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Objective: The Barthel index (BI) is a widely used observer-based instrument to measure physical function. Our objective is to assess the structural validity, reliability, and interpretability of the BI in the geriatric rehabilitation setting., Design: Two studies were performed. First, a prospective cohort study was performed in which the attending nurses completed the BI at admittance and discharge (n = 207). At discharge, patients rated their change in physical function on a 5-point Likert rating scale. To assess the internal structure of the BI, a confirmatory factor analysis was performed. Unidimensionality was defined by comparative fit index and Tucker-Lewis index of >0.95, and root mean square error of approximation of <0.06. To evaluate interpretability, floor/ceiling effects and the minimal important change (MIC) were assessed. Predictive modeling was used to calculate the MIC. The MIC was defined as going home and minimal patient-reported improvement defined as slightly or much improved physical function, which served as anchors to obtain a clinical- and patient-based MIC. A second group of 37 geriatric rehabilitation patients were repeatedly assessed by 2 attending nurses to assess reliability of the BI. The intraclass correlation coefficient, standard error of measurement, and smallest detectable change were calculated., Setting and Participants: Patients receiving inpatient geriatric rehabilitation admitted to 11 Dutch nursing homes (n = 244)., Results: Confirmatory factor analysis showed partly acceptable fit of a unidimensional model (comparative fit index 0.96, Tucker-Lewis index 0.95, and root mean square error of approximation 0.12). The clinical-based MIC was 3.1 [95% confidence interval (CI) 2.0-4.2] and the patient-based MIC was 3.6 (95% CI 2.8-4.3). The intraclass correlation coefficient was 0.96 (95% CI 0.93-0.98). The standard error of measurement and smallest detectable change were 1.1 and 3.0 points, respectively., Conclusions/implications: The structural validity, reliability, and interpretability of the BI are considered sufficient for measuring and interpreting changes in physical function of geriatric rehabilitation patients., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background and Objective: Musculoskeletal, neurological, and traumatic injuries are a considerably increasing problem. There is a lack of studies evaluating the results of outpatient rehabilitative treatment of patients with the abovementioned diseases. The aim of this study was to determine the effectiveness of daily outpatient multidisciplinary rehabilitation., Materials and Methods: This observational study enrolled 223 adult people undergoing outpatient rehabilitation performed in a municipality outpatient clinic during 14 days. The functional assessment of disability was performed by using the Barthel index (BI), functional performance was estimated by the modified Keitel functional test (MKFT), and pain perception was evaluated by the visual analogue scale (VAS). The mean scores of the tests were compared before and after outpatient multidisciplinary rehabilitation., Results: Significantly reduced disability and pain perception as well as increased functional performance were documented after outpatient rehabilitation. The mean scores of BI, MKFT, and VAS before and after rehabilitation did not differ significantly among patients ranked to each cluster of diseases. Increased functional performance of patients had a moderate-to-weak association with decreased disability and pain perception. The positive changes in health status considering disability, functional performance, and pain perception were documented after 14-day rehabilitation., Conclusions: Multidisciplinary outpatient rehabilitation can be considered as effective treatment. However, it is necessary to implement specific, well-adapted consuming assessment instruments in order to evaluate the outcomes of daily multidisciplinary outpatient rehabilitative treatment., (Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Good data quality is vital for personalising plans in rehabilitation. Machine learning (ML) improves prognostics but integrating it with Multiple Imputation (MImp) for dealing missingness is an unexplored field. This work aims to provide post-stroke ambulation prognosis, integrating MImp with ML, and identify the prognostic influential factors. Stroke survivors in intensive rehabilitation were enrolled. Data on demographics, events, clinical, physiotherapy, and psycho-social assessment were collected. An independent ambulation at discharge, using the Functional Ambulation Category scale, was the outcome. After handling missingness using MImp, ML models were optimised, cross-validated, and tested. Interpretability techniques analysed predictor contributions. Pre-MImp, the dataset included 54.1% women, 79.2% ischaemic patients, median age 80.0 (interquartile range: 15.0). Post-MImp, 368 non-ambulatory patients on 10 imputed datasets were used for training, 80 for testing. The random forest (the validation best-performing algorithm) obtained 75.5% aggregated balanced accuracy on the test set. The main predictors included modified Barthel index, Fugl-Meyer assessment/motricity index, short physical performance battery, age, Charlson comorbidity index/cumulative illness rating scale, and trunk control test. This is among the first studies applying ML, together with MImp, to predict ambulation recovery in post-stroke rehabilitation. This pipeline reliably exploits the potential of incomplete datasets for healthcare prognosis, identifying relevant predictors. [ABSTRACT FROM AUTHOR]

Introduction: Hip fracture is particularly seen in elderly patients with frailty and osteoporosis and leads to diminished functional independence and quality of life. Despite the susceptibility of these patients to a second hip fracture (SHF), the literature insufficiently discussed its impact leading to poor outcomes. This study aims to directly assess the outcomes of elderly patients with initial hip fractures (IHF) vs those experiencing an SHF within a well-matched group with similar characteristics. Materials and Methods: This case–control study gathered data from the clinical hip fracture registry at a medical center from 2019 to 2022. Patients with SHF were matched with those with IHF in a 1:2 ratio according to the similarity of age, sex, and Charlson Comorbidity Index classification. Demographics at admission, baseline characteristics, and 1-year postoperative outcome were compared between the SHF and IHF groups. Results: Thirty-two SHF patients were matched with 64 IHF patients (81.25% of women, median age of 86 years). Anthropometric measurements and socioeconomic factors were not significantly different between the two groups. No differences in baseline characteristics were observed, except IHF patients had a significantly lower T-score than SHF patients (−3.98 vs. −3.31, P = 0.016). At one-year follow-up, despite a notable decrease in Barthel Index scores and an uptick in EQ-5D measures among the patients, the IHF and SHF groups demonstrated similar quality of life and a high level of activities of daily living. Discussions: In this case-control study, after matching for age, sex, and comorbidities, an SHF did not indicate poorer outcomes than an IHF, providing a more optimistic outlook for the patients and healthcare providers. Conclusion: Despite the significant challenges presented by hip fracture, the one-year postoperative outcomes did not differ between IHF and SHF patients, suggesting that SHF is not an independent predictor of poor outcomes following hip fracture in the elderly population. [ABSTRACT FROM AUTHOR]

Background/Objectives: Physical rehabilitation based on neurofunctional exercises can have a positive impact on restoring functionality and enhancing the quality of life of these individuals. Therefore, the purpose of this study is to analyze the effects of rehabilitation, including neurofunctional exercises, on the functional status of stroke patients. Methods: The cohort study design included 102 male and female participants: 51 patients underwent physiotherapy rehabilitation including neurofunctional exercises (SG), while the other 51 did not follow a rehabilitation program based on neurofunctional exercises (CG). The participants were assessed twice: once during their stay in the early neurology department after the first stroke, and again six months later. The assessments were conducted using the Barthel Scale (BS), the Rankin Scale (RS), and the National Institutes of Health Stroke Scale (NIHSS). Results: Baseline comparisons revealed significantly greater BS (p = 0.001) in the CG compared to the SG. Conversely, the SG had a significantly higher NIHSS than the CG at baseline (p = 0.001), as well as higher RS (p < 0.001). Within the SG, there were significant increases in BS (p < 0.001), while no significant differences were found between baseline and post 6 months in RS (p = 0.537) and NIHSS (p = 0.475). Regarding the CG, significant increases were observed in BS (p = 0.005) and NIHSS (p < 0.001), while no significant differences were found in RS (p = 0.335). Conclusions: In conclusion, this study reveals that incorporating neurofunctional exercises does not appear to play a significant role in the patients' progress. The controlled group, engaged in home-based activities, showed greater improvements in their condition. [ABSTRACT FROM AUTHOR]

