Search

Louise Moeldrup Nielsen,1,2 Thomas Maribo,3 Hans Kirkegaard,4 Kirsten Schultz Petersen,5 Marianne Lisby,4 Lisa Gregersen Oestergaard2,6 1Department of Occupational Therapy, VIA University College, 2Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, 3Department of Public Health, Aarhus University, DEFACTUM, 4Department of Clinical Medicine, Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, 5Department of Health Science and Technology, Aalborg University, Aalborg, 6Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark Purpose: To examine the effectiveness of the Elderly Activity Performance Intervention on reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. Patients and methods: The study was conducted as a nonrandomized, quasi-experimental trial. Three hundred and seventy-five elderly patients were included and allocated to the Elderly Activity Performance Intervention (n=144) or usual practice (n=231). The intervention consisted of 1) assessment of the patients’ performance of daily activities, 2) referral to further rehabilitation, and 3) follow-up visit the day after discharge. Primary outcome was readmission (yes/no) within 26 weeks. The study was registered in ClinicalTrial.gov (NCT02078466). Results: No between-group differences were found in readmission. Overall, 44% of the patients in the intervention group and 42% in the usual practice group were readmitted within 26 weeks (risk difference=0.02, 95% CI: [-0.08; 0.12] and risk ratio=1.05, 95% CI: [0.83; 1.33]). No between-group differences were found in any of the secondary outcomes. Conclusion: The Elderly Activity Performance Intervention showed no effectiveness in reducing the risk of readmission in elderly patients discharged from a short-stay unit at the emergency department. The study revealed that 60% of the elderly patients had a need for further rehabilitation after discharge. Keywords: occupational therapy, rehabilitation, performance of daily activities, activities of daily living, acute care

Background: Although lumbar spinal fusion has been performed for more than 70 years, few studies have examined rehabilitation strategies for spinal fusion patients, and there is only sparse information about the patient's activity level after surgery. The Canadian Occupational Performance Measure (COPM) is a standardized semi-structured interview, developed to identify patients' problems in relation to activities of daily living (ADL). The COPM has neither been examined in a randomised clinical study nor employed in relation to lumbar spinal fusion patients. We aimed to examine whether or not the use of the semi-structured interview COPM during in-hospital rehabilitation could: (1) identify more ADL-related problems of importance to the patients after discharge from the hospital, (2) enhance the patients' ADL performance after discharge from hospitalMethod: Eighty-seven patients undergoing a lumbar spinal fusion caused by degenerative diseases were randomly assigned to either use of the COPM or to standard treatment.Results and Conclusion: Use of the COPM during hospitalization helped in identifying more ADL problems encountered by patients during the first 3 months post-discharge period as COPM served to identify more treatment goals and plans of action. Use of the COPM had no impact on the patients' ADL performance, and the difference is so small that COPM may be of little clinical consequence. [ABSTRACT FROM AUTHOR]

Objective To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. Methods Randomised controlled trial in the secondary healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP addressing both workplace barriers and leisure-time physical activity. A workplace visit was performed if required. Pain, function and duration of sick leave due to LBP were primary outcomes. Results A reduction in bodily pain and improvement in physical function both measured by the 36-item short-form health survey questionnaire in favour of the intervention group was found. The change in pain score was found to be clinically relevant. The risk of sick leave for at least 8 weeks due to LBP was significantly reduced in the intervention group. Two secondary outcomes, Fear Avoidance Beliefs about physical activity and maximum oxygen uptake, supported compliance and adherence to the part of the intervention focusing on enhanced physical activity. Conclusion Two short counselling sessions by an OP combining advice on meeting workplace barriers and enhancing physical activity had a substantial effect on important prognostic factors for LBP patients with moderate to severe symptoms diagnosed in outpatient rheumatological clinics. Trial registration Current Controlled Trials ISRCTN13071157. [ABSTRACT FROM AUTHOR]

Background: Patient reported outcomes (PROs) are being used frequently in clinical practice. PROs often serve several purposes, such as increasing patient involvement, assessing health status, and monitoring and improving the quality-of-care at an aggregated level. However, the lack of representative PRO-data may have implications for all these purposes. This study aims to assess the association of non-administration of (not sending an electronic invite to PRO) and non-response to (not responding to PRO) electronically administered PROs with social inequality in a primary healthcare cancer rehabilitation setting. Furthermore, it examines whether the workflows surrounding PRO have an impact on non-administration and non-response., Methods: This is a cross sectional study using routinely collected data from electronic health records and registers including cancer survivors (CSs) over 18 years booked for an initial consultation in a primary healthcare cancer rehabilitation setting using PROs for systematic health status assessment. During the study period two different PRO platforms were used, each associated with different workflows. Non-administration and non-response rates were calculated for sociodemographic characteristics for each PRO platform. Crude and adjusted odds ratios were calculated using univariate and multivariate logistic regression., Results: In total, 1868 (platform 1) and 1446 (platform 2) CSCSs were booked for an initial consultation. Of these, 233 (12.5%) (platform 1) and 283 (19.6%) (platform 2) were not sent a PRO (non-administration). Among those who received a PRO, 157 (9.6%) on platform 1 and 140 (12.0%) on platform 2 did not respond (non-response). Non-administration of and non-response to PROs were significantly associated with lower socioeconomic status. Moreover, the workflows surrounding PROs seem to have an impact on non-inclusion in and non-response to PROs., Conclusions: Non-administration of and non-response to PROs in clinical practice is associated with determinants of social inequality. Clinical workflows and the PRO platforms used may potentially worsen this inequality. It is important to consider these implications when using PROs at both the individual and aggregated levels. A key aspect of implementing PROs in clinical practice is the ongoing focus on representativeness, including a focus on monitoring PRO administration and response., (© 2024. The Author(s).)

