation (PRM) outpatient rehabilitation services. Patients referring to Italian PRM outpatient rehabilitation services and Italian Residents in PRM. Each School of Specialization involved, randomly, received the ICF Generic-30 Set with the original descriptions or with the SID. Residents collected over a 4-month period (April-July 2016) patients data related to the ICF Generic-30 Set categories. Moreover, the residents self- assessed their difficulty in using the ICF Generic-30 Set with the original descriptions or with the SID, through a Numeric Rating Scale (NRS). Ninety-three residents collected functioning data of 864 patients (mean aged 57.7±19.3) with ICF Generic-30 Set: 304 with the original descriptions and 560 with SID. The difficulty in using the ICF Generic-30 Set with SID was rated as lower than using the original descriptions (NRS = 2.8±2.5 vs 3.5±3.1; p<0.001). The most common disease was the back pain (9.6%) and

Rehabilitation of Combat-Related Injuries in the Veterans Administration: A Web of Support.

Science.gov (United States)

Howell, Paul; Capehart, Bruce P; Hoenig, Helen

2015-01-01

The Department of Veterans Affairs provides acute, subacute, and continuing rehabilitation for veterans using a hub-and-spoke system of hospitals and outpatient facilities. Using traumatic brain injury as an example, this commentary illustrates how this system provides interdisciplinary rehabilitative care to veterans throughout North Carolina.

Exercise therapy in oncology rehabilitation in Australia: A mixed-methods study.

Science.gov (United States)

Dennett, Amy M; Peiris, Casey L; Shields, Nora; Morgan, Delwyn; Taylor, Nicholas F

2017-10-01

Oncology rehabilitation improves outcomes for cancer survivors but little is known about program availability in Australia. The aims of this study were: to describe oncology rehabilitation programs in Australia: determine whether the exercise component of programs is consistent with guidelines: and to explore barriers and facilitators to program implementation. A sequential, explanatory mixed-methods study was completed in two phases: (1) a survey of Australian oncology rehabilitation programs; and (2) purposively sampled follow-up semistructured interviews with senior clinicians working in oncology rehabilitation who were involved with exercise prescription. Hospitals and/or cancer centers from 42 public hospital health networks (representing 163 hospitals) and 39 private hospitals were contacted to identify 31 oncology rehabilitation programs. All 31 surveys were returned (100% response rate). Programs were typically multidisciplinary, ran twice weekly, provided education and exercise and included self-management strategies. Exercise prescription and progression was patient centered and included a combination of resistance and aerobic training supplemented by balance, pelvic floor, and core stability exercises. Challenges to implementation included a lack of awareness of programs in the community and organizational barriers such as funding. Strong links with oncologists facilitated program referrals. Despite evidence to support oncology rehabilitation, there are few programs in Australia and there are challenges that limit it becoming part of standard practice. Programs that exist are multidisciplinary with a focus on exercise with the majority of programs following a cardiac rehabilitation model of care. © 2016 John Wiley & Sons Australia, Ltd.

Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?

DEFF Research Database (Denmark)

Rasmussen, Marianne Uggen; Amris, Kirstine; Rydahl Hansen, Susan

2017-01-01

OBJECTIVE: To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients. DESIGN: In-depth analyses of secondary outcomes...... of a randomized-controlled trial. SUBJECTS: Women (N = 187) with fibromyalgia. METHODS: Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain...... catastrophizing. Individual and group associations between outcomes were examined. RESULTS: Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (rs = 0.08, p = 0.27) and process (rs = 0.12, p = 0.11), not even in those patients with a clinically relevant...

Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

DEFF Research Database (Denmark)

Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

2015-01-01

OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

Which patients improve the most from arthritis rehabilitation?

DEFF Research Database (Denmark)

Hagel, Sofia; Lindqvist, Elisabet; Petersson, Ingemar F

2014-01-01

Objective: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investi...

34 CFR 350.12 - What are the general requirements for an Advanced Rehabilitation Research Training Project?

Science.gov (United States)

2010-07-01

... multidisciplinary, and emphasizes scientific methodology, and may involve collaboration among institutions. (3... Rehabilitation Research Training Project? 350.12 Section 350.12 Education Regulations of the Offices of the... EDUCATION DISABILITY AND REHABILITATION RESEARCH PROJECTS AND CENTERS PROGRAM What Projects Does the...

Treatment of Odontogenic Myxoma: A Multidisciplinary Approach—6-Year Follow-Up Case

Directory of Open Access Journals (Sweden)

João Gustavo Oliveira de Souza

2014-01-01

Full Text Available The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.

Outpatient management of schizophrenia.

Science.gov (United States)

Martin, R L

1991-03-01

As effective antipsychotic pharmacotherapy has become available, patients with schizophrenia are increasingly managed in an outpatient setting by primary care physicians. Pharmacotherapy is generally effective in treating "positive," or psychotic, symptoms and lessening the risks of relapse, but ineffective in improving "negative," or deficit, symptoms. Aggressive attempts to totally control positive symptoms and to ameliorate negative symptoms tend to increase side effects and may be detrimental to the patient. Intensive psychotherapeutic and rehabilitative approaches are generally unproductive. Attempting to obtain a cure is unrealistic. A moderate approach is recommended, taking into consideration the limitations of existing treatments, achieving control of extreme symptoms and minimizing social and occupational limitations.

An effect of the outpatient rehabilitation programme in patients with chronic respiratory diseases

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Jakub Zatloukal

2013-12-01

Full Text Available BACKGROUND: Pulmonary rehabilitation is a common type of complex treatment especially in patients with chronic obstructive pulmonary disease (COPD. By contrast, only few rehabilitation centres in the Czech Republic provide pulmonary rehabilitation programme to non-COPD patients. OBJECTIVE: To find out if the rehabilitation programme has a similar effect in patient with obstructive and restrictive ventilatory disorder. METHODS: Twenty-eight patients with either COPD or pulmonary sarcoidosis (PS have been enrolled for the 6-week rehabilitation programme. Lung functions, maximal inspiratory (MIP and expiratory (MEP mouth pressures, chest expansion at the level of the 4th intercostal space (IC and at the level of the xiphoid process (XP, six-minute walk test, health-related quality of life using the St. George’s Questionnaire (SGRQ and fatigue occurrence using the Multidimensional Assessment of Fatigue scale (MAF were tested at the baseline and after 6 weeks. The rehabilitation programme consisted of exercise training, ventilatory muscle training, respiratory physiotherapy and soft-tissue techniques. RESULTS: Patients with COPD improved significantly (p < .05 in MIP by 17% (10.5 cm H2O, MEP by 18% (16.8 cm H2O, IC by 65% (1.7 cm, XP by 90% (1.9 cm, six-minute walk distance (6MWD by 15% (64.1 m and SGRQ by –28% (–12.3 points. Patients with PS improved significantly (p < .05 in MIP by 25% (20.1 cm H2O, IC by 29% (1.3 cm, XP by 29% (1.3 cm and 6MWD by 6% (31.6 m. The change in lung functions and MAF in both groups; MEP and SGRQ in PS group were insignificant after the 6-week rehabilitation programme. CONCLUSIONS: The 6-week rehabilitation programme produces similar responses in functional health status of patients with either obstructive or restrictive ventilatory disorder. However, patients with restrictive ventilatory disorder in particular should be encouraged to continue in the programme to enhance the health

Biomechatronics in medical rehabilitation biomodelling, interface, and control

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Xie, Shane (S Q )

2017-01-01

This book focuses on the key technologies in developing biomechatronic systems for medical rehabilitation purposes. It includes a detailed analysis of biosignal processing, biomechanics modelling, neural and muscular interfaces, artificial actuators, robot-assisted training, clinical setup/implementation and rehabilitation robot control. Encompassing highly multidisciplinary themes in the engineering and medical fields, it presents researchers’ insights into the emerging technologies and developments that are being utilized in biomechatronics for medical purposes. Presenting a detailed analysis of five key areas in rehabilitation robotics: (i) biosignal processing; (ii) biomechanics modelling; (iii) neural and muscular interfaces; (iv) artificial actuators and devices; and (v) the use of neurological and muscular interfaces in rehabilitation robots control, the book describes the design of biomechatronic systems, the methods and control systems used and the implementation and testing in order to show how th...

Regenerative Rehabilitation – a New Future?

Science.gov (United States)

Perez-Terzic, Carmen; Childers, Martin K.

2014-01-01

Modern rehabilitation medicine is propelled by newfound knowledge aimed at offering solutions for an increasingly aging population afflicted by chronic debilitating conditions. Considered a core component of future healthcare, the roll-out of regenerative medicine underscores a paradigm shift in patient management targeted at restoring physiologic function and restituting normative impact. Nascent regenerative technologies offer unprecedented prospects in achieving repair of degenerated, diseased or damaged tissues. In this context, principles of regenerative science are increasingly integrated in rehabilitation practices as illustrated in the present Supplement. Encompassing a growing multidisciplinary domain, the emergent era of “regenerative rehabilitation” brings radical innovations at the forefront of healthcare blueprints. PMID:25310603

Dexmedetomidine, ketamine, and midazolam for oral rehabilitation: a case report.

Science.gov (United States)

Kim, Bill W S; Peskin, Robert M

2015-01-01

Intravenous sedation is frequently provided by anesthesiologists for phobic patients undergoing elective dental treatment in outpatient settings. Propofol is one of the most commonly used anesthetic agents that can result in apnea and respiratory depression, thereby posing potential difficulties with perioperative airway management. Dexmedetomidine has been utilized successfully in intravenous sedation for a wide variety of procedures and holds potential as an alternative to propofol in outpatient dental settings. However, as a single agent, it may not provide adequate depth of sedation and analgesia for oral rehabilitation. In this case report we demonstrate an effective alternative intravenous deep-sedation technique for an adult phobic patient undergoing oral rehabilitation utilizing 3 agents in combination: dexmedetomidine, ketamine, and midazolam. This combination of agents may be especially useful for those patients with a history of substance abuse, where administration of opioids may be undesirable or contraindicated.

Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?

Science.gov (United States)

Rasmussen, Marianne Uggen; Amris, Kirstine; Rydahl-Hansen, Susan; Danneskiold-Samsoe, Bente; Mortensen, Erik Lykke; Christensen, Robin; H Sjölund, Bengt

2017-08-01

To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients. In-depth analyses of secondary outcomes of a randomized-controlled trial. Women (N = 187) with fibromyalgia. Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined. Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (r s  = 0.08, p = 0.27) and process (r s  = 0.12, p = 0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (r s  = 0.31, p fibromyalgia.

Improving post-stroke recovery: the role of the multidisciplinary health care team

Directory of Open Access Journals (Sweden)

Clarke DJ

2015-09-01

Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working

Home based rehabilitation for patients with COPD : an attractive alternative

NARCIS (Netherlands)

Wijkstra, Peter

2007-01-01

Pulmonary rehabilitation programs are well established to provide a multidisciplinary approach to control and alleviate symptoms and to optimise functional capacity in patients with chronic obstructive pulmonary disease (COPD). In the last decade a large number of studies have investigated the

Effects of intensive physical rehabilitation on neuromuscular adaptations in adults with poststroke hemiparesis

DEFF Research Database (Denmark)

Andersen, Lars L; Zeeman, Peter; Jørgensen, Jørgen R

2011-01-01

consisting of isokinetic muscle strength, neuromuscular activation measured with electromyography (EMG), electrically evoked muscle twitch contractile properties, and gait performance (10-m Walk Test and 6-min Walk Test). After the 12-week conditioning program, knee extensor and flexor strength increased...... the effect of intensive physical rehabilitation on neuromuscular and functional adaptations in outpatients suffering from hemiparesis after stroke. A within-subject repeated-measures design with the paretic leg as the experimental leg and the nonparetic leg as the control leg was used. Eleven outpatients...... observed in the nonparetic control leg. Gait performance increased 52-68%. In conclusion, intensive physical rehabilitation after stroke leads to clinically relevant neuromuscular improvements, leading to increased voluntary strength during a wide range of contraction modes and velocities, and improved...

Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences?

Science.gov (United States)

Medina-Mirapeix, Francesc; Jimeno-Serrano, Francisco J; Escolar-Reina, Pilar; Del Baño-Aledo, M Elena

2013-06-01

To assess the relationships between patient experiences and two overall evaluations - satisfaction and service quality - in outpatient rehabilitation settings. A cross-sectional, self-reported survey carried out in the year 2009. Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. Self-reported experiences on aspects of care, participants' perception of service quality, satisfaction with care, socio-demographic and health characteristics. Satisfaction and service quality were highly correlated (rho = 0.72, Pservice quality (with adjusted R(2) 31.5% and 37.1%, respectively) indicated that patients' experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. Satisfaction and service quality provide a poor indicator of patients' experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

[Intensified rehabilitation aftercare (IRENA): utilization alongside work and changes in work-related parameters].

Science.gov (United States)

Lamprecht, J; Behrens, J; Mau, W; Schubert, M

2011-06-01

An aftercare programme following medical rehabilitation may be beneficial in order to reinforce and stabilize the positive effects of rehabilitation and to encourage individual health-related modifications of behaviour and lifestyle. Medical rehabilitation and the aftercare programme of the German Pension Insurance Fund primarily are intended to sustain earning capacity. As part of an evaluation of the Intensified Rehabilitation Aftercare Programme (IRENA) established by the German Pension Insurance Fund, work-related aspects in orthopaedic patients were analyzed based on various data sources. Firstly, the significance of institutional and individual conditions for utilization of IRENA alongside work was of interest. Secondly, the IRENA participants' judgements of the changes of work-related parameters due to the programme were examined, differentiating specifically by extent of earning capacity impairments as well as by particular work problems. The data set used for the analysis is composed of person-related routine data of the German Pension Insurance Fund relative to IRENA records of the year 2007 (n=30 663), interview data from orthopaedic rehabilitation centres providing IRENA (n=225), and questionnaires of IRENA participants (n=750) that were either collected during a broad evaluation of the IRENA programme or provided by the German Pension Insurance Fund. The results show that the compatibility of IRENA and work is facilitated by the institutional conditions. However, differences between inpatient and outpatient settings have to be recognized. The possibilities to participate in IRENA throughout the day frequently are more diverse in an outpatient setting. In contrast to inpatient centres, outpatient rehabilitation centres see clearly better chances for patients to return to work and to participate in IRENA alongside. With respect to the work-related parameters (work ability, periods of sick leave), clear improvements were reported by participants from

A break-even analysis of a community rehabilitation falls prevention service.

Science.gov (United States)

Comans, Tracy; Brauer, Sandy; Haines, Terry

2009-06-01

To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centre-based care needs to treat to allow the service to reach a 'break-even' point. A break-even analysis was undertaken for each of two models of care for a multidisciplinary community rehabilitation falls prevention service. The two models comprised either a centre-based group exercise and education program or a similar program delivered individually in the client's home. The service consisted of a physiotherapist, occupational therapist and therapy assistant. The participants were adults aged over 65 years who had experienced previous falls. Costs were based on the actual cost of running a community rehabilitation team located in Brisbane. Benefits were obtained by estimating the savings gained to society from the number of falls prevented by the program on the basis of the falls reduction rates obtained in similar multidisciplinary programs. It is estimated that a multi-disciplinary community falls prevention team would need to see 57 clients per year to make the service break-even using a centre-based model of care and 78 clients for a domiciliary-based model. The service this study was based on has the capability to see around 300 clients per year in a centre-based service or 200-250 clients per year in a home-based service. Based on the best available estimates of costs of falls, multidisciplinary falls prevention teams in the community targeting people at high risk of falls are worthwhile funding from a societal viewpoint.

A general rehabilitation inpatient with exercise-induced vasculitis.

Science.gov (United States)

Cushman, Dan; Rydberg, Leslie

2013-10-01

While on our general inpatient rehabilitation floor, a 58-year-old man with no hematologic or dermatologic history developed an erythematous patch on his medial ankle that turned more purpuric, with a slight orange tint, and was associated with mild pruritus. The diagnosis of exercise-induced vasculitis was made after initially being mistaken for cellulitis. This common exanthem is often misdiagnosed. Due to its association with exercise, the physiatrist should be aware of its presence in both the inpatient and outpatient settings. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Incidence of Osteoporosis in Patients Admitted to our Physical Medicine and Rehabilitation Outpatient Clinics

Directory of Open Access Journals (Sweden)

Berat Meryem Alkan

2011-04-01

Full Text Available Aim: Osteoporosis is a skeletal disease characterized with decreased bone mass and microarchtitectural deterioration of bone tissue which increases bone fragility and fracture risk. Osteoporosis and osteoporotic fractures constitute an important health problem in general population. This study aimed to determine the incidence of osteoporosis, chronic diseases accompanying osteoporosis and incidence of falls in male and female patients admitted to our out patient clinics retrospectively. Material and Methods: Patient records of the 11624 patients admitted to Ankara Atatürk Education and Research Hospital Physical Medicine and Rehabilitation Outpatient clinics between January 2010 and July 2010 were retrospectively reviewed and 644 patients diagnosed as osteoporosis according to femoral neck and/or lumbar dual energy x ray absoptiometry measurements were included in the study. Ages of the patients, sexes, chronic ilnesses, musculoskeletal sytem complaints and fall histories were also recorded. Results: The incidence of osteoporosis was found to be 7.61% in female patients and it was determined that incidence was 5-fold increased in women than in men. Besides, chronic ilnesses and fall history were accompanying in higher ratios in osteoporotic patients. Conclusion: Heart diseases, hypertension, diabetes, neurological diseases leading to impairment in balance and musculoskelatal system complaints were quite frequent in patients with osteoporosis and these diseases should be taken seriously since they increase the risk of falling. It is important to avoid using drugs which lead to balance impairment, to use walk aids like canes or walkers, to perform exercises including balance and coordination training and endurance exercises in order to prevent falls. (Turkish Journal of Osteoporosis 2011;17:10-3

Seniors, risk and rehabilitation: broadening our thinking.

Science.gov (United States)

Egan, Mary Y; Laliberte Rudman, Debbie; Ceci, Christine; Kessler, Dorothy; McGrath, Colleen; Gardner, Paula; King, Judy; Lanoix, Monique; Malhotra, Ravi

2017-06-01

Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations. Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life. Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors' rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary. This work reinforced current concerns about conceptualizations of risk in seniors' rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life. Implications for rehabilitation In seniors' rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment. Focus on provider-defined risk of physical injury limits examination of patient goals and patients' histories of judging and dealing with risk. Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized. Abandonment of ableist and ageist thinking and an

Management of Newly Diagnosed Atrial Fibrillation in an Outpatient Clinic Setting

DEFF Research Database (Denmark)

Thrysoee, Lars; Strömberg, Anna; Brandes, Axel

2018-01-01

fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. CONCLUSIONS: This study indicates that patients were uncertain......AIMS: To gain in-depth knowledge of patients' experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality...... if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision making on medical therapy. DESIGN: This is a qualitative study of 14 patients newly diagnosed...

A new cognitive rehabilitation programme for patients with multiple sclerosis: the 'MS-line! Project'.

Science.gov (United States)

Gich, Jordi; Freixenet, Jordi; Garcia, Rafael; Vilanova, Joan Carles; Genís, David; Silva, Yolanda; Montalban, Xavier; Ramió-Torrentà, Lluís

2015-09-01

Cognitive rehabilitation is often delayed in multiple sclerosis (MS). To develop a free and specific cognitive rehabilitation programme for MS patients to be used from early stages that does not interfere with daily living activities. MS-line!, cognitive rehabilitation materials consisting of written, manipulative and computer-based materials with difficulty levels developed by a multidisciplinary team. Mathematical, problem-solving and word-based exercises were designed. Physical materials included spatial, coordination and reasoning games. Computer-based material included logic and reasoning, working memory and processing speed games. Cognitive rehabilitation exercises that are specific for MS patients have been successfully developed. © The Author(s), 2014.

[A MULTIDISCIPLINARY BIOPSYCHOSOCIAL INTEGRATED APPROACH IN ORGANIZATION OF REHABILITATIVE ACTIVITY IN NURSING HOMES (RSA)].

Science.gov (United States)

Panella, Lorenzo; Piccioni, Davide; Borcescu, Lidia; Isella, Celeste; Callegari, Camilla

2015-01-01

Objectives, social role and organization of Italian nursing homes (RSA) are characterized by a pronounced regional differentiation that causes situations which are difficult to compare about expected outcomes. The definition of a functional outcome is particularly difficult in institutionalized patients and this is due to the failure of a conclusive moment of the rehabilitative treatment. Furthermore we often take care of patients who have already been admitted to intensive and/or extensive rehabilitation units time after time, without further functional profit margin. The inconstant presence of professional figures of rehabilitation in nursing homes' staff makes difficult the drafting of an adequate rehabilitative project, especially for the multiple needs of frail old people. Starting with these assumptions, authors hypothesize and adopt a model of sanitary organization to consent a correct allocation of available resources, according to the patient's needs. They stratified all nursing home patients, using the Multidimensional Prognostic Index (MPI) and "Scheda di osservazione intermedia assistenza" (SOSIA), and measured the residual function. They concluded that a multidimensional evaluation of patients allows to identify wellness (of the sick person and of caregivers) as the main objective; nursing home organization could be think as a "complex supportive prosthesis for old people", made by the interaction among structure, operators and activities.

Increasing the Number of Outpatients Receiving Spiritual Assessment: A Pain and Palliative Care Service Quality Improvement Project.

Science.gov (United States)

Gomez-Castillo, Blanca J; Hirsch, Rosemarie; Groninger, Hunter; Baker, Karen; Cheng, M Jennifer; Phillips, Jayne; Pollack, John; Berger, Ann M

2015-11-01

Spirituality is a patient need that requires special attention from the Pain and Palliative Care Service team. This quality improvement project aimed to provide spiritual assessment for all new outpatients with serious life-altering illnesses. Percentage of new outpatients receiving spiritual assessment (Faith, Importance/Influence, Community, Address/Action in care, psychosocial evaluation, chaplain consults) at baseline and postinterventions. Interventions included encouraging clinicians to incorporate adequate spiritual assessment into patient care and implementing chaplain covisits for all initial outpatient visits. The quality improvement interventions increased spiritual assessment (baseline vs. postinterventions): chaplain covisits (25.5% vs. 50%), Faith, Importance/Influence, Community, Address/Action in care completion (49% vs. 72%), and psychosocial evaluation (89% vs. 94%). Improved spiritual assessment in an outpatient palliative care clinic setting can occur with a multidisciplinary approach. This project also identifies data collection and documentation processes that can be targeted for improvement. Published by Elsevier Inc.

Medical Rehabilitation in Natural Disasters: A Review.

Science.gov (United States)

Khan, Fary; Amatya, Bhasker; Gosney, James; Rathore, Farooq A; Burkle, Frederick M

2015-09-01

To present an evidence-based overview of the effectiveness of medical rehabilitation intervention in natural disaster survivors and outcomes that are affected. A literature search was conducted using medical and health science electronic databases (PubMed, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO) up to September 2014. Two independent reviewers selected studies reporting outcomes for natural disaster survivors after medical rehabilitation that addressed functional restoration and participation. Two reviewers independently extracted data and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. A meta-analysis was not possible because of heterogeneity among included trials; therefore, a narrative analysis was performed for best evidence synthesis. Ten studies (2 randomized controlled trials, 8 observational studies) investigated a variety of medical rehabilitation interventions for natural disaster survivors to evaluate best evidence to date. The interventions ranged from comprehensive multidisciplinary rehabilitation to community educational programs. Studies scored low on quality assessment because of methodologic limitations. The findings suggest some evidence for the effectiveness of inpatient rehabilitation in reducing disability and improving participation and quality of life and for community-based rehabilitation for participation. There were no data available for associated costs. The findings highlight the need to incorporate medical rehabilitation into response planning and disaster management for future natural catastrophes. Access to rehabilitation and investment in sustainable infrastructure and education are crucial. More methodologically robust studies are needed to build evidence for rehabilitation programs, cost-effectiveness, and outcome measurement in such settings. Copyright © 2015 American Congress of Rehabilitation Medicine

Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

DEFF Research Database (Denmark)

Lange, P.; Andersen, Klaus Kaae; Munch, E.

2009-01-01

of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation......Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits...... by focusing on a more systematic approach to the patient assessment by education of the staff of the outpatient clinics. A repeated and continuous education and discussion with the clinical staff is probably essential to reach an acceptable level of the quality of care for outpatients with COPD....

A quantitative, cross-sectional study of depression and self-esteem in teenage and young adult burn victims in rehabilitation.

Science.gov (United States)

Teixeira Nicolosi, Júlia; Fernandes de Carvalho, Viviane; Llonch Sabatés, Ana

2013-09-01

Burns can have a negative physiological and emotional impact, particularly among teenage victims. To assess the presence of depression and level of self-esteem, a cross-sectional study was conducted among 63 teenage and young adult burn victims ages 12 to 20 years undergoing physical and psychological rehabilitation at the Outpatient Unit for Plastic Surgery and Burns at the Central Institute of the Clínicas Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil. Assessment instruments included Beck's Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). Internal consistency within and between the two scales was established via Cronbach's-α coefficient. All variables were analyzed using descriptive statistics, and the statistical difference between means was compared using Student's t-test. The majority of participants were female (38, 60.3%) and unmarried (59, 93.7%) with a mean total body surface area (TBSA) burn of 23.84%. Most burns (58, 92.10%) were the result of accidents and were located on the trunk (47, 74.6%), head (43, 68%), arms (41, 65%), hands (38, 60%), neck (34, 54%), and forearm (29, 46%). Participants had received physical and psychological rehabilitation for an average of 124.74 months (SD 63.67) from a multidisciplinary team. The majority of participants (33, 52.4%) reported functional and aesthetic after-effects and appraised their scar as visible (51, 81.0%). BDI results showed low levels or absence of depression (mean = 7.63, SD 8.72; scale 0 = no depression to 63 = serious depression); the RSE showed adequate levels of self-esteem (mean = 8.41, SD 4.74; scale 0-30, where higher scores indicate worst levels of self-esteem). Burn location did not affect depression (BDI: P = 0.26) or self-esteem (RSE: P = 0.21). However, depression and self-esteem were more significant in participants who were not able to work and/or go to school than in those who were (BDI: P = 0.04 and self-esteem RSE: P = 0

Online communication in a rehabilitation setting: Experiences of patients with chronic conditions using a web portal in Denmark

DEFF Research Database (Denmark)

Cerdan de Las Heras, Jose Manuel; Catalan-Matamoros, Daniel; Warny, Sarah

2017-01-01

mainly reported negative experiences and suggested combining both face-to-face consultations with online care by user-friendly web portals. This will ensure a positive contribution from digital communication tools to rehabilitation. Practice implications Patients’ experiences should be considered......Abstract Objective To gain insight into the experiences of patients with long-term conditions enrolled in an online rehabilitation programme using a web portal. Methods Danish outpatients were recruited from a rehabilitation department and were granted access to a web portal which included...... in the design of web portals in rehabilitation which could help healthcare organizations when developing online rehabilitation programmes. Keywords CommunicationWeb portalPatient's experienceseHealthRehabilitation...

Analysis of medical institutions with various organizational forms of rehabilitation treatment and outpatient departments

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Shapovalenko T.V.

2013-12-01

Full Text Available The study aimed organization of the analysis of activity of two medical institutions rendering services in rehabilitation and recovery treatment to adult population, having various organizational forms. Material and Methods. For five years there had been studied practical experience of rendering medical care on recovery treatment and rehabilitation to adult population on the basis of medico-statistical processing of reporting documentation of the Medicine Recovery Center and the rehabilitation, Ministry of Health of Russia functioning on the basis of the "Medical and Rehabilitation Center" — large versatile medical center and the interdistrict center of recovery treatment on the basis of city policlinic of St. Petersburg. Results. As a result it had been established an advisability of rendering this type of specialized medical care by medical institutions with different organizational forms. Conclusion. The interdistrict centers of rehabilitation functioning as a part of city policlinics, are undoubtedly necessary, as the closest medical setting for patients' homes, however such functions as diagnostics of a functional condition of an organism and an objective assessment of a state of health of patients with use of screening techniques; inspection of the organized collectives and groups of the population for the purpose of identification of groups of risk, establishment of extent of influence of environmental factors on a state of health, active supervision over persons with factors of the increased risk of diseases and correction of the revealed functional violations, etc. can be performed only in the centers organized on the basis of modern versatile treatment-and-prophylactic establishments, equipped with the modern diagnostic devices, allowing to supplement traditional methods of drug therapy with new effective techniques of treatment.

Patient Profile of Drop-Outs From a Pulmonary Rehabilitation Program.

Science.gov (United States)

Almadana Pacheco, Virginia; Pavón Masa, María; Gómez-Bastero Fernández, Ana Paulina; Muñiz Rodríguez, Ana Mirian; Tallón Moreno, Rodrigo; Montemayor Rubio, Teodoro

2017-05-01

While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common. The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics. A prospective study was performed between February and November 2015in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session). A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P=.03), worse results on submaximal exercise test (NA, 6.2minutes vs A, 9.2minutes; P=.02), in total distance walked (NA, 42.6 vs A, 56.5; P=.03) and VO 2 in ml/min/kg (NA, 11.4 vs A, 13.6; P=.03) and in ml/min (NA, 839 vs A, 1020; P=.04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P=.01). More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

[Hospice and palliative care in the outpatient department].

Science.gov (United States)

Ikenaga, M; Tsuneto, S

2000-10-01

In the medical environment, information disclosure to patients and respect of autonomy have spread rapidly. Today, many terminally-ill cancer patients wish to spend as much time at home as possible. In such situations the patient who has been informed that curative treatments are no longer expected to be beneficial can now hope to receive home care and visiting care from hospice/palliative care services. The essential concepts of hospice/palliative care are symptom management, communication, family care and a multidisciplinary approach. These concepts are also important in the outpatient department. In particular, medical staff need to understand and utilize management strategies for common symptoms from which terminally-ill cancer patients suffer (ex. cancer pain, anorexia/fatigue, dyspnea, nausea/vomiting, constipation, hypercalcemia and psychological symptoms). They also need to know how to use continuous subcutaneous infusion for symptom management in the patients last few days. The present paper explains the clinical practices of hospice/palliative care in the outpatient department. Also discussed is support of individual lives so that maximum QOL is provided for patients kept at home.

Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation.

Science.gov (United States)

Martin, Ubaldo J; Hincapie, Luis; Nimchuk, Mark; Gaughan, John; Criner, Gerard J

2005-10-01

To evaluate the prevalence and magnitude of weakness in patients receiving chronic mechanical ventilation and the impact of providing aggressive whole-body rehabilitation on conventional weaning variables, muscle strength, and overall functional status. Retrospective analysis of 49 consecutive patients. Multidisciplinary ventilatory rehabilitation unit in an academic medical center. Forty-nine consecutive chronic ventilator-dependent patients referred to a tertiary care hospital ventilator rehabilitation unit. None. Patients were 58 +/- 7 yrs old with multiple etiologies for respiratory failure. On admission, all patients were bedridden and had severe weakness of upper and lower extremities measured by a 5-point muscle strength score and a 7-point Functional Independence Measurement. Postrehabilitation, patients had increases in upper and lower extremity strength (p respiratory muscle training with an improvement in strength, weaning outcome, and functional status. Whole-body rehabilitation should be considered a significant component of their therapy.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation.

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Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-06-01

The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pulmonary rehabilitation in COPD – available resources and utilization in Swedish primary and secondary care

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Sundh J

2017-06-01

Full Text Available Josefin Sundh,1 Helena Lindgren,2 Mikael Hasselgren,2 Scott Montgomery,3–5 Christer Janson,6 Björn Ställberg,7 Karin Lisspers7 1Department of Respiratory Medicine, School of Medical Sciences, 2Medical Programme, School of Medical Sciences, 3Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, 4Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 5Department of Epidemiology and Public Health, University College, London, UK; 6Department of Medical Sciences, Respiratory, Allergy and Sleep Research, 7Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden Introduction: Pulmonary rehabilitation is effective in all stages of COPD. The availability and utilization of pulmonary rehabilitation resources, and the characteristics of COPD patients receiving rehabilitation, were investigated in primary and secondary care in central Sweden. Materials and methods: Data on available pulmonary rehabilitation resources were collected using questionnaires, to 14 hospitals and 54 primary health care centers, and information on utilization of different rehabilitation professionals was obtained from questionnaires completed by 1,329 COPD patients from the same centers. Multivariable logistic regression examined associations with having received rehabilitation in the previous year. Results: In primary care, nurse-based asthma/COPD clinics were common (87%, with additional separate access to other rehabilitation professionals. In secondary care, rehabilitation was more often offered as part of a multidisciplinary teamwork (71%. In total, 36% of the patients met an asthma/COPD nurse in the previous year. Utilization was lower in primary than in secondary care for physiotherapists (7% vs 16%, occupational therapists (3% vs 10%, nutritionists (5% vs 13%, and counselors (1% vs 4%. A higher COPD Assessment Test score

Subjective cognitive dysfunction in rehabilitation outpatients with musculoskeletal disorders or chronic pain

NARCIS (Netherlands)

Schrier, Ernst; Geertzen, Jan H.; Dijkstra, Pieter U.

BACKGROUND: Rehabilitation patients, without brain damage, sometimes complain about poor concentration and problems with their memory. The magnitude and associations, of this cognitive dysfunction, with different factors is unclear. AIM: To determine the magnitude of cognitive dysfunction in

Low Non-structured Antiretroviral Therapy Interruptions in HIV-Infected Persons Who Inject Drugs Receiving Multidisciplinary Comprehensive HIV Care at an Outpatient Drug Abuse Treatment Center.

Science.gov (United States)

Vallecillo, Gabriel; Mojal, Sergio; Roquer, Albert; Samos, Pilar; Luque, Sonia; Martinez, Diana; Martires, Paula Karen; Torrens, Marta

2016-05-01

Continuous HIV treatment is necessary to ensure successful combined antiretroviral therapy (cART). The aim of this study was to evaluate the incidence of patient-initiated non-structured treatment interruptions in HIV-infected persons who inject drugs and who received a multidisciplinary comprehensive program, including medical HIV care, drug-dependence treatment and psychosocial support, at a drug outpatient addiction center. Non-structured treatment interruptions were defined as ≥30 consecutive days off cART without medical indication. During a median follow-up of 53.8 months, 37/132 (28 %) patients experienced the first non-structured treatment interruptions. The cumulative probability of cART interruption at 5 years was 31.2 % (95 % CI 22.4-40.0). Current drug use injection ≥1/day (HR 14.77; 95 % CI 5.90-36.96) and cART naive patients (HR 0.35, 95 % CI 0.14-0.93) were predictive factors for non-structured treatment interruptions. HIV care provided at a drug addiction center is a useful strategy to sustain continuous cART, however, drug abstinence is essential for the long-term maintenance of cART.

The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study.

