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PubMed2001

A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD.

The use of health status as an outcome measure is becoming more widespread in pulmonary rehabilitation. There are a number of health status measures but the choice remains uncertain. Three disease specific measures and two generic measures of health status were employed to observe their relative sensitivity to a 7-week course of pulmonary rehabilitation. Patients with stable chronic obstructive pulmonary disease (COPD) were recruited into a rehabilitation programme. They completed a shuttle-walking test and three disease-specific questionnaires: the Chronic Respiratory Questionnaire (CRQ), the St. George's Hospital Respiratory Questionnaire (SGRQ) and the Breathing Problems Questionnaire (BPQ). Patients also completed two generic questionnaires: a global quality-of-life scale and an activity checklist. Ninety-seven patients [58 male mean (SD) age 67 (8.7) years] completed the course over a 12-month period. The mean pre-rehabilitation (SD) FEV1 was 1.06 (0.59) l. The shuttle-walking test and the treadmill-endurance test increased significantly after rehabilitation (P<0.001). All three disease-specific questionnaires improved significantly (the CRQ and SGRQ improved beyond minimum clinically important difference). The global score improved significantly whilst the 'things people do' decreased. All three disease-specific measures were responsive to pulmonary rehabilitation. However the operator-led CRQ appears to be the most sensitive short-term outcome measure.

Aged↗
PubMedDate not supplied

[Rope pulley isokinetic system in shoulder rehabilitation--initial results].

AIM: Of this study was to evaluate the results of a shoulder rehabilitation program of different shoulder diseases, based on an isokinetie pulley system ("Moflex", Recotec/Bernina, Swiss). METHOD: In this prospective study 70 patients participated in a standardized rehabilitation program (instability: n = 19; rotator cuff disorders: n = 23; impingement syndrome without lesion: n = 16; others: n = 12; operative therapy: n = 47). The major aspect of the program was an isokinetic pulley system. RESULTS: Isokinetic training with the used device affords strict monitor-feedback to avoid critical torque values. Strength which was attained without relevant pain was almost linearly increased by a mean of 31% until the 20th day of rehabilitation, workload by 79%. At the end of the rehabilitation program the strength of the affected (mostly dominant) shoulder was 15% higher than in the unaffected shoulder; the respective workload values were almost equal. CONCLUSION: These first results demonstrate the value of the isokinetic pulley system in the rehabilitation of the investigated shoulder diseases. The equipment may be used already in an early postoperative state. First results of strength increases using an isokinetic pulley system in shoulder rehabilitation are presented.

Adult↗
PubMed2001

[Ambulatory long-term cardiac rehabilitation--one year results].

After acute hospital therapy of myocardial infarction or bypass surgery the patient in Germany will be treated using an inpatient rehabilitation programme for 3-4 weeks. One year later only 10% of them are still active in outpatients groups. In our study 61 cardiac patients performed an one-year outpatient rehabilitation (instead of 4 weeks inpatient) programme with intense supervised exercise and behaviour therapy. The money input per patient was the same for the usual care 4 weeks inpatient (6000 DM) as for 1 year outpatient rehabilitation (5800 DM). The exercise capacity per heart rate-blood pressure-product was increased by 43% (p > 0.01) after 12 months. The maximum exercise capacity was reached in the 57th week. Without increased medical treatment, cholesterol and LDL-cholesterol were reduced after 12 months by 3.9% down to 195 +/- 25 mg/dl or by 6.6% down to 122 +/- 21 mg/dl, respectively (n.s.). HDL-cholesterol increased by 2.8% to 48 +/- 8 mg/dl (n.s.). This study shows results similar to outpatient rehabilitation programmes in the United States or in Sweden. The long intervention time and the intensity are main factors for the success of cardiac rehabilitation and patient health. Financial resources should primarily be concentrated on long-term outpatient rehabilitation programmes.

Aged↗
PubMedDate not supplied

[Pulley system isokinetic training in knee rehabilitation--initial results].

AIM: The purpose of this study was to evaluate the results of a knee rehabilitation program after knee surgery, based on an isokinetic pulley System (Moflex, Recotec/Bernina, Switzerland). METHOD: In this prospective study, 73 patients participated in a standardized rehabilitation program (ACL reconstruction, ACL/all: n = ;51; patellar tendon, ACL/P: n = 30; semitendinosus tendon, ACL/S: n = 21; arthroscopic meniscus resection: n = 22). The major aspect of the program was an isokinetic pulley system with an implemented, linearly working knee device. RESULTS: Isokinetic training with the used device affords strict monitor feed-back to avoid critical torque values. Concentric training strength and workload which were attained without relevant pain were increased by about 130% within a mean of 16 rehabilitation days. At the end of the rehabilitation program, the maximum concentric strength of the affected knee measured by a rotating isokinetic system (Cybex, Kaphingst, Lahntal) increased by about 69% and amounted to about 90% of that of the unaffected knee. CONCLUSION: These first results demonstrate the value of the isokinetic pulley system in the rehabilitation after knee surgery as described above. The equipment may be used already in an early postoperative stage by the use of a passive or active-assistive mode. First results of strength increases using an isokinetic pulley system in knee rehabilitation are presented.

