Clinical Rehabilitation

To assess the additional benefits of individualized nutritional counselling by a registered dietitian in geriatric patients’ home after discharge from hospital, in relation to risk of re-admissions, functional status, nutritional status, use of social services and mortality.

Twelve-week single-blind randomized controlled study.

Geriatric medical patients (65+ years) at nutritional risk.

Participants were randomly allocated to receive a visit in their homes, either three individualized nutritional counselling by a registered dietitian complemented with three follow-up visits by general practitioners or three follow-up visits by general practitioners alone.

Primary outcome was risk of re-admissions. Secondary outcomes were functional status (hand grip strength, chair stand, mobility, disability and tiredness in daily activities, rehabilitation capacity), nutritional status (weight, BMI, energy and protein intake), need of social services (home care, home nursing, meals-on-wheels) and mortality.

One hundred and fifty-two patients were included; 132 (87%) completed the first and 124 (82%) the second data collection after 12 weeks. Ten per cent of the participants had three contacts with their general practitioner, while compliance with the dietetic intervention was almost 100%. Odds ratio for re-admission and mortality after 26 weeks was 1.62 (95% confidence interval (CI) 0.85 to 3.10) and 0.60 (95% CI 0.17 to 2.13). The intervention had a positive effect on functional status (i.e. mobility, P = 0.029), and nutritional status (i.e. weight, P = 0.035; energy intake, P < 0.001; protein intake, P = 0.001) and the use of meals-on wheels was reduced (P = 0.084).

Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge.

To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the ‘Myomo’ versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment.

Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment.

Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually.

The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention.

After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale.

Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.

To compare the effects of an isolated application of cervical spine thrust joint manipulation vs. the application of cervical, cervico-thoracic junction and thoracic manipulation on neck pain, disability and cervical range of motion in chronic neck pain.

Randomized clinical trial.

Clinical practice.

Eighty-two patients (41 females) with chronic mechanical neck pain.

Patients were randomly assigned to a cervical spine manipulation group or a full manipulative group who received mid-cervical, cervico-thoracic and thoracic joint manipulations.

Neck pain intensity (11-point numeric pain rating scale), self-reported disability (Neck Disability Index) and cervical range of motion were collected at baseline and one week after the intervention by an assessor blinded to the allocation of the patients.

A significant Group * Time interaction for Neck Disability Index (P = 0.022), but not for neck pain (P = 0.612), was found: patients in the full manipulative group exhibited greater reduction in disability than those who received the cervical spine manipulation alone, whereas both groups experienced similar decreases in neck pain. Patients in both groups experienced similar increases in cervical range of motion (P > 0.4). No effect of gender was observed (P > 0.299).

In patients with chronic mechanical neck pain, manipulation of the cervical and thoracic spine leads to a greater reduction in disability at one week than after manipulation of the cervical spine alone, whereas changes in pain and range of motion are not affected differently.

To increase autonomous practice time of patients on the stroke unit of a nursing home.

Nurses stimulated and coached patients with the help of four interventions (muscle strengthening, sitting balance and reach, getting up from a chair, walking) from the evidence-based Clinical Nursing Rehabilitation Stroke Guidelines.

An observational study. Practice time of elderly stroke patients in this study was compared with the time observed in our previous study in the same setting.

Rehabilitation units of a nursing home in the Netherlands.

Seventeen frail stroke patients, including 8 men, 9 women, with a mean age of 75.8 (SD ± 9) and 17 subjects with the same characteristics who participated in a previous observational study.

Time spent on therapeutic activities was measured using the Behavioral Mapping method.

The time spent on therapeutic activities increased significantly from 103.5 minutes measured in our previous study to 156.5 minutes in this study (Z = 2.86; P < 0.005; d′ = 1.09) The mean Barthel Index score was 8.8 (SD ± 4.1). The patients with more possibilities were more active, resulting in a significant positive Barthel Index–therapy time relationship (r = 0.73, P ≤ 0.001).

The autonomous practice time of older fragile comorbid stroke patients increased during the weekdays. Patients, stimulated and challenged by nurses, exercise harder and more according to their possibilities. Since this guideline was developed especially for nurses, nurses can stimulate stroke patients to contribute more to autonomous practice and therefore help their recovery.

To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR’s day-to-day memory functioning 18 months after completion of the intervention programme.

Within-subject A¹B¹A²B²B³ single-case experimental design.

Outpatient memory rehabilitation clinic.

A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment.

A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function.

Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received.

Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.

To assess the feasibility and validity of both the Test of Wheeled Mobility (TOWM) and a wheelie test.

Cross-sectional study.

KU Leuven gymnasium.

Thirty male manual wheelchair users (age range 23–53 years) with spinal cord injury.

