outpatient rehabilitation
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2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Szu-Hung Lin ◽  
Tong-Rong Yang ◽  
I-Ching Chuang ◽  
Chia-Ling Chen ◽  
Ching-Yi Wu

AbstractStroke individuals’ daily function has been demonstrated to be influenced by their somatosensory capability, cognitive capability, and upper extremity (UE) motor abilities. However, the structural relationships among these abilities on stroke individuals’ independence in daily function remain unclear. We analyzed the pretest measures of 153 stroke individuals in outpatient rehabilitation settings by structural equation modeling to determine the structural relationship among somatosensory capability, UE muscle strength, UE motor function, and cognitive capability that influences independence in daily function. The standardized results indicated somatosensory capability negatively influenced UE muscle strength, but positively influenced UE muscle strength mediated by UE motor function. UE muscle strength, then, positively influenced individuals’ independence in daily function. On the other hand, somatosensory capability positively influenced cognitive capability, which marginally and positively affected the performance of independence in daily function. To the best of our knowledge, this is the first study to demonstrate the influence of somatosensory capability on the daily function is mediated mainly by motor functions and marginally by cognitive capability. This structural model may allow future clinical therapists to design more effective task-related training protocols to promote the independence in daily function for stroke individuals.


2022 ◽  
Vol 32 (2) ◽  
pp. 345-359
Author(s):  
Cassie E. McDonald ◽  
Catherine L. Granger ◽  
Catherine M. Said ◽  
Louisa J. Remedios

In this research, we explore and theorize on the potential of hospital outpatient rehabilitation waiting areas to respond and contribute to the health literacy needs of consumers. Constructivist grounded theory informed the sampling and analytical procedures. Thirty-three consumers attending outpatient rehabilitation for a range of health conditions were recruited to this multi-site study. Semi-structured interview and participant observation data were collected and analyzed concurrently using the constant comparison method. The substantive theory of “seeking choice to fulfill health literacy needs” and five interdependent categories were developed. Results indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice. Results provide insight into the health literacy needs of consumers in hospital outpatient waiting areas and how health services can appropriately respond to these needs. Future research should investigate the effect of health service environments on health outcomes.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261475
Author(s):  
Bart Bloemen ◽  
Eirlys Pijpers ◽  
Edith Cup ◽  
Jan Groothuis ◽  
Baziel van Engelen ◽  
...  

Background High quality care of patients with neuromuscular diseases requires a personalised approach that focuses on achieving and maintaining a level of functioning that enables them to be in a state of well-being. The capability approach states that well-being should be understood in terms of capabilities, the substantial opportunities that people have to be and do things they have reasons to value. In this Rehabilitation and Capability care for patients with Neuromuscular diseases (ReCap-NMD) study, we want to investigate whether providing care based on the capability approach (capability care) has an added value in the rehabilitation of patients with neuromuscular diseases (NMD). Methods Two groups of 30 adult patients with facioscapulohumeral muscular dystrophy or myotonic dystrophy type 1 will be included. The first group will receive rehabilitation care as usual with a follow-up period of 6 months. Then, based on theory, and experiences of patients and healthcare professionals, capability care will be developed. During the following 3 months, the multidisciplinary outpatient rehabilitation care team will be trained in providing this newly developed capability care. Subsequently, the second group will receive capability care, with a follow-up period of 6 months. A mixed methods approach is used with both qualitative and quantitative outcome measures to evaluate the effect of capability care and to perform a process evaluation. The primary outcome measure will be the Canadian Occupational Performance Measure. Discussion The ReCap-NMD study is the first study to design and implement a healthcare intervention based on the capability approach. The results of this study will expand our knowledge on how the capability approach can be applied in delivering and evaluating healthcare, and will show whether implementing such an intervention leads to a higher well-being for patients with NMD. Trial registration Registered at Trialregister.nl (Trial NL8946) on 12th of October, 2020.


Author(s):  
Jeremia P. O. Held ◽  
Anne Schwarz ◽  
Johannes Pohl ◽  
Eva Thürlimann ◽  
Silvan Porrtmann ◽  
...  

Introduction: Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods: A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results: Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion: The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.


2021 ◽  
Author(s):  
Christophe Alarie ◽  
Isabelle Gagnon ◽  
Lily Trang Than Huynh ◽  
Karine Doucet ◽  
Adèle Pichette-Auray ◽  
...  

