Psychoeducation Strategy: Acceptance and Commitment Therapy (ACT) To Improve Self-Efficacy of Stroke Patients

Background: Stroke is the most common cerebrovascular event. Stroke patients often have biological, spiritual, and psychosocial changes. Psychosocial problems experienced in stroke patients include problems with self-efficacy. Acceptance and Commitment Therapy (ACT) is commonly used to solve psychosocial problems. Objective: This study aims to determine the effect of ACT on the self-efficacy of stroke patients. Methods: This study utilized quantitative and quasi-experimental designs without a control group. The study was conducted in a selected hospital rehabilitation unit in Yogyakarta. The respondents were selected via the purposive sampling technique. The self-efficacy was assessed using The Strategies Used by Patients to Promote Health (SUPPH) questionnaires and statistically tested with the Wilcoxon test. The total number of respondents of this study was 33 stroke patients. The characteristic of respondents was mostly 45 – 64 years old (72.73% ), male (57.6%) and, had a history of stroke for 1 – 6 months (39 %). Result: Wilcoxon test results showed a computed p-value of 0.000 on the effect of ACT on stroke patients’ self-efficacy; thus, the null hypothesis was rejected. In other words, ACT proves its effectiveness in improving stroke patients’ self-efficacy. Conclusion: Based on the data, this research can be concluded that ACT effectively improved the self-efficacy of stroke patients. The researchers recommend utilizing ACT as a nursing intervention for stroke patients in the hospital rehabilitation unit.

CSA-AKI: Incidence, Epidemiology, Clinical Outcomes, and Economic Impact

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication following cardiac surgery and reflects a complex biological combination of patient pathology, perioperative stress, and medical management. Current diagnostic criteria, though increasingly standardized, are predicated on loss of renal function (as measured by functional biomarkers of the kidney). The addition of new diagnostic injury biomarkers to clinical practice has shown promise in identifying patients at risk of renal injury earlier in their course. The accurate and timely identification of a high-risk population may allow for bundled interventions to prevent the development of CSA-AKI, but further validation of these interventions is necessary. Once the diagnosis of CSA-AKI is established, evidence-based treatment is limited to supportive care. The cost of CSA-AKI is difficult to accurately estimate, given the diverse ways in which it impacts patient outcomes, from ICU length of stay to post-hospital rehabilitation to progression to CKD and ESRD. However, with the global rise in cardiac surgery volume, these costs are large and growing.

Research in the Critical Care Environment

Research into the psychological impact of critical care has burgeoned over the past 20 years. This chapter outlines the major areas of psychological and rehabilitation research being conducted in critical care, as well as the gaps that remain to be filled. The authors review research areas corresponding to the early acute critical care phase, the in-hospital rehabilitation phase, and the post-hospital recovery period. The focus is on patient-centered research. The authors also review how clinicians can set themselves up to conduct psychological research, what kind of teams they need to assemble, and the challenges they could face working in critical care environments. The authors draw on their own experiences conducting linked, critical care psychology research studies, and compare this to methods used by other researchers.

Early hospital trainings in patients with left ventricular mechanical support: influence on exercise tolerance and muscle strength

Background In extreme cases of heart failure, the only method of treatment is heart transplantation. Due to the insufficient number of organs for transplantation, left ventricular assist devices (LVAD) are increasingly being used. Rehabilitation of patients with LVAD is a very important element of complex therapy due to the long-term immobilization of these patients awaiting transplant or regeneration of the heart. The aim of the study was to assess the impact of early hospital rehabilitation on exercise tolerance, muscle strength and complex coordination in patients after LVAD implantation. Material and methods The study included 37 patients (35 men), aged 19–66 years, mean 58.7 years, after LVAD implantation. All of them underwent standard rehabilitation in the postoperative and rehabilitation department. The patients have started and continued trainings in a rehabilitation department for 4–5 weeks: endurance trainings, general fitness exercises with elements of balance and coordination exercises, elements of resistance exercises. Before the start of rehabilitation and after its completion, all patients underwent: cardiopulmonary exercise testing (CPET), a six-minute walk tests (6-MWT), the tests of strength of the right and left hand grip, strenght of muscles of the lower limbs and complex coordination (up and go test). There were no adverse events that would justify changing the mode or discontinuing rehabilitation. Results A significant increase in the value of most of the parameters studied was observed after the completion of hospital rehabilitation: VO2peak [ml/kg/min], baseline: 10.60 (9.60, 12.90) vs. 12.85 (11.60, 15.73), p<0.001; 6-MWT [m]: 322.81 (113.62) vs. 416.12 (106.37), p<0.001; 30 second chair stand: no of stands: 9.12 (3.60) vs. 11.18 (4.50), p<0.001; up & go [sec] 9.18 (8.07, 10.50) vs. 7.58 (6.69, 9.04), p<0.001; left hand grip strengh [kg]: 30.04 (8.38) vs. 31.91 (8.10), p<0.011; right hand grip strengh [kg]: 31.52 (9.88) vs 33.20 (8.72), ns. Conclusions Early hospital rehabilitation in patients after implantation of left ventricular assist devices has significant benefits in terms of exercise tolerance, muscular strength and complex coordination. Complex rehabilitation is safe and effective in this group of patients. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): STRATEGMED II - RH-ROT - NATIONAL RESEARCH AND DEVELOPMENT CENTER

Comprehensive Rehabilitation After Reconstruction of the Anterior Cruciate Ligament

Introduction: The knee joint is the second most frequently injured joint. Anterior cruciate ligament (ACL) injury is a relatively common injury to the inner part of the knee joint, mainly related to contact sports. Its rupture leads to instability of the entire joint. Two treatment options are possible: operative or conservative. Each of them is related to an appropriate rehabilitation process. The aim of this study was to define a comprehensive rehabilitation plan in patients after ACL rupture and meniscal suturing.Materials and methods: The work was written based on the medical history of the patient who was diagnosed with complete rupture of ACL, and then reconstruction was performed with the harvesting of a semitendinous and slender muscle graft.Results: The rehabilitation process can be divided into two stages: hospital and post-hospital. Rehabilitation in hospital conditions begins on the zero day after arthroscopy. The main goals of rehabilitation include: increasing the range of mobility, no myofascial dysfunctions, no thromboembolic complications, and the ability to self-service.Conclusion: Rehabilitation is an indispensable element of the treatment of patients after ACL reconstruction. Early initiation of rehabilitation brings tangible benefits during treatment and return to full physical fitness.

