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Background: Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement. Aim: To assess whether exercise prescriptions by physiotherapists to patients with CVD are better in agreement with European (ESC/EAPC) recommendations when the EXPERT (EXercise Prescription in Everyday practice & Rehabilitative Training) Training tool is used for digital educational training. Design: In a prospective non-randomized intervention study. Methods: Twenty-three belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a onemonth digital training by using the EXPERT Training tool and completed 31 ± 13 training cases. The EXPERT tool is a training and decision support system that automatically generates a (personalised) exercise prescription according to the patient's characteristics, thus integrating the exercise prescriptions for different CVDs and risk factors, all based on ESC/EAPC recommendations. Thereafter, the same three patient cases as at entry of study were filled out again, with reassessment of level of agreement with ESC/EAPC recommendations. Results: After using the EXPERT Training tool, the physiotherapists prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p < 0.05). In cases 1, 2 and 3, the agreement score increased from 29 ± 9 (out of 60), 28 ± 9, and 34 ± 7 to 41 ± 9, 41 ± 10, and 45 ± 8, respectively (p < 0.001). Hence, the total agreement score increased from 91 ± 17 (out of 180) to 127 ± 19 (p < 0.001, +44 ± 32%). A lower starting agreement score and younger age correlated with a greater improvement in total agreement score (p < 0.05). Conclusions: Exercise prescriptions to patients with CVD, generated by physiotherapists, are significantly better in agreement with European recommendations when the EXPERT Training tool is used, indicating its educational potential. [ABSTRACT FROM AUTHOR]

Purpose: The integration of mental health rehabilitees into the labour market is an important policy objective everywhere in the world. The international Clubhouse organization is a thirdsector actor that offers community-based psychosocial rehabilitation and supports and promotes rehabilitees' state of acting and exerting power over their lives, including their (re)employment. In this article, we adopt the perspective of discursive psychology and ask how mental health rehabilitees' agency is constructed and ideally also promoted in the Clubhouse-based Transitional Employment (TE) programme. Methods: The data consisted of 26 video-recorded TE meetings in which staff and rehabilitees of one Finnish Clubhouse discussed ways to further their contacts with potential employers. The analysis was informed by discursive psychology, which has been heavily influenced by conversation analysis. Results: The analysis demonstrated how rehabilitees adopt agentic positions in respect to TErelated future activities, and how Clubhouse staff promote and encourage but also discourage and invalidate these agentic positionings. The analysis demonstrated the multifaceted nature of agency and agency promotion in the TE programme. Conclusions: Although ideally, Clubhouse activities are based on equal opportunities, in everyday interaction practices, the staff exercise significant power over the question whose agency is promoted and validated in the TE programme. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to illuminate the experiences of stroke survivors returning to everyday life in the year following stroke, in the context of client-centred rehabilitation. Methods: Four men who participated in a client-centred rehabilitation program were followed during the first year after stroke. Semi-structured interviews were conducted, allbut the first in the participants' home. The data were analysed using a grounded theory approach. Results: The results revealed a process with the overarching core category; The "new" self becomes reality through challenging everyday experiences, and five main categories driving the process: 1) Striving for structure in a "new" chaotic world, 2) Homecoming an ambiguous experience, 3) Reaching the "new" self through reflections of self-understanding, 4) Socialising in new circumstances, and 5) Realising a new reality. Conclusions: While in hospital, stroke survivors can have unrealistic expectations. When at home they can begin to realise their actual capacity . To find a "new" self after a stroke can involve time-consuming and taxing processes of reflections of self-understanding. Engagement in self-selected meaningful and valued activities can support stroke survivors' reconstruction of the "new" self but not all stroke survivors may succeed in finding their "new" self during the first year after stroke. [ABSTRACT FROM AUTHOR]

Purpose: The impact of a stroke is particularly evident during the transition home, with reported unmet needs. However, little is known about post-stroke adaptation in Portugal. This study aimed to understand how Portuguese people with stroke and their informal carers/family adapt over time, and how health professionals support their adaptation. Methods: A multi-perspective, longitudinal qualitative study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. A purposive sample of 24 participants (8 triads) participated. Thematic and narrative analysis strategies were used. Results: Three themes were identified: Managing change over time; Balancing support over time; Changing priorities. These suggest the importance of time and gradual adjustment of health professionals' approach throughout the rehabilitation process tailored to people with stroke' and carers' needs. Both valued positive thoughts and support from others to adjust life goals and find a balance between a mutual/bidirectional support and time for themselves. Conclusions: Findings show that the manner in which changes after a stroke are approached may be positively transformed to provide strength. As a result of the deeper understanding gained from this study, health professionals may be better placed to acknowledge the needs of people with stroke and carers and find effective ways of supporting them. [ABSTRACT FROM AUTHOR]

Aiming at the position and pose control requirement of the ankle rehabilitation robot, two schemes of 3-PRS (Prismatic-Revolute-Spherical) parallel ankle rehabilitation robots are proposed, and the analysis and simulation of the control strategy are carried out. Two schemes of 3-PRS ankle rehabilitation robots are statically analysed by the finite element method. Through the stress comparison of the two schemes, the stable one is determined. Three control strategies including the traditional PID control, PID control based on the genetic algorithm and adaptive fuzzy PID control are proposed. A multidisciplinary co-simulation platform is established by the combination of ADAMS, SOLIDWORKS and MATLAB, and the three control strategies are verified. The best control strategy for the rehabilitation robots is determined by comparing control effects. This study lays a solid foundation for research on the control of the rehabilitation robots. [ABSTRACT FROM AUTHOR]

Keywords: Family Physicians; Guidelines; Post-Acute Covid; Pulmonary rehabilitation; SARS-COV-2 EN Family Physicians Guidelines Post-Acute Covid Pulmonary rehabilitation SARS-COV-2 1 5 5 11/14/22 20221201 NES 221201 The coronavirus disease 2019 (COVID-19) is a frequent respiratory infection disease, as of November 16 SP th sp , 2021, 254728728 COVID-19 infections, and 5125685 COVID-19-related deaths (2.01%) had been reported worldwide (https://www.worldometers.info/coronavirus/). Therefore, an alternative including the CRR "minimal advice" that a GP should provide to long COVID-19 patients, seems to be necessary to respond to the needs of GPs to face their involvement with long COVID-19 patients. General practitioners should provide the cardiorespiratory rehabilitation' "minimum advice" for long COVID-19 patients Indeed, general practitioners (GPs) are on the front line in the management process of long COVID-19 patients because as the pandemic evolves, more and more long COVID-19 patients will be in need of treatment/assistance [[14]]. [Extracted from the article]

