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Fuzzy methods in tremor assessment, prediction, and rehabilitation.

Tremor is a disabling condition for a large segment of population, mainly elderly. To the present date, there are no adequate tools to diagnose and help rehabilitation of subjects with tremor, but recently there is a tremendous surge of interest in the research in the field. We report on the use of fuzzy methods in applications for rehabilitation, namely in tremor diagnosing and control. We synthesize our results regarding the characterization of the tremor by means of nonlinear dynamics techniques and fuzzy logic, and the prediction of tremor movements in view of rehabilitation purposes. Based on linear and nonlinear analysis of tremor, and using fuzzy aggregation, the fusing of tremor parameters in global functional disabling factors is proposed. Nonlinear dynamic parameters, namely correlation dimension and Lyapunov exponent is used in order to improve the assessment of tremor. The benefits of the fuzzy fused tremor parameters rely on more complete and accurate assessment of the functional impairment and on improved feedback for rehabilitation, based on the fused parameters of the tremor. Further steps in rehabilitation may require external muscular control. In turn, the control of tremor by electrical stimulation requires movement prediction. Several neural and neuro-fuzzy predictors are compared and a neuro-fuzzy predictor is presented, allowing us five-step ahead prediction, with an RMS error of the order of 10%. The benefits of the neuro-fuzzy predictor are good prediction capability, versatility, and apparently a high robustness to individual variations of the tremor. The reported research, which extended over several years and included development of sensors, equipment, and software, has been aimed to development of products. The results may also open new ways in tremor rehabilitation.

Aged↗
PubMed2002

Military lower extremity amputee rehabilitation.

The role of the military has changed over the past eight decades. Although the threat of global warfare still exists, the military of today faces new challenges as a peacekeeper in countries under turmoil. Despite these changes, the fear of bodily injury, such as limb loss and even the possibility of death, are real concerns for our active duty personnel. The military physician must be aware of the appropriate surgical, rehabilitative, and psychosocial needs of the lower extremity traumatic amputee. The physical medicine and rehabilitation specialist is a physician particularly suited to provide direction for and to oversee the overall care of the amputee's condition. An amputee center providing a multidisciplinary team approach has worked well for the military during war and peacetimes. The physical medicine and rehabilitation inpatient service at WRAMC continues the tradition and philosophy of the military amputee centers dating back to WWI. By growing with the fast-paced technologic advances in prosthetic devices, yet keeping true to the fundamentals of prosthetic prescription and design, physical medicine and rehabilitation in the military has remained at the forefront of amputee rehabilitation. Patient satisfaction with the rehabilitation process and his or her new artificial limb remain priorities whether the goal is to return to active duty or to resume an active lifestyle in the civilian world.

Amputation, Surgical↗
PubMed2003

Epilepsy: habilitation and rehabilitation.

Rehabilitation represents not only a distinct field of medicine, but also a philosophical and practical treatment approach that can be applied to a variety of chronic disorders. Neurology encompasses many chronic disorders, making it ideal for the application of rehabilitation principles in daily practice. Epilepsy offers a unique opportunity to incorporate rehabilitation principles into the management of a complex medical disorder. Epilepsy is an evolving disease process that changes with the maturation of the central nervous system. The rehabilitative model provides the framework for a dynamic treatment plan to meet the changing needs of the child with epilepsy through the social and developmental changes of childhood, adolescence, and adulthood. The development of epilepsy may complicate the recovery from many acute and chronic conditions that affect the central nervous system. The rehabilitation process must address these many aspects of the disease process and its sequelae. This makes neurologists uniquely qualified to manage the rehabilitation team. The impact of the therapeutic milieu on the recovery process may be as important as any specific medical or surgical intervention.

Child↗
PubMed2004

The results of rehabilitation on motor and functional improvement of the spinal tuberculosis.

