Clinical Rehabilitation

Objective: To evaluate the effectiveness of a motivation programme the motivation for lifestyle change in patients was measured before and after coronary artery bypass graft (CABG) surgery by comparing a usual care group with a group attending a motivation programme.

Design: Prospective controlled study.

Setting: University hospital cardiothoracic surgery department.

Subjects: One hundred and forty patients (mean age 64.9; SD 8.5 years) who had an elective CABG surgery.

Interventions: Each patient was evaluated regarding his or her motivation for lifestyle change two days before and 10 days after CABG surgery. Between January and May 2002 patients in usual care were investigated as a control group (n=70). From January to May 2003 patients had the opportunity to take part in a motivation programme that was provided by a trained clinical psychologist (n = 70). The programme consists of both personalized single sessions and group lectures.

Measures: A 30-item questionnaire measuring the six factors Vulnerability, Intention, Social expectation, Outcome expectation, Self-efficacy expectation, and Perceived severity was developed.

Results: ANOVA procedures with repeated measurements indicate significant effects in terms of higher motivation for lifestyle change in the treatment group in Vulnerability (F(1, 138) = 4.04; P=0.04), Intention (F(1, 138) = 19.81; P<0.001), Social expectation (F(1, 138)=21.97; P<0.001), Outcome expectation (F(1, 138) =17.95; P<0.001), and Self-efficacy expectation (F(1, 138) =14.31; P<0.001).

Conclusions: This motivation programme performed in a cardiac surgery hospital after CABG may increase the motivation for a positive lifestyle change.

Objective: To examine self and carer perceived changes in communication associated with Parkinson's disease and relate these to speech intelligibility, gender, age and other disease measures.

Design: Cross-sectional survey of a hospital- and community-based sample of 176 people with Parkinson's disease and their carers using a questionnaire based on semantic differential techniques.

Participants: One hundred and four people with Parkinson's disease with no history of communication difficulties prior to onset of their Parkinson's disease and 45 primary carers who returned completed questionnaires.

Main outcome measures: Differences in ratings for `before' the onset of Parkinson's disease versus present status.

Results: There was a strong perception of negative impact on communication between `before' and `now', irrespective of age and gender and largely independent of disease severity and duration, intelligibility and cognitive status. Activities of daily living (assessed by Unified Parkinson's Disease Rating Scale (UPDRS) II) and depression rating scale scores had the strongest association with change (adjusted R ² 0.27). There was a significant correlation between the rank order of perceived change in features examined in people with Parkinson's disease versus their carers, though in general carers rated change as having less impact.

Conclusions: Parkinson's disease exercises a strong influence on communication even before apparent alterations to intelligibility or motor status (UPDRS).

Objective: To investigate the impact of introducing a rehabilitation tool on multidisciplinary team members' satisfaction with team functioning, team conferences and written information exchange.

Design: Pretest posttest design.

Setting: Day patient and inpatient wards of a rheumatology rehabilitation clinic.

Subjects: Members of two multidisciplinary teams.

Interventions: The introduction of an electronic version of the Rehabilitation Activities Profile.

Main measures: The Group Environment Scale and questionnaires on satisfaction with team conferences and administrative procedures administered before (T1) and 12 months after (T2) the introduction of the Rehabilitation Activities Profile.

Results: The Group Environment Scale cohesion subscale was significantly higher at T2 than at T1 in the day patient setting (mean difference 1.9; 95% confidence interval (CI) 0.3; 3.4), whereas in the inpatient setting the Group Environment Scale cohesion and the order and organization subscales were significantly lower (mean differences -3.0; 95% CI -4.7; -1.3 and -2.7; 95% CI -4.3; -1.1, respectively). Satisfaction with team conferences was significantly higher at T2 compared with T1 in the day patient setting (mean difference total score 0.6; 95% CI 0.3; 1.0), but not in the inpatient setting (mean difference -0.3; 95% CI -0.7; 0.2). In both settings, the proportions of health professionals spending >10 minutes on administrative tasks per patient contact were significantly higher at T2 than at T1.

Conclusions: In the day patient setting, the introduction of a rehabilitation tool had a positive effect on team members' satisfaction with team functioning and team conferences, whereas in the inpatient setting the effect was absent or the opposite. In both settings, the time spent on administrative tasks increased.

Objective: To assess how physical limitations relate to self-rated health among family medicine patients after adjustment for severity of illness.

Design: A telephone survey of family medicine patients, linked with medical record information.