Participants preformed both tests after completing a personal information form and a ‘Perceived self-efficacy in WM’ scale. The TOWM consists of 30 tasks reflecting functional wheeled mobility. The wheelie test consists of eight tasks measuring the ability to perform a ‘wheelie’ in challenging situations.

Ability, performance time, qualitative and anxiety scores were assessed. Convergent validity was tested by correlating the TOWM and the wheelie test scores. Construct validity was assessed by testing whether the four scores of both tests are significantly related to perceived self-efficacy in wheeled mobility, time since injury and sport participation.

TOWM average total testing time was 24.7 minutes (±5.93) and the wheelie test was 12.62 minutes (±5.08). Convergent validity was confirmed by the positive correlation between the TOWM and wheelie test total ability scores (r = 0.84; P < 0.001), quality scores (r = 0.88) and anxiety scores (r = 0.66). Moderate correlations were found between the total time scores of the TOWM and wheelie test (r = 0.47). Construct validity was confirmed by fair to moderate correlations between both test’s scores with time since injury, self-efficacy and sport participation after injury.

The TOWM and the wheelie tests are feasible and valid instruments for assessing manual wheelchair mobility in persons with spinal cord injury.

To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward.

Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients.

Six men and three women with neurological impairments and their caregivers.

Patients’ daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as ‘faster and easier’, outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity.

Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.

To investigate the predictive value of self-reported decline in weight, exhaustion, walking difficulty, grip strength and physical activity on development of disabilities in community-dwelling elderly people.

A one-year follow-up study.

Participants were recruited via four Dutch general practitioners.

Community-dwelling elderly people aged 70 years or older.

A total of 687 participants received a questionnaire at baseline regarding weight loss, exhaustion, walking difficulty, grip strength, physical activity and disability. The same questionnaire was sent to them after one year follow-up. Disability was operationalized in two ways: as increased dependence and as increased difficulty in daily activities. Univariate and multivariate logistic regression analyses were used to determine whether self-reported decline in five physical indicators at baseline predicted development of dependence or increased difficulty in daily activities after one year. The analyses were controlled for age, gender and baseline disability.

Four hundred and one participants with a mean age of 76.9 years (SD 5.2) were included in the analyses. Eighty-four of them reported increased dependence (21%) and 76 reported increased difficulty (19%) in daily activities at one-year follow-up. All physical indicators, except weight loss, were significant univariate predictors of disability. Multivariate analyses revealed that self-reported decrease in physical activity (e.g. walking, cycling, gardening) was a significant predictor of development of dependence (odds ratio (OR) = 1.89, 95% confidence interval (CI) = 1.02–3.51) and development of difficulty (OR = 1.98, 95% CI = 1.05–3.71) in daily activities.

Community-dwelling elderly people who report decreased physical activity have a higher risk to develop disability at one-year follow-up.

To assess the relationships between patient experiences and two overall evaluations – satisfaction and service quality – in outpatient rehabilitation settings.

A cross-sectional, self-reported survey carried out in the year 2009.

Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville.

Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years.

Self-reported experiences on aspects of care, participants’ perception of service quality, satisfaction with care, socio-demographic and health characteristics.

Satisfaction and service quality were highly correlated (rho = 0.72, P< 0.001). Two multivariate logistic regression models using satisfaction and service quality (with adjusted R² 31.5% and 37.1%, respectively) indicated that patients’ experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied.

Satisfaction and service quality provide a poor indicator of patients’ experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

The objective of this study was to examine the role of social support in predicting depression in caregivers of adults aging with spinal cord injuries.

Cross-sectional secondary data analyses were conducted for this study.

Participants were recruited from multiple community locations in Pittsburgh, PA and Miami, FL.

Community-dwelling caregivers of aging adults with spinal cord injuries (N = 173) were interviewed as part of a multisite randomized controlled trial.

The Center for Epidemiological Studies Depression Scale measured caregiver depression symptom levels. A hierarchical multiple regression analysis examined the effect of social support (social integration, received social support, and negative social interactions) on depressive symptom levels for the caregivers of adults aging with spinal cord injuries, controlling for demographic characteristics, and caregiving characteristics.

Caregivers were, on average, 53 years old (SD = 15) and care-recipients were 55 years old (SD = 13). Average Center for Epidemiological Studies Depression Scale scores indicated that 69 (40%) of caregivers had significant depressive symptoms (mean 8.69, SD = 5.5). Negative social interactions ( β ^ = 0.27, P< 0.01) and social integration ( β ^ = −0.25, P< 0.01) were significant independent predictors of depressive symptom levels in caregivers of adults aging with spinal cord injuries.

Findings demonstrate that negative social interactions and social integration are associated with the burden in caregivers of adults aging with spinal cord injuries. Negative social interactions and social integration should be investigated in assessments and interventions intended to target caregiver depressive symptom levels.