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PubMed1997

[Peer review: a method for the analysis of the quality of processing in-patient rehabilitation methods].

In order to evaluate the process quality of inpatient rehabilitation we established a peer-review system. In our approach, measurement of process quality is based on the report written by rehabilitation doctors at discharge of their patients. First of all, a list of 52 criteria relevant to process quality was defined by experienced clinicians using the Delphi technique. These criteria may be divided into six dimensions: anamnesis, diagnostic interventions, goals of therapy and therapy, judgement on vocational abilities, recommendations for further treatment and epicrisis. Thereafter, the experts in a manual defined specific requirements for each of the 52 criteria. In a pilot study, we were able to demonstrate reliability and practicability of the peer review system. Using this approach shortcomings in present rehabilitation practice may be detected. Nearly 400 reports from 20 rehabilitation hospitals were reviewed by thoroughly trained peers. Most frequently shortcomings were found in the description of patient's disabilities and in the definition of specific rehabilitation goals. Furthermore, this procedure enables comparison of process quality in different rehabilitation hospitals. In our pilot study we found marked differences in the process quality of the 20 rehabilitation hospitals.

Germany↗
PubMedDate not supplied

Functional assessment: a holistic approach to rehabilitation of the geriatric client.

Functional assessment of the elderly client provides a structured approach to the complex and multidimensional issues in rehabilitation. Rehabilitation nurses may be familiar with some of the long-standing functional assessment tools, such as Barthel's index. It is important to have a working knowledge of a variety of tools, as well as an ongoing awareness of newer ones as they are developed (e.g., the Functional Independence Measure). Functional assessment is part of comprehensive geriatric evaluation. After initial assessment by rehabilitation team members, the team considers the patient's strengths and supports and develops a problem list (NIH, 1987). The individualized plan of care is developed with the elderly client to achieve maximum rehabilitation potential. Functional assessment tools assist in measuring rehabilitation progress and in clinical decision making. They also can be used in clinical research in geriatric rehabilitation. The number of elderly persons in this country is growing rapidly. Rehabilitation nurses will need to expand their clinical skills to integrate holistic geriatric assessment.

Activities of Daily Living↗
PubMedDate not supplied

Pulmonary rehabilitation, psychosocial adjustment, and use of healthcare services.

Chronic obstructive pulmonary disease (COPD) is the second most significant illness in those who are in their middle-to-late adult years. Pulmonary rehabilitation is one means of working with individuals with COPD to improve their quality of life. Nurses are often the facilitators and coordinators of pulmonary rehabilitation. Evaluation of the effects of pulmonary rehabilitation is an essential aspect of providing quality care. The purpose of this study was to evaluate the relationship of pulmonary rehabilitation to individuals' use of healthcare services and to their psychosocial adjustment to COPD. A convenience sample was obtained from an outpatient pulmonary rehabilitation program associated with a rural regional medical center in the southwestern United States. The sample consisted of 13 individuals who had no formal pulmonary rehabilitation and 17 individuals who had completed a formal pulmonary rehabilitation program. Psychosocial adjustment was measured by the Psychosocial Adjustment to Medical Illness Scale-Self Reporting (PAIS-SR). No significant statistical difference was found between the two groups in their PAIS-SR scores or use of healthcare services, as measured by the number of days spent in the hospital during the previous year.

Adaptation, Psychological↗
PubMedDate not supplied

Managed care, cost-effectiveness, and rehabilitation: the case of HIV.

Because of its cost-effective approach to impairment and disability, rehabilitation therapy is uniquely positioned to assume a significant role in today's healthcare environment. As the cost of health care has become a major concern, both the government and the private insurance industry have turned toward rehabilitation services as resources for preventing more costly use of the healthcare system in the future. Although funding in the area of injury research scarce, funding for demonstrating the success of therapies for chronic illness such as HIV is more plentiful. In the case of HIV, rehabilitation nursing techniques and principles can be used as a model for reducing the substantial social costs of the disease. Specifically, rehabilitation nurses can assume a leadership role as service coordinators for HIV-positive patients. If rehabilitation nurses perform this role effectively and participate fully in research efforts aimed at measuring the success of rehabilitation therapy, their efforts have the potential of permanently raising the status of the rehabilitation nursing specialty.

