Including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment

Objective: To test the feasibility, safety and effectiveness of the My Therapy programme for inpatients with mild-moderate cognitive impairment. Design: Observational pilot study. Patients: Rehabilitation inpatients with mild-moderate cognitive impairment. Methods: During their inpatient admission, participants received My Therapy, a programme that can increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy. Outcomes included My Therapy participation, falls, Functional Independence Measure (FIM) and 10-m walk test. Outcomes were compared with those of participants without cognitive impairment from the original My Therapy study (n = 116) using χ2 and independent t-tests. Results: Eight participants with mild-moderate cognitive impairment (mean (standard deviation (SD)) age 89.6 years (4.8); 3 women) were included. All participants completed the My Therapy programme on at least one day of their admission, with no associated falls. Participants had an 8.4 s (SD 5.1) reduction in their 10-m walk test and a 21.5 point (SD 11.1) improvement on FIM scores from admission to discharge. There were no significant between-group differences in feasibility, safety or effectiveness for participants with and without cognitive impairment. Conclusion: This pilot study has shown that including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment. Lay Abstract This study aimed to determine whether it was practical, safe and effective for patients in a rehabilitation hospital with memory or thinking problems to participate in a programme called My Therapy. My Therapy aimed to increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy sessions. There were 8 participants in the study and all of them reported completing the My Therapy programme on at least one day of their rehabilitation stay. There were no falls relating to My Therapy participation. Participants improved their walking speed and function during their rehabilitation stay. There were no differences in the results between people with and without memory or thinking problems, in terms of practicality, safety or effectiveness. This study has shown that including exercise self-management as part of rehabilitation is practical, safe and effective for patients with memory or thinking problems.

Performance of the EQ-5D-Y Interviewer Administered Version in Young Children

(1) Background: An estimated 78% of South African children aged 9–10 years have not mastered basic reading, therefore potentially excluding them from self-reporting on health-related outcome measures. Thus, the aim of this study was to compare the performance of the EQ-5D-Y-3L self-complete to the newly developed interviewer-administered version in children 8–10 years. (2) Methods: Children (n = 207) with chronic respiratory illnesses, functional disabilities, orthopaedic conditions and from the general population completed the EQ-5D-Y-3L self-complete and interviewer-administered versions, Moods and Feelings Questionnaire (MFQ) and Faces Pain Scale-Revised (FPS-R). A functional independence measure (WeeFIM) was completed by the researcher. (3) Results: The 8-year-olds had significantly higher missing responses (x2 = 14.23, p < 0.001) on the self-complete version. Known-group and concurrent validity were comparable across dimensions, utility and VAS scores for the two versions. The dimensions showed low to moderate convergent validity with similar items on the MFQ, FPS-R and WeeFIM with significantly higher correlations between the interviewer-administered dimensions of Mobility and WeeFIM mobility total (z = 1.91, p = 0.028) and Looking After Myself and WeeFIM self-care total (z = 3.24, p = 0.001). Children preferred the interviewer-administered version (60%) (x2 = 21.87, p < 0.001) with 22% of the reasons attributed to literacy level. (4) Conclusions: The EQ-5D-Y-3L interviewer-administered version is valid and reliable in children aged 8–10 years. The results were comparable to the self-complete version indicating that versions can be used interchangeably.

Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial

Objective To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. Design A prospective, randomized controlled trial. Setting A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. Intervention The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. Main measures The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. Results Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked ( p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed ( p = 0.363), lactate levels ( p = 0.302), knee extensor strength ( p = 0.117), handgrip strength ( p = 0.882), global muscle strength ( p = 0.104), electromyographic activity ( p = 0.179) and Functional Independence Measure ( p = 0.059). Conclusions Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

Dance, functioning and quality of life in children with Down syndrome and autism spectrum disorder dance, functioning and quality of life in Down syndrome and autism spectrum disorder

This study investigated dance practice in psychosocial and functional aspects, and quality of life in children with Down syndrome and autism spectrum disorder. Children with DS and ASD, between 3 and 12 years old, attended a dance program during 16 sessions/lessons, lasting 60 min, twice a week, in suitable place. Functional Independence Measure (FIM), Childhood Autism Rating Scale SF-36 quality of life survey, and Knowledge, Attitude and Practice Inquiry (KAP Inquiry) were applied before and after dance classes. Eleven participants concluded the study. Functional independence changes were observed in relation to self-care, sphincter control, locomotion, and communication domains. Children’ “quality of life” reported by parents showed changes in functional capacity, vitality, mental health, physical and social aspects, and general state of health domains. These findings suggest that regular dance practice can underlie psychosocial adjustments in children with DS and ASD.

