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PubMed1997

[Rehabilitation from the economic viewpoint in relation to the legal social security insurance].

Rehabilitation increasingly focuses on patients' chronic diseases and a restricted efficiency in job and everyday life. In Germany, the specialized rehabilitation system has been adapted to this development and produced particular successful, holistic, and interdisciplinary concepts which involve medical, occupational, and social benefits. Medical rehabilitation as a field discipline and treatment method has been advanced continuously and can not be compared with acute or curative care. During recent years rehabilitation expenses increased constantly; however, the cost increase corresponds to the rise of the actual need. The share of all rehabilitation expenses (rehabilitation providers, types of benefit) in health care benefits is between 6% and 7% and consequently considerably lower than hospital charges, for example. Economy in rehabilitation, as it now is especially intended through a restrictive rehabilitation benefit budgeting for the statutory pension insurance, will not reduce health care expenses in all. On the one hand, it is to be expected that benefits for pensions and care will rise in the medium term. On the other hand, economy in rehabilitation will produce additional expenses in other health care sectors without being more effective. Since the need for rehabilitation benefits will further increase due to demographic development, new priorities should be set in favor of patients with chronic diseases.

Aged↗
PubMed2002

Physiotherapist-led programmes and interventions for rehabilitation of anterior cruciate ligament, medial collateral ligament and meniscal injuries of the knee in adults.

BACKGROUND: Soft-tissue injuries of the knee, mainly involving the anterior cruciate ligament (ACL), the medial collateral ligament (MCL) and menisci, are common and their rehabilitation after non-surgical or surgical treatment often involves intensive and prolonged physiotherapy. OBJECTIVES: To examine the evidence for effectiveness of various physiotherapist-led (or 'directed') rehabilitation programmes, and of various interventions used within these programmes, for rehabilitation of acute or chronic ACL, MCL or meniscal injuries of the knee in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register (to June 2001), MEDLINE (from 1966 to August 1999), EMBASE (from 1980 to February 1997), CINAHL (1982 to April 1999), CURRENT CONTENTS (up to March 1999) and reference lists of relevant articles, and consulted colleagues. Date of the most recent search: June 2001. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating physiotherapist-led rehabilitation programmes, or components of rehabilitation programmes, for the treatment or post-surgical rehabilitation of ACL, MCL or knee meniscal injuries. Excluded were trials investigating electrical stimulation, or various interventions such as cryotherapy, immobilisation braces and continuous passive motion when used in initial or early treatment. Laboratory based trials reporting intermediate outcomes were also excluded. DATA COLLECTION AND ANALYSIS: All trials, judged as fitting the selection criteria by two reviewers, were independently assessed by two reviewers for methodological quality by use of an 11 item checklist. Data were independently extracted by two reviewers. Any disagreement was resolved by discussion. Although quantitative data from most trials are presented, using relative risks or mean differences together with 95 per cent confidence intervals, trial heterogeneity and lack of outcome data prevented meaningful pooling of results from comparable trials. MAIN RESULTS: Thirty-one trials, involving 1545 mainly young and male patients, met the inclusion criteria of the review. Methodological quality was highly variable: allocation concealment and / or assessor blinding were rare, and assessment of outcome was often incomplete and short-term. ACL injury and /or deficiency was the main focus of 18 trials, MCL injury of two trials, meniscal injury of nine trials and a mixture of soft-tissue injuries in the other two trials. The trial comparisons fell into five main categories: rehabilitation programme versus control (6 trials); one rehabilitation programme versus another (6 trials); different timing of rehabilitation (4 trials); one component of a programme versus another (6 trials); supplementary interventions to a programme versus none (9 trials). No trial provided sufficient evidence to establish the relative effectiveness of the intervention(s) under investigation. REVIEWER'S CONCLUSIONS: The available evidence for physiotherapist-led rehabilitation of ACL, MCL and meniscal injuries is wide ranging in terms of scope but insufficient to establish the relative effectiveness of the various approaches and methods in current use. There is a need for further research involving good quality, large scale randomised trials with sufficiently long follow-up to fully assess knee function and recovery.

Anterior Cruciate Ligament Injuries↗
PubMed2000

Influence of exercise rehabilitation on myocardial perfusion and sympathetic heart innervation in ischaemic heart disease.