Abstract Background Physical activity interventions have been shown to be an effective therapeutic approach to improve symptoms and reduce recovery time after a mild traumatic brain injury. Service providers from a specialized traumatic brain injury outpatient rehabilitation program recognized the need to ensure their physical activity intervention integrated evidence-based treatment components, while considering user needs and preferences. To inform quality improvement efforts, service providers felt it necessary to learn about the perceptions of key stakeholders, regarding the quality of the intervention. The study objective was to explore the perceptions of administrators, clinicians and users of the specialized program regarding the physical activity intervention’s strengths, weaknesses, opportunities and threats (SWOT). Methods Using a SWOT analysis framework, this qualitative study explored the perspectives of the purposive sample (n=14) composed of the managerial staff, six clinicians and five program users. Semi-structured interviews were performed, recorded, transcribed verbatim and analyzed using a qualitative content analysis approach. Results Fifty categories were generated resulting in 15 strengths, 17 weaknesses, 12 opportunities and 6 threats grouped into 8 overarching categories: physical activity intervention, health-related outcomes, clinical expertise, knowledge translation, communication, user engagement, resources, accessibility. Category descriptions, convergent and divergent perspectives, and salient quotes of participants are provided. Conclusions This study successfully identified perceived strengths, many weaknesses, several opportunities and a few threats. Participants were generally positive about the intervention but identified weaknesses including the need for service providers to better describe the physical activity intervention using theoretically driven approaches before engaging in quality improvement activities. Convergent and divergent perspectives of service providers and program users helped identify areas to maintain and others to improve upon when the program develops their new intervention. Study results may also inform the development of other physical activity interventions designed for adults with persisting symptoms of a mild traumatic brain injury.


2021 ◽  
pp. 003435522110600
Author(s):  
Jasin Wong ◽  
Angelika Kudla ◽  
Tri Pham ◽  
Nnaemezie Ezeife ◽  
Deborah Crown ◽  
...  

Coronavirus disease (COVID-19) may cause long-lasting adverse consequences after acute recovery, including functional limitations and reduced work capacity. Individuals with long-lasting complications of COVID-19 are known as long-haulers. There is a knowledge gap on how COVID-19 complications affect return-to-work (RTW) efforts. We aimed to describe the challenges that long-haulers encounter when RTW from the perspectives of rehabilitation professionals. In this study, four certified rehabilitation counselors and four rehabilitation physicians in outpatient rehabilitation centers participated in focus groups. Participants discussed challenges in working with long-haulers, including personal attributes, post-COVID-19 symptoms and complications, uncertain recovery and unpredictable outcomes, limited health care accessibility and support, and unsupportive work environments. Participants provide individualized services to meet long-haulers’ diverse needs as they do for all persons with disabilities, although they expressed uncertainty due to the variable disease course and risk of infection. Modifying workplace policies, especially gradual RTW, were frequently mentioned accommodations. The findings highlight the RTW issues of long-haulers. We provide recommendations on increasing awareness of the challenges and job accommodations of long-haulers.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260743
Author(s):  
Daigo Sakamoto ◽  
Toyohiro Hamaguchi ◽  
Yasuhide Nakayama ◽  
Takuya Hada ◽  
Masahiro Abo

Background Outpatient rehabilitation was temporarily suspended because of coronavirus disease (COVID-19), and there was a risk that patients’ activities of daily living (ADLs) would decrease and physical functions unmaintained. Therefore, we investigated the ADLs and motor functions of chronic stroke patients whose outpatient rehabilitation was temporarily interrupted. Methods In this observational study, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Barthel Index (BI) scores of 49 stroke hemiplegic patients at 6 and 3 months before rehabilitation interruptions were retrospectively determined and were prospectively investigated on resumption of outpatient rehabilitation. Presence or absence of symptoms and difficulties caused by the interruption period (IP) was investigated using a binomial method. Deltas were analyzed using a generalized linear model (GLM) according to the survey period. Age, sex, severity of FMA-UE immediately post-resumption and post-onset period were used as covariates. For survey items showing significant model fit, the 95% confidence interval of minimum detectable change (MDC95) was calculated, and the amount of change was compared. Questionnaire responses were tested via proportion ratio. Statistical significance was set at 5%. Results The FMA-UE part A and total scores were significantly model fit depending on periods. The estimated FMA-UE total score decreased by 1.64 (z = −2.38, p = 0.02) during the 3-month IP. No fits were observed by GLM in other parts of the FMA-UE, ARAT, or BI. The calculated MDC95 was 3.58 for FMA-UE part A and 4.50 for FMA-UE overall. Answers to questions regarding sleep disturbance and physical pain were significantly biased toward “no” in the psychosomatic function items (p<0.05). There was no bias in the distribution of answers to questions regarding joint stiffness, muscle weakness, muscle stiffness, and difficulty in moving arms and hands. All 16 questions regarding activities and participation items were significantly biased toward answers “no” (p<0.05). Conclusions The FMA-UE part A and total scores were affected. Patients complained of subjective symptoms related to upper limb paralysis after the IP. Since ADLs of patients were maintained, the therapist can recommend that patients not receiving outpatient treatments be evaluated in relation to the shoulder, elbow, and forearm and instructed on self-training to maintain motor function.


Heliyon ◽  
2021 ◽  
pp. e08537
Author(s):  
Marleen J. de Leeuw ◽  
Fabienne C. Schasfoort ◽  
Bea Spek ◽  
Inez van der Ham ◽  
Stella Verschure ◽  
...  

Author(s):  
Ioli Pereira Costa ◽  
Juliana Soares Magno de Senna ◽  
Stephanie Rodrigues ◽  
Camila Vitelli Molinari ◽  
Vivian Bertoni Xavier ◽  
...  