Adult↗
PubMed2004

[Treatment specificity in chronic-back pain: is optimized rehabilitation allocation enough?].

The multidimensional and heterogeneous etiogenesis of chronic low back pain requires multimodal as well as specific treatment programmes. Aim of the present study was to increase the specificity of treatment already at the interface "family health care - assigning institution - rehabilitation clinic" by supporting the assignment to orthopaedic or psychosomatic rehabilitation through extensive diagnostics and deriving a patient's profile of risk factors in the forefield of rehabilitation. In a prospective randomized control group design the rehabilitation success in 309 persons (age 22 - 58) suffering from chronic low back pain was compared on risk factor specific vs. conventional assignment. Between 22 % and 27 % of the assignments following conventional criteria have to be considered as false. On the other hand, rehabilitation success did not turn out to have been increased by specific assignment. In conclusion, implications for more far-reaching change in treatment programmes within and subsequent to stationary rehabilitation are discussed.

Adult↗
PubMed2006

[Multimodal therapy of children with attention deficit/hyperactivity disorder and their parents in in-patient rehabilitation].

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent psychic disorders of childhood, characterized by high persistence and an increased risk for the development of externalising disorders of behavior. Due to ADHD increased problems can be frequently observed at school as well as in the social and emotional context of the child. Concepts for in-patient rehabilitation have not been developed, although effective modifications of the behavior of ADHD patients appeared to be achievable under the conditions found in in-patient rehabilitation. OBJECTIVE: The present pilot study aimed to evaluate whether this newly developed concept has any benefit on psychological problems, coping and quality of life. METHOD: In total, n = 28 boys with ADHD 7 to 12 years old were included into a quasi-experimental pre-post design and completed self-report questionnaires on psychological problems, coping and quality of life. In addition, 26 mothers evaluated the behavior problems, psychological problems and quality of life of their sons at the beginning and the end of in-patient rehabilitation. During a 4-week in-patient rehabilitation all children and their mothers took part in a multimodal training containing components of behavior therapy and cognitive-behavioral therapy (self-instruction, self-management, and stress management), applied in child-, parent-child- and parent-centered interventions. RESULTS: Parents estimated the behavior problems of their children as significantly reduced after in-patient rehabilitation as compared to before. In addition, psychological problems and quality of life improved significantly in self- and parent-proxy reports during the in-patient rehabilitation. CONCLUSION: Our results support the hypothesis that this multimodal therapy concept is an effective tool for the treatment of ADHD patients. However, a replication of our results in a control-group study on a larger population is required.

Adolescent↗
PubMed1998

[Regional muscle flap-plasty and adjuvant measures for rehabilitation of the paralyzed face].

BACKGROUND: The loss of facial nerve activity reduces the quality of life in regard to functional disturbances and to the appearance of the patient. As far as possible a reconstruction of the facial nerve should be advocated. Only this procedure allows the natural variety of differentiated facial expression. If reconstruction of the facial nerve is not indicated or turns out to be unsatisfactory, a dynamic muscle transposition should be considered. PATIENTS AND METHODS: The patient records of the ENT-Departments in Fulda for the period from 1988 to 1995 and in Mönchengladbach from 1993 to 1995 were reviewed to survey the experience of secondary plastic rehabilitation of the paralysed face. Our special interest focussed on the oral region with dynamic muscle transfer. The techniques leading to rehabilitation of the lid region were included in this study. RESULTS: Transfer of the temporalis muscle was performed 12 times and a masseter muscle flap 4 times to rehabilitate the oral region. Static rehabilitation (canthoplasty, tarsorrhaphy) of the lid was performed 8 times, implantation of a gold weight in the upper lid 5 times and dynamic rehabilitation of the lid region with a temporalis muscle transposition once. CONCLUSIONS: Rehabilitation of the oral region is best managed with a temporalis muscle flap because of its favourable vector of tension and its broad, flat form. Masseter muscle transposition is particularly indicated if a temporalis muscle transfer is not possible or if resection of the facial nerve because of malignancy of the parotid gland has to be performed and nerve reconstruction is not advisable.