Resilience contributes to positive adaptation after many health conditions, but little is known about its contribution to long-term recovery after stroke. This study investigated the lived experience of resilience and participation and their relationship to quality of life after stroke in Sweden. Semi-structured telephone interviews were conducted with 19 informants (10 male, 9 female), aged from 44–89 years and between 1 and 19 years post-stroke. Stroke severity ranged from mild (n = 8), moderate (n = 9) to severe (n = 2). Interviews were analysed using content analysis. The analysis resulted in an overarching theme; Life with stroke has been adapted to but not accepted, built on five subthemes: 1) Adapting and adjusting life, 2) Meaningful values in life, 3) Inner resources, 4) Support and treatment from social relations, and 5) Support and treatment from external resources. Participants described a tension between adapting and accepting life after stroke. Resilience was a useful framework, highlighting the contribution of inner, social and societal resources to recovery and quality of life, both directly and as enhanced through increased participation. Important factors for adaptation are meaningful values in life, individual strategies for adaptation and support from both social relationship and the society. [ABSTRACT FROM AUTHOR]

Abstract Pulmonary rehabilitation is a cornerstone intervention for controlling respiratory symptoms in people with chronic respiratory diseases. Chronic cough affects up to 90% of people with chronic respiratory diseases, however, it is currently unknown whether chronic cough is assessed and/or managed in pulmonary rehabilitation. This study aimed to determine if and how chronic cough is assessed and managed in pulmonary rehabilitation. This was a cross-sectional study. Pulmonary rehabilitation programs in Canada were identified via online websites. A representative from each program was invited to complete an online survey including the following topics: program demographics, assessment and management practices, and barriers and facilitators. Of 133 programs contacted, 31 returned a completed survey (23% response rate). Approximately half (52%) of respondents reported enrolling patients with chronic cough. Of those, 45% reported assessing and 62% reported intervening in chronic cough. Inadequate knowledge of assessment and management techniques was commonly identified to be a barrier and increased education was suggested as a possible facilitator. Based on pulmonary rehabilitation programs that responded to our survey, chronic cough is a prevalent symptom; however, it is scarcely assessed and managed. A need for structured education and the use of standardised strategies were reported as facilitators to the assessment and management of chronic cough in pulmonary rehabilitation. [ABSTRACT FROM AUTHOR]

In the United States, attaining the orthopedic certified specialist (OCS) credential or the orthopedic subspecialty credential of Fellow of the American Academy of Orthopedic Manual Physical Therapists (FAAOMPT), may lead to a higher level of orthopedic practice. It is unknown whether attaining these credentials influences physical therapist confidence in and frequency of engagement in prescription opioid medication misuse (POMM) management practices. A national cross-sectional web-based survey of PTs identified whether respondents had an OCS or FAAOMPT credential. Self-report confidence in POMM-related management practices and the frequency of engaging in these practices were assessed. Logistic regression evaluated association between credential status and confidence in, and frequency of, engagement in POMM-related management practices. The analysis included 402 respondents with a mean age of 41.0 (SD = 11.2) and 203 (50.4%) females. There were 91 (22.6%) PTs with a FAAOMPT credential, 143 (35.6%) with an OCS but with no FAAOMPT credential and 168 (41.8%) had neither credential. Compared to those with an OCS credential, FAAOMPTs reported greater confidence in, and greater frequency of engagement in, POMM-related management practices (p<.05). Compared to those without an OCS or FAAOMPT credential and compared to those with an FAAOMPT credential, those with an OCS did not report greater confidence or greater engagement in any POMM-related management practice (p≥.05). Obtain the FAAOMPT credential may increase PTs' confidence in some POMM-related management practices. Research is needed to determine why FAAOMPTs report greater confidence and engagement in POMM-related management practices. [ABSTRACT FROM AUTHOR]

This paper examines the EIA process and its effectiveness in addressing the impacts of a 190 km long national highway project along the Karnataka coast. We analyse the quality and relevance of the environmental clearance conditions established by the Ministry of Environment, Forest, and Climate Change (MoEF&CC) and discusses their potential implications. The findings underline that most of the conditions that pertained to the prevention of pollution, restoration of mangroves, and protection of biodiversity lacked a scientific basis and specific information required for effective implementation. The MoEF&CC also overlooked the social impact of the project and underplayed its own role in ensuring fair compensation to project affected communities for the loss of their land and other livelihoods. The paper concludes by promulgating a long list of irrelevant and ineffective environmental conditions that represent greenwashing because it could misguide affected communities and other stakeholders by creating the impression the state is exercising due diligence in protecting the environment. [ABSTRACT FROM AUTHOR]

There are limited non-invasive treatment options in the home environment for children with cerebral palsy (CP); thus, evaluating such treatment options is needed. We aimed to evaluate the effect of an innovative full-body suit approach for noninvasive surface electrical stimulation ES, the electro-dress Mollii®. The full-body suit was primarily designed to reduce spasticity and improve motor function through the mechanism of reciprocal inhibition among children with CP. This study involved seven experimental single-case studies with an ABAB design. Seven studies were performed among children aged 4–17 years. The primary outcome (spasticity) was analyzed using graphed data with a visual inspection, and median values were analyzed for secondary outcomes (mobility, sitting, upper limb activity, sleep, pain, and adherence to treatment). The study protocol was recorded at clinicaltrials.gov (NCT04078321). Seven studies were analyzed, and the treatment with the electro-dress had little or no impact on the outcomes: spasticity, mobility, sitting, upper limb activity, sleep, and pain, in any of these seven studies. In conclusion, multiple ES treatment with the innovative electro-dress Mollii® revealed little or no observable changes on primary outcome (spasticity) in any of the seven studies. Further the possible impact on motor function is recommended to be further evaluated in future studies. [ABSTRACT FROM AUTHOR]

The rising prevalence of hearing loss is a global health concern. Professional hearing services are largely absent within low- and middle-income countries where appropriate skills are lacking. Task-shifting to community healthcare workers (CHWs) supported by mHealth technologies is an important strategy to address the problem. To evaluate the feasibility of a community-based rehabilitation model providing hearing aids to adults in low-income communities using CHWs supported by mHealth technologies. Between September 2020 and October 2021, hearing aid assessments and fittings were implemented for adults aged 18 and above in two low-income communities in the Western Cape, South Africa, using trained CHWs. A quantitative approach with illustrative open-ended questions was utilised to measure and analyse hearing aid outcomes. Data were collected through initial face-to-face interviews, telephone interviews, and face-to-face visits post-fitting. Responses to open-ended questions were analysed using inductive thematic analysis. The International Outcome Inventory – Hearing Aids questionnaire determined standardised hearing aid outcomes. Of the 152 adults in the community who self-reported hearing difficulties, 148 were successfully tested by CHWs during home visits. Most had normal hearing (39.9%), 24.3% had bilateral sensorineural hearing loss, 20.9% had suspected conductive hearing loss, and 14.9% had unilateral hearing loss, of which 5.4% had suspected conductive loss. Forty adults met the inclusion criteria to be fitted with hearing aids. Nineteen of these were fitted bilaterally. Positive hearing aid outcomes and minimal device handling challenges were reported 45 days post-fitting and were maintained at six months. The majority (73.7%) of participants fitted were still making use of their hearing aids at the six-month follow-up. Implementing a hearing healthcare service-delivery model facilitated by CHWs in low-income communities is feasible. mHealth technologies used by CHWs can support scalable service-delivery models with the potential for improved access and affordability in low-income settings. [ABSTRACT FROM AUTHOR]