Exercise rehabilitation improves the clinical status in ischaemic heart disease. The purpose of this study was to assess the influence of exercise rehabilitation on myocardial perfusion and sympathetic heart innervation. Sixteen patients with ischaemic heart disease and previous myocardial infarction were investigated by means of exercise/rest tetrofosmin and metaiodobenzylguanidine (MIBG) exercise/rest single-photon emission tomography (SPET) studies, before and 6 months after starting an exercise rehabilitation programme. Tomograms were divided into 15 segments, and these were grouped into five myocardial anatomical regions. Regional uptake of both tracers was quantified and expressed as a percentage of maximum peak activity. The percentage < or =55% was chosen to evaluate defect size, and the results were expressed as a percentage of left ventricular mass. Areas with perfused and denervated myocardium and areas with ischaemic myocardium were calculated. In addition, regions with <75% of peak activity in the exercise perfusion study at baseline were divided into two groups according to whether there was an increase in peak activity of >10% (representing reversible regional defects) or an increase of <10% (representing fixed regional defects) in the rest study. These percentages were compared with the percentages obtained in the innervation study, and with the percentages obtained in exercise/rest perfusion and innervation studies performed 6 months after starting rehabilitation. Myocardial perfusion defects were significantly smaller than myocardial innervation defects before and 6 months after starting exercise rehabilitation. The area of ischaemia 6 months after starting exercise rehabilitation was significantly smaller than that before rehabilitation (0.31%+/-1.4% vs 1.4%+/-1.6%, P<0.01). The size of innervation defects and the area of perfused and denervated myocardium did not show significant differences between the two studies performed before and 6 months after starting exercise rehabilitation. In reversible regional defects the percentage of peak activity was significantly increased 6 months after starting exercise rehabilitation in exercise and rest studies (P<0.001), while in fixed regional defects it was significantly increased only in exercise studies (P<0.001). There was no significant change in the regional MIBG percentages. We conclude that in ischaemic heart disease, exercise rehabilitation over a period of 6 months improves myocardial perfusion, but does not cause changes in sympathetic myocardial innervation.

3-Iodobenzylguanidine↗
PubMed1986

Rehabilitation from neonatal hypothyroidism: spontaneous motor activity, exploratory behavior, avoidance learning and responses of pituitary--thyroid axis to stress in male rats.

Long-Evans male rats were made hypothyroid from birth by the addition of 6-N-propylthiouracil (PTU) to their drinking water (0.1%). A group of animals was rehabilitated beginning at postnatal day 25 by withdrawal of the PTU from the drinking water. Subsequently, the rats were tested for a variety of behavioral tasks. Serum concentrations of thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) were determined by radioimmunoassay. At 50 days of age, PTU-treated rats had non-detectable levels of T4 but an eight-fold increase of TSH. In 50-day-old, neonatally hypothyroid but rehabilitated rats, serum TSH and T3 were normal, although T4 was still significantly lower. At 90 days of age, basal levels of TSH and thyroid hormones were normal in the rehabilitated rats, but thyroid hormone secretion in response to various types of neural stress was markedly altered. Comparison of passive avoidance learning revealed no significant alteration in the memory retention of either PTU-treated or rehabilitated animals. The 50-day-old, rehabilitated rats showed increased locomotor activity both in running-wheel and in hole-board tests; this hyperactivity, though markedly reduced, still persisted at day 90. In the early phase of rehabilitation (50 days of age), decreases in exploratory activity and lack of habituation occurred with the hole-board test; by the late phase of rehabilitation (90 days of age) these behavioral parameters had become normal. These results suggest generally longer periods of plasticity of the brain and better prospects for rehabilitation from neonatal cretinoid retardation than commonly believed. Specifically, the pituitary-thyroid system and neural mechanisms integrating adaptive behavior possess considerable capacity for spontaneous recovery from hypothyroidism; certain types of altered neuroendocrine and behavioral responses appear to be less amenable to rehabilitation or require longer periods for complete rehabilitation.

Animals↗
PubMed2005

Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease.

