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PubMed2002

Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial.

OBJECTIVE: To compare hospital and home settings for the rehabilitation of patients following hip fracture. DESIGN: Randomized controlled trial comparing accelerated discharge and home-based rehabilitation (n = 34) with conventional hospital care (n = 32) for patients admitted to hospital with hip fracture. SETTING: Three metropolitan hospitals in Adelaide, Australia. SUBJECTS: Sixty-six patients with fractured hip. INTERVENTIONS: Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient's home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation. MAIN OUTCOME MEASURES: Physical and social dependence, balance confidence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls. RESULTS: While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization (p < 0.05) and scored higher on the Falls Efficacy Scale (p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital (p < 0.05) but a longer stay in rehabilitation overall (p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge. CONCLUSIONS: This trial further supports the practice of accelerated discharge from hospital and home-based rehabilitation in selected patients recovering from hip fracture. Such a practice appears to improve physical independence and confidence in avoiding subsequent falls which may have implications for longevity and overall quality of life.

Aged↗
PubMed1997

Economic analysis of respiratory rehabilitation.

STUDY OBJECTIVE: We report on the incremental costs associated with improvements in health-related quality of life (HRQL) following 6 months of respiratory rehabilitation compared with conventional community care. DESIGN: Prospective randomized controlled trial of rehabilitation. SETTING: A respiratory rehabilitation unit. PARTICIPANTS: Eighty-four subjects who completed the rehabilitation trial. INTERVENTION: Two months of inpatient rehabilitation followed by 4 months of outpatient supervision. MEASUREMENTS AND RESULTS: All costs (hospitalization, medical care, medications, home care, assistive devices, transportation) were included. Simultaneous allocation was used to determine capital and direct and indirect hospitalization costs. The incremental cost of achieving improvements beyond the minimal clinically important difference in dyspnea, emotional function, and mastery was $11,597 (Canadian). More than 90% of this cost was attributable to the inpatient phase of the program. Of the nonphysician health-care professionals, nursing was identified as the largest cost center, followed by physical therapy and occupational therapy. The number of subjects needed to be treated (NNT) to improve one subject was 4.1 for dyspnea, 4.4 for fatigue, 3.3 for emotion, and 2.5 for mastery. CONCLUSION: Cost estimates of various approaches to rehabilitation should be combined with valid, reliable, and responsive measures of outcome to enable cost-effectiveness measures to be reported. Comparison studies with the same method are necessary to determine whether the improvements in HRQL that follow inpatient rehabilitation are cheap or expensive. Such information will be important in identifying the extent to which alternative approaches to rehabilitation can influence resource allocation. A consideration of cost-effectiveness from the perspective of NNT may be useful in the evaluation of health-care programs.

Aged↗
PubMed2001

Quality of life measured with a generic instrument (Short Form-36) improves following pulmonary rehabilitation in patients with COPD.

STUDY OBJECTIVES: The purpose of this study was to evaluate the effects of a 3-week comprehensive pulmonary rehabilitation program on quality of life as measured by the Short Form-36 (SF-36) in patients with COPD. DESIGN AND SETTING: We report on the outcomes of 37 consecutive patients referred for pulmonary rehabilitation at a respiratory specialty medical center. PATIENTS: Thirty-seven patients (mean age, 66 years) with COPD and severe airflow limitation (mean +/- SE FEV(1), 29.6 +/- 1.8% of predicted) were studied. INTERVENTIONS: Rehabilitation consisted of a 3-week pulmonary rehabilitation program incorporating 12 exercise sessions, each of which included bicycle ergometer exercise training, upper-extremity training, strength training, and stretching, along with psychosocial counseling and education. MEASUREMENTS AND RESULTS: The Health Status Index (SF-36) and 6-min walk test were completed before and after rehabilitation. There was an improvement in five of the nine quality-of-life subscales of the SF-36 following pulmonary rehabilitation. Although there was an improvement in functional capacity as measured by the 6-min walk, there was no correlation between improvement in quality of life and improvement in functional capacity. There was no correlation between FEV(1) and improvement in walk distance, but there was a correlation between FEV(1) and improvement in SF-36 physical function and energy/fatigue subscales. CONCLUSION: Health-related quality of life assessed by the SF-36, a general measure of quality of life, improves following an intensive 3-week pulmonary rehabilitation program. Use of the SF-36 allows comparison of the results of pulmonary rehabilitation to therapeutic interventions in patients with other medical disorders.