Purpose: Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. Method: Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton–Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. Findings: Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14–1⋅74], p = 0⋅002). Conclusion: Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs. IMPLICATION FOR REHABILITATION: To our knowledge this is the first prospective cohort study of trajectories of disability in activities of daily living (ADL) in advanced respiratory disease, including recruitment during the Covid-19 pandemic. It adds to existing evidence by identifying individual variability in trajectories of ADL disability which are undetected at group level. The identification of mobility limitation as a predictor of increasing ADL disability, while controlling for malignant or non-malignant respiratory disease, is novel and has practical utility. Our findings have implications for clinical care, as early identification of functional decline through use of mobility limitation tools could flag early referral to rehabilitation services, potentially preventing or delaying forthcoming functional decline and avoiding reactive crisis management. Mobility limitation is a predictor of increasing disability in activities of daily living in advanced disease, which could be used to flag early referral to rehabilitation services, to help prevent or delay forthcoming functional decline and avoid reactive crisis management [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONDifferential Item Functioning (DIF), an item malfunctioning, causes Differential Test Functioning (DTF), thus biasing questionnaire measures. The current study evaluates the relationship between DIF and DTF for the Barthel Index and the Functional Independence Measure, likely the most used disability measures. The aim is to understand under which conditions DIF can be ignored as its DTF is negligible.A simulation study was run. Disability measures were obtained for the Barthel Index and FIM motor domain using Rasch analysis with previously published item calibrations. Several DIF scenarios have been assessed. DTF was tolerable if ≤0.50 logits.Simulations showed that the larger the DIF, the larger the DTF and that, keeping the overall DIF constant, the total number of items with DIF does not affect DTF. DIF of the items with the lowest or highest calibrations is the most dangerous. The DIF of central items should be so massive to matter in DTF terms that it is unlikely to happen in practice. The FIM robustness to DIF is better than that of the Barthel Index.The FIM and the Barthel Index show remarkable robustness to DIF. Thanks to this feature, sample invariant, generalisable disability measures are available.The Barthel Index and the Functional Independence Measure are two assessment procedures for evaluating disability.It is demonstrated that the Functional Independence Measure and the Barthel Index are remarkably resistant to Differential Item Functioning.As a result, these questionnaires yield very generalisable disability measures.The Barthel Index and the Functional Independence Measure are two assessment procedures for evaluating disability.It is demonstrated that the Functional Independence Measure and the Barthel Index are remarkably resistant to Differential Item Functioning.As a result, these questionnaires yield very generalisable disability measures. [ABSTRACT FROM AUTHOR]

Background: This study aimed to reveal differences in the effectiveness of rehabilitation in improving activities of daily living (ADL) in patients with acute stroke across age groups and propose age-appropriate rehabilitation strategies. Methods: This observational study analyzed nationwide administrative data of inpatients admitted to hospitals with acute stroke between April 1, 2018, and March 31, 2020. The data included the average length of daily rehabilitation sessions, weekly frequency of rehabilitation sessions, and initiation of rehabilitation within 3 days. The primary outcome was the improvement in the Barthel Index (BI) score from admission to discharge. We classified the patients based on age and analyzed improvements in ADL according to rehabilitation characteristics. Results: An increased daily rehabilitation dose was associated with improved ADL, except in patients aged <65 years (risk ratio [95% confidence interval] in the 65–74, 75–85, and ≥85 years age groups: 1.20 [1.14‒1.27], 1.21 [1.15‒1.27], and 1.43 [1.34‒1.53], respectively; all p<0.001 vs. <65 years: 1.05 [0.98‒1.12]; p=0.18). A rehabilitation frequency of seven sessions per week was associated with improved ADL in the 75–85 years and ≥85 years age groups (1.06 [1.02‒1.10] and 1.08 [1.03‒1.13], respectively; both p<0.001). The effects of initiating rehabilitation within 3 days on ADL post-admission did not differ across age groups. Conclusion: Increasing the daily dose of rehabilitation was significantly associated with improved ADL in all age groups while increasing the frequency of rehabilitation per week improved ADL in older and very old patients. [ABSTRACT FROM AUTHOR]