OBJECTIVES: To characterize patients referred for pulmonary rehabilitation on a large number of psychologic and sociodemographic variables and to determine the contribution of these variables on the response to rehabilitation. DESIGN: Cross-sectional, explorative. SETTING: University hospital and outpatient clinic. PARTICIPANTS: Eighty-one consecutive patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 40%+/-16% of predicted) were included in outpatient pulmonary rehabilitation. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: Pulmonary function, exercise capacity (Wmax, 6-minute walk test [6MWT]), Chronic Respiratory Disease Questionnaire (CRDQ), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) were assessed before and after 3 months rehabilitation. In addition, psychosocial adjustment, social support, marital status, mode of transportation, education, employment, and smoking status were assessed at the start of the rehabilitation. RESULTS: Rehabilitation improved exercise performance (Wmax, 6+/-12W; P<.01; 6MWT, 41+/-72 m; P<.001), quality of life (CRDQ score, 12+/-13 points; P<.001), functional status (PFSDQ-M activity score, -8+/-11 points; PFSDQ-M dyspnea score, -6+/-12 points; PFSDQ-M fatigue score, -4+/-8 points; all P<.01), HADS anxiety score (-2+/-3 points, P<.01), and HADS depression score (-3+/-3 points, P<.001). In single regression analysis, only baseline depression was weakly negatively correlated with the change in maximal workload. No other relations of initial psychologic or sociodemographic variables with outcome were observed. CONCLUSIONS: The effects of rehabilitation are not affected by baseline psychosocial factors. Patients with less favorable psychologic or sociodemographic conditions can also benefit from pulmonary rehabilitation. The multidisciplinary approach of the rehabilitation program might have contributed to this improvement.

Aged↗
PubMed2004

Reduction in C-reactive protein through cardiac rehabilitation and exercise training.

OBJECTIVES: This study was designed to assess the effects of three-month formal phase II cardiac rehabilitation and exercise training programs on high-sensitivity C-reactive protein (HSCRP) levels in patients with coronary heart disease (CHD). BACKGROUND: High-sensitivity C-reactive protein is associated with abdominal adiposity and other CHD risk factors and is a potent independent predictor of CHD events. Although weight reduction and statin therapy reduce HSCRP levels, the independent effects of cardiac rehabilitation programs on HSCRP are not well established. METHODS: We analyzed plasma levels of HSCRP in 277 patients with CHD (235 consecutive patients before and after formal phase II cardiac rehabilitation and exercise training programs and 42 "control" patients who did not attend cardiac rehabilitation). Additionally, we determined the effects of cardiac rehabilitation on HSCRP independent of statin therapy and weight loss. RESULTS: Rehabilitation patients improved significantly in body fat, obesity indices, exercise capacity, and other cardiac risk factors. Mean (5.9 +/- 7.7 to 3.8 +/- 5.8 mg/l; -36%; p < 0.0001) and median levels of HSCRP (-41%; p = 0.002) decreased significantly in the rehabilitation group but not in the control population. Similar significant reductions in HSCRP occurred in the rehabilitation patients regardless of whether they received statin therapy or lost weight. CONCLUSIONS: Therapeutic lifestyle changes effected through a three-month cardiac rehabilitation program significantly improved numerous cardiac risk factors. Through this holistic approach to secondary prevention, we observed significant reductions in HSCRP levels. These findings identify another clinical modality of reducing HSCRP beyond use of statin drugs and suggest an additional benefit of formal phase II cardiac rehabilitation and exercise training programs.

Aged↗
PubMed2003

Analysis of the condyle/fossa relationship before and after prosthetic rehabilitation with maxillary complete denture and mandibular removable partial denture.

STATEMENT OF PROBLEM: The influence of the loss of posterior teeth on the condylar position and on temporomandibular disorders (TMDs) remains a controversial issue. PURPOSE: This study investigated whether prosthetic rehabilitation promoted modification of the condylar position in subjects without symptoms of TMDs. MATERIAL AND METHODS: The temporomandibular joints (TMJs) of 12 women (age 37 to 74), all with existing maxillary complete dentures but no removable partial denture (RPD) restoring the Kennedy class I partially edentulous mandibular arch and no clinical signs of TMDs according to the criteria established by Helkimo, were viewed in maximal intercuspal position with corrected lateral tomography before and after prosthetic rehabilitation with a new maxillary complete denture and a mandibular RPD. Before prosthetic rehabilitation, a mandibular stabilizing base was fabricated to prevent the existing maxillary complete denture from dislodging during tomographic examination. Two methods were used to evaluate tomograms: (1) linear measurements of the subjective narrowest anterior and posterior intra-articular joint spaces made from the tomograms by use of a digital caliper and (2) linear measurements of the anterior and posterior intra-articular joint spaces on the basis of drawings and tracings. Repeated-measures analysis of variance followed by orthogonal contrasts were used to evaluate differences between measurements carried out on the same subject under the different test conditions of the study (before prosthetic rehabilitation, before prosthetic rehabilitation with a mandibular stabilizing base in position, and after prosthetic rehabilitation) (P<.05). RESULTS: Before prosthetic rehabilitation, a predominance of posterior condylar positions was observed. Before prosthetic rehabilitation with a mandibular stabilizing base in position, a significant decrease was observed in posterior condylar positions (P=.03). This decrease was more marked after prosthetic rehabilitation (P=.02). The subjective evaluation and comparison on the basis of drawings and tracings used to analyze the tomograms produced similar results (P=.70). CONCLUSION: Within the limitations of this study, significant changes in the condylar position occurred after prosthetic rehabilitation in subjects without symptoms of TMDs.