Background: Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care., Methods: A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme., Results: The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks., Conclusions: A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project's next phase., Trial Registration: Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19., (© 2024. The Author(s).)

Background and Purpose: There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs., Material and Methods: This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions 'what concerns you the most?' and 'what matters to you?'  Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease., Interpretation: CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs' challenges.

Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council's framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme's description will guide forthcoming evaluations of its impact.

Objective: To explore health-care use in the 12 months preceding a diagnosis of RA in Denmark., Methods: We conducted a population-based cohort study using data from national registries. Every patient diagnosed with RA in 2014-18 was matched to 10 reference individuals without RA from the Danish background population. Health-care use was defined as contacts to general practitioners, contacts to private practicing physiotherapists, and X-rays of hands and/or feet performed in primary or secondary care. We estimated the monthly contact rates for patients and references in the 12 months preceding the diagnosis, and we compared incidence rates for health-care use in each month between the two groups while adjusting for sociodemographic characteristics and comorbidity., Results: We included 7427 patients with RA and 74 270 references. Patients with RA had increasing contact rates with general practitioners and physiotherapists from 6 to 8 months before the diagnosis. Compared with references, women with RA had statistically significantly more contacts to general practitioners and physiotherapists during all 12 months. A similar contact pattern was seen in men, albeit less distinct. The number of X-rays increased slightly from 8 months before the diagnosis, with a steep increase in the last 3 months., Conclusion: Increased contacts to general practitioners and physiotherapists were seen in all 12 months preceding the RA diagnosis, intensifying in the last 6 to 8 months. Imaging increased from 3 months before the diagnosis. This indicates an opportunity to expedite referral to specialist care and ensure earlier diagnosis of RA., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: A systematically and transparently prepared research priority-setting process within a specific scientific area is essential in order to develop a comprehensive and progressive evidence-based approach that will have a substantial societal impact on the site of interest. On the basis of two consensus workshops, the authors suggest the following methods for all such processes: use of experts, stakeholder involvement, literature review, and ranking., Objectives: The identification, categorisation, and discussion of methods for preparing a research prioritisation process., Methods: Eligibility criteria: Evidence synthesis includes original studies presenting a research prioritisation process and which listed the methods used to create a research prioritisation process. Only evidence syntheses related to health research were included., Data Sources: We searched the following electronic databases, without limiting by date or language: MEDLINE Ovid, Embase Ovid, Epistemonikos, and CINAHL EBSCO., Charting Methods: The methods used were mapped and broken down into different elements, and the use of the elements was determined. To support the mapping, (A) all of the elements were collapsed into unique categories, and (B) four essential categories were selected as crucial to a successful research prioritisation process., Results: Twelve evidence syntheses were identified, including 416 original studies. The identification and categorisation of methods used resulted in 13 unique categories of methods used to prepare a research agenda., Conclusion: None of the identified categories was used in all of the original studies. Surprisingly, all four of the essential categories were used in only one of the 416 original studies identified. There is seemingly no international consensus on which methods to use when preparing a research prioritisation process., Protocol Registration: The protocol was registered in Open Science Framework ( https://osf.io/dygz8/ )., (© 2022. The Author(s).)

The International Classification of Functioning Disability and Health (ICF) was approved in 2001 and, since then, several studies reported the increased interest about its use in different sectors. A recent overview that summarizes its applications is lacking. This study aims to provide an updated overview about 20 years of ICF application through an international online questionnaire, developed by the byline authors, and sent to each World Health Organization Collaborating Centers of the Family of International Classifications (WHO-FIC CCs). Data was collected during October 2020 and December 2021 and descriptive content analyses were used to report main results. Results show how, in most of the respondent countries represented by WHO-FIC CCs, ICF was mainly used in clinical practice, policy development and social policy, and in education areas. Despite its applications in different sectors, ICF use is not mandatory in most countries but, where used, it provides a biopsychosocial framework for policy development in health, functioning and disability. The study provides information about the needs related to ICF applications, that can be useful to organize targeted intervention plans. Furthermore, this survey methodology can be re-proposed periodically to monitor the use of the ICF in the future.

Background: Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy "Learning and Coping" (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA)., Method: A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed., Result: Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05)., Conclusion: This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes., (© 2022. The Author(s).)

Aim: The benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without., Methods: Five databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis., Results: A total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: - 0.15 (95% CI: - 0.24 to - 0.06); SMD at the ≥ 12-month follow-up: - 0.16 (95% CI: - 0.23 to - 0.10, four studies))., Conclusion: The benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes., (© 2022. The Author(s).)

Objectives: High socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR., Design: A population-based, follow-up study., Setting: Hospitals and primary healthcare centres in the Central Denmark Region., Participant: Patients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018)., Variables: Four SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting., Statistical Methods: The associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity., Results: Overall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout)., Conclusions: This study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To understand healthcare providers' experiences with video recording of patient consultations., Background: Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development., Methods: A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens., Findings: Three themes were identified reflecting healthcare providers' experiences with video recording of patient consultations: 'Concerns of compromising primary work tasks', 'Exposing professional and personal skills' and 'A new learning dimension'. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations., Conclusion: Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.

Background: Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD., Methods: We conducted a combined survey- and register-based study in a randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis., Results: The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32-85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1-24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5-70.6) among women aged ≤ 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready., Conclusion: A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components., (© 2022. The Author(s).)

