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PubMedDate not supplied

Cost-effectiveness of cardiac rehabilitation after myocardial infarction.

BACKGROUND: Cardiac rehabilitation is commonly prescribed after myocardial infarction (MI) to coordinate exercise training and secondary preventive services. Cost-effectiveness analysis allows the quantitative comparison of the relative economic worth of cardiac rehabilitation in relation to other common interventions. METHODS: The cost-effectiveness of cardiac rehabilitation, in dollars per year of life saved ($/YLS), was calculated by combining published results of randomized trials of cardiac rehabilitation on mortality rates, epidemiologic studies of long-term survival in the overall postinfarction population, and studies of patient charges for rehabilitation services and averted medical expenses for hospitalizations after rehabilitation. RESULTS: Cardiac rehabilitation participants experienced an incremental life expectancy of 0.202 years during a 15-year period. In 1988, the average cost of rehabilitation and exercise testing was $1,485, partially offset by averted cardiac rehospitalizations of $850 per patient. A cost-effectiveness value of 2,130 $/YLS was determined for the late 1980s, projected to a value of 4,950 $/YLS for 1995. A sensitivity analysis supports the study results. CONCLUSIONS: Compared with other post-MI treatment interventions, cardiac rehabilitation is more cost-effective than thrombolytic therapy, coronary bypass surgery, and cholesterol lowering drugs, though less cost-effective than smoking cessation programs. Cardiac rehabilitation should stand alongside these therapies as standard of care in the post-MI setting.

Cost Savings↗
PubMedDate not supplied

Leisure time physical activity of patients in maintenance cardiac rehabilitation.

PURPOSE Increasing caloric expenditure through physical activity is associated with reduced mortality. On the basis of observational studies, previous authors have suggested that at least 1000 kcal per week and possibly 1500 kcal per week of physical activity is necessary for health benefits. The authors have previously reported that patients in maintenance cardiac rehabilitation accumulate approximately 230 kcal per exercise session, suggesting that additional activity outside of cardiac rehabilitation is needed to achieve the goal of 1500 kcal per week. The authors estimated the amount of energy expenditure performed each week by patients in cardiac rehabilitation during both program participation and leisure time. METHODS For this study, 104 patients enrolled in a supervised maintenance cardiac rehabilitation program at both tertiary care and community settings for at least 6 months completed a self-administered physical activity questionnaire. Energy expenditure in cardiac rehabilitation and leisure time activity was measured in kilocalories. Total caloric expenditure was determined by adding up the number of kilocalories expended by the patients each week climbing stairs, walking, participating in cardiac rehabilitation, and engaging in sports. RESULTS Patients in cardiac rehabilitation expended weekly, on the average, 1504 +/- 830 kcal in physical activity, 830 +/- 428 kcal in cardiac rehabilitation, and 675 +/- 659 kcal in leisure time activity. There was a significant difference in caloric expenditure between men and women, between those with a body mass index (BMI) less than 30 and those with a BMI of 30 or more, and between those younger than 70 years and those 70 years or older. There was no difference between races. Whereas 43% of the patients accumulated 1500 kcal, 57% did not. CONCLUSIONS The findings showed that 72% of the patients in cardiac rehabilitation accumulated at least 1000 kcal of energy expenditure per week and met public health guidelines. Also, 43% of the patients in cardiac rehabilitation accumulated more than 1500 kcal of energy expenditure per week, a level identified as necessary to reduce all-cause mortality. Women of either race, patients with a BMI of 30 or more, and patients age 70 years or older are the groups least likely to achieve 1500 kcal of energy expenditure per week. The authors recommend incorporating weekly kilocalories of energy expenditure in the exercise prescription of patients to ensure achievement of maximum health benefits.

Aged↗
PubMedDate not supplied

Factors associated with referral to outpatient cardiac rehabilitation services.