determinants of access to rehabilitation professionals after stroke in middle-income countries, where the burden of this disease is higher, are little known. To identify the determinants of access to rehabilitation professionals by individuals with stroke at one, three, and six months after hospital discharge in Brazil and compare referral and access rates after discharge. Longitudinal and prospective study, with individuals with primary stroke, without previous disabilities. At hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. The possible determinants of access, according to Andersen's model, were: a) predisposing factors: age, sex, education levels, and belief that they could improve with treatment; b) need factors: stroke severity, levels of disability; c) enabling factors: socioeconomic status, disposable income for health care, and quality of care provided by rehabilitation professionals. One, three, and six months after hospital discharge, individuals were contacted to identify which rehabilitation professionals were accessed. Multiple linear regression model and Wilcoxon tests were used (α=5%). 201 individuals were included. Disability levels and stroke severity explained 31%, 34%, and 39% (p<0.01) of access at one, three, and six months after hospital discharge, respectively. In all periods, there was less access than that recommended at the time of hospital discharge (p<0.01). Need factors (disability levels and stroke severity) were determinants of access in all assessed periods. In addition, in all periods, the comprehensiveness of care for individuals with stroke was compromised. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of repetitive facilitative exercise combined with low-frequency acupoint electrical stimulation therapy in the recovery of patients with upper limb motor dysfunction after stroke. Methods Sixty-two patients with upper limb motor dysfunction after stroke were divided into the observation group (n = 31) and control group (n=31). Patients in the control group were treated with conventional rehabilitation training combined with low-frequency acupoint electrical stimulation in Department of Neurology, and those in the observation group were treated with repetitive facilitative exercise besides the interventions in the control group. The efficacy of the two groups was evaluated by Fugl-Meyer Motor Assessment (FMA) scale, Modified Ashworth scale (MAS) and Modified Barthel Index (MBI) scale before treatment and at 2 weeks after treatment, respectively. Results The FMA scores after treatment were significantly higher than pre-treatment scores in two groups, the FMA scores in the observation group were significantly higher than those in the control group, and the difference of the FMA scores between pre- and post-treatment in the observation group was significantly larger compared with that in the control group (all P<0.05). After treatment, the MAS grade was decreased compared with that before treatment in two groups, and the degree of grade decrease in the observation group was greater than that in the control group (all P<0.05). The MBI scores after treatment were higher than those before treatment in two groups, the MBI scores in the observation group were higher than those in the control group, and the difference of the MBI scores between pre- and post-treatment in the observation group was larger than that in the control group (all P<0.05). Conclusion Repetitive facilitative exercise combined with low-frequency acupoint electrical stimulation therapy yields high efficacy in the recovery of upper limb motor function, mitigation of muscular spasm and improvement of daily living capability after stroke. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of accelerated rehabilitation surgical nursing combined with enteral nutrition on the postoperative recovery of patients undergoing total hip arthroplasty. We enrolled 100 patients admitted to Ankang People's Hospital between January 2021 and December 2022. The patients were randomly divided into a control group and a treatment group. Patients in the control group received routine nursing and targeted dietary guidance, while those in the treatment group received accelerated rehabilitation surgical nursing and enteral nutrition. Patients in the treatment group exhibited lower intraoperative blood loss, postoperative time of getting out of bed, postoperative hospital stays, visual analog scale scores, and incidence of complications than those in the control group. Additionally, patients in the treatment group exhibited higher Harris scores, Barthel indexes, and higher prealbumin, hemoglobin, transferrin, albumin, immunoglobulins G, A, and M levels, and nursing satisfaction than those in the control group. Accelerated rehabilitation surgical nursing combined with enteral nutrition for patients undergoing total hip arthroplasty can effectively improve hip function and life ability recovery, shorten the rehabilitation time, lower the complication rate, promote the nutritional status and immune function and improve the nursing satisfaction rate of patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the predictive factors of transfer of glioblastoma multiforme (GBM) patients who underwent rehabilitation in acute care hospitals. We retrospectively identified 85 patients with GBM who underwent rehabilitation at our hospital. Multivariable logistic regression analysis showed that age and Barthel index (BI) at rehabilitation initiation significantly influenced the discharge destination. Cut-off values for these factors were 76 years of age and 30 BI points. These findings could help predict the discharge destination and the choice of rehabilitation strategies of newly diagnosed patients with GBM admitted to an acute care hospital. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of iTBS stimulation on walking function in patients with stroke. Methods Fifty patients with post-stroke walking dysfunction who met the inclusion criteria were selected for 3-week rehabilitation treatment, and were randomly divided into iTBS group) n = 25) and sham group) n = 25). The iTBS group was treated with conventional rehabilitation therapy combined with iTBS stimulation of contralesional cerebellum, and the sham group was treated with conventional rehabilitation therapy plus iTBS stimulation of contralesional cerebellum. Relevant indicators were analyzed before treatment and at 21 days of treatment. Lower limb motor function scores of the two groups were compared before and after treatment. Fugl-Meyer motor function lower limb activity score, Berg Balance Scale score, Brunnstrom stage) lower limb), hamstring/quadriceps) H/Q) on the affected side, Modified Barthel index ) MBI), gait analysis parameters, and TMS-MEP were used to evaluate the effectiveness of cerebellar iTBS in the rehabilitation of walking dysfunction after stroke. Results After 21 days of treatment, the improvements of Brunnstrom stage, Holden grade, Berg score, FMA score, 6-minute walking distance, NIHSS score and MBI score in iTBS group were significantly better than those in sham group) P < 0.05). After treatment, the H/Q in iTBS group was significantly higher thanbefore) P < 0.05), but there was no significant difference between the two groups) P > 0.05). Stride speed, stride frequency, stride width, single support phase on the affected side and GDI score in iTBS group were significantly improved compared with sham group) P < 0.05), and there was no significant difference in stride length between the two groups after treatment) P > 0.05). The Conclusion Contralesional cerebellar iTBS combined with routine rehabilitation could improve lower limb walking function and daily living ability of stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the therapeutic effect of Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy on cognitive dysfunction after acute ischemic stroke (AIS). Methods: Totally 140 patients with cognitive impairment after AIS admitted to Sichuan Provincial Rehabilitation Hospital from September 2016 to May 2021 were included in this prospective randomized controlled trial. After admission, patients were randomly divided into the trial group and the control group based on a computer-generated random number table. Patients in the trial group were treated with Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy, and those in the control group were treated with modern rehabilitation therapy alone. Before and after treatment, Mini-Mental State Examination (MMSE) and Barthel index (BI) were used to evaluate the cognitive function and daily living activities, and event-related potentials (ERP) were also measured in both groups. Statistical analyses were performed to compare the results between the two groups. Results: Finally 135 patients were included, 67 in the trial group and 68 in the control group. After treatment, the MMSE score and BI were significantly improved in both groups as compared with those before treatment (both P < .001). In the trial group, the BI and the MMSE subscores in the domains of orientation, registration, recall, and language were significantly higher than those in the control group (all P < 0.05). The global MMSE score of the trial group was higher than that of the control group both after 2 and 4 weeks of treatment, and the differences were statistically significant (P = 0.000/0.001). In the analysis of time effect alone, time had significant effects on the MMSE score in both groups (P < 0.001). After treatment, the latencies of P3 waves were significantly shorter and the amplitudes of P3 waves were significantly higher in the trial group as compared with the control group (both P < 0.05). Conclusion: Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy may be associated with a better efficacy in treating cognitive dysfunction after AIS. The effect of Xingnao Kaiqiao acupuncture on ERP may play a role in the mechanism underlying such a therapeutic effect. [ABSTRACT FROM AUTHOR]

Background/Aim: Physical decline is accompanied with malnutrition in advanced cancer patients, thus nutritional care is often provided with cancer rehabilitation. However, a limited number of studies have focused on which nutritional index serves as an important marker to provide more intensive nutritional support for patients. Patients and Methods: We retrospectively reviewed advanced cancer patients who received chemotherapy and rehabilitation during hospitalization. In analysis 1, patients were divided into two groups: a Well group with caloric intake ≥ basal metabolism, calculated by the Harris–Benedict equation, and a Poor group with caloric intake less than their basal energy expenditure. The primary endpoint was the ratio of patients whose Eastern Cooperative Oncology Group Performance Status (ECOG PS) or Barthel index (BI) was maintained during rehabilitation. In analysis 2, the cohort was restratified into Responders, whose ECOG PS and BI improved, and Non-responders, comprising the remaining patients. Several nutritional indices were compared between the groups. Results: Eighty-four patients were evaluated in analysis 1, namely 51 Well patients and 33 Poor patients. The ECOG PS-maintained rate was 98% and 91% (p=0.29), and the BI-maintained rate was 100% and 88% (p=0.02) in the Well and Poor groups, respectively. In analysis 2, 72 patients were evaluated after excluding 12 patients who lacked nutritional data after rehabilitation. Compared with the Responders group, caloric intake appeared worse in the Non-responders group, although their nutritional background tended to be better. Conclusion: Insufficient caloric intake might be a predictive marker of poor outcomes after rehabilitation in advanced cancer patients. [ABSTRACT FROM AUTHOR]