Cost-Benefit Analysis↗
PubMedDate not supplied

Cancer rehabilitation: does it make a difference?

Cancer is a significant cause of physical and cognitive disability. The concept of cancer rehabilitation was developed in the 1970s; it was a concept that led to funding support and to significant contributions to symptom management. A recent trend has been an increase in the number of cancer diagnoses and an increase in cancer survival rate. This suggests that more persons with cancer are living longer despite cancer-caused impairments. Interdisciplinary cancer rehabilitation programs are designed to help cancer patients achieve maximal functional ability and adapt to disabilities resulting from cancer or its treatments. Currently, there are few cancer rehabilitation programs in the United States. Information about the role of rehabilitation nursing in cancer patient care is scarce. The purposes of this article were to review the history of cancer rehabilitation; review functional outcomes that have been reported in current research; and identify the multiple, complex challenges that illustrate the role of a cancer rehabilitation clinical nurse specialist in the rehabilitation of cancer patients.

Adult↗
PubMed1999

[Rehabilitation with the "Ennepetal model"].

The rehabilitation model which is described in this paper shows that optimization of the goals of rehabilitation such as improvement of vocational reintegration is possible by means of a flexible rehabilitation process and that this can also be achieved using existing resources. The patients are cared for according to their disabilities and functional disorders along what can be described as a rehabilitation course, ranging from in-patient and outpatient/semi in-patient treatment to outpatient heart groups. It was possible to achieve marked improvements in vocational reintegration over a 2-year period by an intervention program (intensified aftercare treatment, INA). After completion of follow-up rehabilitation, the number of generally disabled pensioners was substantially lower in the intervention program than in the case of patients in the control group. It has also been shown clearly that flexible rehabilitation models require co-operation on the part of all those involved in the rehabilitation process.

Adult↗
PubMed2003

[Effects of a phase II cardiac rehabilitation program performed on an outpatient basis].

BACKGROUND AND OBJECTIVE: In Germany, phase II cardiac rehabilitation has always been carried out on an inpatient basis. Meanwhile, the governmental health authorities are demanding more flexible solutions for cardiac rehabilitation. The objective of this study is to examine the effects of phase II cardiac rehabilitation performed on an outpatient basis (OCR) in a larger patient cohort. These are the first results of patients before and directly after the OCR performed at six different rehabilitation centers. PATIENTS AND METHODS: The study group consisted of 479 men and 74 women, 56.1 +/- 11.5 years. Cardiovascular indications for the OCR were myocardial infarction in 219 cases, coronary artery disease (CAD) in 92, in 84 cases with invasive procedures, coronary artery bypass graft in 185, cardiac valve surgery in 26, and other cardiac diseases in 29. 70% of the patients were worker, 25% without professional training. Staying with the family (42%) and aversion to stationary programs (61%)were the main reasons for the choice of OCR. Without OCR,27.4% would have refused any rehabilitation program. RESULTS: Maximal physical performance increased from 97.8 + - 31.4 to 120.4 +/- 37.3 W (p < 0.001). LDL cholesterol was reduced from 145.9 +/- 42.7 to 117.5 +/- 34.7 mg% (p < 0.001), triglycerides from 203.3 +/- 136.0 to 161.9 +/- 91.6 mg% (p < ).010), HDL cholesterol increased from 39.8 + 11.2 to 41.0 +/- 11.3 mg% (p = 0.003). The use of lipid-lowering therapy in CAD patients increased from 63.1% to 80.7%. A reduction in body mass index from 27.1 +/- 3.6 to 26.9 +/- 3.5 kg/m2 (p = 0.010) was demonstrated. The number of active smokers decreased from 53.8% to 25.6%. CONCLUSION: The results obtained are interesting with respect to the patients' social status. With 70% general laborers, our cohort is in contrast to previously published OCR data. On the whole, these results demonstrate that rehabilitative measures can also be implemented on an outpatient basis, without a decrease in the quality of treatment. This also applies to patients who represent lower socioeconomic levels. The results should motivate to work harder and more sufficiently on the development of more flexible cardiac rehabilitation programs.

Aged↗
PubMed2002

[Impact of hospital diagnostic related groups on geriatric rehabilitation facilities].

