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PubMed2003

State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment.

OBJECTIVES: To increase recognition of geriatric rehabilitation and to provide recommendations for practice and future research. DATA SOURCES: A CINAHL and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search used the Cochrane database. STUDY SELECTION: One author reviewed the reference for relevance and another for quality. A total of 336 articles were selected. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports. DATA EXTRACTION: The following major geriatric rehabilitation subtopics were identified: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. Part I describes the first 5 subtopics on concepts and processes in geriatric rehabilitation. Part II focuses on the latter 5 subtopics of common clinical problems in frail older persons. A level-of-evidence framework was used to review the literature. Level 1 evidence was a randomized controlled trial (RCT) or a meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts or descriptive studies. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic. In cases in which several articles were written on the same topic and drew similar conclusions, the authors chose those articles with the strongest level of evidence, reducing the total number of references. CONCLUSIONS: Frail elderly patients should be screened for rehabilitation potential. Standardized tools are recommended to aid diagnosis, assessment, and outcome measurement. The team approach to geriatric rehabilitation should be interdisciplinary and use a comprehensive geriatric assessment. Medication reviews and self-medication programs may be beneficial. Future research should address cost effectiveness, consensus on outcome measures, which components of geriatric rehabilitation are most effective, screening, and what outcomes are sustainable.

Aged↗
PubMed1998

Intractable hiccups during stroke rehabilitation.

OBJECTIVE: To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management. DESIGN: Case series, retrospective chart review. SETTING: Inpatient stroke rehabilitation floor within a tertiary care teaching hospital. PATIENTS: Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Response to pharmacologic treatment. RESULTS: All three subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Treatment with carbamazepine was successful in only one patient; in the other two subjects, their hiccups were controlled with haloperidol or baclofen. All subjects were ultimately managed with a single agent. CONCLUSIONS: Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation patient. Intractable hiccups can be associated with potentially fatal consequences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding management of this challenging population.

Aged↗
PubMed1998

Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study.

OBJECTIVE: To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit. DESIGN: A randomized clinical trial. SETTING: A public hospital. PATIENTS: Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40). INTERVENTION: Breathing exercises in the rehabilitation group. MAIN OUTCOME MEASURES: Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays. RESULTS: The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences. CONCLUSIONS: Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.

Adolescent↗
PubMed1998

A retrospective review of the incidence and rehabilitation outcome of concomitant traumatic brain injury and ligamentous knee injury.

OBJECTIVES: To estimate the incidence of ligamentous knee injuries in patients with traumatic brain injury (TBI) involved in pedestrian versus motor vehicle collisions (PVMVC), to identify associated risk factors, and to compare rehabilitation outcomes and costs in TBI patients with and without ligamentous knee injury. DESIGN: Retrospective, case control. SETTING: An academic rehabilitation hospital with a large metropolitan referral base. PATIENTS: Twenty-three consecutive adolescent and adult subjects admitted for acute inpatient rehabilitation after a PVMVC from January 1, 1994, to January 1, 1996. RESULTS: Five subjects (22%) were found to have a ligamentous knee injury, one with bilateral injuries. Two of these six injuries were diagnosed only after presentation to the rehabilitation setting. The most common injury was an anterior cruciate ligament (ACL) disruption in 5 of 6 knees. A coupled ACL and medial collateral ligament injury was identified in 4 of 6 injured knees. The risk of ligamentous knee injury was most closely associated with the presence of a tibial plateau fracture (n=3) (chi2=12.420, p < .001). There was no statistical difference between groups with and without ligamentous knee injuries with respect to age, gender, inpatient acute or rehabilitation length of stay, admission, discharge, or change in motor Functional Independence Measure (FIM) interval measures, or rehabilitation costs. Four of the 5 patients with ligamentous knee injuries were successfully managed nonoperatively. A case illustrating longitudinal management is presented. CONCLUSIONS: TBI and ligamentous knee injuries, in particular ACL injuries, are common comorbidities after PVMVC. Physicians must maintain a high index of suspicion for ligamentous knee injuries in this population, particularly when a tibial plateau fracture is present. TBI patients with and without ligamentous knee injuries can have comparable functional outcomes when the ligament injuries are identified and appropriately managed, without incurring undue cost or length of inpatient rehabilitation.

