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PubMed1995

Enhancing emotional well-being by comprehensive rehabilitation in patients with coronary heart disease.

Since emotional distress is linked to poor prognosis in coronary patients, there is urgent need for research into interventions that may enhance emotional well-being in these patients. Cardiac rehabilitation aims to return the individual to optimal emotional function, but the psychological effect of this therapy still needs to be demonstrated. Hence, we examined the role of cardiac rehabilitation in enhancing emotional health. We examined 170 male patients with coronary heart disease, of whom 85 had participated in the outpatient rehabilitation programme of the University Hospital of Antwerp and 85 had received standard medical care only in two other hospitals. Rehabilitation and control patients were matched by medical category and tendency to experience distress. The Global Mood Scale, the Health Complaints Scale, and the Heart Patients Psychological Questionnaire were used to assess changes in emotional well-being over a 3-month period. These changes were significantly different as a function of cardiac rehabilitation (P<0.0001). Rehabilitation patients, but not control patients, reported a significant improvement in negative affect, positive affect, well-being , health and disability (P<0.001). At follow-up, differences in depression, tranquillizer use (P<0.05), and activity profile (P<0.01) confirmed that rehabilitation patients displayed more healthy behaviour than control patients. Patients not only improved more, but also deteriorated less as a function of rehabilitation. This therapy also had a positive effect on patients suffering minimal distress, which is at variance with previous research. These findings suggest that comprehensive rehabilitation may be an effective therapy for enhancing emotional well-being in patients with coronary heart disease.

Analysis of Variance↗

PubMed2002

Retrospective assessment of rehabilitation outcome after traumatic brain injury: development and utility of the functional independence level.

OBJECTIVE: To develop a measure suitable for retrospective analysis of qualitative brain injury outcome data, the Functional Independence Level (FIL), and document its reliability, validity, and utility. DESIGN: Retrospective analysis of existing records, with inclusion based on availability of records, and quantitative or qualitative documentation of functional status at a minimum of 1.5 years after injury. SETTING: Statewide acute and postacute rehabilitation facilities, as part of a State Head Injury Program. PARTICIPANTS: A total of 338 individuals, with documented moderate to severe traumatic brain injury; primarily males ages 16 to 45. MAIN OUTCOME MEASURES: Disability Rating Scale (DRS) at discharge from primary rehabilitation, Living Situation and Functional Independence Level coded from information in postacute rehabilitation reports, at an average of approximately 6 years after injury. RESULTS: Inter-rater reliability coefficients for FIL ratings extracted from rehabilitation records, and between retrospective and in vivo assessments were highly significant. DRS scores at discharge from primary rehabilitation predicted a significant amount of variance in FIL scores at an average of 5 years after injury, and DRS scores remained a stable and significant predictor of FIL scores as the time period between discharge from rehabilitation and outcome ratings increased to 10 years after injury. FIL ratings were significantly lower for individuals living in residential facilities than those living with their families, as compared to living alone. CONCLUSIONS: The FIL is a reliable and useful tool for retrospective and prospective assessments of rehabilitation outcome. Gains made during primary rehabilitation by people with severe traumatic brain injury are generally maintained at long-term follow up. Retrospective ratings using the DRS and FIL can help guide postacute rehabilitation planning within state or regional head injury programs.

Activities of Daily Living↗

PubMedDate not supplied

Complicated mild traumatic brain injury on the inpatient rehabilitation unit: a multicenter analysis.

OBJECTIVE: To determine characteristics of patients with complicated mild traumatic brain injury (CMTBI) on the inpatient rehabilitation unit and to accentuate limits of current classification systems for patients with mild TBI. DESIGN: Multicenter analysis of individuals with a Glasgow Coma Scale (GCS) score of 13 to 15 (lowest score in 24 h) and positive computed tomography findings admitted to inpatient rehabilitation for TBI. SETTING: 16 TBI Model System centers funded by the National Institute on Disability and Rehabilitation Research. PARTICIPANTS: 373 adults with CMTBI. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM) and Disability Rating Scale (DRS) scores, length of stay, and medical complications. RESULTS: 16% of the sample experienced serious cranial complications (eg, cerebrospinal fluid leak, intracranial hypertension), with seizures being the most common during the course of inpatient rehabilitation. Most patients demonstrated substantial improvements on functional outcome measures during rehabilitation (mean admission FIM 68.2, discharge FIM 100.6; admission DRS 9.1, discharge DRS 4.8). Age, acute length of stay, and FIM score on rehabilitation admission were significant predictors of rehabilitation length of stay. Factors not predictive of rehabilitation duration were GCS score, ethnicity, gender, incidence of fractures, and incidence of cranial/noncranial complications. CONCLUSION: Despite favorable GCS scores, some patients with CMTBI suffer a variety of serious cranial and noncranial complications. Such patients appear to benefit from additional brain injury services offered in inpatient rehabilitation. Further study of the unique treatment needs of these patients is warranted.