BACKGROUND: Although practice guidelines and policy statements for cardiac rehabilitation recommend that it be offered to all patients with cardiovascular disease, the participation rates in most Western countries are low. PURPOSE: This study aimed to determine the factors associated with referral to outpatient cardiac rehabilitation in the Hunter region of New South Wales, Australia. METHODS: The study sample comprised 1933 patients discharged from public hospitals in the Hunter region between March 1, 1998 and February 28, 1999 who were eligible for cardiac rehabilitation, and for inclusion on the Hunter Area Heart and Stroke Register (the Register). Data were obtained from the Register database (gender, age, clinical information) and via a self-completed questionnaire eliciting referral, sociodemographic, and cardiovascular disease risk factor information. Multiple logistic regression analysis was conducted to determine the factors independently associated with referral. RESULTS: : Of the respondents (1202/1933), 41% (493/1202; 95% confidence interval, 38-44%) reported that they had been referred to outpatient cardiac rehabilitation. The factors independently associated with referral were age younger than 65 years, previous participation in an outpatient cardiac rehabilitation program, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery. CONCLUSIONS: Younger age, previous participation in outpatient cardiac rehabilitation, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery were associated with referral to cardiac rehabilitation. Research testing strategies designed to increase cardiac rehabilitation referral rates are needed and could include testing the potential role of modern quality management methods.

Age Distribution↗
PubMed1996

Rehabilitation of the older lower limb amputee: a brief review.

OBJECTIVE: To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation. DESIGN: Literature review of articles and reports about lower limb amputation, using key words elderly amputee rehabilitation, and lower limb amputation, through a computerized Medline Search. CONCLUSIONS: Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait. Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (transfemoral) amputations has increased, overall postsurgical mortality (10-30%), long term survival (40-50%@2 years, 30-40%@5 years), and risk of loss of the contralateral leg (15-20%@2 years) has not changed significantly since the 1960s. Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years. The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person. Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed. In addition, comparison of the various rehabilitation protocols and the impact of cardiac resting before rehabilitation are needed.

Age Factors↗
PubMed2003

Achieving national service framework standards for cardiac rehabilitation and secondary prevention.

PROBLEM: Integrated care for patients who survive a myocardial infarction is lacking. Many patients are not offered cardiac rehabilitation, and secondary prevention is not optimal. DESIGN: 12 month audit of 106 patients who survived an acute myocardial infarction. BACKGROUND AND SETTING: Carrick Primary Care Trust in Cornwall (population 98 500) and one district general hospital. KEY MEASURES FOR IMPROVEMENT: Proportion of patients who complete a cardiac rehabilitation programme after a myocardial infarction. Proportion of patients with optimal secondary prevention, as measured by smoking status, body mass index, cholesterol <5.0 mmol/l, and blood pressure <140/85 mm Hg. STRATEGIES FOR CHANGE: We set up a novel, integrated, and seamless system for cardiac rehabilitation. We employed a cardiac liaison nurse to identify and assess in hospital all patients with suspected acute myocardial infarction. The nurse offered patients the choice of home based rehabilitation with the Heart Manual or hospital based rehabilitation. The nurse gave discharge details to the patient's general practice; these were to be included on a practice based register of coronary heart disease. EFFECTS OF CHANGE: All 106 eligible patients were offered cardiac rehabilitation and were included in a practice based register of coronary heart disease to facilitate long term follow up in primary care. 47 (44%) patients chose home based rehabilitation with the Heart Manual, and 41 (87%) of these completed the programme; 35 (33%) patients chose hospital based rehabilitation, and 17 (49%) of these completed the programme. The numbers of patients achieving secondary prevention targets improved significantly: those with serum cholesterol <5.0 mmol/l at discharge increased from 28% at baseline to 75% at 12 months. Optimal care (at least 80-90% uptake of an intervention) was seen with antiplatelet and statin treatments and with smoking cessation. Significantly more patients were prescribed statins at follow up than at baseline (77/106 v 80/91, P=0.005). LESSONS LEARNT: National service framework targets for cardiac rehabilitation and secondary prevention can be achieved in patients who survive a myocardial infarction by integrating rehabilitation services (home and hospital) with secondary prevention clinics in primary care. Nurse led clinics in primary care facilitate long term structured care and optimal secondary prevention.

