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PubMed2005

Antihypertensive medication usage during stroke rehabilitation: the Post-Stroke Rehabilitation Outcomes Project (PSROP).

Blood pressure management is an important issue for the primary prevention, acute management, and secondary prevention of a stroke. Rehabilitation professionals need to consider the timing in lowering blood pressures in stroke survivors, the types of medications that should be used in managing hypertension, and the target pressures to achieve. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the types of antihypertensive medications prescribed to stroke survivors, compare prescription patterns with current practice guidelines of the management of hypertension after a stroke, and determine whether systolic and diastolic blood pressures decrease during admissions to inpatient rehabilitation facilities (IRFs). Of the 1,161 patients in the PSROP database, the most commonly prescribed antihypertensive medications were the angiotensin-converting enzyme antagonists and angiotensin II antagonists, followed by beta-blockers, calcium-channel blockers and diuretics, adrenergics (alpha-blockers), and other (minoxidil, hydralazine) medications. Systolic, diastolic, and mean arterial pressures declined in participants during admissions to IRFs. However, blood pressures were significantly higher throughout IRF stays in participants receiving antihypertensive medications when compared to those not receiving antihypertensive medications. Rehabilitation professionals need to be cognizant of the relationship between stroke and hypertension, clinical practice guidelines that provide evidence-based management tools for hypertension, and patient issues that may hinder the effective treatment of hypertension.

Aged↗
PubMedDate not supplied

Emotional rehabilitation of the physical rehabilitation patient.

Emphasis on the process and content of the emotional aspects of rehabilitation are presented as a process interwoven with a patient's physical rehabilitation. The impact of trauma and subsequent rehabilitation involves for patients the resolution of these stages: shock, denial, depressive reaction, reaction against independence, and adaptation. Factors which facilitate and impede the negotiation of these steps on both the part of the patient and attending staff are examined from the prospective of the psychiatrist as a member of the medical rehabilitation team.

Adaptation, Psychological↗
PubMedDate not supplied

The brain injury rehabilitation scale (BIRS): a measure of change during post-acute rehabilitation.

This article describes the development of the Brain Injury Rehabilitation Scale (BIRS), a 20-item scale rating attention, memory, cognition, goal-directed behaviour, social interaction, and adjustment to injury. The BIRS was designed to provide ratings of clinical progress during post-acute rehabilitation from the perspective of the patient, the family and the treating staff. The BIRS was administered to two groups. Group one included five patients in a post-acute rehabilitation programme who were administered the BIRS each week for the 24 weeks of the programme. Group two was a control group composed of 21 college students. The BIRS was administered to each control subject for three consecutive weeks. The BIRS was found to be a sensitive and reliable measure of rehabilitation progress. Inter-rater reliability was high. Further evaluation of the BIRS is warranted.

Activities of Daily Living↗
PubMed1987

The longitudinal development of a rehabilitation agency: an integrated rehabilitation service delivery model.

Health care services in the late 1980's are undergoing drastic changes. Similarly the laws, insurance regulations, etc. are changing so rapidly that the health care system appears to be having a difficult time keeping up with the ever changing needs of the consumers (that is, the patients). Diagnosis Related Groups (DRGs) have resulted in decreased hospital stays for patients with subacute and chronic conditions, and therefore patients are being care for in outpatient rehabilitation agencies, and/or outpatient clinics associated with hospitals. In short, a patient cannot stay in the hospital unless he or she is acutely ill or in need of surgery. Outpatient care is gradually becoming more important since patients who would have still been in the hospital several years ago, are now released to go home, with an order to receive outpatient therapy at the local rehabilitation agency. Currently there is no model available for starting an outpatient rehabilitation agency, and as a result health care professionals interested in starting such a facility have no guidelines or methodology for establishing a private rehabilitation practice.

Health Facility Planning↗
PubMed1999

Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury.