The introduction of the DRGs (diagnosis related groups) for paying hospitals in Germany in 2003 will result in changes in quality, quantity and financial flows foremost for the hospital sector but also for the important sector of the geriatric rehabilitation. This geriatric sector will experience a growth in total patient numbers, an enhanced and altered service range and a change in the market relationship towards the hospitals. The introduction of case-related payments also for the geriatric rehabilitation could, on the one hand, reduce the negative spillover effects from the hospital sector and, on the other hand, guaranty an efficient service provision. Furthermore, there would be a good comparability among the geriatric rehabilitation facilities and between costs in institutions of geriatric rehabilitation and hospitals. If hospital and geriatric rehabilitation services were payed by case-related payments, efficiency of health care services could be further improved by a broad definition of cases (complex case-based reimbursement), including care in the hospital as well as the care in the rehabilitation clinic afterwards. If rehabilitation would be financed by case-based reimbursement as well as by of a complex case-based reimbursement, a quality assurance program would be necessary.

Aged↗
PubMed2006

[Persons requiring long-term care: Recommendation and utilization of rehabilitative therapies].

In Germany all members of the statutory health insurance are also compulsory members of the nursing care insurance which financially supports nursing care at home and in nursing homes. Benefits are provided dependent on a standardized medical examination performed at the home of the applicants by trained physicians or nurses of the health insurances' medical service (MDK). The benefits are granted to those persons who are limited in the performance of activities of daily living due to physical, cognitive or mental disorders. In the German Code of Social Law regulating the long-term care system, one important entitlement is "rehabilitation before long-term care". It aims at maintaining life of disabled persons in their familiar surroundings as long as possible. Up to now in the nursing care insurance this aim has been implemented insufficiently. The objective of this study was therefore to investigate the frequency of suggested ambulatory rehabilitation, which is recommended by the MDK at the examinations, and the following prescription of ambulatory rehabilitation, issued by an office-based physician. The database included the medical examinations of the years 2001 to 2002 linked to a random sample of persons insured in a statutory sickness fund in the German federal state of Hesse. Nursing care-related information including recommended rehabilitation therapy was derived from the medical examinations. Insurance data provided information on prescriptions. Data of 7,840 persons could be analyzed. Rehabilitative therapy was recommended in 15% of the nursing care applicants, mostly physiotherapy (ca. 90%). Persons receiving the recommendation were mainly male, they were younger, were more disabled, had less often a diagnosis of the ICD-10 chapter "symptoms and abnormal clinical and laboratory findings" or "mental and behavioral disorders", live less often alone and were more restricted in their motion compared to persons without recommendation for rehabilitative therapy. Only 55.3% of the persons with a recommendation for physiotherapy and only one-third with a recommendation for occupational therapy or logopedics received a prescription for the respective therapy in the following three months after examination. The age younger than 80 years, professional care, no home care, and-as the strongest item-preceding therapy were positively related to receiving a prescription. These findings show that disabled persons have the capability for prevention and rehabilitation, but it is used in only half of them. One possible reason might be the financing of the remedies, which burdens the budget of the health insurance, where instead the nursing care insurance benefits from the possible delay of the utilization of nursing care.

Activities of Daily Living↗
PubMed2006

Cardiac rehabilitation in Austria: short term quality of life improvements in patients with heart disease.

BACKGROUND: The goal of cardiac rehabilitation programs is not only to prolong life, but also to improve physical functioning, symptoms, wellbeing and health-related quality of life (HRQL). The aim of the study was to document short-term outcomes of cardiac rehabilitation programs in Austria. METHODS: Consecutive patients (N = 487, 64.7% male, age 60.9 +/- 12.5 SD years) after myocardial infarction (MI), with or without percutaneous interventions (PCI), coronary artery bypass grafting (CABG) or heart valve surgery (HVS), referred to the six inpatient rehabilitation centers of the Austrian PVA insurance company, were included in the study. Exercise capacity, risk factors and HRQL (MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]) were measured at the beginning and end of the 4-week inpatient cardiac rehabilitation program. RESULTS: Global HRQL (MacNew) improved significantly over time in all patients combined (+0.75 +/- 0.88 SD, T = -16.99, df = 394, p < .001) and exceeded the minimal important difference. Patients with CABG, HVS or MI without PCI showed the greatest improvements in global HRQL after cardiac rehabilitation (p < .02). Blood pressure, cholesterol, triglyceride, body mass index, waist circumference improved significantly (all p < .001). CONCLUSION: These findings provide evidence that the improvements in HRQL and risk factors following cardiac rehabilitation in Austria are clinically important. HRQL should become a standard outcome parameter in cardiac rehabilitation.