Adult↗
PubMed1992

Disability and need for rehabilitation among patients with inflammatory bowel disease.

Physicians who manage patients with inflammatory bowel disease (IBD) as well as the patients themselves need to know about the prospects of disability and the demand for rehabilitation associated with this chronic disease. The present study uses German social security statistics to characterize IBD patients undergoing a rehabilitation or having a disability and their employment status before and after rehabilitation. Each year, about 9 and 3% of all German employees with IBD underwent a rehabilitation or were granted a disability pension, respectively. In comparison with other diseases, IBD patients tended to be young, female and employed in white-collar occupations. Although they had significantly longer sick leaves, 87% were still employed before entering rehabilitation. The majority, i.e. 72%, improved under rehabilitation. Compared with other diseases, however, rehabilitation of patients with IBD was less successful, i.e. less patients improved, and more patients remained unchanged or even worsened during rehabilitation. After rehabilitation, continuation of the last employment was recommended in 82% of the cases, in 94% after additional medical or vocational measures. Overall, failed rehabilitation led to a similar rate of disability in IBD as in other diseases. Within the IBD population, however, female sex and white-collar occupations were associated with an increased risk, while male sex and blue-collar occupations were associated with a reduced risk for disability. These data reflect the underlying epidemiology of IBD as well as its natural history. Despite its severity and chronicity, the overwhelming majority of patients with IBD manage to stay in the work force and succeed in overcoming the obstacles posed by their disease.

Age Factors↗
PubMed1990

Efficiency, effectiveness, and duration of stroke rehabilitation.

This prospective multicenter study identifies the variables significant in the prediction of rehabilitation efficiency, achievement of rehabilitation potential and duration of rehabilitation stay in 258 persons with a first stroke admitted to comprehensive inpatient rehabilitation in Brisbane, Australia, during 1984. All three dependent variables were poorly predicted, with only 17% of the variance in rehabilitation efficiency, only 30% of the variance in achievement of rehabilitation potential, and only 22% of the variance in duration of rehabilitation stay explained. Unlike other reports, we considered most of the major medical (side of paralysis, stroke etiology, site of the lesion, arterial distribution affected, etc.), rehabilitative (initial Barthel Index score, interval from stroke onset to acute-care hospital admission, interval from hospital admission to rehabilitation commencement, neurologic measures, etc.), and demographic (age, years of education, occupation, ethnicity, etc.) variables. The high proportion of unexplained variance is likely to be due to nonmedical factors influencing the selection of patients for rehabilitation.

Analysis of Variance↗
PubMed2001

Reducing emotional distress improves prognosis in coronary heart disease: 9-year mortality in a clinical trial of rehabilitation.

BACKGROUND: The impact of treating emotional distress on prognosis in coronary heart disease (CHD) has not been documented convincingly. We tested the hypothesis that treatment-related changes in emotional distress may explain the beneficial effect of rehabilitation on prognosis. METHODS AND RESULTS: In this nonrandomized clinical trial, 150 men with CHD participated in rehabilitation (n=78) or received standard medical care (n=72). There were no differences between rehabilitation and control patients with regard to left ventricular ejection fraction (LVEF) or standard care. End points were reduction in distress after 3 months and mortality after 9 years. At the end of the 3-month trial, 64 patients (43%) reported improvement and 22 (15%) reported deterioration in negative affect. Rehabilitation patients improved more (P=0.004) and deteriorated less (P=0.001) than control patients; rehabilitation was effective in reducing distress. After 9 years of follow-up, 15 patients had died (13 cardiac and 2 cancer deaths). Mortality was associated with LVEF </=50% (P=0.038) and deterioration in negative affect (P=0.007). Rate of death was 17% (12/72) for control patients versus 4% (3/78) for rehabilitation patients (P=0.009); rehabilitation was effective in reducing mortality. LVEF </=50% (OR 3.2; 95% CI 1.1 to 9.8; P=0.041) and rehabilitation (OR 0.2; 95% CI 0.1 to 0.7; P=0.016) were independent predictors of mortality. Rehabilitation warded off the deleterious effect of deterioration in negative affect on prognosis. CONCLUSIONS: Deterioration in negative affect is associated with a high long-term mortality risk. Warding off deterioration in negative affect is a mechanism that may explain the beneficial effect of comprehensive rehabilitation on prognosis in patients with CHD.