Stroke survivors often face diverse unmet needs highlighting the significance of identifying and addressing these needs to enhance rehabilitation outcomes and overall quality of life. This study aimed to validate the modified Needs Assessment Questionnaire (mNAQ) as a reliable and valid tool for assessing the needs of stroke patients in the Greek context. Additionally the research sought to identify potential differences in the assessment of stroke patients' needs based on their stroke phase and National Institutes of Health Stroke Scale (NIHSS) scores. A sample of 71 adult stroke survivors adhering to World Health Organization guidelines and providing autonomous consent participated in the study. The mNAQ comprising 141 items across 12 domains was utilized to evaluate stroke patients' needs. The NIHSS and Barthel Index (BI) were employed for functional independence and mobility assessment. Data analysis incorporated confirmatory factor analysis, exploratory factor analysis and Cronbach's reliability analysis to establish construct validity and internal consistency. Concurrent and known-groups validity analyses were conducted; and Spearman's rho correlation explored the relationship between mNAQ and BI scores. Non-parametric analyses were applied to identify differences based on stroke phase and NIHSS scores. The study revealed that the mNAQ initially lacked satisfactory psychometric properties in the Greek context. Subsequent modifications guided by confirmatory and exploratory factor analyses resulted in a refined three-factor scale encompassing 31 items in the domains of communication, mobility, and social functioning needs. This adapted measure effectively differentiated between acute and chronic stroke patients and those with minor and moderate strokes. In conclusion, the validated 31-item Greek mNAQ emerges as a crucial tool for comprehensively assessing the needs of stroke patients. Its application holds promise for optimizing post-stroke care improving functional outcomes and ultimately enhancing the overall well-being and quality of life for stroke survivors. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18–24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. On average, 56.6% (95% CI 52.4–60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies. The amount of professionally active people affected by stroke events is rising worldwide, with increasing numbers of survivors with restricted occupational participation. Higher age and lower socioeconomic status appear to be main determinants for no return to work and so, a special attention should be given to this particular group of stroke survivors. Vocational and social support after stroke is highly needed to help in the reintegration of a professionally active life. Social and community support after stroke should be offered as soon as possible after stroke to promote a successful professional reintegration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Impaired upper limb function in stroke survivors is characterized by muscle weakness, increased muscle tone, contracture, or impaired motor control. OBJECTIVE: We aimed to evaluate the effectiveness of Kinesio-taping application for functional recovery on the affected arm and forearm during rehabilitation. METHODS: Forty-one patients eligible for this study were randomly assigned to either the Kinesio-taping group (n = 21), receiving Kinesio-taping intervention and conventional therapy, or control group (n = 20), receiving sham Kinesio-taping intervention and conventional therapy. The whole intervention lasted for 3 weeks. Fugl-Meyer assessment of the upper extremity, Barthel Index, the Stroke Impact Scale, and modified Ashworth scale were measured at 3 time points: baseline, post-treatment (3rd week), and follow-up (6th week). RESULTS: In the Kinesio-taping group, there were significant differences in the upper extremity (p = 0.003), wrist (p = 0.000) and hand (p = 0.000) parts of the Fugl-Meyer assessment of the upper extremity between the three assessment times. On the other hand, the Barthel Index showed significant differences in both groups after therapy. CONCLUSION: Combining conventional rehabilitation with Kinesio-taping intervention may improve functional motor performance of both the proximal and distal parts of the affected upper extremity in stroke survivors, with potential benefits for activity of daily living. [ABSTRACT FROM AUTHOR]

Objective To evaluate the rehabilitation effect of innovative mirror therapy (MT) on the upper limb function and daily living activity ability of stroke patients. Methods Sixty patients with impaired hand function after stroke were enrolled and divided into the intervention n = 30 ) and control groups (n = 30) according to the random number table method. Patients in the intervention group received conventional rehabilitation training combined with innovative MT, and those in the control group received conventional rehabilitation training and conventional MT. Before treatment and 4 weeks after treatment, the Fugl-Meyer Assessment Scale for the upper limb (FMA-UE), the Fugl-Meyer Assessment Scale for the wrist and fingers (FMA-WH), and the modified Barthel Index (MBI) were evaluated to compare the rehabilitation effects between two groups. Results After 4 weeks of treatment, the FMA- UE, FMA-WH, and MBI scores of patients in two groups were higher than those before treatment (all P < 0.05 ) . The FMA-UE, FMA-WH, and MBI scores in the intervention group were higher than those in the control group (50.00 (25.75, 57.25) vs.24.00 (9.75, 51.50), 12.00 (1.75, 14.75) vs. 0 (0, 12.50), 24.50 (13.00, 28.75) vs. 13.00 (4.75, 21.00), all P < 0.05 ) . The differences before and after treatment of FMA-UE, FMA-WH and MBI scores in the intervention group were all higher than those in the control group (all P < 0.05 ) . Conclusion Compared with traditional MT, innovative MT yields higher efficacy in improving the upper limb function and enhancing daily living capability of patients with impaired hand function after stroke. [ABSTRACT FROM AUTHOR]

Background After an acute infection, older persons may benefit from geriatric rehabilitation (GR). Objectives This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. Design Multicentre prospective cohort study. Setting 59 GR facilities in 10 European countries. Participants Post-COVID-19 patients admitted to GR between October 2020 and October 2021. Methods Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. Results 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0–7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P  < 0.001) points per month and stabilised around 17.0 (quadratic slope: −0.26, SE 0.02, P  < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P  < 0.001) and stabilised around 0.8 (quadratic slope: −0.014, SE 0.001, P  < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. Conclusions Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) (deep vein thrombosis and its complication, pulmonary embolism) is a major cause of morbidity and mortality in hospitalized patients and about 7% of these cases are due to immobility secondary to a neurological impairment. Acquired brain injury (ABI) has also been recognized as one of the main risk factors for VTE. Numerous epidemiological studies have been conducted to assess the risk factors for VTE in institutionalized polytrauma patients, although there is a lack of information about neurorehabilitation wards. Since VTE is often undiagnosed, this prospective study aimed to determine the prevalence and clinical characteristics of lower-limb deep venous thrombosis (DVT) in ABI patients at neurorehabilitation admission. Methods: ABI patients were screened for DVT on admission to the intensive rehabilitation unit (IRU) with compression ultrasonography and basal D-dimer assay and were daily clinically monitored until discharge. A total of 127 consecutive ABI patients (mean age: 60.1 ± 17.6 years; 63% male; time from event: 30.9 ± 22.1 days; rehabilitation time in IRU: 84.6 ± 58.4 days) were enrolled. Results: On admission to the IRU, the DVT prevalence was about 8.6%. The mean D-dimer level in patients with DVT was significantly higher than in patients without DVT (6 ± 0.9 vs. 1.97 ± 1.61, p-value = 0.0001). ABI patients with DVT did not show any significant clinical characteristics with respect to ABI without DVT, although a prevalence of hemorrhagic strokes and patients originating from the Intensive Care Unit and Neurosurgery ward was revealed. During the rehabilitation period, patients with DVT showed a significant difference in pharmacological DVT prophylaxis (high prevalence of nadroparin with 27.3% vs. 1.7%, p-value = 0.04) and a prevalence of transfers in critical awards (36% versus 9.5% of patients without DVT, p-value = 0.05). The mortality rate was similar in the two groups. Conclusions: Our research offers a more comprehensive view of the clinical development of DVT patients and confirms the prevalence rate of DVT in ABI patients as determined upon IRU admission. According to our findings, screening these individuals regularly at the time of rehabilitation admission may help identify asymptomatic DVT quickly and initiate the proper treatment to avoid potentially fatal consequences. However, to avoid time-consuming general ultrasonography observation, a more precise selection of patients entering the rehabilitation ward is required. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The recovery of upper extremity motor impairment after stroke remains a challenging task. The clinical effectiveness of repetitive transcranial magnetic stimulation (rTMS), which is believed to aid in the recovery process, is still uncertain. Methods: A systematic search was conducted in Medline (Ovid), Cochrane and Embase electronic databases from March 28, 2014, to March 28, 2023. The inclusion criteria consisted of randomized controlled trials that assessed the effects of rTMS on the recovery of upper limb motor impairment among stroke patients. Various measurements, including the Fugl Meyer Assessment Upper Extremity Scale (FMA-UE), Brunnstrom recovery stage, Action Research Arm Test (ARAT), and Barthel index, were evaluated both before and after the intervention. Results: Nineteen articles with 865 patients were included. When considering only the rTMS parameters, both inhibitory and excitatory rTMS improved FMAUE (MD = 1.87, 95% CI = [0.88]-[2.86], p < 0.001) and Barthel index (MD = 9.73, 95% CI = [4.57]-[14.89], p < 0.001). When considering only the severity of upper limb hemiplegia, both less severe (MD = 1.56, 95% CI = [0.64]-[2.49], p < 0.001) and severe (MD = 2.05, 95% CI = [1.09]-[3.00], p < 0.001) hemiplegia benefited from rTMS based on FMA-UE. However, when considering the rTMS parameters, severity of hemiplegia and stroke stages simultaneously, inhibitory rTMS was found to be significantly effective for less severe hemiplegia in the acute and subacute phases (MD = 4.55, 95% CI = [2.49]-[6.60], p < 0.001), but not in the chronic phase based on FMA-UE. For severe hemiplegia, inhibitory rTMS was not significantly effective in the acute and subacute phases, but significantly effective in the chronic phase (MD = 2.10, 95% CI = [0.75]-[3.45], p = 0.002) based on FMA-UE. Excitatory rTMS was found to be significantly effective for less severe hemiplegia in the acute and subacute phases (MD = 1.93, 95% CI = [0.58]-[3.28], p = 0.005) based on FMA-UE. The improvements in Brunnstrom recovery stage and ARAT need further research. Conclusion: The effectiveness of rTMS depends on its parameters, severity of hemiplegia, and stroke stages. It is important to consider all these factors together, as any single grouping method is incomplete. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to demonstrate the incidence of altered level of consciousness after hemorrhagic stroke and identify factors associated with altered level of consciousness at 3 mos after stroke. Design: This study used data from a prospectivemulticenter cohort study conducted in nine hospitals in Korea and included 1677 patients with first-ever hemorrhagic stroke. Patients were dichotomized into those with and without altered level of consciousness at 3mos after stroke. Multivariate logistic regression analysiswas performed to identify factors associated with subacute to chronic stage altered level of consciousness. Results:Among patientswith hemorrhagic stroke (age: 20-99 yrs, female 50.21%), the prevalence of altered level of consciousness at admission was 38.58% (25.4% [drowsy], 6.38% [stupor], and 6.8% [coma]) and 17.29% 3 mos after stroke. Multivariate logistic regression analysis revealed that independent factors associated with altered level of consciousness at 3 mos after stroke included late seizure (odds ratio [95% confidence interval], 5.93 [1.78-20.00]), stroke progression (3.84 [1.48-9.64]), craniectomy (2.19 [1.19-4.00]), history of complications (1.74 [1.18-2.55]), age at stroke onset (1.08 [1.07-1.10]), and initial Glasgow Coma Scale score category (0.36 [0.30-0.44]). Conclusions: The factors associated with altered level of consciousness at 3 mos after stroke should be considered when explaining long-term consciousness status and focused management of modifiable factors in acute care hospitals could help ameliorate altered level of consciousness and promote recovery after stroke. [ABSTRACT FROM AUTHOR]