OBJECTIVES: To evaluate the result of rehabilitation on motor and functional improvement in spinal tuberculosis. METHOD: Prospective case study. Data were collected from 47 patients with spinal tuberculosis medically and/or surgically treated, and rehabilitated over 6 months of period, after spinal decompression and fusion. The main outcome measures were motor development of the patients who were evaluated at the beginning, in the 1st week, in the 3rd month, and in the 6th month. Functional development of the patients was evaluated at the beginning and in the 6th month. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was made according to American Spinal Injury Association (ASIA). RESULTS: The study population consisted of 47 patients (22 males and 25 females) mean aged 37.9 +/- 18.3 years (range 5-76 years). The most common site of spinal tuberculosis was the thoracic region. Localized back pain, paraparesis, sensory dysfunction and fever were typical clinical manifestations. Surgical management was performed as anterior or posterior drainage of abscess and/or stabilization of the spine. The rehabilitation program was performed in all patients during the preoperative, early postoperative and late postoperative 6 month periods. Muscle-strengthening exercises on necessary localization such as pectoral, abdominal, lower extremities; truncal and sacrospinal extensors were started for the rehabilitation. The motor score for the lower limbs and the MBI scores for activities of daily living (ADL) and mobility improved significantly (P < 0.001). The self-care and mobility categories of the MBI on admission; were 14.8% severely dependent and 10.6% independent. However, at the end of the rehabilitation program, 4.2% were severely dependent and 70.2% independent. IN CONCLUSION: Early diagnosis and appropriate medical and/or surgical treatment together with a rehabilitation program will improve the life quality of patients with spinal tuberculosis.

Activities of Daily Living↗
PubMed2004

Rehabilitation benefits highly motivated patients: a six-year prospective cost-effectiveness study.

OBJECTIVES: To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined. METHODS: A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques. RESULTS: Total costs per treated patient in the rehabilitation group and the control group were pound 43,464 (SD = 31,093) and pound 44,123 (SD = 33,333), respectively (p = .896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs. CONCLUSION: In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure.

Adult↗
PubMed1996

Restoration of depressed immune function in spinal cord injury patients receiving rehabilitation therapy.

Both natural and adaptive immune responses were strikingly decreased 2 weeks after injury in 49 spinal cord injuries, 28 tetraplegic and 21 paraplegic patients compared to agematched controls. All values are expressed as means. NK cell function decreased to 21.0% 2 weeks after spinal cord injury compared to 48.6% in controls. At 2 weeks, plasma ACTH values increased to 17.0 pg/ml in patients compared to 11.2 pg/ml in controls and urine free cortisol levels were elevated to 162.4 micrograms/24 h in patients compared to 53.6 ug/24 h in controls. T cell function decreased to 40.2% of normal (lymphocyte transformation) by 3 months post injury. T cell activation (IL-2R) was diminished, i.e., 183.4 ug/ml compared to 328.2 ug/ml in controls. With rehabilitation therapy, NK cell function increased to 41.6% by 7 months post injury. NK cell-mediated lysis diminished sharply between 7 and 9 months decreasing to 22.8% at 10 months and ultimately returning to the 2 week post injury level. Rehabilitation therapy contributed to the restoration of T cell function to 92.0% of normal by 6 months post injury where it remained for 6+ months. IL-2R values improved in parallel with lymphocyte transformation. Whereas NK cell-induced lysis remained depressed, i.e., 11.8% at 6 months and 11.4% at 12+ months in patients not receiving therapy, the restoration of NK cell function at 6 months to 40.6% in rehabilitated patients decreased to 23.0% with cessation of treatment. NK cell-mediated lysis values in cervical injury patients were significantly less than those in the thoracic injury group. FIM scores of the two paralleled their NK cell function. With rehabilitation therapy, NK cell-mediated lysis in the cervical group increased from 15.2% to 28.4%, whereas it improved in the thoracic group with therapy from 26.8% to 43.7%. With rehabilitation therapy, lymphocyte transformation in the cervical group increased from 37.3% to 85.6% and improved in the thoracic group from 48.4% to 88.9%. With rehabilitation therapy, FIM scores improved from 49.7 to 74.0 in the cervical group and from 79.8 to 97.3 in thoracic patients compared to 126 in controls of healthy age matched controls.

Adrenocorticotropic Hormone↗
PubMed2002

Perceived exertion and rehabilitation with wheelchair ergometer: comparison between patients with spinal cord injury and healthy subjects.