BackgroundAimsMethodsResultsConclusionHealthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators.To understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous Peoples.: Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semi-structured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed.: Three overarching themes were identified with the following subthemes: 1) Healthcare access challenges: challenges to accessing care, challenges within the health system, challenges leading to self-directed management/coping strategies. 2) Healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, care closer to home. 3) Participant recommendations for improved care provision: coordination of care, integrative and holistic care, patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care.: Participants identified a range of challenges and facilitators, and recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants. [ABSTRACT FROM AUTHOR]

Effectiveness of interventions for violent behaviour may be undermined by the presence of neurocognitive impairment, which is known to be common among alcohol and other drug (AOD) users and violent offenders. The current study aimed to examine whether the cognitive functioning of individuals with AOD histories presenting to a specialist addiction neuropsychology service differed according to their offending history (i.e. non-offending, non-violent offending and violent offending), using a retrospective case file audit design. Data were extracted from 190 clients. Tests assessed a breadth of cognitive domains. Violent offenders demonstrated the lowest premorbid IQ out of the three groups, and a significantly higher proportion of violent offenders presented with impaired divided attention and impaired cognitive inhibition compared to non-violent offenders. Rates of impairment across groups were well beyond those expected within the general population. Delivery of both AOD and violence interventions should be adapted to accommodate individuals' cognitive difficulties. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of patients on PD. In this manuscript a brief review of the history of peritoneal dialysis in China is presented; this includes a description of pioneers and their important contributions, discussion of peritoneal dialysate, the technique of the use of Tenckhoff catheter, the use of continuous ambulatory peritoneal dialysis (CAPD) and dialysis registration. Current ongoing PD research activities among Chinese PD academicians are also discussed. Finally, we present four areas of future focus: 1) the promotion of PD in rural areas where PD use is still very limited due to the lack of PD awareness and education; 2) PD quality management and continuous quality improvement (CQI) program particularly focusing on PD adequacy and patient rehabilitation; 3) development and enforcement of national standards on PD management; 4) multi-center studies to compare the benefits of PD and hemodialysis (HD) that should include survival, rehabilitation and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Well-being after spinal cord injury is affected by a range of factors, many of which are within the influence of rehabilitation services. Although improving well-being is a key aim of rehabilitation, the literature does not provide a clear path to service providers who seek to improve well-being. This study aimed to inform service design by identifying the experience and perspective of people with SCI about interventions targeting their well-being. The scoping review of qualitative literature used thematic analysis to identify and categorize themes related to service activities, valued aspects, limitations and perceived outcomes. Thirty-eight studies were selected, related to a range of service types. Most studies did not adopt a well-being conceptual framework to design and evaluate the services. People with SCI particularly valued being treated with dignity, positive expectations, increased autonomy and peer support. Improvements to well-being were reported, including many years post-SCI. However, people with SCI reported limited opportunities to engage in such services. Rehabilitation services can improve well-being across the lifetime of people with SCI, but gaps in service provision are reported. The review identified valued aspects of services that may inform service design, including staff approach and positive expectations, having own skills and worth valued, peer support and interaction, autonomy in valued occupations, and long-term opportunities for gains. [ABSTRACT FROM AUTHOR]

Purpose: As part of intervention feasibility evaluation before conducting a clinical trial, this study aimed to investigate perspectives of patients and clinicians involved in the occupational therapy lifestyle-oriented programme REVEAL(OT) [Redesign your EVEveryday Activities and Lifestyle with Occupational Therapy] which was added to multidisciplinary chronic pain treatment. Methods: We conducted three focus group interviews, two with eight voluntarily selected patients and one with four clinicians. Data were analysed using Braun & Clarke's semantic data-driven analysis. Results: Patients reported satisfaction with the intervention and a greater acceptance of living with chronic pain through increased understanding of pain mechanisms, more effective daily planning and improved social interaction. Patients felt empowered to change lifestyle habits by restarting habitual interests, prioritizing joyful occupations for improved occupational balance, and lifestyle modifications. Contact to occupational therapists and peer support were important empowering factors for working with lifestyle goals. Patients and clinicians expressed their views on further improvement of the REVEAL(OT). Conclusions: Patients and clinicians found the lifestyle-oriented occupational therapy programme relevant as an add-on to the multidisciplinary chronic pain treatment. A need was expressed for a reduced information and treatment load and a higher degree of communication and cooperation among the clinicians involved in the intervention. [ABSTRACT FROM AUTHOR]

Purpose: Although it is believed that involving the workplace and stakeholders in return-to-work interventions is beneficial, Norwegian occupational rehabilitation programmes rarely do. During 2015–2016, Hysnes Rehabilitation Centre provided inpatient multimodal occupational rehabilitation, including workplace meetings with employees, supervisors, and rehabilitation therapists. This study aims to explore the meetings´ content and stakeholders´ experiences.Methods: This was a multiple case study including non-participant observation of workplace meetings and interviews with participantsResults: Essential features of meetings included revealing and aligning the employee's and supervisor's understandings. Three components seemed instrumental in developing shared understandings leading to appropriate adjustments: 1) disclosing causes of absence, 2) validating difficulties, attitudes, and efforts, and 3) delimiting responsibility. Therapists played a vital role in addressing these components, supporting employees, and ensuring planning of appropriate solutions.Conclusion: Developing shared understandings by addressing and aligning illness- and return-to-work representations appears important for return-to-work interventions. Although pivotal to developing appropriate adjustments, disclosure depends upon supervisors' display of understanding and should not be encouraged without knowledge of the employee´s work situation. How supervisors relate to employees and implement adjustments may be as important as the types of adjustments. The therapist's support and validation of employees in vulnerable situations also seem valuable.Trial registration: The trial is registered at clinicaltrials.gov (NCT02541890), 4 September 2015. https://clinicaltrials.gov/ct2/show/NCT02541890. [ABSTRACT FROM AUTHOR]

Purpose: Cancer research and connected innovation processes often lack a major component; patient participation. We revisit three studies (a-c) in order to explore how Momentary contentment theory may be used to improve patient participation and psychosocial health. Method: We revisited data from the initial (a) classic grounded theory study on Momentary contentment, based on four years of observation and 14 interviews. It explains a way of dealing with life close to death and morbidity. In the imminence of danger the studied culture resembles the context of cancer patients. The two following studies used focus group interviews with (b) 19 cancer patients and (c) 17 relatives of cancer patients in southern Sweden. Results: We suggest a process where cancer patients are taught to be submissive and that the support they receive from health providers may be counterproductive to contentment; a patientification process. We present alternative ways for people to handle issues such as hope, waiting, knowledge gaps and healthcare navigation while living with cancer. We introduce an alternative to patientification and passive patients where active patients create their own safety and truly participates in their care.Conclusions: We propose clinical studies to introduce such a shift from patentification to co-creation of care. [ABSTRACT FROM AUTHOR]