Aged↗
PubMed1996

A community-oriented programme for rehabilitation of persons with arthritis.

A community-oriented programme for rehabilitation of persons with arthritis is described. It combines an 8-week ambulatory rehabilitation course (including patient education) at a rehabilitation institution, with long-term self-rehabilitation (at patients' homes), supervised by primary-care nurses. Sixty persons (mean age 54; 80% females) with a 13-year average duration of arthritis, were suffering pain, physical limitations, difficulties in social activities, tension and a tendency to depression. They had completed the course and a 12-month self-rehabilitation at home, and were assessed with the Arthritis Impact Measurement Scales (AIMS) questionnaire on admission to the course, at its completion and 1 year thereafter. Assessment upon completion of the course showed improvement in all areas studied. Measurements at follow-up showed that the majority carried out self-rehabilitation activities and preserved the improved functional status. The programme provided a much-needed service to arthritis sufferers living in the community, and promoted both the reorientation of institution-based rehabilitation professionals towards the community and self-rehabilitation and the cooperation between the institution and primary care.

Activities of Daily Living↗
PubMed1998

Rehabilitation after traumatic brain injury in adults.

PURPOSE: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.

Activities of Daily Living↗
PubMed1997

[The effects of pulmonary rehabilitation combined with inspiratory muscle training on pulmonary function and inspiratory muscle strength in elderly patients with chronic obstructive pulmonary disease].

It has been suggested that pulmonary rehabilitation compined with inspiratory muscle training (IMT) might improve pulmonary function and respiratory muscle strength in elderly patients with chronic obstructive pulmonary disease (COPD). To test this hypothesis, inspiratory muscle strength (PImax), expiratory muscle strength (PEmax) and resting pulmonary function were measured in 13 elderly patients with COPD (aged 70.3 +/- 2.7 years). Inspiratory muscle training (IMT) was performed for 15 min twice a day, using a pressure threshold device, for a total of 12 weeks. The inspiratory threshold was set at 15% of maximal inspiratory pressure (PImax) for each individual. Pulmonary rehabilitation was performed for 12-h sessions over a 12-week period. Patients with COPD were assigned randomly to two groups: pulmonary rehabilitation combined with IMT (group A) (n = 7), and conventional pulmonary rehabilitation only (group B) (n = 6). Functional residual capacity (FRC) decreased significantly from 4.3 +/- 0.4 L at baseline to 3.9 +/- 0.4 L after rehabilitation (p < 0.01), Vp significantly increased from 4.6 +/- 0.8 L/sec at baseline to 5.1 +/- 0.7 L/sec after rehabilitation (p < 0.05) and the PImax increased significantly from 51.5 +/- 5.4 cmH2O at baseline to 80.9 +/- 7.0 cmH2O after rehabilitation (p < 0.02) in group A. However, these variables did not change in group B. There was no improvement in the 10-minutes walking distance of group A, but there was a significant increase in that of group B. It can be concluded that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD.

Aged↗
PubMed2005

Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury.

PURPOSES: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. METHODS: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who 'liaises' between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. RESULTS: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation), 2. the organisational and financing level (e.g. availability of facilities and finances), and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care). The most important weakness experienced was that there was not enough time to put all the activities into practice. The strength of the care model lies in the combination of support of patients after discharge, support of and cooperation with primary care professionals, and feedback of experiences to the clinical rehabilitation teams. CONCLUSION: We recommend further improving and implementing the care model and encourage other care professionals and researchers to share their implementation experiences of follow-up care innovations for people with SCI.

Journal Article↗
PubMed1999

[Conceptual development of partial inpatient psychosomatic rehabilitation].