Science.gov (United States)

Malandraki, Georgia A; Rajappa, Akila; Kantarcigil, Cagla; Wagner, Elise; Ivey, Chandra; Youse, Kathleen

2016-04-01

To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. Intervention study; before-after trial with 4-week follow-up through an online survey. Outpatient university clinics. A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d. Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (PDysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline

NARCIS (Netherlands)

Achttien, R. J.; Staal, J. B.; van der Voort, S.; Kemps, H. M. C.; Koers, H.; Jongert, M. W. A.; Hendriks, E. J. M.

2013-01-01

To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR

Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline

NARCIS (Netherlands)

Achttien, R.J.; Staal, J.B.; Voort, S. van der; Kemps, H.M.; Koers, H.; Jongert, M.W.; Hendriks, E.J.; Development, G. Practice Recomm

2013-01-01

BACKGROUND: To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary

Low Vision Rehabilitation and Diabetic Retinopathy

International Nuclear Information System (INIS)

Khan, Sarfaraz A.

2007-01-01

Diabetic retinopathy is emerging as a major cause of blindness. Diabetic retinopathy calls for a multidisciplinary to the patients. Management of the patient requires a team work by the internist, diabetologist, dietician, ophthalmologist and low vision therapist. Diabetic retinopathy very often results in vision loss. It is important for ophthalmologist to recognize the importance of low vision rehabilitation in formulating appropriate treatment strategies. People with low vision loss due to diabetic retinopathy usually experience difficulty in daily life. Most people with diabetic retinopathy (who have remaining useful vision) can be helped with low vision devices. However, often one low vision device may not be suitable for all purposes. A comprehensive low vision evaluation is required to assess the person's current visual status, identify the goals and the visual needs, and then design an individualized vision rehabilitation program to meet these needs. (author)

Factors affecting poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke

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N.P. Ntamo

2013-12-01

Full Text Available Background: Stroke is a major cause of disability inthe world and its long term effects require adherence to physiotherapyprotocols for optimal rehabilitation. Clinical impression of data fromMthatha General Hospital (MGH Physiotherapy Department revealedthat there was poor attendance of outpatient physiotherapy by strokepatients discharged from MGH and this had negative effects on outcomesand health care costs.Objective: To determine the extent and the socio-demographic reasonsfor poor attendance for outpatient physiotherapy by stroke patients.Methods: An observational descriptive study was conducted using arandomly selected sample of 103 stroke patients from a population of 139who attended physiotherapy in MGH in 2007. Structured interviews wereconducted and SPSS was used for data analysis.Results: The majority (86% of patients did not attend physiotherapy until discharge from the Physiotherapy Department. Themajor reasons for poor attendance were lack of finances (95%, migration to other areas (36%, and living a long distance fromMGH (38%.Conclusion: Almost 9 out of 10 stroke patients fail to attend for outpatient physiotherapy because of lack of finances.Recommendation: Development of a Provincial Rehabilitation Policy with specific reference to decentralization of rehabilitationservices to address unavailability of physiotherapy services at clinics and health care centers which are proximal to the patients’residential areas is recommended.

OPTIMIZATION OF EARLY PHYSICAL REHABILITATION OF PATIENTS WITH SPASTIC INFANTILE CEREBRAL PALSIES

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G. S. Lupandina-Bolotova

2014-01-01

Full Text Available Infantile cerebral palsy is an urgent issue of pediatric neurology all over the world. Adequate choice of the term and methods of rehabilitation helps children with this pathology to adapt to the society and improves prognosis of motor and mental development thereof. The article presents the optimal methods of physical rehabilitation at early stages of a child’s development based on the current understanding of neuroplasticity, reserve capabilities of a developing brain, as well as of pathophysiological aspects of recovery and compensation of the damaged structures of the central nervous system. The authors demonstrate crucial differences between approaches to rehabilitation of children under and over 2 years of age. Despite the selected methods of rehabilitation of children with infantile cerebral palsy, successful results of the therapy require a multidisciplinary approach characterized by early onset, balanced combination of methods of physical rehabilitation and drug therapy, physiotherapy and psychological-pedagogic support. 

Exercise-based cardiac rehabilitation after heart valve surgery

DEFF Research Database (Denmark)

Hansen, T B; Zwisler, Ann-Dorthe; Berg, S K

2015-01-01

BACKGROUND: Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR...... expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis....

The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

Science.gov (United States)

von Kodolitsch, Yskert; Rybczynski, Meike; Vogler, Marina; Mir, Thomas S; Schüler, Helke; Kutsche, Kerstin; Rosenberger, Georg; Detter, Christian; Bernhardt, Alexander M; Larena-Avellaneda, Axel; Kölbel, Tilo; Debus, E Sebastian; Schroeder, Malte; Linke, Stephan J; Fuisting, Bettina; Napp, Barbara; Kammal, Anna Lena; Püschel, Klaus; Bannas, Peter; Hoffmann, Boris A; Gessler, Nele; Vahle-Hinz, Eva; Kahl-Nieke, Bärbel; Thomalla, Götz; Weiler-Normann, Christina; Ohm, Gunda; Neumann, Stefan; Benninghoven, Dieter; Blankenberg, Stefan; Pyeritz, Reed E

2016-01-01

Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means

The Australian Centre for Minesite Rehabilitation Research - an initiative to meet the strategic research needs for sustainable mining rehabilitation

International Nuclear Information System (INIS)

Bell, L.C.

1996-01-01

The Australian Centre for Minesite Rehabilitation Research (ACMRR) was established through a mining industry initiative to meet the need of industry governments and the community for sustainable systems for land affected by exploration, mining and mineral processing activities. The Centre, which is a consortium of the major groups associated with mining rehabilitation research in Australia, has a focus on both strategic research and technology transfer and combines a wide range of multidisciplinary skills covering engineering and the physical and biological sciences. The paper briefly describes the goals, structure, expertise and research and technology transfer activities of the Centre. The major research program areas of waste rock dump and final void stability, acid mine drainage, tailings disposal and remediation of ecosystem reconstruction are described in the context of national priorities. 3 refs., 1 fig

Oral rehabilitation of a patient with sub - total maxillectomy

Directory of Open Access Journals (Sweden)

Romesh Soni

2011-01-01

Full Text Available This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.

Oral rehabilitation of a patient with sub - total maxillectomy.

Science.gov (United States)

Soni, Romesh; Jindal, Shitu; Singh, B P; Mittal, Neelam; Chaturvedi, T P; Prithviraj, D R

2011-01-01

This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.

Treatment of Low Back Pain with a Digital Multidisciplinary Pain Treatment App: Short-Term Results.

Science.gov (United States)

Huber, Stephan; Priebe, Janosch A; Baumann, Kaja-Maria; Plidschun, Anne; Schiessl, Christine; Tölle, Thomas R

2017-12-04

Even though modern concepts of disease management of unspecific low back pain (LBP) postulate active participation of patients, this strategy is difficult to adapt unless multidisciplinary pain therapy is applied. Recently, mobile health solutions have proven to be effective aides to foster self-management of many diseases. The objective of this paper was to report on the retrospective short-term results of a digital multidisciplinary pain app for the treatment of LBP. Kaia is a mobile app that digitalizes multidisciplinary pain treatment and is in the market as a medical product class I. For the current study, the data of anonymized Kaia users was retrospectively analyzed. User data were evaluated for 12 weeks regarding duration of use and effect on in-app user reported pain levels, using the numerical rating scale (NRS), depending on whether LBP was classified as acute, subacute, or chronic back pain according to current guidelines. Data of 180 users were available. The mean age of the users was 33.9 years (SD 10.9). Pain levels decreased from baseline NRS 4.8 to 3.75 for all users at the end of the observation period. Users who completed 4, 8, or 12 weeks showed an even more pronounced decrease in pain level NRS (baseline 4.9 [SD 1.7] versus 3.6 [SD 1.5] at 4 weeks; baseline 4.7 [SD 1.8] versus 3.2 [SD [2.0] at 8 weeks; baseline 4.6 [SD 2.2] versus 2.6 [SD 2.0] at 12 weeks). In addition, subgroup analysis of acute, subacute, or chronic classification revealed no significant main effect of group (P>.30) on the reduction of pain. Conclusions: This retrospective study showed that in a pre-selected population of app users, an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly. The observed effect size was clinically relevant. Ongoing prospective randomized controlled trials (RCTs) will adjust for potential bias and selection effects. This retrospective study showed that in a pre

Completion of Multidisciplinary Treatment for Persistent Postconcussive Symptoms Is Associated With Reduced Symptom Burden.

Science.gov (United States)

Janak, Jud C; Cooper, Douglas B; Bowles, Amy O; Alamgir, Abul H; Cooper, Sharon P; Gabriel, Kelley P; Pérez, Adriana; Orman, Jean A

To investigate the pre- to posttreatment changes in both posttraumatic stress disorder (PTSD) and persistent postconcussive symptoms (PPCSs). We studied 257 active-duty patients with a history of mild traumatic brain injury (mTBI) who completed multidisciplinary outpatient treatment at Brooke Army Medical Center TBI Clinic from 2008 to 2013. This treatment program included cognitive rehabilitation; vestibular interventions; headache management; and integrated behavioral healthcare to address co-occurring psychiatric conditions such as PTSD, depression, and sleep disturbance. A 1-group; preexperimental, pre- to posttreatment study. The Neurobehavioral Symptom Inventory (NSI) was used to assess PPCSs, and the PTSD Checklist-Military Version (PCL-M) was used to asses PTSD symptoms. Global PPCS resolution (mean NSI: 35.0 pre vs 23.8 post; P < .0001; d = 0.72) and PTSD symptom resolution (mean PCL-M: 43.2 pre vs 37.7 post; P < .0001; d = 0.34) were statistically significant. Compared with those with only mTBI, patients with mTBI and PTSD reported greater global PPCS impairment both pretreatment (mean NSI: 48.7 vs 27.9; P < .0001) and posttreatment (mean NSI: 36.2 vs 17.4; P < .0001). After adjusting for pretreatment NSI scores, patients with comorbid PTSD reported poorer PPCS resolution than those with mTBI alone (mean NSI: 27.9 pre vs 21.7 post; P = .0009). We found a reduction in both self-reported PPCSs and PTSD symptoms; however, future studies are needed to identify specific components of care associated with symptom reduction.

The benefit of pulmonary rehabilitation against quality of life alteration and functional capacity of chronic obstructive pulmonary disease patient assessed using St George’s respiratory questionnaire and 6 minutes walking distance test

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Wiwien H. Wiyono

2006-09-01

Full Text Available Patients with chronic obstructive pulmonary disease (COPD have been shown to be benefit from pulmonary rehabilitation programs. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with COPD, using the St George’s Respiratory Questionnaire (SGRQ and six minutes walking distance test (6MWD (which measures health-related quality of life and functional exercise tolerance as the primary outcome measure. We undertook a randomized, opened, prospective, parallel-group controlled study of outpatient rehabilitation program in 56 patients with COPD (52 men and 4 women. The active group (n=27 took part in a 6-weeks program of education and exercise. The control group (n=29 were reviewed routinely as medical outpatients. The SGRQ and 6MWD were administered at study entry and after 6 weeks. Outcome with SGRQ and 6MWD before and after therapy was performed. Decrease score SGRQ and increase 6MWD in both groups of study, it was analyzed by statistic study and in active group the decrease of SGRQ and the increase of 6MWD was statistically significant. In conclusion 6-weeks outpatient-based program significantly improved quality of life and functional capacity in mild-to-moderate COPD patient. (Med J Indones 2006; 15:165-72 Keywords: COPD, pulmonary rehabilitation, SGRQ, 6MWD

Cost-efficiency of specialist hyperacute in-patient rehabilitation services for medically unstable patients with complex rehabilitation needs: a prospective cohort analysis.

Science.gov (United States)

Turner-Stokes, Lynne; Bavikatte, Ganesh; Williams, Heather; Bill, Alan; Sephton, Keith

2016-09-08

To evaluate functional outcomes, care needs and cost-efficiency of hyperacute (HA) rehabilitation for a cohort of in-patients with complex neurological disability and unstable medical/surgical conditions. A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2012-2015. Two HA specialist rehabilitation services in England, providing different service models for HA rehabilitation. All patients admitted to each of the units with an admission rehabilitation complexity M score of ≥3 (N=190; mean age 46 (SD16) years; males:females 63:37%). Diagnoses were acquired brain injury (n=166; 87%), spinal cord injury (n=9; 5%), peripheral neurological conditions (n=9; 5%) and other (n=6; 3%). Specialist in-patient multidisciplinary rehabilitation combined with management and stabilisation of intercurrent medical and surgical problems. Rehabilitation complexity and medical acuity: Rehabilitation Complexity Scale-version 13. Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK FIM+FAM). (1) reduction in dependency and (2) cost-efficiency, measured as the time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care in the community. The mean length of stay was 103 (SD66) days. Some differences were observed between the two units, which were in keeping with the different service models. However, both units showed a significant reduction in dependency and acuity between admission and discharge on all measures (Wilcoxon: pspecialist HA rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

What Do Stroke Patients Look for in Game-Based Rehabilitation

Science.gov (United States)

Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

2016-01-01

Abstract Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients’ places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey – interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey – a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing

Multidisciplinary nutritional support for undernutrition in nursing home and home-care

DEFF Research Database (Denmark)

Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe

2016-01-01

Objective To assess the effect of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care identified with the validated Eating Validation Scheme (EVS). Methods An 11 wk cluster randomized trial with a home-care (3 clusters) or nursing home (3 clusters.......3] versus 1.3 [0.5], P = 0.021) was observed. There was a almost significant difference in mortality (2% versus 13%, P = 0.079). Conclusions Multidisciplinary nutritional support in older adults in nursing home and home-care could have a positive effect on quality of life, muscle strength, and oral care....... means of EuroQol-5D-3L), physical performance (30-seconds chair stand), nutritional status (weight and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (participants from home-care), and mortality. Results Respectively, 55 (46 from 2 home...

Long-Term Outcome after Rehabilitation of Bilateral Total Hip Arthroplasty in Renal Transplant Recipient – A Case Report

Directory of Open Access Journals (Sweden)

Erieta Nikolikj Dimitrova

2016-02-01

CONCLUSION: Rehabilitation is integral part of multidisciplinary treatment of renal transplant recipient after total hip arthroplasty. Regular exercise training of these patients is very important for improving of their long-term outcome.

Integration of healthcare rehabilitation in chronic conditions

Directory of Open Access Journals (Sweden)

Anne Frølich

2010-02-01

Full Text Available Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

Current state of craniofacial prosthetic rehabilitation.

Science.gov (United States)

Ariani, Nina; Visser, Anita; van Oort, Robert P; Kusdhany, Lindawati; Rahardjo, Tri Budi W; Krom, Bastiaan P; van der Mei, Henry C; Vissink, Arjan

2013-01-01

This study aimed to review the current state of the techniques and materials used to rehabilitate maxillofacial defects. The MEDLINE and EMBASE databases were searched for articles pertinent to maxillofacial prostheses published from January 1990 to July 2011. The main clinical stages were the subject of analysis. A multidisciplinary approach is preferred when rehabilitating maxillofacial defects. Surgical reconstruction can be used for smaller defects, but larger defects require a prosthesis to achieve an esthetic rehabilitation. Implant retained prostheses are preferred over adhesive prostheses. Silicone elastomer is currently the best material available for maxillofacial prostheses; however, longevity and discoloration, which are greatly influenced by ultraviolet radiation, microorganisms, and environmental factors, remain significant problems. In the near future, the widespread availability and cost effectiveness of digital systems may improve the workflow and outcomes of facial prostheses. Patients report high satisfaction with their prostheses despite some areas that still need improvement. Maxillofacial prostheses are a reliable treatment option to restore maxillofacial defects and improve quality of life. Significant progress has been made in the application of implants for retention and digital technology for designing surgical guides, suprastructures, and craniofacial prostheses. Further improvements are necessary to enhance longevity of prostheses.

Effects of behavioural exercise therapy on the effectiveness of a multidisciplinary rehabilitation for chronic non-specific low back pain: study protocol for a randomised controlled trial.

Science.gov (United States)

Hofmann, Jana; Peters, Stefan; Geidl, Wolfgang; Hentschke, Christian; Pfeifer, Klaus

2013-03-11

In Germany, a multidisciplinary rehabilitation named "behavioural medical rehabilitation" (BMR) is available for treatment of chronic low back pain (clbp). A central component of BMR is standard exercise therapy (SET), which is directed mainly to improve physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with clbp. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is unclear. To compare the effectiveness of two exercise programs with different approaches within BMR on the effects of BMR a prospective randomized controlled trial (RCT) in two rehabilitation centres will be performed. 214 patients aged 18-65 with clbp will be, based on an "urn randomisation"-algorithm, randomly assigned to a BMR with SET (function-oriented, n=107) and BMR with BET (behaviour-oriented, n=107). Both exercise programs have a mean duration of 26 hours in three weeks and are delivered by a limited number of not-blinded study therapists in closed groups with six to twelve patients who will be masked regarding study group. The main differences of BET lie in its detailed manualised program with a theory-based, goal-orientated combination of exercise, education and behavioural elements, active participation of patients and consideration of their individual preferences and previous experiences with exercise. The primary outcome is functional ability assessed with the Hannover Functional Ability Questionnaire directly before and after the rehabilitation program, as well as a six and twelve-month follow-up. This RCT is designed to explore the effects of BET on the effectiveness of a BMR compared to a BMR with SET in the management of patients with clbp. Methodological challenges arise from conducting a RCT within routine health care

A prospective examination of disease management program use by complex cardiac outpatients.

Science.gov (United States)

Gravely, Shannon; Reid, Robert D; Oh, Paul; Ross, Heather; Stewart, Donna E; Grace, Sherry L

2012-01-01

The use of disease management programs (DMPs) by patients with cardiovascular disease (CVD) is associated with improved outcomes. Although rates of cardiac rehabilitation (CR) use are well established, less is known about other DMPs. The objectives of this study were to describe the degree of DMP utilization by CVD outpatients, and examine factors related to use. This study represents a secondary analysis of a larger prospective cohort study. In hospital, 2635 CVD inpatients from 11 hospitals in Ontario Canada completed a survey that assessed factors affecting DMP utilization. One year later, 1803 participants completed a mailed survey that assessed DMP utilization. One thousand seventy-three (59.5%) participants reported using at least 1 DMP. Overall, 951 (52.7%) reported participating in cardiac rehabilitation, and among participants with a comorbid indication, 212 (41.2%) reported attending a diabetes education centre, 28 (25.9%) attended stroke rehabilitation, 35 (12.9%) used a heart failure clinic, and 13 (11.7%) attended a smoking cessation program. A multinomial logistic regression analysis showed that compared with no DMP use, participants that attended 1 or multiple programs were younger, married, diagnosed with a myocardial infarction, less likely to have had a percutaneous coronary intervention and had higher perceptions of personal control over their heart condition. There were few differences between participants that used 1 vs multiple DMPs, however, having diabetes or comorbid stroke significantly increased the likelihood of multiple DMP use. Approximately 40% of CVD outpatients do not access DMPs. An integrated approach to vascular disease management appears warranted. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Oral rehabilitation of a patient with sub - total maxillectomy

OpenAIRE

Romesh Soni; Shitu Jindal; B P Singh; Neelam Mittal; T P Chaturvedi; D R Prithviraj

2011-01-01

This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise t...

Rehabilitation Risk Management: Enabling Data Analytics with Quantified Self and Smart Home Data.

Science.gov (United States)

Hamper, Andreas; Eigner, Isabella; Wickramasinghe, Nilmini; Bodendorf, Freimut

2017-01-01

A variety of acute and chronic diseases require rehabilitation at home after treatment. Outpatient rehabilitation is crucial for the quality of the medical outcome but is mainly performed without medical supervision. Non-Compliance can lead to severe health risks and readmission to the hospital. While the patient is closely monitored in the hospital, methods and technologies to identify risks at home have to be developed. We analyze state-of-the-art monitoring systems and technologies and show possibilities to transfer these technologies into rehabilitation monitoring. For this purpose, we analyze sensor technology from the field of Quantified Self and Smart Homes. The available sensor data from this consumer grade technology is summarized to give an overview of the possibilities for medical data analytics. Subsequently, we show a conceptual roadmap to transfer data analytics methods to sensor based rehabilitation risk management.

Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial

NARCIS (Netherlands)

van Eijk-Hustings, Yvonne; Kroese, Mariëlle; Tan, Frans; Boonen, Annelies; Bessems-Beks, Monique; Landewé, Robert

2013-01-01

This study aimed to examine the effectiveness of a multidisciplinary intervention with aftercare (MD) compared to aerobic exercise (AE) and usual care (UC) in recently diagnosed patients with fibromyalgia (FM). In a Zelen-like design, eligible patients from the outpatient rheumatology clinics of

The effect of rehabilitation on health-care utilisation in COPD patients in Copenhagen

DEFF Research Database (Denmark)

Jacobsen, Ramune; Rusch, Ea; Andersen, Per Kragh

2014-01-01

INTRODUCTION: The Integrated Rehabilitation Programme for Chronic Conditions project (SIKS) implemented rehabilitation programmes for people with four chronic conditions in the local area within the Municipality of Copenhagen. OBJECTIVES: The objective of this study was to evaluate the impact of ...... of Copenhagen with an assessment of the effect of a real-life intervention. It shows that the pulmonary rehabilitation programme introduced had the anticipated effects on health-care utilisation. The study also suggests that the methods used for evaluation were appropriate....... of rehabilitation on health-care utilisation in chronic obstructive pulmonary disease (COPD) patients as a subgroup of SIKS. METHODS: For the analyses, data from Danish National Registers' were obtained. The following outcomes were analysed: (i) COPD hospital admissions, (ii) COPD bed days, (iii) COPD outpatient...... rehabilitation and were matched with the intervention group according to propensity score calculated on the basis of patient socio-demographic characteristics and health-care utilisation pattern in 2 years prior to the rehabilitation programme. The effect was assessed by applying the principle of difference...

Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy.

Science.gov (United States)

Akiyama, Yuji; Iwaya, Takeshi; Endo, Fumitaka; Shioi, Yoshihiro; Kumagai, Motoi; Takahara, Takeshi; Otsuka, Koki; Nitta, Hiroyuki; Koeda, Keisuke; Mizuno, Masaru; Kimura, Yusuke; Suzuki, Kenji; Sasaki, Akira

2017-12-01

We aimed to evaluate the effectiveness of intervention by a perioperative multidisciplinary support team for radical esophagectomy for esophageal cancer. We retrospectively reviewed 85 consecutive patients with esophageal cancer who underwent radical esophagectomy via right thoracotomy or thoracoscopic surgery with gastric tube reconstruction. Twenty-one patients were enrolled in the non-intervention group (group N) from May 2011 to September 2012, 31 patients in the perioperative rehabilitation group (group R) from October 2012 to April 2014, and 33 patients in the multidisciplinary support team group (group S) from May 2014 to September 2015. Morbidity rates were 38, 45.2, and 42.4% for groups N, R, and S, respectively. Although there were no significant differences in the incidence of pneumonia among the groups, the durations of fever and C-reactive protein positivity were shorter in group S. Moreover, postoperative oral intake commenced earlier [5.9 (5-8) days] and postoperative hospital stay was shorter [19.6 (13-29) days] for group S. The intervention by a perioperative multidisciplinary support team for radical esophagectomy was effective in preventing the progression and prolongation of pneumonia as well as earlier ambulation, oral feeding, and shortening of postoperative hospitalization.

The importance of 'global meaning' for people rehabilitating from spinal cord injury.

Science.gov (United States)

Littooij, E; Leget, C J W; Stolwijk-Swüste, J M; Doodeman, S; Widdershoven, G A M; Dekker, J

2016-11-01

Qualitative study. To explore whether aspects of global meaning (that is, fundamental beliefs and life goals concerning core values, relationships, worldview, identity and inner posture) are associated with processes and outcomes in rehabilitation, as experienced by people with spinal cord injury (SCI). People living in the community receiving outpatient rehabilitation in a Dutch rehabilitation center. In-depth semi-structured interviews were conducted with 16 people with SCI. Interviews were analyzed using qualitative research methods: structural and provisional coding. Core values, relationships, worldview, identity and inner posture (that is, the way in which people relate to the facts of life) were associated with various processes and outcomes of rehabilitation. Elements of the rehabilitation process included motivation, regulation of emotion, making decisions and handling stress. Elements of the outcome of rehabilitation included physical functioning, emotional functioning, social functioning and subjective sense of meaning. The influence was positive, with the exception of one case in which worldview and inner posture were negatively associated with motivation. Besides that, respondents emphasized the importance of rehabilitation professionals attuning to their global meaning. All aspects of global meaning were positively associated with various processes and outcomes of rehabilitation. It is recommended that rehabilitation professionals are aware of the importance of global meaning to people with SCI and that they take people's fundamental beliefs and life goals into account.

Responsiveness and Minimal Important Changes of the Scoliosis Research Society-22 Patient Questionnaire in Subjects With Mild Adolescent and Moderate Adult Idiopathic Scoliosis Undergoing Multidisciplinary Rehabilitation.

Science.gov (United States)

Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

2017-06-01

Single-center, prospective study. Evaluating the responsiveness and minimal important changes (MICs) for the Scoliosis Research Society-22 Patient Questionnaire (SRS-22) in adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AS). Despite the SRS-22 properties have been investigated in various different languages, there is still a lack of information concerning responsiveness and MIC, limiting the use of SRS-22 for clinical and research purposes. At the beginning and end of multidisciplinary rehabilitation programs, 149 subjects with mild AIS (Cobb angle self-perceived image, 0.40 (0.609;79;42) for AIS and 0.60 (0.751;61;82) for AS. Correlations between change scores of the SRS-22 domains and GPE were low to moderate, ranging from -0.347 to -0.667. The SRS-22 was sensitive in detecting clinical changes in subjects with adolescent and adult scoliosis. We recommend taking the MICs provided into account when assessing patients' improvement or planning studies in these clinical contexts. 3.

Comorbidities in patients over 60 years of age treated at the rehabilitation clinic

Directory of Open Access Journals (Sweden)

Pietrzyńska Magdalena

2015-12-01

Full Text Available Patients aged above 60 represent a very diversified population group with respect to their health condition. This may result from multimorbidity. In the rehabilitation process of elderly patients it is especially crucial to identify not only the underlying diseases which constituted the grounds for referral to the rehabilitation clinic, but also the comorbidities that have to be taken into consideration while planning their rehabilitation. The aim of the present paper is the assessment of comorbidities in patients of the rehabilitation clinic. The study population included 1616 patients (447 man and 1169 women treated at the rehabilitation clinic. The factors put through analysis were the age and gender of the patient, the main diagnosed (underlying illness subject to rehabilitation treatment, as well as comorbidities. All diseases, both the underlying conditions and the comorbidities have been classified according to the International Statistical Classification of Diseases and Related Health Problems (10th revised edition. The main reasons for the treatment at the rehabilitation outpatient clinic were arthrosis of the spine, knee and hip joints, polyarthritis, osteoporosis, diseases of the central nervous system diseases and paralytic syndromes as consequences of strokes, hypertension or atherosclerosis, as well as post-traumatic conditions.

Graduate Medical Education Funding and Curriculum in Physical Medicine and Rehabilitation: A Survey of Physical Medicine and Rehabilitation Department Chairs.

Science.gov (United States)

Perret, Danielle; Knowlton, Tiffany; Worsowicz, Gregory

2018-03-01

This national survey highlights graduate medical education funding sources for physical medicine and rehabilitation (PM&R) residency programs as well as perceived funding stability, alignment of the current funding and educational model, the need of further education in postacute care settings, and the practice of contemporary PM&R graduates as perceived by PM&R department/division chairs. Approximately half of the reported PM&R residency positions seem to be funded by Centers of Medicare and Medicaid Services; more than 40% of PM&R chairs believe that their residency program is undersized and nearly a quarter feel at risk for losing positions. A total of 30% of respondents report PM&R resident experiences in home health, 15% in long-term acute care, and 52.5% in a skilled nursing facility/subacute rehabilitation facility. In programs that do not offer these experiences, most chairs feel that this training should be included. In addition, study results suggest that most PM&R graduates work in an outpatient setting. Based on the results that chairs strongly feel the need for resident education in postacute care settings and that most graduates go on to practice in outpatient settings, there is a potential discordance for our current Centers of Medicare and Medicaid Services graduate medical education funding model being linked to the acute care setting.

Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation.

Science.gov (United States)

Hamm, Larry F; Sanderson, Bonnie K; Ades, Philip A; Berra, Kathy; Kaminsky, Leonard A; Roitman, Jeffrey L; Williams, Mark A

2011-01-01

Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice

Directory of Open Access Journals (Sweden)

Sabus C

2016-12-01

Full Text Available Carla Sabus,1 Ellen Spake2 1Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, 2Rockhurst University, Kansas City, MO, USA Background and purpose: New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice.Design: Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs, including 3 owners and a manager, participated in the study.Methods: The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, ­workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators.Results: Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational

[Multidisciplinary approach of hip fractures based on Hungarian data].

Science.gov (United States)

Juhász, Krisztina; Turchányi, Béla; Mintál, Tibor; Somogyi, Péter

2016-09-01

Hip fractures are described by increased mortality, loss of quality of life, functional decline and burden of diseases. They show a growing number worldwide. The aim of the present study is to summarise the existing data on the incidence, mortality, complications and rehabilitation of hip fractures, which relevance is reported only by few studies. To reduce mortality and complications of hip fractures the authors emphasize the importance of primary treatment within 12 hours, appropriate selection of surgical methods corresponding to the fracture type after the assessment of femoral head viability, vitamin D supplementation, same conditions for primary treatment during everyday of the week, and an adequate acute treatment and rehabilitation for patient's general health status. In the future integrated processing of multidisciplinary results of hip fractures based on Hungarian data can support the development of efficient treatment and prevention strategies, which can be advantageous for the patient, families, health care system, and the society, too, by the reduction of costly complications of hip fracture healing and mortality. Orv. Hetil., 2016, 157(37), 1469-1475.

Development, implementation and evaluation of a multidisciplinary cancer rehabilitation programme : The CANSURVIVOR Project : meeting post-treatment cancer survivors’ needs

LENUS (Irish Health Repository)

Ivers, Mary E.

2009-01-01

Cancer survivor numbers in Ireland are increasing due to the success of modern treatments. Although most survivors have a good quality of life not all survivors return to \\'normal\\' after treatment. The HSE funded CANSURVIVOR research project has found that many survivors have difficulties and need help to recover and adjust after cancer treatment. Over a number of exploratory studies using interviews, focus groups and a survey of 262 breast, prostate, colorectal and lung cancer survivors, the researchers found that over 25% of survivors experienced significant difficulties with physical, emotional and social functioning, including symptoms such as insomnia and fatigue, while 33% experienced high levels of anxiety. Of particular concern were the findings that over 50% of survivors were overweight, 35% had reduced their physical activity levels and 13% continued to smoke after cancer, putting them at risk for further health problems. This evidence led to the development of an 8-week multi-disciplinary pilot rehabilitation programme. Significant quality of life improvements were achieved with increases in strength and fitness as well as a reduction in anxiety levels and dietary improvements. The researchers highlight the need for a structured, co-ordinated survivorship service, education of health professionals about survivorship and the provision of high quality information to survivors. This research was led by the School of Psychology at UCD in collaboration with the Physiotherapy and Nutrition departments of St. Vincent\\'s hospital.

Dental wear caused by association between bruxism and gastroesophageal reflux disease: a rehabilitation report

Directory of Open Access Journals (Sweden)

Naila Aparecida de Godoi Machado

2007-08-01

Full Text Available Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks, periodontal signs (gingival recession and tooth mobility and muscle-joint sensivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately. After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders.

Dental wear caused by association between bruxism and gastroesophageal reflux disease: a rehabilitation report.

Science.gov (United States)

Machado, Naila Aparecida de Godoi; Fonseca, Rodrigo Borges; Branco, Carolina Assaf; Barbosa, Gustavo Augusto Seabra; Fernandes Neto, Alfredo Júlio; Soares, Carlos José

2007-08-01

Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks), periodontal signs (gingival recession and tooth mobility) and muscle-joint sensitivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO) for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately). After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders.

Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective.

Science.gov (United States)

Hartley, Naomi A

2015-07-02

Communication is powerful predictor of health-related quality of life and overall well-being, yet its role in promoting rehabilitation outcomes in spinal cord injury (SCI) is rarely mentioned. This article systematically analyzes and synthesizes literature from multiple disciplines according to a biopsychosocial perspective, providing an evidence base for clinical practice and clear direction for future research. Systematic literature review and analysis, incorporating mapping to International Classification of Functioning, Disability and Health (ICF) codes. In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990-2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the complex interactions between communicative function with daily living after SCI. Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research. Implications for Rehabilitation Communication fosters empowerment, independence and greater participation in life roles; recognized as a powerful predictor of health-related quality of life and overall well-being. The ICF framework elucidates influences to communicative function, and components which are influenced by communication, providing valuable insight for clinicians and researchers

Design and Qualitative Evaluation of Tactile Devices for Stroke Rehabilitation

OpenAIRE

Merrett, Geoff V; Metcalf, Cheryl D; Zheng, Deyi; Cunningham, Sarah; Barrow, Stuart; Demain, Sara H

2011-01-01

Rehabilitation environments combining virtual reality with everyday motor tasks can promote recovery from neurological illness, such as stroke. Tactile devices, providing physical stimulation to the skin, may improve motor retraining. While many tactile devices have been reported, there is a distinct paucity of studies evaluating how they are perceived. This multidisciplinary research has investigated three tactile devices (vibration motors, a motor-driven ‘squeezer’, and shape memory alloys)...

A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa.

Science.gov (United States)

Chetty, Verusia; Hanass-Hancock, Jill

2016-01-01

In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The

Systematic overview of economic evaluations of health-related rehabilitation.

Science.gov (United States)

Howard-Wilsher, Stephanie; Irvine, Lisa; Fan, Hong; Shakespeare, Tom; Suhrcke, Marc; Horton, Simon; Poland, Fiona; Hooper, Lee; Song, Fujian

2016-01-01

Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered. To provide an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation. We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist. We included 64 SRs, most of which included economic evaluations alongside randomized controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n = 14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n = 24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioral, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4). Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Home-based mobile cardio-pulmonary rehabilitation consultant system.

Science.gov (United States)

Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

2011-01-01

Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

'Miracle baby': an outcome of multidisciplinary approach to neurotrauma in pregnancy.

