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PubMed2003

Rehabilitation after total femur replacement: a report of 2 cases.

We describe the rehabilitation of 2 patients who underwent total femur replacement after neoplastic involvement of the bone. In the past, patients with cancer of the femur were generally advised to undergo a hip disarticulation or transfemoral amputation. It is now feasible to salvage the limb in selected patients, by excising the entire femur together with any contiguous soft tissue tumor and replacing it with an endoprosthesis. The surgical literature contains a number of reports on total femur replacement, which mention the rehabilitation aspects only briefly, but we found nothing on this relatively uncommon form of surgery in the rehabilitation literature. Physiotherapy techniques such as active assisted exercises, isometric exercises, and hydrotherapy are extremely useful during the early phase of rehabilitation to facilitate a graduated strengthening program. Certain exercises, such as active hip abduction or knee flexion, may not be permitted for several weeks to protect muscles that have been reattached to the prosthesis. Partial weight bearing may be required to allow incorporation of bone allograft around the prosthetic hip joint. Because of these factors patients with total femur replacement may need a longer period of rehabilitation (6-8wk) than patients with total hip or knee replacement. Patients with total femur replacement can, however, achieve full independence with an appropriate rehabilitation program.

Activities of Daily Living↗
PubMed2004

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact.

OBJECTIVE: To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation. PARTICIPANTS: Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. RESULTS: Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. CONCLUSIONS: Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.

Aged↗
PubMed1996

Clinical experience in rehabilitation of spinal cord injury associated with schizophrenia.

OBJECTIVE: To identify the clinical features and rehabilitation outcomes in spinal cord injury (SCI) patients with preexisting schizophrenia. DESIGN: A retrospective study conducted by reviewing the charts of all patients diagnosed with both SCI and schizophrenia hospitalized from 1987 throughout 1994 in 2 rehabilitation units. SETTING: Rehabilitation wards of two hospitals in Taiwan. PATIENTS: Seventeen traumatic SCI patients with schizophrenia, including 7 men and 10 women. Patients without neurological deficits were excluded. INTERVENTION: All subjects received psychiatric intervention and intensive rehabilitation programs during hospitalization. MAIN OUTCOME MEASURES: The injury pattern and psychiatric condition were described. Abilities of locomotion, management of activities of daily living, and bladder control were measured. RESULTS: Fifteen injuries caused by a voluntary fall subsequently resulted in thoracolumbar insult. Ten incomplete paraplegics were able to ambulate with or without a device on discharge. Four subjects had poor bladder control. The outcome of self-care skills was worse in those with high level injury. Psychiatric symptoms were one of the main obstacles during rehabilitation. CONCLUSION: Voluntary fall that caused thoracolumbar injuries was the main cause of injuries in these patients. Psychiatric symptoms were present in the majority and might hinder the prognosis of treatment. Nevertheless rehabilitation programs were found to benefit subjects after their psychiatric problems were under control.

Activities of Daily Living↗
PubMed1997

Systemic sclerosis (scleroderma): an integrated challenge in rehabilitation.

Systemic sclerosis (SSc), a multisystem disease involving the microvascular system and the connective tissue, is considered one of the most difficult rheumatic diseases to treat. The natural history of the disease evolves from an edematous to a scleroatrophic phase following two different temporal patterns: acute or chronic. The former leads to early death, and the latter evolves slowly toward severe disability that deserves rehabilitative intervention. Despite the poor prognosis, recent improvements in diagnosis and treatment have led to longer patient survival, thus increasing the need to intervene against the development of tissue fibrosis and contractures by using appropriate integrated rehabilitation programs. This article does not review the medico-pharmacological management of visceral manifestations of the disease. Rather, it is divided into six parts, which include analyses of the changes in skin, joints and tendons, and muscle induced by SSc; examination of the existing literature on rehabilitation strategies and treatments; discussions of the pain and peripheral sensory-motor system involvement that are present to a greater or lesser extent in almost all patients and influence not only the duration and outcome of rehabilitation but also the patient's family, social life, and working ability; and consideration of ergonomic and occupational interventions. No controlled studies have been done on the few rehabilitation guidelines and specific protocols identified, so it must be emphasized that this article is a summary of opinions expressed in the literature and the authors' own findings. Particularly lacking are studies on such aspects as ergonomics, work intervention, or the management of sexual dysfunction. Experience gained in the rehabilitation of skin burns and other rheumatic diseases forms the basis for a logical approach to SSc patients.