The conceptual development of partial hospitalization treatment is a present-day task for psychosomatic rehabilitation. For this task the general regulations of the pension insurance agencies as well as the conceptions existing in the field of psychosomatics and psychotherapy can serve as a sufficient basis for the conceptual development of partial hospitalization psychosomatic rehabilitation inspite of several differences between them. The elaboration of concrete outlines of this kind of psychosomatic rehabilitation takes place within a framework of structural models which encompasses different variants of institutional, organizational, functional and content forms of partial hospitalization rehabilitation. Moreover, the conceptual development of day treatment in rehabilitation raises several questions of the overall system of psychosomatic rehabilitation and offers possible solutions of general problems in psychosomatic rehabilitation. On this conceptual basis, in the further construction of partial hospitalization in psychosomatic rehabilitation concrete models should be designed and tested in clinical practice along with scientific evaluation.

Day Care, Medical↗
PubMed1999

Patients with metastatic breast cancer: their physical and psychological rehabilitation needs.

Few studies have monitored the physical and psychological sequelae of a diagnosis and treatment of metastatic breast cancer and the findings of the present study enables members of the rehabilitation team to understand the range of problems patients encounter, refer patients to other rehabilitation, and plan appropriate treatment. The present study aimed to describe the levels of anxiety and depression; to describe their rehabilitation status; and to ascertain whether any relationship exists between mood disturbance and physical rehabilitation status in a sample of women with metastatic breast cancer. Eighty patients with staging confirmed metastatic breast cancer were interviewed at home every eight weeks from diagnosis of metastases, on eight occasions using the Cancer Rehabilitation Evaluation System--Short Form, the Hospital Anxiety and Depression Scale, and an interview schedule to ascertain demographic and disease details. Results suggested that patients had a range of rehabilitation needs throughout the course of their disease. Mood disturbance was a significant problem in this sample of patients with many patients scoring in the case range for anxiety and depression on the HAD. A positive and strong relationship was found to exist between mood disturbance and physical rehabilitation status. The results of the study are discussed in the context of previous research and future research and clinical implications for the rehabilitation team are discussed.

Affect↗
PubMed1999

Characteristics of AMD patients with low vision receiving visual rehabilitation.

The purpose of this retrospective study done on 255 AMD patients evaluated at a low vision rehabilitation service was: 1) to describe the visual function characteristics (VFCs) of AMD patients presenting to visual rehabilitation, 2) to document changes in these VFCs between initial and follow-up rehabilitation visits, and 3) to investigate the relationship of the VFCs found at rehabilitation intake to the length of time between initial diagnosis and initial rehabilitation visit. Standard clinical testing (visual acuity and contrast sensitivity) as well as Scanning Laser Ophthalmoscope (SLO) visual function testing were performed to determine visual function including: 1) macular perimetry for scotoma boundary mapping and 2) PRL (preferred retinal locus) location and abilities in fixation, saccadic, and pursuit eye movements. The difference between the first and second visit VFCs were compared to the length of time between visits for 44 of the 255 patients returning for a second visit 0.5 to 4.5 years later. Finally, the initial date of AMD diagnosis was found for 51 of the 255 patients to analyze VFCs as a function of the time duration between diagnosis and the intake to the rehabilitation. Most VFCs had a wide range of results at initial intake to rehabilitation, while all patients had significant visual impairment by 24 months after initial diagnosis. The majority of low vision patients with AMD have bilateral central scotomas with the corresponding visual function and ADL problems that can often be overcome with visual rehabilitation.

Aged↗
PubMed2000

Relationship between baseline sympatho-vagal balance and the autonomic response to cardiac rehabilitation after a first uncomplicated myocardial infarction.