Реабілітаційне обстеження пацієнтів після вогнепальних поранень кисті і передпліччя

Резюме. Мета. Розробити та охарактеризувати схему реабілітаційного обстеження осіб після вогнепальних поранень кисті і передпліччя. Методи. Теоретичні (аналіз та систематизація спеціалізованої науково-методичної літератури щодо використання реабілітаційного обстеження пацієнтів з травмами верхніх кінцівок); клінічні (аналіз медичних карток, опитування, огляд); інструментальні (на рівні аналізу функцій та структур організму: гоніометрія, мануальне тестування м’язів, антропометричні виміри сегменту кінцівки, модифікована вербальна шкала болю, шкала тривоги Гамільтона та шкала самооцінки депресії; на рівні активності: шкала функціональної незалежності FIM (Functional Independence Measure); на рівні участі: шкала DASH (The Disabilities of the Arm, Shoulder and Hand Score), опитувальник військового). Результати. Запропоновано схему реабілітаційного обстеження, яка включала спостереження, опитування, збір анамнезу, визначення рухових порушень і рівня якості життя та базувалася на доменах Міжнародної класифікації функціонування, обмежень життєдіяльності та здоров’я (МКФ), спрямованих на покращення показників якості життя, корекцію рухових розладів та повернення пацієнтів до попереднього рівня функціонування. Проведене первинне обстеження дозволило чітко сформулювати реабілітаційний діагноз, визначити категоріальний профіль пацієнтів для подальшого планування і розроблення алгоритму фізичної терапії осіб після вогнепального поранення верхньої кінцівки, спрямованого на поетапне вирішення довго- та короткотривалих цілей реабілітаційного втручання у SMART форматі. Ключові слова: реабілітаційне обстеження, вогнепальні поранення, фізична терапія, рухові порушення, якість життя.

Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

BackgroundEvidence is scarce regarding the polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine.AimTo investigate the prevalence and impact on outcomes of polypharmacy and PIMs in stroke rehabilitation.MethodsA retrospective cohort study was conducted with 849 older inpatients after stroke.Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included Functional Independence Measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay and the rate of home discharge. To consider the impact of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes.ResultsAfter enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = -0.072, P = 0.017), FIM-cognitive score (β = -0.077, P = 0.011), energy intake (β = -0.147, P = 0.004), and home discharge (OR: 0.499; 95% CI: 0.280, 0.802; P = 0.015). PIMs were negatively associated with energy intake (β = -0.066, P = 0.042) and home discharge (OR: 0.452; 95% CI: 0.215, 0.756; P = 0.005).ConclusionsPolypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy and PIMs are negatively associated with outcomes.

The Falls Efficacy Scale International is a valid measure to assess the concern about falling and its changes induced by treatments

Objective To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling. Design Longitudinal observational study, before–after rehabilitation. Setting Inpatient rehabilitation. Subjects A total of 251 neurological patients with balance impairment. Interventions Physiotherapy and occupational therapy aimed at reducing the risk of falling. Main measures Participants (median age, first–third quartile: 74.0, 65.5–80.5 years; stroke and polyneuropathy: 43% and 21% of the sample, respectively) received a balance assessment (Falls Efficacy Scale International included) pre- and post-rehabilitation. Rasch analysis was used to evaluate the Falls Efficacy Scale International. Differential item functioning, which assesses the measures’ stability in different conditions (e.g. before vs. after treatment) and in different groups of individuals, was tested for several variables. Results Patients suffered a moderate balance impairment (Mini-BESTest median score; first–third quartile: 15; 11–19), mild–moderate concern about falling (Falls Efficacy Scale International: 28; 21–37) and motor disability (Functional Independence Measure, motor domain: 70.0; 57.0–76.5). Falls Efficacy Scale International items fitted the Rasch model (range of infit and outfit mean square statistics: 0.8–1.32 and 0.71–1.45, respectively) and the questionnaire's reliability was satisfactory (0.87). No differential item functioning was found for treatment, gender, age and balance impairment. Differential item functioning was found for diagnosis and disability severity, but it is shown that it is not such as to bias measures. Conclusions Falls Efficacy Scale International ordinal scores can be turned into interval measures, i.e. measures of the type of temperature. Being differential item functioning-free for treatment, these measures can be safely used to compare concern about falling before and after rehabilitation, such as when interested in assessing the rehabilitation effectiveness.

How Do Geriatric Scores Predict 1-Year Mortality in Elderly Patients with Suspected Pneumonia?

Background: Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. We aimed to assess the ability of scores that evaluate patients’ comorbidities (cumulative illness rating scale—geriatric, CIRS-G), malnutrition (mini nutritional assessment, MNA) and functionality (functional independence measure, FIM) to predict 1-year mortality in a cohort of older patients having a suspicion of pneumonia. Methods: Our prospective study included consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia enrolled in a monocentric cohort from May 2015 to April 2016. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results: 200 patients were included (51% male, mean age 83.8 ± 7.7). Their 1-year mortality rate was 30%. FIM (p < 0.01), CIRS-G (p < 0.001) and MNA (p < 0.001) were strongly associated with poorer long-term outcomes in univariate analysis. CIRS-G (p < 0.05) and MNA (p < 0.05) were significant predictors of 1-year mortality in multivariate analysis. Conclusion: Long-term prognosis of patients hospitalized for pneumonia was poor and we identified that scores assessing comorbidities and malnutrition seem to be important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care.