Adult↗
PubMed2006

[Functional status and survival in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation].

OBJECTIVES: To study functional status and survival in patients with chronic obstructive pulmonary disease (COPD) following a pulmonary rehabilitation program. PATIENTS AND METHODS: We assessed lung function, 6-minute walk distance, Borg score for dyspnea upon completion of the 6-minute walk, workload in watts on a cycle ergometer, quality of life using the St George's Respiratory Questionnaire (SGRQ); the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index; and survival. RESULTS: One hundred five patients participated in the pulmonary rehabilitation program. The patients had a mean (SD) age of 63.9 (9.3) years, body mass index of 24.5 (4.56) kg/m2, and forced expiratory volume in 1 second (FEV1) of 0.91 (0.46) L. The mean distances walked in 6 minutes were 412.8 (79.4) m before the pulmonary rehabilitation program and 443.46 (81.57) m after rehabilitation. The mean workloads on the cycle ergometer before and after rehabilitation, respectively, were 47.9 (29.6) W and 77.76 (20.88) W. The mean Borg scores were 2.2 (1.37) before and 1.47 (1.37) after rehabilitation, and the SGRQ scores at the same times were 27.63 (16.02) and 25.45 (15.12). Mortality due to respiratory disease (105 months) was 19%. Cumulative survival rates at 1 year, 3 years, and 6 years were 91%, 86.7%, and 6.75%, respectively. Survival was related to an FEV1 greater than 1.02 L (P = .05), a 6-minute walk distance over 448 m before rehabilitation (P = .04) and 454 m after rehabilitation (P = .05), and a workload on the cycle ergometer of over 54 W before rehabilitation (P = .01) and 72 W (P = .02) afterwards. The correlations between survival and both SGRQ and BODE scores were weaker. CONCLUSIONS: We observed improved exercise capacity, dyspnea ratings, and, to a lesser extent, better SGRQ scores in our COPD patients following pulmonary rehabilitation. The best predictors of survival were FEV1, the 6-minute walk distance, and the cycle ergometer workloads.

Aged↗
PubMed2001

Quality of life after in-patient rehabilitation in children with obesity.

OBJECTIVE: Treating obesity concerns not only medical concomitants and future complications but also quality of life. The study was planned to investigate the effect of obesity and obesity treatment on quality of life in children. DESIGN: In the study presented, quality of life as well as psychosocial, clinical, sociodemographic and family related information was obtained from both children and their parents, at four time points by questionnaires: (1) Prior to in-patient rehabilitation (at home); (2) at the end of the in-patient rehabilitation (in clinics); (3) three months after admission into rehabilitation clinics; and (4) twelve months after admission into rehabilitation clinics. MEASUREMENT: Quality of life (QoL) was assessed in children using the revised German KINDL(R) quality of life questionnaire, a 24 item instrument yielding six dimensions and a total score as well as a chronic generic and an obesity module. Psychosocial determinants included assessments of stress, emotional support, coping and internal locus of control as well as expectations and motivations with regard to the rehabilitation programme. SUBJECTS: Seven large German in-patient rehabilitation clinics participated in the study in which 1019 children participated. These children were suffering from obesity (n=584) or asthma/atopic dermatitis (n=330) or both (n=105). RESULTS: Children as well as parents did not differ across the diagnostic groups in sociodemographic and general clinical variables. QoL in children was dependent on age and gender with increased age over 13 y and female gender being associated with lower self reported QoL. Differences between diagnostic groups were significant, indicating higher impairments in QoL in children with obesity. Multiple regression analysis showed that stress level, coping, as well as lack of emotional support and poor global health explained 37% of the variance of the KINDL(R) total score at the first measure point in the obesity group. Predicting QoL at the end of rehabilitation from data collected at the beginning of the study, psychosocial variables explained 28% of the variance. The results indicate that QoL of children with obesity is affected by age and gender and can be explained by stress, coping and support as well as global health ratings. QoL of obese children differs from the QoL of children with asthma/atopic dermatitis and improves from before to after rehabilitation. QoL after rehabilitation is predicted by psychosocial indicators, health resources and strains. CONCLUSION: The results of the study suggest that QoL assessment in children with obesity is relevant in understanding what life is like for children with obesity, which aspects of their life affect their well-being and how quality of life can be improved through rehabilitation programmes.