BACKGROUND: After a first uncomplicated myocardial infarction, cardiac rehabilitation increases the parasympathetic tone, in a direction linked to a reduced risk of sudden cardiac death. This change in sympatho-vagal balance may be related to other clinical variables. The aim of this study was to define the factors implicated in determining the autonomic response to cardiovascular rehabilitation after myocardial infarction. METHODS: In 55 patients (39-80 years) we evaluated the modulation of the autonomic profile induced by 8 weeks of rehabilitation: we analyzed the changes in pNN50 derived from time-domain analysis (deltapNN50) and in the low frequency/high frequency (LF/HF) ratio derived from autoregressive power spectral analysis (deltaLF/HF). A control group of 15 patients not undergoing rehabilitation was also studied. Variables considered at 4 weeks postinfarction and related to deltapNN50 and deltaLF/HF ratio were: age, site of myocardial infarction, previous thrombolysis, ejection fraction, stress test duration, baseline LF/HF ratio. RESULTS: Patients not undergoing rehabilitation did not change their autonomic profile. On the contrary, rehabilitation induced a higher vagal tone (pNN50 from 6.5 +/- 1.5 to 16.2 +/- 3.1; LF/HF ratio from 8.3 +/- 5.2 to 5.1 +/- 2.9, p < 0.05). Eleven patients (20%) had baseline LF/HF ratio exceeding the mean value by 1.5 SD (19.4 +/- 1.4): in this subgroup, pNN50 was very low. In these patients, rehabilitation increased pNN50 and decreased LF/HF ratio. Indeed, both deltapNN50 and deltaLF/HF ratio were significantly related to their baseline values (p < 0.001), even considering thrombolysis, site of myocardial infarction, age, and beta-blocker therapy. CONCLUSIONS: After a first uncomplicated myocardial infarction, sympatho-vagal balance may be very disturbed in some patients, despite a preserved ventricular function, good exercise capability and beta-blockers. These patients should be encouraged to undergo rehabilitation, since the significant improvement in the parasympathetic tone may protect them against subsequent arrhythmic events.

Aged↗
PubMed2000

[Good reasons to propose to the cardiology patient a cardiologic rehabilitation program].

According to the latest data available, in Italy a cardiac rehabilitation program is currently proposed to only 17% of patients after an acute myocardial infarction and to 76% of patients after a coronary artery bypass grafting. One possible explanation for this difference is an underestimation of the rehabilitating techniques and some doubts about its efficacy on the quality of life and on secondary prevention. Regarding secondary prevention, many research results and independent reviews are now available and they give us the opportunity to develop a sufficiently evidence-based analysis of cardiac rehabilitation program results. Great improvements in functional capacity and substantial changes in the way of life seem to have been demonstrated, with good-health oriented behaviors and improvements in the whole risk profile (less cigarette smoking, more sports activities, less stress, improvement in lipid profile). It has been well proven that with comprehensive rehabilitation programs, there is a relevant slow down in atherosclerosis progression. Rehabilitation programs also have favorable effects on the quality of life in patients with cardiac disorders, with fewer symptoms and more psychological and social well being. Three high-quality meta-analyses resulted in a significant reduction in total and cardiovascular mortality, mostly linked to sudden death and fatal reinfarction reduction, equal to the one obtained by currently recommended postinfarct treatments. Certainly, there are still difficulties to overcome before definitive conclusions can be reached, because of differences both in rehabilitation programs in the various studies and because of the results achieved in recent years through changes in the pharmacological approach to secondary prevention. The Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL study) from the Italian Study Group on Cardiac Rehabilitation (GICR) has been designed to answer to some of these questions. One of its goals is to evaluate whether an intensive intervention of cardiac rehabilitation in the postinfarct patients is actually applicable and efficacious.

Heart Diseases↗
PubMed2001

[Rehabilitation of patients with multiple sclerosis].

BACKGROUND: During the last decades a significant progress in rehabilitation of patients with multiple sclerosis (MS) has been achieved. This pilot study aims to study effect of weeks-lasting rehabilitation programme of MS patients in conditions of non-profiled inpatient rehabilitation unit. METHODS AND RESULTS: The rehabilitation program of 25 hospitalised patients was mostly aimed at complex kinesitherapy and physical therapy, partly also at ergotherapy and orthetics. Functional status of patients was evaluated at the beginning of the hospital stay and before dismission. Spasticity of lower limbs was scored using Global Assessment of Spasticity Scale (GSA) and modified Ashwort's scale. Motor subscore of Functional Independence Measure (FIM) was used to assess the patient's disability. In interval of 5 to 6 months a questionnaire was distributed among the patients to evaluate the rehabilitation stay. During the rehabilitation none of the studied patients got worse. At the beginning of hospitalisation average EDSS was 6.7 (median 6.5) +/- 1.0, before the demission it was 6.5 (6.5) +/- 0.9. Among the parameters studied statistically significant improvement came in the modified Ashwort's scale (from 2.5 +/- 0.8 to 1.8 +/- 0.6) and in the motor subscore of Functional Independence Measure (from 59 +/- 15 to 64 +/- 14). No statistically significant difference was found when the Global Assessment of Spasticity Scale was used--the improvement score of the group was 1.0 +/- 0.7. Not all of questionnaires returned. The results obtained from responders showed positive evaluation of the rehabilitation program, which lasted for several months. CONCLUSION: Results of the study correspond to the literary data both in immediate effects of the treatment and in its persistence after dismission. As important reveals the fact that most of the patients has primary or secondary progressive MS. It can be reasonably presumed that further improvement of the rehabilitation of patients with neurological diseases could be achieved in specialised neurorehabilitation centres.