Adult↗
PubMed2001

Cardiac rehabilitation in the elderly.

BACKGROUND: Although patients >/=65 years old account for the majority of cardiac admissions and procedures in the United States, studies of cardiac rehabilitation have traditionally focused on younger patients. Only recently has the effectiveness of cardiac rehabilitation in the elderly population begun to receive more attention. METHODS: We present a comprehensive literature review of studies that have looked specifically at the effectiveness of cardiac rehabilitation in the elderly. We discuss the methodologic limitations of studies to date, compare outcomes among elderly rehabilitation patients with those of younger patients, and examine barriers to participation among the elderly. RESULTS: The majority of studies published to date have been small observational case series. Despite these limitations, these studies generally show consistent improvements in exercise capacity, cardiac risk factors, and quality-of-life parameters in elderly cardiac rehabilitation patients. These benefits appear to be similar to those seen in younger patients. In spite of this, participation rates among the elderly are low, primarily because of less aggressive referral. CONCLUSIONS: Although further studies are necessary, the current literature shows that cardiac rehabilitation is associated with improved outcomes after a cardiac event, regardless of age. However, innovative recommendation and referral strategies are needed because few elderly patients actually enroll.

Age Factors↗
PubMed2002

Improvements in blood rheology after cardiac rehabilitation and exercise training in patients with coronary heart disease.

OBJECTIVES: Our purpose was to examine the effect of cardiac rehabilitation and exercise training on blood rheology in patients with coronary heart disease (CHD). Although increased blood and plasma viscosity have been associated with an increased risk of CHD, the effects of cardiac rehabilitation and exercise training on blood rheology in patients with CHD are uncertain. METHODS: We assessed whole blood effective viscosity (mu), hematocrit standardized blood viscosity (mu45)), red blood cell transport efficiency (tau(rbc)), and plasma viscosity (PV) in 23 nonsmoking patients with CHD before and after a phase II cardiac rehabilitation and exercise training program. In addition, we compared the group data with the data of a healthy reference group of 10 subjects. RESULTS: Patients with CHD had significantly elevated mu (3.35 +/- 0.35 cp vs 3.06 +/- 0.19 cp, P <.05) and mu45 (3.51 +/- 0.29 cp vs 3.12 +/- 0.06 cp, P <.001) and reduced tau(rbc) (12.7% +/- 1.0% x cp(-1) vs 14.2% +/- 0.7% x cp(-1), P <.001) compared with healthy subjects. After rehabilitation, patients with CHD had reductions in PV (1.85 +/- 0.18 cp vs 1.77 +/- 0.11 cp, P <.01) and mu45 (3.58 +/- 0.22 cp vs 3.39 +/- 0.22 cp, P <.0001) and an increase in tau(rbc) (12.4% +/- 0.8% x cp(-1) vs 13.2% +/- 0.9% x cp(-1), P <.0001). CONCLUSIONS: Cardiac rehabilitation improves blood rheology in patients with CHD by reducing mu45 and PV and elevating tau(rbc). These improvements may contribute to the increased functional capacity and reduced morbidity and mortality that is associated with participation in cardiac rehabilitation and exercise programs.

Aged↗
PubMed2002

Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease.

BACKGROUND: Although cardiovascular rehabilitation and exercise training have substantial benefits in various ischemic heart disease (IHD) risk factors and subsequent prognosis after major IHD events, there is a paucity of information about its effects on autonomic regulation (such as heart rate variability [HRV] and baroreflex gain), particularly considering its arterial and cardiopulmonary components. METHODS: We studied 40 patients (aged 60 +/- 6 y) after major IHD events, including 29 who underwent a comprehensive phase II cardiac rehabilitation and exercise training program and 11 controls who did not attend cardiac rehabilitation. Specifically, we determined whether active training improves prognostic indices of autonomic regulation of the SA node and whether changes in baroreflex gain could be ascribed to the arterial or to the cardiopulmonary component of the overall arterial pressure/heart period baroreflex. RESULTS: Only patients with IHD undergoing active rehabilitation demonstrated a significant increase in R-R interval, in its variance, in overall gain of arterial pressure/heart period baroreflex (7.44 +/- 1.20 ms/mm Hg to 12.12 +/- 1.48 ms/mm Hg, P <.001) and in peak oxygen consumption (Delta = 2.45 mL/kg/min, P <.001). Separate examination of the selective arterial and cardiopulmonary components showed that only the latter increased significantly (6.17 +/- 1.09 ms/mm Hg to 10.62 +/- 1.56 ms/mm Hg; P <.01). CONCLUSIONS: Cardiac rehabilitation is associated with significant improvements in autonomic markers of neural regulation of the SA node, such as increases in R-R variance and the gain of the overall spontaneous baroreflex, with specific improvements in the cardiopulmonary component as opposed to the arterial baroreflex component of this system. These improvements may further explain the reduction in morbidity and mortality noted after formal cardiac rehabilitation and exercise training programs.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Chiropractic rehabilitation of the cervical spine.