Adolescent↗
PubMed1999

Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission.

OBJECTIVE: To determine the rate of deep vein thrombosis (DVT) newly diagnosed by duplex ultrasound in patients with acute spinal cord injury (SCI) at admission for rehabilitation. DESIGN: Retrospective case-control study. SETTING: Independent specialized spinal cord rehabilitation hospital. PATIENTS: Data were collected from records of 189 SCI patients admitted for rehabilitation over a 1-year period who underwent a duplex scan and were not admitted with a known diagnosis of DVT. MAIN OUTCOME MEASURES: A DVT newly diagnosed by duplex ultrasound at rehabilitation admission. RESULTS: Twenty-two patients (11.6%) had a newly diagnosed DVT at time of admission. Chi-square analysis found no statistically significant relationship between level of injury (tetraplegia vs paraplegia), motor complete (ASIA A and B) versus incomplete status (ASIA C and D), or cause of SCI (traumatic vs nontraumatic injury) in determining a positive or negative duplex result (chi2 = 1.709, p = .191; chi2 = 1.314, p = .252; chi2 = 3.155, p = .076; respectively). Prophylaxis for DVT decreased the risk of developing a DVT: 4.1% of patients administered prophylaxis as compared to 16.4% of patients not given prophylaxis (chi2 = 6.558, p = .01). Only 38.6% of patients transferred to rehabilitation were undergoing DVT prophylaxis. CONCLUSIONS: The prevalence of DVT in acute SCI patients at admission to rehabilitation is significant. A duplex ultrasound is an important noninvasive technique to screen patients with acute and subacute SCI for DVT on admission to the rehabilitation setting regardless of the completeness, level, or cause of the patients' injury.

Adolescent↗
PubMed1999

Home-based multicomponent rehabilitation program for older persons after hip fracture: a randomized trial.

OBJECTIVE: To determine whether a home-based systematic multicomponent rehabilitation strategy leads to improved outcomes relative to usual care. DESIGN: A randomized controlled trial with 12 months of follow-up. SETTING: General community; 27 home care agencies. PARTICIPANTS: Three hundred four nondemented persons at least 65 years of age who underwent surgical repair of a hip fracture at two hospitals in New Haven, CT, and returned home within 100 days. INTERVENTION: Systematic multicomponent rehabilitation strategy addressing both modifiable physical impairments (physical therapy) and activities of daily living (ADL) disabilities (functional therapy) versus usual care. MAIN OUTCOME MEASURES: A battery of self-report and performance-based measures of physical and social function. RESULTS: There was no significant difference in the proportion of participants in the two groups who recovered to prefracture levels in self-care ADL at 6 months (71% vs 75%) or 12 months (74% in both groups) or in home management ADL at 6 months (35% vs 44%) or 12 months (44% vs 48%). There also was no difference between the two groups in social activity levels, two timed mobility tasks, balance, or lower extremity strength at either 6 or 12 months. Compared with participants who received usual care, those in the multicomponent rehabilitation program showed slightly greater upper extremity strength at 6 months (p = .04) and a marginally better gait performance (p = .08). CONCLUSIONS: The systematic multicomponent rehabilitation program was no more effective in promoting recovery than usual home-based rehabilitation. Compared with previous cohorts, however, participants randomized to usual care in our study received more rehabilitative and home care services and experienced a higher rate of recovery. This finding is important given the current pressures to reduce home services. The challenge is to determine the composition and duration of rehabilitation and home services that will ensure optimal functional recovery most efficiently in older persons after hip fracture.

Activities of Daily Living↗
PubMed1999

Medical complications during acute rehabilitation following spinal cord injury--current experience of the Model Systems.