Activities of Daily Living↗

PubMedDate not supplied

Post-stroke inpatient rehabilitation. I. Predicting length of stay.

This study was undertaken to identify factors predicting stroke inpatient rehabilitation length of stay in an acute inpatient rehabilitation program, including occupational therapy, physical therapy, and speech therapy. A cohort of 152 patients suffering from stroke (76 women and 76 men) voluntarily participated in this study. They were recruited from a general hospital in which they had received physical rehabilitation. The functional status of patients was observed by a physiotherapist, using the Functional Independence Measure(SM). The functional status was observed on patient admission to rehabilitation and at 1 wk from admission. Post-stroke biologic characteristics, including physical, neuropsychological, and clinical characteristics, as well as sociodemographic characteristics were also collected. A path analysis, using successive multiple linear regressions, was adopted to predict length of stay in rehabilitation. Significant predictors of length of stay were age, functional status at 1 wk post-rehabilitation admission, perceptual status, and balance status. These predictors accounted for 43.6% of the total variance in the rehabilitation length of stay. Indirect predictors of length of stay were identified as the following: functional status at admission, rehabilitation program, motor status, communication problems, and medical complications. Functional, biologic, and sociodemographic characteristics should be considered simultaneously in the prediction of length of stay as well as for the better understanding of the stroke rehabilitation process.

Adult↗

PubMedDate not supplied

Admission balance and outcomes of patients admitted for acute inpatient rehabilitation.

The objective of the study contained herein was to evaluate the clinical use of the Berg Balance Scale in a heterogeneous acute inpatient rehabilitation population and to assess the relationship between balance scores at admission and rehabilitation outcomes, including functional gain and length of stay. This was a prospective study of 45 patients with diagnoses including stroke (n = 15), traumatic brain injury (n = 19), and other impairments (n = 11) who were admitted for acute inpatient rehabilitation. Functional ability was evaluated with the Functional Independence Measure (FIM) instrument, and balance was measured using the 14-item Berg Balance Scale. These measures were assessed both at admission to and discharge from inpatient rehabilitation. Correlation and multiple regression analyses were used to determine the relationship between balance and functional ability scores at admission and rehabilitation outcomes at discharge, including length of stay, functional gain, and efficiency. Analyses of variance comparing impairment groups indicated that patients with traumatic brain injury were younger than the stroke and other groups, but there were no group differences on FIM or balance scores at admission or discharge. There were no significant group differences for any of the outcome measures. When the impairment groups were collapsed into a single heterogeneous group, multiple regression analyses demonstrated that the sitting unsupported item score at admission accounted for 27% of the variation in length of stay, once demographic influences were controlled. The FIM efficiency score was predicted best by the total Berg Balance Scale score, with 22% of the variance accounted for. In contrast, balance scores did not provide predictive information about the FIM gain score beyond that already provided by the FIM-Total score at admission, which accounted for 10% of the variance once demographics were controlled. Balance scores collected at admission to inpatient rehabilitation, in whole and in part, were shown to account for moderate amounts of variation in length of stay and the FIM efficiency score. For several of the rehabilitation outcomes, balance scores at admission accounted for more variation than scores on the FIM instrument. These findings suggest that routine assessment of balance at admission to inpatient rehabilitation may enhance the ability to predict rehabilitation outcomes beyond that provided by assessment of functional status alone.

Adult↗

PubMed2000

What is treatment evaluation research? What is its relationship to the goals of audiological rehabilitation? Who are the stakeholders of this type of research?