Activities of Daily Living↗
PubMed1995

Multidisciplinary rehabilitation versus medical care: a meta-analysis.

Research studies in physical medicine have not demonstrated the effectiveness of inpatient rehabilitation services, primarily due to differences in methodological approaches which have led to inconsistent findings. Because of differing inclusion and outcome criteria, even meta-analyses have been inconclusive. To address this problem, research literature comparing the clinical effectiveness of rehabilitation programs with medical care was evaluated for three uniformly available outcome criteria: survival; functional ability; and discharge location. Published trials were obtained from citations in Index Medicus (Medicine) and Nursing and Allied Health Abstracts covering the recent 20 year period from 1974 to 1994. We used meta-analyses to test the hypotheses that specialized rehabilitative care (vs conventional medical care) improves health outcomes. Results of our meta-analyses indicated that rehabilitation services were significantly associated with better rates of survival and improved function during hospital stay (P < 0.01), but significance was not observed at follow-up. Also, rehabilitation patients returned to their homes and remained there more frequently than controls (P < 0.001). We concluded that patients who participate in inpatient rehabilitation programs function better at hospital discharge, have a better chance of short term survival, and return home more frequently than non-participants. However, long term survival and function were the same for experimental and control subjects. The sustaining benefit of returning home may suffice to justify the provision of inpatient rehabilitation. However, the lack of other long term benefits suggests that services may need to be continued at home or in subacute care settings to optimize their effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2004

Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury.

OBJECTIVE: To evaluate the effectiveness of an intensive cognitive rehabilitation program (ICRP) compared with standard neurorehabilitation (SRP) for persons with traumatic brain injury (TBI). DESIGN: Nonrandomized controlled intervention trial. SETTING: Community-based, postacute outpatient brain injury rehabilitation program. PARTICIPANTS: Fifty-six persons with TBI. INTERVENTIONS: Participants in ICRP (n=27) received an intensive, highly structured program of integrated cognitive and psychosocial interventions based on principles of holistic neuropsychologic rehabilitation. Participants in SRP (n=29) received comprehensive neurorehabilitation consisting primarily of physical therapy, occupational therapy, speech therapy, and neuropsychologic treatment. Duration of treatment was approximately 4 months for both interventions. MAIN OUTCOME MEASURES: Community Integration Questionnaire (CIQ); and Quality of Community Integration Questionnaire assessing satisfaction with community functioning and satisfaction with cognitive functioning. Neuropsychologic functioning was evaluated for the ICRP participants. RESULTS: Both groups showed significant improvement on the CIQ, with the ICRP group exhibiting a significant treatment effect compared with the SRP group. Analysis of clinically significant improvement indicated that ICRP participants were over twice as likely to show clinical benefit on the CIQ (odds ratio=2.41; 95% confidence interval, 0.8-7.2). ICRP participants showed significant improvement in overall neuropsychologic functioning; participants with clinically significant improvement on the CIQ also showed greater improvement of neuropsychologic functioning. Satisfaction with community functioning was not related to community integration after treatment. Satisfaction with cognitive functioning made a significant contribution to posttreatment community integration; this finding may reflect the mediating effects of perceived self-efficacy on functional outcome. CONCLUSIONS: Intensive, holistic, cognitive rehabilitation is an effective form of rehabilitation, particularly for persons with TBI who have previously been unable to resume community functioning. Perceived self-efficacy may have significant impact on functional outcomes after TBI rehabilitation. Measures of social participation and subjective well-being appear to represent distinct and separable rehabilitation outcomes after TBI.

Adult↗
PubMed2005

Early versus delayed inpatient spinal cord injury rehabilitation: an Italian study.