Purpose: Organized care in specialist stroke units is fundamental for achieving better outcomes for persons with stroke. Although the importance of the physical environment for health and well-being is well recognized, research regarding how environmental features can influence stroke care is limited. The aim was to elucidate healthcare professionals' experiences of the physical environment in newly built stroke units with respect to stroke care.Methods: Healthcare professionals (n = 42) representing eight professions participated in semi-structured, face-to-face interviews. Qualitative content analysis was used.Results: The physical environment both facilitated and restricted the professionals' ability to provide stroke care. Five categories were identified: "Working towards patient engagement in single rooms", "Hampered rehabilitation in an environment not always adapted to patients' difficulties", "Addressing patients' psychosocial needs in the environment", "Ensuring patient safety by using the environment in accordance with individual needs", and "Collaboration and task fulfilment—a challenge due to care unit design".Conclusions: The healthcare professionals viewed the physical environment mainly in relation to stroke patients' specific needs, and several environmental features were considered poorly adapted to meet these needs. The physical environment is essential to high-quality care; thus, the process of planning and designing stroke units should be based on existing evidence. [ABSTRACT FROM AUTHOR]

Background: Lumbosacral orthosis (LSO) and/or the isolated contraction of the transversus abdominis muscle by the abdominal drawing-in maneuver (ADIM) can increase lumbar stiffness, consequently influencing postural control. The purpose of this study was to compare the effects of LSO and ADIM on postural control during two balance tasks and determine their reliability. Methods: Twenty participants (50% men) randomly performed three experimental conditions: 1) without lumbar stabilization, 2) with LSO), and 3) with ADIM. Each experimental condition was tested in two postural tasks: semi-tandem and one-legged stance on a force platform for 30 seconds, while the Center of pressure postural (COP) parameters were computed. Results: The two methods of lumbar stabilization were comparable and did not significantly reduce the COP values across time, even though a few individuals presented a change in their COP data above the levels of measurement errors. The reliability of these measurements was generally acceptable and sometimes excellent ( ≥ 0.90 and ≤10% error measurement). Conclusions: Both LSO and isolated contraction of the transversus abdominis muscle by ADIM do not change postural control in one-legged stance and in semi-tandem tasks. These results have implications for use or not these methods for postural control on a rehabilitation perspective. [ABSTRACT FROM AUTHOR]

The management of patients with chronic post-surgical low back pain can be very challenging to surgeons, physiotherapists, and patients alike. Subsequent surgery is often associated with post-operative complications and even lower levels of success than the initial spinal surgery. Physiotherapy is often recommended as the first-line management, however, debate exists amongst physiotherapists regarding the optimal treatment strategy. A key focus of this debate has been the use of manual therapy in chronic pain populations, leading clinicians to reevaluate its use. A 44-year-old female presented to physiotherapy with a 13-year history of persistent pain, having had a spinal fusion 12 years prior, following a skiing accident. Her primary complaints were pain and decreased self-efficacy. The patient was treated with a 12-week multimodal approach consisting of manual therapy, exercise rehabilitation, and pain neuroscience education. The patient had a significant reduction in the Numerical Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI) and the Fear Avoidance Belief Questionnaire Physical Activity Subscale (FABQ-PA) scores following the intervention. She returned to running and cycling, reporting that pain was something she would 'work with instead of against'. This case study suggests that manual therapy can enhance an individualized biopsychosocial approach in the physiotherapy management of a patient with chronic post-surgical low back pain. Further research is needed to evaluate optimal intervention dosages and effective strategies in the management of patients with chronic low back pain following spinal surgery. [ABSTRACT FROM AUTHOR]

Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania. This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p-value<0.05 was considered statistically significant. Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation. Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania. [ABSTRACT FROM AUTHOR]

If Sustainable Developmental Goal 3 and Universal Health Coverage are to be achieved, functioning is a third health indicator which must be assessed and integrated into global health population-based metrics alongside mortality and morbidity. In this paper, we define functioning according to the International Classification of Functioning, Disability and Health (ICF) and present why functioning is important to measure, especially when considering the need for, and outcome of, rehabilitation and assistive technology (AT). We discuss examples of tools that measure components of functioning through clinical assessment and self-report methodologies, and present the development of a comprehensive population level tool which aligns with the ICF and combines self-report and clinical measurement methods to measure functioning and the need for rehabilitation and AT. Throughout the paper a survivor of Coronavirus 2019 (COVID-19) is given as an example to illustrate functioning according to the ICF and how access to the interventions of rehabilitation and AT might be of benefit to improve and optimise his/her functioning. We argue that the Global Health community must take action and ensure that the measurement of functioning is well established, accepted and integrated as the third health indicator following the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The prevalence of inadequate treatments for chronic pain has necessitated the search for biological factors that influence the transition to chronicity. Methods: Antecubital blood was drawn from those who experienced acute, noncatastrophic musculoskeletal trauma. Follow-up occurred at 1, 3, 6, and 12 months with the primary outcome being Brief Pain Inventory (BPI) Functional Interference scores. Eight markers were chosen for latent profile analysis: brain-derived neurotrophic factor (BDNF); transforming growth factor-beta 1 (TGF-β1); C-reactive protein (CRP); tumor necrosis factor-alpha (TNF-α); interleukins (ILs) 1-beta, 6, and 10; and the stress hormone cortisol. Results: Mean age of the 106 participants was 44.6 years and 58.5% were female. The final model indicated a three-class solution that could be adequately described by three of the eight markers: class 1 = low concentration of all markers (33.9% of the sample), class 2 = average concentration of all markers (47.7%), and class 3 = high concentration of BDNF and TGF-β1 (18.3%). BPI Pain Interference scores captured at both inception and 6-month follow-up were compared across the three groups. Mean scores were significantly higher in class 3 for the BPI Interference subscale at inception (27.0 [SD 16.4] vs. 35.8 [SD 17.3], P = 0.05) and at 6-month follow-up (2.2 [SD 4.8] vs. 7.3 [SD 10.7], P = 0.03) compared to those of the other two classes. Conclusions: Although recovered populations are not significantly different in BDNF and TGF-β1 levels, those who experience persisting disability are more likely to have moderate to high levels in serum. [ABSTRACT FROM AUTHOR]