Three topics related to treatment evaluation research in audiological rehabilitation are discussed. First, the International Classification of Impairments, Activities and Participation (ICIDH-2) (World Health Organization, 1999) is described and proposed as a general conceptual framework for the design of intervention and research activities in audiological rehabilitation. Second, the three main domains of treatment evaluation research (efficacy, effectiveness, and efficiency) are briefly outlined. Third, the various consumers of treatment evaluation research in audiological rehabilitation are identified. Also, the domains of treatment evaluation research that are of interest to each of these consumer groups are presented. An analysis of the main interests of each group of stakeholders suggests that, at present, evaluative research in audiological rehabilitation does not adequately meet the needs of all stakeholders. Nevertheless, the future of evaluative research in audiological rehabilitation is promising, for several reasons: 1) research related to audiological rehabilitation is being actively pursued especially in the areas of treatment efficacy and treatment effectiveness; 2) the audiological rehabilitation community should be able to adapt its endeavors to the proposed conceptual framework of health conditions fairly easily (ICIDH-2; World Health Organization, 1999); 3) the research needs of the primary stakeholders of audiological rehabilitation are known; and 4) there is a keen interest within the professional community to develop this area of research. All of these conditions are propitious for setting the research agenda of treatment evaluation research in audiological rehabilitation for the next several years.

Audiology↗

PubMed1995

Validity of the Applied Rehabilitation Concepts (ARCON) system for lumbar range of motion.

STUDY DESIGN: This study compared a new computerized method of assessing lumbar range of motion, the Applied Rehabilitation Concepts, with standard dual inclinometry. Motions examined were flexion, extension, right and left lateral flexion, and right and left straight leg raising. OBJECTIVES: The Applied Rehabilitation Concepts and dual inclinometry data were examined to obtain the reliability for each method and to compare values obtained between the two methods. SUMMARY OF BACKGROUND DATA: Because standard inclinometry as described in the American Medical Association's "Guides to the Evaluation of Permanent Impairment" is cumbersome, time-consuming, and requires considerable patient compliance, a computerized method that could give us comparable results would be desirable. This is the first study to compare the Applied Rehabilitation Concepts computerized system with standard dual inclinometry. METHODS: In Part 1, 34 (16 male, 18 female) young adults (22.8 +/- 4.9 years old) each performed four separate testing sessions in random order, two with the Applied Rehabilitation Concepts system and two with dual inclinometry. In Part 2, 33 (16 male, 17 female) young adults (21.7 +/- 3.8 years old) performed four separate Applied Rehabilitation Concepts sessions, in random order, two with the previously used techniques, and two with improved stabilization techniques. RESULTS: In Part 1, dual inclinometry and the Applied Rehabilitation Concepts system lacked repeatability. The two methods correlated highly with each other, although consistent differences were seen for some of the measurements. In Part 2, improved stabilization techniques resulted in higher reliability for Applied Rehabilitation Concepts measurements. CONCLUSIONS: The Applied Rehabilitation Concepts system provided fairly reliable results when improved stabilization techniques were employed. However, because of differences in lumbar range of motion values obtained, impairment ratings based on standard inclinometry may not be appropriate for measurements obtained on the Applied Rehabilitation Concepts.

Adolescent↗

PubMedDate not supplied

Smoking cessation in pulmonary rehabilitation: goal or prerequisite?

It has been more than 35 years since the Surgeon General of the United States released the first report of the Advisory Committee on Smoking and Health. Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality in North America. During the 1990s, tobacco was the largest single cause of premature death in the developed world. Smoking cessation is followed by immediate health benefits in terms of symptoms and organ function. It dramatically reduces the risk of most smoking-related diseases, including chronic obstructive pulmonary disease and lung cancer. Respiratory rehabilitation has been defined as a multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individual's maximum level of independence and functioning in the community. A European Respiratory Society task force on rehabilitation recently commented that respiratory rehabilitation must address medical management including reinforcement of smoking cessation, education of the patient and family, exercise reconditioning, physical and occupational therapy, nutritional support, and long-term oxygen therapy. Many patients have quit smoking by the time they enroll in a pulmonary rehabilitation program. Nevertheless, the inclusion of smokers in respiratory rehabilitation programs remains controversial. Among 14 trials included in a meta-analysis of respiratory rehabilitation of patients with chronic obstructive pulmonary disease (COPD), the smoking status of the patients was reported in 9 of the trials, and only 2 trials stated that smoking was an absolute exclusion criterion for enrollment. Some investigators have used a trial of smoking cessation as an index of the patient's motivation to improve his or her health status. This article describes the effect of smoking on the course of COPD and the opportunity to address smoking in the context of comprehensive rehabilitation. The authors' line of reasoning is that (1) smoking causes COPD and perpetuates the pathophysiologic processes defining the disease, (2) symptomatic COPD does not facilitate smoking cessation, (3) smoking may alter rehabilitation outcomes, and (4) if smoking cessation is not a prerequisite to pulmonary rehabilitation, then a smoking cessation intervention should at least he offered as part of such a program.