OBJECTIVE: To provide biomedical researchers and clinicians with information regarding and recommendations for effective rehabilitation measures for persons who have experienced a traumatic brain injury (TBI). PARTICIPANTS: A nonfederal, nonadvocate, 16-member panel representing the fields of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hearing, occupational therapy, nursing, epidemiology, biostatistics, and the public. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 883 members of the public. The conference consisted of (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussions that were part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and part of the third. Primary sponsors of the conference were the National Institute of Child Health and Human Development and the National Institutes of Health Office of Medical Applications of Research. EVIDENCE: The literature was searched through MEDLINE for articles from January 1988 through August 1998 and an extensive bibliography of 2563 references was provided to the panel and the conference audience. Experts prepared abstracts for their conference presentations with relevant citations from the literature. The panel prepared a compendium of evidence, including a patient contribution and reports from federal agencies. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented during the open forum (October 26-28, 1998) and in the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the Internet immediately following its release at the conference and was updated with the panel's final revisions. CONCLUSIONS: Traumatic brain injury results principally from vehicular incidents, falls, acts of violence, and sports injuries and is more than twice as likely to occur in men as in women. The estimated incidence rate is 100 per 100000 persons, with 52000 annual deaths. The highest incidence is among persons aged 15 to 24 years and 75 years or older, with a less striking peak in incidence in children aged 5 years or younger. Since TBI may result in lifelong impairment of physical, cognitive, and psychosocial functioning and prevalence is estimated at 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Mild TBI is significantly underdiagnosed and the likely societal burden is therefore even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance. However, the focus of this conference was the evaluation of rehabilitative measures for the cognitive and behavioral consequences of TBI. Evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI. This research needs to be replicated in larger, more definitive clinical trials and, thus, funding for research on TBI needs to be increased.

Adolescent↗
PubMedDate not supplied

[A comparative analysis of the efficacy of rehabilitative treatment after a surgical intervention in ischemic heart disease patients at a rehabilitation center and under home conditions].

Early 12-week combined rehabilitation of IHD patients after surgery enhances physical performance, diminishes the damage of IHD risk factors, raises quality of life. Physical performance and cardiorespiratory functional reserve improve in a greater degree in patients undergoing rehabilitation according to the individual program in the rehabilitation center. Home rehabilitation also provides positive results but it is less effective.

Aged↗
PubMedDate not supplied

[Psicosocial rehabilitation in schizophrenia: variables related with rehabilitation].

INTRODUCTION: The interest of vocational rehabilitation and integration in patients with chronic mental illness has grown in the last few decades. Different studies has tried identify predictors of vocational outcome with controversial results. In spite of the growing development of this field, there's a lack of studies in Spain looking for specific predictor variables of vocational outcome in schizophrenia. The aim of this study is to identify variables associated to vocational outcome in a social-vocational rehabilitation program (INICIA). METHODS: Two groups of subjects participating in a social-vocational rehabilitation program were selected based on different vocational outcomes. Sociodemographics, clinic, cognitive variables, social competence, basal work skills, and family variables, all assessed at intake, were compared between both groups. RESULTS: In our study, good initial scores in memory, comprehension, social and vocational skills, as well as, lower basal scores in tests of general psychopathology and psychotic symptomatology, were associated with a better vocational outcome. Patients with good insight and with lower number of previous admissions also showed better outcomes. CONCLUSIONS: Initial scores in different domains could be a useful guide to predict the outcome in some of the current rehabilitation programs. We come to the conclusion about the importance of developing future research studies about predictors of vocational outcome in patients with severe mental illness in our country.

Adult↗
PubMed2001

Rehabilitation and rehabilitation nursing.

This article provides some of the foundational content that forms the basis of rehabilitation and rehabilitation nursing. The content included definitions, rehabilitation philosophy, and rehabilitation teams. A particular case example was integrated throughout the article to exemplify the content.

Adult↗
PubMed1991

[Individual rehabilitation planning in the vocational rehabilitation of mentally ill young people].

For many young people, their aspiration for an environmentally compatible, and societally meaningful, field of activity is very marked and reflects the values they hold. Vocational rehabilitation should be oriented accordingly, and take up the motivational potential implied. The more accurate the knowledge of previous vocational experience, motivations, attitudes toward work, and of the subjective difficulties in coping with work-related requirements, the more detailed can vocational rehabilitation planning be devised. The potential is increased by a concept that is guided by insights from the psychology of work and emphasizes individual rehabilitation planning as well as follow-along developmental counselling. Assessment of 52 individual service instances for mentally ill youths and young adults, of Berlin-Kreuzberg, revealed an appropriate placement quota of 67%. The developmental course taken in the individual cases shows that satisfactory long-term outcomes can be achieved through careful entry diagnostics, individual rehabilitation planning, ongoing developmental counselling, selective educational intervention, industrial try-outs, as well as stabilizing aftercare.

Adaptation, Psychological↗
PubMed1988

[Rehabilitation treatment of patients with sequelae of stroke at a specialized rehabilitation center in Leningrad].