Humans↗
PubMed2001

Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines.

BACKGROUND: Rehabilitation methods that generate increased tendon force and motion have been advocated to improve results following intrasynovial flexor tendon repair. However, the effects of rehabilitation force and motion on tendon-healing may be masked by the high stiffness produced by newer suture methods. Our objective was to determine whether the biomechanical properties of tendons repaired by one of two multistrand suture methods were sensitive to an increased level of applied rehabilitation force. METHODS: Two hundred and fourteen flexor digitorum profundus tendons from 107 adult dogs were transected and repaired. Dogs were assigned to one of four groups based on the rehabilitation method (low force [<5 N] or high force [17 N]) and the repair technique (four-strand or eight-strand core suture) and were killed between five and forty-two days after the procedure. Repair-site structural properties were determined by tensile testing, and digital range of motion was assessed with use of a motion-analysis system. RESULTS: Tensile properties did not differ between the low and high-force rehabilitation groups, regardless of the repair technique (p > 0.05). In contrast, tensile properties were strongly affected by the repair technique, with tendons in the eight-strand group having an approximately 35% increase in ultimate force and rigidity compared with those in the four-strand group (p < 0.05). Ultimate force did not change significantly with time during the first twenty-one days (p > 0.05); there was no evidence of softening in either of the repair or rehabilitation groups. Force increased significantly from twenty-one to forty-two days, while rigidity increased throughout the forty-two-day period (p < 0.05). CONCLUSIONS: Increasing the level of force applied during postoperative rehabilitation from 5 to 17 N did not accelerate the time-dependent accrual of stiffness or strength. Suture technique was of primary importance in providing a stiff and strong repair throughout the early healing interval. CLINICAL RELEVANCE: Our findings suggest that there be a reexamination of the concept that increases in force produced by more vigorous mobilization protocols are beneficial to tendon-healing. While more vigorous rehabilitation may help to improve hand function, we found no evidence that it enhances tissue-healing or strength in the context of a modern suture repair.

Animals↗
PubMed2003

Dynamics of muscle strength improvement during isokinetic rehabilitation of athletes with ACL rupture and chondromalacia patellae.

AIM: To assess quantitatively dynamics and extent of the increase in muscle strength during isokinetic rehabilitation. METHODS EXPERIMENTAL DESIGN: daily measurements of muscle strength; detailed testing at the beginning and at the end of rehabilitation. SETTING: Cybex Rehabilitation Center, Zagreb. SUBJECTS: 44 athletes (31 m, 13 F, age 16-35), 3 injury-defined groups: athletes with ACL rupture (non-reconstructed and reconstructed) and chondromalacia patellae. INTERVENTIONS: all subjects underwent isokinetic rehabilitation on Cybex Orthotron KT2 device, using individually designed protocols (extension and flexion exercises, concentric muscle contractions, 15 treatments). MEASUREMENTS: monitoring of daily progress on rehabilitation device and detailed testing on diagnostic device. RESULTS: All patients showed considerable improvement. Muscle strength improved on average 141% (SD=110) in ACL-reconstructed group, 144% (SD=130) for chondromalacia patellae group and 150% (SD=74) for ACL-non-reconstructed group, comparing to initial strength. Dynamic status tested on Cybex Otrhotron diagnostic device prior and after rehabilitation strongly correlated with final progress monitored on the rehabilitation device. CONCLUSION: Isokinetic rehabilitation is a quick and effective method in treating knee injuries in athletes. Both types of objective criteria have shown significant increase in muscle strength. The improvement of muscle strength was on the average 149% (SD=101), which is about 10% daily for 15 treatments. The greatest progress, 19% per day, occurred during first five days. The athletes were able to resume their sport activities as follows: patients from chondromalacia patellae group, and most of them from the non-reconstructed ACL group were back in competition within a month, while 75% from the ACL reconstructed group came back within 3 months, and the rest of them within 5 months.