OBJECTIVES: To examine the frequency of common secondary medical complications during acute rehabilitation in persons with new spinal cord injury (SCI). DESIGN: Survey and analysis of data in the National SCI Statistical Center (NSCISC) database. SETTING: Eighteen Model System SCI Centers located in urban, public medical centers around the United States. SUBJECTS: A total of 1,649 persons with new SCI entered into the NSCISC database between 1996 and mid-1998. RESULTS: Since 1992, the number of days from injury to admission to rehabilitation has steadily decreased, resulting in the increased potential to develop common secondary medical complications during rehabilitation hospitalization. Pressure ulcers occur with high frequency and were found to have developed in 23.7% of patients during rehabilitation. In addition, autonomic dysreflexia and atelectasis/pneumonia also occur with relative frequency during rehabilitation. Conversely, deep vein thrombosis and pulmonary embolism have decreased, most likely because of greater awareness of their potential to develop, as well as improved methods of prophylaxis. Cardiopulmonary arrest and gastrointestinal hemorrhage occur with relatively small frequency. The frequency of renal complications is difficult to gauge because of the decreasing number of patients who have any renal testing performed during rehabilitation hospitalization. CONCLUSION: The continued declining lengths of acute care hospitalization after SCI have resulted in the occurrence in the rehabilitation setting of medical complications that were previously seen in acute care. Greater awareness and attention to these conditions are necessary to reduce their occurrence, so that obstacles to recovery and functional improvement after SCI are minimized.

Autonomic Dysreflexia↗
PubMed1999

Rapid growth of rehabilitation services in traditional community-based nursing homes.

OBJECTIVE: To describe the changes in rehabilitation therapy services in nursing homes based in the community during a period of rapid escalation of Medicare payments to nursing homes. SETTING: All Medicaid-certified nursing homes in Ohio. SUBJECTS: The 52,705 residents newly admitted to nursing homes in 1994 and 1995. DESIGN: Retrospective trend analysis of administrative data. MAIN OUTCOME MEASURES: For newly admitted residents receiving 90 or more minutes of rehabilitation therapy per week, the trends in percentage and in the amount and type of therapy received were determined for eight quarters. RESULTS: Of all newly admitted residents, 50.5% received 90 or more minutes of therapy. When they received such therapy it averaged 412 minutes per week (SD = 259). Those residents who received rehabilitation services increased by 2.2% each quarter (p<.001), and the amount of therapy they received increased by 6.4 minutes each quarter (p<.0001). All three types of rehabilitation therapy-physical, occupational, and speech-increased (p<.015) over the study period. CONCLUSIONS: The traditional nursing home is an important site for the provision of rehabilitation therapy services. Rehabilitation specialists should be aware of these trends as they plan for the future of rehabilitation. The effectiveness of this increased provision of therapy service in terms of measurable outcomes needs to be evaluated.

Aged↗
PubMed1999

Cognitive and affective improvement in brain dysfunctional patients who achieve inpatient rehabilitation goals.

OBJECTIVE: To evaluate whether improvements in specific cognitive and affective functions are associated with achieving inpatient rehabilitation goals after the acute onset of brain dysfunction. DESIGN: Retrospective analysis of data obtained in a prospective inception cohort study. STUDY SETTING: Medical center and neurological institute. SUBJECTS: Ninety-five heterogeneous brain dysfunctional patients who participated in an interdisciplinary inpatient neurorehabilitation program. Subjects were classified as having achieved their rehabilitation goals (Group 1) or not (Group 2) at time of discharge. MAIN OUTCOME MEASURE: Number of treatment goals attained. RESULTS: Although overall level of performance on the BNI Screen (BNIS) for Higher Cerebral Functions distinguished patients who later achieved their inpatient rehabilitation goals, on admission only performance on the visual spatial subtest was associated with later goal attainment. In contrast, at discharge, patients who showed greater improvement in awareness, affect, visual spatial skills, memory, and attention/concentration were likely to obtain their rehabilitation goals. This was true when the initial level of performance was taken into account. CONCLUSIONS: Measurement of overall neuropsychological status and specific visual spatial abilities at time of admission may help determine which brain dysfunctional patients will obtain inpatient rehabilitation goals. Improvement in a variety of cognitive and affective functions was associated with goal attainment. Early cognitive rehabilitation should focus on both cognitive and affective disturbances to facilitate recovery and rehabilitation outcome.