Background: Cardiac rehabilitation (CR) and medical treatment are integrated parts of the intervention for cardiac patients and are a class 1A recommendation. However, CR dropout is reported to be relatively high and little is known about the reasons for CR dropout in primary health settings., Aim: This study investigates causes for CR dropout through a qualitative audit of medical charts among patients with ischaemic heart disease., Methods: This was a qualitative retrospective audit of patient's medical charts. Patients who dropped out from CR between 1 January and 31 December 2018 in five primary health settings were included. Local patient charts provided information related to causes and formed the basis of the analysis. Data were analyzed using thematic analysis., Results: A total of 690 patients were referred for and commenced CR and 199 (29%) dropped out. Twenty-five (12.6%) patients finished CR but were excluded due to standards of ≥180 days between CR meetings, leaving 118 patients included. Four themes as causes for patient's dropout were identified: (1) CR-programmes, (2) logistical, (3) intrapersonal and (4) clinical factors., Conclusion: This study identified new focus areas to which health professionals may attend in reducing drop-out from CR. Organisation of CR, challenges with combining labor market attachment and CR, focus on patient education and comorbidities. The results underline the importance of health professionals emphasizing the benefits of CR and explains that CR enhances long-term labor market attachment. Furthermore, health professionals should encourage participation in patient education and adapt exercise to the individual patient's potential., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ravn, Uhd, Svendsen, Ørtenblad and Maribo.)

Background: Cardiac rehabilitation (CR) is a class 1A recommendation and an integrated part of standard treatment for patients with cardiac disease. In Denmark, CR adheres to European guidelines, it is group-based and partly conducted in primary health settings. Despite high evidence for the benefits of CR, it remains underutilized. How to facilitate CR adherence in primary health settings is poorly understood., Aim: This study explores health professional's perspectives on how to facilitate CR adherence for patients with ischaemic heart disease in primary health settings., Methods: Data were collected through focus group discussions. Respondents were health professionals specialized in and working with CR in primary health settings. Data were analyzed using thematic analysis., Results: Eleven health professionals participated in two focus group discussions. Five themes emerged as facilitators of CR; (1) placing the person at the center, (2) coherent programme, (3) flow of information, (4) contextual factors, and (5) feeling of belonging., Conclusion: This study illuminates the complexity of facilitating adherence to CR in primary health settings and provides ways in which health professionals may facilitate adherence. Placing the person at the center is pivotal and may be done by adapting CR offers to patients' social context, culture and life circumstances and ensuring a feeling of belonging. The rhetoric related to CR should be positive and throughout the entire course of treatment health professionals should possess a generic and collective approach to and view of CR. Perceiving these elements as potential facilitators is of vital importance and addressing them may facilitate adherence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ravn, Uhd, Svendsen, Ørtenblad and Maribo.)

Objectives: To investigate the association between clinical/sociodemographic factors and labor market attachment, and to estimate employment probability 2 years after colorectal cancer (CRC) surgery., Background: A rising prevalence of younger CRC survivors commands a stronger focus on labor market attachment. The association between clinical factors like type of surgery and CRC survivors' labor market attachment remains poorly investigated., Methods: National registries provided information on employment status and clinical/sociodemographic variables for all 20- to 60-year-old CRC patients without previous cancer diagnosed in Denmark from 2001 to 2014, undergoing surgery and being attached to the labor market. Associations between clinical/sociodemographic factors and labor market attachment were investigated in multiple logistic regression analyses., Results: A total of 5755 CRC patients were included. Two years after surgery, 59.7% were working. Factors significantly associated with a higher probability of working were being in the 46 to 50 years age group, male gender, higher educational level, no comorbidity, working at the time of diagnosis, lower Union for International Cancer Control stage, and undergoing surgery in the most recent of four time-periods. Two years after undergoing surgery, the probability of working was significantly higher for left-sided than for right-sided colon resections, higher for low anterior resection (LAR)/high tumor than for LAR/low tumor, and higher for abdominoperineal resection than for Hartmann's procedure. Of the 4798 (86.8%) patients alive 2 years after surgery, 68.8% were working, 7.8% had retired, whereas 23.4% were on temporary benefits, sick leave, or disability pension., Conclusions: Clinical/sociodemographic factors were associated with the probability of working 2 years after surgery. This knowledge can be used to inform patients and target interventions towards patients with low post-CRC probability of working., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Multiple sclerosis (MS) is the most common cause of non-traumatic disability in people aged 10-65 years. Evidence exists for the effectiveness of multidisciplinary rehabilitation and exercise. However, the effectiveness of other rehabilitation approaches in MS needs further evaluation. The purposes were to systematically synthesise and evaluate knowledge on effectiveness of rehabilitation interventions and determinants for participation among persons with MS (pwMS) to inform clinical guidelines on rehabilitation. Joanna Briggs Institute methodology was used. PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for reviews, systematic reviews, meta-analyses, and meta-syntheses published 2009-2019. All types of rehabilitation interventions provided to pwMS at any time and in all settings were eligible. Two reviewers independently screened and extracted data. The most recently published reviews on mixed and specific modalities were included. The findings were reported in a narrative summary and a mixed-method analysis. Among 108 eligible reviews, 6 qualitative or mixed-method reviews and 66 quantitative were included (total pwMS>90,000). This overview provides solid evidence for effectiveness of a spectrum of modalities. Among the modalities, there was strong evidence for the effectiveness of multidisciplinary, cognitive and exercise approaches, physiotherapy, and occupational therapy including full body training on functioning and participation outcomes. Employment significantly influenced quality of life; thus, vocational rehabilitation should be initiated early. The healthcare professionals should identify personal factors including relations and coping, and the rehabilitation process should involve partners or close family. The mixed-method analysis revealed insufficient consensus between the perspectives of pwMS on their rehabilitation and reported effects indicating that further research should target the experiences of pwMS. Further, results showed that rehabilitation should be patient-centred, focus on the complexity of needs, and be organised and performed by an experienced multidisciplinary team. Evidence-based rehabilitation should be initiated early after pwMS are diagnosed and follow international guidelines. DATABASE REGISTRATION: PROSPERO ID: CRD42020152422., (Copyright © 2021 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Patient-centred care has received increased attention in recent years. Patient-Reported Outcomes (PROs) and shared decision-making are key components of Patient-Centred care. Low back pain (LBP) is a complex symptom affected by multiple, interacting factors. Therefore, evidence strongly recommend a biopsychosocial and patient-centred approach in the assessment and management. The International Classification of Functioning, Disability and Health (ICF) provide a biopsychosocial model for describing functioning and disability. ICF is widely acknowledged, but implementation into clinical practice is lacking. To support the use of a biopsychosocial and patient-centred approach in daily clinical practice among patients with LBP we developed a practice-friendly tool based on ICF; the LBP assessment tool. Objective: To compare an ICF-based assessment facilitated by the LBP assessment tool with standard care in terms of the use of PROs and shared decision-making in order to promote patient-centred care in patients with LBP. Methods: A non-randomized controlled design was used. Eligible patients were allocated to one of two groups: the ICF group, assessed with the LBP assessment tool or the control group, assessed with a conventional LBP assessment. Primary outcome includes use of PROs. Secondary outcomes include use of a graphical overview displaying the patient profile and shared decision-making. A patient evaluation questionnaire was used to collect data. Results: Seven hundred ten patients were assessed for eligibility of whom 531 were allocated to the ICF group ( n = 299) or the control group ( n = 232). A significantly higher use of PRO data ( p < 0.00) and the patient profile ( p < 0.00) was reported in favor of the ICF group. Patients in the ICF group also experienced being more involved in decision-making ( p = 0.01). Conclusions: This study showed that a functioning assessment, by means of the LBP assessment tool, increased use of PROs and shared decision-making when compared to a conventional LBP assessment. Additionally, this study demonstrated that routine use of ICF-based PRO data and shared decision-making promoted patient-centred care in patients with LBP. The LBP assessment tool may be a strong candidate for a user-friendly ICF-based tool with the potential to support health professionals in a shift toward a biopsychosocial and patient-centred approach to patients with LBP., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ibsen, Maribo, Nielsen, Hørder and Schiøttz-Christensen.)