The aim of this retrospective, cross-sectional, observational study was to assess the frequency of falls and evaluate the predictive validity of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) among patients aged ≥65 years, transferred to the rehabilitation ward of a university hospital. The predictive ability was assessed using receiver operating characteristic curve analysis, and the optimal threshold was established using the Youden index. We analyzed the overall cohort (N = 175) with subacute stroke and the subgroup with a low unaffected handgrip strength (HGS; men: <28 kg, women: <18 kg). Overall, 135/175 patients (77.1%) had a low HGS. The fall rate was 6.9% overall and 5.9% for patients with a low HGS. The JHFRAT predictive value was higher for patients with a low HGS than that for the overall cohort, but acceptable in both. The optimal cutoff score for the overall cohort was 11 (sensitivity, 67%; specificity, 68%), whereas that for the subgroup was 12 (sensitivity, 75%; specificity: 72%). These results are expected to aid nurses working in rehabilitation wards in more effectively utilizing JHFRAT outcomes for post-stroke older patients with a low HGS and contribute to the development of more appropriate fall prevention strategies for high-risk patients in the future. [ABSTRACT FROM AUTHOR]

We investigated the clinical characteristics, fall outcomes, and related factors of falls in patients who were hospitalized in the rehabilitation department, and explored strategies to reduce the incidence of falls and prevent falls in patients. Methods: Data from 60 patients who fell in the rehabilitation department between 2016 and 2021 were analyzed for clinical characteristics, associated factors, incidence of falls, injuries, and patient demographics. Under the random stratified sampling method, 60 patients who did not fall during the same period were selected as the control group, and relevant data was collected. Measurement data were compared using an independent sample t-test. Enumeration data were compared using chi-squared (χ2) test was employed to compare these data between the two groups. Non-parametric data were analyzed using the Mann–Whitney U-test. Factors potentially influencing falls were scrutinized through both univariate and binary logistic regression analyses. Results: The median annual incidence of falls among patients who were hospitalized in the rehabilitation department was 0.04%, while the overall fall injury rate was 60%. Falls were most prevalent within 30 days of hospitalization (71.67%). The most common fall-related condition was craniocerebral disease (83.33%). The incidents of falls location of fall were mainly reported in nearby areas of rehabilitation ward (70%). Most accidents occurred between 7:00 a.m.– 12:00 p.m. and 3:01 p.m.– 6:00 p.m. (63.33%), and dyskinesia was the most common cause of falls (71.67%). There were 39 patients (65.00%) with Barthel Index (BI) scores ranging between 40– 60. Conclusion: Patients in the rehabilitation department had a greater incidence of falls and fall injuries. Within 30 days of admission, patients with moderately dependent craniocerebral disorders and dyskinesia frequently experienced falls during typical daytime shifts in areas characterized by endemic conditions. [ABSTRACT FROM AUTHOR]

Introduction: At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation. Method: Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI). Results: A total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was [SMD = 1.40, 95%CI(1.16,1.63), p < 0.001]; the score of Fugl-Meyer Assessment Scale was [SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001]; the score of NIHSS was [SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001]; the result of China Stroke Scale score was [SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001]. Conclusion: In comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients. Trial registration: This meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022. [ABSTRACT FROM AUTHOR]

Introduction: Limb paresis following a stroke is a common sequela that can impact patients' quality of life. Many rehabilitation strategies targeting the restoration of motor function exist. This systematic review and meta-analysis aim to evaluate the effects of contralaterally controlled functional electrical stimulation (CCFES) as a modality for limb rehabilitation. Unlike conventional neuromuscular electrical simulation (NMES), the contra-laterality in CCFES is achieved by two methods a bend angle sensor or an electromyographic bridge (EMGB) method, both of which targets signals from the unaffected limb. Method: This review study was performed following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Records that met the inclusion criteria were extracted from the following databases: Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Additional articles were also retrieved from clinicaltrials.gov and China/Asia on Demand (CAOD). Only randomized controlled studies (RCTs) were included. Results: Sixteen RCTs met the inclusion criteria, and 14 of which were included in the quantitative analysis (meta-analysis). The results of the analysis show that when compared to conventional NMES, CCFES displayed a better improvement in the upper extremity Fugl--Meyer assessment (UEFMA) (SMD = 0.41, 95% CI: 0.21, 0.62, p-value <0.0001, I2 = 15%, GRADE: moderate), box and blocks test (BBT) (SMD = 0.48, 95% CI: 0.10, 0.86, p-value = 0.01, I2 = 0%, GRADE: very low), modified Barthel index (mBI) (SMD = 0.44, 95% CI: 0.16, 0.71, pvalue = 0.002, I2 = 0%, GRADE: moderate), active range of motion (AROM) (SMD = 0.61, 95% CI: 0.29, 0.94, p-value = 0.0002, I2 = 23%, GRADE: moderate), and surface electromyography (sEMG) scores (SMD = 0.52, 95% CI: 0.14, 0.90, p-value = 0.008, I2 = 0%, GRADE: low). The results of the subgroup analysis for the type of sensor used in CCFES shows that an EMGB (SMD = 0.58, 95% CI: 0.33, 0.84, p-value <0.00001, I2 = 7%) is more effective than a bend angle sensor (SMD = 0.17, 95% CI: -0.12, 0.45, p-value = 0.25, I2 = 0%). Conclusion: The results of this study provide strong evidence that shows CCFES being a better electrical stimulation modality compared to conventional NMES. This could be explained by the fact that CCFES is bilateral in nature which offers a platform for better neuroplasticity following a stroke. There is still a need for high-quality studies with a standardized approach comparing CCFES to other treatment modalities. [ABSTRACT FROM AUTHOR]