Belgium↗
PubMed2004

JNER: a forum to discuss how neuroscience and biomedical engineering are reshaping physical medicine & rehabilitation.

Advances in neuroscience and biomedical engineering deeply affect the clinical practice of physical medicine & rehabilitation. New research findings and engineering tools are continuously made available that have the potential of dramatically enhancing the ability of clinicians to design effective rehabilitation interventions. This quickly evolving research field is difficult to track because related literature appears in a wide range of scientific journals. There is a need for a scientific journal that offers to its readership a forum at the intersection of neuroscience, biomedical engineering, and physical medicine & rehabilitation. The Journal of NeuroEngineering and Rehabilitation (JNER) is intended to fill this gap and foster cross-fertilizations among these disciplines. By making readily available to clinicians selected studies with potential impact on physical medicine & rehabilitation, JNER is anticipated to foster the development of novel and more effective rehabilitation strategies. Conversely, by presenting clinical problems to a readership of neuroscientists and engineers, JNER is expected to generate innovative work in neuroscience and biomedical engineering with future applications to physical medicine & rehabilitation. JNER will leverage on Open Access as a means to guarantee that its content is readily available to scientists, clinicians, and the general public thus promoting scientific and technological advances that are relevant to rehabilitation. JNER is an Open Access initiative. Open Access assures dissemination to the widest possible audience and is seen by many as essential for publicly funded research. BioMed Central offers an outstanding platform to make JNER possible and allow neuroscientists, biomedical engineers, and clinicians to see their work published in a timely manner and thus make an immediate impact in the field of rehabilitation. JNER will focus on innovative work with higher likelihood of a dramatic impact on rehabilitation. Thus, priority will be given to outstanding and visionary scientific reports, i.e. those proposing exceptionally innovative concepts with great potential in the field.

Journal Article↗
PubMed2005

The effect of cardiac rehabilitation on recovery of heart rate over one minute after exercise in patients with coronary artery bypass graft surgery.

OBJECTIVE: To evaluate the effects of cardiac rehabilitation on the recovery of heart rate over 1 min after peak exercise of patients who received coronary artery bypass graft (CABG) surgery. DESIGN: Thirty subjects who received CABG surgery were randomly assigned to enter or not enter a cardiac rehabilitation exercise programme (cardiac rehabilitation n = 15; control group n = 15). SETTING: Outpatient cardiac rehabilitation centre in a national medical hospital. INTERVENTIONS: Patients assigned to the cardiac rehabilitation group received 36 sessions of the exercise programme, three times a week, with the intensity designed to achieve an individual 60-85% peak heart rate in cardiopulmonary exercise test. Patients assigned to the control group did not get further advice about a specific exercise programme. MAIN OUTCOME MEASURES: Resting heart rate and recovery of heart rate over 1 min after a peak exercise test at discharge and three months later were collected. The heart rates were analysed with computer-recorded electrocardiogram. RESULTS: At follow-up, the 15 patients in the cardiac rehabilitation group had a significantly lower resting heart rate (77.46+/-9.49 versus 92.31+/-10.18 bpm; p<0.001) and a significantly higher recovery of heart rate over 1 min (16.38+/-6.32 versus 11.38+4.81 bpm; p = 0.03) compared with the control group. There were also significant reductions in resting heart rates (cardiac rehabilitation p < 0.001; control p = 0.05) and improvements in recovery on heart rate over 1 min (cardiac rehabilitation p < 0.001; control p = 0.001) compared with baseline measurements in both the cardiac rehabilitation and control groups. CONCLUSION: Cardiac rehabilitation had a positive effect on the improvement of recovery on heart rate over 1 min in patients with coronary artery disease who received CABG surgery.