COVID-19 can lead to a long-term loss of functioning, which may affect activities and participation in daily living in various ways. The extent and characteristics of post-COVID-19 persistent symptoms are currently being studied extensively worldwide. The purpose of this exploratory study is to explore functioning and rehabilitation needs among persons with self-reported disability following COVID-19. This mixed methods study is based on data from patient-reported outcome measures (PRO), tests of body functions, visual drawings and focus groups among persons with self-reported disability after having suffered from COVID-19. PRO covered quality of life, activity and participation. Tests of body functions targeted strength and endurance. Focus groups and visual drawings elaborated on how post COVID-19 persistent symptoms affected functioning, activities and daily living. Data was collected in August and September 2020. The study sample consisted of 11 women, nine men, aged 35-79 years. Self-reported PRO data showed low quality of life and disability among the participants primarily related to fatigue, energy and drive, breathing and concentration. Tests of body functions showed low strength in lower extremities but otherwise no striking limitations on a group level. Analysis of the focus groups generated the following four themes: (1) Persistent symptoms , particularly in regards to concentration, memory, lack of energy, fatigue and headaches. (2) Balancing activities in daily living with fluctuating symptoms. (3) Uncertainty and Powerlessness , which included a need for directional guidance in order to regain functioning and unmet needs regarding further clinical assessment of persistent symptoms, referral to rehabilitation and returning to work. (4) Hope associated with the experiences of recovery - and for the future. This study highlights that persons with persistent symptoms after COVID-19 may experience a range of limitations in their daily living. This points toward a need for individual assessment and guidance to tailor relevant rehabilitation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Backmann, Maribo, Zwisler, Davidsen and Rottmann.)

Introduction: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is designed to measure functioning and disability in six domains. It is included in the International Classification of Diseases 11th revision (ICD-11). The objective of the study was to examine the construct validity of WHODAS 2.0 and describe its clinical utility for the assessment of functioning and disability among older patients discharged from emergency departments (EDs). Material and Methods: This cross-sectional study is based on data from 129 older patients. Patients completed the 36-item version of WHODAS 2.0 together with the Barthel-20, the Assessment of Motor and Process Skills (AMPS), Timed Up and Go (TUG), and the 30-Second Chair Stand Test (30 s-CST). Construct validity was examined through hypothesis testing by correlating the WHODAS with the other instruments and specifically the mobility domain in WHODAS 2.0 with the TUG and 30 s-CST tests. The clinical utility of WHODAS 2.0 was explored through floor/ceiling effect and missing item responses. Results: WHODAS 2.0 correlated fair with Barthel-20 ( r = -0.49), AMPS process skills ( r = -0.26) and TUG ( r =0.30) and correlated moderate with AMPS motor skills ( r = -0.58) and 30s-CST ( r = -0.52). The WHODAS 2.0 mobility domain correlated fair with TUG ( r = 0.33) and moderate with 30s-CST ( r = -0.60). Four domains demonstrated floor effect: D1 "Cognition," D3 "Self-care," D4 "Getting along," and D5 "Household." Ceiling effect was not identified. The highest proportion of missing item responses were present for Item 3.4 (Staying by yourself for a few days), Item 4.4 (Making new friends), and Item 4.5 (Sexual activities). Conclusion: WHODAS 2.0 had fair-to-moderate correlations with Barthel-20, AMPS, TUG, and 30s-CST and provides additional aspects of disability compared with commonly used instruments. However, the clinical utility of WHODAS 2.0 applied to older patients discharged from EDs poses some challenges due to floor effect and missing item responses. Accordingly, patient and health professional perspectives need further investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nielsen, Oestergaard, Kirkegaard and Maribo.)