Adolescent↗
PubMedDate not supplied

A 10-year perspective on the patients referred to a geriatric rehabilitation complex: the influence of managed care.

OBJECTIVE: In the past 10 years, HMOs have used managed care to reduce patients referrals for rehabilitation in our Geriatric Rehabilitation Complex (GRC). DESIGN: This study compares data regarding patients referred for rehabilitation for 4 months in 1998 with data from a similar study we performed in 1989. SETTING: The GRC, which is part of a 396-bed geriatric hospital, includes a 36-bed ward complemented by departments of physical and occupational therapy, a speech therapy unit, and a rehabilitation psychologist. It is supported by modern rehabilitation equipment and facilities and is staffed by experienced, highly qualified academic personnel. RESULTS: The overall number of patients referred for rehabilitation decreased by 36% during this period. However, the average age of patients is higher, the number of patients with Recc. Stroke dominates, and length of stay was reduced by 20%. CONCLUSION: Although the rehabilitation needs of older people are increasing, fewer patients are referred to our GRC. Those who are referred are older, and their condition is more complicated; nevertheless, their length of stay has also been reduced. These are the results of HMO policies to refer older patients to new "rehabilitation settings" that charge lower prices while offering services of still unproved quality. As geriatricians, it is our duty to prevent cost considerations from overtaking the need to maximizing functional recovery.

Journal Article↗
PubMed2003

Age-Related Differences in Predictors of Adherence to Rehabilitation After Anterior Cruciate Ligament Reconstruction.

OBJECTIVE: To examine whether the relationships between psychological factors and rehabilitation adherence after knee surgery differ as a function of age. DESIGN AND SETTING: Participants completed inventories of self-motivation, social support, athletic identity, and psychological distress before anterior cruciate ligament (ACL) reconstruction. After surgery, participants recorded their completion of home rehabilitation exercises and cryotherapy, and the sport rehabilitation professionals providing their treatment reported on the patients' attendance at, and adherence during, rehabilitation sessions. SUBJECTS: Sixty-one individuals with acute ACL tears. MEASUREMENTS: The Self-Motivation Inventory, Social Support Inventory, Athletic Identity Measurement Scale, Brief Symptom Inventory, and Sport Injury Rehabilitation Adherence Scale were used to measure self-motivation, social support, athletic identity, psychological distress, and adherence, respectively, during rehabilitation sessions. RESULTS: Hierarchic regression analyses indicated that age moderated the relationships between (1) self-motivation and home exercise completion, (2) social support and home exercise completion, (3) athletic identity and home exercise completion, and (4) athletic identity and home cryotherapy completion. CONCLUSIONS: The prospective moderating relationships for between psychological factors and indices of adherence to home-based rehabilitation activities indicate the need to consider developmental issues when examining psychological aspects of sport-injury rehabilitation.

Journal Article↗
PubMed2004

[Early results of rehabilitation after repair of the anterior cruciate ligament with open surgical or arthroscopic method].

The purpose of the study was to evaluate the methods of rehabilitation in patients who had undergone a plastic procedure (open or arthroscopic surgery) of the anterior cruciate ligament (ACL). The value of objective measurement methods used for monitoring the rehabilitation process was also assessed, with particular attention to the usefulness of goniometric pendulum test. All patients underwent rehabilitation in the Department of Motor Organ Rehabilitation at the Upper Silesian Rehabilitation Center in Ustroń. For the purpose of the rehabilitation process evaluation, the condition of patients: goniometry and the pendulum test were performed twice, i.e. at admission and then at termination of rehabilitation. A modification of the Lysholm Scale and a subjective knee questionnaire (WAS) were also used. In group of healthy subjects only the pendulum test was done. Based on the obtained results it was found that the convalescence period needed to achieve the best ultimate capability within the knee joint mainly depended on the operative technique. However, appropriate kinesitherapy may affect the rate of convalescence in the group of patients with less favorable surgical outcome. In patients who had undergone a reconstruction of the anterior cruciate ligament, goniometric pendulum test is an effective tool to aid the evaluation of rehabilitation results; the test adds to the assessment done by the well-known subjective methods.

Adult↗