Introduction: The factors determining the level of functional efficiency in patients after ischemic stroke are: age, sex, physical condition, mental activity before stroke, previous neurological deficits, comorbidities, nutritional status and the course of the stroke. Aim: Assessment of the functional efficiency of patients before and after rehabilitation due to ischemic stroke and determination of the influence of selected factors on the effects of rehabilitation measured by functional efficiency. Material and Methods: The study was conducted in neurological rehabilitation centers among 82 people diagnosed with ischemic stroke. The examination was performed twice: on admission to the ward and after a month of neurological rehabilitation. The diagnostic survey method, the Barthel scale, the NRS 2002 scale were used, and the BMI was calculated. Results: The functional efficiency level of the patients was varied, higher after one month of rehabilitation (p < 0.05). Among the patients who achieved a lower level of functional efficiency, the following factors had a significant influence: underweight and overweight (p = 0.002), risk of malnutrition (p = 0.002), right-sided paresis (p = 0.016), limited physical activity before stroke (p = 0.01) and the later rehabilitation period (p = 0.01). There was no correlation between sociodemographic data and the level of efficiency of patients after a stroke after one month of rehabilitation. Conclusion: The level of functional efficiency after rehabilitation improved in all patients, however, to a different extent depending on the nutritional status and physical activity. Therefore, it is important to to undertake rehabilitation in the shortest possible time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. OBJECTIVE: Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. METHODS: Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher's Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. RESULTS: Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. CONCLUSION: About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable. [ABSTRACT FROM AUTHOR]

To investigate the responsiveness and minimal clinically important difference (MCID) of the Functional Independence Measure (FIM) from a clinician's perspective in hip-fractured elderly undergoing inpatient rehabilitation. Data of 701 hip-fractured elderly admitted to our rehabilitation institute were retrospectively collected. Ten a priori hypotheses were formulated. The effect size of the FIM scores after treatment were large (total = 1.38, motor = 1.78). Moderate correlations were found between the change total score of FIM and Barthel Index (BI, rs = 0.51), Functional Ambulation Categories (FAC, rs = 0.52) and a checklist regarding participants' independence in transfers (rs = 0.59). The area under the receiving operating characteristics were 0.82, 0.81, and 0.85 when BI, FAC and checklist were used as anchors, respectively. Based on these findings, the FIM showed high responsiveness (9/10 hypotheses met). Triangulation of findings showed that MCIDs of 22 and 21 points were the most appropriate for the FIM total and motor score, respectively. The FIM scale is appropriate for assessing independence and functional recovery in hip-fractured elderly. Improvements of 22 and 21 points at the total and motor FIM were identified as indicators of minimal clinical change in those admitted to a rehabilitation facility with an FIM total score between 40 and 80. This study provides evidence of the high responsiveness of the Functional Independence Measure (FIM) total score and of its motor subscore, while the cognitive subscore is not responsive to change among older adults with hip fractures hospitalized for rehabilitation. After a rehabilitative program, a change of at least 22 points in the FIM total score is clinically important in older adults with hip fractures. This change scores will be useful for researchers and clinicians in order to determine a possible clinically meaningful improvement in independence as a response to rehabilitation after a hip fracture. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the efficacy and safety of adjunctive hyperbaric oxygen therapy (HBOT) in acute ischaemic stroke (AIS) based on existing evidence. Methods: We conducted a comprehensive search through April 15, 2023, of seven major databases for randomized controlled trials (RCTs) comparing adjunctive hyperbaric HBOT with non-HBOT (no HBOT or sham HBOT) treatments for AIS. Data extraction and assessment were independently performed by two researchers. The quality of included studies was evaluated using the tool provided by the Cochrane Collaboration. Meta-analysis was conducted using Rev Man 5.3. Results: A total of 8 studies involving 493 patients were included. The meta-analysis showed no statistically significant differences between HBOT and the control group in terms of NIHSS score (MD = -1.41, 95%CI = -7.41 to 4.58), Barthel index (MD = 8.85, 95%CI = -5.84 to 23.54), TNF-α (MD = -5.78, 95%CI = -19.93 to 8.36), sICAM (MD = -308.47, 95%CI = -844.13 to 13227.19), sVCAM (MD = -122.84, 95%CI = -728.26 to 482.58), sE-selectin (MD = 0.11, 95%CI = -21.86 to 22.08), CRP (MD = -5.76, 95%CI = -15.02 to 3.51), adverse event incidence within ≤ 6 months of follow-up (OR = 0.98, 95%CI = 0.25 to 3.79). However, HBOT showed significant improvement in modified Rankin score (MD = 0.10, 95%CI = 0.03 to 0.17), and adverse event incidence at the end of treatment (OR = 0.42, 95%CI = 0.19 to 0.94) compared to the control group. Conclusion: While our findings do not support the routine use of HBOT for improving clinical outcomes in AIS, further research is needed to explore its potential efficacy within specific therapeutic windows and for different cerebral occlusion scenarios. Therefore, the possibility of HBOT offering clinical benefits for AIS cannot be entirely ruled out. [ABSTRACT FROM AUTHOR]

Background: Assessing functional outcomes in Severe Closed Head Injury (SCHI) is complex due to brain parenchymal changes. This study examines the Ventricles to Intracranial Volume Ratio (VBR) as a metric for these changes and its correlation with behavioral scales. Methods: Thirty-one SCHI patients were included. VBR was derived from CT scans at 3, 30, and 90 days post-injury and compared with Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) assessments at 30 and 90 days. Results: Ten patients were excluded post-decompressive craniectomy or ventriculoperitoneal shunt. Findings indicated a VBR decrease at 3 days, suggesting acute phase compression, followed by an increase from 30 to 90 days, indicative of post-acute brain atrophy. VBR correlated positively with the Marshall score in the initial 72 h, positioning it as an early indicator of subsequent brain atrophy. Nevertheless, in contrast to the Marshall score, VBR had stronger associations with DRS and ERBI at 90 days. Conclusions: VBR, alongside behavioral assessments, presents a robust framework for evaluating SCHI progression. It supports early functional outcome correlations informing therapeutic approaches. VBR's reliability underscores its utility in neurorehabilitation for ongoing SCHI assessment and aiding clinical decisions. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to determine the effect of task-oriented training on the dexterous movements of hands in Hemiplegic post-stroke patients.Methods: This study has been registered on site ClinicalTrial.gov with clinical trial number NCT05201196. The study was Randomized controlled trial, 18 patients were recruited that meet the inclusion criteria, randomly allocated to task-oriented training Group A (n = 9) and Conventional Therapy Group B (n = 9). Both exercise trainings were applied for 45 min/session, 5 times/week for 6 weeks. Fugl-Meyer Assessment Scale Motor, sensory and coordination portion, Wolf Motor Function Scale and Barthel Index were used as outcome measures, assessed patients at Baseline, after 3 weeks and 6 weeks after training. Data were analyzed by SPSS version 23.Results: The results suggested the mean Age was 60.78 ± 9.08 and 61.33 ± 6.78 for Group A and Group B, respectively. Average BMI was 23.66 ± 2.66 for Task-oriented group and 21.36 ± 2.46 for Conventional group. Fugl-Meyer scale shows significant P-value 0.03 post treatment compare to pre-treatment which was.283, Wolf Motor Function test and Barthel Index also showed significant P-values as 0.023 and 0.007, respectively, indicating that Task-oriented training shows more significant improvements than conventional group.Conclusion: Task-based training produced statistically significant as well as clinically meaningful enhancement in the dexterous hand movements of acute and subacute stroke patients than conventional therapy and ultimately improves the functional independence in their daily activities such as feeding, bathing and hygiene. [ABSTRACT FROM AUTHOR]