Adolescent↗
PubMed2003

The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury.

OBJECTIVE: To ascertain the association between early computed tomography (CT) scan findings and the need for assistance with ambulation, activities of daily living (ADLs), and supervision at rehabilitation discharge and at 1 year after traumatic brain injury (TBI). DESIGN: Prospective longitudinal design. SETTING: Seventeen Traumatic Brain Injury Model Systems (TBIMS) centers. PARTICIPANTS: A total of 1,839 adults with TBI admitted to TBIMS trauma centers with subsequent acute rehabilitation; 849 were followed to 1 year after injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Accumulated CT scan pathology from the first week after injury; FIM instrument and Disability Rating Scale at rehabilitation discharge and 1 year after injury; and Supervision Rating Scale at 1 year. RESULTS: Chi-square analyses showed that individuals with a midline shift greater than 5mm (lateral compression) were more likely to require the assistance of another person at discharge from acute rehabilitation with ambulation (29% vs 17%-19%, P=.02), toileting (47% vs 33%-38%, P=.05), lower-body dressing (57% vs 39%-46%, P=.015), bladder continence (32% vs 19%-23%, P=.03), and overall supervision (53% vs 44%, P=.0006) than patients with a midline shift of lesser degree. At 1 year, 57% of patients with a midline shift greater than 5mm on acute CT scans were being supervised in the home versus 30% to 39% of those with a shift of lesser degree (P=.003); there were no significant differences in the percentages of those needing assistance for ambulation or ADLs. The association of subdural hematoma with ambulation, self-care, and supervision needs was related to the degree of midline shift but not to the presence of subdural hematoma. Individuals with subcortical contusions were more likely to require assistance at rehabilitation discharge for ambulation (32% vs 18%, P<.0001), lower-body dressing (61% vs 44%), toileting (52% vs 35%), bladder continence (34% vs 22%), and overall supervision (61% vs 44%) than those without subcortical contusions (P<.0001). At 1 year, individuals with acute subcortical contusions were more likely to need assistance with ambulation (15% vs 8%, P=.004) and stair climbing (15% vs 9%, P=.03). Those with bilateral frontal (54% vs 46%, P=.009) or bilateral temporal (58% vs 46%, P=.03) contusions were more likely to need assistance with overall supervision at rehabilitation discharge, compared with those with unilateral or no cortical contusions. CONCLUSIONS: The presence of either a midline shift greater than 5mm or a subcortical contusion on acute CT scans is associated with a greater need of assistance with ambulation, ADLs, and global supervision at rehabilitation discharge. Patients with bilateral cortical contusions require more global supervision at rehabilitation discharge but no more supervision for ambulation and ADLs. These findings may aid health care professionals and potential caregivers in planning for rehabilitation and supervision needs after rehabilitation discharge and, to a lesser extent, at 1 year after TBI.

Activities of Daily Living↗
PubMed2005

[Cardiac rehabilitation--expectations and appraisals of patients].