LENUS (Irish Health Repository)

Neville, Grace

2012-01-01

Traumatic brain injury (TBI) warranting neurosurgical intervention in the pregnant population is a rarity. We describe a case of a 27-year-old woman who at 13 weeks of gestation presented with multiple traumas having been involved in a near fatal road traffic accident. Glasgow Coma Scale was 6\\/15. CT brain showed extensive haemorrhagic contusions, diffuse brain swelling and multiple skull and facial fractures. Decompressive craniectomy was performed to control her intracranial pressure during her management in the intensive care. A viable intrauterine pregnancy was confirmed and progressed as maternal stabilisation and rehabilitation continued. At 35+3 weeks a 2770 g male child was delivered via emergency caesarean section after spontaneous onset of labour. The child had no detectable abnormalities and is clinically well. Eight months post-TBI the patient continues to make gradual improvements but is left with severe cognitive impairment and currently undergoing rehabilitation. A multidisciplinary approach was adopted in the management of this patient.

Multidisciplinary approach in the management of ectodermal dysplasia: A case report

Directory of Open Access Journals (Sweden)

Brahmananda Dutta

2016-01-01

Full Text Available Ectodermal dysplasias are rare hereditary disorders characterized by abnormal development of certain tissues and structures of ectodermal origin. The condition is of importance to dentists as it affects the teeth resulting in hypodontia or anodontia, and a dentist plays an important role in the rehabilitation of the patient. Apart from having difficulties in eating and speaking, young affected individuals can also feel that they look different from their contemporaries resulting in low self-esteem. Well-fitting and functioning prosthesis could be a great help during their schooling years, as it will improve appearance and thus boost their self-confidence. We report a case of hypohidrotic ectodermal dysplasia in a 12-year-old girl who exhibited partial anodontia, and a multidisciplinary approach comprising restorative, orthodontic, surgical, and prosthetic treatment was planned to rehabilitate the girl.The aim of the treatment was to improve psychological development apart from promoting better functioning of the stomatognathic system.

Neglect: failure to thrive and obesity.

Science.gov (United States)

Harper, Nancy S

2014-10-01

Medical providers need to monitor growth at every visit. Weight status is influenced by genetics, medical conditions, socioeconomic status, and family environment. Screening for food security and psychosocial risk factors is an integral tool to identify families at risk for nutritional deficits and child maltreatment. Nutritional rehabilitation is best accomplished in an outpatient, multidisciplinary setting. Medical neglect should be considered in failure to thrive and obesity when there is a serious risk of harm from identified medical complications, additional or worsening medical complications occurring despite a multidisciplinary approach, and/or non-adherence with the treatment plan. Copyright © 2014 Elsevier Inc. All rights reserved.

[Adding the perspective of emotion on cognitive rehabilitation].

Science.gov (United States)

Nakagome, Kazuyuki

2011-01-01

Cognitive rehabilitation has been gradually disseminated in Japan lately. Cognitive rehabilitation is distinct from other psychosocial rehabilitation methods, which aims to enhance cognitive function per se, by various training tools, using paper and pencil tasks, computer games, etc. It stands on the hypothesis that enhancing cognitive function should lead to improvement in social functioning. However, it is becoming clear that cognitive rehabilitation on its own is not strongly effective on social functioning, but rather it appears effective when combined with other methods of rehabilitation. Moreover, it does not treat the emotional problems, which is essential considering the treatment endpoint, to enhance "subjective well-being". Emotional problems arise much often at social interaction in patients with schizophrenia, which can be amended by improving their social cognition as well as social skills. Recently, one of the social cognition training programs has been developed in USA by Penn and his colleagues, named SCIT (Social Cognition and Interaction Training) . The program treats a number of factors involved in social cognition, a) emotion perception, b) attributional style, and c) theory of mind, using various techniques such as Socrates quotes. In previous studies, SCIT showed good effectiveness in various aspects of social cognition for inpatients, whereas the finding was not as clear for outpatients. It may be assumed that integrating SCIT into a cognitive rehabilitation program should alleviate emotional stress the patients often encounter at social interaction in their daily activities. Presumably the next candidate target for psychosocial treatments coming after cognition and emotion should be "intrinsic motivation".

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

Science.gov (United States)

Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

2015-02-01

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions.

Science.gov (United States)

Silver, Julie K; Gilchrist, Laura S

2011-05-01

Cancer rehabilitation is an important part of survivorship as a distinct phase of treatment. Although cancer rehabilitation may involve many disciplines, this article specifically covers evidence-based treatment in physical and occupational therapy. Patients may need physical and occupational therapy services for a variety of cancer-related or cancer-treatment-related problems, including pain, fatigue, deconditioning, and difficulty with gait. They may also have problems resuming their previous level of function, which can impact on activities of daily living, instrumental activities of daily living, return to previous home and community activity levels, and return to work. This review discusses the role of physical and occupational therapy in helping cancer patients improve pain and musculoskeletal issues, deconditioning and endurance effects, fatigue, balance and falls, and lymphedema and psychosocial problems.

Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity : Rehabilitation process and prosthetics. Part 2

NARCIS (Netherlands)

Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S.; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

2015-01-01

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis

A parallel-group randomized clinical trial of individually tailored, multidisciplinary, palliative rehabilitation for patients with newly diagnosed advanced cancer

DEFF Research Database (Denmark)

Nottelmann, Lise; Groenvold, Mogens; Vejlgaard, Tove Bahn

2017-01-01

BACKGROUND: The effect of early palliative care and rehabilitation on the quality of life of patients with advanced cancer has been only sparsely described and needs further investigation. In the present trial we combine elements of early, specialized palliative care with cancer rehabilitation...... in a 12-week individually tailored, palliative rehabilitation program initiated shortly after a diagnosis of advanced cancer. METHODS: This single center, randomized, controlled trial will include 300 patients with newly diagnosed advanced cancer recruited from the Department of Oncology, Vejle Hospital...... initiated shortly after an advanced cancer diagnosis. The study will contribute with evidence on the effectiveness of implementing early palliative care in standard oncology treatment and hopefully offer new knowledge and future directions as to the content of palliative rehabilitation programs. TRIAL...

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands

NARCIS (Netherlands)

Leensen, Monique C. J.; Groeneveld, Iris F.; van der Heide, Iris; Rejda, Tomas; van Veldhoven, Peter L. J.; van Berkel, Sietske; Snoek, Aernout; van Harten, Wim; Frings-Dresen, Monique H. W.; de Boer, Angela G. E. M.

2017-01-01

Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients : A prospective study in the Netherlands

NARCIS (Netherlands)

Leensen, Monique C.J.; Groeneveld, Iris F.; Heide, Iris Van Der; Rejda, Tomas; Van Veldhoven, Peter L.J.; Berkel, Sietske Van; Snoek, Aernout; van Harten, Willem H.; Frings-Dresen, Monique H.W.; Boer, Angela G.E.M.

2017-01-01

Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to

Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders.

Science.gov (United States)

Schwarz, Betje; Neuderth, Silke; Gutenbrunner, Christoph; Bethge, Matthias

2015-01-01

Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.

Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention

Directory of Open Access Journals (Sweden)

Petersen Karin D

2011-05-01

Full Text Available Abstract Background Multidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4-12 weeks due to low back pain (LBP. However, comparison of a brief and a multidisciplinary intervention in a randomised comparative trial of sick-listed employees showed similar return to work (RTW rates in the two groups. The aim of the present study was to identify subgroups, primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention. Methods A total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners. They received a brief or a multidisciplinary intervention. Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist. The multidisciplinary intervention also comprised assignment of a case manager, who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team. Using data from a national database, we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention. At the first interview in the clinic, it was ensured that sick leave was primarily due to low back problems.Questionnaires were used to obtain data on health, disability, demographic and workplace-related factors. Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios (HRR = HRmultidisciplinary/HRbrief were adjusted for demographic and health-related variables. An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor. Subsequently, a new study was performed that included 120 patients who followed the same protocol. This group was analyzed in the same way to verify the findings from the original

Parent Perspectives on Rehabilitation Services for Their Children with Disabilities: A Mixed Methods Approach

Science.gov (United States)

Schreiber, Joseph; Benger, Jennifer; Salls, Joyce; Marchetti, Gregory; Reed, Lindsey

2011-01-01

Health care providers have adopted a family-centered care (FCC) approach. Parent satisfaction is an indicator of the effectiveness of FCC. The purpose of this project was to describe parent perceptions of the extent to which FCC behaviors occurred in an outpatient pediatric rehabilitation facility. The Measure of Processes of Care (MPOC)-20, a…

Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit.

Science.gov (United States)

Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan

2012-12-01

To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.

Can Older Adults Accurately Report their Use of Physical Rehabilitation Services?

Science.gov (United States)

Freedman, Vicki A; Kasper, Judith D; Jette, Alan

2018-04-10

To explore accuracy of rehabilitation service use reports by older adults and variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). We calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of survey-based measures from an observational panel study, the National Health and Aging Trends Study (NHATS), relative to measures developed from linked Medicare claims. Community-dwelling sample of Medicare fee-for-service beneficiaries in 2015 NHATS who were enrolled in Medicare Parts A and B for 12 months prior to their interview (N=4,228). Respondents were asked whether they received rehabilitation services in the last year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the last year. Self-reported measures had high sensitivity (77%) and PPV (80%) and even higher specificity and NPV (approaching 95%). However, in adjusted models sensitivity was lower for Black enrollees, the very old, and those with lower education levels. Survey-based measures of rehabilitation accurately captured use over the past year but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans. Copyright © 2018. Published by Elsevier Inc.

Guidelines for competency development and measurement in rehabilitation psychology postdoctoral training.

Science.gov (United States)

Stiers, William; Barisa, Mark; Stucky, Kirk; Pawlowski, Carey; Van Tubbergen, Marie; Turner, Aaron P; Hibbard, Mary; Caplan, Bruce

2015-05-01

This study describes the results of a multidisciplinary conference (the Baltimore Conference) that met to develop consensus guidelines for competency specification and measurement in postdoctoral training in rehabilitation psychology. Forty-six conference participants were chosen to include representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, persons involved in medical education practice and research, and consumers of training programs (students). Consensus education and training guidelines were developed that specify the key competencies in rehabilitation psychology postdoctoral training, and structured observation checklists were developed for their measurement. This study continues the development of more than 50 years of thinking about education and training in rehabilitation psychology and builds on the existing work to further advance the development of guidelines in this area. The conference developed aspirational guidelines for competency specification and measurement in rehabilitation psychology postdoctoral training (i.e., for studying the outcomes of these training programs). Structured observation of trainee competencies allows examination of actual training outcomes in relation to intended outcomes and provides a methodology for studying how program outcomes are related to program structures and processes so that program improvement can occur. Best practices in applying program evaluation research methods to the study of professional training programs are discussed. (c) 2015 APA, all rights reserved).

Innovative physical therapy practice: a qualitative verification of factors that support diffusion of innovation in outpatient physical therapy practice.

Science.gov (United States)

Sabus, Carla; Spake, Ellen

2016-01-01

New ideas, methods, and technologies spread through cultures through typical patterns described by diffusion of innovation (DOI) theory. Professional cultures, including the physical therapy profession, have distinctive features and traditions that determine the adoption of practice innovation. The Consolidated Framework for Implementation Research (CFIR) proposes a framework of innovation implementation specific to health care services. While the CFIR has been applied to medical and nursing practice, it has not been extended to rehabilitation professions. The purpose of this qualitative study was to verify the CFIR factors in outpatient physical therapy practice. Through a nomination process of area rehabilitation managers and area directors of clinical education, 2 exemplar, outpatient, privately owned physical therapy clinics were identified as innovation practices. A total of 18 physical therapists (PTs), including 3 owners and a manager, participated in the study. The 2 clinics served as case studies within a qualitative approach of directed content analysis. Data were collected through observation, spontaneous, unstructured questioning, workflow analysis, structured focus group sessions, and artifact analysis including clinical documents. Focus group data were transcribed. All the data were analyzed and coded among 4 investigators. Through data analysis and alignment with literature in DOI theory in health care practice, the factors that determine innovation adoption were verified. The phenomena of implementation in PT practice are largely consistent with models of implementation in health care service. Within the outpatient practices studied, patient-centered care and collaborative learning were foundational elements to diffusion of an innovation. Innovation in outpatient physical therapy practice can be understood as a social process situated within the culture of the physical therapy professional that follows predictable patterns that strongly align with

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings : Managing tensions in rehabilitation care

NARCIS (Netherlands)

Hoekstra, Femke; van Offenbeek, Marjolein A. G.; Dekker, Rienk; Hettinga, Florentina J.; Hoekstra, Trynke; van der Woude, Lucas H. V.; van der Schans, Cees P.

2017-01-01

Background: Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary

Goal setting and action planning in the rehabilitation setting: development of a theoretically informed practice framework.

Science.gov (United States)

Scobbie, Lesley; Dixon, Diane; Wyke, Sally

2011-05-01

Setting and achieving goals is fundamental to rehabilitation practice but has been criticized for being a-theoretical and the key components of replicable goal-setting interventions are not well established. To describe the development of a theory-based goal setting practice framework for use in rehabilitation settings and to detail its component parts. Causal modelling was used to map theories of behaviour change onto the process of setting and achieving rehabilitation goals, and to suggest the mechanisms through which patient outcomes are likely to be affected. A multidisciplinary task group developed the causal model into a practice framework for use in rehabilitation settings through iterative discussion and implementation with six patients. Four components of a goal-setting and action-planning practice framework were identified: (i) goal negotiation, (ii) goal identification, (iii) planning, and (iv) appraisal and feedback. The variables hypothesized to effect change in patient outcomes were self-efficacy and action plan attainment. A theory-based goal setting practice framework for use in rehabilitation settings is described. The framework requires further development and systematic evaluation in a range of rehabilitation settings.

Psychiatric Assessment and Rehabilitation of Burn Patients

Directory of Open Access Journals (Sweden)

Süleyman Akarsu

2017-03-01

Full Text Available Objective: Psychiatric rehabilitation has gained significance owing to improved healthcare facilities for burn injuries and decreased mortality/ morbidity rates. Burn traumas may result in psychiatric signs such as denial, anger, guilt, confusion, disgrace, anxiety, distress, and nervousness. Psychiatric disorders such as delirium, depression, anxiety, post-traumatic stress disorder, and sexual problems can also be encountered. Therefore, it is necessary to look for these signs and disorders through regular sessions with burn patients and appropriate psychometric tests. This study aims at examining the process of psychological rehabilitation for burn patients in light of the current literature. Material and Methods: This study has been carried out in the light of the main and current literature review. The study intends to put forth the data observed in the course of the psychological diagnosis, treatment and rehabilitation of burn patients. The study has been conducted in accordance with the Helsinki Declaration Guidelines. Results: Treatment and rehabilitation process requires a multidisciplinary teamwork that consists of physicians, dieticians, psychologists, social service specialists, and other healthcare workers who can meet the needs of burn patients and their families. It is necessary for the team to contribute both to the hospitalization process and the social environment of the patients and their families. Conclusion: It is observed that the quality of life of these patients can be considerably improved with the effective assessment of psychiatric signs that occur during or after the injury and with appropriate treatment methods.

Why do patients decline participation in offered pulmonary rehabilitation?

DEFF Research Database (Denmark)

Mathar, Helle; Fastholm, Pernille; Lange, Peter

2017-01-01

of chronic obstructive pulmonary disease and among stable patients attending an outpatient clinic. Participants: Patients who decline participation in offered pulmonary rehabilitation, who speak Danish, who are able to give informed consent and to participate in a 1-hour interview. Method: The research...... question was answered through interviews with 19 patients. Data Analysis: The interviews were recorded and transcribed verbatim. The transcripts were analyzed using inductive content analysis. The transcripts were condensed; categories were developed providing different types of explanations for declining...

What Do Stroke Patients Look for in Game-Based Rehabilitation: A Survey Study.

Science.gov (United States)

Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

2016-03-01

Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients' places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey - interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey - a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing, appropriately

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain.

Science.gov (United States)

Marin, Teresa J; Van Eerd, Dwayne; Irvin, Emma; Couban, Rachel; Koes, Bart W; Malmivaara, Antti; van Tulder, Maurits W; Kamper, Steven J

2017-06-28

Low back pain (LBP) is associated with enormous personal and societal burdens, especially when it reaches the chronic stage of the disorder (pain for a duration of more than three months). Indeed, individuals who reach the chronic stage tend to show a more persistent course, and they account for the majority of social and economic costs. As a result, there is increasing emphasis on the importance of intervening at the early stages of LBP.According to the biopsychosocial model, LBP is a condition best understood with reference to an interaction of physical, psychological, and social influences. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.This review is an update of a Cochrane Review on MBR for subacute LBP, which was published in 2003. It is part of a series of reviews on MBR for musculoskeletal pain published by the Cochrane Back and Neck Group and the Cochrane Musculoskeletal Group. To examine the effectiveness of MBR for subacute LBP (pain for a duration of six to 12 weeks) among adults, with a focus on pain, back-specific disability, and work status. We searched for relevant trials in any language by a computer-aided search of CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and two trials registers. Our search is current to 13 July 2016. We included randomised controlled trials (RCTs) of adults with subacute LBP. We included studies that investigated a MBR program compared to any type of control intervention. We defined MBR as an intervention that included a physical component (e.g. pharmacological, physical therapy) in combination with either a psychological, social, or occupational component (or any combination of these). We also required involvement of healthcare professionals from at least two different clinical backgrounds with appropriate training to deliver the component for which they were

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.

Science.gov (United States)

Kamper, Steven J; Apeldoorn, Andreas T; Chiarotto, Alessandro; Smeets, Rob J E M; Ostelo, Raymond W J G; Guzman, Jaime; van Tulder, Maurits W

2014-09-02

Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds. To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term. We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review. All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds. Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the

Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal

OpenAIRE

Nikola Džakula; Josip Kranjčić; Denis Vojvodić

2016-01-01

The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The tw...

Improving Fall Risk Factor Identification and Documentation of Risk Reduction Strategies by Rehabilitation Therapists through Continuing Education

Science.gov (United States)

Karnes, Michele J.

2011-01-01

This static group comparison study determined that an educational intervention was effective in increasing fall risk factor assessment, documentation of fall risk factors, and strategies devised to reduce fall risk factors by rehabilitation therapists for their older adult outpatients in clinics. Results showed that experimental group identified…

Risk factors and complications in type 2 diabetes outpatients

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Ellen Fernandes Flávio Silva

Full Text Available Summary Objective: Our study investigated type 2 diabetes mellitus (T2DM outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. Method: This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. Results: With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not have a healthy lifestyle. The main complication reported was high blood pressure (HBP, occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042 and multidisciplinary monitoring (p=0.050. Conclusion: The associations identified reflect the condition of patients that were already treating diabetes and its complications, especially HBP. The characteristics of the study population indicate the need to improve clinical follow-up and increase motivation for healthy behaviors.

Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling.

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Boyages, John; Kastanias, Katrina; Koelmeyer, Louise A; Winch, Caleb J; Lam, Thomas C; Sherman, Kerry A; Munnoch, David Alex; Brorson, Håkan; Ngo, Quan D; Heydon-White, Asha; Magnussen, John S; Mackie, Helen

2015-12-01

This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p multidisciplinary team is essential.

What reductions in dependency costs result from treatment in an inpatient neurological rehabilitation unit for people with stroke?

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O'Connor, Rory J; Beden, Rushdy; Pilling, Andrew; Chamberlain, M Anne

2011-02-01

This paper examines the reductions in care costs that result from inpatient multidisciplinary rehabilitation for younger people with acquired brain injury. Thirty-five consecutive patients admitted following a stroke over one year were recruited to this observational study. Physical ability, dependency and potential community care costs were measured on admission and discharge. Fifty-one community-dwelling patients were transferred to rehabilitation from acute medical wards in a large teaching hospital; 35 met the inclusion criteria. After a median of 59 days of rehabilitation, 29 patients were discharged home and six to nursing homes. Patients made highly significant gains in physical ability (median Barthel index 50 to 64; p rehabilitation costs was 21 weeks. Savings occurred in those with moderate and severe disability and they have the potential to continue to accrue for over 12 years. Similar results will probably be found for rehabilitation in other forms of acquired brain injury.

Rehabilitation robotics: an academic engineer perspective.

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Krebs, Hermano I

2011-01-01

In this paper, we present a retrospective review of our efforts to revolutionize the way physical medicine is practiced by developing and deploying rehabilitation robots. We present a sample of our clinical results with well over 600 stroke patients, both inpatients and outpatients. We discuss the different robots developed at our laboratory over the past 20 years and their unique characteristics. All are configured both to deliver reproducible interactive therapy and also to measure outcomes with minimal encumbrance, thus providing critical measurement tools to help unravel the key remaining question: what constitutes "best practice"? While success to date indicates that this therapeutic application of robots has opened an emerging new frontier in physical medicine and rehabilitation, the barrier to further progress lies not in developing new hardware but rather in finding the most effective way to enhance neuro-recovery. We close this manuscript discussing some of the tools required for advancing the effort beyond the present state to what we believe will be the central feature of research during the next 10 years.

Balance and ambulation improvements in individuals with chronic incomplete spinal cord injury using locomotor training-based rehabilitation.

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Harkema, Susan J; Schmidt-Read, Mary; Lorenz, Douglas J; Edgerton, V Reggie; Behrman, Andrea L

2012-09-01

To evaluate the effects of intensive locomotor training on balance and ambulatory function at enrollment and discharge during outpatient rehabilitation after incomplete SCI. Prospective observational cohort. Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN). Patients (N=196) with American Spinal Injury Association Impairment Scale (AIS) grade C or D SCI who received at least 20 locomotor training treatment sessions in the NRN. Intensive locomotor training, including step training using body-weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Berg Balance Scale; Six-Minute Walk Test; 10-Meter Walk Test. Outcome measures at enrollment showed high variability between patients with AIS grades C and D. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for patients with AIS grades C and D. The magnitude of improvement significantly differed between AIS groups for all measures. Time since SCI was not associated significantly with outcome measures at enrollment, but was related inversely to levels of improvement. Significant variability in baseline values of functional outcome measures is evident after SCI in individuals with AIS grades C and D and significant functional recovery can continue to occur even years after injury when provided with locomotor training. These results indicate that rehabilitation, which provides intensive activity-based therapy, can result in functional improvements in individuals with chronic incomplete SCI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

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Werhagen, Lars; Borg, Kristian

2016-10-01

Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective.

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Löbner, Margrit; Stein, Janine; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans Jörg; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

2017-01-01

This study aims to investigate (1) motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2) how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation) three months after disc surgery. The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation), follow-up interviews three months later (post-rehabilitation). Binary logistic regression and multiple linear regression analyses were applied. (1) Motives, motivations and expectations: Inpatient rehabilitation (IPR) patients stated "less effort/stress" (40.9%), more "relaxation and recreation" (39.1%) and greater "intensity of care and treatment" (37.0%) regarding their setting preference, whereas outpatient rehabilitation (OPR) patients indicated "family reasons" (45.3%), the wish for "staying in familiar environment" (35.9%) as well as "job-related reasons" (11.7%) as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p job (p example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p satisfaction with rehabilitation (OR = .806; p < .05). Rehabilitation-related motivations and expectations differed substantially between IPR and OPR patients before rehabilitation and were significantly associated with rehabilitation outcome. Taking motivational and expectation-related aspects into account may help to improve allocation procedures for different rehabilitation settings and may improve rehabilitation success.

Online communication in a rehabilitation setting: Experiences of patients with chronic conditions using a web portal in Denmark.

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Cerdan, Jose; Catalan-Matamoros, Daniel; Berg, Sarah Warny

2017-12-01

To gain insight into the experiences of patients with long-term conditions enrolled in an online rehabilitation programme using a web portal. Danish outpatients were recruited from a rehabilitation department and were granted access to a web portal which included an online rehabilitation programme with key information, clinical advice, and self-management activities. After two weeks, patients were invited to participate in focus groups. A topic guide was used to explore this new online rehabilitation programme in relation to participants' experiences. Fourteen participants, ranging from 42 to 72 years old, were allocated into three focus groups. Participants mainly reported negative experiences by the following four themes: 'patients' experiences', 'technical aspects', 'areas for improvement', and 'digitalization added value'. Participants mainly reported negative experiences and suggested combining both face-to-face consultations with online care by user-friendly web portals. This will ensure a positive contribution from digital communication tools to rehabilitation. Patients' experiences should be considered in the design of web portals in rehabilitation which could help healthcare organizations when developing online rehabilitation programmes. Copyright © 2017 Elsevier B.V. All rights reserved.

Nature-assisted rehabilitation for reactions to severe stress and/or depression in a rehabilitation garden: long-term follow-up including comparisons with a matched population-based reference cohort.

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Währborg, Peter; Petersson, Ingemar F; Grahn, Patrik

2014-03-01

To determine the effect of a nature-assisted rehabilitation programme in a group of patients with reactions to severe stress and/or mild to moderate depression. Changes in sick-leave status and healthcare consumption in these patients were compared with those in a matched population-based reference cohort (treatment as usual). Retrospective cohort study with a matched reference group from the general population. A total of 118 participants referred to a nature-assisted rehabilitation programme, and 678 controls recruited from the Skåne Health Care Register. For both groups, information on sick leave was extracted from the National Social Insurance Register and on healthcare consumption data from the Skåne Health Care Register. The interventional rehabilitation programme was designed as a multimodal programme involving professionals from horticulture and medicine. The programme was conducted in a rehabilitation garden, designed especially for this purpose. A significant reduction in healthcare consumption was noted among participants in the programme compared with the reference population. The main changes were a reduction in outpatient visits to primary healthcare and a reduction in inpatient psychiatric care. No significant difference in sick-leave status was found. A structured, nature-based rehabilitation programme for patients with reactions to severe stress and/or depression could be beneficial, as reflected in reduced healthcare consumption.

Early initiation of night-time NIV in an outpatient setting: a randomized non-inferiority study in ALS patients.

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Bertella, Enrica; Banfi, Paolo; Paneroni, Mara; Grilli, Silvia; Bianchi, Luca; Volpato, Eleonora; Vitacca, Michele

2017-12-01

In patients with amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is usually initiated in an in-hospital regime. We investigated if NIV initiated in an outpatient setting can be as effective in terms of patients' acceptance/adherence. We also evaluated factors predicting NIV acceptance and adherence and disease progression. Prospective randomized study. Outpatient versus inpatient rehabilitation. ALS patients. ALS patients were randomized to two groups for NIV initiation: outpatients versus inpatients. At baseline (T0), end of NIV trial program (T1) and after 3 months from T1 (T2), respiratory function tests, blood gas analysis, and sleep study were performed. At T1, we assessed: NIV acceptance (>4 h/night), and dyspnea symptoms (day/night) by Visual analogue scale (VAS), staff and patients' experience (how difficult NIV was to accept, how difficult ventilator was to manage, satisfaction); at T2: NIV adherence (>120 h/month) and patients' experience. Fifty patients participated. There were no differences in acceptance failure (P=0.733) or adherence failure (P=0.529). At T1, outpatients had longer hours of nocturnal ventilation (PNIV acceptance/adherence failure. There were no between-group differences in progression of respiratory impairment, symptoms and sleep quality. Early outpatient initiation of NIV in ALS is as effective as inpatient initiation.

[Changes in workers' rehabilitation procedures under the Brazilian social security system: modernization or undermining of social protection?].

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Takahashi, Mara Alice Batista Conti; Iguti, Aparecida Mari

2008-11-01

This article describes the changes in workers' rehabilitation practices under the Brazilian National Social Security Institute (INSS) in the 1990s, in the context of neoliberal economic adjustment measures, based on an analysis of INSS documents from 1992 to 1997. The INSS plan for "modernization" of workers' rehabilitation led to: (1) dismantling of multidisciplinary teams; (2) induction of workers to accept proportional retirement pensions and voluntary layoffs; (3) under-utilization of the remaining INSS professional staff; (4) elimination of treatment programs for workers' rehabilitation; and (5) dismantling of INSS rehabilitation centers and clinics. The changes in the Brazilian social security system undermined the county's social security project and hegemony and reduced social security reform to a mere management and fiscal issue. Current "rehabilitation" falls far short of the institution's original purpose of social protection for workers, while aiming at economic regulation of the system to contain costs of workers' benefits. Workers that suffer work-related accidents are denied occupational rehabilitation, which aggravates their social disadvantage when they return to work.

Phytoremediation and rehabilitation of municipal solid waste landfills and dumpsites: A brief review.

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Nagendran, R; Selvam, A; Joseph, Kurian; Chiemchaisri, Chart

2006-01-01

Environmental problems posed by municipal solid waste (MSW) are well documented. Scientifically designed landfills and/or open dumpsites are used to dispose MSW in many developed and developing countries. Non-availability of land and need to reuse the dumpsite space, especially in urban areas, call for rehabilitation of these facilities. A variety of options have been tried to achieve the goals of rehabilitation. In the last couple of decades, phytoremediation, collectively referring to all plant-based technologies using green plants to remediate and rehabilitate municipal solid waste landfills and dumpsites, has emerged as a potential candidate. Research and development activities relating to different aspects of phytoremediation are keeping the interest of scientists and engineers alive and enriching the literature. Being a subject of multi-disciplinary interest, findings of phytoremediation research has resulted in generation of enormous data and their publication in a variety of journals and books. Collating data from such diverse sources would help understand the dynamics and dimensions of landfill and dumpsite rehabilitation. This review is an attempt in this direction.

Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology.

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Hay, Casey M; Lefkowits, Carolyn; Crowley-Matoka, Megan; Bakitas, Marie A; Clark, Leslie H; Duska, Linda R; Urban, Renata R; Creasy, Stephanie L; Schenker, Yael

2017-09-01

Concern that patients will react negatively to the idea of palliative care is cited as a barrier to timely referral. Strategies to successfully introduce specialty palliative care to patients have not been well described. We sought to understand how gynecologic oncologists introduce outpatient specialty palliative care. We conducted a national qualitative interview study at six geographically diverse academic cancer centers with well-established palliative care clinics between September 2015 and March 2016. Thirty-four gynecologic oncologists participated in semistructured telephone interviews focusing on attitudes, experiences, and practices related to outpatient palliative care. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework. This analysis focuses on practices for introducing palliative care. Mean participant age was 47 years (standard deviation, 10 years). Mean interview length was 25 minutes (standard deviation, 7 minutes). Gynecologic oncologists described the following three main strategies for introducing outpatient specialty palliative care: focus initial palliative care referral on symptom management to dissociate palliative care from end-of-life care and facilitate early relationship building with palliative care clinicians; use a strong physician-patient relationship and patient trust to increase acceptance of referral; and explain and normalize palliative care referral to address negative associations and decrease patient fear of abandonment. These strategies aim to decrease negative patient associations and encourage acceptance of early referral to palliative care specialists. Gynecologic oncologists have developed strategies for introducing palliative care services to alleviate patient concerns. These strategies provide groundwork for developing system-wide best practice approaches to the presentation of palliative care referral.

The reablement team’s voice: a qualitative study of how an integrated multidisciplinary team experiences participation in reablement

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Hjelle KM

2016-11-01

Full Text Available Kari Margrete Hjelle,1,2 Olbjørg Skutle,2,3 Oddvar Førland,2,4 Herdis Alvsvåg4 1Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 2Centre for Care Research Western Norway, Bergen University College, Bergen, Norway; 3Department of Health and Social Educators, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway; 4VID Specialized University, Bergen, Norway Background: Reablement is an early and time-limited home-based rehabilitation intervention that emphasizes intensive, goal-oriented, and multidisciplinary assistance for people experiencing functional decline. Few empirical studies to date have examined the experiences of the integrated multidisciplinary teams involved in reablement. Accordingly, the aim of this study was to explore and describe how an integrated multidisciplinary team in Norway experienced participation in reablement.Methods: An integrated multidisciplinary team consisting of health care professionals with a bachelor’s degree (including a physiotherapist, a social educator, occupational therapists, and nurses and home-based care personnel without a bachelor’s degree (auxiliary nurses and nursing assistants participated in focus group discussions. Qualitative content analysis was used to analyze the resulting data.Results: Three main themes emerged from the participants’ experiences with participating in reablement, including “the older adult’s goals are crucial”, “a different way of thinking and acting – a shift in work culture”, and “a better framework for cooperation and application of professional expertise and judgment”. The integrated multidisciplinary team and the older adults collaborated and worked in the same direction to achieve the person’s valued goals. The team supported the older adults in performing activities themselves rather than completing tasks for them. To

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

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2013-01-01

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries

The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair.

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Thigpen, Charles A; Shaffer, Michael A; Gaunt, Bryce W; Leggin, Brian G; Williams, Gerald R; Wilcox, Reg B

2016-04-01

This is a consensus statement on rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The purpose of this statement is to aid clinical decision making during the rehabilitation of patients after arthroscopic rotator cuff repair. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. This statement describes a rehabilitation framework that includes a 2-week period of strict immobilization and a staged introduction of protected, passive range of motion during weeks 2-6 postoperatively, followed by restoration of active range of motion, and then progressive strengthening beginning at postoperative week 12. When appropriate, rehabilitation continues with a functional progression for return to athletic or demanding work activities. This document represents the first consensus rehabilitation statement developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients after arthroscopic rotator cuff repair. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Developing community based rehabilitation for cancer survivors: organizing for coordination and coherence in practice

Science.gov (United States)

2013-01-01

Background Increasing incidences of cancer combined with prolonged survival have raised the need for developing community based rehabilitation. The objectives of the analysis were to describe and interpret the key issues related to coordination and coherence of community-based cancer rehabilitation in Denmark and to provide insights relevant for other contexts. Methods Twenty-seven rehabilitation managers across 15 municipalities in Denmark comprised the sample. The study was designed with a combination of data collection methods including questionnaires, individual interviews, and focus groups. A Grounded Theory approach was used to analyze the data. Results A lack of shared cultures among health care providers and systems of delivery was a primary barrier to collaboration which was essential for establishing coordination of care. Formal multidisciplinary steering committees, team-based organization, and informal relationships were fundamental for developing coordination and coherence. Conclusions Coordination and coherence in community-based rehabilitation relies on increased collaboration, which may best be optimized by use of shared frameworks within and across systems. Results highlight the challenges faced in practical implementation of community rehabilitation and point to possible strategies for its enhancement. PMID:24004881

A palliative approach for rehabilitation of a pediatric patient with retinoblastoma

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Himanshi Aggarwal

2013-01-01

Full Text Available Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually far advanced at the time of detection, requiring enucleation to salvage the child′s life. However, the cosmetic rehabilitation of these patients should always be an integral part of their treatment, which helps in their re-integration in the society. This paper presents a case of 5-year-old patient who had undergone enucleation of her left eye due to retinoblastoma. A multidisciplinary approach, including ophthalmologist, psychotherapist, and a prosthodontist, was adopted to meet her physical, psychological, functional, emotional, social, and cosmetic demands. The patient was rehabilitated cosmetically with precisely fabricated ocular prosthesis. An ocular prosthesis is a highly positive and non-invasive approach to improve the cosmetic appearance and psychological well-being of patient.

Functional outcomes of community-based brain injury rehabilitation clients.

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Curran, Christine; Dorstyn, Diana; Polychronis, Con; Denson, Linley

2015-01-01

Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. Two phase design involving retrospective and longitudinal study of programme completers with ABI (n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others (n = 32) and staff (n = 32). Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design.