Acute Disease↗
PubMed1997

Rehabilitation of Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is the most common cause of acute neuromuscular paralysis in developed countries. GBS is a significant cause of new long-term disability for at least 1,000 persons per year in the United States, and more elsewhere. Given the young age at which GBS sometimes occurs and the relatively long life expectancies following GBS, it is likely that at least 25,000 and perhaps 50,000 persons in the US are experiencing some residual effects of GBS. Approximately 40% of patients who are hospitalized with GBS will require admission to inpatient rehabilitation. For GBS persons necessitating admission to inpatient rehabilitation, the requirement of prior ventilator support most strongly predicts an extended length of stay on inpatient rehabilitation. Other issues that affect rehabilitation are dysautonomia, cranial nerve involvement, and various medical complications associated with GBS. Deafferent pain syndrome is common in the early stages of recovery. Multiple medical complications, including deep venous thrombosis, joint contractures, hypercalcemia of immobilization, and decubitii, may develop in the early stages of recovery and interfere with the rehabilitation program. Anemia is a frequent finding in the first few months of illness but does not appear to interfere with functional recovery. Therapy should not overfatigue the motor unit, which has been associated with paradoxical weakening. Little is known of the long-term implications of the disability caused by GBS. Work similar to that performed for postpolio syndrome and spinal cord injury should be started in the rehabilitation setting.

Acute Disease↗
PubMed1998

Rehabilitation of the post-cardiac surgery stroke patient: analysis of cognitive and functional assessment.

OBJECTIVE: Determine whether, as expected, patients sustaining post-cardiac surgery stroke (PCS) (n = 19) differ from other stroke (OS) patients (n = 216). DESIGN: A total of 235 stroke patients were surveyed. Therapist ratings of Functional Independence Measure (FIM) on admission to and discharge from a rehabilitation unit were compared. Cooperation with formal neuropsychologic evaluation was assessed. SETTING: The rehabilitation unit of a tertiary care hospital. PARTICIPANTS: Medical records for consecutive stroke patients were reviewed (January 1994 to December 1995). Groups did not differ in age, gender, or admission FIM. INTERVENTIONS: Standardized neuropsychologic evaluation of seven cognitive domains was attempted for each patient referred to the neuropsychology service. All of the patients received FIM ratings on admission to and discharge from the rehabilitation unit. OUTCOME MEASURES: Gain in FIM per week of rehabilitation unit stay (FIM efficiency) and discharge destination. RESULTS: Contrary to expectations, PCS patients did not differ significantly from OS patients in FIM efficiency or discharge destination. However, PCS patients were significantly less able to cooperate with formal neuropsychologic testing, possibly secondary to their physical condition, higher-level cognitive deficits, or both. CONCLUSION: Although PCS patients may sustain medical and cognitive deficits that interfere with exhaustive neuropsychologic evaluation, these deficits do not significantly interfere with functional progress in rehabilitation and should not make PCS patients ineligible for rehabilitation services.

Activities of Daily Living↗
PubMed1999

Validity of the PULSES profile compared with the Functional Independence Measure for measuring disability in a stroke rehabilitation setting.