In-hospital rehabilitation in the treatment of multiple myeloma

Wprowadzenie: Szpiczak mnogi (MM) jest jednym z najczęstszych złośliwych nowotworów kości. Podstawową procedurą leczenia szpiczaka mnogiego jest chemioterapia połączona z autologicznym przeszczepem komórek macierzystych. Leczenie operacyjne, polegające na wycięciu guza, jest wskazane, gdy istnieje ryzyko patologicznego złamania kości lub ucisku guza na korzenie nerwowe. Konieczne jest stworzenie indywidualnego planu leczenia we współpracy interdyscyplinarnej. Ważnym elementem leczenia jest pomoc w zakresie rehabilitacji. Celem pracy było wskazanie procedur rehabilitacyjnych w leczeniu szpiczaka mnogiego po rekonstrukcji endoprotezy w okresie szpitalnym.Materials and methods: The work was written based on the medical history of a patient diagnosed with multiple myeloma in the proximal part of the right femur. The entire treatment procedure was carried out at the Department of Orthopedics, Traumatology and Oncology of the Musculoskeletal System, located at Unii Lubelskiej 1 in Szczecin.Results: Rehabilitation in the treatment process of patients after resection of the tumor in the proximal part of the femur and arthroplasty is implemented as early as 1 day after the surgery in order to activate the patient as soon as possible. The rehabilitation program was as individualized as possible to the patient and included modern techniques such as osteopathy and manulana therapy.Wniosek: Rehabilitacja jest nieodzownym elementem leczenia chorych na nowotwory. Wprowadzenie do rehabilitacji nowoczesnych technik wpływa pozytywnie na skuteczność terapii. Wczesne rozpoczęcie rehabilitacji przynosi wymierne korzyści w trakcie leczenia i powrót pacjenta do aktywnego udziału w życiu społecznym.

Patients Undergoing Hip or Knee Arthroplasty in Poland Based on National Data—Challenge for Healthcare in Aging Society

Arthroplasty procedures are more frequently performed due to their impact on the quality of life. The aim of this study was to evaluate and analyze the Polish national datasets and registries for hip and knee arthroplasty across Poland in order to describe and understand the challenges for healthcare in an aging society. The study included national data on 83,525 hip or knee arthroplasties performed in 2017. Of those, 78,388 (93.8%, 63.0% females) were primary operations: 66.6% underwent hip replacement surgery (HPRO, mean age 68.43 years, SD 11.9), and 5137 were secondary operations (females: 62.9%), with 75.2% of those being HPRO (mean age 69.0 years, SD 12.0). The mean age of the patients undergoing knee surgery (KPRO) was 68.50 years (SD 8.2). The majority (79.9%) were scheduled. The main reason for hospitalization was arthrosis (84.2% in total, HPRO—76.5%, and KPRO—99.5%), then trauma (15.1%; p < 0.001). In 5137 cases (6.2%, 62.9% females) in revision surgery group, 75.2% underwent HPRO (mean age 69.0 years; SD12.0), and 24.8% KPRO (mean age 68.0 years; SD 10.5). Similarly, 71.1% were scheduled. The main reason for hospitalization was complications (total—90.9%, HPRO—91.4%, and KPRO—89.4%) (p < 0.001). Comorbidities were present (over 80%) with the level of influenza, hepatitis B vaccination, and pre-hospital rehabilitation not exceeding 8% each in both groups. Due to the increasing age of patients, implicating comorbidities, there is a need for better preparation prior to surgery.

Analysis of Home-Based Rehabilitation Awareness, Needs and Preferred Components of Elderly Patients with Hip Fracture Surgery in South Korea

The importance and necessity of home-based rehabilitation with professional and systematic interventions should be considered since home-based rehabilitation has been institutionalized as it is more feasible, cost effective, and even safer than in-hospital rehabilitation in most countries—though not in South Korea. In addition, the need for home-based rehabilitation is increasing due to the increasing number of hip fracture patients and limited capacity of acute hospital rehabilitation. Therefore, the purpose of this study was to investigate the awareness, needs, and preferred components of home-based rehabilitation services after discharge for elderly patients with hip fracture surgery in South Korea. A survey of 98 elderly patients who recently underwent hip fracture surgery was performed using a questionnaire. More than 75% of patients agreed on the need for home-based rehabilitation, even though most had never heard of it. The reason for the need for home-based rehabilitation was that it is possible to receive continuously ongoing treatment (53.0%), and it alleviates the inconvenience of visiting hospitals (27.7%). In addition to this, about 15.7% of patients responded that they could achieve mental comfort. In other words, patients can recover in an emotionally stable environment without the psychological anxiety they might experience in hospital. Thus, in order to maximize the effectiveness of home-based rehabilitation and provide comprehensive guidance including exercise, education, motivational support, and environmental modification, to patients undergoing hip fracture surgery, the component of the rehabilitation program must be developed based upon rehabilitation experts’ knowledge and patients’ value. Additionally, corresponding policies should be established.