Reflective action assessment with a prospective clinical problem solving tool in the context of rehabilitation medicine: an illustrative case study.

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Kellett, David; Mpofu, Elias; Madden, Richard

2013-06-01

This study describes a case formulation approach applying a prospective ICF derived clinical tool to assess rehabilitation needs for a community dwelling stroke survivor with care from an outpatient rehabilitation medicine clinic. Case history data on the person were assessed for rehabilitation management planning using a prospective tool to interlink current with projected future functional status in everyday settings. Implicit assessment with reflective action informed decision points at each stage of the rehabilitation process. As a result of reflective action using the prospective tool, rehabilitation management led to significant changes in client participation after limitations to mobility and self care were mapped to the living conditions of the stroke survivor. The context sensitive rehabilitative plan resulted in higher subjective health-related quality of life in the stroke survivor and significant other and enhanced their capacity for participation. Reflective action informed assessment applying ICF concepts to clinical problem solving resulted in positive gains in health-related quality of life in a stroke survivor.

Toward a more personalized motor function rehabilitation in Myotonic dystrophy type 1: The role of neuroplasticity.

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Simona Portaro

Full Text Available Myotonic dystrophy type 1 (DM1 is the most prevalent adult muscular dystrophy, often accompanied by impairments in attention, memory, visuospatial and executive functions. Given that DM1 is a multi-system disorder, it requires a multi-disciplinary approach, including effective rehabilitation programs, focusing on the central nervous system neuroplasticity, in order to develop patient-tailored rehabilitative procedures for motor function recovery. Herein, we performed a transcranial magnetic stimulation (TMS study aimed at investigating central motor conduction time, sensory-motor plasticity, and cortical excitability in 7 genetically defined DM1 patients. As compared to healthy individuals, DM1 patients showed a delayed central motor conduction time and an abnormal sensory-motor plasticity, with no alteration of cortical excitability. These findings may be useful to define patient-tailored motor rehabilitative programs.

International casemix and funding models: lessons for rehabilitation.

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Turner-Stokes, Lynne; Sutch, Stephen; Dredge, Robert; Eagar, Kathy

2012-03-01

This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is 'An understanding of the different international models for funding of health care services and casemix systems, as exemplified by those in the US, Australia and the UK.' Payment for treatment in healthcare systems around the world is increasingly based on fixed tariff models to drive up efficiency and contain costs. Casemix classifications, however, must account adequately for the resource implications of varying case complexity. Rehabilitation poses some particular challenges for casemix development. The objectives of this educational narrative review are (a) to provide an overview of the development of casemix in rehabilitation, (b) to describe key characteristics of some well-established casemix and payment models in operation around the world and (c) to explore opportunities for future development arising from the lessons learned. Diagnosis alone does not adequately describe cost variation in rehabilitation. Functional dependency is considered a better cost indicator, and casemix classifications for inpatient rehabilitation in the United States and Australia rely on the Functional Independence Measure (FIM). Fixed episode-based prospective payment systems are shown to contain costs, but at the expense of poorer functional outcomes. More sophisticated models incorporating a mixture of episode and weighted per diem rates may offer greater flexibility to optimize outcome, while still providing incentive for throughput. The development of casemix in rehabilitation poses similar challenges for healthcare systems all around the world. Well-established casemix systems in the United States and Australia have afforded valuable lessons for other countries to learn from, but have not provided all the answers. A range

Cardiac rehabilitation services in Denmark: still room for expansion

DEFF Research Database (Denmark)

Zwisler, Ann-Dorthe O; Traeden, Ulla I; Videbaek, Jørgen

2005-01-01

support, dietary counselling, smoking cessation, and pharmaceutical risk factor management) were available during each of three phases: (I) in hospital; (II) outpatient; and (II) community-based services. RESULTS: Many hospitals offered one or more of the CR components during phases I and II: physical......AIM: European cardiologists agree that cardiac rehabilitation (CR) should be offered as an integrated part of cardiac care, and CR guidelines have been published. The authors aimed to ascertain the potential for expanding CR coverage at hospitals in Denmark. METHOD: A cross-sectional questionnaire...

Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263

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Lane Deirdre

2003-09-01

Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the

A lonely life--A qualitative study of immigrant women on long-term sick leave in Norway.

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Nortvedt, Line; Lohne, Vibeke; Kumar, Bernadette Nirmal; Hansen, Helle Ploug

2016-02-01

This study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants' special needs. The objective of the study was to explore how immigrant women on long-term sick leave in Norway due to chronic pain experience their illness and their relationships at work and in the family. This article has a qualitative design, using participant observation and in-depth interviews. Participant observations were carried out in an outpatient clinic and qualitative interviews were conducted after the rehabilitation period. A hermeneutic approach was used to understand the meaning of the narrated text. All the authors participated in the discussion of the findings, and consensus was obtained for each identified theme. The research was conducted at an outpatient clinic at a rehabilitation hospital in the southern part of Norway. The clinic offers wide-ranging, specialized, multidisciplinary patient evaluations that last between 24 and 48h, followed by advice and/or treatment either individually or in a group, i.e. in a rehabilitation course. Participants (immigrant women) who had been referred to the outpatient clinic and to a rehabilitation course were recruited. Fourteen African and Asian women were observed in two rehabilitation courses, and eleven of them agreed to be interviewed once or twice (3). The interpretation revealed the following two main themes: 'Shut inside the home' and 'Rejected at the workplace'. Based on the women's experiences, a new understanding emerged of how being excluded or not feeling sufficiently needed, wanted or valued by colleagues, employers or even by family members rendered their daily lives

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database

OpenAIRE

Malec, James F.; Kean, Jacob

2016-01-01

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer...

The Danish Cardiac Rehabilitation Database.

Science.gov (United States)

Zwisler, Ann-Dorthe; Rossau, Henriette Knold; Nakano, Anne; Foghmar, Sussie; Eichhorst, Regina; Prescott, Eva; Cerqueira, Charlotte; Soja, Anne Merete Boas; Gislason, Gunnar H; Larsen, Mogens Lytken; Andersen, Ulla Overgaard; Gustafsson, Ida; Thomsen, Kristian K; Boye Hansen, Lene; Hammer, Signe; Viggers, Lone; Christensen, Bo; Kvist, Birgitte; Lindström Egholm, Cecilie; May, Ole

2016-01-01

The Danish Cardiac Rehabilitation Database (DHRD) aims to improve the quality of cardiac rehabilitation (CR) to the benefit of patients with coronary heart disease (CHD). Hospitalized patients with CHD with stenosis on coronary angiography treated with percutaneous coronary intervention, coronary artery bypass grafting, or medication alone. Reporting is mandatory for all hospitals in Denmark delivering CR. The database was initially implemented in 2013 and was fully running from August 14, 2015, thus comprising data at a patient level from the latter date onward. Patient-level data are registered by clinicians at the time of entry to CR directly into an online system with simultaneous linkage to other central patient registers. Follow-up data are entered after 6 months. The main variables collected are related to key outcome and performance indicators of CR: referral and adherence, lifestyle, patient-related outcome measures, risk factor control, and medication. Program-level online data are collected every third year. Based on administrative data, approximately 14,000 patients with CHD are hospitalized at 35 hospitals annually, with 75% receiving one or more outpatient rehabilitation services by 2015. The database has not yet been running for a full year, which explains the use of approximations. The DHRD is an online, national quality improvement database on CR, aimed at patients with CHD. Mandatory registration of data at both patient level as well as program level is done on the database. DHRD aims to systematically monitor the quality of CR over time, in order to improve the quality of CR throughout Denmark to benefit patients.

Development of a brief multidisciplinary education programme for patients with osteoarthritis

Directory of Open Access Journals (Sweden)

Moe Rikke H

2011-11-01

questions are addressed. As part of an ongoing process, a patient representative regularly attends the MEP and gives feedback concerning content and perceived value. Conclusion A MEP has been developed to enhance self-management in patients with OA attending a multidisciplinary OA outpatient clinic. The effectiveness of the MEP followed by individual consultations with members of the multidisciplinary team is currently evaluated in a randomised controlled trial with respect to patient satisfaction and functioning.

Pain management: the multidisciplinary roessingh back-school rehabilitation program and e-health interventions for chronic pain sufferers

NARCIS (Netherlands)

Vollenbroek-Hutten, Miriam Marie Rosé; Hermens, Hermanus J.; Wever, Daniel; Söderback, Ingrid

2015-01-01

Abstract Multidisciplinary team interventions aiming at breaking the vicious circle of impaired functioning are effective for clients with chronic pain. However, because of the growing number of people with such complaints, these interventions cannot be provided totally on a face-to-face basis.

Physiotherapy Rehabilitation for People With Progressive Multiple Sclerosis: A Systematic Review.

Science.gov (United States)

Campbell, Evan; Coulter, Elaine H; Mattison, Paul G; Miller, Linda; McFadyen, Angus; Paul, Lorna

2016-01-01

To assess the efficacy of physiotherapy interventions, including exercise therapy, for the rehabilitation of people with progressive multiple sclerosis. Five databases (Cochrane Library, Physiotherapy Evidence Database [PEDro], Web of Science Core Collections, MEDLINE, Embase) and reference lists of relevant articles were searched. Randomized experimental trials, including participants with progressive multiple sclerosis and investigating a physiotherapy intervention or an intervention containing a physiotherapy element, were included. Data were independently extracted using a standardized form, and methodologic quality was assessed using the PEDro scale. Thirteen studies (described by 15 articles) were identified and scored between 5 and 9 out of 10 on the PEDro scale. Eight interventions were assessed: exercise therapy, multidisciplinary rehabilitation, functional electrical stimulation, botulinum toxin type A injections and manual stretches, inspiratory muscle training, therapeutic standing, acupuncture, and body weight-supported treadmill training. All studies, apart from 1, produced positive results in at least 1 outcome measure; however, only 1 article used a power calculation to determine the sample size and because of dropouts the results were subsequently underpowered. This review suggests that physiotherapy may be effective for the rehabilitation of people with progressive multiple sclerosis. However, further appropriately powered studies are required. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy.

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Yilmaz, Volkan; Umay, Ebru; Tezel, Nihal; Gundogdu, Ibrahim

2018-06-01

The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.

Preferences of older patient regarding hip fracture rehabilitation service configuration: A feasibility discrete choice experiment.

Science.gov (United States)

Charles, Joanna M; Roberts, Jessica L; Din, Nafees Ud; Williams, Nefyn H; Yeo, Seow Tien; Edwards, Rhiannon T

2018-05-14

As part of a wider feasibility study, the feasibility of gaining older patients' views for hip fracture rehabilitation services was tested using a discrete choice experiment in a UK context. Discrete choice experiment is a method used for eliciting individuals' preferences about goods and services. The discrete choice experiment was administered to 41 participants who had experienced hip fracture (mean age 79.3 years; standard deviation (SD) 7.5 years), recruited from a larger feasibility study exploring a new multidisciplinary rehabilitation for hip fracture. Attributes and levels for this discrete choice experiment were identified from a systematic review and focus groups. The questionnaire was administered at the 3-month follow-up. Participants indicated a significant preference for a fully-qualified physiotherapist or occupational therapist to deliver the rehabilitation sessions (β = 0·605, 95% confidence interval (95% CI) 0.462-0.879), and for their rehabilitation session to last less than 90 min (β = -0.192, 95% CI -0.381 to -0.051). The design of the discrete choice experiment using attributes associated with service configuration could have the potential to inform service implementation, and assist rehabilitation service design that incorporates the preferences of patients.

Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy.

Science.gov (United States)

Landi, Luca; Piccinelli, Stefano; Raia, Roberto; Marinotti, Fabio; Manicone, Paolo Francesco

2016-01-01

Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.

Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study.

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Gandolfi, Marialuisa; Smania, Nicola; Bisoffi, Giulia; Squaquara, Teresa; Zuccher, Paola; Mazzucco, Sara

2014-12-01

Stroke is a major cause of dysphagia. Few studies to date have reported on standardized multidisciplinary protocolized approaches to the management of post-stroke dysphagia. The aim of this retrospective cohort study was to evaluate the impact of a standardized multidisciplinary protocol on clinical outcomes in patients with post-stroke dysphagia. We performed retrospective chart reviews of patients with post-stroke dysphagia admitted to the neurological ward of Verona University Hospital from 2004 to 2008. Outcomes after usual treatment for dysphagia (T- group) were compared versus outcomes after treatment under a standardized diagnostic and rehabilitative multidisciplinary protocol (T+ group). Outcome measures were death, pneumonia on X-ray, need for respiratory support, and proportion of patients on tube feeding at discharge. Of the 378 patients admitted with stroke, 84 had dysphagia and were enrolled in the study. A significantly lower risk of in-hospital death (odds ratio [OR] 0.20 [0.53-0.78]), pneumonia (OR 0.33 [0.10-1.03]), need for respiratory support (OR 0.48 [0.14-1.66]), and tube feeding at discharge (OR 0.30 [0.09-0.91]) was recorded for the T+ group (N = 39) as compared to the T- group (N = 45). The adjusted OR showed no difference between the two groups for in-hospital death and tube feeding at discharge. Use of a standardized multidisciplinary protocolized approach to the management of post-stroke dysphagia may significantly reduce rates of aspiration pneumonia, in-hospital mortality, and tube feeding in dysphagic stroke survivors. Consistent with the study's exploratory purposes, our findings suggest that the multidisciplinary protocol applied in this study offers an effective model of management of post-stroke dysphagia.

Hypohidrotic ectodermal dysplasia: a multidisciplinary approach.

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Bildik, Tezan; Ozbaran, Burcu; Kose, Sezen; Koturoglu, Guldane; Gokce, Bulent; Gunaydin, Asli; Altintas, Inci

2012-01-01

Hypohidrotic ectodermal dysplasia (HED; Christ-Siemens-Touraine syndrome) is a genetic disorder characterized by sparse hair, oligodontia with peg-shaped teeth, reduced sweating, and defects in a number of other ectodermal organs. A partial or complete absence of eccrine glands can lead to recurrent severe overheating that may cause seizures and neurological deficits. This clinical report presents a 14-year-old male patient with hypohidrotic ectodermal dysplasia, including the clinical and radiographic findings, and multidisciplinary treatment. The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was administered to patient along with mother to assess for any psychiatric disorders. The screening and rating scales completed by mother and two teachers to evaluate the severity of attention deficit hyperactivity disorder (ADHD) symptoms, and other behavioral problems. Patient's academic performance, adaptive functioning, and problem behavior was evaluated using. The Teacher Report Form. Mental capacity was assessed with the Wechsler Intelligence Scale for Children (WISC-R). Illness Perception Questionnaire Revised was used to systematically assess illness representation attributes and emotional representations of illness. On the psychiatric diagnosis assessment using K-SADS-PL sub-threshold attention deficits and anxiety symptoms were determined. In this case we established a multidisciplinary approach in his treatment with pediatric, dermatological, and dental examinations, beside his psychiatric evaluation. The prosthetic rehabilitation included restoring upper teeth with copings and fabrication of upper and lower complete dentures. Metal framework was not incorporated in the partial denture design allowing modifications as the oral and maxillofacial development continued. Removable complete or partial dentures without metal framework is a treatment of choice until the completion of facial growth at

How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers.

Science.gov (United States)

Reinkensmeyer, David J; Blackstone, Sarah; Bodine, Cathy; Brabyn, John; Brienza, David; Caves, Kevin; DeRuyter, Frank; Durfee, Edmund; Fatone, Stefania; Fernie, Geoff; Gard, Steven; Karg, Patricia; Kuiken, Todd A; Harris, Gerald F; Jones, Mike; Li, Yue; Maisel, Jordana; McCue, Michael; Meade, Michelle A; Mitchell, Helena; Mitzner, Tracy L; Patton, James L; Requejo, Philip S; Rimmer, James H; Rogers, Wendy A; Zev Rymer, W; Sanford, Jon A; Schneider, Lawrence; Sliker, Levin; Sprigle, Stephen; Steinfeld, Aaron; Steinfeld, Edward; Vanderheiden, Gregg; Winstein, Carolee; Zhang, Li-Qun; Corfman, Thomas

2017-11-06

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet

Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat.

Science.gov (United States)

Melcer, Ted; Pyo, Jay; Walker, Jay; Quinn, Kimberly; Lebedda, Martin; Neises, Kamaran; Nguyen, Christina; Galarneau, Michael

2016-01-01

This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.

The use of rehabilitation among patients with breast cancer: a retrospective longitudinal cohort study

Directory of Open Access Journals (Sweden)

Lin Yi-Hsien

2012-08-01

Full Text Available Abstract Background Breast cancer is the most common malignancy in women. Along with improvements in treatment, the number of women who survive breast cancer has increased. Rehabilitation can alleviate post-treatment side effects and maintain quality of life. This study aimed to explore the use of rehabilitation among a cohort of patients diagnosed with breast cancer. Methods A retrospective longitudinal cohort study was conducted using a National Health Insurance (NHI research database in Taiwan. The study cohort consisted of 632 patients with breast cancer diagnosed in 2005. Their NHI claims over a period spanning 2005 through 2009 were analyzed. Results Overall, 39.6% of the cohort received rehabilitation therapy, with 9,691 rehabilitation visits claimed (an average of 38.8 visits per user. The prevalence of rehabilitation service use among the cohort was 16.5%, 13.3%, 13.0%, 13.3%, and 12.8% in the years 2005 through 2009, respectively. The average number of visits per rehabilitation user was 16.8, 25.0, 31.1, 24.2, and 23.8 in the years 2005 through 2009, respectively. Most rehabilitation therapy occurred as an outpatient service (96.0%. Physical therapy was the most commonly used form of rehabilitation (84.2%, followed by occupational therapy (15.4%. The most frequently recorded diagnoses were malignant neoplasm of the female breast, peripheral enthesopathies and allied syndromes, and osteoarthrosis and allied disorders. Conclusions Only a small proportion of patients with breast cancer received rehabilitation therapy in the first five years after diagnosis. The average number of rehabilitation visits per user peaked in the third year after diagnosis.

The prevalence of underweight is increased in chronic pancreatitis outpatients and associates with reduced life quality.

Science.gov (United States)

Olesen, Søren S; Frandsen, Louise Kuhlman; Poulsen, Jakob Lykke; Vestergaard, Peter; Rasmussen, Henrik Højgaard; Drewes, Asbjørn M

Underweight is a well-known complication of chronic pancreatitis (CP), but little is known about its prevalence in the outpatient setting. We investigated the prevalence of underweight in outpatients with CP and its association with quality of life (QOL) and various risk factors. This was a cross-sectional study of 166 outpatients with CP that was conducted at a tertiary referral center. The primary outcome was the prevalence of underweight (body mass index [BMI] pancreatic insufficiency (EPI), pain severity, pain pattern (constant versus intermittent), opioid use, and smoking and drinking habits were analyzed for their association with BMI. Patients with CP had a decreased mean BMI compared with controls (22.9 ± 4.2 kg/m 2 versus 26.8 ± 5.2 kg/m 2 ; P associated with underweight, including physical functioning (P = 0.024). Alcoholic etiology (P = 0.002), EPI (P = 0.004), and constant pain (P = 0.026) were independently associated with low BMI. One quarter of outpatients with CP are underweight and report reduced life quality compared with their normal-weight counterparts. EPI, alcoholic etiology, and pain-related symptoms are independent risk factors. Our findings emphasize the need for a multidisciplinary approach in the handling of patients with CP that focuses on alcohol cessation and the appropriate treatment of pain and EPI. Copyright © 2017 Elsevier Inc. All rights reserved.

Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

Directory of Open Access Journals (Sweden)

Daniel Chiung-Jui Su

2015-01-01

Full Text Available Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab and delayed rehabilitation (Delayed Rehab. Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001 higher medical and rehabilitation expenses and more outpatient department (OPD visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR: 3.152; 95% confidence interval (CI: 1.211–8.203; p<0.05 than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

Feasibility of a real-time hand hygiene notification machine learning system in outpatient clinics.

Science.gov (United States)

Geilleit, R; Hen, Z Q; Chong, C Y; Loh, A P; Pang, N L; Peterson, G M; Ng, K C; Huis, A; de Korne, D F

2018-04-09

Various technologies have been developed to improve hand hygiene (HH) compliance in inpatient settings; however, little is known about the feasibility of machine learning technology for this purpose in outpatient clinics. To assess the effectiveness, user experiences, and costs of implementing a real-time HH notification machine learning system in outpatient clinics. In our mixed methods study, a multi-disciplinary team co-created an infrared guided sensor system to automatically notify clinicians to perform HH just before first patient contact. Notification technology effects were measured by comparing HH compliance at baseline (without notifications) with real-time auditory notifications that continued till HH was performed (intervention I) or notifications lasting 15 s (intervention II). User experiences were collected during daily briefings and semi-structured interviews. Costs of implementation of the system were calculated and compared to the current observational auditing programme. Average baseline HH performance before first patient contact was 53.8%. With real-time auditory notifications that continued till HH was performed, overall HH performance increased to 100% (P machine learning system were estimated to be 46% lower than the observational auditing programme. Machine learning technology that enables real-time HH notification provides a promising cost-effective approach to both improving and monitoring HH, and deserves further development in outpatient settings. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting

DEFF Research Database (Denmark)

Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper

2008-01-01

AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior...... to the amputations and those who had not. METHODS: We examined all clinical records from the orthopaedic surgery department and the diabetic outpatient foot clinic of diabetic patients who underwent amputations for 6 years. RESULTS: Eighty-eight patients with type 2 diabetes underwent 142 amputations; 42 major...... and 100 minor amputations. There was no increase in the number of major amputations in this period. In the group not followed in the foot clinic prior to amputations we showed a greater major amputations rate (p

Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

Science.gov (United States)

2012-11-15

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center.

Science.gov (United States)

Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.

Diabetes quality management in Dutch care groups and outpatient clinics: a cross-sectional study.

Science.gov (United States)

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E H M

2014-08-07

In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%).Mean scores on the six domains for care groups and outpatient clinics respectively were: 'organisation of care' 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); 'multidisciplinary teamwork' 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); 'patient centeredness' 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); 'performance management' 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); 'quality improvement policy' 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and 'management strategies' 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on 'care program' (83.3%) and 'measured outcomes' (98.3%) and lowest on 'patient safety' (15.1%) and 'patient involvement' (17.7%). Outpatient clinics scored high on the presence of a 'diabetic foot team' (81.6%) and the support in 'self-management' (81.0%) and low on 'patient

Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions.

Science.gov (United States)

Caruana, Erin L; Kuys, Suzanne S; Clarke, Jane; Brauer, Sandra G

2017-11-20

Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit. Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data. Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment. Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback. What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS. What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support. What are the implications for practitioners? Staff engagement and open communication are important to

Punjabi Sikh patients' cardiac rehabilitation experiences following myocardial infarction: a qualitative analysis.

Science.gov (United States)

Galdas, Paul M; Kang, H Bindy K

2010-11-01

To explore the cardiac rehabilitation experiences of Punjabi Sikh patients post myocardial infarction. Punjabi Sikh people are at significantly higher risk of mortality from myocardial infarction compared with those of European descent. Punjabi Sikh patients' participation in cardiac rehabilitation post myocardial infarction is therefore likely to yield considerable benefits. However, uptake of cardiac rehabilitation by South Asian people has been reported to be modest. Previous investigators have seldom provided insight into experiences of Punjabi Sikh patients post myocardial infarction and the steps that can be taken to improve the appropriateness of cardiac rehabilitation programmes for this at-risk patient group. Interpretive qualitative design. In-depth interviews, based on the McGill Illness Narrative Interview schedule, with 15 Punjabi Sikh patients post myocardial infarction attending a cardiac rehabilitation programme in British Columbia, Canada, were conducted; thematic analysis using grounded theory methods of coding and constant comparative analysis was employed. Four mutually exclusive themes emerged relating to the salient aspects of participants' cardiac rehabilitation experience: 'making sense of the diagnosis', 'practical dietary advice', 'ongoing interaction with peers and the multi-disciplinary team' and 'transport and attendance'. The themes identified point towards some of the ingredients necessary for providing culturally appropriate cardiac rehabilitation interventions for Punjabi Sikh patients following myocardial infarction. The findings highlight the importance of providing culturally relevant rehabilitation advice about diet and lifestyle changes and providing time for ongoing dialogue with support from health care professionals and peers. The findings from this study also illustrate the need to avoid generalisations about the impact religious beliefs may have on South Asian individuals' willingness to adhere to cardiac rehabilitation

Perioprosthetic and Implant-Supported Rehabilitation of Complex Cases: Clinical Management and Timing Strategy

Directory of Open Access Journals (Sweden)

Luca Landi

2016-01-01

Full Text Available Treatment of complex perioprosthetic cases is one of the clinical challenges of everyday practice. Only a complete and thorough diagnostic setup may allow the clinician to formulate a realistic prognosis to select the abutments to support prosthetic rehabilitation. Clinical, radiographic, or laboratory parameters used separately are useless to correctly assign a reliable prognosis to single teeth except in the case of a clearly hopeless tooth. Therefore, it is crucial to gather the greatest quantity of data to determine the role that every single element can play in the prosthetic rehabilitation of the case. The following report deals with the management of a multidisciplinary periodontally compromised case in which a treatment strategy and chronology were designed to reach clinical predictability while reducing the duration of the therapy.

Initiation of a multidisciplinary summer studentship in palliative and supportive care in oncology

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Fairchild A

2012-09-01

Full Text Available Alysa Fairchild,1 Sharon Watanabe,1 Carole Chambers,2 Janice Yurick,3 Lisa Lem,4 Patty Tachynski51Faculty of Medicine and Dentistry, University of Alberta, Edmonton, 2Department of Pharmacy, Alberta Health Services, 3Department of Rehabilitation Medicine, Cross Cancer Institute, Edmonton, 4Department of Respiratory Therapy, Cross Cancer Institute, Edmonton, 5Department of Clinical Nutrition, Cross Cancer Institute, Edmonton, Alberta, CanadaPurpose: The optimal setting for interprofessional education (IPE for prelicensure health care trainees is unclear, especially in a field as complex and emotionally challenging as oncology. In this article, the authors describe the initiation of the Cross Cancer Institute Multidisciplinary Summer Studentship in Palliative and Supportive Care in Oncology, a 6-week, multidisciplinary team-based clinical placement in supportive care, designed to incorporate features of best practice cooperative learning.Methods: A steering committee established goals, structure, eligibility criteria, application process, funding, and a consensus approach to instruction and evaluation for the IPE program. Studentship components included mandatory and flexible clinical time, an exploratory investigation, discussion groups, and a presentation. Two senior students per iteration were selected from clinical nutrition, medicine, nursing, occupational therapy, pharmacy, physiotherapy, respiratory therapy, social work, and speech–language pathology applicants. These students completed questionnaires investigating their views of their own and others' professions at baseline, at the end of the rotation, and 6 months after the studentship.Results: Eight students from medicine, clinical nutrition, occupational therapy, physiotherapy, and speech–language pathology have participated to date. At the elective's end, students have described a more positive view of multidisciplinary team practice, with each participating discipline perceived as

Oral Rehabilitation in a Patient with Major Maxillofacial Trauma: A Case Management

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Elif Bahar Tuna

2012-01-01

Full Text Available Traumatic injuries may cause anatomic deficiencies in soft and hard tissues. These defects often result in the loss of attached mucosa and alveolar processes, which might reduce potential prosthesis support and require bone and skin grafting. As a result of major maxillofacial trauma, complete or partial avulsion of the palate may require extensive surgical and prosthodontic rehabilitation. The appropriate treatment for the maxillary defect demands a multidisciplinary approach by a team which consists of various fields of dentistry and medicine. The planning prostheses should replace not only missing teeth but also lost soft tissues and bone, and they should include the hard palate, residual alveolar ridges, and, in some instances, the soft palate. This paper describes the treatment procedures including plastic surgery operation procedures and prosthetic rehabilitation in a 19-year-old woman after her severe bicycle accident.

34 CFR 303.17 - Multidisciplinary.

Science.gov (United States)

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Multidisciplinary. 303.17 Section 303.17 Education... DISABILITIES General Purpose, Eligibility, and Other General Provisions § 303.17 Multidisciplinary. As used in this part, multidisciplinary means the involvement of two or more disciplines or professions in the...

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

Science.gov (United States)

Hoekstra, Femke; van Offenbeek, Marjolein A G; Dekker, Rienk; Hettinga, Florentina J; Hoekstra, Trynke; van der Woude, Lucas H V; van der Schans, Cees P

2017-12-01

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613)�

Scoliosis short-term rehabilitation (SSTR according to 'Best Practice' standards - are the results repeatable?

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Borysov Maksym

2012-01-01

Full Text Available Abstract Claims have been made in a pilot study that a new form of short-term rehabilitation according to 'Best Practice' standards would change signs and symptoms of patients with scoliosis in the short-term. Aim of this study is to repeat the study published 2010 with a larger sample of patients using the same protocol. Both authors have undergone training in this special approach to scoliosis rehabilitation in 2010. Materials and methods 34 patients with Adolescent Idiopathic Scoliosis (AIS, 32 girls and 2 boys, average age 13.7 years and an average Cobb angle of 28.7 degrees (21-43 degrees underwent Scoliosis Short-Term Rehabilitation (SSTR of seven days. Two days with an intensity of 3 × 90 min sessions/day, and five days with an intensity of 2 × 60 min sessions/day. Angle of trunk rotation (ATR was measured before and after the time of treatment as well as the active correctability of the ATR after the programme as it has been done in the pilot investigation. Additionally to that, we also recorded the changes in Vital Capacity (VC before and after the programme. Results ATR was reduced significantly from 11,5 degrees to 8,4 degrees, the active correctability as measured with the Scoliometer (TM was also reduced significantly from the ATR after treatment 8,9 degrees to 6,5 degrees in the patients with thoracic curves. VC improved significantly (P Discussion The results achieved in the pilot investigation published previously are repeatable. The deformity of the trunk can be reduced significantly after SSTR. During the pilot study VC was not investigated. In our study VC improved significantly. Therefore, also shorter rehabilitation times with an appropriate programme seem to be able to change signs and symptoms of a patient with scoliosis. Like the out-patient Schroth programme as described in a study from Turkey, the SSTR provides benefits leading to an improvement of the condition. Conclusion Out-patient rehabilitation following the

Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

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Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

2012-04-01

The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Implementation of a respiratory rehabilitation protocol: weaning from the ventilator and tracheostomy in difficult-to-wean patients with spinal cord injury.

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Gundogdu, Ibrahim; Ozturk, Erhan Arif; Umay, Ebru; Karaahmet, Ozgur Zeliha; Unlu, Ece; Cakci, Aytul

2017-06-01

Following repeated weaning failures in acute care services, spinal cord injury (SCI) patients who require prolonged mechanical ventilation and tracheostomy are discharged to their homes or skilled nursing facilities, with a portable mechanical ventilator (MV) and/or tracheostomy tube (TT) with excess risk of complications, high cost and low quality of life. We hypothesized that many difficult-to-wean patients with cervical SCI can be successfully managed in a rehabilitation clinic. The aim of our study was to develop a respiratory rehabilitation, MV weaning and TT decannulation protocol and to evaluate the effectiveness of this protocol in tetraplegic patients. A multidisciplinary and multifaceted protocol, including respiratory assessment and management themes, was developed and performed based on the findings from other studies in the literature. Tetraplegic patients with the diagnosis of difficult-to-wean, who were admitted to the rehabilitation clinic after having been discharged from the intensive care unit to their home with home-type MV and/or TT, were included in this prospective observational study. The respiratory rehabilitation protocol was applied to 35 tetraplegic patients (10 home-type MV and tracheostomy-dependent, and 25 tracheostomized patients) with C1-C7 ASIA impairment scale grade A, B, and C injuries. Seven out of 10 patients successfully weaned from MV and 30 of 35 patients were decannulated. Four patients were referred for diaphragm pace stimulation and tracheal stenosis surgery. The mean durations of MV weaning and decannulation were 37 and 31 days, respectively. A multifaceted, multidisciplinary respiratory management program can change the process of care used for difficult-to-wean patients with SCI. Implications for rehabilitation Findings from this study indicate the significance of a multidimensional evaluation of any reversible factors for prolonged MV- and/or TT-dependent SCI patients. Thus, rehabilitation specialists should take this

42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... outpatient prospective payment system. 419.21 Section 419.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM... Excluded From the Hospital Outpatient Prospective Payment System § 419.21 Hospital outpatient services...

Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

Science.gov (United States)

2005-01-01

The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: A literature Review

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Ahyana Ahyana

2013-01-01

Full Text Available Background: Cardiac rehabilitation (CR is a process that involves a multidisciplinary team of health professionals in order to optimize the status of patients’ physical, psychological, social, and vocational well being. The CR program has been proven to influence health outcomes in patients with cardiac diseases, particularly myocardial infarction (MI and stable angina. However, patients’ compliance with cardiac rehabilitation programs remains a challenge.Purpose: The purpose of this study is to review and identify interventions that enhance cardiac rehabilitation behaviors in MI patients.Method: A literature review was conducted by analyzing related research reports published since 2000 to 2012. Only English language articles were included.Result: There were 10 experimental studies and 2 meta-analysis studies. Interventions widely used to enhance cardiac rehabilitation behaviors in MI patients were self-efficacy and self management derived programs. These programs involved interventions that enhance cardiac rehabilitation behaviors, including training exercise, behavioral change, education and psychological support, and lifestyle changing strategies. None have reported the use of culturally tailored intervention. Four phases of cardiac rehabilitation were accepted as each phase represents a different aspect of care: inpatient care, early post discharge period, exercise training, and long term follow up. Critical factors for patients in maintaining an optimum health condition after a cardiac event are, in order, status of patient’s physical, psychological, social, and vocational well being.Conclusion: Cardiac Rehabilitation program has been shown to improve quality of life and decrease mortality in MI patients. The development of culturally specific interventions to increase cardiac rehabilitation behaviors will provide a significant improvement for cardiac patient’s care that ultimately results in better health outcomes. Health care

Association between Spirituality and Adherence to Management in Outpatients with Heart Failure

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Juglans Souto Alvarez

2016-01-01

Full Text Available Abstract Background: Spirituality may influence how patients cope with their illness. Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure. Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence. Results: One hundred and thirty patients (age 60 ± 13 years; 67% male were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003 and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments. Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.