OBJECTIVES: To test the validity of the PULSES profile for measuring the disability of stroke rehabilitation patients and to compare it with the Functional Independence Measure (FIM); and to determine the ability of the PULSES score to predict discharge home from a stroke rehabilitation setting. STUDY DESIGN: Retrospective cohort. SETTING: A tertiary stroke rehabilitation unit. PATIENTS: One hundred ninety-seven patients admitted consecutively to a stroke rehabilitation unit from September 1992 to April 1995. METHODS: The PULSES profile was tested for internal consistency. Criterion validity was evaluated by comparing with the FIM. Construct validity was tested using the multimethod-multitrait matrix method and by performing logistic regression to determine if admission PULSES score was predictive of discharge home. RESULTS: Internal consistency of the PULSES profile was supported with a Cronbach's alpha of .74. There was a high correlation between the PULSES and FIM admission and discharge scores of -.82 and -.88, respectively. The multimethod-multitrait matrix correlations demonstrated good convergent and divergent validity for the correlation of the PULSES profile items and the FIM subcategories. Multivariate logistic regression determined the admission PULSES total score to be an independent variable in the model to predict discharge home. CONCLUSIONS: The PULSES profile is a valid measure for assessing disability in the stroke rehabilitation setting. The PULSES profile correlates highly with the FIM. The admission PULSES total score is predictive of discharge home from a stroke rehabilitation program.

Activities of Daily Living↗
PubMed1998

Associations between selected demographic parameters and dental status: potential implications for orodental rehabilitation.

PURPOSE: This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer. METHODS: The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older. RESULTS: Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05). CONCLUSIONS: Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended.

Age Factors↗
PubMed2003

Modulation and rehabilitation of spatial neglect by sensory stimulation.

After unilateral cortical or subcortical, often parieto-temporal lesions, patients exhibit a marked neglect of their contralateral space and/or body side. These patients are severely disabled in all daily activities, have a poor rehabilitation outcome and therefore require professional treatment. Unfortunately, effective treatments for neglect are just in the process of development. The present chapter reviews three aspects related to the rehabilitation of neglect. The first part summarizes findings about spontaneous recovery in patients and experimental animals with neglect. The second part deals with techniques and studies evaluating short-term sensory modulation effects in neglect. In contrast to many other neurological syndromes spatial neglect may be modulated transiently but dramatically in its severity by sensory (optokinetic, neck proprioceptive, vestibular, attentional, somatosensory-magnetic) stimulation. In part three, current treatment approaches are summarized, with a focus on three novel techniques: repetitive optokinetic stimulation, neck vibration training and peripheral somatosensory-magnetic stimulation. Recent studies of repetitive optokinetic as well as neck vibratory treatment both indicate significantly greater as well as multimodal improvements in neglect symptomatology as compared to the standard treatment of neglect. This clear superiority might result from the partial (re)activation of a distributed, multisensory vestibular network in the lesioned hemisphere. Somatosensory-magnetic stimulation of the neglected or extinguishing hand provides another feasible, non-invasive stimulation technique. It may be particularly suited for the rehabilitation of somatosensory extinction and unawareness of the contralesional body side. Finally, pharmacological approaches for the treatment of neglect are shortly addressed. Isolated drug treatment of neglect is currently no successful rehabilitation strategy due to inconsistent results as well as possible side effects. However, combined behavioural and drug treatments might yield better results. This has to be tested empirically in patient studies. In conclusion, the findings obtained in short-term sensory stimulation studies led to the development of effective techniques for the long-term rehabilitation of neglect. Future rehabilitation studies should evaluate effective treatment combinations considering all possible techniques and devices (behavioural, pharmacological, prosthetic or physiological).

Acoustic Stimulation↗
PubMed2000

Behavioral effects of protein deprivation and rehabilitation in adult rats: relevance to morphological alterations in the hippocampal formation.

In the present study we have analyzed the behavioral and neuroanatomical effects of protein deprivation in adult rats. Starting at 2 months of age, animals were maintained on 8%-casein diet either for 8 months (malnourished group), or for 6 months followed by a 2-month period of nutritional rehabilitation (17%-protein diet, rehabilitated group). Malnourished rats exhibited reduced emotional reactivity and impaired habituation in the open field. In a water maze, these animals did not differ from controls during training, but showed retention deficits on the probe trial. However, working memory, sensorimotor abilities and passive avoidance behavior were not significantly impaired in malnourished rats. The performance of rehabilitated group was similar to that of the control group throughout behavioral testing. Postmortem morphological analysis revealed that the total number of neurons in the granular layer of the dentate gyrus, and in CA3 and CA1 hippocampal fields was reduced in protein-deprived and rehabilitated rats relative to controls. In addition, it was found that protein deprivation caused a 30% loss of synapses established between mossy fibers and dendrites of CA3 pyramidal cells, whereas nutritional rehabilitation resulted in a reversal of this effect. These results show that prolonged malnutrition in adult rats produces marked loss of hippocampal neurons and synapses accompanied by substantial impairments of hippocampal-dependent behaviors. The fact that nutritional rehabilitation results in restoration of the total number of hippocampal synapses and parallel amelioration of the behavioral impairments suggests that the mature CNS possesses a remarkable potential for structural and functional recovery from the damage induced by this type of dietary insult.