OBJECTIVES: The purpose of this study was to compare the effects of a rehabilitation program on the perceived exertion (PE) and the cardioventilatory responses during exercise in healthy people and paraplegics. METHODS: A group of seven healthy persons (age 26.6 SD 6.2 years) and one of seven paraplegics (age 42 SD 15.9 years) participated in a rehabilitation program composed of Square Wave Exercise Tests (SWEET) during six weeks. The maximal oxygen uptake, the power output (PO), heart rate (HR) and measures of PE using the Borg CR 10 scale were investigated during a maximal graded test performed before and after the rehabilitation program. During the first SWEET session (SWEET 1) measures of PE and HR (base and peak) were also investigated and compared to the last session (SWEET 2) of the same absolute workload after the 6 weeks. RESULTS: Statistical analysis revealed no significant difference in both groups for PE between the two maximal graded tests. However, a significant decrease in the PE values (P<0.01) was observed in both groups during the SWEET 2. There was no significant difference in maximal HR between the two graded tests, but a significant decrease in HR (P<0.0001 for base HR and P<0.001 for peak HR) was observed in SWEET 2 compared to 1. The maximal tolerated power (MTP) and the peak oxygen uptake increased significantly in both healthy and paraplegic groups (P<0.0001 and P<0.05 respectively) after the 6 weeks of rehabilitation exercise. CONCLUSION: The results of the present study suggest that PE could be used to control the exercise intensity during a rehabilitation training program for paraplegics, similar to healthy subjects. The increase in the peak oxygen uptake and MTP demonstrates the positive effects of the rehabilitation program on the physical fitness of the subjects.

Adult↗
PubMed2004

Implantation of the Freehand System during initial rehabilitation using minimally invasive techniques.

STUDY DESIGN: Series of four single subjects with and without intervention design. OBJECTIVES: To describe a minimally invasive surgical technique used to implant the Freehand System during initial spinal cord injury (SCI) rehabilitation and to report rehabilitation outcomes of four recently injured adolescents using the Freehand System. SETTING: Nonprofit children's hospital specializing in orthopedic and SCI care. METHODS: Four subjects with C5 tetraplegia between 13 and 16 years of age and between 9 and 16 weeks following traumatic SCI underwent implantation of the Freehand System using minimally invasive surgical techniques. Outcomes on muscle strength, pinch force, hand function, performance of activities of daily living and satisfaction with and without the Freehand System were collected. RESULTS: Each subject was successfully implanted with the Freehand System without perioperative complications and employed the Freehand System during therapy services and ad lib on the rehabilitation floor. At the last follow-up, every subject remained a motor candidate for the Freehand System. With the Freehand System, average lateral and palmar pinch force was 1.8 and 1.6 kg respectively; average pinch force without functional electrical stimulation (FES) was 0.29 kg. With the Freehand System, three subjects improved their rate of performance on The Upper Extremity Capabilities Questionnaire. All subjects increased their level of independence on The Quadriplegia Index of Function. On the Canadian Occupational Performance Measure (COPM) with the Freehand System, average performance and satisfaction scores improved for every patient. Three of the four subjects continued to use the system at home. CONCLUSION: This case series demonstrates that the Freehand System can vastly improve hand function and performance of rehabilitation activities within days after a minimally invasive implant procedure during initial SCI rehabilitation. Satisfaction with the Freehand System beyond initial rehabilitation is evidenced by continued use at home.

Activities of Daily Living↗
PubMed2006

Factors influencing discharge location following high lesion spinal cord injury rehabilitation in British Columbia, Canada.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To identify and describe factors that influence discharge location -- extended care unit (nursing home) or other (private home, group home, or acute care) -- following rehabilitation for individuals with a new high lesion spinal cord injury (SCI) (C1-C4) in British Columbia, Canada. SETTING: GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. METHODS: Eligible clients were adults admitted to the GF Strong Rehabilitation Centre Spinal Cord Program between 1994 and 2003, with a new C1-4 lesion (traumatic or nontraumatic), and an ASIA score of A-C at time of discharge. Medical charts of 52 individuals were reviewed and data regarding individual characteristics, health-related characteristics, personal context, hospitalization factors, health resources, and other contextual factors were extracted. RESULTS: In total, 40% of clients were discharged to extended care units post rehabilitation. Seven variables were associated at a univariate level: age, employment at the time of injury, pre-existing medical conditions, social support, preinjury living situation, and insurance (worker's compensation or motor vehicle) or private funding for equipment. Four variables were associated at the multivariate level: age, preinjury living situation, and insurance or private funding for equipment. CONCLUSION: A range of individual, health-related, family and social policy variables influence discharge location following rehabilitation for high lesion SCI in British Columbia. The unique combination of variables presented by each individual should be considered by the rehabilitation team in the discharge planning process.