Rubbish tips rehabilitation. Degradation mechanisms and impacts; Rehabilitation des decharges. Mecanismes de degradation et impacts

Energy Technology Data Exchange (ETDEWEB)

Chassagnac, Th. [CSZ AZUR, 69 - Lyon (France)

2005-06-01

Waste storage activity really started in the beginning of the industrial era when the consumption of goods has led to a production of wastes higher than the environment assimilation capacity. The waste storage and disposal activity has led to environmental impacts and risks which need to be evaluated and, if needed, processed. Waste storage remains the most common way of wastes elimination because of its simpleness and low cost. However, the closing down of sites is today strictly controlled by the law and the rehabilitation problems concerns mainly the ancient sites. The waste storage domain is at the crossroads of multiple scientific domains like: hydrogeology, rudology, biology, hydraulics and hydrology, water and gases processing, ecology, health sciences and risk assessments, and thus requires a multi-disciplinary approach. This article deals with the rehabilitation of rubbish tips and presents: 1 - the typology and regulatory evolution of waste storage centers; 2 - the main pollutants, their mechanisms and way of impact on the environment: typology of pollutants (origin and nature; mobility influencing factors; risk, hazard, exposure and impact notions); impacts on air (origin and mechanism of biogas generation, biogas composition, mass status of biogas production, risks linked with biogas); impact on waters (leachates; hydric status; impact on groundwaters; impact on surface waters; impact on soils and natural ecosystems; other harmful effects: aesthetics, noise, vermin; stability). (J.S.)

Choosing the right rehabilitation setting after herniated disc surgery: Motives, motivations and expectations from the patients' perspective.

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Margrit Löbner

Full Text Available This study aims to investigate (1 motives, motivations and expectations regarding the choice for a specific rehabilitation setting after herniated disc surgery and (2 how rehabilitation-related motivations and expectations are associated with rehabilitation outcome (ability to work, health-related quality of life and satisfaction with rehabilitation three months after disc surgery.The longitudinal cohort study refers to 452 disc surgery patients participating in a subsequent rehabilitation. Baseline interviews took part during acute hospital stay (pre-rehabilitation, follow-up interviews three months later (post-rehabilitation. Binary logistic regression and multiple linear regression analyses were applied.(1 Motives, motivations and expectations: Inpatient rehabilitation (IPR patients stated "less effort/stress" (40.9%, more "relaxation and recreation" (39.1% and greater "intensity of care and treatment" (37.0% regarding their setting preference, whereas outpatient rehabilitation (OPR patients indicated "family reasons" (45.3%, the wish for "staying in familiar environment" (35.9% as well as "job-related reasons" (11.7% as most relevant. IPR patients showed significantly higher motivation/expectation scores regarding regeneration (p < .001, health (p < .05, coping (p < .001, retirement/job (p < .01, psychological burden (p < .05 and physical burden (p < .001 compared to OPR patients. (2 Associations with rehabilitation outcome: Besides other factors (e.g. age, gender and educational level rehabilitation-related motivations/expectations were significantly associated with rehabilitation outcome measures. For example, patients with less motivations/expectations to achieve improvements regarding "physical burden" showed a better health-related quality of life (p < .01 three months after disc surgery. Less motivations/expectations to achieve improvements regarding "psychological burden" was linked to a better mental health status (p < .001 and a

Pulmonary rehabilitation improves exercise capacity and dyspnea in air pollution-related respiratory disease.

Science.gov (United States)

Miyamoto, Naomi; Senjyu, Hideaki; Tanaka, Takako; Asai, Masaharu; Yanagita, Yorihide; Yano, Yudai; Nishinakagawa, Tsuyoshi; Kotaki, Kenji; Kitagawa, Chika; Rikitomi, Naoto; Kozu, Ryo; Honda, Sumihisa

2014-01-01

Air pollution in Japan caused respiratory disease, such as chronic bronchitis and asthma, in many individuals in the 1960s. Although air pollution has decreased, many victims of air pollution-related respiratory disease are limited in their activities of daily living because of respiratory symptoms. The purpose of this study was to evaluate the efficacy of pulmonary rehabilitation in victims of air pollution-related chronic bronchitis or asthma. Subjects were enrolled in a 12-week (2-week inpatient followed by 10-week outpatient) pulmonary rehabilitation program. The program comprised conditioning, strength training, endurance training, and patient education. We assessed the Modified Medical Research Council (MMRC) dyspnea grade, pulmonary function, peripheral muscle force, incremental shuttle walk distance (ISWD), and physical activity at baseline and immediately after the program. Twenty-nine subjects (mean age 74.2 ± 10.1 years, 11 males) completed the program, including 11 subjects with COPD and 18 subjects with asthma. Following rehabilitation, the participants (n = 29) showed significant improvements in MMRC dyspnea grade, vital capacity % predicted, quadriceps force and ISWD (all P pollution-related asthma. In conclusion, we recommend that patients with chronic bronchitis or asthma, resulting from exposure to air pollution, are referred for pulmonary rehabilitation.

Multidisciplinary Approaches to Allergies

NARCIS (Netherlands)

Gao Zhongshan,; Shen, Hua-Hao; Zheng, M.; Frewer, L.J.; Gilissen, L.J.W.J.

2012-01-01

Allergy is an immunological disease caused by multiple factors and characterized by variability, specificity and complexity. "Multidisciplinary Approaches to Allergies" covers diverse aspects ranging from basic molecular mechanisms to societal issues within the framework of multidisciplinary

Rehabilitation in peripheral non femoral fractures: a review.

Science.gov (United States)

Mangone, Giuseppe; Postiglione, Marco; Pasquetti, Pietro

2010-01-01

This paper is a short review of the available information on peripheral non femoral fractures (PNFF) which are strictly related to osteoporosis. Particular attention is focused on wrist fractures in view of their frequent occurrence as indicated by world wide statistics. Of special interest is the definition of risk groups (old age), risk areas (developed countries) and risk factors. Reference is made to 2008 WHO guidelines for fracture risk assessment. PNFF are a serious concern to health authorities because their high incidence in constant growth, causes a serious burden on the health budget. The pathway of patient care is described, from initial evaluation (including bone fragility, multi-morbidity and risk factors) to specific diagnosis and treatment. The multiplicity of etiological factors involved requires multidisciplinary approach. This aspect justifies the importance given to rehabilitation, which is the longest part of patient care and is strictly connected to preventive measures. There is ample reference to falls, to exercises, to appropriate sports, to complications and to active and passive mobilization. The paper suggests research in areas related to PNFF, to health economics, epidemiology, prevention, health education, training and multidisciplinary coordination.

Shuttle Walking Test as Predictor of Survival in Chronic Obstructive Pulmonary Disease Patients Enrolled in a Rehabilitation Program

DEFF Research Database (Denmark)

Ringbæk, Thomas; Martinez, Gerd; Brøndum, Eva

2010-01-01

BACKGROUND: The Incremental Shuttle Walking Test (ISWT) is used to assess exercise capacity in chronic obstructive pulmonary disease (COPD) and is employed as an outcome measure for pulmonary rehabilitation. We studied the value of this test in predicting survival in COPD patients enrolled...... in a rehabilitation program. METHODS: A total of 416 patients performed an ISWT before entering a 7-week outpatient pulmonary rehabilitation program. Their survival was observed over a mean period of 4.5 years (range = 1.2-7.2 years). RESULTS: During the observation period, 169 (40.6%) patients died. Univariate...... analyses showed that the ISWT as well as age, gender, present and previous tobacco smoking, forced expiratory volume in 1 second, body mass index, oxygen saturation at rest, long-term oxygen therapy, Medical Research Council dyspnea score, and treatment with oral corticosteroids were significantly...

The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

Directory of Open Access Journals (Sweden)

von Kodolitsch Y

2016-11-01

Full Text Available Yskert von Kodolitsch,1 Meike Rybczynski,1 Marina Vogler,2 Thomas S Mir,3 Helke Schüler,1 Kerstin Kutsche,4 Georg Rosenberger,4 Christian Detter,5 Alexander M Bernhardt,5 Axel Larena-Avellaneda,6 Tilo Kölbel,6 E Sebastian Debus,6 Malte Schroeder,7,8 Stephan J Linke,9,10 Bettina Fuisting,9 Barbara Napp,1 Anna Lena Kammal,11 Klaus Püschel,11 Peter Bannas,12 Boris A Hoffmann,13 Nele Gessler,13 Eva Vahle-Hinz,14 Bärbel Kahl-Nieke,14 Götz Thomalla,15 Christina Weiler-Normann,16 Gunda Ohm,17 Stefan Neumann,18 Dieter Benninghoven,19 Stefan Blankenberg,1 Reed E Pyeritz20 1Clinic of Cardiology, University Heart Centre, 2Marfan Hilfe Deutschland e.V., Zentrumsehstärke, 3Clinic for Pediatric Cardiology, University Heart Centre, 4Institute of Human Genetics, 5Clinic of Cardiovascular Surgery, University Heart Centre, 6Clinic of Vascular Medicine, University Heart Centre, 7Department of Trauma, Hand, and Reconstructive Surgery, 8Department of Orthopedics, 9Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 10Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 11Department of Legal Medicine, 12Diagnostic and Interventional Radiology Department and Clinic, 13Clinic of Electrophysiology, University Heart Centre, 14Department of Orthodontics, Center for Dental and Oral Medicine, 15Clinic of Neurology, 16Martin Zeitz Center for Rare Diseases, 17Strategic Business Development, 18Business Unit Quality Management, University Medical Center Hamburg-Eppendorf, 19Mühlenberg-Clinic for Rehabilitation, Bad Malente-Gremsmühlen, 20Zentrumsehstärke, Hamburg, Germany Abstract: Marfan syndrome (MFS is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary

Can workers with chronic back pain shift from pain elimination to function restore at work? Qualitative evaluation of an innovative work related multidisciplinary programme.

Science.gov (United States)

Buijs, Peter C; Lambeek, Ludeke C; Koppenrade, Vera; Hooftman, Wendela E; Anema, Johannes R

2009-01-01

Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpatient) health care. So we developed and implemented an innovative, patient-activating alternative: the multidisciplinary outpatient care (MOC) programme, including work(place) intervention and graded activity. It aims at function restore (instead of pain elimination), return to work (RTW) and coordinated communication. To qualitatively explore how patients and health care providers perceive the programme effectiveness and which factors influence its implementation. In-depth, semi structured interview with patients and focus groups of health care providers are used, all recorded, transformed into verbatim transcript and analysed. This qualitative study shows that although patients' expectations were low at the start of the program, and despite long LBP histories, including many different therapies, (primarily) directed at pain reduction, the MOC programme was successful in changing patients' goal setting from pain oriented towards function restore and RTW. The programme was therefore perceived as applicable and effective. Patient compliance was influenced by barriers - despair, supervisory and subordinate resistance at work, waiting period, medicalisation in health care - and facilitators: disciplinary motivation, protocolled communication, information supply, tailor-made exercises. For some patients the barriers were too high. Several improvement suggestions were given. This qualitative study shows that generally, patients and professionals perceived the multidisciplinary outpatient care programme as applicable and effective. After incorporating improvement suggestions this program seems promising for further, broader application and hypothesis testing. For those, negatively evaluating

Study protocol: to investigate effects of highly specialized rehabilitation for patients with multiple sclerosis. A randomized controlled trial of a personalized, multidisciplinary intervention

Directory of Open Access Journals (Sweden)

Sørensen Jan

2012-09-01

Full Text Available Abstract Background Multiple sclerosis (MS is a complex, chronic and progressive disease and rehabilitation services can provide important support to patients. Few MS rehabilitation programs have been shown to provide health improvements to patients in a cost-effective manner. The objective of this study is to assess the effects in terms of changes measured by a variety of standardized quality of life, mastery, coping, compliance and individual goal-related endpoints. This combination provides the basis for analyzing the complexity of MS and outcomes of a personalized rehabilitation. Methods/Design Patients with MS referred to hospital rehabilitation services will be randomized to either early admission (within two months or usual admission (after an average waiting time of eight months. They will complete a battery of standardized health outcome instruments prior to randomization, and again six and twelve months after randomization, and a battery of goal-related outcome measures at admission and discharge, and again one, six and twelve months after randomization. Discussion The results of the study are expected to contribute to further development of MS rehabilitation services and to discussions about the design and content of such services. The results will also provide additional information to health authorities responsible for providing and financing rehabilitation services. Trial registration Current Controlled Trials (ISRCTN05245917

Late mental health changes in tortured refugees in multidisciplinary treatment

DEFF Research Database (Denmark)

Carlsson, Jessica Mariana; Olsen, Dorte Reff; Kastrup, Marianne

2010-01-01

to the Rehabilitation and Research Centre for Torture Victims in 2001 to 2002. Data on background, trauma, present social situation, mental symptoms (Hopkins Symptom Checklist-25, Hamilton Depression Scale, Harvard Trauma Questionnaire), and on health-related quality of life (World Health Organization Quality of Life......-Bref) were collected before treatment and after 9 and 23 months. No substantial changes in mental health were observed at the 9-month follow-up, and the minor decrease in some symptoms observed between the 9 and 23 months may reflect regression toward the mean or the natural course of symptoms in this cohort......The aim of this study was to examine long-term changes in symptoms of post-traumatic stress disorder, depression, anxiety, and in health-related quality of life in traumatized refugees 23 months after admission to multidisciplinary treatment. The study group comprised 45 persons admitted...

Multidisciplinary team functioning.

Science.gov (United States)

Kovitz, K E; Dougan, P; Riese, R; Brummitt, J R

1984-01-01

This paper advocates the need to move beyond interdisciplinary team composition as a minimum criterion for multidisciplinary functioning in child abuse treatment. Recent developments within the field reflect the practice of shared professional responsibility for detection, case management and treatment. Adherence to this particular model for intervention requires cooperative service planning and implementation as task related functions. Implicitly, this model also carries the potential to incorporate the supportive functioning essential to effective group process. However, explicit attention to the dynamics and process of small groups has been neglected in prescriptive accounts of multidisciplinary child abuse team organization. The present paper therefore focuses upon the maintenance and enhancement aspects of multidisciplinary group functioning. First, the development and philosophy of service for the Alberta Children's Hospital Child Abuse Program are reviewed. Second, composition of the team, it's mandate for service, and the population it serves are briefly described. Third, the conceptual framework within which the program functions is outlined. Strategies for effective group functioning are presented and the difficulties encountered with this model are highlighted. Finally, recommendations are offered for planning and implementing a multidisciplinary child abuse team and for maintaining its effective group functioning.

Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics

DEFF Research Database (Denmark)

Gustafsson, Finn; Schou, Morten; Videbaek, Lars

2009-01-01

AND RESULTS: A total of 4012 consecutive outpatients referred for HF management in 18 Danish HF clinics were included. Clinical data were collected prospectively. Outcome data were obtained from a validated, national registry. Mean follow-up time was 580 days. The mean age of patients was 69 years, 83% had...... creatinine 1.03 (1.02-1.04), NYHA III and IV 1.32 (1.15-1.52), and hospitalization prior to referral to the HF clinic 1.81 (1.57-2.08). CONCLUSIONS: Event rates in this cohort were lower than most published data from HF clinic populations. Factors such as advanced age, NYHA class, and prior hospitalization...... predict poor outcome in patients managed in multidisciplinary HF clinics....

Environmental project and public space rehabilitation: the great project for the historic center of Naples Unesco World Heritage Site

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Mario Losasso

2014-05-01

Full Text Available “Historic Centre of Naples, World Heritage Site Enhancement” project has as its goal the rehabilitation of the oldest part of the historic center of Naples, one of the largest and most representative of Europe. The research reference field is placed on the level of strategic approach to the project and process management downstream of EU funding in large cities, with particular multidisciplinary relevance and urban issues of a complex nature. The scientific products of study, training and research were collected in Guidelines for the rehabilitation of public spaces and for sustainable performance of interventions on roads, walkways, squares and urban facilities.

Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis.

Science.gov (United States)

Gauthier, Lynne V; Kane, Chelsea; Borstad, Alexandra; Strahl, Nancy; Uswatte, Gitendra; Taub, Edward; Morris, David; Hall, Alli; Arakelian, Melissa; Mark, Victor

2017-06-08

Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in

[An individual approach to the surgical treatment and medical rehabilitation of duodenal ulcer patients].

Science.gov (United States)

Kochetkov, A V; Barashkov, V G; Papazov, V I

1996-01-01

Since 1986 403 patients have been treated according to the following programme: successive preparation for surgery, the operative intervention chosen individually for each patient, the purposeful medical rehabilitation. Different types of vagotomy with draining operations were performed in 85.6% of the cases, stomach resection--in 14.4% of the patients. The mortality rate was 0%. The indications for various types of vagotomy, stomach resection and different types of draining operations were determined. Rehabilitation of 55% of the patients after the operative treatment took place at the gastroenterological department, the others--at an outpatient department. The indications for rehabilitation, its volume and time were established. The best remote results in the follow-up periods up to five years were obtained after truncal vagotomy and stomach resection. Ulcer recurrences were noted in 3.5% and 5.2% of the cases respectively. Recurrences of the disease were noted in 7.8% after combined vagotomy and in more than 20% after SPV. Nine patients out of 34 with recurrent ulcers were reoperated with good results, the others were successfully treated by conservative therapy.

Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury.

Science.gov (United States)

Poncet, Frédérique; Pradat-Diehl, Pascale; Lamontagne, Marie-Eve; Alifax, Anne; Fradelizi, Pascaline; Barette, Maude; Swaine, Bonnie

2017-09-01

A holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. This study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. We used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. We included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). Participant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality

Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury.

Science.gov (United States)

Scott, Whitney; Wideman, Timothy H; Sullivan, Michael J L

2014-03-01

Pain catastrophizing has emerged as a significant risk factor for problematic recovery after musculoskeletal injury. As such, there has been an increased focus on interventions that target patients' levels of catastrophizing. However, it is not presently clear how clinicians might best interpret scores on catastrophizing before and after treatment. Thus, the purpose of this study was to provide preliminary guidelines for the clinical interpretation of scores on pain catastrophizing among individuals with subacute pain after musculoskeletal injury. A sample of 166 occupationally disabled individuals with subacute pain due to a whiplash injury participated in this study. Participants completed a 7-week standardized multidisciplinary rehabilitation program aimed at fostering functional recovery. Participants completed the Pain Catastrophizing Scale (PCS) upon program commencement and completion. One year later, participants indicated their pain severity and involvement in employment activities. Separate receiver operating characteristic curve analyses were conducted to determine absolute pretreatment and posttreatment and percent change scores on the PCS that were best associated with clinically important levels of pain and employment status at the follow-up. An absolute pretreatment PCS score of 24 best identified patients according to follow-up clinical outcomes. Posttreatment PCS scores of 14 and 15 best identified patients with high follow-up pain intensity ratings and those who did not return to work, respectively. PCS reductions of approximately 38% to 44% were best associated with return to work and low pain intensity ratings at follow-up. The results indicate scores on catastrophizing before and after treatment that are clinically meaningful. These results may serve as preliminary guidelines to assess the clinical significance of interventions targeting pain catastrophizing in patients with subacute pain after musculoskeletal injury.

Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

Directory of Open Access Journals (Sweden)

N. V. Bestuzheva

2014-01-01

Full Text Available Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV is most frequently encountered.Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice.Patients and methods. The investigation enrolled 80 patients, including 55 (68.7% women and 25 (31.3% men, aged 18 to 75 years (mean age 53.8±12.8 years, who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University.Results. The most common causes of dizziness in outpatient practice were BPPV (46.2% and postural phobic vertigo (35%. The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5% of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3% patients.Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted.

Multidisciplinary Treatment of Severe Osteogenesis Imperfecta: Functional Outcomes at Skeletal Maturity.

Science.gov (United States)

Montpetit, Kathleen; Palomo, Telma; Glorieux, Francis H; Fassier, François; Rauch, Frank

2015-10-01

To determine the functional outcomes associated with long-term multidisciplinary treatment, intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation in children with severe osteogenesis imperfecta (OI) (diagnosed clinically as OI types III or IV). Retrospective study where outcomes were measured prospectively. Pediatric orthopedic hospital. Adolescents (N=41; age range, 15-21y) with severe OI (OI type III: n=17; OI type IV: n=24) who had started therapy before the age of 6 years, had received treatment for at least 10 years, and had achieved final height. Intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation. Pediatric Evaluation of Disability Inventory. At the time of the last available follow-up examination, none of the individuals diagnosed with OI type III (most severely affected group) was able to ambulate without ambulation aids, whereas 20 (83%) patients with OI type IV were able to ambulate without ambulation aids. Regarding self-care, we specifically assessed 8 skills that we deemed essential for living independently (grooming; dressing; toileting; bed, chair, toilet, tub, and car transfers). Only 6 (35%) of the youths with OI type III were able to complete all 8 items, whereas 23 (96%) individuals with OI type IV managed to perform all tasks. Teens with OI type III often needed assistance for the transfer to toilet, tub, and car and for personal hygiene and clothing management associated with toileting, usually because of limitations in upper-extremity function. These observations suggest that further improvements in the functional status of the most severely affected children with OI are contingent on advances in the clinical management of upper-extremity issues. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II).

Science.gov (United States)

Ilarraza-Lomelí, Hermes; García-Saldivia, Marianna; Rojano-Castillo, Jessica; Justiniano, Samuel; Cerón, Norma; Aranda-Ayala, Zulema-L; Rodríguez, Azucena; Hernández, Alejandro; Cassaigne, María-Elena; Cantero, Raúl; Gasca, Pablo; Hinojosa, Tania; Alonso, Jesús; Romo, Ricardo; Lara, Jorge; Pimentel, Elizabeth; Zavala, Juana; Rius-Suárez, María-Dolores; Cherebetiu, Gabriel; Cortés, Othniel; Almaraz, Alejandro; Mendoza, Pedro; Silva, Jesús; Tirado, Enrique; Martínez, Leonel

The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation. All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units. In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%). CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Feasibility and changes in symptoms and functioning following inpatient cancer rehabilitation.

Science.gov (United States)

Bertheussen, Gro F; Kaasa, Stein; Hokstad, Anne; Sandmæl, Jon Arne; Helbostad, Jorunn L; Salvesen, Øyvind; Oldervoll, Line M

2012-11-01

need comprehensive inpatient rehabilitation and also compare the effects of inpatient with outpatient rehabilitation programs.

Patient outcomes using Wii-enhanced rehabilitation after total knee replacement - the TKR-POWER study.

Science.gov (United States)

Negus, J J; Cawthorne, D P; Chen, J S; Scholes, C J; Parker, D A; March, L M

2015-01-01

Home-based rehabilitation following total knee replacement surgery can be as effective as clinic-based or in-patient rehabilitation. The use of the Nintendo Wii has been postulated as a novel rehabilitation tool that adds an additional focus on balance and proprioception into the recovery protocol. The aim of the proposed clinical trial is to investigate the effectiveness of this novel rehabilitation tool, used at home for three months after total knee replacement surgery and to assess any lasting improvements in functional outcome at one year. This will be a randomised controlled trial of 128 patients undergoing primary total knee replacement. The participants will be recruited preoperatively from three surgeons at a single centre. There will be no change to the usual care provided until 6 weeks after the operation. Then participants will be randomised to either the Wii-Fit group or usual rehabilitative care group. Outcomes will be assessed preoperatively, a 6-week post surgery baseline and then at 18 weeks, 6 months and 1 year. The primary outcome is the change in self-reported WOMAC total score from week 6 to 18 weeks. Secondary outcomes include objective measures of strength, function and satisfaction scores. The results of this clinical trial will be directly relevant for implementation into clinical practice. If beneficial, this affordable technology could be used by many patients to rehabilitate at home. Not only could it optimize the outcomes from their total knee replacement surgery but decrease the need for clinic-based or outpatient therapy for the majority. (ACTRN12611000291987). Copyright © 2014 Elsevier Inc. All rights reserved.

Diabetes rehabilitation : development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

NARCIS (Netherlands)

Keers, JC; Blaauwwiekel, EE; Hania, M; Bouma, J; Scholten-Jaegers, SMHJ; Sanderman, R; Links, TP

For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of

Multidisciplinary treatment

International Nuclear Information System (INIS)

Hayabuchi, Naofumi; Jingu, Kenichi; Matsuura, Keiichi

1985-01-01

Multidisciplinary treatment for malignant lymphoma is reported in terms of indication, current status, and outcome of this approach to Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NLH). HD is considered to be most successfully managed with multidisciplinary treatment. Success of treatment of HD in European countries and the US, which has resulted from accurate staging of HD and developments in radiotherapy and chemotherapy, is reviewed in the literature. Problems in the treatment of HD in Japan are presented. A treatment policy for NHL is discussed according to the original site, i.e. lymph nodes, Waldeyer's ring or other sites of tumor involvement. (Namekawa, K.)

Compliance of patients with chronic obstructive pulmonary disease to a pulmonary rehabilitation program

Directory of Open Access Journals (Sweden)

Janaina Schafer

2012-04-01

Full Text Available Background and Objectives: The lack of adherent and non-adherent to recommended treatment is a very common problem that interferes with the successful care and assistance to people with Chronic Obstructive Pulmonary Disease-COPD. This study compared the profi le of COPD patients that were adherent with non-adherent to a pulmonary rehabilitation program. Methods: was done an exploratory prospective observational study involving 24 patients with COPD Pulmonary Rehabilitation Program, divided into two groups according to full participation of the proposed treatment: Adhesive Group (GA = 18 subjects and non-adherent (GN = 06 subjects. The treatment occurred in 08 weeks, 3 times a week, lasting 1 hour and 30 minutes, assisted by a multidisciplinary team composed by physiotherapist, physical education professional, nutritionist, pharmacist, psychologist and pneumologist. Results: The GA did not differ from GN about the situation sociodemographic, anthropometric, cardiopulmonary exercise capacity and respiratory function. GN had more comorbidities when compared to GA and higher average amount of drugs used. All patients were characterized with reduced quality of life and correlation between cardiac function and quality of life was seen for both groups. Conclusion: Our results show that the advanced stage of disease and worsening of symptoms were determinants for the adherence of patients with COPD in the Pulmonary Rehabilitation Program. KEYWORDS: COPD. Pulmonary Rehabilition. Interdisciplinary Health Team.

Rehabilitation after THR: Telephone interview and individual support versus visits in outpatient clinic

DEFF Research Database (Denmark)

Hørdam, Britta

2011-01-01

. Participating patients were allocated to a control group or an intervention group after discharge. The intervention group had telephone-interviews and individual counseling 2 and 8 months after THR, and the control group had conventional visit in outpatient clinic 3 months after THR. Outcome: Patients......Results from a RCT carried out from 2006 to 2007 including 180 patients aged 65 years and over based on patients´ self-rated health and by using telephone interviews and individual counseling as intervention 2 and 10 weeks after discharge had a significant improvement in patients´ self-rated health...... by using SF-36 scores within 3 months after surgery, whereas the control group had improvement after 9 months. Both groups had SF-36 filled out preoperatively and 3, 6 and 9 months after THR. In a new study a sub group was identified by having a reduction in general health during 12 months postoperatively...

Organizational Dimensions of Innovative Practice: A Qualitative Investigation of the Processes Supporting Innovation Adoption in Outpatient Physical Therapy Practice.

Science.gov (United States)

Sabus, Carla; Spake, Ellen

2018-01-01

The ability to innovate and adapt practice is a requirement of the progressive healthcare provider. Innovative practice by rehabilitation providers has largely been approached as personal professional development; this study extends that perspective by examining innovation uptake from the organizational level. The varied professions can be expected to have distinct qualities of innovation adoption that reflect professional norms, values, and expectations. The purpose of this qualitative study was to describe the organizational processes of innovation uptake in outpatient physical therapy practice. Through nomination, two outpatient, privately owned physical therapy clinics were identified as innovation practices. Eighteen physical therapists, three owners, and a manager participated in the study. The two clinics served as case studies within a grounded theory approach. Data were collected through observation, unstructured questioning, work flow analysis, focus group sessions, and artifact analysis. Data were analyzed and coded among the investigators. A theoretical model of the innovation adoption process in outpatient physical therapy practice was developed. Elements of the model included (1) change grounded in relationship-centered care, (2) clinic readiness to accept change, and (3) clinic adaptability and resilience. A social paradigm of innovation adoption informed through this research complements the concentration on personal professional development.

Can audio recording of outpatient consultations improve patients recall and understanding?

DEFF Research Database (Denmark)

Wolderslund, Maiken

of the dialogue between the patient and the clinician via the telephone in the consultation room. By dialing a dedicated number, patients can get access to an audio recording of their consultation by entering their social security number along with a PIN. The primary objective of this study is to determine......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation, all of which are crucial knowledge with regards to patient compliance, decision making and general patient satisfaction. Despite good communication skills among...... clinicians, the communication is challenged by the fact that patients tend to forget or misunderstand parts of the information given. Thus we have designed a study which gives the patients a possibility to hear their consultation again. An Interactive Voice Response platform enables an audio recording...

The effect of work-focused rehabilitation among patients with neck and back pain

DEFF Research Database (Denmark)

Myhre, Kjersti; Marchand, Gunn Hege; Leivseth, Gunnar

2014-01-01

. The median time to RTW was 161 days in the work-focused group and 158 days in the control group. A comparison of the work-focused and control interventions revealed a relative RTW probability (hazard ratio) of 0.94 (95% confidence interval = 0.75-1.17) after adjusting for age, sex, and education. CONCLUSION......STUDY DESIGN: Multicenter randomized trial with patients listed as sick for 1 to 12 months due to neck or back pain and referred to secondary care. OBJECTIVE: To compare the return-to-work (RTW) rate among patients offered work-focused rehabilitation or multidisciplinary rehabilitation. SUMMARY......: A total of 405 patients who were referred to the spine clinics at 2 university hospitals in Norway were randomly assigned into work-focused and control intervention groups. The existing treatments at each hospital were used as the control interventions, which entailed either a comprehensive...

Focused and Sustained Attention Is Modified by a Goal-Based Rehabilitation in Parkinsonian Patients.

Science.gov (United States)

Ferrazzoli, Davide; Ortelli, Paola; Maestri, Roberto; Bera, Rossana; Gargantini, Roberto; Palamara, Grazia; Zarucchi, Marianna; Giladi, Nir; Frazzitta, Giuseppe

2017-01-01

Rehabilitation for patients with Parkinson's disease (PD) is based on cognitive strategies that exploit attention. Parkinsonians exhibit impairments in divided attention and interference control. Nevertheless, the effectiveness of specific rehabilitation treatments based on attention suggests that other attentional functions are preserved. Data about attention are conflicting in PD, and it is not clear whether rehabilitative treatments that entail attentional strategies affect attention itself. Reaction times (RTs) represent an instrument to explore attention and investigate whether changes in attentional performances parallel rehabilitation induced-gains. RTs of 103 parkinsonian patients in "on" state, without cognitive deficits, were compared with those of a population of 34 healthy controls. We studied those attentional networks that subtend the use of cognitive strategies in motor rehabilitation: alertness and focused and sustained attention, which is a component of the executive system. We used visual and auditory RTs to evaluate alertness and multiple choices RTs (MC RTs) to explore focused and sustained attention. Parkinsonian patients underwent these tasks before and after a 4-week multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT). Unified Parkinson's Disease Rating Scale (UPDRS) III and Timed Up and Go test (TUG) were assessed at the enrollment and at the end of MIRT to evaluate the motor-functional effectiveness of treatment. We did not find differences in RTs between parkinsonian patients and controls. Further, we found that improvements in motor-functional outcome measures after MIRT ( p attention, are preserved in "on" state. This explains why Parkinsonians benefit from a goal-based rehabilitation that entails the use of attention. The reduction in MC RTs suggests a positive effect of MIRT on the executive component of attention and indicates that this type of rehabilitation provides benefits by exploiting executive functions

[Multidisciplinary team building in enhanced recovery after surgery].

Science.gov (United States)

Jia, W D

2018-01-01

There has been 10 years to explore the road in line with China's actual enhanced recovery after surgery(ERAS) since Academician Li Jieshou introduced the view of ERAS into China. ERAS has been widely carried out in the field of surgery, and gradually formed with Chinese characteristics of ERAS clinical pathway.The clinical implementation of ERAS relies on the effective integration of a series of perioperative methods, and any single technique or method can't completely reduce the perioperative physiological and psychological traumatic stress of the patient, so as to achieve the patient's rapid rehabilitation patient-centered multidisciplinary team(MDT)collaboration is an inevitable trend in ERAS development. On the basis of drawing lessons from foreign experience, the establishment of ERAS-MDT model in line with China's national conditions is a new subject that needs to be studied at present. The construction of ERAS-MDT might promote the development of new ERAS services, new technologies, and ultimately promote the improvement of surgical treatment, and bring the greatest clinical benefit to the society and patients.

Alleviating speech and deglutition: Role of a prosthodontist in multidisciplinary management of velopharyngeal insufficiency.

Science.gov (United States)

Nanda, Aditi; Koli, Dheeraj; Sharma, Sunanda; Suryavanshi, Shalini; Verma, Mahesh

2015-01-01

Surgical resection of soft palate due to cancer affects the effective functioning of the velopharyngeal mechanism (speech and deglutition). With the loss of speech intelligibility, hyper resonance in voice and impaired function of swallowing (due to nasal regurgitation), there is a depreciation in the quality of life of such an individual. In a multidisciplinary setup, the role of a prosthodontist has been described to rehabilitate such patients by fabrication of speech aid prosthesis. The design and method of fabrication of the prosthesis are simple and easy to perform. The use of prosthesis, together with training (of speech) by a speech pathologist resulted in improvement in speech. Furthermore, an improvement in swallowing had been noted, resulting in an improved nutritional intake and general well-being of an individual. The take-home message is that in the treatment of oral cancer, feasible, and rapid rehabilitation should be endeavored in order to make the patient socially more acceptable. The onus lies on the prosthodontist to practise the same in a rapid manner before the moral of the patient becomes low due to the associated stigma of cancer.

Managing sub-gingival fracture by multi-disciplinary approach: Endodontics-forced orthodontic extrusion and prosthetic rehabilitation

Directory of Open Access Journals (Sweden)

Rakesh Mittal

2013-01-01

Full Text Available Traumatized anterior teeth with sub-gingival crown fractures are a challenge to treat. The management of sub-gingival fractures includes exposing the cervical margin followed by appropriate coronal restoration. The treatment modalities, which involve exposing the cervical margin, are surgical crown lengthening and orthodontic extrusion. This paper reports a case of fractured maxillary anterior tooth at the sub-gingival level that was managed by forced orthodontic extrusion after endodontic treatment followed by esthetic rehabilitation, a much forgotten technique not utilized routinely yet conservative and cost-effective.

Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data.

Science.gov (United States)

Engler, J; Güthlin, C; Dahlhaus, A; Kojima, E; Müller-Nordhorn, J; Weißbach, L; Holmberg, C

2017-11-01

The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards. © 2017 John Wiley & Sons Ltd.

Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project.