Analysis of Variance↗
PubMed2001

Shoulder rehabilitation strategies, guidelines, and practice.

This framework for rehabilitation is consistent with the proximal-to-distal kinetic chain biomechanical model and applies current concepts of motor control and closed chain exercises. This framework approaches the final goal--glenohumeral motion and function-through facilitation by scapular control, and scapular control through facilitation by hip and trunk activation. This article supplies guidelines for rehabilitation and practices to implement the guidelines that have proved effective in our hands. Other protocols may be effective, as long as they adhere to several basic concepts of kinetic chain-based shoulder rehabilitation: 1. Functional shoulder rehabilitation requires that the muscle activations and joint motions follow a proximal-to-distal pathway along the appropriate kinetic chain. 2. Muscles around the shoulder function in an integrated fashion and should be rehabilitated in integrated patterns. Specific muscles may need isolated activation, but this activation should be facilitated by placing the proximal segments in a facilitating function. 3. Scapular control and coupled rotator cuff activation is vital to normal shoulder function. 4. Closed chain axial loading exercises are the primary means of early shoulder rehabilitation and are the mainstays of functional rehabilitation protocols.

Anthropometry↗
PubMed1994

Randomised controlled trial of respiratory rehabilitation.

Disability associated with chronic obstructive pulmonary disease has led to the development of rehabilitation programmes that aim to increase exercise tolerance and improve quality of life. Many reports of the benefits of rehabilitation have been from uncontrolled trials and unsupervised programmes. In view of the commitment asked of patients, their families, and health-care professionals, rehabilitation should be justified by a demonstration of sustained improvement over conventional treatment. We undertook a prospective randomised controlled trial of respiratory rehabilitation in 89 subjects (44 men, 45 women) aged 66 (SD 7) years with severe but stable chronic obstructive pulmonary disease who received rehabilitation or conventional community care. The treatment group were rehabilitated as inpatients for 8 weeks and supervised as outpatients for 16 weeks. Primary outcome measures of exercise tolerance and quality of life were made at baseline and repeated at 12, 18, and 24 weeks. The difference between baseline and last follow-up was significant for 6 min walk distance (37.9 m [95% CI 10.8-65.0], p = 0.0067) and submaximal cycle time (4.7 min [2.1-7.3]). There were also significant differences in questionnaire assessment of dyspnoea (p = 0.0061), emotional function (p = 0.0150), mastery (p = 0.0002), and dyspnoea index (p = 0.0053). Improvements in exercise tolerance and quality of life can be achieved and sustained for 6 months in patients undergoing respiratory rehabilitation compared with those receiving conventional care.

Aged↗
PubMed1996

Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease.

BACKGROUND: Respiratory rehabilitation is increasingly recognised as an important part of the management of patients with chronic obstructive pulmonary disease (COPD). The widespread application of such programmes should be preceded by evidence of directly attributable improvements in function. We assessed the effect of respiratory rehabilitation on exercise capacity and health-related quality of life (HRQL) in patients with COPD. METHODS: We carried out a meta-analysis of randomised controlled trials of respiratory rehabilitation in patients with COPD that assessed functional or maximal exercise capacity, HRQL, or both. Respiratory rehabilitation was defined as exercise training (for at least 4 weeks) with or without education, psychological support, or both. The most commonly used measure for HRQL was the chronic respiratory questionnaire, in which responses were presented on a 7-point scale. The control groups received no rehabilitation. Within each trial and for each outcome an effect size was calculated; the effect sizes were then pooled by a random-effects model. The overall effect of treatment was compared with its minimum clinically important difference (MCID)--defined as the smallest difference perceived as important by the average patient. FINDINGS: We included 14 trials. Significant improvements were found for all the outcomes. For two important features of HRQL, dyspnoea and mastery, the overall treatment effect was larger than the MCID: 1.0 (95% CI 0.6-1.5) and 0.8 (0.5-1.2), respectively, compared with an MCID of 0.5. For functional exercise capacity (6-min walk test), the overall effect was 55.7 m (27.8-92.8), and for maximum exercise capacity (incremental cycle ergometer test), 8.3 W (2.8-16.5). Functional exercise capacity showed heterogeneity that could not be explained by the sensitivity analyses. INTERPRETATION: Respiratory rehabilitation relieves dyspnoea and improves the control over COPD. These improvements are clinically important. The value of the improvement in exercise capacity is not clear. Respiratory rehabilitation is an effective part of care in patients with COPD.