Adult↗
PubMed2006

Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To study upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using subjects with a spinal cord injury (SCI) and its relation with lesion characteristics, muscle strength and functional outcome. SETTING: Eight rehabilitation centers with an SCI unit in the Netherlands. METHODS: Using a questionnaire, number, frequency and seriousness of musculoskeletal pain complaints of the upper extremity were measured. A pain score for the wrist, elbow and shoulder joints was calculated by multiplying the seriousness by the frequency of pain complaints. An overall score was obtained by adding the scores of the three joints of both upper extremities. Muscle strength was determined by manual muscle testing. The motor score of the functional independence measure provided a functional outcome. All outcomes were obtained at four test occasions during and 1 year after rehabilitation. RESULTS: Upper extremity pain and shoulder pain decreased over time (30%) during the latter part of in-patient rehabilitation (P<0.001). Subjects with tetraplegia (TP) showed more musculoskeletal pain than subjects with paraplegia (PP) (P<0.001). Upper extremity pain and shoulder pain were significantly inversely related to functional outcome (P<0.001). Muscle strength was significantly inversely related to shoulder pain (P<0.001). Musculoskeletal pain at the beginning of rehabilitation and BMI were strong predictors for pain 1 year after in-patient rehabilitation (P<0.001). CONCLUSIONS: Subjects with TP are at a higher risk for upper extremity musculoskeletal pain and for shoulder pain than subjects with PP. Higher muscle strength and higher functional outcome are related to fewer upper extremity complaints.

Adolescent↗
PubMed2003

Effectiveness of home-based cardiac rehabilitation for special needs patients.

BACKGROUND: The benefits of cardiac rehabilitation programmes have been well documented including reductions in mortality, improved physical performance, and improved quality of life. However, a large number of special needs patients often fail to access these programmes. Of particular concern are elderly patients with chronic illness and disability. AIMS: To evaluate the effectiveness of a home-based cardiac rehabilitation programme in improving health outcomes and rehabilitation access for special-needs patients. DESIGN: Using a one-group pre and post-test quasi-experimental design 40 elderly patients recently discharged from hospital following a cardiac event completed the Short Form Health Survey, the Angina Quiz, and the Exercise Assessment Questionnaire prior to undertaking home-based rehabilitation. The rehabilitation programme consisted of four community nursing contacts over a 9-week period primarily aimed at individual patient education and carer support. ANALYSIS: Descriptive statistics provided analysis for demographic data. Repeated measures multivariate analysis of variance (manova) were computed to examine changes in health-state and practices. RESULTS: Significant positive changes were found for measures of quality of life, knowledge of angina, and exercise tolerance. Additionally, the higher levels of participation and completion by older women was encouraging. Development of carer competence through an improved knowledge base and nursing support was also evident. LIMITATIONS: While theoretically defensible positive outcomes were found these results need to be replicated in a larger study. Similarly, the limitations imposed by a single group pretest, post-test design suggest that claims of generalizability need to be limited to the specific variables measured in this study. CONCLUSION: The study demonstrated medium term positive health outcomes. These positive findings suggest that home-based rehabilitation using larger samples of older patients with comorbidities, and using randomized comparative group designs, may be a fruitful area in future research.

Aftercare↗
PubMed2004

Cardiac rehabilitation: the importance of patient expectations--a practitioner survey.