Science.gov (United States)

Gabbe, Belinda J; Watterson, Dina M; Singer, Yvonne; Darton, Anne

2015-05-01

Most studies about burn injury focus on admitted cases. To compare outpatient and inpatient presentations at burn centers in Australia to inform the establishment of a repository for outpatient burn injury. Data for sequential outpatient presentations were collected at seven burn centers in Australia between December 2010 and May 2011 and compared with inpatient admissions from these centers recorded by the Burns Registry of Australia and New Zealand for the corresponding period. There were 788 outpatient and 360 inpatient presentations. Pediatric outpatients included more children burns (39% vs 24%). Adult outpatients included fewer males (58% vs 73%) and intentional injuries (3.3% vs 10%), and more scald (46% vs 30%) and contact burns (24% vs 13%). All pediatric, and 98% of adult, outpatient presentations involved a %TBSAburns presenting to burn centers differed to inpatient admission data, particularly with respect to etiology and burn severity, highlighting the importance of the need for outpatient data to enhance burn injury surveillance and inform prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Implant-supported Oral Rehabilitation in Child with Ectodermal Dysplasia - 4-year Follow-up.

Science.gov (United States)

Cezária Triches, Thaisa; Ximenes, Marcos; Oliveira de Souza, João Gustavo; Rodrigues Lopes Pereira Neto, Armando; Cardoso, Antônio Carlos; Bolan, Michele

2017-01-01

Ectodermal dysplasia (ED) is an anomaly determined by genetic factors that alter ectodermal structures such as skin, hair, nails, glands, and teeth. Children affected by this condition require extensive, comprehensive, and multidisciplinary treatment. An 8-year-old female patient visited the Dentistry Clinic of the Federal University of Santa Catarina with the chief complaint of multiple missing teeth. The mother reported that the patient had ED. Clinical and radiographic examination revealed the congenital absence of several primary and permanent teeth and tooth germs. Subsequent oral rehabilitation comprised the application of a maxillary denture and mandibular implant-supported fixed prosthesis. The child was also supplied with a wig for further enhancement of esthetics aimed at improving her emotional wellbeing. Psychological follow-up and speech therapy were also provided. After 4 years of follow-up, implant-supported oral rehabilitation has proved to be a satisfactory treatment option, allowing restoration of masticatory, phonetic, and esthetic function, as well as an improvement in the patient's self-esteem and social wellbeing.

Chronic pain affects the whole person--a phenomenological study.

Science.gov (United States)

Ojala, Tapio; Häkkinen, Arja; Karppinen, Jaro; Sipilä, Kirsi; Suutama, Timo; Piirainen, Arja

2015-01-01

The aim of this qualitative study was to explore participants' perspectives on the effects of chronic pain on the psychophysical unity. Thirty-four chronic pain outpatients were interviewed, and the transcribed interviews were analysed with Giorgi's four-phase phenomenological method. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the pain duration was more than 5 years, and most had degenerative spinal pain. The results of this whole research project indicated that the phenomenon chronic pain consisted of four essential themes: Pain affects the whole person, invisibility, negativity, and dominance of pain. This study concentrates only on one theme "Chronic pain affects the whole person", in which were found eight subthemes in the interviews. The strongest argument made by the participants was not the physical pain itself but the psychosocial consequences, such as distress, loneliness, lost identity, and low quality of life which were their main problems. In multidisciplinary holistic rehabilitation, it is essential to take care of the patient's psychological distress. A potential source of psychosocial symptoms may be the subjective responses to experience of chronic pain due to the subjective meanings of pain. Implications for Rehabilitation About chronic pain Pain is an experience, not only an aversive sensation. Intensity of pain describes only the sensation, not the experience of pain. In chronic pain, the main complaint may be not the physical pain, but the distress. In rehabilitation, the patient needs to be taken as a whole person. Multidisciplinary rehabilitation, including patient counselling should be the fundamental part of treatment. In rehabilitation, the individual meaning of chronic pain needs to be disclosed.

Multidisciplinary care of craniosynostosis

Directory of Open Access Journals (Sweden)

Buchanan EP

2017-07-01

Full Text Available Edward P Buchanan,1 Yunfeng Xue,1 Amy S Xue,1 Asaf Olshinka,1 Sandi Lam2 1Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, 2Michael E. DeBakey Department of Surgery, Division of Neurosurgery, Baylor College of Medicine, Houston, TX, USA Abstract: The management of craniosynostosis, especially in the setting of craniofacial syndromes, is ideally done in a multidisciplinary clinic with a team focused toward comprehensive care. Craniosynostosis is a congenital disorder of the cranium, caused by the premature fusion of one or more cranial sutures. This fusion results in abnormal cranial growth due to the inability of the involved sutures to accommodate the growing brain. Skull growth occurs only at the patent sutures, resulting in an abnormal head shape. If cranial growth is severely restricted, as seen in multisuture craniosynostosis, elevation in intracranial pressure can occur. Whereas most patients treated in a multidisciplinary craniofacial clinic have non-syndromic or isolated craniosynostosis, the most challenging patients are those with syndromic craniosynostosis. The purpose of this article was to discuss the multidisciplinary team care required to treat both syndromic and non-syndromic craniosynostosis. Keywords: multidisciplinary team care, syndromic craniosynostosis, nonsyndromic craniosynostosis

[Consequence of secondary complications during the rehabilitation of patients with severe brain injury].

Science.gov (United States)

Dénes, Zoltán

2009-01-25

stay in the rehabilitation unit was much longer in these cases. We strongly suggest that actions to prevent secondary complications must be started at the acute care unit. After acute care, rehabilitation of patients with severe brain injury should be performed in specialised centers with multidisciplinary team for different functional deficits (physical, cognitive, communicative, psycho-social impairments). Early and direct admission from the neurologic intensive care unit to the rehabilitation centrum seems to be optimal for best patient outcome, because this lowers the chance for the development of secondary complications.

Predictors of Post-concussion Rehabilitation Outcomes at Three-month Follow-up.

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Scott, Katie L; Strong, Carrie-Ann H; Gorter, Bethany; Donders, Jacobus

2016-01-01

To determine factors related to three-month follow-up outcomes for individuals participating in an outpatient rehabilitative treatment program for mild traumatic brain injury (TBI). Fifty participants underwent neuropsychological screening prior to treatment initiation and completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) at treatment initiation, discharge from treatment, and three months following discharge. Regression models indicated that information garnered from the neuropsychological screening prior to treatment initiation (e.g., mood symptoms and prior psychiatric history) accounted for unique variance in three-month post-discharge outcomes on several MPAI-4 subscales. Specifically, after controlling for baseline MPAI-4 ratings, higher Beck Depression Inventory-second edition (BDI-II) scores were associated with worse MPAI-4 Ability scores at three-month follow-up, and the presence of a psychiatric history was associated with worse MPAI-4 Adjustment scores at three-month follow-up. Neuropsychological screening prior to the initiation of treatment for mild TBI can help to identify patients who may be at greater risk for poorer rehabilitation outcomes, thus allowing for the implementation of specific interventions to address these risk factors.

Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain.

Science.gov (United States)

Pedersen, Pernille; Nielsen, Claus Vinther; Jensen, Ole Kudsk; Jensen, Chris; Labriola, Merete

2018-05-01

To evaluate differences in employment status, during a five-year follow-up period in patients on sick leave due to low back pain who had participated in a trial comparing a brief and a multidisciplinary intervention. From 2004 to 2008, 535 patients were referred to the Spine Centre at the Regional Hospital in Silkeborg if they had been on sick leave for 3-16 weeks due to low back pain. All patients underwent a clinical examination by a rehabilitation physician and a physiotherapist, and were randomised to either the brief intervention or the multidisciplinary intervention. The outcome was employment status from randomisation to five years of follow-up and was measured by the mean number of weeks in four different groups of employment status (sequence analysis) and a fraction of the number of weeks working (work participation score) that were accumulated over the years. A total of 231 patients were randomised to the brief intervention and 233 patients to the multidisciplinary intervention. No statistically significant differences in the mean weeks spent within the different employment statuses were found between the two intervention groups. After five years of follow-up, participants in the multidisciplinary intervention had a 19% higher risk of not having a work participation score above 75% compared to participants in the brief intervention. After five years of follow-up no differences in employment status were found between participants in the brief and the multidisciplinary intervention.

Further validation of the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) in patients with acquired brain injury.

Science.gov (United States)

Boosman, Hileen; van Heugten, Caroline M; Winkens, Ieke; Smeets, Sanne M J; Visser-Meily, Johanna M A

2016-01-01

The Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) evaluates motivation for rehabilitation in four subscales: Interest in rehabilitation, Lack of anger, Lack of denial, and Reliance on professional help. The objective of this study was to further validate the MOT-Q in 122 inpatients and 92 outpatients with acquired brain injury (ABI). The main measures were motivation for rehabilitation (MOT-Q), self-awareness (Patient Competency Rating Scale), and treatment motivation (Visual Analogue Scale). The MOT-Q showed adequate feasibility in terms of few items with missing responses and few undecided responses. We found no floor or ceiling effects, and significant item-total MOT-Q correlations for 29 of 31 items. Internal consistency was good for the MOT-Q total and acceptable to good for the subscales. The MOT-Q scores were significantly intercorrelated except for the subscales Lack of denial and Reliance on professional help in the inpatient group. The MOT-Q total and subscales were significantly associated with treatment motivation. The Lack of denial subscale showed no significant association with treatment motivation and no to moderate significant associations with self-awareness. In conclusion, the overall MOT-Q is a valid instrument to assess motivation for rehabilitation in patients with ABI. Further research is needed to examine the validity of the subscales.

Return to work after vocational rehabilitation: does mindfulness matter?

Directory of Open Access Journals (Sweden)

Vindholmen S

2014-02-01

Full Text Available Solveig Vindholmen,1 Rune Høigaard,2 Geir Arild Espnes,3 Stephen Seiler41Department of Psychosocial Health, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway; 2Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway; 3Research Centre for Health Promotion and Resources, Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway; 4Faculty of Health and Sport Sciences, University of Agder, Kristiansand, NorwayPurpose: Mindfulness has become an important construct in return-to-work (RTW rehabilitation. The aim of this study was to investigate whether mindfulness is a predictor for RTW, and to examine the indirect effect of mindfulness on RTW and work ability through quality of life (QOL.Methods: A retrospective study was conducted among 80 former participants (71 females and seven males from age 24 to 66, in a multidisciplinary vocational rehabilitation program (MVRP. Self-report questionnaires were used to measure work status, work ability, QOL, and mindfulness. Demographic data were also collected.Results: In the current sample, 47% of participants reported having returned to ordinary work. The majority of the non-working sub-sample reported being in work-related activity or education. A bias-corrected bootstrapping technique was used to examine indirect effects. Results revealed that mindfulness was indirectly related to both RTW and work ability through QOL. There was no significant total effect of mindfulness on work ability or RTW. Logistic regression analysis was performed to assess the impact of mindfulness on the likelihood that respondents returned to work. None of the independent mindfulness variables (observe, describe, act aware, non-judge, non-react made a unique statistically significant contribution to the model. The covariates work ability and education level significantly

Recommending Research Profiles for Multidisciplinary Academic Collaboration

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Gunawardena, Sidath Deepal

2013-01-01

This research investigates how data on multidisciplinary collaborative experiences can be used to solve a novel problem: recommending research profiles of potential collaborators to academic researchers seeking to engage in multidisciplinary research collaboration. As the current domain theories of multidisciplinary collaboration are insufficient…

The Integration of Cognitive Remediation Therapy into the Whole Psychosocial Rehabilitation Process: An Evidence-Based and Person-Centered Approach

Directory of Open Access Journals (Sweden)

Rafael Penadés

2012-01-01

Full Text Available Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.

Rehabilitation needs for older adults with stroke living at home: perceptions of four populations

Directory of Open Access Journals (Sweden)

Viscogliosi Chantal

2007-08-01

Full Text Available Abstract Background Many people who have suffered a stroke require rehabilitation to help them resume their previous activities and roles in their own environment, but only some of them receive inpatient or even outpatient rehabilitation services. Partial and unmet rehabilitation needs may ultimately lead to a loss of functional autonomy, which increases utilization of health services, number of hospitalizations and early institutionalization, leading to a significant psychological and financial burden on the patients, their families and the health care system. The aim of this study was to explore partially met and unmet rehabilitation needs of older adults who had suffered a stroke and who live in the community. The emphasis was put on needs that act as obstacles to social participation in terms of personal factors, environmental factors and life habits, from the point of view of four target populations. Methods Using the focus group technique, we met four types of experts living in three geographic areas of the province of Québec (Canada: older people with stroke, caregivers, health professionals and health care managers, for a total of 12 groups and 72 participants. The audio recordings of the meetings were transcribed and NVivo software was used to manage the data. The process of reducing, categorizing and analyzing the data was conducted using themes from the Disability Creation Process model. Results Rehabilitation needs persist for nine capabilities (e.g. related to behaviour or motor activities, nine factors related to the environment (e.g. type of teaching, adaptation and rehabilitation and 11 life habits (e.g. nutrition, interpersonal relationships. The caregivers and health professionals identified more unmet needs and insisted on an individualized rehabilitation. Older people with stroke and the health care managers had a more global view of rehabilitation needs and emphasized the availability of resources. Conclusion Better

A Two-Year Multidisciplinary Training Program for the Frontline Workforce in Community Treatment of Severe Mental Illness.

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Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore

2016-01-01

Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.

How Do You Learn Multidisciplinary Idea?

OpenAIRE

Shigehiro Hashimoto

2015-01-01

The way how to learn multidisciplinary ideas has been discussed. Biomedical engineering is exemplified for a multidisciplinary field. "Biomedical Engineering" makes a multidisciplinary research area, which includes biology, medicine, engineering and others. The cross-cultural student seminars on biomedical engineering have been exemplified as the case studies. In the group fieldwork, students were divided into small groups. Each group visited the university hospital to find research topics re...

Successful management of Barth syndrome: a systematic review highlighting the importance of a flexible and multidisciplinary approach

Directory of Open Access Journals (Sweden)

Reynolds S

2015-07-01

Full Text Available Stacey Reynolds Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA, USA Abstract: This review describes and summarizes the available evidence related to the treatment and management of Barth syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA standards were used to identify articles published between December 2004 and January 2015. The Cochrane Population, Intervention, Control, Outcome, Study Design (PICOS approach was used to guide the article selection and evaluation process. Of the 128 articles screened, 28 articles matched the systematic review inclusion criteria. The results of this review indicate the need for a flexible and multidisciplinary approach to manage the symptoms most commonly associated with Barth syndrome. It is recommended that a comprehensive care team should include individuals with Barth syndrome, their family members and caregivers, as well as medical, rehabilitative, nutritional, psychological, and educational professionals. The evidence for specific treatments, therapies, and techniques for individuals with Barth syndrome is currently lacking in both quality and quantity. Keywords: Barth syndrome, rare disorders, rehabilitation, cardiac, systematic review

Medicare Provider Utilization and Payment Data - Outpatient

Data.gov (United States)

U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

The uses of outcome measures within multidisciplinary early childhood intervention services: a systematic review.

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Calder, Samuel; Ward, Roslyn; Jones, Megan; Johnston, Jenelle; Claessen, Mary

2017-07-18

Purpose of the article: To review the use of outcome measures, across the domains of activity, participation, and environment, within multidisciplinary early childhood intervention services. A systematic literature search was undertaken that included four electronic databases: Medline, CINAHL, EMBASE, and the Cochrane Library and Cochrane Database of Systematic Review. Inclusion criteria were age 0-24 months, having or at risk of a developmental disability, in receipt of multidisciplinary early childhood intervention services, and included outcome measures across all domains of the International Classification of Functioning-Child & Youth (ICF-CY). Only peer-reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale for randomised controlled trials and the QualSyst for non-randomised control trials. Of the total of 5764 records identified, 10 were considered to meet inclusion criteria. Fourteen outcome measures were identified, addressing the domains of activity, participation, and environment. Of these, eight have been recommended in the early intervention literature. While the methodological quality of the 10 studies varied, these papers make a contribution to the body of research that acknowledges the role of routine and enriched environments. Implications for Rehabilitation Core practice elements of multidisciplinary early childhood intervention services indicate it is necessary to select outcome measures framed within the International Classification of Functioning-Child & Youth to inform clinical decision-making for measuring intervention effectiveness across the domains of activity, participation and environment. Of the identified measures, three (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory, and Goal Attainment Scaling) are well-established and identified in the literature as

Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory.

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Malec, J F; Moessner, A M; Kragness, M; Lezak, M D

2000-02-01

Evaluate the psychometric properties of the Mayo-Portland Adaptability Inventory (MPAI). Rating scale (Rasch) analysis of MPAI and principal component analysis of residuals; the predictive validity of the MPAI measures and raw scores was assessed in a sample from a day rehabilitation program. Outpatient brain injury rehabilitation. 305 persons with brain injury. A 22-item scale reflecting severity of sequelae of brain injury that contained a mix of indicators of impairment, activity, and participation was identified. Scores and measures for MPAI scales were strongly correlated and their predictive validities were comparable. Impairment, activity, and participation define a single dimension of brain injury sequelae. The MPAI shows promise as a measure of this construct.

Psychosocial and socio-demographic factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders: a pilot study.

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Baltov, Petko; Côte, Julie; Truchon, Manon; Feldman, Debbie Ehrmann

2008-01-01

Identify psychosocial and socio-demographic factors (measured prior to treatment) that were associated with post-treatment self-perceived pain and disability and two secondary outcomes: psychological distress, and return to work in patients undergoing multidisciplinary rehabilitation for chronic whiplash associated disorders (WAD). Interviews were conducted with 28 patients with chronic WAD at entry to and completion of an intensive rehabilitation program, and a telephone interview was carried out three months later. Participants completed pain and disability, and psychological distress questionnaires, at baseline and at both follow-ups. They also completed psychosocial questionnaires and provided socio-demographic information. The effect of each of the independent variables on the outcomes was first evaluated by simple regressions, and then subsequently by multiple regression analysis. Higher baseline pain and disability predicted higher pain and disability at both follow-ups (p factor that affected pain and disability post-rehabilitation. Psychosocial factors played a role in the prognosis of psychological distress and return to work.

Interdisciplinary facilitation of the minimal participation of patients with severe brain injury in early rehabilitation

DEFF Research Database (Denmark)

Pallesen, Hanne; Buhl, Inge

2016-01-01

ABSTRACT Aim: The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions. Methodology...... of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10. Major findings: Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element...

Efficacy of cognitive rehabilitation using computer software with individuals living with schizophrenia: A randomized controlled trial in Japan.

Science.gov (United States)

Iwata, Kazuhiko; Matsuda, Yasuhiro; Sato, Sayaka; Furukawa, Shunichi; Watanabe, Yukako; Hatsuse, Norifumi; Ikebuchi, Emi

2017-03-01

Cognitive impairment is common in schizophrenia, and is associated with poor psychosocial functioning. Previous studies had inconsistently shown improvement in cognitive functions with cognitive remediation therapy. This study examined whether cognitive remediation is effective in improving both cognitive and social functions in schizophrenia in outpatient settings that provide learning-based psychiatric rehabilitation. This study is the first randomized controlled trial of cognitive remediation in Japan. Study participants were individuals with schizophrenia from 6 outpatient psychiatric medical facilities who were randomly assigned either a cognitive remediation program or treatment as usual. The cognitive remediation intervention includes Cognitive training using computer software (CogPack; Japanese version) administered twice a week and a weekly group over 12 weeks and was based on the Thinking Skills for Work program. Most study participants were attending day treatment services where social skills training, psychoeducation for knowledge about schizophrenia, group activities such as recreation and sport, and other psychosocial treatment were offered. Cognitive and social functioning were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) and Life Assessment Scale for Mentally Ill (LASMI) at pre- and postintervention. Of the 60 people with schizophrenia enrolled, 29 were allocated to the cognitive remediation group and 31 were allocated to the treatment as usual group. Processing speed, executive function, and the composite score of the BACS showed significantly greater improvement for the cognitive remediation group than the treatment as usual group. In addition, there was significant improvement in interpersonal relationships and work skills on the LASMI for the cognitive remediation group compared with the treatment as usual group. Changes from pretreatment to posttreatment in verbal fluency and interpersonal relationships were

Outpatient management of pediatric acute mastoiditis.

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Alkhateeb, Ahmed; Morin, Francis; Aziz, Haya; Manogaran, Mayuri; Guertin, William; Duval, Melanie

2017-11-01

Evaluate the Montreal Children's Hospital experience with outpatient management of uncomplicated acute mastoiditis with parenteral antibiotic therapy alone and determine if it is a safe alternative to inpatient management. A retrospective review of pediatric patients diagnosed with acute mastoiditis at a tertiary care pediatric hospital between 2013 and 2015 was performed. Patients with syndromes, immunodeficiency, cholesteatoma, chronic otitis media, cochlear implant in the affected ear, or incidental mastoid opacity were excluded. 56 children age 6 months to 15 years old were treated for acute mastoiditis, including 29 hospitalizations and 27 outpatients. Patients managed as outpatient with daily intravenous ceftriaxone had a 93% cure rate. Eighteen hospitalized and one outpatient had complications of acute mastoiditis. Children with complications were more likely to be febrile (p = 0.045). Two patients failed outpatient therapy and were admitted; one for myringotomy and piperacillin-tazobactam treatment and one required a mastoidectomy. 4/27 children treated as outpatient underwent myringotomy and tube insertion, 2 underwent myringotomy and tube along with admission and 21 did not require tube insertion. The average total duration of intravenous antibiotic therapy was respectively 4.9 and 18.9 days in the outpatient and hospitalized group. The average duration of admission was 5.9 days. Outpatient medical therapy of uncomplicated pediatric mastoiditis is safe, successful, and efficient. Benefits include efficient use of surgical beds, cost savings and patient and family convenience. Careful patient selection and close monitoring are keys for successful outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

Use of protection motivation theory, affect, and barriers to understand and predict adherence to outpatient rehabilitation.

Science.gov (United States)

Grindley, Emma J; Zizzi, Samuel J; Nasypany, Alan M

2008-12-01

Protection motivation theory (PMT) has been used in more than 20 different health-related fields to study intentions and behavior, albeit primarily outside the area of injury rehabilitation. In order to examine and predict patient adherence behavior, this study was carried out to explore the use of PMT as a screening tool in a general sample of people with orthopedic conditions. New patients who were more than 18 years old and who were prescribed 4 to 8 weeks of physical therapy treatment (n=229) were administered a screening tool (Sports Injury Rehabilitation Beliefs Scale, Positive and Negative Affect Schedule, and a barriers checklist) prior to treatment. Participants' adherence was assessed with several attendance measures and an in-clinic assessment of behavior. Statistical analyses included correlation, chi-square, multiple regression, and discriminant function analyses. A variety of relationships among affect, barriers, and PMT components were evident. In-clinic behavior and attendance were influenced by affect, whereas dropout status was predicted by affect, severity, self-efficacy, and age. The screening tool used in this study may assist in identifying patients who are at risk for poor adherence and provide valuable information to enhance provider-patient relationships and foster patient adherence. However, it is recommended that more research be conducted to further understand the impact of variables on patient adherence and that the screening tool be enhanced to increase its predictive ability.

Self-rating level of perceived exertion for guiding exercise intensity during a 12-week cardiac rehabilitation programme and the influence of heart rate reducing medication

DEFF Research Database (Denmark)

Tang, Lars H.; Zwisler, Ann-Dorthe; Taylor, Rod S

2016-01-01

OBJECTIVES: To investigate whether self-rating level of perceived exertion can adequately guide exercise intensity during a 12-week cardiac rehabilitation programme. DESIGN: Linear regression analysis using rehabilitation data from two randomised controlled trials. METHODS: Patients undergoing ra......-led and self-regulated model using rating of perceived exertion can help guide exercise intensity in everyday clinical practice among patients with heart disease, irrespective if they are taking heart rate-reducing medication....... radiofrequency ablation for atrial fibrillation or following heart valve surgery and participating in exercise-based rehabilitation were included. The 12-week rehabilitation outpatient programme comprised three weekly training sessions, each consisting of 20min aerobic exercise divided into three steps. Patients...... were asked to base their exercise intensity for each step on a predefined rating of perceived exertion specified in a training diary. Exercise intensity was objectively measured by heart rate during the last 2min for each exercise step. Comparative analysis and linear regression of the rating...

The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities.

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Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G

2015-01-01

There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

Multi-disciplinary decision making in general practice.

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Kirby, Ann; Murphy, Aileen; Bradley, Colin

2018-04-09

Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation

DEFF Research Database (Denmark)

Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

2014-01-01

BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association......: A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95...

Myocardial Infarction Injury in Patients with Chronic Lung Disease Entering Pulmonary Rehabilitation: Frequency and Association with Heart Rate Parameters.

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Sima, Carmen A; Lau, Benny C; Taylor, Carolyn M; van Eeden, Stephan F; Reid, W Darlene; Sheel, Andrew W; Kirkham, Ashley R; Camp, Pat G

2018-03-14

Myocardial infarction (MI) remains under-recognized in chronic lung disease (CLD) patients. Rehabilitation health professionals need accessible clinical measurements to identify the presence of prior MI in order to determine appropriate training prescription. To estimate prior MI in CLD patients entering a pulmonary rehabilitation program, as well as its association with heart rate parameters such as resting heart rate and chronotropic response index. Retrospective cohort design. Pulmonary rehabilitation outpatient clinic in a tertiary care university-affiliated hospital. Eighty-five CLD patients were studied. Electrocardiograms at rest and peak cardiopulmonary exercise testing, performed before pulmonary rehabilitation, were analyzed. Electrocardiographic evidence of prior MI, quantified by the Cardiac Infarction Injury Score (CIIS), was contrasted with reported myocardial events and then correlated with resting heart rate and chronotropic response index parameters. CIIS, resting heart rate, and chronotropic response index. Sixteen CLD patients (19%) demonstrated electrocardiographic evidence of prior MI, but less than half (8%) had a reported MI history (P CLD patients with a resting heart rate higher than 80 beats/min had approximately 5 times higher odds of having prior MI, as evidenced by a CIIS ≥20. CLD patients entering pulmonary rehabilitation are at risk of unreported prior MI. Elevated resting heart rate seems to be an indicator of prior MI in CLD patients; therefore, careful adjustment of training intensity such as intermittent training is recommended under these circumstances. III. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database.

Science.gov (United States)

Malec, James F; Kean, Jacob

2016-07-15

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p MPAI-4 Ability (F = 14.135, p 1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity.

Mobile information and communication in the hospital outpatient service.

Science.gov (United States)

Jen, Wen-Yuan; Chao, Chia-Chen; Hung, Ming-Chien; Li, Yu-Chuan; Chi, Y P

2007-08-01

Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

A Multidisciplinary Approach for Rehabilitation of Enucleated Sockets: Ocular Implants with Custom Ocular Prosthesis.

Science.gov (United States)

Choudhury, Minati; Banu, Fathima; Natarajan, Shanmuganathan; Kumar, Anand; Tv, Padmanabhan

2018-02-16

Interdisciplinary prosthodontics goes beyond our imagination into fields that have a direct effect on our total body health and quality of life. Removal of an eye has a detrimental effect on the psychology of the patient. Enucleation involves removal of the eyeball proper and leads to an enophthalmic socket with a shrunken eye, which has a crippling effect on patient's emotional and social life. Custom-made eye prosthesis simulates the characteristics of the companion eye and helps in restoring the normal facial appearance. Restoration of saccadic eye movements occurring during speech is desirable because this greatly contributes to a normal facial expression. This can be achieved by an orbital implant, which helps in orbital volume replacement and restoration of prosthesis movement and comfort. This article describes prosthodontic rehabilitation of enucleated eye sockets with orbital implants for two patients.

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

Science.gov (United States)

Marsh, Fiona; Kremer, Christian; Duffy, Sean

2004-03-01

To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

European initiative for the application of the International Classification of Functioning, Disability and Health: development of Clinical Assessment Schedules for specified rehabilitation services.

Science.gov (United States)

Prodinger, Birgit; Scheel-Sailer, Anke; Escorpizo, Reuben; Stucki, Gerold

2017-04-01

Clinical assessment schedule (CLAS) is a core part of the ICF-based implementation of functioning reporting across health conditions and along the continuum of care. The Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists (UEMS PRM) workshop held in January 2016 aimed to develop and specify a CLAS within the context of rehabilitation services. UEMS PRM Workshop in Nottwil, Switzerland, January 2016. PRM physicians representatives from 12 European countries, as well as Israel and Japan, mostly delegates of UEMS PRM Section and Board, and experts with other rehabilitation professional backgrounds. Participants were divided into 6 working groups and asked to specify what functioning aspects would be essential to document using the available ICF sets for the identified rehabilitation services contained in the newly developed service classification (ICSO-R): acute, post-acute and long-term rehabilitation services. The 7 ICF Generic and 23 Rehabilitation Set categories were confirmed as well as specific health condition categories for acute rehabilitation services (mobile team), for postacute rehabilitation services (general outpatient rehabilitation, musculoskeletal and neurological rehabilitation, as well as specialized SCI rehabilitation), and for long-term rehabilitation services (day clinic and rehabilitation provided in the community). While general principles of the CLAS were defined, the need to align the CLAS for a specific service, as well as across services along the continuum of care was highlighted. All groups deliberated on this topic; however, no conclusive statement was presented yet. The groups recognized a need for a systematic effort to identify data collection tools currently used. CLASs will serve in the future to ensure that functioning information is systematically and consistently collected across services, and thus respond also to various global reports and initiatives which stress the need for

Economic evaluation of multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: A randomized controlled trial.

Science.gov (United States)

Vos-Vromans, Desirée; Evers, Silvia; Huijnen, Ivan; Köke, Albère; Hitters, Minou; Rijnders, Nieke; Pont, Menno; Knottnerus, André; Smeets, Rob

2017-01-01

A multi-centre RCT has shown that multidisciplinary rehabilitation treatment (MRT) is more effective in reducing fatigue over the long-term in comparison with cognitive behavioural therapy (CBT) for patients with chronic fatigue syndrome (CFS), but evidence on its cost-effectiveness is lacking. To compare the cost-effectiveness of MRT versus CBT for patients with CFS from a societal perspective. A multi-centre randomized controlled trial comparing MRT with CBT was conducted among 122 patients with CFS diagnosed using the 1994 criteria of the Centers for Disease Control and Prevention and aged between 18 and 60 years. The societal costs (healthcare costs, patient and family costs, and costs for loss of productivity), fatigue severity, quality of life, quality-adjusted life-year (QALY), and cost-effectiveness ratios (ICERs) were measured over a follow-up period of one year. The main outcome of the cost-effectiveness analysis was fatigue measured by the Checklist Individual Strength (CIS). The main outcome of the cost-utility analysis was the QALY based on the EuroQol-5D-3L utilities. Sensitivity analyses were performed, and uncertainty was calculated using the cost-effectiveness acceptability curves and cost-effectiveness planes. The data of 109 patients (57 MRT and 52 CBT) were analyzed. MRT was significantly more effective in reducing fatigue at 52 weeks. The mean difference in QALY between the treatments was not significant (0.09, 95% CI: -0.02 to 0.19). The total societal costs were significantly higher for patients allocated to MRT (a difference of €5,389, 95% CI: 2,488 to 8,091). MRT has a high probability of being the most cost effective, using fatigue as the primary outcome. The ICER is €856 per unit of the CIS fatigue subscale. The results of the cost-utility analysis, using the QALY, indicate that the CBT had a higher likelihood of being more cost-effective. The probability of being more cost-effective is higher for MRT when using fatigue as primary

Rehabilitation of adolescents after surgical treatment of dysplastic coxarthrosis

Directory of Open Access Journals (Sweden)

Oksana V. Bortuleva

2018-03-01

Full Text Available Background. The prevalence and severity of stage II and III dysplastic coxarthrosis determine the medical and social importance of its prevention and treatment. For a practicing orthopedic surgeon, there are two established stages of orthopedic treatment: the surgical stage and the restorative stage. The domestic and foreign literature from the previous 25 years comprises few publications regarding the rehabilitation of young children after reconstructive hip joint surgeries. Thus, the issues regarding the rehabilitation of teenagers following extra-articular operations on the hip joint remain unexplored. Aim. To evaluate the effectiveness of the developed program of rehabilitation for children after the surgical treatment of dysplastic coxarthrosis stages I and II. Material and methods. We analyzed the results of the surgical and rehabilitative treatment of 40 children (100% with dysplastic coxarthrosis stage I and II; the study population included 27 girls (67.5% and 13 boys (32.5 per cent aged 13–18 years (total 54 joints. The rehabilitation period was divided into the following 4 stages: I preoperative, II postoperative day 1–2, III postoperative day 3–21, IV outpatient treatment (after hospital discharge to 1 year postoperatively. Results. By the time of discharge, the range of motion in the hip joint was as follows: bending 950° ± 40°, withdrawal 150° ± 50°, and extension 100° ± 30°. According to the results of the electromyography performed 3 months postoperatively, there was an increase in the amplitude of biopotentials for the gluteal muscle. The long-term result was evaluated after 1 year. The average modified Harris Hip Score and a scale developed in the The Turner Scientific and Research Institute for Children’s Orthopedics, significantly (p < 0.05 differed from preoperative ones. Conclusion. Early rehabilitation allows an increase in the strength and tone of muscles and restores the amplitude of movements in

Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial.

Science.gov (United States)

Hassett, Leanne; van den Berg, Maayken; Lindley, Richard I; Crotty, Maria; McCluskey, Annie; van der Ploeg, Hidde P; Smith, Stuart T; Schurr, Karl; Killington, Maggie; Bongers, Bert; Howard, Kirsten; Heritier, Stephane; Togher, Leanne; Hackett, Maree; Treacy, Daniel; Dorsch, Simone; Wong, Siobhan; Scrivener, Katharine; Chagpar, Sakina; Weber, Heather; Pearson, Ross; Sherrington, Catherine

2016-06-06

People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise. However, since providing a high dose of exercise is logistically challenging and resource-intensive, people in rehabilitation spend most of the day inactive. This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone. A pragmatic, assessor blinded, parallel-group randomised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted. Participants will be individually randomised to intervention or control groups. The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months. The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors. The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period. The coprimary outcomes will be objectively assessed physical activity (proportion of the day spent upright) and mobility (Short Physical Performance Battery) at 6 months after randomisation. Secondary outcomes will include: self-reported and objectively assessed physical activity, mobility, cognition, activity performance and participation, utility-based quality of life, balance confidence, technology self-efficacy, falls and service utilisation. Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate. Fall rates between groups will be compared using negative binomial regression. Primary analyses will be preplanned, conducted while masked to group allocation and use an intention-to-treat approach. The

Rehabilitation in patients with pulmonary arterial hypertension.