Aged↗
PubMed2005

Survey of wildlife rehabilitators regarding rabies vector species.

OBJECTIVE: To evaluate the risks associated with wildlife rehabilitation and the reemergence of wildlife rabies in North Carolina through assessment of the status of knowledge and attitudes of licensed in-state wildlife rehabilitators about rabies and rabies vector species (RVS). DESIGN: Questionnaire survey. SAMPLE POPULATION: 672 North Carolina licensed wildlife rehabilitators registered in 1999. PROCEDURE: Wildlife rehabilitators were contacted by mail to determine their status of knowledge and attitudes regarding rabies and RVS. The questionnaire was designed to determine rehabilitators' recent experiences with RVS, attitudes toward regulations, and knowledge of rabies virus transmission. Results were analyzed by use of the chi2 test. RESULTS: Questionnaire responses were provided by 210 of the 672 (31.3%) wildlife rehabilitators. Among rehabilitators, there were some inconsistencies in their knowledge base regarding rabies (eg, 25% reported that they did not know at what age animals were capable of transmitting rabies virus). Most respondents were amenable to all proposed licensing prerequisites for handling RVS (ie, record keeping, additional training, and veterinarian support). Respondents reported > 580 calls annually about rehabilitating RVS, and 80% believed at least some of their peers were rehabilitating RVS illegally. CONCLUSIONS AND CLINICAL RELEVANCE: With the establishment of rabies as a disease that is endemic among wildlife species in North Carolina, educational efforts directed at wildlife rehabilitators (a subpopulation of residents potentially at high risk of rabies virus infection) would have direct and indirect public health benefits; similar efforts may be useful to public health communities elsewhere in the United States.

Animals↗
PubMed1996

In- and out-patient rehabilitation in rheumatoid arthritis. A controlled, open, longitudinal, cost-effectiveness study.

Twenty-six patients with rheumatoid arthritis (RA) participated either in a 21 day, community sponsored, in-patient multidisciplinary rehabilitation program (N = 20) or; received traditional, out-patient physiotherapy designed by the patient's rheumatologist (N = 6). Clinical assessments were made (prior to, immediately after, and 6 months after rehabilitation) to evaluate the response to these two quite different rehabilitative measures that included: functional classification, joint score index, subjective VAS of pain, HAQ, pain disability index, Comprehensible psychopathological rating scale, hemoglobin, and CRP measurements. Economic assessments included salary, direct and community sponsored costs, for rehabilitation and costs for sick days and production losses. No clear-cut differences between the two rehabilitation modes were detected. Both modes showed improvement in different assessment parameters; patients with higher education and, therefore, with a less joint-disturbing work profile appeared to profit more from an extensive in-patient rehabilitation program. Patients with less education and a more manually-oriented working profile, did worse and had a higher tendency to seek medical pensioning, in spite of rehabilitative measures. As the total costs for out-patient rehabilitation only add up to 15.8% of the total costs for in-patient rehabilitation, this study setting cautiously suggests that out-patient rehabilitation might be an acceptable alternative to individualized patient groups that might not compromise clinical and vocational outcome. Larger patient groups are needed, however, to confirm these findings.

Arthritis, Rheumatoid↗
PubMed1999

The influence of rehabilitation therapy on the prognosis for stroke patients--a preliminary study.

The purpose of this prospective study was to investigate the influence of rehabilitation therapy on the prognosis for stroke patients. Sociodemographic and clinical factors were collected in a sample of 147 stroke patients (81 men and 66 women) admitted to the inpatient rehabilitation department at our university hospital over 10 days between January 1, 1997 and December 31, 1997. Functional Independence Measure (FIM) scores at discharge and gains during rehabilitation period were used as the prognosis index. Statistical techniques with univariate and multiple regression analyses indicated that significant predictors of discharge FIM scores include age, previous attacks twice or over, medical comorbidities, sensory and orientation impairments, and dementia. In addition, previous stroke attacks twice or over and sensory impairment were significant predictors of FIM gains during rehabilitation period. We concluded that: 1) age is a critical factor to determine the rehabilitation outcome, but may not be an important factor to predict the ability for the improvement through rehabilitation therapy; 2) the delay of rehabilitation therapy may not affect the potential for further improvement; 3) patients with low initial functional level may have poor final outcome, they may still have good rehabilitation potential to improve the functional level; 4) complications of stroke may affect the rehabilitation outcome and should be prevented; and 5) patients with impaired mental status should not routinely be excluded from rehabilitation programs.