Analysis of Variance↗
PubMed2000

An experimental soft-release of oil-spill rehabilitated American coots (Fulica americana): II. Effects on health and blood parameters.

The Unocal-Metrolink oil spill of 21 February 1995 resulted in approximately 7800 barrels of San Joaquin crude oil being deposited into the San Gabriel River in Huntington Beach, CA, USA. In order to determine long-term pathological effects of oil exposure and rehabilitation, hematological and serum biochemical parameters for both rehabilitated (RHB) American coots (Fulica americana) and reference (REF) coots were examined every 3-4 weeks (56, 81, 108 and 140 days post oil exposure) after birds were cleaned, rehabilitated and soft-released. Most significant differences in monthly comparisons between RHB and REF birds occurred 56 days following oil exposure. Total white blood cell (WBC) count, albumin:globulin (A:G) ratio and calcium concentration were higher in RHB birds compared to REF birds 56 days post oil exposure. In addition, mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase and creatine kinase activities, and creatinine, total protein (TP) and globulin concentrations were lower in RHB birds. Blood results from 56 days post oil exposure for RHB coots which subsequently died were compared to blood results from days 108 and 140 for REF coots which survived. Oiled and rehabilitated birds which died had significantly higher WBCs, packed cell volume, TP and globulin concentrations, and lower A:G ratio, MCH, MCHC, glucose and sodium concentrations compared to REF birds which survived. Blood result differences detected at 3-4-week intervals between RHB and REF survivors, and differences detected between RHB coots which died and REF coots which survived, suggested that RHB coots developed an inflammatory response (infectious or non-septic) and, concurrently, may have experienced decreased immune responsiveness. Additionally, RHB coots experienced either an iron (Fe) utilization or Fe metabolism problem. These pathophysiological mechanisms were consistent with increased hemosiderin (stored Fe) present in the liver, spleen and kidney of necropsied RHB birds, and may have contributed to RHB coot mortality. When blood parameter differences were examined for their impact on survival time, it was determined that RHB coots had shorter survival times if they had very high cholesterol (> or =449 mg/dl) or chloride (> or =110 MEQ/l) concentrations on day 56 post oil exposure. Interestingly, the lack of differences between RHB and REF coots from day 81 through day 140 suggested that, from a hematologic and clinical chemistry perspective, coots which were oiled, rehabilitated, released and survived at least 3.5 months could not be differentiated from wild (REF) coots. From these findings it appears that blood analysis, coupled with post-release survival data, may help discern reasons for increased mortality of oiled and rehabilitated birds, compared to non-oiled reference birds.

Journal Article↗
PubMed1997

Pulmonary rehabilitation and surgery for end-stage lung disease.

Pulmonary rehabilitation is a multidisciplinary approach to the comprehensive management of patients with end-stage lung disease. Components of the pulmonary rehabilitation program include education, exercise, nutrition, and psychosocial support. Most of the information published on pulmonary rehabilitation has been from patients with COPD. There are some data on patients with cystic fibrosis but, unfortunately, there is a lack of information on other causes of end-stage lung disease. Published data almost invariably show improvements in functional capacity (i.e., walk distance) and quality of life. There are no objective physiologic changes in lung function. Because patients who attend programs regularly are a carefully selected subpopulation, conclusions from published reports may not apply to all patients with end-stage lung disease. The recommendation for pulmonary rehabilitation prior to lung volume reduction surgery or lung transplantation is based on assumptions that may not necessarily be true. No data exist that conclusively show that preoperative rehabilitation alters outcome. Nevertheless, given the relatively benign nature of pulmonary rehabilitation and the documented benefits, it is reasonable to recommend such a program to patients who are awaiting surgical intervention. Further research is required to define the role, nature, duration, intensity, and frequency of exercise training in the management of patients who are to undergo surgical treatment for advanced lung disease.