Exercise Therapy↗
PubMed2000

Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial.

BACKGROUND: Pulmonary rehabilitation seems to be an effective intervention in patients with chronic obstructive pulmonary disease. We undertook a randomised controlled trial to assess the effect of outpatient pulmonary rehabilitation on use of health care and patients' wellbeing over 1 year. METHODS: 200 patients with disabling chronic lung disease (the majority with chronic obstructive pulmonary disease) were randomly assigned a 6-week multidisciplinary rehabilitation programme (18 visits) or standard medical management. Use of health services was assessed from hospital and general-practice records. Analysis was by intention to treat. FINDINGS: There was no difference between the rehabilitation (n=99) and control (n=101) groups in the number of patients admitted to hospital (40 vs 41) but the number of days these patients spent in hospital differed significantly (mean 10.4 [SD 9.7] vs 21.0 [20.7], p=0.022). The rehabilitation group had more primary-care consultations at the general-practitioner's premises than did the control group (8.6 [6.8] vs 7.3 [8.3], p=0.033) but fewer primary-care home visits (1.5 [2.8] vs 2.8 [4.6], p=0.037). Compared with control, the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status. INTERPRETATION: For patients chronically disabled by obstructive pulmonary disease, an intensive, multidisciplinary, outpatient programme of rehabilitation is an effective intervention, in the short term and the long term, that decreases use of health services.

Aged↗
PubMed2001

[Long term outcome of a severe non fluent aphasia. The effect of prolonged rehabilitation].

INTRODUCTION: Long-term clinical outcome of severe non-fluent aphasia is poorly reported. The efficacy of intensive speech therapy has been previously demonstrated but not the efficacy of prolonged speech rehabilitation. METHOD: We report a single case of aphasia, with a description of the initial clinical features and the long term outcome. Moreover we discuss the rehabilitation efficacy in two situations : delayed rehabilitation and long-lasting rehabilitation. RESULTS: A young adult was admitted after fronto-temporal cerebral infarction and presented with a severe non fluent aphasia. Spontaneous recovery involved comprehension but not verbal expression. Speech therapy began 10 months after onset and an improvement of oral expression was observed during at least 6 years. DISCUSSION: This case illustrates long term-recovery patterns of aphasia and the efficacy of delayed speech therapy, and moreover its efficacy at a long time after onset. No rehabilitation was performed during the period of spontaneous recovery. Consequently recovery of spontaneous oral expression can be attributed to speech rehabilitation. Furthermore long-lasting improvement can also be attributed to prolonged rehabilitation. Total amount of speech therapy for the patient can be similar to the amount of efficacious intensive therapy previously described. CONCLUSION: These findings confirm the efficacy of speech therapy in the late stage of recovery, and the possibility of late improvement after stroke.

Adult↗
PubMed1996

Rehabilitation of the cancer patient at home.

OBJECTIVES: To provide a framework for considering home nursing care of the cancer patient within the context of cancer rehabilitation and to briefly review various aspects of cancer rehabilitation. DATA SOURCES: Review articles and reference books of current and classic works that discuss cancer rehabilitation. CONCLUSIONS: Rehabilitation is an important concept that should transcend cancer care in all settings, and one that naturally fits with home care. The effects of cancer and cancer treatment on the individual's quality of life, eg, psychological and social factors, sexual functioning, nutrition, fitness and exercise, symptom management, and physical disabilities are important considerations in the rehabilitation needs of persons with cancer. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the home health nurse to promote optimal functioning of cancer patients in their home environment. Assessment of the cancer patient's rehabilitation needs, skilled interventions, establishment of realistic goals, and coordinating care between members of the rehabilitation team are major responsibilities.