Humans↗

PubMedDate not supplied

Effects of cardiac rehabilitation on self-reported health status after coronary artery bypass surgery.

PURPOSE: To examine the effectiveness of cardiac rehabilitation on health status following coronary artery bypass surgery. METHODS: A prospective cohort study of patients having coronary artery bypass surgery at 14 centers in the state of Washington. Baseline clinical and demographic data were collected, as was information from the Rand Short Form, 36 (SF-36), the Seattle Angina Questionnaire, and other questions regarding health status before surgery and at 6 and 12 months after surgery. In the 12-month follow-up survey, subjects were asked to complete questions pertaining to their participation in postdischarge cardiac rehabilitation programs. RESULTS: A total of 947 subjects from 13 centers received 1-year follow-up surveys, with 75% responding. Of these, 691 (95%) answered questions about participation in cardiac rehabilitation programs. SF-36 and Seattle Angina Questionnaire scores improved significantly after surgery for both cardiac rehabilitation participants and nonparticipants. Although more than 90% of subjects who participated in the cardiac rehabilitation programs stated that they were beneficial, for eight SF-36 domains and five Seattle Angina Questionnaire domains, no significant associations were found with participation in cardiac rehabilitation. When the participation status was defined as only those participants who completed at least 8 weeks of cardiac rehabilitation, only 1 of 13 health status domains favored cardiac rehabilitation. Responses to a series of questions about perceptions of change in general and cardiac-specific health did not differ among participants and nonparticipants. CONCLUSIONS: Although patients report favorable impressions of cardiac rehabilitation after coronary artery bypass surgery, it does not appear to provide a measurable benefit in self-reported health status beyond that achieved from the revascularization procedure itself.

Activities of Daily Living↗

PubMedDate not supplied

Social support as a predictor of participation in cardiac rehabilitation after coronary artery bypass graft surgery.

PURPOSE: Cardiac rehabilitation promotes recovery and enhances quality of life after a coronary artery bypass graft (CABG), but participation in such rehabilitation is low. The role of social support in promoting participation has been suggested by prior studies, but is not clearly defined. The purpose of this study was to investigate the role of social support as an independent predictor of participation in cardiac rehabilitation. METHODS: This study examined 944 patients who underwent first isolated CABG between May 1999 and February 2001, then were followed for 6 months after surgery. Social support before CABG and 6 weeks after CABG was assessed using the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory (ESSI) and evaluated for its association with participation in cardiac rehabilitation. RESULTS: Of 944 patients, 524 (56%) reported participation in rehabilitation. The participants were younger, better educated, more often employed, and less financially strained. The participants also had a lower prevalence of cardiovascular disease risk factors and better physical function. According to unadjusted analysis, the patients with low social support (ESSI </= 22) before surgery were less likely to participate in rehabilitation than the other patients (52% vs 59%; risk ratio [RR], 0.89; 95% confidence interval [CI], 0.78-0.99). However, adjustment for demographic factors, medical history, cardiovascular disease risk factors, physical and psychological function, and hospital complications attenuated this association (adjusted RR, 0.92; 95% CI, 0.78-1.07). A low ESSI score measured 6 weeks after CABG similarly did not significantly affect participation in rehabilitation (adjusted RR, 0.96; 95% CI, 0.81-1.11). CONCLUSIONS: Contrary to what is believed generally, social support may not be a strong determinant of participation in rehabilitation after CABG. Correlates of social support such as gender, socioeconomic status, and comorbidity burden may have a more important role in cardiac rehabilitation participation than social support itself. When marital status was examined as a main predictive variable, the analyses yielded similar results (unadjusted RR, 0.72; 95% CI, 0.58-0.86; RR adjusted for the same covariates, 0.80; 95% CI, 0.60-1.02).