BACKGROUND: Numerous cardiac rehabilitation national guidelines consistently endorse the need for psychological support to create effective individualized care. Recent surveys suggest that the psychological factors remain poorly assessed and the measurement of psychological parameters remains patchy. AIM: To examine cardiac rehabilitation practitioners' perception and understanding of the importance of patient expectations and their capacity to assess and utilize these expectations to develop individualized care. METHODS: A survey of cardiac rehabilitation professionals from 10 hospitals in the south-east of England. The questionnaire used in the survey was developed from content analyses of the current cardiac rehabilitation literature and expectancy theory articulated in Bandura's writings. RESULTS: The results of the study show that cardiac rehabilitation practitioners are very aware of the general importance of patient expectations but have little structured support in the development of techniques to either assess these expectations or to utilize them in a therapeutic context. This leaves them unsure about the extent to which patients do receive individualized care and how best to develop their own practice in this regard. RELEVANCE TO CLINICAL PRACTICE: This study suggests that there is a need for the development of a structured assessment tool, which has a sound theoretical basis to assess patients' expectation if good practice is to be established in providing individualized car in cardiac rehabilitation.

Attitude of Health Personnel↗
PubMed2002

Economic evaluation of a randomised trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction.

BACKGROUND: Although there have been a number of economic evaluations of cardiac rehabilitation after acute myocardial infarction (AMI), none has considered only low-risk patients or control groups with no rehabilitation at all. METHODS: An economic evaluation was included in a randomised controlled trial of patients following uncomplicated AMI. Eligible patients were randomised to return to normal activities after 6 weeks of standard rehabilitation (REHAB, n = 70) or to early return to normal activities 2 weeks after AMI with no formal rehabilitation (ERNA, n = 72). Outcomes were assessed weekly for 6 weeks, then 3, 6 and 12 months post-AMI. Outcomes included four quality of life (QOL) measures (physical abilities, distress, usual/social activities, self-care) and four measures of return to normal activities (paid and unpaid return to any work and to pre-AMI level of work). Statistical analysis included repeated-measures regression (QOL outcomes) and survival analysis (work outcomes). RESULTS: There were no statistically significant differences between the two groups in any of the outcomes measured or in the use of other health services. The net cost that could be saved by the health service by targeting rehabilitation to high-risk patients was approximately $300 (Australian, 1999) per low-risk patient. CONCLUSIONS: Early return to normal activities without formal rehabilitation is cost-effective for low-risk patients.

Journal Article↗
PubMed2000

Preliminary outcome analysis of a long-term rehabilitation program for severe acquired brain injury.

OBJECTIVES: To describe the general characteristics and functional outcomes of individuals treated in a publicly funded, long-term, acquired brain injury rehabilitation program and investigate variables affecting functional outcomes in this patient population. DESIGN: Retrospective database review of demographic, descriptive, and functional outcome assessment data. SETTING: Publicly funded, comprehensive, multidisciplinary, long-term, residential brain injury rehabilitation program in Alberta, Canada (64 beds). PATIENTS: All rehabilitation patients admitted to and discharged from the brain injury program from February 1991 to March 1999 (n = 349). INTERVENTIONS: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: Demographic and descriptive information included sex, age at admission, type and severity of injury, time from injury to long-term program admission, and length of stay (LOS). Functional outcome information included level of care required at admission and discharge, admission and discharge Rappaport disability rating scale scores, and admission and discharge FIM instrument and Functional Assessment Measure scores for a subset of patients. RESULTS: Fifty-nine percent of the subjects had severe traumatic brain injuries (TBI) and 41% had severe nontraumatic brain injuries (NTBI) of various causes. Mean age at admission was older and LOS was longer for NTBI compared with TBI; there were no other differences between the groups in demographic or descriptive measures. The TBI group had significantly lower admission motor subscale scores than the NTBI group, but the groups did not differ on cognitive scores. All functional assessment measures showed statistically significant improvement from admission to discharge, and 85.6% of patients were discharged to community living after a mean LOS of 359.5 days. Functional status at admission, age at admission, length of time between injury and admission, and LOS in the rehabilitation program significantly correlated with functional improvement. CONCLUSIONS: Patients with severe TBI and NTBI who were not candidates for other more conventional forms of rehabilitation showed significant improvement in functional outcomes after extended program admissions. Consideration was also given to the potential insensitivity of commonly used outcome assessment measures in this population.

Adult↗
PubMed2001

Gender-related differences in acute rehabilitation lengths of stay, charges, and functional outcomes for a matched sample with spinal cord injury: a multicenter investigation.