Adult↗
PubMed2000

[Current issues in gastroeneterologic rehabilitation].

In Hungary gastroenteric diseases' rehabilitation, which is one of the youngest branch of medical rehabilitation, has grown out of traditional, sanatorial care from the 70s. Its main feature that it is based on a biopsychosocial attitude towards patients as a team-work. Though it comprises traditional, medical diagnosis and treatment, medicine and medical technology are not the primary resources of gastroenteric diseases rehabilitation: it is mainly built on a friendly and co-operating relations with the patients, which helps doctors to exert their mental and intellectual influence promoting their patients recovery. Therefore, gastroenteric diseases' rehabilitation can be sharply separated from active treatment and care. The article gives full details of the possible methods of gastroenteric diseases' rehabilitation, such as diagnosis, medicinal treatment, psychotherapy, dietotherapy, physiotherapy and regimen guidance. In addition, it is emphasized that under sanatorial circumstances the effects of rehabilitation, especially of regimen guidance multiplies. Furthermore it gives numerical data about the present situation of gastroenteric diseases' rehabilitation in Hungary. Considering the data gained from the special rehabilitation hospital located in Visegrád, the article touches upon the illnesses calling for this kind of rehabilitative treatment not passing over the fact of multimorbidity, especially important in rehabilitation.

Behavior Therapy↗
PubMed2004

[Rating evaluation of the effect of pre-lingual cochlear implanted's aural/oral rehabilitation by questionnaires].

OBJECTIVE: To evaluate the effect of cochlear implanted's aural/oral rehabilitation using rating evaluation method by questionnaires, to analyze the relationship between rehabilitation effect and its possible influence factors including type of implant, age at surgery, pathology, etc, and to explore the rating questionnaire method for cochlear implanted's aural/oral rehabilitation effect evaluation. METHODS: Ninety-seven pre-lingual cochlear implanted's were involved in this investigation, all of which were severe or profound deafness before implantation. Interviewed the implanted's parents or teachers, asking them to rate the implanted's aural ability objectively from 1 to 8 according to Categories of Auditory Performance (CAP) and speech producing ability from 1 to 5 according to Speech Intelligibility Rating (SIR), then analyzed the relationship between effect of aural/oral rehabilitation represented by CAP/SIR rating results and its possible 9 influence factors including type of implant, age at surgery, pathology, duration of hearing loss, hearing aid wearing, inserting length of electrodes, implanted period, rehabilitation mode and financial conditions. Univariate test and multivariate stepwise logistic regression model were used for the analysis. RESULTS: In a univariate analysis, it was confirmed that 4 factors i.e. type of implant (P = 0.0439), implanted period (P = 0.0001), rehabilitation mode (P = 0.0460) and financial conditions (0.0140) were correlated to CAP; 2 factors i.e. implanted period (P = 0.0001), rehabilitation mode (P = 0.0271) were correlated to SIR. In a multivariate analysis using stepwise logistic regression model, the more significant influence factor for CAP was implanted period and financial conditions, and for SIR was implanted period. CONCLUSIONS: Cochlear implants will be more effective for aural/oral rehabilitation of implanted's with longer implanted period. Rehabilitation mode and method contribute to the effect of rehabilitation.

Adolescent↗
PubMed2004

Tegner and Lysholm scores in brace-free rehabilitation.