Aged↗

PubMed2005

Economic evaluation of cardiac rehabilitation: a systematic review.

BACKGROUND: Economic evaluation is an important tool in the evaluation of competing healthcare interventions. Little is known about the economic benefits of different cardiac rehabilitation program delivery models. DESIGN: The goal of this study was to review and evaluate the methodological quality of published economic evaluations of cardiac rehabilitation services. METHODS: Electronic databases were searched for English language evaluations (trials, modeling studies) of the economic impact of cardiac rehabilitation. A review of study characteristics and methodological quality was completed using standardized tools. All costs are adjusted to 2004 US dollars. RESULTS: Fifteen economic evaluations were identified which met eligibility criteria but which displayed wide variation in the use of comparators, evaluation type, perspective and design. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation in myocardial infarction and heart failure patients was identified. The range of cost per life year gained was estimated as from 2193 dollars to 28,193 dollars and from - 668 dollars to 16,118 dollars per quality adjusted life year gained. The level of evidence supporting the economic value of home-based cardiac rehabilitation interventions is limited to partial economic analyses. CONCLUSIONS: Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. Further trials are required to support the cost-effectiveness of cardiac rehabilitation in cardiac patients who have under gone revascularization. The literature evaluating home-based and alternative delivery models of cardiac rehabilitation was insufficient to draw conclusions about their relative cost-effectiveness. The overall quality of published economic evaluations of cardiac rehabilitation is poor and further well-designed trials are required.

Cost-Benefit Analysis↗

PubMed2005

Association of hemoglobin levels, acute hemoglobin decrease, age, and co-morbidities with rehabilitation outcomes after total knee replacement.

OBJECTIVE: A study was undertaken to assess the association of preoperative and postoperative hemoglobin levels with rehabilitation outcomes, age, and selected co-morbidities DESIGN: Charts of 49 patients admitted to rehabilitation after total knee arthroplasty due to degenerative joint disease were reviewed. Outcome measures included rehabilitation admission and discharge motor FIMtrade mark scores, motor FIM gain, and rehabilitation length of stay. RESULTS: Patients with higher preoperative hemoglobin levels had higher rehabilitation admission motor FIM scores (r=0.38, P<0.01) and lower motor FIM gains (r=-0.45, P<0.001). Patients who had higher hemoglobin levels at rehabilitation admission had higher admission motor FIM scores and shorter length of stay. Patients with diabetes had lower preoperative hemoglobin levels. Patients with hypertension had longer length of stay. Older patients had lower admission and discharge motor FIM scores and longer length of stay. CONCLUSIONS: Patients admitted to rehabilitation after total knee replacement have the potential to improve motor function, regardless of their preoperative and rehabilitation admission hemoglobin levels and the decrease in hemoglobin levels. However, those admitted to rehabilitation with lower hemoglobin levels, those with lower admission motor FIM scores, those who are older, and those who have hypertension may expect longer hospital stays to reach their functional goals.

Age Factors↗

PubMed2005

A realist study of the mechanisms of cardiac rehabilitation.

AIM: The aim of this paper is to report patients' experiences of cardiac rehabilitation and perceptions of the mechanisms and contexts influencing its long-term effectiveness. BACKGROUND: Cardiac rehabilitation programmes for the secondary prevention of coronary heart disease are common. The effects of these programmes, however, can be inconsistent and little is known of the personal and contextual factors that influence service effectiveness. METHOD: Forty-seven participants with a formal diagnosis of coronary heart disease who had attended a programme of cardiac rehabilitation in Scotland 3 years previously were included in focus groups to discuss their perceptions and experiences (30 males and 17 females). The data were generated in 2002 and analysed using the realist approach of Pawson and Tilley (1997). RESULTS: Participants' accounts indicated that the didactic content of cardiac rehabilitation was not strongly linked to longer-term health behaviour change. The main positive effects of cardiac rehabilitation were related to the effect of participation on mediating social and body-focused mechanisms that were triggered when the rehabilitation setting was perceived to be safe. Social mechanisms identified included social comparisons, camaraderie, and social capital. Body-focused mechanisms included greater knowledge of personal physical boundaries and a greater trust in the heart-diseased body. Collectively, these mechanisms had a positive effect on confidence that was perceived as being imperative to maintain health behaviour change. CONCLUSIONS: More support is required to promote health behaviour change after the completion of cardiac rehabilitation. Use of community-based exercise services and conventional or web-based support groups for coronary heart disease patients should be encouraged, as these appear to extend the positive health effects of the mechanisms that promote behaviour change. At the completion of cardiac rehabilitation programmes, patients should be referred to safe and appropriate community-based exercise services. Further research is needed to examine the effects on health outcomes of mechanisms and contexts related to cardiac rehabilitation.