Background: Little is known about how the specialized treatment journey is perceived by youth with pain-related disability and their parents. Aims: Describe and compare the treatment effects and outcomes as perceived by youth and their parents enrolled in intensive interdisciplinary pain treatment (IIPT) or multimodal treatment (MMT). Methods: Eleven IIPT youth and five parents and three MMT youth and five parents were recruited. All were asked to complete a treatment journey timeline, followed by separately conducted semistructured interviews. Transcribed interviews were analyzed using reflective thematic analysis. Results: The main themes spanned the treatment trajectory. All participants described similar initial struggles (Theme 1). Positive and negative treatment effects associated with acquisitions and disruptions (Theme 2), and outcomes post-discharge related to supports and realities (Theme 3) emerged. Knowledge, skills, and support acquisition during treatment and feeling empowered and confident to self-manage postdischarge were identified as IIPT benefits. However, the change effort and life disruptions required and the difficulty transitioning to real life postprogram were acknowledged as detrimental IIPT impacts. Continuing with life as usual and maintaining supports in daily contexts (e.g., school personnel, friends) were reported MMT benefits. However, the challenges of managing pain, treatment adherence within the competing demands of daily realities, and the lack of support to integrate strategies were emphasized as detrimental MMT impacts. Conclusions: Detailed impacts of two specialized multidisciplinary pain rehabilitation interventions on the lives of youth with pain-related disability and their parents are described. The treatments benefits and previously unexplored detrimental effects are unveiled. [ABSTRACT FROM AUTHOR]

This article presents a commentary on the current status of offender rehabilitation in Australian prisons. Prompted by recent debates concerning the value of rehabilitation programs in reducing rates of re-imprisonment, it considers the current evidence to support the effectiveness of Australian correctional programs highlighting the importance of the prison social climate, the intensity and quality of treatment and the need for psychological treatment to be integrated within broader models of rehabilitation and reintegration. [ABSTRACT FROM AUTHOR]

The EU COST Action 15111 collaboration on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) aims to assess current research and identify knowledge gaps in Europe. Presently, our purpose is to map the effects of non-pharmacological therapies (NPTs) for ME/CFS, and what patients find important in the treatment process. A scoping mixed methods literature review of European studies identified 16 papers fulfiling our inclusion criteria. The quantitative and qualitative studies were synthesized separately in tables. Additionally, extracts from the qualitative studies were subjected to translational analysis. Effect studies addressed cognitive behavioural therapy (CBT, n = 4), multimodal rehabilitation (n = 2) and activity-pacing (n = 2). CBT reduced fatigue scores more than usual care or waiting list controls. The effects of rehabilitation and activity-pacing were inconsistent. The contents, assessment methods and effects of rehabilitation and activity pacing studies varied. For patients, health professionals' recognition of ME/CFS and support were crucial, but they expressed ambiguous experiences of what the NPTs entail. Methodological differences make comparisons across NPTs impossible, and from a patient perspective the relevance of the specific contents of NPTs are unclear. Future well-designed studies should focus on developing NPTs tailored to patients' concerns and evaluation tools reflecting what is essential for patients. [ABSTRACT FROM AUTHOR]

Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians. [ABSTRACT FROM AUTHOR]

International competition inevitably presents logistical challenges for athletes. Events such as the Tokyo 2020 Olympic Games require further consideration given historical climate data suggest athletes will experience significant heat stress. Given the expected climate, athletes face major challenges to health and performance. With this in mind, heat alleviation strategies should be a fundamental consideration. This review provides a focused perspective of the relevant literature describing how practitioners can structure male and female athlete preparations for performance in hot, humid conditions. Whilst scientific literature commonly describes experimental work, with a primary focus on maximizing magnitudes of adaptive responses, this may sacrifice ecological validity, particularly for athletes whom must balance logistical considerations aligned with integrating environmental preparation around training, tapering and travel plans. Additionally, opportunities for sophisticated interventions may not be possible in the constrained environment of the athlete village or event arenas. This review therefore takes knowledge gained from robust experimental work, interprets it and provides direction on how practitioners/coaches can optimize their athletes' heat alleviation strategies. This review identifies two distinct heat alleviation themes that should be considered to form an individualized strategy for the athlete to enhance thermoregulatory/performance physiology. First, chronic heat alleviation techniques are outlined, these describe interventions such as heat acclimation, which are implemented pre, during and post-training to prepare for the increased heat stress. Second, acute heat alleviation techniques that are implemented immediately prior to, and sometimes during the event are discussed. Abbreviations: CWI: Cold water immersion; HA: Heat acclimation; HR: Heart rate; HSP: Heat shock protein; HWI: Hot water immersion; LTHA: Long-term heat acclimation; MTHA: Medium-term heat acclimation; ODHA: Once-daily heat acclimation; RH: Relative humidity; RPE: Rating of perceived exertion; STHA: Short-term heat acclimation; TCORE: Core temperature; TDHA: Twice-daily heat acclimation; TS: Thermal sensation; TSKIN: Skin temperature; V̇O2max: Maximal oxygen uptake; WGBT: Wet bulb globe temperature [ABSTRACT FROM AUTHOR]

Having sought 22 clinicians' views of how rehabilitation was practised in a forensic mental health service, this study explores whether or not these views are consistent with claims that forensic rehabilitation can be hampered by the lack of a coherent rehabilitation framework. Two major, mutually influencing themes emerged from the participants' narratives, the first of which delineates the culture and functioning of individuals and systems in a forensic service and the underlying philosophies and beliefs guiding professional behaviour. The second theme outlines the participants' views of the ways in which client needs are assessed and how clients are subsequently provided with the skills and opportunities required for their rehabilitation. The results indicate that while the participants perceived that there were positive aspects to the forensic mental health care that was provided; they also stated that systematicity in the formulation and provision of forensic mental health clients' needs was lacking. These findings reinforce previous claims that there needs to be a theoretically sound means of embedding and systematising effective rehabilitation practice in forensic services. [ABSTRACT FROM AUTHOR]