Study Design: Systematic review of qualitative studies., Objective: To synthesise qualitative research exploring the experiences and perspectives of persons with spinal cord injury (SCI), relatives and health professionals concerning goal setting in SCI rehabilitation., Methods: Five electronic databases were searched. A search strategy was constructed with key concepts identified using PICo (Population, phenomena of Interest and Context). Peer reviewed studies complying with the inclusion criteria were selected. Interpretive Description methodology guided analysis and synthesis of the findings., Results: The search yielded 427 records. Of 12 full text studies assessed for eligibility, four were included describing goal setting in SCI rehabilitation from the perspective of persons with SCI and health professionals. Persons with SCI described a need for goal setting to be related to their everyday life, whereas the health professionals tended to use the hospital setting as their point of reference. Persons with SCI emphasised the importance of being self-directed and taking an active role in goal setting and rehabilitation. No studies presented the perspective of relatives., Conclusions: This review illuminates the divergence in the understanding of goal setting between persons with SCI and health professionals. Goal setting in SCI rehabilitation often directly reflects physical functioning goals set by the health professionals, which does not prepare persons with SCI for everyday life and emotional issues. There is lack of focus on goals addressing psychosocial components such as family issues and change of roles. A shared process with goal setting relevant to persons with SCI and their everyday life is needed.

Background: Readmission is a serious and adverse event for elderly patients. Despite efforts, predicting the risk of readmission remains imprecise. The objective of this study is to examine if performance-based tests of daily activities can identify elderly patients at risk of readmission within 26 weeks after discharge from a short-stay unit in the emergency department., Methods: The current study is an observational study based on data from 144 elderly patients included in a previous non-randomised controlled trial. Before discharge, patients were assessed for limitations in performing daily activities using three performance-based tests with predetermined cut-off values: the Assessment of Motor and Process Skills, Timed Up and Go and the 30s-Chair Stand Test. Outcome was risk of readmission within 26 weeks after discharge., Results: Limitations in performing daily activities were associated with risk of readmission as measured by the Assessment of Motor and Process Skills motor scale (Crude OR = 4.38 [1.36; 14.12]), (Adjusted OR = 4.17 [1.18; 14.75]) and the 30s-Chair Stand Test (Adjusted OR = 3.36 [1.42; 7.93]). No significant associations were found in regards to other measures., Conclusion: The Assessment of Motor and Process Skills motor scale and the age, gender and comorbidity adjusted 30s-Chair Stand Test can identify elderly patients at increased risk of readmission after discharge from the emergency department. The results were limited by one-third of the patients did not perform the Assessment of Motor and Process Skills and the association between 30s-Chair Stand Test and risk of readmission were only positive when adjusted for age, gender and comorbidity.

Background: There seems to be inequity within cancer survivorship care in primary care settings related to gender, shorter education, and early poor health, but there is uncertainty regarding the character of the needs in hospital and in primary care settings and whether there is inequity regarding meeting these needs. This study aims to describe potential differences in needs among patients in hospital and in primary care settings, and to assess the need for survivorship care and rehabilitation in patients with cancer in relation to socioeconomic status., Methods: In a cross-sectional study including patients in hospital (n = 89) and primary care settings (n = 99), information from needs assessments was linked with population-based data on socioeconomic status via unique personal identification numbers. The association between socioeconomic status and stated needs was analyzed separately for patients in hospital and primary care settings, with adjustment for age and gender., Results: A total of 90% patients expressed one or more needs in the physical area, 51% in the emotional area, and 40% in the practical area. Patients in primary care expressed more needs than patients in hospital. Men expressed more needs than women in primary care (adjusted odds ratio (OR) (95% confidence interval (CI)): 2.66 (1.04 - 6.79)). The results indicate that higher socioeconomic status is associated with fewer stated needs., Conclusions: This study suggests that the association between gender and stated needs may depend on healthcare setting and confirms that higher socioeconomic status in relation to civil status, educational level, income, and labor market status is associated with fewer stated needs., Competing Interests: The authors all declare that they have no competing interest and no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

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 .