OBJECTIVE: To examine what effect the injury-to-rehabilitation interval has on the outcome of spinal cord injury (SCI) rehabilitation. DESIGN: Retrospective study. SETTING: Spinal unit of a large rehabilitation hospital. PARTICIPANTS: Consecutive admissions were divided into groups according to age, sex, and American Spinal Injury Association impairment grade and neurologic level of injury. The patients were matched for these variables and divided into groups according to the interval from injury to admission into acute rehabilitation. This approach resulted in 150 patients with SCI grouped into 50 comparison subgroupings. Interventions Three comparison groups-short (<30 d), medium (31-60 d), and long (>60 d) time to admission (TTA)-were evaluated for rehabilitation outcomes. MAIN OUTCOME MEASURES: Barthel Index, Rivermead Mobility Index, Walking Index for Spinal Cord Injury, and motor scores at admission and discharge were examined. The changes and efficiencies were evaluated. RESULTS: The 3 groups were comparable for all medical and demographic characteristics as well as neurologic recovery. The 3 subgroups differed significantly in activity of daily living outcomes, with the short TTA group exhibiting higher Barthel Index raw discharge scores, score increases, and score efficiencies. CONCLUSIONS: Early rehabilitation seems to be a relevant prognostic factor of functional outcome. Rehabilitation intervention in patients with SCI should begin as soon as possible, in a specialized setting, because delay may adversely affect functional recovery.

Activities of Daily Living↗
PubMed2005

Cost-effectiveness of screening for deep vein thrombosis by ultrasound at admission to stroke rehabilitation.

OBJECTIVE: This project was a cost-effectiveness analysis of the practice of routine Doppler ultrasound screening for deep vein thrombosis (DVT) in patients with ischemic stroke at the time of admission to rehabilitation. DESIGN: A decision-analysis model was created to compare 2 approaches for detecting DVT in a stroke population: (1) screening all patients with acute ischemic stroke at admission to stroke rehabilitation for DVT by Doppler ultrasound with subsequent treatment; or (2) clinical surveillance for signs of DVT and treatment after confirmation by Doppler ultrasound. The prevalence of DVT, risk of complication from DVT, and risk of complication from treatment were obtained from published reports. Costs are in 2004 dollars and the effectiveness was measured in quality-adjusted life-years (QALYs) gained. We conducted these analyses from a societal perspective. SETTING: Inpatient stroke rehabilitation unit. PARTICIPANTS: Not applicable. INTERVENTION: Screening all patients with acute ischemic stroke at admission to stroke rehabilitation for DVT by Doppler ultrasound with subsequent treatment. MAIN OUTCOME MEASURE: Cost in 2004 dollars per QALY gained by screening all patients with acute ischemic stroke at admission to stroke rehabilitation for DVT by Doppler ultrasound with subsequent treatment. RESULTS: The expected utility of screening patients with ischemic stroke for DVT by Doppler ultrasound on admission to rehabilitation is 1.875 QALYs and that of not screening is 1.872 QALYs. The expected gain is .0026 QALYs (23 h). Obtaining this increase in quality-adjusted life incurs additional cost of 168 dollars per stroke patient and a marginal cost-effectiveness of 67,200 dollars for each QALY gained. CONCLUSIONS: This study estimates that the cost-effectiveness ratio is considerably higher than that reported in other rehabilitation conditions and higher than the commonly stated level for an intervention to be considered cost-effective. The difference from previous reports primarily relates to the shorter life expectancy following stroke, the prevalence of occult DVT at admission, rate of complications of anticoagulation, and the estimates of the screening's test characteristics used in our study. Further study of these areas is likely to contribute to improving our understanding of the most appropriate care of these patients.

Anticoagulants↗
PubMed2006

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.

OBJECTIVE: To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI). DESIGN: Case-controlled study. SETTING: SCI unit in a rehabilitation center. PARTICIPANTS: Seventeen patients with SCI-AA and 17 patients with traumatic SCI. INTERVENTION: Standard rehabilitation therapy for SCI. MAIN OUTCOME MEASURES: Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge. RESULTS: No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community. CONCLUSIONS: SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.

Adult↗
PubMed2000

Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation.

OBJECTIVE: To compare lumbar paraspinal, gluteus maximus, and biceps femoris muscle function during sagittal trunk flexion and extension in patients with chronic low back pain and healthy control subjects, and to assess the influence of rehabilitation in the back pain patients. DESIGN: A cross-sectional study comparing chronic low back pain patients and healthy controls, and a prospective follow-up in back pain patients during rehabilitation. SETTING: Physical medicine and rehabilitation clinic. SUBJECTS: Nineteen women with chronic low back pain, and 19 women without pain (controls). INTERVENTION: Five-week active outpatient rehabilitation (1 hour three times a week) guided by a physiotherapist, followed by 5-week self-motivated exercise at home. OUTCOME MEASURES: Subjects performed sagittal trunk flexion and extension while surface electromyogram was bilaterally recorded of paraspinal (L1-L2 level), gluteus maximus, and biceps femoris muscles. The muscle activity was assessed from the average electromyogram and the relative muscle activation onsets and their duration were calculated. RESULTS: During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension. CONCLUSIONS: The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients.