Across the continuum of care, providers representing multiple professions (i.e., rehabilitation, medical, mental health) influence post-acute care planning for persons with brain injury, yet insufficient evidence informs how decisions are made. The need to understand provider decision-making is paramount, particularly for a person with brain injury whose sequelae necessitates integrated, interprofessional care. Using vignettes drawn from authentic scenarios, this qualitative study investigated case management decisions made by providers serving individuals with varying neurobehavioral needs. Responses to three open-ended scenarios concerning neurobehavioral service provision were collected, coded, and analyzed in accordance with rigorous qualitative conventions. Participants (n = 84) represented an array of organizations serving persons with brain injury. The results revealed two courses of action: dominant and supporting. Although most respondents indicated integrated care as the ideal pathway, their concretized recommendations yielded actions focused on a single referral within the traditional medical model rather than an interdisciplinary approach. While integrated, interprofessional treatment and working across systems are considered optimal, this study suggests that in the current practice such a model is still evolving. This duel between "ideal" and "actual" highlights the need for further study, as well as resources to support best practices in rehabilitation and recovery. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) in 2017 estimated that around 35–40 million people require prosthetic or orthotic services. The Framework and Strategy for Disability and Rehabilitation 2015–2030 for South Africa highlights a shortage of human resources for disability and rehabilitation services to manage the various risks and types of impairments faced by the population. To describe the demographic trends of Prosthetists/Orthotists (P/O) registered with the Health Professions Council of South Africa (HPCSA) from 2002 to 2018. The study was a retrospective record-based review of the Health Professions Council of South Africa (HPCSA) database from 2002 until 2018. The database of registered Prosthetists/Orthotists was obtained from the HPCSA. Data were analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). In 2018, there were 544 P/Os registered with the HPCSA with a ratio of 0.09 P/Os per 10,000 population. There has been an average annual increase of 6% from 2002 to 2018. The majority (71.9%) of P/Os are located in the more densely populated and urbanized provinces, namely Gauteng, KwaZulu-Natal and Western Cape. The majority of registered P/Os identified as white (61%) followed by Black (22%), Indian (7%) and Coloured (2%). Most of registered P/Os are under the age of 40 years (54.2%) and males make up 73% of the registered P/Os. This study highlights the unequal spatial distribution trends of P/Os which could be accounted for by South Africa’s apartheid history and the subsequent slow pace of transformation. Addressing the existing shortages is necessary to expand access to P/Os services and to ensure the motivation, planning and provision of adequate infrastructure to provide these services. The study presents a compelling case for the prioritization and strengthening of this workforce for the achievement of effective universal health coverage for persons with disabilities. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) in 2017 estimated that around 35–40 million people require prosthetic or orthotic services. The Framework and Strategy for Disability and Rehabilitation 2015–2030 for South Africa highlights a shortage of human resources for disability and rehabilitation services to manage the various risks and types of impairments faced by the population. To describe the demographic trends of Prosthetists/Orthotists (P/O) registered with the Health Professions Council of South Africa (HPCSA) from 2002 to 2018. The study was a retrospective record-based review of the Health Professions Council of South Africa (HPCSA) database from 2002 until 2018. The database of registered Prosthetists/Orthotists was obtained from the HPCSA. Data were analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). In 2018, there were 544 P/Os registered with the HPCSA with a ratio of 0.09 P/Os per 10,000 population. There has been an average annual increase of 6% from 2002 to 2018. The majority (71.9%) of P/Os are located in the more densely populated and urbanized provinces, namely Gauteng, KwaZulu-Natal and Western Cape. The majority of registered P/Os identified as white (61%) followed by Black (22%), Indian (7%) and Coloured (2%). Most of registered P/Os are under the age of 40 years (54.2%) and males make up 73% of the registered P/Os. This study highlights the unequal spatial distribution trends of P/Os which could be accounted for by South Africa's apartheid history and the subsequent slow pace of transformation. Addressing the existing shortages is necessary to expand access to P/Os services and to ensure the motivation, planning and provision of adequate infrastructure to provide these services. The study presents a compelling case for the prioritization and strengthening of this workforce for the achievement of effective universal health coverage for persons with disabilities. [ABSTRACT FROM AUTHOR]

Denunciation and general deterrence are major objectives of sentencing those who are convicted of possessing or distributing child exploitation material in Australia (CEM offenders), but courts also strive to achieve specific deterrence. To this end, courts tend to rely on professional reports as evidence of risk of reoffending and prospects for rehabilitation. After outlining matters that courts consider when sentencing CEM offenders, we discuss key empirical findings concerning CEM offenders' risk of recidivism, and then evaluate two approaches for assessing this risk: actuarial assessments; and structured professional judgment. We recommend that professional reports prepared for sentencing reflect current research findings regarding risk of recidivism amongst CEM offenders and that the structured professional judgment approach is used. We also recommend that matters which inform offenders' risk of recidivism and their prospects for rehabilitation be reported separately. [ABSTRACT FROM AUTHOR]

Stroke is the second leading cause of mortality worldwide and one of the main causes of adult disability. Many studies have suggested that combination therapies provide better outcomes in patients with stroke than monotherapies. The combination of botulinum-A toxin (BTX) injection with rehabilitation methods, such as modified constraint-induced movement therapy (BTX-mCIMT), has emerged as a highly promising intervention for promoting motor recovery after stroke. Thus, the present study compared the effectiveness of the combination of BTX with high-dose conventional therapy (BTX-ICT) and BTX-mCIMT for improving motor recovery and reducing spasticity of the upper limb in patients with stroke. This study recruited 64 patients with stroke. The patients were randomly allocated to two groups, namely, BTX-ICT and BTX-mCIMT. Modified Ashworth scale (MAS), Fugl–Meyer assessment (FMA), and Barthel index (BI) assessment scores were determined for the patients in both the groups before and at 4 weeks after the BTX injection. After four weeks of treatment, the MAS, FMA, and BI assessment scores of the patients in both groups were significantly higher than the scores before the treatments (P < 0.05). At the end of 4 weeks, the patients in the BTX-mCIMT group showed significantly higher mean FMA and BI assessment scores than the patients in the BTX-ICT group (P < 0.05). However, no significant statistical difference was observed in the MAS score of the patients in the two groups (P > 0.05). Our results indicated that while both BTX-mCIMT and BTX-ICT promoted motor function recovery in patients with stroke, BTX-mCIMT exerted higher therapeutic effects than BTX-ICT on motor function recovery and in the activities of daily living of patients with stroke. [ABSTRACT FROM AUTHOR]

Purpose: Exploring real-life experiences of Chronic Obstructive Pulmonary Disease (COPD) patients during rehabilitation can contribute with new knowledge of what has significance for their participation and chance for improved health and well-being. Therefore, this study aims to gain in-depth knowledge of COPD patients' lived experiences while following standard pulmonary out-patient rehabilitation. Methods: Combined participant observations and interviews were conducted among 21 participants in pulmonary rehabilitation. A three-leveled phenomenological-hermeneutic interpretation was applied. Results: Living with COPD was challenging due to dyspnea and other physical troubles. This caused a lack of trust in the body and complicated rehabilitation participation. When improving management of breath during rehabilitation, the patients gained a new sense of trust in the body. This was accompanied by a nascent hope and increased well-being. However, not succeeding in this left patients with a persistent lack of hope. Conclusions: Comprehensive troubles in living with COPD paradoxically prevents patients' prospect of overcoming a perceived lack of trust in their body during standard pulmonary rehabilitation. Enhancing breath management has a significant impact on COPD patients' trust in own capabilities to improve well-being and health. Future rehabilitation must accommodate COPD patients' troubles by longer-lasting, well-coordinated, individually supportive and more easily accessible programmes. [ABSTRACT FROM AUTHOR]