Introduction: Lumbar spinal stenosis is a common cause of low back and leg pain in the elderly and affects both physical activity and quality of life. First-line treatments are non-surgical options but if unsuccessful, surgery is advocated. The literature is not clear as to the outcome of surgery compared with non-surgical treatment, and the optimal time for surgery is not explicit. This observational study is designed to investigate the course of treatment, compare effectiveness of surgical and non-surgical management in patients with lumbar spinal stenosis and identify prognostic factors for outcome in the context of current clinical practice., Materials and Analysis: Prospectively registered data on treatment, outcome and patient characteristics are collected from nationwide registers on health and social issues, a clinical registry of people with chronic back pain and hospital medical records. Primary outcome is change in physical function measured by the Zurich Claudication Questionnaire. Secondary outcomes are changes in symptom severity, pain-related function, health-related quality of life and general self-efficacy. Outcomes are assessed at baseline and 6 and 12 months. Outcomes at 12 months will be compared for patients who undergo surgery for lumbar spinal stenosis and patients managed non-surgically, using different analytical approaches. Prespecified prognostic factors of interest at baseline include treatment allocation, back and leg pain intensity, comorbidity, duration of symptoms, pretreatment function, self-rated health, income, general self-efficacy and MRI-graded severity of central stenosis., Ethics and Dissemination: The study has been evaluated by the Regional Committees on Health Research for Southern Denmark (S-20172000-200) and notified to the Danish Data Protection Agency (18/22336). All participants provide consent. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences according to the Strengthening the Reporting of Observational Studies in Epidemiology and Prognosis Research Strategy statements. Potential sources of bias will be addressed using Risk of Bias in Non-randomised Studies of Interventions., Trial Registration Number: NCT03548441; Pre-results., Competing Interests: Competing interests: TM and BS-C have nothing to disclose. HAB reports unrestricted grants from the University of Southern Denmark, the Region of Southern Denmark, the University College of Southern Denmark and non-financial support from Spine Centre of Southern Denmark, during the conduct of the study. RC reports non-financial support from Board membership, grants from Consultancy (AbbVie, Amgen, Axellus A/S, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Eli Lilly, Hospira, MSD, Norpharma, Novartis, Orkla Health, Pfizer, Roche, Sobi, Takeda), personal fees from Employment (Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark), non-financial support from Expert testimony, grants from grants/grants pending (Axellus A/S, AbbVie, Cambridge Weight Plan, Janssen, MSD, Mundipharma, Novartis and Roche), grants from payment for lectures including service on speakers bureaus (Abbott, Amgen, Axellus, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb, Cambridge Weight Plan, Ipsen, Janssen, Laboratoires Expanscience, MSD, Mundipharma, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus, Sobi and Wyeth), grants from payment for manuscript preparation (Axellus, Bristol-Myers Squibb and Cambridge Weight Plan, Aleris-Hamlet (via Norpharma)), non-financial support from Patents (planned, pending or issued), non-financial support from Royalties, grants from payment for development of educational presentations (Bristol-Myers Squibb, MSD, Pfizer), non-financial support from stock/stock options, grants from travel/accommodations/meeting expenses unrelated to activities listed (Abbott, AbbVie, Axellus, Biogen, Bristol-Myers Squibb, Cambridge Weight Plan, Celgene, Laboratoires Expanscience, Norpharma, Novartis, Pfizer, Roche, Rottapharm-Madaus and Wyeth), non-financial support from Other (err on the side of full disclosure), outside the submitted work and is involved in many healthcare initiatives and research that could benefit from wide uptake of this publication (including Cochrane, OMERACT, IDEOM, RADS and the GRADE Working Group). Musculoskeletal Statistics Unit, The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. The Parker Institute is supported by a core grant from the Oak Foundation; The Oak Foundation is a group of philanthropic organisations that, since its establishment in 1983, has given grants to not-for-profit organisations around the world., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The aim of this study was to examine the use of standardised instruments to describe functioning in stroke patients in the transition from hospital to home-based rehabilitation., Methods: Questionnaires were sent to 26 hospitals discharging patients with stroke and 52 primary care health services treating stroke patients at home, within an area with a population of three million. Questionnaires were targeted at healthcare professionals who typically take part in home-based stroke rehabilitation asking: "Which instruments, outcome measures or tests are commonly used to describe functioning in persons with stroke?" Instruments routinely used to assess functioning were reported., Results: 85% of the hospitals and 90% of the primary care services returned the questionnaire. 95% of the hospitals and 96% of the primary care services used standardised instruments. Hospitals reported 61 standardised instruments and primary care services reported 60 standardised instruments. A total of 89 standardised instruments were reported. No instrument was used in every hospital or primary care service., Conclusions: The vast majority of services use standardised instruments, but there is absolutely no consensus on which instruments to use. There is a strong need for recommendations on which instruments should be used in stroke rehabilitation in the transition from hospital-based to home-based rehabilitation., Funding: This study was supported by a grant from the Management Forum for Collaboration between Aarhus University and the Central Denmark Region, Denmark. None of the authors have any personal financial interests in the work undertaken or the findings reported., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Background: Limitations in performing daily activities and a incoherent discharge are risk factors for readmission of elderly patients after discharge from the emergency department. This paper describes the development and design of a complex intervention whose aim was to reduce the risk of readmission of elderly patients discharged from the emergency department., Methods: The intervention was described using the Intervention Mapping approach. In step 1, a needs assessment was conducted to analyse causes of readmission. In steps 2 and 3, expected improvements in terms of intervention outcomes, performance objectives and change objectives were specified and linked to selected theory- and evidence-based methods. In step 4, the specific intervention components were developed; and in step 5, an implementation plan was described. Finally, in step 6, a plan for evaluating the effectiveness of the intervention was described. The intervention was informed by input from a literature search, informal interviews and an expert steering group., Results: A three-phased theory- and evidence-based intervention was developed. The intervention consisted of 1) assessment of performance of daily activities, 2) defining a rehabilitation plan and 3) a follow-up home visit the day after discharge with focus on enhancing the patients' performance of daily activities., Conclusion: The intervention mapping protocol was found to be a useful method to describe and systemize this theory- and evidence-based intervention.

Objective: To test the effect of patient-reported outcome (PRO)-based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses., Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis., Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were -0.10 (90% confidence interval [90% CI] -0.30, 0.13) and -0.19 (90% CI -0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare., Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses., (© 2017, American College of Rheumatology.)