Patients' expectancies are widely hypothesized to influence the course of rehabilitation. Therefore, an exploratory cross-sectional survey was performed in cardiological rehabilitation patients to analyse the relationships of patients' expectations and rehabilitation outcomes. Patients were recruited from ambulatory heart groups (phase III rehabilitation). All participants judged both their expectations and experiences regarding their inpatient rehabilitation (phase II) in retrospect. Of 300 eligible heart group members, 238 (79 %) consented to participate (81 % male; mean age 65.5 years). Discussions with their physician, in-depth clinical examination, and information regarding treatment and healthy life-style were rated as most important by the patients. Nutritional counselling, gymnastics, massage, walking and the pleasant surroundings of the clinic were also frequently mentioned. One third stated that they had changed their attitudes regarding life-style, stress management, and nutrition as a result of rehabilitation. However, according to their self-reports, changes in body weight were not substantial whereas the proportion of smokers declined. 70 % reported to be interested in attending a future rehabilitation treatment. Patients with high expectations regarding physical training, health counselling, behaviour modification and physician care had better rehabilitation outcomes. When interpreting the results, both the selective nature of the sample and possible recall bias due to the retrospective assessments have to be considered. Our findings may thus be seen as hints as to patients overall judging their rehabilitation in a positive way. However, critical aspects were also mentioned. While these did not touch the general concepts of the interventions, they highlighted specific aspects of its performance and implementation, issues that should be taken into account by the individual rehabilitation clinic.

Attitude to Health↗
PubMed2002

Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison.

OBJECTIVE: Nontraumatic spinal cord injury (NT/SCI), which can occur secondary to spinal stenosis, has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. The objective of this study was to compare demographics and outcomes of patients with spinal stenosis-induced SCI (SS/SCI) with those with traumatic spinal cord injury (T/SCI) following inpatient rehabilitation. DESIGN: This 7-year prospective review compared 81 patients with SS/SCI and 102 patients with T/SCI admitted to an SCI rehabilitation unit with similar levels and completeness of injury. Main outcome measures included rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, rehabilitation charges, and discharge rates to home. RESULTS: Results indicate that, when compared with the T/SCI, patients with SS/SCI had a significantly (P < .05) higher mean age (64.1 years vs 44.4 years), were more often female (39% vs 20%), and tended to present with paraplegia vs tetraplegia (69% vs 46%) and with motor incomplete SCI vs incomplete SCI (100% vs 49%). When comparing etiologies of SCI within tetraplegic and paraplegic groups, results showed that individuals with tetraplegic SS/SCI had a significantly (P < .05) shorter rehabilitation LOS (25.7 vs 35.9 days), and lower FIM change (24.5 vs 32.5) and FIM efficiency (1.0 vs 1.3); however, no statistical differences were noted for discharge FIM scores and discharge to home rates. Individuals with paraplegic SS/SCI also had significantly lower FIM change (20.2 vs 28.7); however no significant differences were noted for rehabilitation LOS, charges, FIM efficiency, or discharge-to-home rates. CONCLUSIONS: The findings indicate that patients with SS/SCI present with less severe clinical impairments (motor incomplete and paraplegia) in comparison with patients with T/SCI. Clinically similar SS/SCI groups were noted to achieve rates of functional gain and community discharge comparable with T/SCI patients. Although patients with T/SCI achieved greater overall functional improvement, patients with SS/SCI had shorter rehabilitation LOS and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with NT/SCI.

Adult↗
PubMed2006

New East-Westfalian Postoperative Therapy Concept: a telemedicine guide for the study of ambulatory rehabilitation of patients after cardiac surgery.

In-hospital rehabilitation can improve recovery of patients after surgery, but also contributes to the high costs of the German health system. A telemedicine-based rehabilitation used in the home as an alternative to in-hospital rehabilitation was evaluated in a pilot study. In an open trial, 170 patients performed a 3-month ambulatory rehabilitation after cardiac surgery. There were two groups (group 1 [n = 70] and group 2 [n = 100]). Group 1 participated in conventional in-hospital rehabilitation. Group 2 received ambulant rehabilitation using telemedicine. Physical performance, quality of life, (measured with a questionnaire), complications and costs were assessed and compared between the two groups. Maximal physical performance (MPP) was assessed at 6 and at 12 months after cardiac surgery. It was significantly increased by 46-54 watts in both study groups compared to their baseline value. Moreover, physical and psychological quality of life had increased in both study groups compared to baseline values. However, group 2 was the only group to show statistical significance in all categories. Fewer incidents of angina pectoris were reported within the study interval in group 2 compared to group 1 (p < 0.01). The total cost of rehabilitation was 58% lower in group 2 compared to group 1. Ambulatory rehabilitation using telemedicine improves physical performance, quality of life, is safe, and is inexpensive. Our data indicate that home-based rehabilitation is more effective than in-hospital rehabilitation for patients after cardiac surgery.

Ambulatory Care↗
PubMed1988

Effects of a comprehensive rehabilitation programme in patients with three-vessel coronary disease.