Introdução: A pandemia da COVID-19 exigiu recursos e esforços de diversos profissionais de saúde para melhorar a assistência aos pacientes acometidos. A fisioterapia ganhou destaque na redução da progressão da doença em sintomas respiratórios e na manutenção da capacidade funcional e física. Objetivo: Apresentar um dos casos de assistência fisioterapêutica de um paciente com COVID-19, da internação na unidade de terapia intensiva (UTI) à reabilitação ambulatorial e os recursos utilizados, de forma a demonstrar o benefício da fisioterapia ao longo de todo o percurso do paciente até a alta. Relato do caso: Homem de 53 anos foi internado devido a piora clínica, queixa de dispneia em repouso associada a febre, tosse seca, agenesia e hipoxemia. Admitido à UTI com acometimento de 50% do parênquima pulmonar em tomografia computadorizada, recebeu oxigênio a 10 L/min, para atingir saturação periférica de oxigênio (SpO2) a 99% e relação de pressão parcial de oxigênio arterial (PaO2/FiO2) a 95. Durante nove dias de internação, recebeu atendimento de fisioterapia quatro vezes ao dia, com recursos de ventilação não invasiva, prona ativa, sedestação, deambulação precoce e recursos de aumento de demanda física ajustada progressivamente de acordo com a avaliação e objetivo terapêutico. Na alta hospitalar, com remissão dos sintomas importantes, sem oxigênio e SpO2 a 96%, PaO2/FiO2 a 302, foi encaminhado para reabilitação cardiopulmonar e, após 38 sessões, recuperou a capacidade funcional e recebeu alta do serviço com teste de caminhada de seis minutos com valores adequados para a idade e sexo. Conclusão: Neste caso de COVID19, os objetivos terapêuticos da fisioterapia foram alcançados desde a internação até a reabilitação, com utilização de recursos conhecidos pela especialidade e priorizando os cuidados contínuos e a personalização da terapia. Palavras chave: COVID-19, Modalidades de fisioterapia, Ventilação não invasiva, decúbito ventral, Deambulação precoce ABSTRACT Introduction: The COVID-19 pandemic required resources and efforts from health professionals to improve care for affected patients. Physical therapy has gained prominence in reducing the progression of the disease in respiratory symptoms and in maintaining functional and physical capacity. Objective: To report one of the cases of physiotherapy care of a patient with COVID-19, from admission to the intensive care unit (ICU) to outpatient rehabilitation and the resources used, in order to demonstrate the benefit of physiotherapy throughout the course of the patient until discharge. Case report: A 53 -year-old man was admitted due to clinical worsening, complaint of dyspnea at rest associated with fever, dry cough, agenesis and hypoxemia. Admitted to ICU with 50% involvement of the lung parenchyma on computed tomography, he received oxygen at 10 L/min to achieve peripheral oxygen saturation (SpO2) at 99% and arterial oxygen partial pressure ratio (PaO2/FiO2) at 95. During nine days of hospitalization, he received physiotherapy care four times a day, with non-invasive ventilation, prone position, sitting, early ambulation and resources for increasing physical demand, progressively adjusted according to the assessment and therapeutic objective. At hospital discharge, with remission of important symptoms, without oxygen and SpO2 96%, PaO2/FiO2 to 302, he was referred for cardiopulmonary rehabilitation and, after 38 sessions, he recovered functional capacity and was discharged from the service with a six-walk test minutes with appropriate values for age and sex. Conclusion: In this case of COVID19, the therapeutic objectives of physiotherapy were achieved from hospitalization to rehabilitation, using resources known by the specialty and prioritizing continuous care and personalized therapy.Keywords: COVID-19, Physical therapy modalities, Noninvasive ventilation, Prone position, Early ambulation


2021 ◽  
Vol 12 ◽  
Author(s):  
Alwyn Gomez ◽  
Amanjyot Singh Sainbhi ◽  
Logan Froese ◽  
Carleen Batson ◽  
Arsalan Alizadeh ◽  
...  

Multimodal monitoring has been gaining traction in the critical care of patients following traumatic brain injury (TBI). Through providing a deeper understanding of the individual patient’s comprehensive physiologic state, or “physiome,” following injury, these methods hold the promise of improving personalized care and advancing precision medicine. One of the modalities being explored in TBI care is near-infrared spectroscopy (NIRS), given it’s non-invasive nature and ability to interrogate microvascular and tissue oxygen metabolism. In this narrative review, we begin by discussing the principles of NIRS technology, including spatially, frequency, and time-resolved variants. Subsequently, the applications of NIRS in various phases of clinical care following TBI are explored. These applications include the pre-hospital, intraoperative, neurocritical care, and outpatient/rehabilitation setting. The utility of NIRS to predict functional outcomes and evaluate dysfunctional cerebrovascular reactivity is also discussed. Finally, future applications and potential advancements in NIRS-based physiologic monitoring of TBI patients are presented, with a description of the potential integration with other omics biomarkers.


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