Objective: To show the effectiveness of goal-oriented proprioceptive training in subacute stroke for balance, autonomy, and fall risk. Methods: Out a total of 35 patients, consistent in age (75.31±8.65 years), type of stroke (ischemic, 3 to 11 weeks before), and motor impairment, 18 patients underwent solely proprioceptive rehabilitation, the other 17 dual task exercises. The study assessed autonomy using Barthel Index, fall risk with Timed Up and Go Test (TUG), balance through Berg Balance Scale (BBS) and Tinetti test. Results: After two months, significant improvements were recorded in Barthel Index, BBS (p<0.0001), Tinetti test (p<0.0001 in dual task group, p=0.0029 in single task group), and TUG (p=0.0052 in dual task group, p=0.0020 in single task group) in both groups. Comparing the two groups, dual task group showed a significant difference in Tinetti balance assessment (p=0.0052), between the total score of Tinetti test and TUG in single (p=0.0271), and dual task (p=0.0235). Likewise, Tinetti gait test was significantly related to TUG in single (p=0.0536), and dual task (p=0.0466), while Tinetti balance test to Barthel Index (p=0.0394), BBS (p<0.0001), and TUG in single (p=0.0219), and dual task (p=0.0196). Lastly, there is a positive correlation of the use of aids with BBS (p=0.0074), and total score of Tinetti test (p=0.0160). Conclusion: In subacute stroke, goal-oriented proprioceptive training improved balance, but only partially autonomy. Furthermore, the use of aids after dual-task exercises improved recovery of balance, but did not reduced falls. [ABSTRACT FROM AUTHOR]

To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain. Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0–10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively. 678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0–7.0 at 3 and 3.0–6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time. The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time. About one-third of patients with stroke reported upper extremity pain at 30 months after starting rehabilitation. In patients with stroke who reported persistent upper extremity pain, there was no significant change in pain intensity over time. There is room for improvement of diagnosis and treatment of upper extremity pain in patients with stroke. [ABSTRACT FROM AUTHOR]

• The control of the trunk is an essential predictor for the recovery of basic ADLs, as measured by the mBI. • Reduced trunk control, pressure ulcers, low functional and communication abilities at admission to post-acute inpatient rehabilitation, as well as premorbid disability can independently affect the global function level at discharge. • Strategies to accelerate TCT recovery during the acute stay and post-stroke inpatient rehabilitation may have a positive effect on global functional recovery at discharge. To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI. Multicentric retrospective observational cohort study. Two Italian inpatient rehabilitation units. A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled. Not applicable. The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes. All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P <.001) independently predicted discharge mBI (adjusted R 2=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R 2 of 65.1%. On the other side, the model with the TCT only presented an R 2 of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R 2 increase up to 68.5%. TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI. [ABSTRACT FROM AUTHOR]

Low muscle strength, functional score at discharge, and complications during a ten-day rehabilitation hospital stay can affect mortality rates in bedridden geriatric patients. This was a prospective observational study in a cohort of 105 bedridden geriatric patients admitted to the Rehabilitation ward after a major illness or surgery. All participants had a severe dependency on another person (Barthel's Index < 60). The one-year mortality rate in this cohort was 15.2%, with further subdivision according to the number of complications: 61.5% in patients with ≥3 complications during hospitalization, 17.6% in patients with two complications, 9.5% with one complication, and 3% in patients with no complications. The Barthel Index at discharge (OR = 0.95; p = 0.003) and ≥3 medical complications (OR = 8.33; p = 0.005) during rehabilitation ward stay were significant predictors for one-year mortality. The odds of one-year mortality after discharge increased eightfold in patients with ≥3 medical complications. Sarcopenia, age, and sex were not significant predictors of mortality in this cohort. The 10-day acute rehabilitation was too short to achieve progress from severe to moderate independence in 60% of patients. The Barthel Index at discharge and a number of complications affect the mortality rate. These findings provide valuable insights into the complex dynamics of mortality and functional outcomes in bedridden geriatric patients. [ABSTRACT FROM AUTHOR]

We explored the impacts of postoperative enteral nutrition-based diversified nursing on postoperative complications and the nutritional status of hip replacement for elderly femoral neck fracture patients. A total of 86 patients undergoing total hip replacement in our hospital between January 2021 and December 2022 were enrolled in this study. While the patients in the control group received routine nursing intervention, those in the treatment group received postoperative enteral nutrition-based diversified nursing intervention. Compared to the control group, the first time of getting out of bed and the hospital stay in the treatment group were shorter. After nursing, the Harris score in the treatment group was higher than the control group, and the visual analog scale, self-rating anxiety scale, and self-rating depression scale scores, as well as the incidence of complications, were lower. The Barthel index in the treatment group was higher when compared with the control group. Also, serum albumin and total protein levels in the treatment group were higher when compared with the control group. Patient's satisfaction with nursing in the treatment group was higher than in the control group. To conclude, postoperative enteral nutrition-based diversified nursing intervention can lessen the incidence of postoperative complications as well as elevate the nutritional status of elderly femoral neck fracture patients undergoing hip replacement. [ABSTRACT FROM AUTHOR]

Objective: The Utrecht Scale for Evaluation of Rehabilitation is a multi-domain measurement with good content validity, structural validity and reliability for measuring physical functioning (mobility, selfcare) and cognitive functioning in geriatric rehabilitation. We aimed to determine the construct validity of both Utrecht Scale for Evaluation of Rehabilitation scales and the responsiveness and interpretability of the scale for physical functioning in geriatric rehabilitation. Design: Prospective follow-up study embedded in routine care. Setting: Four care organisations in The Netherlands. Subjects: Patients admitted for inpatient geriatric rehabilitation (2021–2022). Main measures: Data collection included the Utrecht Scale for Evaluation of Rehabilitation, Mini-Mental State Examination, Barthel index, and a global rating scale anchor on recovery. Hypothesis testing was used to determine construct validity and responsiveness. For interpretability, minimal important change and floor and ceiling effects were determined. Results: The mean age of participants (n = 211) was 77 (SD 10.4). Their mean length of stay was 38.6 days (SD 26.3), and 81% returned home. The Utrecht Scale for Evaluation of Rehabilitation showed adequate construct validity, as all three hypotheses were confirmed for both scales. The Utrecht Scale for Evaluation of Rehabilitation-physical function scale showed adequate responsiveness, with all five hypotheses confirmed. The mean change for physical function (scale range 0–70) was 15.5 points (SD 17.1). The minimal important change for Utrecht Scale for Evaluation of Rehabilitation-physical function was 14.5 points difference for improvement. This scale showed no floor (2%) and ceiling effects (14%) at admission and discharge. Conclusions: The Utrecht Scale for Evaluation of Rehabilitation showed to be effective for evaluating physical functioning during geriatric rehabilitation as well as screening cognitive functioning. In total, 14.5 points difference has been established as a minimal important change for physical functioning. [ABSTRACT FROM AUTHOR]