The aim of the study was to assess the effects of rehabilitation in 46 consecutive three-vessel coronary disease patients who were considered to have no possibility of revascularization; there were 45 males and one female (mean age 58) sent in the third week after acute myocardial infarction (N = 31) or after unstable angina (N = 15). Left ventricular ejection fraction (EF) was normal in 50% of the patients, but 15% had an EF less than or equal to 0.30. Three patients could not begin their rehabilitation because of unstable angina (N = 2) or severe pulmonary oedema (N = 1). After a 4-week rehabilitation programme, the comparison of stress tests revealed an increase in functional capacities (maximal work-load = 103.6 +/- 27 W before rehabilitation, 126.4 +/- 31 W after rehabilitation, P less than 0.001), and an improvement of the ischaemic threshold [82 +/- 32 W before rehabilitation, 91 +/- 31 W after rehabilitation, P less than 0.05]. During long-term follow up [20.8 months], four patients died of cardiac events [8.7%]; all of them had an EF less than 0.45. Among the 42 living patients 61.9% were asymptomatic, 28.7% had exertional angina, and 9.4% had cardiac complications, and coronary surgery was performed in two cases with good results. The level of return to work was 85% with the mean delay of 1.7 months after rehabilitation. So, rehabilitation in three-vessel coronary disease patients is safe under medical control; improvements in exertional capacities are obvious and give the patients a better self confidence as assessed by the good score of return to work after rehabilitation.

Angina Pectoris↗
PubMed2003

A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach.

BACKGROUND: The optimal setting and design of a comprehensive treatment for elderly hip fracture patients is unknown. The aims of this study were to compare the functional outcomes associated with an innovative comprehensive single-step (geriatric-based) and classic double-step (orthopedic-based) treatment of such patients. METHODS: This is a partially concurrent prospective study, taking place in the orthogeriatric unit of a department of geriatric rehabilitation, in a large urban academic freestanding hospital. The participants were 336 consecutive elderly people, admitted for surgery of extracapsular or intracapsular hip fracture. 204 patients were admitted to the department of orthopedic surgery and transferred, shortly after surgery, to the orthogeriatric ward for ongoing rehabilitation (ORT group). Another 116 patients were admitted directly to a geriatric-based orthogeriatric ward, and they received surgical, medical, and rehabilitation treatment within the same facility (ORTGER group). The main outcome measures were length of stay, absolute functional gains of the motor functional independence measure (FIM), and relative functional motor gains according to the Montebello rehabilitation factor score. Successful rehabilitation was defined as relative functional gain >.5. RESULTS: 320 patients were included in the final analysis. The two groups were similar, yet ORT-group patients were somewhat younger (p <.02) and were cognitively better preserved (p <.01). Admission cognitive FIM was the strongest positive predictive factor associated with successful rehabilitation (odds ratio = 2.45, 95% confidence interval 1.89-3.31, and p <.001). Significant improvement of total FIM scores occurred during rehabilitation in both groups. The relative functional gain was similar in the two groups, but total hospital length of stay was 5 days shorter in the ORTGER group (p <.01). After the effect of age, sex, length of stay, fracture type, and cognition at onset of the rehabilitation period were adjusted for, patients of the ORTGER group had a twofold chance for successful rehabilitation, compared with ORT-group patients (odds ratio = 1.97, 95% confidence interval 1.09-3.65, and p =.03). CONCLUSIONS: The functional outcome of elderly hip fracture patients is better for those treated in the orthogeriatric setting, as compared with the common two-steps model of orthopedic surgery followed by transfer to a geriatric rehabilitation facility.

Aged↗
PubMed1994

Randomized clinical trial comparing hospital to ambulatory rehabilitation of malnourished children in Niger.

This study compared hospital to ambulatory nutritional rehabilitation outcomes and costs. Following a hospital stay to resolve initial acute medical conditions, 100 malnourished children (54 per cent male, ages 5 to 28 months) in Niger were randomly assigned to either hospital or ambulatory nutritional rehabilitation. Anthropometric measures were assessed at 15, 30, 60, 90 and 180 days post-randomization. Following randomization, the hospital group received a mean of 12.9 days of hospital rehabilitation and 5.6 days of ambulatory rehabilitation, while the ambulatory group received 2.2 days of hospital rehabilitation and 11.9 days of ambulatory rehabilitation. No significant differences between the two study groups in mortality rates or weight gain were found. The mean cost for hospital rehabilitation was 120 per cent higher (P < 0.001) than ambulatory rehabilitation. This study was the first randomized clinical trial directly comparing hospital to ambulatory nutritional rehabilitation and suggests that ambulatory rehabilitation is more cost-effective.