Science.gov (United States)

Keusch, Stephan; Turk, Alexander; Saxer, Stéphanie; Ehlken, Nicola; Grunig, Ekkehard; Ulrich, Silvia; On Behalf Of The Swiss Society Of Pulmonary Hypertension

2017-07-11

Exertional dyspnoea is a leading symptom in patients with pulmonary arterial hypertension (PAH). Patients suffering from PAH report poor quality of life, have skeletal muscle dysfunction and in the absence of advanced medical therapy deteriorate progressively due to right heart failure which can lead to death. For decades, patients with PAH were advised to avoid exercise in fear of exacerbated right heart failure. Recently, it has been shown that a highly supervised rehabilitation programme in expert centres leads to significant improvements in symptoms, quality of life, exercise capacity and may even enhance haemodynamics in selected stable patients treated with advanced regimens of PAH-targeted drugs. As a consequence of these promising results, pulmonary rehabilitation performed in an expert centre has been included in recent guidelines. The underlying mechanisms are not completely understood, but positive effects can be measured in different organ systems such as skeletal muscles, the cardiopulmonary system and immune system (inflammation), and also on the psychological level. Thus, improvements in 6-minute walking distance (6MWD), peak oxygen uptake (VO2 peak), muscle strength and muscle endurance, as well as physical and mental quality of life scores (SF-36 questionnaire) have been shown. Different training protocols have been used. Essential are qualified patient selection in expert centres, a low workload endurance and dumbbell (weight lifting) training avoiding strenuous exercise and exhaustion, thorough patient education and close supervision by experts especially during the first weeks. Adverse events may occur (e.g., pre-/syncope, arrhythmia, respiratory infections). PAH patients tend to overestimate their physical capacity, not perceiving their own limits properly, which makes education and expert advice even more important as exercise training can also worsen the right heart failure. Therefore, a core issue of the multidisciplinary rehabilitation is

Multidisciplinary Computational Research

National Research Council Canada - National Science Library

Visbal, Miguel R

2006-01-01

The purpose of this work is to develop advanced multidisciplinary numerical simulation capabilities for aerospace vehicles with emphasis on highly accurate, massively parallel computational methods...

Functional and Structural Brain Plasticity Enhanced by Motor and Cognitive Rehabilitation in Multiple Sclerosis

Directory of Open Access Journals (Sweden)

Luca Prosperini

2015-01-01

Full Text Available Rehabilitation is recognized to be important in ameliorating motor and cognitive functions, reducing disease burden, and improving quality of life in patients with multiple sclerosis (MS. In this systematic review, we summarize the existing evidences that motor and cognitive rehabilitation may enhance functional and structural brain plasticity in patients with MS, as assessed by means of the most advanced neuroimaging techniques, including diffusion tensor imaging and task-related and resting-state functional magnetic resonance imaging (MRI. In most cases, the rehabilitation program was based on computer-assisted/video game exercises performed in either an outpatient or home setting. Despite their heterogeneity, all the included studies describe changes in white matter microarchitecture, in task-related activation, and/or in functional connectivity following both task-oriented and selective training. When explored, relevant correlation between improved function and MRI-detected brain changes was often found, supporting the hypothesis that training-induced brain plasticity is specifically linked to the trained domain. Small sample sizes, lack of randomization and/or an active control group, as well as missed relationship between MRI-detected changes and clinical performance, are the major drawbacks of the selected studies. Knowledge gaps in this field of research are also discussed to provide a framework for future investigations.

Multi-disciplinary management of athletes with post-concussion syndrome: an evolving pathophysiological approach

Directory of Open Access Journals (Sweden)

Michael John Ellis

2016-08-01

Full Text Available Historically, patients with sports-related concussion (SRC have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS. Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually-tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further validate this evolving pathophysiological approach.

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach.

Science.gov (United States)

Ellis, Michael J; Leddy, John; Willer, Barry

2016-01-01

Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach.

Pipeline rehabilitation planning

Energy Technology Data Exchange (ETDEWEB)

Palmer-Jones, Roland; Hopkins, Phil; Eyre, David [PENSPEN (United Kingdom)

2005-07-01

An operator faced with an onshore pipeline that has extensive damage must consider the need for rehabilitation, the sort of rehabilitation to be used, and the rehabilitation schedule. This paper will consider pipeline rehabilitation based on the authors' experiences from recent projects, and recommend a simple strategy for planning pipeline rehabilitation. It will also consider rehabilitation options: external re-coating; internal lining; internal painting; programmed repairs. The main focus will be external re-coating. Consideration will be given to rehabilitation coating types, including tape wraps, epoxy, and polyurethane. Finally it will discuss different options for scheduling the rehabilitation of corrosion damage including: the statistical comparison of signals from inspection pigs; statistical comparison of selected measurements from inspection pigs and other inspections; the use of corrosion rates estimated for the mechanisms and conditions; expert judgement. (author)

Cardiac EASE (Ensuring Access and Speedy Evaluation) – the impact of a single-point-of-entry multidisciplinary outpatient cardiology consultation program on wait times in Canada

Science.gov (United States)

Bungard, Tammy J; Smigorowsky, Marcie J; Lalonde, Lucille D; Hogan, Terry; Doliszny, Katharine M; Gebreyesus, Ghirmay; Garg, Sipi; Archer, Stephen L

2009-01-01

BACKGROUND: Universal access to health care is valued in Canada but increasing wait times for services (eg, cardiology consultation) raise safety questions. Observations suggest that deficiencies in the process of care contribute to wait times. Consequently, an outpatient clinic was designed for Ensuring Access and Speedy Evaluation (Cardiac EASE) in a university group practice, providing cardiac consultative services for northern Alberta. Cardiac EASE has two components: a single-point-of-entry intake service (prospective testing using physician-approved algorithms and previsit triage) and a multidisciplinary clinic (staffed by cardiologists, nurse practitioners and doctoral-trained pharmacists). OBJECTIVES: It was hypothesized that Cardiac EASE would reduce the time to initial consultation and a definitive diagnosis, and also increase the referral capacity. METHODS: The primary and secondary outcomes were time from referral to initial consultation, and time to achieve a definitive diagnosis and management plan, respectively. A conventionally managed historical control group (three-month pre-EASE period in 2003) was compared with the EASE group (2004 to 2006). The conventional referral mechanism continued concurrently with EASE. RESULTS: A comparison between pre-EASE (n=311) and EASE (n=3096) revealed no difference in the mean (± SD) age (60±16 years), sex (55% and 52% men, respectively) or reason for referral, including chest pain (31% and 40%, respectively) and arrhythmia (27% and 29%, respectively). Cardiac EASE reduced the time to initial cardiac consultation (from 71±45 days to 33±19 days) and time to a definitive diagnosis (from 120±86 days to 51±58 days) (P<0.0001). The annual number of new referrals increased from 1512 in 2002 to 2574 in 2006 due to growth in the Cardiac EASE clinic. The number of patients seen through the conventional referral mechanism and their wait times remained constant during the study period. CONCLUSIONS: Cardiac EASE reduced

Passion for leisure activity contributes to pain experiences during rehabilitation.

Science.gov (United States)

Courbalay, Anne; Deroche, Thomas; Brewer, Britton

2017-03-01

The primary aim of this study was to determine whether the levels of obsessive passion (OP) and harmonious passion for a suspended leisure activity contribute to pain catastrophizing and pain intensity in patients undergoing the rehabilitation process. The secondary aim was to examine whether the levels of passion associated with a maintained leisure activity offset the contribution of having a leisure activity suspended to pain intensity and catastrophizing. Ninety-one outpatients from functional rehabilitation units (Mage=37, SD=13.44 years) completed measures of pain catastrophizing, pain intensity, and passion about valued leisure activities (one they were prevented from practicing and one they remained able to practice). Correlation analysis showed that the level of OP for a suspended valued leisure activity was positively associated with pain catastrophizing and pain intensity. Results showed that pain catastrophizing mediated the relationship between this level of passion and pain intensity. The levels of harmonious passion and OP for a maintained valued leisure activity did not offset the contribution of OP for a suspended leisure activity to pain-related outcomes. When prevented from practicing a valued leisure activity, only OP contributes to the prediction of pain catastrophizing and pain intensity. The contribution of pain catastrophizing provides a potential explanation for why the level of OP for a suspended leisure activity is related to pain intensity ratings. The benefits of maintaining a valued leisure activity during rehabilitation do not seem sufficient to counterbalance the maladaptive effects of being prevented from the practice of a previous/another valued leisure activity.

Rehabilitation Engineering Sourcebook [and] Rehabilitation Engineering Sourcebook Supplement I.

Science.gov (United States)

Institute for Information Studies, Falls Church, VA.

Intended for use by rehabilitation counselors and work supervisors, the sourcebook contains 173 problems and solutions provided by rehabilitation engineering. A section titled "Guidelines for Formulating Problem Statements" is intended to summarize the most effective ways for either disabled individuals or rehabilitation practitioners to…

Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery: Data From the Clinical Outcomes Assessment Program.

Science.gov (United States)

Beatty, Alexis L; Bradley, Steven M; Maynard, Charles; McCabe, James M

2017-06-01

Despite guideline recommendations that patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass surgery, or valve surgery be referred to cardiac rehabilitation, cardiac rehabilitation is underused. The objective of this study was to examine hospital-level variation in cardiac rehabilitation referral after PCI, coronary artery bypass surgery, and valve surgery. We analyzed data from the Clinical Outcomes Assessment Program, a registry of all nonfederal hospitals performing PCI and cardiac surgery in Washington State. We included eligible PCI, coronary artery bypass surgery, and valve surgery patients from 2010 to 2015. We analyzed PCI and cardiac surgery separately by performing multivariable hierarchical logistic regression for the outcome of cardiac rehabilitation referral at discharge, clustered by hospital. Patient-level covariates included age, sex, race/ethnicity, comorbidities, and procedure indication/status. Cardiac rehabilitation referral was reported in 48% (34 047/71 556) of PCI patients and 91% (21 831/23 972) of cardiac surgery patients. The hospital performing the procedure was a stronger predictor of referral than any individual patient characteristic for PCI (hospital referral range 3%-97%; median odds ratio, 5.94; 95% confidence interval, 4.10-9.49) and cardiac surgery (range 54%-100%; median odds ratio, 7.09; 95% confidence interval, 3.79-17.80). Hospitals having an outpatient cardiac rehabilitation program explained only 10% of PCI variation and 0% of cardiac surgery variation. Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was the hospital performing the procedure. Efforts to improve cardiac rehabilitation referral should focus on increasing referral after PCI, especially in low referral hospitals. © 2017 American Heart Association, Inc.

An Accelerated Multi-Modality Rehabilitation Protocol Combined with Botulinum Toxin-A Injection in Adult Idiopathic Toe Walking: Case Report

Science.gov (United States)

Yavuz, Ferdi; Balaban, Birol

2016-01-01

Diagnosis of Adult Idiopathic Toe Walking (AITW) is very rare in clinical practice. High quality studies regarding AITW and its treatment options have not been conducted previously. A 28-year-old male patient complaining of lower leg pain was referred to outpatient rehabilitation clinic. Physical examination revealed a gait abnormality of insufficient heel strike at initial contact. The aetiology was investigated and the patient’s walking parameters were assessed using a computerized gait analysis system. The AITW was diagnosed. Botulinum toxin-A (Dysport®) was injected to the bilateral gastrocnemius muscles. A combined 10-days rehabilitation program was designed, including a daily one-hour physiotherapist supervised exercise program, ankle dorsiflexion exercises using an EMG-biofeedback unit assisted virtual rehabilitation system (Biometrics) and virtual gait training (Rehawalk) every other day. After treatment, the patient was able to heel strike at the initiation of the stance phase of the gait. Ankle dorsiflexion range of motions increased. The most prominent improvement was seen in maximum pressure and heel force. In addition center of pressure evaluations were also improved. To the best of our knowledge this is the first case, of AITW treated with combined botulinum toxin, exercise and virtual rehabilitation systems. This short report demonstrates the rapid effect of this 10-days combined therapy. PMID:27504395

[Vitreoretinal outpatient surgery: clinical and financial considerations].

Science.gov (United States)

Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

2008-11-01

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

Psychiatric disorders in outpatients with borderline intellectual functioning: comparison with both outpatients from regular mental health care and outpatients with mild intellectual disabilities.

Science.gov (United States)

Wieland, Jannelien; Kapitein-de Haan, Sara; Zitman, Frans G

2014-04-01

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

Science.gov (United States)

Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

2015-01-01

We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

Health of the elderly: multidisciplinary residence as an instrument for the care improvement Saúde do idoso: residência multiprofissional como instrumento transformador do cuidado

Directory of Open Access Journals (Sweden)

Rosana Klaesener

2009-08-01

Full Text Available Objective: To describe the actions taken by the team of the Health Aging Program Multidisciplinary Residency in Health (PREMUS / PUCRS. Description of the experience: In the primary care, the residents participated in home assistance, outpatient services and developed actions of health popular education in aged groups. The team was also inserted in a University hospital, assisting in the fields of outpatient and hospitalization units. Conclusion: The Multidisciplinary Residency Program in Health, with emphasis on the health of the elderly, has proposed a dynamic care based on the concepts of interdisciplinarity, integration and humanized care, as well as guided by the guidelines of the Unified Health System (SUS.Objetivo: Relatar as ações realizadas pela equipe Saúde do Idoso do Programa de Residência Multiprofissional em Saúde (PREMUS/PUCRS. Descrição da experiência: Na atenção básica, os residentes participaram na assistência domiciliar, ambulatorial e desenvolveram ações de educação popular em saúde em um grupo de idosos. A equipe também atuou em um hospital universitário, prestando assistência nos âmbitos ambulatorial e unidades de internação. Conclusão: O Programa de Residência Multiprofissional em Saúde, com ênfase na saúde do idoso, proporcionou aos residentes uma dinâmica assistencial fundamentada nos conceitos da interdisciplinaridade, integralidade e humanização do cuidado, tal como orientado pelas diretrizes do Sistema Único de Saúde (SUS.

Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer): Methods and results.

Science.gov (United States)

Reese, Christina; Weis, Joachim; Schmucker, Dieter; Mittag, Oskar

2017-10-01

The goal of this project was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer). First of all, we conducted a literature search and survey of all oncological rehabilitation centers in Germany (N = 145) to obtain a thorough perspective of the recent evidence, guidelines, the structural framework, and practice of psychological services in oncological rehabilitation. Next, an expert workshop was held with national experts from scientific departments, clinicians from rehabilitation centers, and patients. In this workshop, we drafted and agreed upon an initial version of the practice guidelines. Afterwards, the practice guidelines were sent to all head physicians and senior psychologists at oncological rehabilitation centers in Germany for approval (N = 280 questionnaires). In addition, key recommendations were discussed with a group of rehabilitation patients. Finally, the practice guidelines were revised by the expert panel and made available online to the public. The practice guidelines have been widely accepted by both the expert panel and the surveyed clinicians and patients. They include recommendations for psycho-oncological interventions that should be offered to all rehabilitation patients with breast, prostate, or colorectal cancer. They also comprise recommendations for specific problem areas concerning psychological functions, body functions, and environmental and personal factors. The practice guidelines provide detailed recommendations for high-quality psychosocial care in an oncological rehabilitation context. It is their aim to guide the multidisciplinary team, especially psychologists and physicians, in their daily practice. Copyright © 2016 John Wiley & Sons, Ltd.

Vitamin d status in patients with chronic obstructive pulmonary disease who participate in pulmonary rehabilitation

DEFF Research Database (Denmark)

Ringbaek, Thomas; Martinez, Gerd; Durakovic, Amal

2011-01-01

PURPOSE: Vitamin D deficiency is common in patients with chronic obstructive pulmonary disease; however, no study has evaluated the influence of vitamin D status on effects of pulmonary rehabilitation (PR). METHODS: We studied 311 patients, who participated in a 7-week outpatient PR. Vitamin D...... higher body mass index and fat-free mass index, had worse quality of life score, tended to have lower percent predicted value for forced expiratory volume in the first second of expiration, and more frequently were current smokers. They had a 3-time higher risk of dropout from the PR program (P = .003...

Outpatient invasive radiologic procedures - Diagnostic and therapeutic

International Nuclear Information System (INIS)

Dublin, A.

1987-01-01

This book is a ''how-to'' book for radiologists who are planning to, or considering whether to establish outpatient practice in response to DRGs. It provides practical, expert advice on both the administrative and clinical sides of outpatient radiology. It focuses on the essentials of clinical practice in the outpatient setting - and how it differs from inpatient practice

Sexual Dysfunction before and after Cardiac Rehabilitation

Directory of Open Access Journals (Sweden)

Jörg Schumann

2010-01-01

variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR between April 1999 and December 2007. Exercise capacity (ExC and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm from 18% to 23% (<.0001 during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR.

Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics.

Science.gov (United States)

Elliott, Stacy; Matthew, Andrew

2018-04-01

Supportive sexual health care is much-needed adjuvant care to oncologic management for men with prostate cancer (PCa). To inspire the initiation of biopsychosocial sexual health programming where it does not exist and to inform program enhancement in existing sexual rehabilitation clinics (SRCs). This article reviews the combined 30-year experience of 2 well-established Canadian SRCs for men and their partners after PCa treatments, interwoven with empirical evidence. To comprehensively review the biopsychosocial approach to sexual health assessment of men with PCa and their partners to direct the practicalities of running a successful and sustainable SRC. A full description of the biomedical and psychosocial approaches, inclusive of comprehensive sexual function, the penile rehabilitation controversy, and other medical and relationship issues affecting sexual adjustment, is provided to highlight the relevance of proper assessment and follow-through for sexual adaptation and adjustment. 10 recommendations for a successful SRC are discussed, including the principles behind developing a sustainable business plan, staff acquisition and training, budget, integration of treatment and research priorities, respectful and multidisciplinary approaches to care, and suggestions of visit formats, protocols, and questionnaires. We recommend a phased approach of an SRC into usual care with the option to provide accessible and equitable care to patients not within proximal access of treating institutions. Sexual rehabilitation after treatment for PCa requires a complex treatment process. Providing sustainable sexual rehabilitation programming under the financially strained environment of the Canadian medical system is a challenge; therefore, to provide Canadian patients and their partners with comprehensive cancer care, they deserve a biopsychosocial approach combined with a creative and systematic implementation strategy. Elliott S, Matthew A. Sexual Recovery Following Prostate

Volume, structure and funding of specialized outpatient care at the outpatient Advisory Department of Mariinskaya hospital

Directory of Open Access Journals (Sweden)

E. M. Kutyrev

2015-01-01

Full Text Available With the development of technologies, and discovery of new methods of diagnostics and treatment of diseases, a shift of the disease towards chronic disease is observed. Growth in prosperity will increase average life expectancy and mean age of population. Year after year, the elderly sector grows, with several chronic diseases per person. This is especially true for St. Petersburg, where 25 % of the populations of over working age. Thus, the demand for specialized medical care, particularly outpatient, will increase. Given that outpatient care is more profitable than hospital care, particular attention should be paid to its organization and expansion (increase in area, number of personnel, logistics, and so on. The article attempts to analyze changes in the volume of specialized outpatient medical care delivered at the outpatient Advisory Department of St. Petersburg state establishment of healthcare Mariinsky hospital in the period from 2008 through 2013.

The development of a multidisciplinary, evidence-based guideline for "HIV and employment".

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Wagener, Marlies N; Roelofs, Pepijin; Miedema, Harold S; Brandjes, Dees P M; Dahmen, Rutger; van Gorp, Eric C M

2015-01-01

The objective of this study was to develop a multidisciplinary guideline that supports the care and vocational rehabilitation of HIV-infected people with employment-related problems. The guideline was developed according to the "evidence-based guideline development" method developed by the Dutch Institute for Health Care Improvement. This method consists of the following steps: forming a multidisciplinary core group and an expert panel, formulating key questions, searching and appraising the available literature, formulating considerations and recommendations, peer reviewing the draft guideline, and authorizing the final guideline. All relevant professional associations were represented in the core group that was assembled to develop the guideline, i.e., HIV doctors, HIV nurses, general practitioners, occupational health physicians, psychologists, social workers, occupational health nurses, vocational experts, and insurance physicians. Five key questions for the guideline were formulated with the following themes: determinants of employment, disclosure and stigma, self-management, interventions, and the organization of care. In the literature review on these topics, 45 studies met the inclusion criteria. The methodological quality of the included articles was poor. Factors such as patient preferences and medical/ethical issues were considered. The recommendations in the guideline are a weighting of the scientific evidence and the considerations of the core group. The guideline, as well as its summary for daily practice, clarifies the most important barriers and facilitators to people with HIV either staying at work or returning to work, and it constitutes a clinical, easy-to-use guideline for health-care providers and how they can support people with HIV who want to work.

[Evaluation on efficacy of Jin's "Sanzhen" therapy combined with rehabilitation training for hemiplegia of stroke patients by Fugl-Meyer scale].

Science.gov (United States)

Han, De-Xiong; Zhuang, Li-Xing; Zhang, Ying

2011-06-01

To assess the therapeutic effect of Jin's "Sanzhen" therapy combined with rehabilitation training on limb-motor function of stroke patients by using Fugl-Meyer scale. A total of 254 hemiplegic stroke outpatients and inpatients from 7 hospitals were randomly divided into Jin's "Sanzhen" (JSZ) group (n = 83), rehabilitation group (n = 84) and combination group (n = 87). Acupuncture was applied to acupoints of Jin's "Sanzhen" including Quchi (LI 11), Waiguan (SJ 5) and Hegu (LI 4); Futu (ST 32). Zusanli (ST 36) and Sanyinjiao (SP 6); etc. The acupuncture needles were retained for 30 min after "Deqi". Rehabilitation training included passive joint movement, standing-sitting training, tapping-pressing stimulation, walking training, etc. The treatment was conducted once daily, 5 sessions a week and for 4 weeks. Fugl-Meyer scale composed of 100-point motor domain of the upper- and lower-extremity sections was used to assess the patients' motor function. On day 28 after the treatment, of the 83.84 and 87 hemiplegic stroke patients in the JSZ, rehabilitation and combination groups, 48 (57.8%), 31 (36.9%) and 50 (57.5%) experienced marked improvement in their clinical symptoms and signs, 26 (31.3%), 44 (52.4%) and 31(35.6%) had an improvement, and 9 (10.8%), 9 (10.7%) and 6 (6.9%) failed in the treatment, with the total effective rates being 89.2%, 89.3% and 93.1%, respectively. The neurological deficit score (NDS) of the combination group was significantly lower than that of the rehabilitation group (P rehabilitation groups (P rehabilitation groups in both NDS and FMAS (P > 0.05). Jin's "Sanzhen" therapy combined with rehabilitation training can significantly improve the limb motor function of hemiplegic stroke patients, and has a good synergistic effect.

The knowledge level of chest physicians about the pulmonary rehabilitation topic

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Hadice Selimoğlu Şen

2014-09-01

Full Text Available Objective: The pulmonary rehabilitation (PR is multidisciplinary, evidence-based and personalized treatment approach for patients with a symptomatic chronic respiratory disease and reduced daily living activities. In this study, we aimed to determine the knowledge level of chest physicians about PR in our city. Methods: A standardized questionnaire consisting of 10 questions was conducted to a total of 40 chest diseases specialist and assistant doctors who are working at the university hospital, training and research hospital and a private hospital in Diyarbakir city and its purlieus. The questions about the definition of PR, goals, evaluation criteria, patient who candidate for rehabilitation and rehabilitation team, were asked in questionnaire. Ten points was given for each correct answer to closed-ended questions. The knowledge level were identified as low, moderate and high when points were <50, 50-79 and 80-100 respectively. Results: The mean age of participants was 36.1 ± 7.79 and working duration time in chest disease department was 5.57 ± 7.71 years. Seventy-eight point nine percent of university hospital doctors, 57.1% of training and research hospital doctors, 50% of private hospital doctors were answered correctly more than half of the questions. Conclusion: The knowledge of chest physicians about PR is substantially in low and moderate levels in our city. The creation of a curriculum about PR in medical schools, and postgraduate training of physicians in the field will raise awareness about this issue, and might increase the interest of physicians and patients to PR. J Clin Exp Invest 2014; 5 (3: 386-390

Treatment of anorexia nervosa with long-term risperidone in an outpatient setting: case study.

Science.gov (United States)

Kracke, Elsa J; Tosh, Aneesh K

2014-01-01

There are currently few studies focusing on the efficacy of long-term atypical antipsychotics to treat anorexia nervosa in the pediatric population. This case report follows the treatment of a 17 year-old female with anorexia nervosa over her four-year undergraduate career. After two years of multidisciplinary treatment, low-dose risperidone was initiated due to persistence of her disease. She expressed decreased rigidity around meal times, her weight improved and she had resumption of menses. She was compliant with treatment through graduation and maintained her weight gain. Atypical antipsychotics are a treatment option in the management of anorexia nervosa. Risperidone has not been studied as frequently as olanzapine for eating disorders. Risperidone was chosen for its more favorable side effect profile and decreased cost to the patient. Previous studies on anorexia nervosa treatment have occurred during inpatient treatment and have limited follow-up due to patients' refusal to initiate or maintain medication compliance. This case presents 17 months of outpatient data. The efficacy of risperidone therapy was evaluated with frequent weight checks, subjective decrease in rigidity, serial complete metabolic panels, and restoration of menses. In this case report, an adolescent female treated with low-dose risperidone had decreased rigid thinking, weight gain and resolution of secondary amenorrhea without medication side effects. Therefore, the atypical antipsychotic risperidone may be an effective long-term outpatient treatment option for patients with anorexia nervosa.

Perceived heart risk factors can predict experienced psychological stress in outpatient cardiac rehabilitation

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Mozhgan Saeidi

2018-01-01

Full Text Available Background: The study was done to investigate the role of perceived heart risk factors (PHRFs in the prediction of psychological symptoms of cardiac rehabilitation (CR patients. Methods: In this cross-sectional study, 124 CR patients referred to Kermanshah Hospital of Imam Ali were assessed during April–July 2015. PHRFs scale and Depression, Anxiety, and Stress scale-21 used for data collection. The data were analyzed using linear multiple regression analysis. Results: The mean age of samples (69.4% male was 58.9 ± 9.7 years. The results of regression analysis evidenced that there is no significant relationship between any of the PHRFs with depression and anxiety (P > 0.05; however, biological (P = 0.018 and psychological (P = 0.019 risk factors significantly can predict stress. The model generally can explain 6.4% of the stress variance. Conclusion: PHRFs are included some significant predictors for experienced stress among the CR patients. Given that the biological and psychological risk factors are more effective in experienced stress by the patients, it is recommended that specialists pay more attention to the potential psychological outcomes of this group of patients.

The use of alternative therapies in the Saskatchewan stroke rehabilitation population

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Jefromova Ludmilla

2002-07-01

Full Text Available Abstract Background Many patients use alternative therapies. The purpose of this study was to determine the percentage of stroke rehabilitation patients in Saskatchewan using alternative therapies, whether patients found these therapies effective in alleviating stroke-related symptoms, how often those patients who used alternative therapies discuss this fact with their primary care doctor and the main reason why patients might not do so. Methods Telephone questionnaire surveys were conducted with 117 patients who had suffered a stroke and undergone inpatient or outpatient rehabilitation at Saskatoon City Hospital. Results The study revealed that 26.5% of 117 stroke rehabilitation patients visited alternative practitioners at least once or used some form of unconventional therapy. Only 16.1% of patients found that alternative therapy made them feel much better. Of those who used alternative therapy, 61.3% did not discuss this fact with their primary physician. Many of the respondents (47.3% who did not inform their physician stated that they did not see the necessity of talking about these treatments and 21.1% did not discuss the issue with their physician because they felt that he or she might disapprove of alternative therapies. Conclusion A relatively small percentage of stroke patients found alternative therapies beneficial. Doctors should be aware that a significant number of patients will try alternative treatment without discussion with their primary care physician or specialist. The current study suggests that after completing routine questioning, doctors should also ask their patients about their use of alternative therapies and, when appropriate, review issues of safety and efficacy.

A piezo surgery with corticotomies and implant placement as part of a multidisciplinary approach to treat malocclusion disorder in an adult patient: clinical report.

Science.gov (United States)

Gelpi, Federico; De Santis, Daniele; Marconcini, Simone; Briguglio, Francesco; Finotti, Marco

2015-12-01

This clinical report illustrates a multidisciplinary approach for the rehabilitation of a young adult patient affected by a bilateral edentulous space and an anterior deep bite. The patient required orthodontics and surgical corticotomy and implantology (both performed with a piezo device). A multidisciplinary planning approach, including orthodontics, oral and periodontic surgery, and restorative dentistry, has an important role in the final outcome of treatment. In fact a dental class I occlusion has been established only on the right side. The left side could not be restored to an ideal class I relationship due to the pontic prosthesis. The original collapsed right posterior occlusion was corrected. A stable posterior occlusion was established, and the balancing interference was eliminated. Centric relation and centric occlusion were established at the same vertical dimension of occlusion. The cephalometric analysis and clinical aspect at the end of treatment showed that the patient had improvements in overbite and overjet.Multidisciplinary management, including endodontic and restorative dentistry, periodontics, corticotomy-assisted orthodontics, implants, and prosthetics, was used for a young female patient with multiple missing teeth, anterior deep bite, and a malocclusion with cant of the occlusal plane. The interaction of interdisciplinary specialties and careful treatment planning were required. The patient also benefited esthetically from our effort.

Cognitive and social cognitive predictors of change in objective versus subjective quality-of-life in rehabilitation for schizophrenia.

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Kurtz, Matthew M; Bronfeld, Melanie; Rose, Jennifer

2012-12-30

A small but growing body of work has studied the role of cognitive skills in predicting response to integrated programs of rehabilitation in schizophrenia. No studies however, have directly compared the roles and interrelationships of cognition, social cognition and other disease factors in predicting improvements in the separate domains of objective quality-of-life (QOL) and subjective satisfaction with life (SWL) in response to rehabilitation in schizophrenia. Forty-four outpatients with schizophrenia were administered measures of cognition, social cognition, and symptoms at entry to a psychosocial and cognitive rehabilitation program. Change in objective QOL and subjective SWL before and after treatment were measured as outcome variables. Cognitive measures of verbal memory and social cognitive measures of facial affect recognition were linked to improvements in objective QOL, while verbal memory and crystallized verbal skill was linked to improvements in SWL. Facial affect recognition partially mediated the relationship between verbal memory and improvements in objective QOL. The implications of these findings for understanding interrelationships between cognition and social cognition and their role in predicting change in different domains of outcome as a function of behavioral treatment are discussed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

77 FR 5317 - Medicaid Program; Covered Outpatient Drugs

Science.gov (United States)

2012-02-02

... for Medicare & Medicaid Services 42 CFR Part 447 Medicaid Program; Covered Outpatient Drugs; Proposed... Part 447 [CMS-2345-P] RIN 0938-AQ41 Medicaid Program; Covered Outpatient Drugs AGENCY: Centers for... requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the...

Advances in rehabilitation medicine.

Science.gov (United States)

Ng, Yee Sien; Chew, Effie; Samuel, Geoffrey S; Tan, Yeow Leng; Kong, Keng He

2013-10-01

Rehabilitation medicine is the medical specialty that integrates rehabilitation as its core therapeutic modality in disability management. More than a billion people worldwide are disabled, and the World Health Organization has developed the International Classification of Functioning, Disability and Health as a framework through which disability is addressed. Herein, we explore paradigm shifts in neurorehabilitation, with a focus on restoration, and provide overviews on developments in neuropharmacology, rehabilitation robotics, virtual reality, constraint-induced therapy and brain stimulation. We also discuss important issues in rehabilitation systems of care, including integrated care pathways, very early rehabilitation, early supported discharge and telerehabilitation. Finally, we highlight major new fields of rehabilitation such as spasticity management, frailty and geriatric rehabilitation, intensive care and cancer rehabilitation.

[Effect of low frequency magnetic fields used in magnetotherapy and magnetostimulation on the rehabilitation results of patients after ischemic stroke].

Science.gov (United States)

Woldańska-Okońska, Marta; Czernicki, Jan

2007-01-01

New methods of rehabilitation should be introduced in order to reduce disability resulting from stroke. During the twelve months of follow-up, effect of low frequency magnetic field (If mf) on the course of patient rehabilitation following ischemic stroke was evaluated on in-patient (acute and subacute period of the stroke) and outpatient (chronic period) basis with the use of Mathew et al's and Barthel's scales. Lf mf (20 procedures of 20-min. duration) of magnetotherapy (I group--placebo, II--group 5.6 mT induction, 10 Hz frequency and sinusoidal shape, III group--2.8 mT induction, 10 Hz frequency and sinusoidal shape) and magnetostimulation (IV group--M1P1 program of Viofor JPS system, 16 min a day) was applied as early as in the subacute period of the stroke (1-8 weeks). The data obtained were presented in the form of percentage changes in the pain levels as well as in the form of the arithmetical mean and standard deviation (X +/- SD). The ANOVA test was used for a statistical evaluation of the data obtained in the tests. The results obtained indicate beneficial effects of If mf in the III and IV group of patients in the Barthel's scale and Mathew scale, which were observed during the examination 12 months after the stroke. The recommended doses of If mf seem to be adequate to obtain therapeutic effects and may be used in the early period of rehabilitation. The neurological and functional improvement persisted for a long-period of the out-patient treatment, which was confirmed during the control examination 12 months after the ischemic stroke. As no adverse effects (which could be attributed to If mf), were observed, this method of physical therapy can be recognized as a safe one and worth making popular in clinical practice.

Vaginal hysterectomy, an outpatient procedure.

Science.gov (United States)

Engh, Marie Ellström; Hauso, Wenche

2012-11-01

To report our experience of treating women undergoing vaginal hysterectomy in an outpatient setting and to identify risk factors for hospital admission and women dissatisfied with care. Prospective observational report. department of obstetrics and gynecology, university hospital in Norway. 150 women who underwent vaginal hysterectomy at the outpatient clinic from February 2009 to April 2010. Perioperative data were collected prospectively and case notes were searched for complications. On the first postoperative day all women were contacted by telephone by a nurse. A visual analogue scale (VAS) was used to monitor pain and nausea during the stay at the outpatient clinic and the day after surgery. VAS was also used to specify the women's degree of satisfaction with care the day after surgery. The number of women who could be discharged from the outpatient unit and had a satisfaction score of ≥7 the day after surgery. Of the 150 women, 84% could be discharged after a mean observation period of 276 min (SD ± 80 min). The mean satisfaction score was 9.0, SD ± 1.4, and 92.6% of the women reported ≥7 points in the satisfaction score. No women with serious complications were sent home. Using a multivariable logistic regression model only pain at discharge was found as significant (p= 0.009) for admittance to hospital. Vaginal hysterectomy is a feasible outpatient procedure and the majority of women were satisfied with the care they received. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Outpatient treatment for acute uncomplicated diverticulitis

NARCIS (Netherlands)

Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.

2013-01-01

Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment

Useful Method To Optimize The Rehabilitation Effort At A SCI Rehabilitation Centre

DEFF Research Database (Denmark)

Steensgaard, Randi; Dahl Hoffmann, Dorte

“Useful Method To Optimize The Rehabilitation Effort At A SCI Rehabilitation Centre” The Nordic Spinal Cord Society (NoSCoS) Meeting, Trondheim......“Useful Method To Optimize The Rehabilitation Effort At A SCI Rehabilitation Centre” The Nordic Spinal Cord Society (NoSCoS) Meeting, Trondheim...