BACKGROUND: Rehabilitation has been a part of chiropractic almost since the beginning of the profession. Yet today, relatively few chiropractors provide rehabilitation in any systematic way in their practices. The modern era of health care calls for all spine specialists to emphasize exercise in their management strategies, and the chiropractic profession has the opportunity to establish itself as a leader in the area of rehabilitation in patients with spine-related disorders. OBJECTIVE: To present the principles and techniques of cervical rehabilitation as it is used by the author and explain the rationale for these procedures based on current knowledge of the neurophysiology of the cervical spine. CONCLUSION: Rehabilitation of the cervical spine can be performed by virtually any chiropractor because effective rehabilitative methods can be applied with minimal space and equipment. The methods presented here are designed to assess several essential functions of the cervical spine and apply procedures that are designed to maximize these functions while monitoring the clinical response to the management strategy. Future research in this area should provide more information about cervical function and assist in the development of improved management of patients with cervical spine syndromes.

Cervical Vertebrae↗
PubMed1988

Effect of the duration of malnutrition and of nutritional rehabilitation on blood glucose homeostasis and pancreatic hormones in rats.

1. To study the efficiency of rehabilitation after different periods of protein-energy malnutrition, we used as a model preweaning malnourished rats. After weaning, male Wistar rats were fed on a protein-deficient diet (50 g casein/kg) ad lib. for the whole study (DR group) or rehabilitated with normal diet (180 g casein/kg; RR group) from weaning, week 0, or weeks 1, 3, 5, 8 and 16 thereafter. 2. Twelve animals from the DR group were killed at the beginning of each rehabilitation period. The twelve rehabilitated rats were killed after 2 weeks. Body-weight and epididymal adipose tissue weight, blood glucose, plasma immunoreactive insulin (IRI) and immunoreactive glucagon (IRG), and pancreatic contents of IRI and IRG were determined. 3. Food intake of RR rats rose significantly except during the last period where body-weight increased less than that during the previous period. Fat-pad weights increased in the same manner in DR and RR groups. 4. Blood glucose fell and plasma IRG rose significantly without any change in plasma IRI after each rehabilitation period, except during the last period where blood glucose concentrations became stable. Pancreatic IRG and IRI showed the same type of response to those of the plasma. 5. All short-term rehabilitation periods were similarly efficient at producing catch-up growth. High insulin sensitivity of target cells was responsible for good recovery except after long-term malnutrition.

Animals↗
PubMed2006

Vestibular rehabilitation and 6-month follow-up using objective and subjective measures.

CONCLUSIONS: Vestibular rehabilitation improves quality of life by reducing the degree of handicap, improving the ability to perform everyday tasks and providing long-term rehabilitation stability (at 6 months). Recovery of the vestibulo-ocular reflex and the vestibulo-spinal reflex efficiency was proven by the objective results obtained in this study. Vestibular rehabilitation improves both subjective and objective parameters, although no significant correlation between these two indices was found. OBJECTIVE: To determine the outcome of subjective and objective parameters and long-term rehabilitation stability after vestibular rehabilitation in 43 patients with vestibular disorders. MATERIAL AND METHODS: The subjective tests used were the Medical Outcomes Study 36-item Short Form, the Dizziness Handicap Inventory and the Activity-specific Balance Confidence scale. The objective tests used were video-oculoscopy, dynamic visual acuity, the Equitest and the Dynamic Gait Index. All indices were evaluated before and after rehabilitation and at follow-up. RESULTS: All patients showed an improvement in quality of life and a reduction in handicap due to dizziness. Improvement in objective test results was also seen. These results were stable at follow-up. A correlation was found between different subjective measures, but there was no correlation between subjective and objective measures.

Adult↗
PubMed1998

Reflections on evaluative research in audiological rehabilitation.

Changes in service delivery triggered by current conceptualizations of rehabilitation require an accompanying paradigm shift in the approaches used to evaluate the effectiveness of intervention programs in audiological rehabilitation. The present article outlines three fundamental principles of contemporary rehabilitative audiology that have implications concerning the way that audiological rehabilitation services should be conceived and dispensed, as well as the way in which comprehensive evaluative research investigations should be designed and conducted. Traditional treatment efficacy paradigms used to assess the effectiveness of intervention programs in rehabilitative audiology are critiqued. Finally, factors that should guide the development of comprehensive evaluative research paradigms which are consistent with current models of intervention in audiological rehabilitation are outlined.