Introduction: Elderly patients often receive care and rehabilitation from different providers across healthcare settings. Collaboration between hospital and primary care providers is therefore essential to ensure that the discharge and transition of rehabilitation is coherent. However, research that focuses on elderly patients' experiences of the discharge, and their everyday lives after, has attracted little attention. Purpose: This study explores elderly patients' experiences of being discharged and returning to everyday lives after discharge from a short-stay unit at the Emergency Department. Methods: Eleven qualitative interviews with elderly patients were conducted two weeks after their discharge. The transcribed interviews were analysed using systematic text condensation. Results: The study identified four themes related to the participants experiences. In the participants perspective it was difficult, due to fatigue and pain, to perform daily activities after discharge. Participants who experienced not being prepared and clarified in relation to their discharge continued to have concerns for the future. They also experienced some challenges related to lack of being involved and lack of receiving the information needed. Conclusion: The findings contribute with impotant knowledge about elderly patients' experiences and concerns which should be taken into consideration in the discharge planning process. [ABSTRACT FROM AUTHOR]

Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor. [ABSTRACT FROM AUTHOR]

Objective: There is strong evidence that medication adherence and lifestyle changes are essential in patients undergoing secondary cardiovascular disease prevention. Cardiac rehabilitation (CR) increases medication adherence and improves lifestyle changes. Patients with cardiac diseases and a low educational level and patients with little social support are less responsive to improve medication adherence and to adapt lifestyle changes. The aim of the present study was to investigate the long-term effects of a socially differentiated CR intervention on medication adherence as well as changes in biological and lifestyle risk factors at two- five- and ten-year follow-up. Design: A prospective cohort study. Setting: The cardiac ward at Aarhus University Hospital, Denmark. Intervention: A socially differentiated CR intervention in addition to the standard CR program. Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N = 379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network. Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status. Results: No significant long-term effect of the intervention was found. Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors. Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking. General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status. [ABSTRACT FROM AUTHOR]

Background: The 11th revision of the International Classification of Diseases includes a new chapter of stress-related disorders and presents two distinct sibling conditions: Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Studies show that PTSD and CPTSD are associated with different levels of symptom burden, comorbidity and functional impairment, but have not yet addressed the qualitative and quantitative differences in work-related impairment between the two diagnoses. Objective: The aim of this study was to replicate differences in symptom severity, global distress, and the number of comorbid diagnoses between three groups that suffer from no PTSD, PTSD, or CPTSD. More importantly, we evaluated whether the three groups differ in indicators of functional impairment such as qualitative and quantitative working capacity. Finally, this study supplies information on prevalence rates of PTSD and CPTSD in a clinical sample suffering from psychosomatic complaints. Methods: Participants were 662 patients of a Psychosomatic Rehabilitation Clinic (age M = 50.99, SD 8.99 years; 70.1% female). Self-report screening instruments were administered to participants at the beginning of their inpatient psychotherapy. Multivariate analysis of variance and Chi Square tests were utilized to assess group differences in symptom severity, comorbidity and work-related impairment. Results: A prevalence of 13.3% CPTSD and 9.5% PTSD was found among the current sample. CPTSD was associated with heightened symptom burden and more comorbid diagnoses. More importantly, CPTSD was associated with a significantly lowered qualitative and quantitative working capacity compared to PTSD and no-PTSD. Conclusions: The high prevalence, greater psychopathological burden and work-related impairments in CPTSD compared to PTSD highlight the need for developing and evaluating new interventions in rehabilitation that address the complexity of the new disorder. [ABSTRACT FROM AUTHOR]

Posterior cortical atrophy (PCA) is a neurodegenerative disease affecting the posterior region of the brain. Little is known about both the impact of PCA on functioning and how to support patients on a daily basis. The purpose of this study was to describe the functional profile of DD, a woman diagnosed with PCA, as well as to explore a pilot cognitive rehabilitation program designed to optimize functioning in daily living. The ADL Profile was used to assess the daily tasks that DD chose to undertake. Four operations, i.e. formulate a goal, plan, carry out and verify goal attainment, were scored for each task. Difficulties were observed during the execution of all tasks, as she struggled to find items or showed unsafe behaviors. Impairments were also seen in formulating a goal and planning, especially for less routine tasks. DD identified two tasks to be addressed in rehabilitation: setting the table and dealing cards. Learning was optimized using errorless learning and compensatory aids when setting the table, while dealing cards received no intervention. Only setting the table improved significantly with time. Further studies should be conducted to portray a wider functional profile of people living with PCA and develop effective rehabilitation programs. [ABSTRACT FROM AUTHOR]

Purpose: This study describes and compare the ability of professionals working in municipality stroke rehabilitation services to facilitate learning and change in the daily living of stroke survivors in two regions: one in northern Norway, the other central Denmark. Materials and Methods: Semi-structured individual interviews were conducted with survivors 3 and 9 months after discharge from in-patient care. By contrast, field observations and focus group interviews were completed with professionals on multidisciplinary teams in the two regions. A sociocultural perspective on learning was applied during data analysis. Results: Altogether, the ability of municipal health services to facilitate learning and change for stroke survivors during the first year generally depended upon developing comprehensive integrated rehabilitation plans and ensuring access to coordinated, qualified multidisciplinary teams with professional knowledge and skills to support the survivors and their families during processes of adjustment, learning and change. However, Danish stroke survivors seemed positioned to be more active, proactive and empowered, and their processes of learning and change seemed more closely co-constructed with professional support. Conclusion: Findings reveal considerable differences in municipal stroke rehabilitation services in northern Norway and central Denmark and their ability to support stroke survivors in performing self-management. [ABSTRACT FROM AUTHOR]

Measuring the proximity of the body to the environment has the potential to provide rehabilitation health care professionals (RHCP) new, additional information to assess mobility. The aims of this study were to explore the opinions and needs of professionals to use a new device to measure such proximity, and to determine potential barriers and facilitators to implement it within the clinical setting. Four focus groups were conducted with 23 RHCP. The concept of a proximity measurement device in the early stages of development was introduced. A qualitative content analysis using a model of clinical utility as guidance for coding of the transcribed texts was used. Many potential uses were raised including: improving patient safety, motor learning, independence in tasks as gait, transfers and reaching tasks, saving time during assessment, improving follow-up with the client, data precision and objectivity to assess tasks. Barriers were related to still unclear relevance, effectiveness, the added value of such a device, and time required for use. The development of a turnkey device with support to facilitate its implementation was seen to be positive. These focus groups provided important information to further identify potential uses of such a device and to help to decrease barriers to its implementation. [ABSTRACT FROM AUTHOR]

Upper limb amputations can significantly impact daily functions and affect quality of life. Significant advances over the last few decades have resulted in lighter and stronger artificial limbs; however, users have indicated that improved function and control strategies are desirable to become more in line with able-bodied limb function. The complexity of the amputated limb muscle physiology makes quantitative clinical assessment challenging. In addition, most clinical research has focused on studying isometric (stationary) limb movements. In order to develop more robust systems, it is critical to study muscle mechanics of those with amputations under dynamic (moving) movements. One method of safely examining dynamic movements is the use of isokinetic dynamometers. These machines allow measurement of upper and lower extremity isokinetic movements at controlled angular velocities while ensuring no stress is placed on the individual (even if the participant is unable to move the lever arm). For able-bodied participants, this doesn't present a problem. However, there is currently no commercially available isokinetic dynamometer adapter for prosthesis users. The purpose of this project was to develop an adapter for those with amputations to safely and effectively operate the dynamometer. The adapter was tested by one clinical patient to determine its effectiveness. [ABSTRACT FROM AUTHOR]