Setting: A large family medicine department in Rochester, Minnesota, USA.

Subjects: Self-ratings of health were linked to medical records for 804 adult patients.

Results: Adjusting for severity and other confounders using multiple logistic regression analysis revealed that having physical limitations was inversely and independently related to good self-rated health (adjusted odds ratio = 0.20, P<0.001). Odds ratios also were lower for high severity of illness (adjusted odds = 0.43). Morbidly obese patients and patients older than 65 years of age also had reduced odds of good self-rated health.

Conclusions: In our sample of family medicine patients, part of the disparity in health status experienced by people with physical limitations is attributable to greater severity of illness, age and obesity.

Objective: To investigate whether the Patient Competency Rating Scale at three months predicts global functioning and participation one year after traumatic brain injury.

Design: Prospective cohort study with follow-up at 3 and 12 months post injury. The Patient Competency Rating Scale was analysed in a logistic regression model with the outcomes Community Integration Questionnaire, Glasgow Outcome Scale Extended and return to work/study.

Setting: The neurosurgical department of a trauma referral centre in a metropolitan hospital.

Subjects: A cohort of 70 patients with acute traumatic brain injury, ranging from mild to severe injury.

Main measures: The Patient Competency Rating Scale, assessing competency in activities, was applied as a predictor. Outcomes describing community participation at 12 months were the Community Integration Questionnaire and return to work/study. Global functioning was evaluated by the Glasgow Outcome Scale Extended.

Results: Factor analysis of the Patient Competency Rating Scale items yielded three domains: activities demanding cognition, interpersonal/emotional skills, and activities of daily living (ADL) competency. The first two of these domains significantly predicted return to work/study and community integration, whilst global functioning at one year was predicted by interpersonal/emotional competency.

Conclusions: The Patient Competency Rating Scale at three months predicted functioning and participation one year after traumatic brain injury. This indicates that rehabilitation interventions should focus on cognitive and interpersonal competency in order to enhance participation after traumatic brain injury.

Objective: To determine preoperative ventricular function in vascular amputees by measuring N-terminal pro-brain natriuretic peptide (NT-proBNP) and to analyse the relationship between NT-proBNP levels and 30-day postoperative mortality. Design: Prospective pilot study.

Subjects and methods: In 19 patients planned for a lower limb amputation for non-reconstructable peripheral arterial disease NT-proBNP was measured the day before amputation.

Results: Four amputees died within 30 days after the amputation. In 17 of 19 patients NT-proBNP values were found more than 2 standard deviations above the age corrected reference value. Pre-amputation NT-proBNP levels did not differ significantly between non-survivors and survivors (P = 0.162).

Conclusion: Preoperative NT-proBNP levels are not significantly related to 30-day mortality after lower limb amputation procedure. Preoperative NT-proBNP levels are very high, indicating that serious ventricular dysfunction may be present in vascular amputees.

Objective: National guidelines recommend screening for poststroke depression, but compliance is low. This research studied staff compliance in stroke units using the theory of planned behaviour to investigate influences upon screening.

Design: The study used a questionnaire based on a semi-structured interview and measuring the theory of planned behaviour components.

Setting: Sixteen stroke units throughout the UK were included.

Subjects: Seventy-five health care professionals in stroke services participated.

Main measures: A postal questionnaire with 7-point rating scales and open-ended questions was used.

Results: Response rates were low, but the 75 returns demonstrated poor compliance for screening, despite positive attitudes towards it. Five variables, including three of the theory of planned behaviour components, predicted intention to screen: perceived control over screening, perceived expectations of others (direct and indirect normative beliefs), awareness of guidelines and screening being part of routine assessment. Perceived expectations of others, perceived control and awareness of guidelines also differentiated those intending to screen from `non-intenders'. Being knowledgeable about screening, having screening in the job role and belief in its clinical value were additional facilitating factors, while time pressure and concerns about screening tests were barriers. Profession and psychology input were not associated with screening.

Conclusions: The theory of planned behaviour provides a framework for understanding screening intentions. Both individual and organizational factors were associated with screening. Compliance may be enhanced by: training to increase knowledge and skills, providing evidence of the utility, increasing awareness of guidelines, support from colleagues and integrating mood assessment into job roles and routine assessment.

These are poster abstracts from the spring meeting of the British Society of Rehabilitation Medicine, `Rehabilitation Medicine Today and Tomorrow: Service models for specialist rehabilitation in hospitals and communities', held at the Royal College of Physicians, London, on 22 May 2007