Activities of Daily Living↗
PubMed2004

[Home-based pulmonary rehabilitation: the evidence, practical issues and medico-economics].

INTRODUCTION: Pulmonary rehabilitation is an established part of the management of chronic obstructive airway disease. For longer-term effects, extending rehabilitation into domiciliary care settings may be necessary. There are few studies evaluating precisely this modality of management in a home setting. STATE OF THE ART: This review analyses the current literature on home based rehabilitation. The benefits of pulmonary rehabilitation, the practical aspects of its application, and its advantages and limitations are detailed. The few data on economic aspects of home rehabilitation are also discussed. PERSPECTIVES: Home-based pulmonary rehabilitation is effective with positive short-term effects on quality of life, breathlessness and effort tolerance. Its practical application needs to be defined. CONCLUSION: Home-based pulmonary rehabilitation appears to be an effective intervention in patients with COPD but more studies are necessary to evaluate it fully.

Dyspnea↗
PubMed1998

A short outpatient pulmonary rehabilitation programme: immediate and longer-term effects on exercise performance and quality of life.

Pulmonary rehabilitation is widely available in North America and parts of Europe for patients with chronic obstructive pulmonary disease (COPD). Here, we describe the feasibility and benefits of providing a comprehensive but cost effective pulmonary rehabilitation programme in a U.K. district general hospital. Two hundred and sixty-seven patients with respiratory disability were referred for pulmonary rehabilitation. Patients were assessed and recruited onto a 7 week outpatient-based pulmonary rehabilitation programme including elements of exercise and education without longer term maintenance. Exercise performance was measured by the shuttle walking test and a treadmill endurance test, and quality of life as measured by two disease specific questionnaires, the Breathing Problems Questionnaire and the Chronic Respiratory Disease Questionnaire. Of 267 patients referred between 1993 and 1996, 132 (110 with COPD) have completed rehabilitation and could be evaluated. For all graduates, shuttle distance increased by 58 m (27%) and treadmill endurance time increased by 15.9 min (294%). The Breathing Problems Questionnaire proved sensitive to changes in quality of life in some domains. The Chronic Respiratory Disease Questionnaire showed significant improvements in all domains in a sub-set of 57 patients who completed it. Longer term follow-up of 49 patients at a mean of 10.3 months following pulmonary rehabilitation revealed that previous gains in exercise performance and quality of life were maintained with improvements in shuttle walking distance of 33 m (14% over baseline) and endurance time of 16 min (280% over baseline). The Breathing Problems Questionnaire showed no overall change but the Chronic Respiratory Disease Questionnaire showed continued improvement in a small number of patients. We therefore concluded that a short outpatient based pulmonary rehabilitation programme without a maintenance element has produced significant gains in exercise performance and quality of life for 132 patients at a district general hospital in the U.K.

Aged↗
PubMed2002

Landmine injuries and rehabilitation for landmine survivors.

There is a tremendous international need for the development of rehabilitation educational programs, especially in low-income countries. These programs are most urgently needed in those countries where there is active conflict, where there has been recent civil war, and where significant casualties have been created because of landmines and weapons-fire. Most of these countries are developing nations where rehabilitation is a lower priority than the provision of basic health needs. These countries generally have few financial, personnel, and system resources to provide much rehabilitation for their disabled citizens. Also, they generally have few, if any, physicians trained in the principles and practice of rehabilitation medicine. These countries can benefit from the use of psychiatric consultants to help assess their rehabilitation needs in designing relevant educational curricula for health professionals and in developing rehabilitation teams. These teams can then develop systems of care for the most common disabling conditions in that area of the world. Western technology, however, cannot be imposed on these countries. Any rehabilitation systems of care must be established within the context of the particular culture and governmental health system organization, if it is to be useful and succeed in a particular nation.

Amputees↗