How Multidisciplinary Are the Multidisciplinary Journals Science and Nature?

Science.gov (United States)

Solomon, Gregg E A; Carley, Stephen; Porter, Alan L

2016-01-01

Interest in cross-disciplinary research knowledge interchange runs high. Review processes at funding agencies, such as the U.S. National Science Foundation, consider plans to disseminate research across disciplinary bounds. Publication in the leading multidisciplinary journals, Nature and Science, may signify the epitome of successful interdisciplinary integration of research knowledge and cross-disciplinary dissemination of findings. But how interdisciplinary are they? The journals are multidisciplinary, but do the individual articles themselves draw upon multiple fields of knowledge and does their influence span disciplines? This research compares articles in three fields (Cell Biology, Physical Chemistry, and Cognitive Science) published in a leading disciplinary journal in each field to those published in Nature and Science. We find comparable degrees of interdisciplinary integration and only modest differences in cross-disciplinary diffusion. That said, though the rate of out-of-field diffusion might be comparable, the sheer reach of Nature and Science, indicated by their potent Journal Impact Factors, means that the diffusion of knowledge therein can far exceed that of leading disciplinary journals in some fields (such as Physical Chemistry and Cognitive Science in our samples).

Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial

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Jensen BT

2014-07-01

Full Text Available Bente Thoft Jensen,1,2 Jørgen Bjerggaard Jensen,1,2 Sussie Laustsen,2,3 Annemette Krintel Petersen,2,4 Ingrid Søndergaard,2 Michael Borre1,2 1Department of Urology, 2Department of Clinical Medicine, Centre of Research in Rehabilitation, 3Department of Cardiothoracic and Vascular Surgery, 4Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark Purpose: Health related quality of life (HRQoL is an important outcome in cancer care, although it is not well reported in surgical uro-oncology. Radical cystectomy (RC with lymph-node dissection is the standard treatment of muscle-invasive bladder cancer and high-risk noninvasive bladder cancer. A wide range of impairments are reported postsurgery. The aims were to evaluate whether a standardized pre- and postoperative physical exercise program and enhanced mobilization can impact on HRQoL and inpatient satisfaction in RC, as defined by the European Organisation for Research and Treatment of Cancer (EORTC. Materials and methods: Patients were randomized to fast-track RC and intervention (nI=50 or fast-track standard treatment (ns=57. HRQoL and inpatient satisfaction was measured using valid questionnaires: EORTC Quality of Life Questionnaire Core 30 (QLQ-C30 combined with the disease-specific EORTC BLS24 (baseline, and EORTC BLM30 (follow-up, and IN-PATSAT32 inpatient-satisfaction survey at discharge. Efficacy was defined as the differences in HRQoL-scores between treatment groups at the 4-month follow-up. Results: The intervention group significantly improved HRQoL scores in dyspnea (P≤0.05, constipation (P<0.02, and abdominal flatulence (P≤0.05 compared to the standard group. In contrast, the standard group reported significantly reduced symptoms in sleeping pattern (P≤0.04 and clinically relevant differences in role function, body function, and fatigue. The intervention did not compromise inpatient satisfaction. Conclusion: We found no overall impact

Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.

Science.gov (United States)

Beck, Anne Marie; Gøgsig Christensen, Annette; Stenbæk Hansen, Birthe; Damsbo-Svendsen, Signe; Kreinfeldt Skovgaard Møller, Tina; Boll Hansen, Eigil; Keiding, Hans

2014-08-28

Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach. An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary

Prosthetic Rehabilitation by Palatal Hollow Bulb Obturator with Cast Metal Denture Base: A Case Report

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George Francis

2015-01-01

Full Text Available Background: Prosthetic reconstruction of partial maxillectomy defects is a challenging procedure that requires multidisciplinary expertise to achieve an acceptable function, speech and esthetics. This procedure improves the quality of life for the patient as a normal individual. Obturation of the defect depends on its volume and position of remaining hard and soft tissues which determine the retention, stability and support for the prosthesis. The prosthesis should be simple to handle, easy to maintain, biocompatible, light in weight and convenient for future adjustments. This case report describes a clinical case of partial maxillectomy which was successfully rehabilitated with a definitive closed hollow bulb obturator and cast metal denture base.

Rehabilitation robotics.

Science.gov (United States)

Krebs, H I; Volpe, B T

2013-01-01

This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. Copyright © 2013 Elsevier B.V. All rights reserved.

Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT

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Julie A Luker

2016-05-01

Full Text Available Abstract Background The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT. Methods A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Results Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to ‘get staff on board’, and developing different ways of working. Conclusions The AVERT stroke rehabilitation trial required commitment to deliver

Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT.

Science.gov (United States)

Luker, Julie A; Craig, Louise E; Bennett, Leanne; Ellery, Fiona; Langhorne, Peter; Wu, Olivia; Bernhardt, Julie

2016-05-10

The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT). A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to 'get staff on board', and developing different ways of working. The AVERT stroke rehabilitation trial required commitment to deliver an intervention that needed strong collaboration between nurses and

Rehabilitation and older people.

OpenAIRE

Young, J.

1996-01-01

Rehabilitation is concerned with lessening the impact of disabling conditions. These are particularly common in older people and considerable health gain can be achieved by successful rehabilitation. Hospital doctors and general practitioners should be aware of the core principles of rehabilitation, be able to recognise rehabilitation need in their patients, and have sufficient knowledge of their local rehabilitation services to trigger the referral process.

Multidisciplinary workshops: learning to work together.

Science.gov (United States)

Fatchett, Anita; Taylor, Dawn

2013-03-01

Health and social care professional practice needs to move with the times and to respond to the ever-changing combination of health needs, economic realities and health-policy imperatives. A clear understanding of the variety of forces at play and the ability to marshal these to good effect by working in partnership with multidisciplinary colleagues and children/families is a must, not least in this time of economic austerity and ever-rising health inequalities, when vulnerable children's lives and complex family relationships and behaviours so easily become increasingly strained and challenged. This sad reality calls out for relevant joined-up solutions by all participants--an agenda so often called into question by court judgement after court judgement. The multidisciplinary workshops to be discussed have developed and changed over the past decade and provide a safe but realistic learning environment for students from health and social care backgrounds to experience the difficulties and barriers to good multidisciplinary working, to better understand others' perspectives and activities and consider and develop new and better practical strategies for working with multidisciplinary professional colleagues, children and families. All of the workshops are underpinned by specific discipline-focused theoretical work.

Cognitive and physical rehabilitation of intensive care unit survivors: results of the RETURN randomized controlled pilot investigation.

Science.gov (United States)

Jackson, James C; Ely, E Wesley; Morey, Miriam C; Anderson, Venice M; Denne, Laural B; Clune, Jennifer; Siebert, Carol S; Archer, Kristin R; Torres, Renee; Janz, David; Schiro, Elena; Jones, Julie; Shintani, Ayumi K; Levine, Brian; Pun, Brenda T; Thompson, Jennifer; Brummel, Nathan E; Hoenig, Helen

2012-04-01

Millions of patients who survive medical and surgical general intensive care unit care every year experience newly acquired long-term cognitive impairment and profound physical and functional disabilities. To overcome the current reality in which patients receive inadequate rehabilitation, we devised a multifaceted, in-home, telerehabilitation program implemented using social workers and psychology technicians with the goal of improving cognitive and functional outcomes. This was a single-site, feasibility, pilot, randomized trial of 21 general medical/surgical intensive care unit survivors (8 controls and 13 intervention patients) with either cognitive or functional impairment at hospital discharge. After discharge, study controls received usual care (sporadic rehabilitation), whereas intervention patients received a combination of in-home cognitive, physical, and functional rehabilitation over a 3-month period via a social worker or master's level psychology technician utilizing telemedicine to allow specialized multidisciplinary treatment. Interventions over 12 wks included six in-person visits for cognitive rehabilitation and six televisits for physical/functional rehabilitation. Outcomes were measured at the completion of the rehabilitation program (i.e., at 3 months), with cognitive functioning as the primary outcome. Analyses were conducted using linear regression to examine differences in 3-month outcomes between treatment groups while adjusting for baseline scores. Patients tolerated the program with only one adverse event reported. At baseline both groups were well-matched. At 3-month follow-up, intervention group patients demonstrated significantly improved cognitive executive functioning on the widely used and well-normed Tower test (for planning and strategic thinking) vs. controls (median [interquartile range], 13.0 [11.5-14.0] vs. 7.5 [4.0-8.5]; adjusted p improving cognitive performance and functional outcomes in just 3 months. Future investigations

Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal.

Science.gov (United States)

Kranjčić, Josip; Džakula, Nikola; Vojvodić, Denis

2016-09-01

The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression - the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal

Directory of Open Access Journals (Sweden)

Nikola Džakula

2016-01-01

Full Text Available The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area and the resection cavity was performed. A primary impression- the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression – the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

Perceptions of disability among south Asian immigrant mothers of children with disabilities in Canada: implications for rehabilitation service delivery.

Science.gov (United States)

Daudji, Anisa; Eby, Sarah; Foo, Tina; Ladak, Fahreen; Sinclair, Cameal; Landry, Michel D; Moody, Kim; Gibson, Barbara E

2011-01-01

The objectives of this study were to describe perceptions of disability among South Asian immigrant mothers of children with disabilities in a large multicultural urban centre in Ontario, Canada, and to explore how these perceptions influence rehabilitation services. The study was built on our previous work conducted with mothers in South Asia. A descriptive qualitative research design was employed. Semi-structured interviews were conducted with five mothers who had immigrated to Canada from South Asia in the last decade, and whose children were receiving outpatient rehabilitation services. Three primary themes were identified: (1) perceptions of disability reflected a mix of traditional and western beliefs; (2) mothers experienced physical, emotional and social suffering related to socio-cultural and material barriers and (3) mothers' primary goal for their children was the achievement of independent walking, which was linked to notions of achieving a ?normal? life and the desire for more rehabilitation interventions. South Asian immigrant mothers' perceptions of their children's disabilities had important similarities and differences to mothers living in South Asia. Healthcare professionals can assist families in managing and coping with their child's disabilities by exploring their unique values and beliefs and identifying achievable outcomes together.

Community-Based Rehabilitation to Improve Stroke Survivors' Rehabilitation Participation and Functional Recovery.

Science.gov (United States)

Ru, Xiaojuan; Dai, Hong; Jiang, Bin; Li, Ninghua; Zhao, Xingquan; Hong, Zhen; He, Li; Wang, Wenzhi

2017-07-01

The aim of this study was to evaluate the effectiveness of a community-based rehabilitation appropriate technique (CRAT) intervention program in increasing rehabilitation participation and improving functional recovery of stroke survivors. This study followed a quasi-experimental design. In each of 5 centers servicing approximately 50,000 individuals, 2 communities were designated as either the intervention or control community. A CRAT intervention program, including 2-year rehabilitation education and 3-month CRAT treatment, was regularly implemented in the intervention communities, whereas there was no special intervention in the control community. Two sampling surveys, at baseline and after intervention, were administered to evaluate the rehabilitation activity undertaken. In intervention communities, stroke survivor's motor function, daily activity, and social activity were evaluated pretreatment and posttreatment, using the Fugl-Meyer Motor Function Assessment, Barthel index, and Social Functional Activities Questionnaire. The proportion of individuals participating in rehabilitation-related activity was increased significantly (P rehabilitation (P 0.05). Community-based rehabilitation appropriate technique increases rehabilitation participation rates and enhances motor function, daily activity, and social activity of stroke survivors.

78 FR 35758 - Final Priority; National Institute on Disability and Rehabilitation Research-Rehabilitation...

Science.gov (United States)

2013-06-14

... Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY... for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority...

Disease-in-a-dish: the contribution of patient-specific induced pluripotent stem cell technology to regenerative rehabilitation.

Science.gov (United States)

Mack, David L; Guan, Xuan; Wagoner, Ashley; Walker, Stephen J; Childers, Martin K

2014-11-01

Advances in regenerative medicine technologies will lead to dramatic changes in how patients in rehabilitation medicine clinics are treated in the upcoming decades. The multidisciplinary field of regenerative medicine is developing new tools for disease modeling and drug discovery based on induced pluripotent stem cells. This approach capitalizes on the idea of personalized medicine by using the patient's own cells to discover new drugs, increasing the likelihood of a favorable outcome. The search for compounds that can correct disease defects in the culture dish is a conceptual departure from how drug screens were done in the past. This system proposes a closed loop from sample collection from the diseased patient, to in vitro disease model, to drug discovery and Food and Drug Administration approval, to delivering that drug back to the same patient. Here, recent progress in patient-specific induced pluripotent stem cell derivation, directed differentiation toward diseased cell types, and how those cells can be used for high-throughput drug screens are reviewed. Given that restoration of normal function is a driving force in rehabilitation medicine, the authors believe that this drug discovery platform focusing on phenotypic rescue will become a key contributor to therapeutic compounds in regenerative rehabilitation.

Ambivalence in rehabilitation

DEFF Research Database (Denmark)

Christensen, Jan; Langberg, Henning; Doherty, Patrick

2017-01-01

BACKGROUND: Knowledge about the organization and factors of importance to rehabilitation of veterans with lower limb amputation is sparse. The aim of this study was, therefore, to improve understanding of the influences of "military identity" on the organization of rehabilitation services...... and to investigate those factors influential in achieving successful rehabilitation, including interprofessional collaboration between different sectors involved in the rehabilitation of veterans with lower limb amputations. METHODS: We used a qualitative exploratory design, triangulating interviews and participant...... observation. Data were generated using in-depth semi-structured interviews (n = 6) exploring in-hospital and post-hospital rehabilitation in Danish veterans after unilateral lower limb amputation due to trauma. We conducted four sessions of participant observation, during weekly post...

Rehabilitating torture survivors

DEFF Research Database (Denmark)

Sjölund, Bengt H; Kastrup, Marianne; Montgomery, Edith

2009-01-01

survivors can be addressed from an evidence base generated both from traumatized and non-traumatized patient populations. Thus, trauma-focused cognitive behavioural therapy and/or eye movement desensitization and reprocessing, as well as interdisciplinary pain rehabilitation, should be components......, in December 2008. The main topics were: the context of torture; mental problems including psychotherapy; internet-based therapy and pharmaco-therapy; chronic pain; social integration and family; and functioning and rehabilitation. Available evidence highlights the importance of an interdisciplinary approach......, "Rehabilitating Torture Survivors", was organized by the Rehabilitation and Research Centre for Torture Victims (a rehabilitation clinic and global knowledge and research centre with government support) in collaboration with the Centre for Transcultural Psychiatry at Rigshospitalet in Copenhagen, Denmark...

Structured outpatient treatment of alcohol vs. drug dependencies.

Science.gov (United States)

Washton, A M

1990-01-01

This chapter describes the rationale, indications, design, and use of a structured outpatient treatment approach as an effective alternative to residential treatment for alcohol and drug dependencies. An increasing demand for outpatient treatment services is being created by a combination of clinical and economic factors, including the influx of employed drug abusers who do not need or desire residential care and mounting financial pressures to contain health care costs. To be effective as a primary treatment modality, outpatient programs must be highly structured and intensive and able to deal with the full spectrum of alcohol and drug addictions. Perpetuating the historical separation between alcoholism and drug abuse treatment programs is unnecessary and counterproductive, although certain modifications in treatment approaches are needed to accommodate the distinctive characteristics of particular classes of drugs and the people who use them. The "outpatient rehab," a treatment model that approximates the intensity of inpatient treatment on an outpatient basis, may help to maximize the clinical efficacy and cost-effectiveness of outpatient treatment as a viable alternative to residential care. Initial treatment results with this model are encouraging.

Hospital Outpatient Prospective Payment System (OPPS) Lim...

Data.gov (United States)

U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - Facility

Data.gov (United States)

U.S. Department of Health & Human Services — A list of hospital outpatient department ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS)...

Perceptive rehabilitation and trunk posture alignment in patients with Parkinson disease: a single blind randomized controlled trial.

Science.gov (United States)

Morrone, Michelangelo; Miccinilli, Sandra; Bravi, Marco; Paolucci, Teresa; Melgari, Jean M; Salomone, Gaetano; Picelli, Alessandro; Spadini, Ennio; Ranavolo, Alberto; Saraceni, Vincenzo M; DI Lazzaro, Vincenzo; Sterzi, Silvia

2016-12-01

Recent studies aimed to evaluate the potential effects of perceptive rehabilitation in Parkinson Disease reporting promising preliminary results for postural balance and pain symptoms. To date, no randomized controlled trial was carried out to compare the effects of perceptive rehabilitation and conventional treatment in patients with Parkinson Disease. To evaluate whether a perceptive rehabilitation treatment could be more effective than a conventional physical therapy program in improving postural control and gait pattern in patients with Parkinson Disease. Single blind, randomized controlled trial. Department of Physical and Rehabilitation Medicine of a University Hospital. Twenty outpatients affected by idiopathic Parkinson Disease at Hoehn and Yahr stage ≤3. Recruited patients were divided into two groups: the first one underwent individual treatment with Surfaces for Perceptive Rehabilitation (Su-Per), consisting of rigid wood surfaces supporting deformable latex cones of various dimensions, and the second one received conventional group physical therapy treatment. Each patient underwent a training program consisting of ten, 45-minute sessions, three days a week for 4 consecutive weeks. Each subject was evaluated before treatment, immediately after treatment and at one month of follow-up, by an optoelectronic stereophotogrammetric system for gait and posture analysis, and by a computerized platform for stabilometric assessment. Kyphosis angle decreased after ten sessions of perceptive rehabilitation, thus showing a substantial difference with respect to the control group. No significant differences were found as for gait parameters (cadence, gait speed and stride length) within Su-Per group and between groups. Parameters of static and dynamic evaluation on stabilometric platform failed to demonstrate any statistically relevant difference both within-groups and between-groups. Perceptive training may help patients affected by Parkinson Disease into restoring

Outpatient Vascular Intervention: A Two-Year Experience

International Nuclear Information System (INIS)

Macdonald, Sumaira; Thomas, Steven M.; Cleveland, Trevor J.; Gaines, Peter A.

2002-01-01

Purpose: To retrospectively analyze the outcome of a range of interventional vascular procedures performed on outpatients. Methods: Suitability for outpatient procedures was assessed according to agreed protocols. An episode was defined as any procedure/s through a single access site at one attendance. Retrospective case-note review was performed. Results: There were 693 outpatient episodes between April 1998 and May 2000 (290 interventional, and 403 diagnostic procedures),comprising 25% (693/2769) of the total workload. Follow-up is available in 214; 38 of these were transfers from outlying hospitals and were excluded from analysis. One hundred and seventy-six were true outpatients. There were 98 iliac and 46 femoropopliteal interventions,2 aortic stents, 1 renal and 5 upper-limb angioplasties (PTAs), 5 embolizations, 8 Hickman lines, 1 line stripping, 3 atherectomies, 1 dialysis-graft PTA and 6 bypass-graft PTAs. Sixty-eight closure devices were used. Twelve patients were converted to inpatients (6.8%,12/176). The readmission rate was 3.4% (6/176). The reattendance rate was 1.1% (2/176), both subsequently attending for outpatient duplex ultrasound examination to exclude pseudoaneurysm. The major complication rate was 3.4% and the delayed major complication rate was 1.7%. Conclusion: Outpatient vascular intervention is safe with appropriate protocols and with careful patient selection. Local vascular services benefit from the release of inpatient beds

Multidisciplinary training of cancer specialists in Europe

DEFF Research Database (Denmark)

Benstead, Kim; Turhal, Nazim Serdar; O'Higgins, Niall

2017-01-01

The best care for patients with cancer is most likely to be achieved when decisions about diagnosis, staging and treatment are made at multidisciplinary and multiprofessional meetings, preferably when all the professional expertise relevant to the patient's condition is gathered together. Questio......The best care for patients with cancer is most likely to be achieved when decisions about diagnosis, staging and treatment are made at multidisciplinary and multiprofessional meetings, preferably when all the professional expertise relevant to the patient's condition is gathered together....... Questionnaires were sent to National Societies of Radiation Oncology and Medical Oncology concerning similarities and differences in training programs and multidisciplinary care in member states in Europe. Results indicated wide variation in training systems and practice. Data were lacking for Surgery because...... surgeons training in cancer surgery) is recommended. This is likely to improve the value of multidisciplinary meetings and may result in improved patient care. The Expert Group on Cancer Control of the European Commission has endorsed this recommendation....

Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation.

Science.gov (United States)

Pardaens, Sofie; De Smedt, Delphine; De Bacquer, Dirk; Willems, Anne-Marie; Verstreken, Sofie; De Sutter, Johan

Despite the clear benefits of cardiac rehabilitation (CR), a considerable number of patients drop out early. Therefore, we wanted to evaluate dropout in CR with a special focus on comorbidities and psychosocial background. Patients who attended CR after acute coronary syndrome, cardiac surgery, or heart failure (N = 489) were prospectively included. Dropout was defined as attending 50% of the training sessions or less (n = 96 [20%]). Demographic and clinical characteristics, exercise parameters, and psychosocial factors were analyzed according to dropout, and those with a trend toward a significant difference (P dropout, and a comparable trend was seen for the presence of chronic obstructive pulmonary disease (2.55 [0.99-6.54]). Attending the training program only twice per week also implicated a higher risk of an early withdrawal (3.76 [2.23-6.35]). In contrast, patients on β-blockers were less likely to withdraw prematurely (0.47 [0.22-0.98]). Singles were more likely to drop out (2.89 [1.56-5.35]), as well as those patients who were dependent on others to get to CR (2.01 [1.16-3.47]). Finally, the reporting of severe problems on the anxiety/depression subscale of the EuroQOL-5D questionnaire involved a higher odds for dropout (7.17 [1.46-35.29]). Neither demographic characteristics nor clinical status or exercise capacity could independently identify patients who were at risk of dropout. The presence of comorbidities and a vulnerable psychosocial background rather seem to play a key role in dropout.

Aspiration Curettage and its Outpatient Usage

African Journals Online (AJOL)

Aspiration Curettage and its Outpatient Usage. D. A. G. BARFORD, M, NOTELOVITZ. SUMMARY ... its use on a number of outpatients without anaesthesia is discussed. S. Afr. Med. l., 48, 22 (1974). In order to ... plastic aspiration chamber and suction is applied centrally at the base of the chamber, a cylindrical filter within the.

Multidisciplinary chronic pain management in a rural Canadian setting.

Science.gov (United States)

Burnham, Robert; Day, Jeremiah; Dudley, Wallace

2010-01-01

Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.

[Acute Care Rehabilitation is the First Link in a Chain of Rehabilitation Interventions].

Science.gov (United States)

Beyer, Joachim; Seidel, Egbert J

2017-08-01

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established. © Georg Thieme Verlag KG Stuttgart · New York.

Nintendo Wii Fit for balance rehabilitation in patients with Parkinson's disease: A comparative study.

Science.gov (United States)

Negrini, Stefano; Bissolotti, Luciano; Ferraris, Alessandro; Noro, Fulvia; Bishop, Mark D; Villafañe, Jorge Hugo

2017-01-01

Impaired postural stability places individuals with Parkinson's disease (PD) at an increased risk for falls. We evaluated the effectiveness of 10 vs. 15 sessions of Nintendo Wii Fit for balance recovery for outpatients PD. Twenty-seven patients, 48.1% female (66 ± 8 years), with PD. Patients with PD were consecutively assigned to one of two groups receiving either 10 or 15 sessions (low dose or high dose group, respectively) with Nintendo Wii Fit in recovering balancing ability. All outcome measures were collected at baseline, immediately following the intervention period, and 1-month following the end of the intervention. Falls risk test (FRT), Stability index (PST), Berg balance scale (BBS) and Tinetti scale. The patients undergoing the 10 sessions demonstrated significantly improvement on the balance performances (Tinetti balance and gait scales, BBS and BSF) (all, P Wii Fit, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. The results suggest that functional improvement can be made in fewer visits during outpatient rehabilitation sessions with Nintendo Wii Fit improving the efficiency of intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Tele-rehabilitation using in-house wearable ankle rehabilitation robot.

Science.gov (United States)

Jamwal, Prashant K; Hussain, Shahid; Mir-Nasiri, Nazim; Ghayesh, Mergen H; Xie, Sheng Q

2018-01-01

This article explores wide-ranging potential of the wearable ankle robot for in-house rehabilitation. The presented robot has been conceptualized following a brief analysis of the existing technologies, systems, and solutions for in-house physical ankle rehabilitation. Configuration design analysis and component selection for ankle robot have been discussed as part of the conceptual design. The complexities of human robot interaction are closely encountered while maneuvering a rehabilitation robot. We present a fuzzy logic-based controller to perform the required robot-assisted ankle rehabilitation treatment. Designs of visual haptic interfaces have also been discussed, which will make the treatment interesting, and the subject will be motivated to exert more and regain lost functions rapidly. The complex nature of web-based communication between user and remotely sitting physiotherapy staff has also been discussed. A high-level software architecture appended with robot ensures user-friendly operations. This software is made up of three important components: patient-related database, graphical user interface (GUI), and a library of exercises creating virtual reality-specifically developed for ankle rehabilitation.

HISTORY OF NEUROPSYCHOLOGICAL REHABILITATION

Directory of Open Access Journals (Sweden)

N. A. Varako

2014-01-01

Full Text Available ABSTRACT. The article reviews the history of neuropsychological rehabilitation. It begins with the description of first rehabilitation programs developed by Paul Broca and Shepherd Franz. Franz’s experimental work for motor recovery in monkeys and correlation between active movement or affected limb immobilization and rehabilitation outcomes are described in further details. Special focus is given on ideas of famous German neurologist and psychiatrist Kurt Goldstein, who laid the foundation for modern approach in rehabilitation. Goldstein developed the idea of connection between rehabilitation and patient’s daily life. He also pointed out the necessity of psychological care of patients with brain damage.Russian neuropsychological approach is presented by its founders L.S. Vygotskiy and A.R. Luriya. Aspects of higher mental processes structure and options of its correction such as “cognitive prosthesis” are described in the sense of the approach.Y. Ben-Yishay, G. Prigatano, B. Wilson represent neuropsychological rehabilitation of the second half of the 20th century. The idea of a holistic approach for rehabilitation consists of such important principles as patient’s active involvement in a process of rehabilitation, work of a special team of rehabilitation professionals, inclusion of patient’s family members. The short review of a new rehabilitation approach for patients in coma, vegetative states and critical patients under resuscitation is given. 

How Multidisciplinary Are the Multidisciplinary Journals Science and Nature?

Science.gov (United States)

Solomon, Gregg E. A.; Carley, Stephen; Porter, Alan L.

2016-01-01

Interest in cross-disciplinary research knowledge interchange runs high. Review processes at funding agencies, such as the U.S. National Science Foundation, consider plans to disseminate research across disciplinary bounds. Publication in the leading multidisciplinary journals, Nature and Science, may signify the epitome of successful interdisciplinary integration of research knowledge and cross-disciplinary dissemination of findings. But how interdisciplinary are they? The journals are multidisciplinary, but do the individual articles themselves draw upon multiple fields of knowledge and does their influence span disciplines? This research compares articles in three fields (Cell Biology, Physical Chemistry, and Cognitive Science) published in a leading disciplinary journal in each field to those published in Nature and Science. We find comparable degrees of interdisciplinary integration and only modest differences in cross-disciplinary diffusion. That said, though the rate of out-of-field diffusion might be comparable, the sheer reach of Nature and Science, indicated by their potent Journal Impact Factors, means that the diffusion of knowledge therein can far exceed that of leading disciplinary journals in some fields (such as Physical Chemistry and Cognitive Science in our samples). PMID:27043924

75 FR 21273 - Office of Special Education and Rehabilitative Services; Overview Information; Rehabilitation...

Science.gov (United States)

2010-04-23

... Rehabilitation of Individuals Who are Mentally Ill. 84.129J Rehabilitation Psychology. 84.129P Specialized... students with community-based rehabilitation service providers are encouraged. Projects must include an... Mentally Ill. 84.129J Rehabilitation 100,000 2 Psychology. 84.129P Specialized Personnel 100,000 3 for...

Multidisciplinary approaches to climate change questions

Science.gov (United States)

Middleton, Beth A.; LePage, Ben A.

2011-01-01

Multidisciplinary approaches are required to address the complex environmental problems of our time. Solutions to climate change problems are good examples of situations requiring complex syntheses of ideas from a vast set of disciplines including science, engineering, social science, and the humanities. Unfortunately, most ecologists have narrow training, and are not equipped to bring their environmental skills to the table with interdisciplinary teams to help solve multidisciplinary problems. To address this problem, new graduate training programs and workshops sponsored by various organizations are providing opportunities for scientists and others to learn to work together in multidisciplinary teams. Two examples of training in multidisciplinary thinking include those organized by the Santa Fe Institute and Dahlem Workshops. In addition, many interdisciplinary programs have had successes in providing insight into climate change problems including the International Panel on Climate Change, the Joint North American Carbon Program, the National Academy of Science Research Grand Challenges Initiatives, and the National Academy of Science. These programs and initiatives have had some notable success in outlining some of the problems and solutions to climate change. Scientists who can offer their specialized expertise to interdisciplinary teams will be more successful in helping to solve the complex problems related to climate change.

[Methods for the costing process in the field of economic evaluation of a rehabilitation program for patients with chronic obstructive lung diseases].

Science.gov (United States)

Hessel, F P; Wittmann, M; Petro, W; Wasem, J

2000-07-01

Studies in health economics especially economic evaluations of health care technologies and programmes are getting more and more important. However, in Germany there are no established, validated and commonly used instruments for the costing process. For the economic evaluation of a rehabilitation programme for patients with chronic lung diseases such as asthma and chronic bronchitis we developed methods for identification, measurement and validation of resource use during the inpatient rehabilitation programme and during the outpatient follow-up period. These methods are based on methodological considerations as well as on practical experience from conducting a pilot study. With regard to the inpatient setting all relevant diagnostic and therapeutic resource uses could be measured basing on routine clinical documentation and validated by using the cost accounting of the clinic. For measuring the use of resources during the follow-up period in an outpatient setting no reliable administrative data are accessible. Hence, we compared a standardised retrospective patient questionnaire used in a 20-minute interview (n = 50) and a cost diary for the continuing documentation by the patient over a period of 4 weeks (n = 50). Both tools were useful for measuring all relevant resource uses in sufficient detail, but because of higher participation rates and lower dropouts the structured interview appears to be more suitable. Average total costs per month were 1591 DM (interview), respectively 1867 DM (cost diary). Besides productivity loss, costs for medication and GP visits caused the relatively highest resource uses. Practicable instruments were developed for the costing process as part of an economic evaluation in a German rehabilitation setting for pulmonary diseases. After individual modification, these could also be used for different indications and in other institutional settings.

Rehabilitation after stroke.

Science.gov (United States)

Knecht, Stefan; Hesse, Stefan; Oster, Peter

2011-09-01

Stroke is becoming more common in Germany as the population ages. Its long-term sequelae can be alleviated by early reperfusion in stroke units and by complication management and functional restoration in early-rehabilitation and rehabilitation centers. Selective review of the literature. Successful rehabilitation depends on systematic treatment by an interdisciplinary team of experienced specialists. In the area of functional restoration, there has been major progress in our understanding of the physiology of learning, relearning, training, and neuroenhancement. There have also been advances in supportive pharmacotherapy and robot technology. Well-organized acute and intermediate rehabilitation after stroke can provide patients with the best functional results attainable on the basis of our current scientific understanding. Further experimental and clinical studies will be needed to expand our knowledge and improve the efficacy of rehabilitation.

REHABILITATION NEEDS AND PLANS AMONG PATIENTS WITH CANCER, ASSESSED AT HOSPITALS AND WHEN REHABILITATION BEGINS

DEFF Research Database (Denmark)

Handberg, Charlotte; Maribo, Thomas; Jensen, Charlotte Maria

and the specifics of needs and plans facilitates targeted rehabilitation interventions. Implications: Systematic needs assessment in cancer rehabilitation unveil the requirement of physical rehabilitation. Supervised physical activity renders an intervention possible tailored the special needs cancer patients have......Background: Systematic assessment of rehabilitation needs is prerequisite for sufficient rehabilitation, but little is known about patients' needs. Purpose: The aim of this study was to describe specific stated rehabilitation needs and plans among patients with cancer at hospitals when diagnosed...... and when municipal rehabilitation begins. Methods: Needs-assessment-forms for rehabilitation from 188 cancer patients from two hospitals and two municipal cancer rehabilitation programmes were analysed. The forms included 1) stated needs: 58 fixed areas categorised in six domains and 2) an area to document...

Cancer rehabilitation in Denmark

DEFF Research Database (Denmark)

Hansen, Helle Ploug; Tjørnhøj-Thomsen, Tine

2008-01-01

A fundamental assumption behind cancer rehabilitation in many Western societies is that cancer survivors can return to normal life by learning to deal with the consequences of their illness and their treatment. This assumption is supported by increasing political attention to cancer rehabilitation...... and a growth in residential cancer-rehabilitation initiatives in Denmark (Danish Cancer Society 1999; Government of Denmark 2003). On the basis of their ethnographic fieldwork in residential-cancer rehabilitation courses, the authors examine the new rehabilitation discourse. They argue that this discourse has...

Billing for outpatient transplant pharmacy services.

Science.gov (United States)

Maldonado, Angela Q; Seiger, Todd C; Urann, Christina L; McCleary, Jo Ann; Goroski, Angela L; Ojogho, Okechukwu N

2012-01-15

The economic impact of out-patient pharmacy services in a transplant program was evaluated. Full-time kidney transplant pharmacy services were implemented at Providence Sacred Heart Medical Center (PSHMC) in the fall of 2008, with two pharmacists combining hours to provide one full-time-equivalent position. At PSHMC, posttransplantation patients are seen three times per week. The number of patient visits with pharmacists for 2010 was compared with the total number of patient visits. The face-to-face time spent with the patient was translated to a level of billing that was associated with a set reimbursement schedule. For each patient encounter in which a pharmacist was involved, the incremental difference between the nursing and pharmacy levels of billing was examined, as were the levels most often billed by pharmacists. The difference in billing levels between pharmacists and nurses for the same patient encounter was also evaluated. Overall, pharmacist visits accounted for 208 (22%) of the 994 out-patient kidney transplant visits in 2010, with pharmacists billing at a higher level of acuity compared with nursing for the same patient encounter 48% of the time. This translated to an approximate increase of $100 per patient visit. For the one-year study period, pharmacists utilizing facility- fee billing increased out-patient reimbursement by approximately $10,000. By utilizing outpatient facility-fee billing for pharmacy services, the transplant program at PSHMC increased reimbursement in the outpatient setting.

The influence of post-acute rehabilitation length of stay on traumatic brain injury outcome: a retrospective exploratory study.