Ambulatory Care↗
PubMed1991

Effect of associated injuries and blood volume replacement on death, rehabilitation needs, and disability in blunt traumatic brain injury.

OBJECTIVE: To examine the effects of associated injuries on death, disability, rehabilitation needs, and cost in patients with blunt traumatic brain injury. DESIGN: A retrospective case series analysis of 1,709 patients with blunt traumatic brain injury, or 37.2% of 4,590 consecutive blunt trauma patients, was combined with a prospective study of a subset of 202 of the 1,709 brain-injured patients obtained during the same time period with regard to need for rehabilitation services, residual disability, and costs at 1 yr after discharge from the acute trauma center. SETTING: A level I regional trauma center that is also the statewide neurotrauma and multiple trauma unit serving a population of more than 3 million persons. RESULTS: Contingency table analysis showed the Glasgow Coma Scale to be highly predictive (p less than .0001) of likelihood of mortality, need for postacute inpatient rehabilitation, or discharge home. Of the blunt traumatic brain injury patients, 40.4% (691) had an isolated brain injury and 59.6% (1,018) had brain plus at least one other systemic injury. The mortality rate of the isolated brain injury group was 11.1% compared with 21.8% in all brain plus systemic injury groups (p less than .0001). Spine, lung, visceral, pelvis, or extremity injuries in blunt traumatic brain injury all increased mortality rate to greater than 25% (all simultaneously significant, p less than .0001). Analysis of the interaction of brain injury (quantified by Glasgow Coma Scale) with blood replacement in the initial 24 hrs showed that at any Glasgow Coma Scale range, percent mortality increased as the volume of blood increased. Hypovolemic shock increased the mortality rate from 12.8% to 62.1% (p less than .0001). The need for postacute inpatient rehabilitation in survivors also increased as blood replacement increased, and shock increased the percent of patients requiring post-acute inpatient rehabilitation from 39.7% to 60.3%. In 202 consecutive surviving brain trauma patients followed for 1 yr, isolated brain-injured patients with moderate brain injuries had a 4% need for posttrauma, postacute inpatient rehabilitation with a total cost per case of $12,489 compared with the brain plus extremity injury group, who had a 23% postacute inpatient rehabilitation rate and a total cost per case of $36,177 at 1 yr. With severe brain injury, isolated brain injury increased postacute inpatient rehabilitation to 29% and 1-yr cost to $59,274, but with the brain plus extremity injury group, postacute inpatient rehabilitation increased to 49% and cost to $84,950. CONCLUSIONS: In blunt traumatic brain injury, the addition of major visceral or extremity injuries, with need for blood replacement or shock, increases the risk of death, the need for rehabilitation, and the costs of disability.

Baltimore↗
PubMed2001

All well at work? Evaluation of workplace-based early rehabilitation in the Finnish State administration.

A comprehensive system for the early rehabilitation of personnel has been developed and practised within the Finnish State administration since 1989. The rehabilitation process can be initiated as soon as the working capacity of a person or work community is threatened but is not yet seriously impaired. Rehabilitation is principally carried out on an outpatient basis alongside ordinary work. The aim of the study was to evaluate the outcomes and processes of early rehabilitation. The research data comprised several thousands of cases and consisted of a cross-sectional and a follow-up survey and a register-based follow-up. The surveys showed that during the rehabilitation period the average performance of the participants began to match that of the better-off non-participants, especially with respect to their general working capacity, mental well-being and occurrence of musculoskeletal problems. The sense of coherence rose in both groups, which can be partly attributed to positive changes in the workplace. In the group process, there also proved to be many factors contributing to achievement of the participants' rehabilitation objectives. The register-based follow-up showed that rehabilitation had a positive effect on average longer-term morbidity. In the cases of early retirement, the average retirement age of early rehabilitation participants was considerably higher than the average for the State sector as a whole. A system of outpatient early rehabilitation, where the rehabilitation programme and the development of working circumstances progress side by side, proved to give encouraging results at very moderate cost.

Cost-Benefit Analysis↗