Adult↗
PubMed2003

Lateral pelvic displacement during gait: abnormalities after stroke and changes during the first month of rehabilitation.

OBJECTIVES: To measure the amplitude and symmetry of lateral pelvic displacement (LPD) in patients with acute hemiparetic stroke; to assess the relationship between LPD and walking speed; and to quantify changes in LPD during 1- and 4-week intervals in the early stages of gait rehabilitation. DESIGN: LPD amplitude and symmetry were measured in stroke patients on admission to acute rehabilitation, 1 week later, and at 4-week follow-up. Performance was compared with sex-, height-, and age-matched control subjects. SETTING: Urban geriatric inpatient rehabilitation facility in Australia. PARTICIPANTS: Fifteen patients with a single-hemisphere stroke, confirmed by computed tomography, were compared with the data from 12 control subjects. Patients' FIM trade mark instrument scores ranged from 54 to 124. INTERVENTION: Gait rehabilitation involved twice-daily individual physical therapy sessions of 45 to 60 minutes, 5 days a week, incorporating whole and part practice, mental rehearsal, verbal feedback on performance, manual guidance, and strengthening techniques. MAIN OUTCOME MEASURES: Three-dimensional motion analysis of LPD amplitude and symmetry; and preferred walking speed over 10m. RESULTS: Compared with controls, stroke patients initially showed increased amplitude of LPD, with no difference in LPD symmetry. A statistically significant linear relationship existed between walking speed and amplitude of LPD (r=-.53; P=.04), yet not between walking speed and symmetry (r=-.41, P=.13). Amplitude and symmetry values remained consistent during the 4-week period of rehabilitation. CONCLUSIONS: These results provide baseline LPD values for patients with acute hemiparetic stroke and demonstrate the relationship between LPD and walking speed. Change in LPD during inpatient rehabilitation was not uniform or predictable, particularly during longer periods. This highlights the need for therapists to regularly reassess each patient during the early rehabilitation phase after stroke, especially given that individual differences can be marked.

Aged↗
PubMed2003

The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis.

OBJECTIVES: To identify factors relating to the intensity of rehabilitation services received and to ascertain the relation between injury outcomes, demographics, types of therapy, and the intensity of rehabilitation services provided. DESIGN: A multicenter, prospective, nonrandomized study with inpatient rehabilitation data collected between 1989 and 1996. SETTING: Three medical centers in the federally sponsored Traumatic Brain Injury Model Systems. In each setting, the continuum of care includes emergency medical services, intensive and acute medical care, and inpatient rehabilitation. PARTICIPANTS: A total of 491 consecutively enrolled patients with a mean age +/- standard deviation of 34.3+/-15.88 years recruited from 3 medical centers. To be included in the study, patients must have been at least 16 years of age, have presented to the emergency department within 24 hours of injury, and have received acute care and inpatient rehabilitation. INTERVENTIONS: Patients received comprehensive medical care along with a combination of rehabilitative therapies, including physical, occupational, psychologic, and speech therapy. MAIN OUTCOME MEASURES: Therapy intensity; levels of functional independence, cognitive function, functional gain, and treatment efficiency, as indicated by the FIM instrument; rehabilitation length of stay (LOS); and charges. RESULTS: Age predicted the intensity of both psychologic (P<.001) and total therapy (P<.01) services. Acute care LOS was also a significant predictor of psychologic services (P<.01). Only admission motor FIM was relevant in predicting speech services intensity (P<.01). Therapy intensity was predictive of motor functioning at discharge (P<.001). However, therapy intensity did not predict cognitive gain (P<.05). CONCLUSIONS: This study is among the first multicenter efforts to examine the potential benefits of individual therapy services. Findings support assertions that increased therapy intensity, particularly physical and psychologic therapies, enhances functional outcomes.

Adult↗