Adult↗

PubMed2006

Quantifying the functional rehabilitation of injured football players.

OBJECTIVE: To determine whether quantified, auditable records of functional rehabilitation can be generated using subjective assessments of players' performance in fitness tests routinely used in professional football. METHOD: Ten sequential test elements grouped into three phases (fitness, ball and match skills, match pace football) were used to monitor players' functional recovery from injury. Physiotherapists subjectively assessed players' performance in each test element using a six point subjective rating scale. Satisfactory performance in each element of the assessment programme added 10% to the injured player's recovery score. Daily recovery scores for injured players were recorded against the time spent in functional rehabilitation. RESULTS: Rehabilitation data for 118 injuries sustained by 55 players over two seasons were recorded. The average time in functional rehabilitation depended on the time spent in pre-functional rehabilitation and the nature and location of injury. Benchmark functional rehabilitation curves (y = mln(x) + c) were developed for thigh (n = 15) and lower leg (n = 8) muscle strains and knee (n = 7) and ankle (n = 9) ligament sprains (R(2) = 0.95-0.98). CONCLUSIONS: A structured, quantified rehabilitation programme based on routine fitness and skills exercises and a graded subjective assessment of performance provides an auditable record of a player's functional recovery from a range of lower limb injuries and a transparent exit point from rehabilitation. The proposed method provides a permanent record of the functional rehabilitation of players' injuries and evidence based data to support management's return to play decisions.

Adult↗

PubMed1998

Outcome of subacute stroke rehabilitation: a randomized controlled trial.

BACKGROUND AND PURPOSE: Organized acute stroke treatment reduces mortality, functional deficits, and the need of institutionalization after stroke. It is largely unknown whether the effects of treatment are due to early or subacute efforts. The aim of this randomized, controlled study was to test the hypothesis that rehabilitation of stroke patients in the subacute phase in a hospital rehabilitation unit is beneficial in reducing death and dependency and increasing health-related quality of life. METHODS: 251 patients initially treated in the hospital were randomized to subacute rehabilitation in a hospital rehabilitation unit (n = 127) or to the health services in the municipality (n = 124) and were followed up for 7 months. RESULTS: The combined outcome of patients being dead or dependent (Barthel Index score of < 75) was 23% in the hospital group and 38% in the municipality group (P=.01). Seven-month survival rates were 90.6% and 83.9% (P=.11), respectively. Dependency in activities of daily living was 12.6% in the hospital group and 25.0% in the municipality group (P=.07). Patients with a BI score of < 50 before rehabilitation had significantly better outcome in the hospital rehabilitation unit, with fewer patients becoming dependent (P=.005) and patients having higher Scandinavian Stroke Scale (P=.026) and BI scores (P=.005). No significant differences in health-related quality of life were found. Many patients treated in the municipalities (30%) did not receive any organized rehabilitation in this study. CONCLUSIONS: Subacute rehabilitation of stroke patients in a hospital-based rehabilitation unit improves outcome. Patients with moderate or severe stroke appear to benefit most.

Acute Disease↗

PubMed2000

Rehab rounds: overcoming barriers to individualized psychosocial rehabilitation in an acute treatment unit of a state hospital.