The article reviews a ten-year experience with rehabilitation of post-stroke patients accumulated at specialized in- and out-patient rehabilitation centers. The authors present the principles of structuring the recovery process, as well as the main components of rehabilitation programmes, individual methods, and their combination. The ultimate results of rehabilitation treatment are considerably better than those observed following the traditional chemo- and physiotherapy.

Adult↗
PubMed1986

[Effect of stepwise rehabilitation of patients with various types of myocardial infarct on their work capacity and disability and means of increasing the social efficacy of rehabilitation measures (cooperative study)].

The results of stepwise rehabilitation as part of current state-wide rehabilitation system, on working capacity and invalidism of the survivors of transmural, large-focal and small-focal myocardial infarction and 2 years' follow-up of 2193 patients of giving age are reported. Combined stepwise rehabilitation improves working capacity and invalidism rates both within the first and second year after myocardial infarction. Great potentials of improving social efficacy of stepwise rehabilitation involve better assessment of patients' condition, using specific criteria (clinical ones in particular) with due regard to acceptable and unacceptable occupations, careful choice of adequate jobs and correct estimation of the duration of temporary postinfarction disability.

Adult↗
PubMed1998

[Integrated occupational work capacity evaluation in medical rehabilitation--experiences and prospects exemplified by psychosomatic rehabilitation].

Psychosomatic rehabilitation is often initiated when lasting work disability, loss of job, and pension application have occurred. After a review of the relevance of vocational strains and of predictors for reintegration, we present a model of an integrated work hardening programme in Psychosomatic Rehabilitation. Results for 64 patients are illustrated by case vignettes. Especially when lasting work disability and unemployment have undermined the patients' sense of competence and endurance, work hardening promotes return to work, realistic self-appraisal and vocational reorientation. The social and medical assessment and the coordination of vocational rehabilitation measures are improved. The implementation of a work hardening programme requires the provision of a variety of (unpaid) work opportunities, independent assessment of work performance by supervisors and social worker, psychological support and close cooperation with rehabilitation services.

Adolescent↗
PubMed2003

Multimodal rehabilitation for faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation.

BACKGROUND: Sphincter exercises and biofeedback therapy have been used to treat faecal incontinence but results have been unpredictable and standards of treatment have not yet been established. The aim of this study was to retrospectively evaluate the effects of a new multimodal rehabilitation model on faecal incontinence. METHODS: All of the rehabilitative procedures are guided by manometric data. Primary study outcome criteria were the determination of changes or deterioration in incontinence, failure to achieve full continence and/or presence of faecal urgency. The clinical outcome was designed according to the Jorge-Wexner incontinence score. RESULTS: Between 1997 and 2001, one hundred forty-nine incontinent patients (85 F and 64 M; age range, 41-73 years; mean age, 60.6 years) underwent multimodal rehabilitation at our outpatient unit. The overall mean incontinence score had significantly improved after treatment ( p<0.001), and 58 patients (38.9%) were symptom free. No patient reported any deterioration in incontinence. Faecal urgency persisted in 23 patients (15.4%). CONCLUSION: In conclusion, multimodal rehabilitation, using manometric study, can modify the incontinence score.

Adult↗
PubMed2003

[Developing an evidence based clinical guideline on cardiac rehabilitation--Phase 2: comparative analysis of the present level of service provision in cardiac rehabilitation based on the KTL statistics].

BACKGROUND: This project aims to develop an evidence based clinical guideline for the rehabilitation of cardiac patients considering recent scientific literature (stage 1), procedures received by cardiac patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) based on the Classification of Therapeutic Procedures (KTL) (stage 2), and expert agreement of the professionals involved (stage 3). This study presents the results of stage 2. The analysis of the KTL-statistics was carried out to determine whether it is essentially necessary to implement a guideline and to define "critical" aspects, i. e. aspects that require high priority implementation. The project is part of a research programme funded by the BfA. METHODS: 317 out of the 840 possible KTL-codes were attributed to one of twelve therapeutic modules that--according to the results of stage 1--are characteristics of cardiac rehabilitation. For these modules the number of people having received therapeutic procedures belonging to the respective module the duration per patient and per week were calculated. The influence of concomitant factors such as age, gender and indication were analysed multivariately. Furthermore, the hospitals involved were compared. The analyses are based on approximately 87,400 KTL-entries from 5,494 patients (indication: "myocardial infarction" or "coronary artery bypass surgery") treated in 2000. RESULTS: On average the patients receive therapeutic procedures "stemming" from 5.5 modules. More than 90 % receive procedures assigned to the modules "endurance training" or "motivation", respectively, and almost 70 % from "nutrition training". The other modules are rendered not consistently and occasionally to a relatively small degree. Younger patients following a myocardial infarction receive therapeutic procedures more frequently and longer while older patients after bypass surgery are treated less frequently and for a shorter duration. There is substantial variability between individual clinics. DISCUSSION: It appears to be necessary to implement clinical practice guidelines in all evaluated therapeutic modules but "endurance training" and "motivation". An evidence based clinical practice guideline for the rehabilitation of cardiac patients should detail the kind and extent of procedure(s) required. It should also inform about the lack of evidence for variations in treatment with respect to age, gender, or indication. To facilitate monitoring of the degree of implementation of the guideline precise instructions for the documentation using the KTL should be developed and implemented. As a next step towards an evidence based, empirically proven and acceptable guideline this project's results will be discussed with experts from science and clinical practice.