Activities of Daily Living↗
PubMed1998

Psychiatric rehabilitation: efficacy of four models.

This paper is a critical review of four major rehabilitation programs: assertive community treatment, case management, vocational rehabilitation, and educational rehabilitation. Reported outcomes are reviewed in the context of study design, service characteristics, client characteristics, and operationalization of outcomes. Findings from the four programs are compared with one another. The authors concluded that clients are able to learn most of the skills taught, independently of the rehabilitation model. Furthermore, skills learned in one life domain generalized to a moderate extent to other areas. The four rehabilitation programs had varied effects on the outcome variables, and part of the variability in the findings appears to be related to client characteristics. Limitations of the studies reviewed are identified and a set of recommendations was suggested for the future practice of research into psychiatric rehabilitation.

Activities of Daily Living↗
PubMed2000

Cardiac rehabilitation: a review of current developments.

An overview is given of the current status of cardiac rehabilitation and its effects on morbidity and mortality. While there is an emphasis in most current programs upon physical exercise as an important autonomous risk factor for Coronary Heart Disease (CHD), there is at the same time a tendency in cardiac rehabilitation to go beyond mere physical exercise towards adding more multimodal psychoeducational modules in rehabilitation programs; those approaches are aimed at educating the patient about a less risky and healthier way of life. Such psycho-education is more and more aimed at the "toxic" aspects of negative emotions. The in-between classic Type A Behavior Pattern (TABP) might, in general, be less powerful in predicting later CHD morbidity or mortality than some specific emotional components of TABP, such as anger and hostility. The literature is reviewed as to risk factors and CHD and the role of negative affectivity in development and or maintenance of CHD. Approaches for modification are discussed against the background of their effectivity in cardiac rehabilitation. The recent Dutch guidelines, issued by the Dutch Heart Foundation, appear to incorporate many of the elements mentioned in the research literature on cardiac rehabilitation. On a scientific level they form an excellent audit to evaluate and to contour efficiently the until-now very heterogeneous field of cardiac rehabilitation.

Affect↗
PubMed2000

Neurological rehabilitation of severely disabled cardiac arrest survivors. Part I. Course of post-acute inpatient treatment.

BACKGROUND: Some survivors of out-of-hospital cardiac arrest (CA) sustain anoxic brain injury. The aim of this study was to offer these patients a new treatment approach, to describe the course and outcome of rehabilitation, and to judge whether rehabilitation provided benefit. METHODS: Twenty severely disabled patients (mean age 47.6 years, 17 M:3 F) were admitted for inpatient rehabilitation after sustaining anoxic brain damage secondary to CA. The multidisciplinary treatment approach aimed at orientation, communication, mobility, and self care. Function was assessed using Barthel index (BI) score. On discharge, placement and global outcome was noted. Medical charts of consecutive patients were reviewed retrospectively. RESULTS: Inpatient rehabilitation lasted on for average 12 weeks. Improvement in function was slow with a median increase of 1.88 BI score per week. Patients achieved clinically significant functional improvement as measured by pre-post comparison of BI (P<0.001). On discharge, overall disability was mild in 2 (10%), moderate in 7 (35%), and severe in 11 (55%) patients. CONCLUSION: Rehabilitation of selected CA survivors is appropriate, reducing the subsequent burden of care. Although in 55%, only minor dependence on care persisted, on a group level, the potential for rehabilitation was modest, and recovery curve was flat. Before admission, families should be given realistic information about the possible outcome, because independence was rarely achieved.

Acute Disease↗
PubMed2003

Neuropsychologic rehabilitation for visuoperceptual impairments.