Psychiatric rehabilitation begins during the acute stages of a psychiatric disorder and continues throughout the person's lifetime, with the types of services flexibly keyed to the person's phase of illness, needs, and personal goals. During periods of relapse and exacerbation of symptoms, when hospitalization is often required, psychiatric rehabilitation should include the following five objectives: * Clarify how the person's own goals in life, such as a desire for more self-control, freedom of choice, privacy, and time with friends and family, can be served by inpatient treatment and symptom stabilization. * Educate the patient about the nature of his or her illness and how medications work to restore self-control. * Teach the patient about side effects and self-monitoring and negotiating about medication and its effects in a collaborative way with the psychiatrist and other members of the treatment team. * Connect with the family or other natural supports that the person has in the community. * Enable the patient to make appropriate aftercare plans for residential and continuing treatment needs after discharge. When rehabilitation is viewed from the vantage point of these objectives, the inextricable interweaving of "treatment" with "rehabilitation" becomes clear. Treatment and rehabilitation are two sides of the same. It is much easier to integrate psychiatric rehabilitation into more traditional methods of treatment than it is to reorganize a treatment program or facility so that it blends rehabilitation with prevailing treatment imperatives of pharmacotherapy, supervision, and security and safety. In previous Rehab Rounds columns, we have described examples of creative methods for bringing the principles and practices of psychiatric rehabilitation into the treatment milieu (1,2,3). Faced with regulatory criticism from governmental agencies, Dr. Dhillon and his colleagues at Eastern State Hospital in Williamsburg, Virginia, launched a vigorous initiative to bring psychiatric rehabilitation into the forefront of their clinical enterprise. To enable readers to learn from their successful experience and adapt some of the administrative and clinical procedures that worked in Virginia, Dr. Dhillon and Ms. Dollieslager describe the operational details of their odyssey. We believe that their effectiveness in changing a traditional institution can be duplicated in many other places-in units within general hospitals or other community-based settings-as well as in state psychiatric hospitals, where acute treatment has been limited to pharmacotherapy and recreational and diversional activities.

Acute Disease↗

PubMed2026

Application of musculoskeletal ultrasound in postoperative rehabilitation assessment and monitoring after rotator cuff repair: A systematic review.

BACKGROUND: The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce. OBJECTIVE: To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes. RESULTS: Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks. CONCLUSION: Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Humans↗

PubMed1996

High-intensity physical training in adults with asthma. A 10-week rehabilitation program.

Twenty-six adults (23 to 58 years) with mild to moderate asthma underwent a 10-week supervised rehabilitation program, with emphasis on physical training. In the first 2 weeks, they exercised daily in an indoor swimming pool (33 degrees C) and received education about asthma, medication, and principles of physical training. In the following 8 weeks, they exercised in the pool twice a week. Every training session lasted 45 min. The training sessions were made as suitable as possible for the individual subjects, in order to minimize "drop outs" from the program. The aim of the study was to evaluate the efficacy of the rehabilitation program and to determine if inactive asthmatic adults can exercise at high intensity. The rehabilitation program was preceded by a 6-min submaximal cycle ergometry test, a 12-min walking test, spirometry, and a methacholine provocation test. The subjects also responded to a five-item questionnaire related to anxiety about exercise, breathlessness, and asthma symptoms using a visual analogue scale. All subjects were able to perform physical training at a very high intensity, to 80 to 90% of their predicted maximal heart rate. No asthmatic attacks occurred in connection with the training sessions. Twenty-two of the 26 subjects completed the rehabilitation program, felt confident with physical training, and planned to continue regular physical training after the 10-week program. Improvements in cardiovascular conditioning, measured as a decreased heart rate at the same load on the cycle ergometer (average of 12 beats/min), and as a longer distance at the 12-min walking test (average of 111 m), were observed during the program. FEV1 increased significantly from 2.2 to 2.5 L. Forced expiratory flow at 25% of vital capacity also increased slightly but significantly. Methacholine provocation dose causing a fall in FEV1 by 20% was unchanged. Seventeen subjects had a peak expiratory flow reduction of more than 15% after the preprogram ergometry test and were classified as having exercise-induced asthma (EIA). Only three of these subjects had EIA after 10 weeks. The asthmatic subjects were less afraid of experiencing breathlessness during exercise and less anxious about exercising at a high intensity after 10 weeks (p < 0.05). The asthma symptoms abated significantly during the rehabilitation program and the subjects needed less acute asthma care after the rehabilitation program. The results indicate that asthmatic persons benefit from a rehabilitation period, including physical training. Rehabilitation programs are therefore of value as a supplement to conventional pharmacologic treatment of asthma. This rehabilitation program can be adapted for use in clinical practice.

Adult↗