Combined Modality Therapy↗
PubMed2004

[Cluster formation - an operationalization of rehabilitation success in rehabilitants with chronic low back pain].

To investigate the impact of the way of allocation for rehabilitation on rehabilitation success in patients with chronic low back pain it was necessary to define appropriate criteria of success. A multidimensional model of success is presented in this article. First, the outcomes of rehabilitation are described and statistically tested. No statistically or clinically relevant changes between pre and post measurements were found. For further analysis of predictors and group comparisons it is necessary to define multidimensional success. For this purpose, cluster analyses are introduced as a possible model, resulting in three groups of patients with differing outcomes, i. e.: 20 % patients with declined pain symptoms, 40 % patients without any changes, 40 % patients with increased symptoms. No impact of the way of allocation for rehabilitation could be verified.

Adult↗
PubMed1996

Rehabilitation after total knee arthroplasty: a comparison of 2 rehabilitation techniques.

This study was conducted to compare postoperative total knee arthroplasty rehabilitation protocols. The hypothesis of this study was that patients undergoing total knee arthroplasty could achieve range of motion and hospital discharge in the same period using a postoperative rehabilitation protocol that did not use a continuous passive motion machine. This randomized prospective study compared 46 total knee arthroplasties in which a continuous passive motion machine was used with 37 total knees that were rehabilitated with early passive flexion of the knee (named drop and dangle protocol). Postoperative physical therapy regimens were otherwise the same for both groups. Surgical technique was the same for both groups except for closure which was performed in the drop and dangle group with the knee at 90 degrees to 95 degrees flexion. Only patients with osteoarthritis were included in the study, and in both groups of patients received the same prosthetic components. Patients in the drop and dangle group were discharged from the hospital 1 day earlier (p = 0.01) and had a statistically better extension range of 2.8 degrees at 6 months (p = 0.03). Knees in the drop and dangle group had less drainage (p = 0.06). Range of motion and hospital discharge can be achieved in a similar time interval with the drop and dangle technique as with using a continuous passive motion device, and that such a device is not required for postoperative knee rehabilitation.

Adult↗
PubMed1996

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months.

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.

Aged↗
PubMed2001

Pulmonary rehabilitation in outpatients with asthma or chronic obstructive lung disease. A pilot study of a "modular" rehabilitation programme.

STUDY/PRINCIPLES: Pulmonary rehabilitation programmes are often costly and dependent on the infrastructure of specialised centres. We developed a modular, outpatient-based rehabilitation programme, which is inexpensive and can be implemented in a variety of settings. The aim of this study was to determine the effects and feasibility of this programme. METHODS: Thirteen patients with COPD and 7 patients with asthma were enrolled by their primary care physician because of dyspnoea. Initial assessment included cardiopulmonary exercise testing, six-minute walking distance, lung function testing and multiple questionnaires addressing dyspnoea, depression and quality of life issues. The training consisted of 36 sessions of high intensity training of 2 hours duration to improve exercise tolerance, including 30 minutes of stationary cycling at the anaerobic threshold. Another complete assessment was done on completion of the study at 3 months. RESULTS: The six-minute walking distance improved significantly from 401 to 551 m (p < 0.0001). The maximal exercise capacity increased significantly from 85 W to 99 W (p < 0.001). The anaerobic threshold remained unchanged despite the high intensity training. There was a reduction of dyspnoea and an improvement of quality of life. CONCLUSION: This study shows that our outpatient rehabilitation programme leads to a benefit in exercise tolerance and health related quality of life comparable to other programmes published in the literature. The rehabilitation programme was very well accepted among patients, primary care physicians and health insurers.

Adult↗