South Africa has numerous voluminous tailings dumps that will certainly require rehabilitation. The aim of this work was to develop a methodological approach for prioritization of rehabilitation of abandoned tailings dumps. To test the applicability of the developed method in different conditions, it was applied on six abandoned tailings dumps denoted as FGMT, LMMT, KLMT, MCMT, NMMT-A and NMMT-B found in the Giyani and Musina areas of South Africa. The method involved integration of quantitative and qualitative techniques in making sound decision on the order of rehabilitation of the tailings dumps in the area. It considered the contamination potential of the dumps, the ease of their dispersion to the surroundings and the impact they have on the appearance of the natural landscape. The use of the tool on abandoned tailings dumps in the study area revealed that gold tailings dumps are to be rehabilitated first than magnesite and copper tailings dumps. The study indicated that the dump with the highest pollution potential was the FGMT and that physical stabilization was considered the most suitable rehabilitation option for abating its high toxic metals from polluting the environment. The combination of methods that improve physical stability of the dump while enhancing nutrient availability for plant growth were found appropriate for rehabilitation of MCMT. The rehabilitation of the rest of the dumps required the use of chemical methods that promote growth of vegetation. According to the study, the developed tool can be used to guide rehabilitation of abandoned tailings dumps in different settings. [ABSTRACT FROM AUTHOR]

This paper presents a simplified empirical model for predicting the asphaltic remaining strength factor to be used in estimating the resurfacing thickness for both thin and thick asphaltic surfaces. The proposed model for predicting the asphaltic remaining strength factor in the case of thin asphaltic surface is mainly a function of key performance indicators and calibration constant (K). In the case of thick asphaltic surface, an average remaining strength factor is proposed which is a function of the existing asphaltic surface thickness, cold milling thickness, and the remaining strength factor associated with thin asphaltic surface. The proposed remaining strength factor is to be used in estimating the resurfacing thickness component due to the strength loss endured by the asphaltic surface. Two case studies are presented to predict the remaining strength factor. The first one applies the remaining strength factor model to estimate the resurfacing thicknesses for two sample projects considering variable rehabilitation scheduling time, while the second one calibrates the remaining strength factor model for a local roadway sample using minimization of the sum of squared errors. The sample results indicate that the remaining strength factor values (0.45–0.94) are lower for thin asphaltic surface compared to the corresponding values (0.72–0.97) for thick surface considering 6–12 years rehabilitation scheduling time, and they are lower for inferior pavement performance compared to a superior one. The sample results also indicate that the optimal (K) values for thin asphaltic surface (0.71–1.24) are considerably lower than the corresponding optimal (K) values for thick surface (2.08–3.83). [ABSTRACT FROM AUTHOR]

Mindfulness is a technique and sense of being present in the moment that incorporates aspects of acceptance, openness and meditation with the ultimate intention of improving well-being. Research indicates that mindfulness can significantly improve negative personality traits, reduce stress, increase attention, alleviate chronic pain and enhance mental health. Mindfulness-based interventions in correctional facilities have resulted in reduced hostility and improved self-esteem for adults, but less is known about its applicability amongst youth. This article reviews the research-based literature on the use of mindfulness-based interventions for youths (aged 13 to 24 years) involved in the justice system. A total of ten studies were located and synthesised into four themes of stress reduction, self-regulation, anger management and acceptance. The article concludes by considering the methodological rigour of the reviewed studies, providing recommendations for future research and contemplating the positive impact that mindfulness interventions might have on youth in the criminal justice system. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the effects of the Mulligan Concept (MC) ‘squeeze’ technique compared to a sham technique in participants with a clinically diagnosed meniscal tear. Methods: A multi-site randomized sham-controlled trial of participants (n = 23), aged 24.91 ± 12.09 years, with a clinically diagnosed meniscal tear were equally and randomly divided into two groups. Groups received a maximum of six treatments over 14 days. Patient outcomes included the numeric pain rating scale (NRS), patient-specific functional scale (PSFS), the disablement in the physically active (DPA) scale and the knee injury osteoarthritis outcome score. Data were analysed using univariate ANOVA, univariate ANCOVA, and descriptive statistics. Results: All participants in the MC ‘squeeze’ group met the discharge criteria of ≤2 points on the NRS, ≥9 points on the PSFS, and ≤34 points or ≤23 on the DPA Scale for chronic or acute injuries, respectively within the treatment intervention timeframe. A significant difference was found in favor of the MC ‘squeeze’ technique in PSFS scores (F(1, 21) = 4.40, p = .048, partial eta squared = .17, observed power = .52) and in DPA Scale scores (F(1, 21) = 7.46, p = .013, partial eta squared = .27, observed power = .74). Discussion: The results indicate the MC ‘squeeze’ technique had positive effects on patient function and health-related quality of life over a period of 14 days and was clinically and statistically superior to the sham treatment. Further investigation of the MC ‘squeeze’ technique is warranted. [ABSTRACT FROM AUTHOR]

Study design: Randomized clinical trial. Background: Patients with fractures to the talus and calcaneus report decreased functional outcomes and develop long-term functional limitations. Although physical therapy is typically not initiated until six weeks after fixation, there’s little research on the optimal time to initiate a formal physical therapy program. Objectives: To assess whether initiating physical therapy including range of motion (ROM) and manual therapy two weeks post-operatively (EARLY) vs. six weeks post-operatively (LATE) in patients with fixation for hindfoot fractures results in different clinical outcomes. Methods: Fifty consecutive participants undergoing operative fixation of a hindfoot fracture were randomized to either EARLY or LATE physical therapy. Outcomes, including the American Orthopedic Foot and Ankle Society Hindfoot Scale (AOFAS), the Lower Extremity Functional Scale (LEFS), active ROM, swelling, and pain, were collected at three and six months and analyzed using linear mixed-modeling to examine change over time. Adverse events were tracked for 12 months after surgery. Results: The EARLY group demonstrated significantly larger improvements for the AOFAS (p = .01) and the LEFS (p = .01) compared to the LATE group. Pairwise comparison of the LEFS favors the EARLY group at 6 months [7.5 (95%CI −.01 to 15.0), p = .05]. There were no differences between the groups with regard to ROM, pain, and swelling. The LATE group incurred increased adverse events in this study. Conclusion: Initiating early physical therapy may improve long-term outcomes and mitigate complications in patients after hindfoot fractures. Level of Evidence: Therapy, level 2b. [ABSTRACT FROM AUTHOR]