Background: Identifying older adults with reduced physical performance at the time of hospital admission can significantly affect patient management and trajectory. For example, such patients could receive targeted hospital interventions such as routine mobilisation. Furthermore, at the time of discharge, health systems could offer these patients additional therapy to maintain or improve health and prevent institutionalisation or readmission. The principle aim of this study was to identify predictors for persisting, reduced physical performance in older adults following acute hospitalisation., Methods: This was a prospective cohort study that enrolled 117 medical patients, ages 65 or older, who were admitted to a short-stay unit in a Danish emergency department. Patients were included in the study if at the time of admission they performed ≤8 repetitions in the 30-s Chair-Stand Test (30s-CST). The primary outcome measure was the number of 30s-CST repetitions (≤ 8 or >8) performed at the time of follow-up, 34 days after admission. Potential predictors within the first 48 h of admission included: age, gender, ability to climb stairs and walk 400 m, difficulties with activities of daily living before admission, falls, physical activity level, self-rated health, use of a walking aid before admission, number of prescribed medications, 30s-CST, and the De Morton Mobility Index., Results: A total of 78 (67%) patients improved in physical performance in the interval between admission and follow-up assessment, but 76 patients (65%) had persistent reduced physical performance when compared to their baseline (30s-CST ≤ 8). The number of potential predictors was reduced in order to create a simplified prediction model based on 4 variables, namely the use of a walking aid before hospitalisation (score = 1.5), a 30s-CST ≤ 5 (1.8), age > 85 (0.1), and female gender (0.6). A score > 1.8 identified 78% of the older adults who continued to have reduced physical performance following acute hospitalisation., Conclusion: At the time of admission, the variables of age, gender, walking aid use, and a 30s-CST score ≤ 5 enabled clinicians to identify 78% of older adults who had persisting reduced physical performance following acute hospitalisation., Trial Registration: ClinicalTrials.gov Identifier: NCT02474277 . (12.10.2014).

Background: Formalized and systematic assessment of survivorship care and rehabilitation needs is prerequisite for ensuring cancer patients sufficient help and support through their cancer trajectory. Patients are often uncertain as to how to express and address their survivorship care and rehabilitation needs, and little is known about specific, unmet needs and the plans necessary to meet them. There is a call for both ensuring survivorship care and rehabilitation for cancer patients in need and further for documenting the specific needs related to the cancer disease and its treatment. Thus the aim of this study was to describe specific survivorship care and rehabilitation needs and plans as stated by patients with cancer at hospitals when diagnosed and when primary care survivorship care and rehabilitation begins., Methods: Needs assessment forms from cancer patients at two hospitals and two primary care settings were analyzed. The forms included stated needs and survivorship care and rehabilitation plans. All data were categorized using the International Classification of Functioning, Disability and Health (ICF)., Results: Eighty-nine patients at hospitals and 99 in primary care, stated their needs. Around 50% of the patients completed a survivorship care and rehabilitation plan. In total, 666 (mean 7.5) needs were stated by hospital patients and 836 (mean 8.0) by those in primary care. The needs stated were primarily within the ICF component "body functions and structure", and the most frequent needs were (hospitals/primary care) fatigue (57%/67%), reduced muscle strength (55%/67%) and being worried (37%/36%)., Conclusions: The results underpin an urgent need for a systematic procedure to assess needs in clinical practice where cancer patients are being left without survivorship care and rehabilitation needs assessment. Gaining knowledge on needs assessment and the detailed description of needs and plans can facilitate targeted interventions. The findings indicate an urgent need to change the practice culture to be systematic in addressing and identifying survivorship care needs among patients with cancer. Further the findings call for considering the development of a new needs assessment form with involvement of both patients and healthcare professionals., Competing Interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED)., Methods: Participants were 61 patients aged 65 years and above admitted to an ED. The self-reported measure used was the Barthel-20; the performance-based measures were Timed Up and Go (TUG); 30s-Chair Stand Test (30s-CST) and Assessment of Motor and Process Skills (AMPS) with the two scales; motor and process. Correlation analyses were conducted to examine the relationships between the self-reported and performance-based measures of functional ability., Results: The correlation between the Barthel-20 and the TUG was moderate (r = -0.64). The correlation between the Barthel-20 and the AMPS motor was also moderate (r = 0.53). The correlation between the Barthel-20 and the 30s-CST was fair (r = 0.45). The correlation between Barthel-20 and the AMPS process was non-significant. The results were affected by high ceiling effect (Barthel-20)., Conclusion: Self-reported and performance-based measures seem to assess different aspects of functional ability. Thus, the two methods provide different information, and this highlight the importance of supplementing self-reported measures with performance-based measures when assessing functional ability in elderly patients.

Background: Assessing primary rehabilitation needs in patients with acquired brain injury is a challenge due to case complexity and the heterogeneity of symptoms after brain injury. The Rehabilitation Complexity Scale-Extended (RCS-E) is an instrument used in assessment of rehabilitation complexity in patients with severe brain injury. The aim of the present study was to translate and test the face validity of the RCS-E as a referral tool for primary rehabilitation. Face validity was tested in a sample of patients with acquired brain injury., Methods: Ten clinicians and records from 299 patients with acquired brain injury were used in the translation, cross-cultural adaptation and face validation study of the RCS-E. RCS-E was translated into Danish by a standardized forward-backward translation by experts in the field. Face validity was assessed by a multi-professional team assessing 299 patients. The team was asked their opinion on whether the RCS-E presents a sufficient description of the patients., Results: The RCS-E was translated according to international guidelines and tested by health professionals; some adaptations were required due to linguistic problems and differences in the national health system structures. The patients in the study had a mean age of 63.9 years (SD 14.7); 61 % were male. We found an excellent face validity with a mean score of 8.2 (SD 0.34) assessed on a 0-10 scale., Conclusions: The RCS-E demonstrated to be a valid assessment of primary rehabilitation needs in patients with acquired brain injury. Excellent face validity indicates that the RCS-E is feasible for assessing primary rehabilitation needs and the present study suggests its applicability to the Danish health care system.