Copyright of Enfermeir@s is the property of Colegio Oficial de Enfermeria de Lugo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To observe the curative effect of fire needle combined with rehabilitation training on spastic hemiplegia after stroke (SHAS). Methods: A total of 130 SHAS patients admitted to the People’s Hospital of Funan County from January 2020 to November 2021 were selected. The selected patients were randomly divided into 2 groups according to a random number table method, as the control group and the study group. There were 65 cases in the control group, and they were given conventional drugs combined with rehabilitation training. There were 65 cases in the study group, and they were given fire needle on the basis of the control group. The curative effect, modified Ashworth grade, motor function, Fugl-Meyer assessment (FMA) score and modified Barthel index (MBI) score were compared. Results: After treatment, the total effective rate of the study group (91.80%) was significantly higher than that of the control group (78.69%), and the difference was statistically significant (P < 0.05). After treatment, the modified Ashworth grade of both study group and control group was better than that before treatment (P < 0.05). Moreover, the modified Ashworth grade of the study group was significantly better than that of the control group (P < 0.05) after treatment. After treatment, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of study group and control group were higher than those before treatment (P < 0.05). Moreover, the FMA scores of upper limbs, FMA scores of lower limbs and MBI scores of the study group increased more significantly than those of the control group (P < 0.05) after treatment. Conclusion: The curative effect of fire needle combined with rehabilitation training on SHAS is certain, which can improve limb spasm, motor function and activities of daily living. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to investigate the efficacy of a comprehensive rehabilitation program on quality of life, anxiety, fatigue, and functional status in post-COVID-19 patients admitted to a specialized rehabilitation unit. The secondary objective of the study was to compare the differences between vaccinated and unvaccinated patients. Results: The single-center prospective study was conducted. Demographics, comorbidities, vaccination, clinical signs and symptoms, and oxygen saturation were assessed. The rehabilitative protocol was created considering the condition of patients, age, the direct impact of COVID-19 on the systems, sequelae, severity of disease, and comorbidities. The comprehensive rehabilitation program through a multidisciplinary team is applied in a stepwise graded manner. The Nottingham Health Profile (NHP), Fatigue Severity Scale (FSS) The Functional Ambulation Categories (FAC), the modified Medical Research Council (mMRC), the Modified Borg Scale, post-COVID-19 Functional Status (PCFS) scale, Hospital Anxiety and Depression Scale (HADS), and the Barthel Index (BI) were used. In total, 39 patients (61.5% men, age 59.7.0 ± 15.6 years) participated in the study. They were discharged home after 37.5 ± 17.6 days stay in the hospital. The most frequently reported persistent symptoms were dyspnea (76.9%), fatigue (69.2%), and myalgia (64.1%). There was a statistically significant improvement in baseline outcomes including BI, HADS, PCFS, FSS, MMRC, Modified Borg Scale, FAC, O2 support, and NHP after the comprehensive rehabilitation program (p < 0.001). The vaccinated patients had older age, high BMI, and shorter duration of rehabilitation (p = 0.003, p = 0.040, p = 0.022, respectively), while unvaccinated patients had higher BI, FSS, PCFS, and FAC. Conclusion: The comprehensive rehabilitation program improves quality of life, reduces fatigue, anxiety, and depression, and regains function in patients with post-COVID-19 syndrome. In addition, vaccinated patients had older ages and shorter duration of rehabilitation, while unvaccinated patients achieved higher functional status and had significantly higher levels of fatigue at discharge. [ABSTRACT FROM AUTHOR]

To examine patients' perception of performance and satisfaction with the activities in their set goals before and after very early supported discharge (VESD) with continued rehabilitation. A descriptive cohort study with data extracted from a randomized controlled trial. Sixty-nine patient allocated to the intervention group were eligible. Before discharge, the patients were asked to set rehabilitation goals, and they were asked to rate the performance and satisfaction of their set goals. At discharge from the rehabilitation, the patients were asked to re-evaluate their experience and satisfaction with the goal performance. One hundred and forty goals were registered. At 81.5% of the set goals, the patients estimated that they performed the task better at discharge than at enrolment and at 86.5% of the set goals the patients were more satisfied with the performance at discharge than at enrolment. Patients with mild to moderate stroke, undergoing a VESD after stroke, reported high performance level for their set goals and were satisfied with their performance execution. Further research is needed to investigate whether the goal should be set preferably at home or at hospital before discharge. Many of the patients can formulate achievable goals with their rehabilitation after stroke. Patients ongoing rehabilitation after stroke are satisfied with their performance of the set goals. As part of patient-centered care, stroke patients should be given the opportunity to formulate their own goals with their rehabilitation. Short hospital times and fast planning of goal-meetings, seems to influence patient goal setting in early discharge rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: The present study examined the relationship between body mass index and the ability to perform the activities of daily living in patients with vertebral compression fractures. Methods: A retrospective cohort analysis of patients aged >65 years hospitalized with a vertebral compression fracture was carried out using a nationwide database in Japan. Body mass index was categorized as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–27.4 kg/m2) and obese (≥27.5 kg/m2) according to the World Health Organization criteria for the Asia–Pacific region. The primary outcome was Barthel Index gain, namely, the change in the Barthel Index score at discharge from that at admission. Secondary outcomes were the length of hospital stay and readmission within 30 days of discharge. Results: Among 41 423 participants, 24.5% were classified as underweight, excluding those with missing body mass index data. The underweight group had a significantly lower Barthel Index gain than the normal, overweight and obese groups (median 20 vs 25 vs 30 vs 30, respectively, P < 0.001). The underweight group also had longer hospital stays and higher 30‐day readmission rates than the other groups. A multivariable analysis showed that being underweight was independently associated with a Barthel Index gain −3.63 points (95% confidence interval −4.58 to −2.68) lower than normal weight. Furthermore, being underweight was an independent variable affecting the length of hospital stay and readmission within 30 days (P < 0.001). Conclusions: In patients with vertebral compression fractures, being underweight leads to lower Barthel Index scores, longer hospital stays and increased readmissions within 30 days of discharge. Geriatr Gerontol Int 2023; 23: 788–794. [ABSTRACT FROM AUTHOR]

Background: Pulmonary Rehabilitation (PR) is recommended as a standard, effective, and important treatment for COVID-19 survivors who remain symptomatic after the acute phase. Therefore, we aimed to compare the effect of mobile phone-based PR application with face-to-face PR on the quality of life, anxiety, depression, and daily life activities of COVID-19 survivors. Materials and Methods: A quasi-experimental was conducted on 65 COVID-19 survivors during 2022. Convenient sampling was done based on the inclusion criteria. The intervention group (n = 31) received PR through a mobile phone application, and the control group (n = 34) received face-to-face PR. Data were collected before and after the intervention in both groups using a demographic information questionnaire, SF-12, the hospital anxiety and depression scale, and Barthel scale. For all tests, a maximum error of 5% was considered. Results: The two studied groups had no statistically significant difference with respect to all the investigated variables at baseline (p > 0.05). After the intervention, the mean anxiety and depression score of the patients in the control group was significantly lower than the intervention group (t = −3.46, f = 63, p = 0.01). After our intervention, there was no statistically significant difference in the mean quality of life and daily life activity scores between the two groups (t = −0.68, f = 63, p > 0.05). Conclusions: The application of PR does not show a statistically significant difference in terms of improving the quality of life and daily activities compared with the face-to-face method; we suggest that the PR application be used as a cost-effective method when face-to-face PR is not possible. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke. Objective: The purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life. Method: A literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD). Results: Ten studies were included in the meta-analysis. The results of the metaanalysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: -0.56; 95% CI: -0.85 to -0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: -0.21 to 0.90; SMD: 0.35, 95% CI: -0.18 to 0.87; SMD: 0.03, 95% CI: -0.49 to 0.55; respectively). Conclusion: Our results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects. [ABSTRACT FROM AUTHOR]