OBJECTIVE: To compare results of aggressive method of rehabilitation after reconstruction of anterior cruciate ligament against results of standard braced method of rehabilitation, and to determine prognostic factors. This is a retrospective comparative study with statistical analysis. METHODS: In this study, 85 patients were operated in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between December 1998 and December 2001, and underwent rehabilitation with a minimum follow up of 2 years. The patients were split into 2 groups. Group A consist of 32 patients and they underwent the standard rehabilitation program according to established braced programs. Group B is the subsequent 53 consecutive patients who were subjected to aggressive brace-free rehabilitation program. All knees were measured for Tegner and Lysholm scores as the main indicator of assessment in the preinjury hindsight appraisal, and compared with scores obtained 4 months and 2 years post reconstruction. RESULTS: Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group A, there was a mean loss of 1.9 and 14 constituting 26% and 22.2% (p=0.015), range 1.07-3.5 and 9.8-23.5. Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group B, there was a mean loss of 1.1 and 9.0 constituting 15.4% and 13.6% (p=0.012), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to the 2 years follow up scores for group A, there was a mean loss of 1.0 and 8.0 constituting 13.6% and 11.6% (p=0.024), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to 2 years follow up scores for group B, there was a mean loss of 0.4 and 1.0 constituting 5.5% and 1.5% (p=0.015), range 0.1-1.5 and 6.8-13.5. Appraisal of the aggregate data of 2 groups has shown that the loss from preinjury Tegner and Lysholm scores was 20.7% versus 16.9% lower at 4 months (p=0.013), but only 12.6% versus 3.55% lower at 2 years (p=0.036). CONCLUSION: Results of aggressive rehabilitation after anterior cruciate ligament reconstruction both subjectively and clinically are superior to that of the standard braced rehabilitation. A better prognostic result with aggressive rehabilitation can be predicted for patients with high preinjury scores compared to patients with a low preinjury score. The result of this study support the use of accelerated brace free rehabilitation in autogenous patellar tendon graft, and has shown that intensive rehabilitation facilitate return to sport activities at 4 months postoperatively.

Adolescent↗
PubMed1992

[Rehabilitation of the aged].

It is common knowledge that in the light of demographic and social developments in the years to come our society will have to rise to the enormous challenge of medical care for the old, sick and needy. In order to shorten long-time nursing periods for old people in need of medical care preventive treatment and medical rehabilitation must be the main priority of all measures. Geriatric rehabilitation is subdivided into prophylactic rehabilitation (medical care, social sector), general rehabilitation and target-specific rehabilitation. Both the rehabilitation team and the motivation to rehabilitate are of particular importance during geriatric rehabilitation. On the whole, it has to be reckoned that older people need a distinctly longer period of recuperation, in which the clinical picture rather than the age is the decisive factor of a successful rehabilitation. As for Germany, that is only the beginning of stationary geriatric rehabilitation.

Activities of Daily Living↗
PubMed1991

The elderly reach independence through a community stroke rehabilitation programme.

Cerebrovascular disease resulting in stroke had shown a rising trend in the last decade among the elderly population in Singapore. To prevent dependency states, a home stroke rehabilitation programme was implemented in 1988 with the help of staff nurses trained to provide rehabilitation for stroke patients at home. These nurses were specially trained by experienced physiotherapists. A simple format was used to identify patients with good rehabilitation potential, while they were in the acute hospitals. The 244 stroke patients were studied by their age, sex, the status of motivation to go through rehabilitation and the level of family support. Out of the 224, 139 patients who had good and fair rehabilitation potential were referred to the Senior Citizens' Health Care Centres (SCHCCs) directly, as they already had sitting and standing balance. Twenty-two patients with poor rehabilitation potential were provided home nursing care. The rest of 83 patients with good and fair rehabilitation potential needed home rehabilitation before being referred to the SCHCC, as they had no sitting and standing balance. These 83 patients followed-up at home, were studied by their age, sex, rehabilitation potential, family support, number of nurse home visits and duration of rehabilitation required to gain independence in mobility. By 12 weeks, 84% of the patients improved in their goals towards independence irrespective of age. Marked improvement were shown in all the ten areas studied namely concentration, head control, return of tone, sitting balance, standing balance, mobility, power of upper and lower limbs, co-ordination and continence.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