Objective: To investigate the efficacy of 4 weeks of preoperative and 4 weeks of postoperative progressive resistance training (PRT), compared to 4 weeks of postoperative PRT only on functional performance, muscle strength, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA)., Methods: In total, 59 patients were randomized to 4 weeks of preoperative PRT (intervention group) or to a group who lived as usual (control group). Both groups performed 4 weeks of PRT after TKA. At 6 weeks and 1 week before TKA, and at 1, 6, and 12 weeks after TKA, performance-based measures (30-second chair stand test [30sCST], timed-up-and-go [TUG], and walking tests), knee extensor and flexor muscle strength (dynamometry), patient-reported functional performance, health-related quality of life, and pain scores were evaluated., Results: When comparing the changes from baseline to the primary test point 6 weeks after TKA, a significant group difference in favor of the intervention group was found for the 30sCST (2.5 repetitions [95% confidence interval (95% CI) 0.9, 4.1] versus -1.1 repetitions [95% CI -2.8, 0.7]; P < 0.004), the TUG (-0.7 seconds [95% CI -1.6, 0.1] versus 0.8 seconds [95% CI -0.1, 1.7]; P = 0.015), normalized knee extensor muscle strength (-0.2 Nm/kg [95% CI -0.3, -0.1] versus -0.4 Nm/kg [95% CI -0.5, -0.3]; P = 0.002), and normalized knee flexor muscle strength (0.1 Nm/kg [95% CI 0.0, 0.2] versus 0.0 Nm/kg [95% CI -0.1, 0.1]; P = 0.016). No differences were found between groups on patient-reported outcomes., Conclusion: Supervised preoperative PRT is an efficacious and safe intervention for improving postoperative functional performance and muscle strength, but improvements in patient-reported outcomes were not detected., (© 2016, American College of Rheumatology.)

Background: Studies have shown a negative social gradient in the incidence of early retirement. To prevent undesired early retirement, there is a need for knowledge of specific predictors in addition to social factors with a limited potential for change. The main purpose of this study was to examine musculoskeletal complaints and working conditions as predictors of early retirement among Danish female cleaners., Methods: Using Cox regression with an adjustment for extraneous factors, we compared the risk of disability pension and retirement before the nominal retirement age (65 years) in an 11-year cohort study with registry-based follow-up of 1430 female cleaners and 579 shop assistants. In subsequent analyses of female cleaners, disability pension and voluntary early retirement were modeled according to work characteristics and upper extremity complaints., Results: The adjusted hazard rate (HR) for disability pension among cleaners compared to the control group was 2.27 (95% CI 1.58 to 3.28) and, for voluntary early retirement, 1.01 (95% CI 0.85 to 1.20). In the subset of cleaners, the predictors of disability pension were persistent shoulder pain HR: 1.98 (95% CI 1.47 to 2.67), elbow pain HR: 1.41 (95% CI 1.02 to 1.94) and symptoms of nerve entrapment of the hand HR: 1.58 (95% CI 1.14 to 2.20). Predictors of voluntary early retirement were persistent shoulder pain HR: 1.40 (95% CI 1.16 to 1.67) and floor mopping for more than 10 h per week HR: 1.20 (95% CI 1.03 to 1.40)., Conclusion: Cleaners have a twofold higher risk of disability pension compared to the control group. Risk factors for disability pension among cleaners were persistent shoulder and elbow pain together with symptoms of nerve entrapment of the hand. The findings of specific health related predictors of early retirement could be used in secondary prevention with targeted temporary reduced workload.

We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as "clinical and/or rehabilitation contexts" or "non-clinical contexts". One hundred seventy papers were included, of these 99 papers were from the categories "clinical and/or rehabilitation contexts" or "non-clinical contexts". Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories "clinical and/or rehabilitation contexts" and "non-clinical contexts". The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

Introduction: There is a need to establish a framework and exercise level for patients with early rheumatoid arthritis (RA). The aim of this study was to compare the effect of a partly supervised and a self-administered exercise programme for patients with early RA., Methods: A total of 51 patients with early (≤ 5 years) RA were randomised to either a six-week supervised, progressive, high-intensity exercise programme followed by a six-week self-administered exercise programme or a 12-week self-administered exercise programme., Results: A total of 36 patients completed the study. Following the 12 weeks of exercises, patients in the two groups had improved both their muscle strength and their physical fitness. There was a significant difference in Disease Activity Score in 28 joints calculated with C-reactive protein between the two exercise groups, but no significant differences in physical fitness, pain perception, Health Assessment Questionnaire, Short Form 36 health survey questionnaire, Fear-Avoidance Beliefs Questionnaire, or in muscle strength, except from a significant difference in trunk extensors. The dropout was 40% in the supervised group versus 20% in the self-administered group., Conclusion: A progressive, high-intensity exercise programme is feasible for patients with early RA, although we observed an elevated number of dropouts for reasons not related to the intervention. The partly supervised exercise programme with follow-up after 12 weeks does not seem to be more effective than the self-administered exercise programme., Funding: none., Trial Registration: The trial was registered with www.clinicaltrials.gov (NCT01553305).

Introduction: Altered postural control has been observed in low back pain (LBP) patients. They seem to be more dependent on vision when standing. The objective of the study was to determine concurrent and predictive validity of measures of postural stability in LBP patients., Materials and Methods: Centre of Pressure (CoP) measurements were tested against pain, fear of pain, and physical function. Velocity, anterior-posterior displacement, and the Romberg Ratio obtained on a portable force platform were used as measures of postural stability., Results: Baseline and 12-week follow-up results of 97 LBP patients were evaluated. The correlations between CoP measurements and pain, fear of pain, and physical function were poor. There were no significant differences in CoP measurements between patients with no change or deterioration and patients with improvement in pain and back-specific function., Conclusion: This first study of concurrent and predictive validity of postural balance in LBP patients revealed no association between CoP measures and pain, fear of pain, and physical function.