OBJECTIVE: To examine the effects of gender on length of stay (LOS), treatment costs, and outcomes by using a matched sample of patients with spinal cord injury (SCI). DESIGN: A 2 x (15 x 3) mixed, block design was used retrospectively to analyze the impact of gender on subjects matched for age, American Spinal Injury Association (ASIA) motor impairment classification, and level of neurologic injury. SETTING: Twenty medical centers in the federally sponsored Spinal Cord Injury Model Systems project. PARTICIPANTS: One thousand seventy-four adult patients with SCI admitted between 1988 and 1998 were assessed at acute-care admission, inpatient rehabilitation admission, and inpatient rehabilitation discharge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ASIA motor index and FIM instrument admission, discharge, and efficiency scores; rehabilitation LOS and medical care charges; and discharge disposition. RESULTS: Analysis revealed no gender-related differences in FIM motor scores on admission and discharge. No differences in FIM motor efficiencies or daily change were observed. No significant differences were found for ASIA motor scores on acute-care admission and rehabilitation discharge. No differences in acute rehabilitation LOS and charges were observed. No gender-related differences were seen in the likelihood of discharge to an institutional setting. CONCLUSION: Gender was not a significant factor in functional outcome of SCI patients after acute rehabilitation.

Activities of Daily Living↗
PubMed2002

Ethical concerns in isolating patients with methicillin-resistant Staphylococcus aureus on the rehabilitation ward: a case report.

Concern about methicillin-resistant Staphylococcus aureus (MRSA) is increasing in rehabilitation facilities. Those affected are often isolated to prevent the spread of MRSA to other patients. Because this isolation often interferes with the traditional rehabilitative approach, rehabilitation team members find themselves in an ethical dilemma as to how to approach these patients. Some patients may feel that strict isolation protocols violate their rights. We report a case showing the ethical dilemmas that an MRSA-positive patient brings to the rehabilitation setting. Isolation techniques make it difficult to treat rehabilitation patients using the current standards of care without compromising the medical ethics principles of autonomy and beneficence. Further study is required to establish protocols for patients with MRSA in the rehabilitation setting.

Convalescence↗
PubMed1998

Cardiac rehabilitation.

Cardiac rehabilitation as a multifactorial intervention has been shown to improve functional capacity, emotional well-being, return to work rate and longevity. Cardiac rehabilitation is cost effective, and in many aspects represents causal therapy. The meta-analyses do not include studies where pharmacological lipid lowering was used. The use of generally accepted and recommended medical treatment strategies in the EuroAspire study has been below the expected rate, Therefore, cardiac rehabilitation programmes should educate the patient and emphasize the need to apply the appropriate medical regimen in addition to the non-pharmacological treatment modalities of cardiac rehabilitation to achieve maximal benefit. Cardiac rehabilitation has an important role in assuring the application of the available knowledge, to avoid cardiac complications and progression of disease, and improve cardiorespiratory fitness and survival. Cardiac rehabilitation should therefore be an integral part of cardiological management after a cardiac event.

Combined Modality Therapy↗
PubMed2000

Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient!

Several studies of chronic obstructive pulmonary disease (COPD) have shown that pulmonary rehabilitation, consisting of at least three training sessions a week, improves exercise performance and health status. This study investigates feasibility, effect and economic aspects of a rehabilitation programme consisting of two sessions a week for 8 weeks. Twenty-four patients with moderate COPD were randomized to rehabilitation and 21 to placebo. Patients were assigned to an 8-week programme of exercise plus education (Exercise group) or conventional community care (Placebo group). The rehabilitation program was carried out in a hospital outpatient setting and consisted of 16 h exercise and 13.5 h of education. The exercise group received physiotherapy and education twice a week. Seven patients did not complete the programme. The characteristics of the 38 COPD-patients at baseline were the following: (mean +/- SD) forced expiratory volume in 1 sec (FEV1) 1.1+/-0.4 1 (47% of predicted), 6-min walking distance (6MWD) 413+/-75 m, score of St. George's Respiratory Questionnaire (SGRQ) 44+/-21. Health-status, assessed by SGRQ and The Psychological General Well-being (PGWB) Index, did not improve. Rehabilitation resulted in an insignificant improvement in the 6MWD [29 m (95% confidence interval: -8 -66 m)]. We conclude that a rehabilitation program consisting of exercise and education twice a week for 8 weeks had no effect on exercise performance and well being in patients with moderate COPD.

Ambulatory Care↗