Correction of Hearing Impairment↗
PubMed1983

The spinal cord injured female in the veterans hospital: the role of the environment in rehabilitation.

The outcome of rehabilitation is influenced by the interface of the patient and his/her environment. A primary element is the physical setting in which rehabilitation occurs. This paper discusses the course of rehabilitation of this center's seven, singly admitted, female spinal cord injured (SCI) patients. Four of the patients were admitted to a private room and three were admitted to an open ward with other male SCI patients. Data were collected from clinical records, letters of complaints on discharge, and personal communication. Those patients accommodated in the private room generally reported less satisfaction with rehabilitation received, remained in rehabilitation longer, and appeared to have experienced more difficulty in achieving independence commensurate with their level of injury. Psychosocial issues prevalent with the private room patients were alienation, isolation, anger, and interpersonal conflicts with the nursing staff. Surprisingly, issues of sex differences, privacy, or modesty were not expressed as primary concerns for the open ward patients. These results suggest that in the interest of maximizing the rehabilitative efforts for the females at this center, attention to the setting in which they spend most of their unscheduled time is of major importance.

Adult↗
PubMed2001

A preliminary study to investigate the empowerment factors of survivors who have experienced brain damage in rehabilitation.

BACKGROUND: This study was an extension of previous studies on the empowering of families caring for a relative who had experienced brain damage. The demand to adopt a similar empowerment concept in the direct rehabilitation of people with brain damage was proposed. OBJECTIVE: The development of a theory-driven instrument, in the form of a person-administered empowerment questionnaire, so as to establish the empowerment factors of people with brain damage during their rehabilitation process. RESEARCH DESIGN: A kind of methodological study was used to develop, validate and evaluate research tools. This study concentrated on the development of a questionnaire that accurately measures empowerment in people with brain damage. METHODS AND PROCEDURE: This questionnaire derived items from both the existing literature on brain damage rehabilitation and related studies on people coping with brain damage. Open-ended questions were also included to investigate how patients may be encouraged to achieve successful rehabilitation (such as degree of acceptance, learning of adaptive skills and community re-entry). A structural empowerment model has been constructed by both content validity analysis and construct validity through an explorative factor analysis of 112 people with brain damage. MAIN OUTCOME AND RESULTS: A 42-item questionnaire has been developed, constructing four interpretable factors: Support (13 items), Skill (14 items), Aspiration (nine items), and Knowledge (six items), which accounted for 49.99% of the total variance. Analyses of open-ended questions showed that they generally lack external resources and support in the coping process. They did not have sufficient information to face their problems in a variety of areas, although they were quite aware of their importance. They could rely only on personal assets and families, and less on friends, work-mates, and external social resources. CONCLUSION: It is suggested that the results of this initial empowerment framework can either guide ways to improve the case management of patients with brain damage (in terms of structure, methods, and evaluation mechanisms) or assist in the research and design (R&D) of rehabilitation programmes with better efficacy and effectiveness. Further research using Rasch Analysis is suggested to establish item difficulties, and using the findings as an outcome measure in rehabilitation is recommended.

Adaptation, Psychological↗
PubMed1999

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

OBJECTIVE: 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. DESIGN: Treatment arm of a randomized control trial. SETTING: US military tertiary care hospital inpatient rehabilitation programme. PATIENTS: Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. INTERVENTION: 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. MAIN OUTCOME MEASURES: Successful return to work and return to duty. RESULTS: At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. CONCLUSION: 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.

Adaptation, Psychological↗
PubMed2001

The Prevalence of Cigarette Smoking in an Acute Inpatient Physical Medicine and Rehabilitation Population.

The purpose of this study was to determine the prevalence of cigarette smoking among patients before and after discharge from an acute inpatient physical medicine and rehabilitation unit and to assess smokers' interest in and desire for smoking cessation. A consecutive sample of inpatients (n = 233) admitted over a 5-month period to a regional rehabilitation inpatient center for acute rehabilitation treatment was surveyed for their smoking patterns. Ten percent of patients admitted to rehabilitation were active smokers prior to their hospitalization. In spite of reporting high motivation to stop smoking, half were not interested in participating in a smoking cessation program if one were offered to them. Following discharge from inpatient rehabilitation, 54% of a small sample of patients who could be contacted had resumed smoking (all within 4 weeks of being home). Given the prevalence of smoking in this population and its adverse consequences on health and quality of life, we suggest that rehabilitation professionals actively address this health problem during the patient's hospitalization.

Journal Article↗

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