Impairments of visual perception resulting from brain damage can have serious implications for many aspects of patients' lives, and these impairments should be targeted for intervention. Rehabilitation programs need to be individually tailored to each patient's needs; thus, characterization of a patient's visual perception and related abilities, by means of neuroophthalmologic and neuropsychologic evaluations, is a necessary starting point for rehabilitation. Several promising treatment approaches based on restorative and compensatory methods are described, although as yet there is limited systematic study of the efficacy of these methods. Treatment models and compensatory devices from the mature field of low-vision rehabilitation have obvious application in the rehabilitation of cortically based visual perceptual impairments. In addition, ongoing rapid advances in the cognitive neuroscience of vision are likely to provide guidance in the development of new interventions. One area in which functional imaging studies may prove useful is gaining information regarding critical periods of recovery and plasticity. For some visuoperceptual disorders, restorative procedures may be of particular benefit in facilitating brain reorganization during certain recovery periods, but rehabilitation specialists still have few empiric data to guide their efforts. Despite the major limitations in our understanding of key issues influencing outcome, most patients with cerebral visual dysfunction can receive some benefit from carefully designed rehabilitation programs.

Auditory Perception↗
PubMed2003

Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study.

PURPOSE: Increased stress within a certain limit enhances ligament healing and improves joint function. In this prospective randomized clinical trial, we compared the clinical results of early motion versus conventional immobilization after arthroscopic Bankart repair in a selected patient population. TYPE OF STUDY: Prospective randomized clinical trial. METHODS: We performed an arthroscopic Bankart repair using suture anchors in 62 patients with traumatic recurrent anterior instability of the shoulder. Patients were randomized into 2 groups; group 1 (28 patients; mean age, 28 years) was managed with 3 weeks of immobilization using an abduction sling and conventional rehabilitation program, and group 2 (34 patients; mean age, 29 years) was managed with an accelerated rehabilitation program that consisted of staged range of motion and strengthening exercises from the immediate postoperative day. Selection criteria were nonathletes with recurrent anterior shoulder dislocation and a classic Bankart lesion with a robust labrum limited to 1 cm from the midglenoid notch. The patients were followed up for a mean of 31 months (range, 27 to 45 months; standard deviation, 9 months). Analysis of outcome included pain scores at 6 weeks and at final follow-up evaluation, range of motion, return to activity, recurrence rate, patient satisfaction with each rehabilitation program, and shoulder scores assessed by the American Shoulder and Elbow Surgeons Shoulder Index, the rating system of the University of California at Los Angeles, and another scoring system. RESULTS: The recurrence rate was not different between the 2 groups (P =.842). None of the groups developed recurrent dislocation. Two patients from each group were positive for anterior apprehension signs. Patients who underwent accelerated rehabilitation resumed functional range of motion faster (P <.001) and returned earlier to the functional level of activity (P <.001). Accelerated rehabilitation decreased postoperative pain (P =.013), and more patients were satisfied with this program (P <.001). Shoulder scores, return to activity, pain score, and range of motion were not different between the 2 groups at the final follow-up evaluation (P >.05). CONCLUSIONS: Early mobilization of the operated shoulder after arthroscopic Bankart repair does not increase the recurrence rate in a selected group of patients. Although the final outcomes are approximately the same for both groups, the accelerated rehabilitation program promotes functional recovery and reduces postoperative pain, which allows patients an early return to desired activities.

Adolescent↗
PubMed2001

Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation.

Although there is substantial evidence that cardiac rehabilitation is beneficial for post myocardial infarction (MI) patients, such programs are currently under utilized. This study examined systematic criteria predicting physician referral to and patients' participation in cardiac rehabilitation programs. Patients discharged for MI were interviewed in-hospital and at 6-12 weeks post discharge to determine referral, participation, and completion. Stepwise logistic regression analyzed factors associated with rehabilitation. Factors associated with referral to rehab were catheterization (p < 0.001), bypass surgery (p < 0.01), cardiologist/cardiac surgeon appointment (p < 0.02), and age (p < 0.01). Participation was increased for those with bypass surgery (p < 0.001), and referral to cardiologist or cardiac surgeon (p < 0.001). Type of provider significantly influences referral to and participation in cardiac rehabilitation. This suggests that encouragement plays a strong role in attendance for rehabilitation. The same strong encouragement should be given to the broader range of MI patients who stand to benefit from cardiac rehabilitation.

Adult↗