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Hasta el momento, la enfermedad COVID-19 ha demostrado tener implicaciones funcionales a corto, y en ocasiones, a largo plazo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colombiano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales involucradas en la rehabilitación intrahospitalaria y ambulatoria de usuarios con COVID-19 en Colombia. Se realizó una revisión de la literatura sobre el rol y la efectividad de la Terapia Ocupacional en la rehabilitación hospitalaria, las complicaciones reportadas en usuarios con COVID-19, y su manejo terapéutico en la rehabilitación intrahospitalaria y ambulatoria. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. La Terapia Ocupacional, como parte del equipo de rehabilitación, incide de manera directa en el nivel de independencia, la autonomía y la futura reincorporación a las actividades dentro de la sociedad; adicionalmente, facilitando y promoviendo actividades cognitivas, psicosociales y de ocio, aporta al mantenimiento del equilibrio ocupacional para prevenir la aparición de disfunciones de índole sensoriomotor, perceptivo y psicosocial a corto, mediano y largo plazo. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupacional hospitalaria.

Ehlers–Danlos syndromes (EDS) are a group of inherited connective tissue disorders with an impaired quality of life in association with fatigue, pain, and kinesiophobia. A retrospective evaluation of the effects of an outpatient rehabilitation program (RP) was performed in Ehlers–Danlos syndrome hypermobile type (hEDS) patients. The 6‐minute walk test (6MWT) was used to evaluate functional capacity. Kinesiophobia, fatigue, pain, and quality of life were self‐evaluated at the start, at the end, and 6 weeks after the end of the RP. The retrospective analysis of patients' records showed significant improvement for the walked distance during the 6MWT (491.8 ± 72.5 vs. 439.4 ± 100.9 m) maintained at 6‐week follow‐up (p = .001), significant improvement for kinesiophobia (p = .033) and the impact of fatigue on activity (p = .01), and significant increase for quality of life with in particular improvements of vitality (p = .001). This retrospective study showed encouraging results of a RP for hEDS patients on functional capacity and quality of life, and prospective studies with long‐term follow‐up are needed to confirm them.

Objectives: We aimed to explore barriers to discussing sexual health with spinal cord injured (SCI) patients as perceived by health care professionals, to determine interest and preferences regarding further education in sexual health, and to assess the perceived need for an inpatient Sexual Health Team. Design: Pre and post surveys were completed by attendees following a 1–2 hour educational session on sexual health and SCI, assessing core elements including participant characteristics, confidence levels, and perceptions towards sexual health counselling and education. Setting: Wascana Rehabilitation Centre, a facility in Regina, SK offering inpatient and outpatient rehabilitation services in Saskatchewan. Participants: Eighty-six participants with a mean age of 39 years took part in this study. Among them, nearly half were nurses. Interventions: Educational sessions on SCI patients’ sexual health. Outcome Measures: Self-administered surveys. Results: Significant differences were observed between pre- and post-session participant responses regarding their confidence levels (P

Objective: The aim of this study was to assess the benefit of using high-intensity interval training for cardiovascular patients undergoing outpatient rehabilitation in a standard short-term (three-week) program in Germany. Design: This is a randomized controlled trial (RCT). Setting: This study was conducted at Cardiowell (Wuppertal, Germany), an outpatient rehabilitation center. Intervention: Patients underwent the typical three-week German outpatient rehabilitation program using either moderate continuous training (i.e. the standard training program) or high-intensity interval training. Main measures: A total of 50 patients of an outpatient rehabilitation center were randomized into two groups. The control group underwent the standard rehabilitation protocol that applied moderate continuous training, and the intervention group trained according to a high-intensity interval protocol. Patients trained on a bicycle ergometer. Peak power output, oxygen uptake parameters, heart frequencies, and blood pressure were compared at the beginning and at the end of the rehabilitation program. Results: After three weeks, the intervention group had improved to a significantly greater extent in maximal performance parameters than the control group: the peak power output (20.9 (±14.1) W; control 8.8 (±10.4) W), maximum oxygen uptake (0.33 (±0.33) L/min; control 0.05 (±0.29) L/min)), relative maximum oxygen uptake (3.4 (±4.2) mL/kg/min; control 0.9 (±3.1) mL/kg/min), and O2 pulse (1.8 (±2.2) mL/heart beat; control 0.35 (±1.7) mL/heart beat). Conclusion: The implementation of high-intensity interval training during a typical three-week German cardiac rehabilitation has the power to increase the outcome for the patients.

Spontaneous spinal epidural hematoma (SSEH) is a neurological condition that can lead to severe deficits if it is not properly diagnosed and surgically evacuated. Due to the rarity of the disease, few cases have been reported, and the etiology poorly understood; however, identifying the risk factors associated with SSEH can allow for both a swift and accurate diagnosis, as well as better health outcomes. Here, we present two cases of SSEH with stroke-like symptoms that occurred in the setting of hypertensive emergency and uncontrolled hypertension (210/112 and 181/117, respectively). MRI confirmed diagnoses of SSEH, and subsequent hemilaminectomies were performed, resulting in significant improvement of neurological function and discharge to outpatient rehabilitation. To the best of the authors’ knowledge, we could only identify few other reports of SSEH attributed to uncontrolled hypertension. Considering that SSEH is an emergent condition requiring rapid diagnosis and surgical treatment, physicians should consider SSEH as a possible differential in hypertensive patients, particularly when presenting with stroke-like symptoms.

This study aims to identify individual determinants of antidepressant treatment and outpatient rehabilitation after stroke. People with ischemic stroke ( N = 303) recruited at 2 inpatient rehabilitation clinics were included into a prospective longitudinal study with follow-up telephone interviews 6 and 12 months later. Participants reported on their use of antidepressant medication and psychotherapy as well as physical, occupational, speech, and neuropsychological therapy. The use of antidepressants at discharge ( n = 65, 23.8%) was predicted by the severity of depressive symptoms, severity of stroke, history of depression, and use of antidepressants at admission (all p < .05, R2= .55). The number of outpatient rehabilitation services used at follow-ups was predicted by higher functional and cognitive impairment, higher education, younger age, severity of depressive symptoms, and lower self-efficacy (all p < .05; R26M = .24, R212M = .49). The relevance of identified determinants for the improvement of treatment rates after stroke is discussed.

Telehealth cardiac rehabilitation (CR) is a feasible and effective alternative to conventional outpatient CR. Present evidence is limited on the comparison of exercise intensity adherence in telehealth and outpatient CR. The purpose of the study was to evaluate and compare training intensity adherence through 12-week phase II CR in telehealth and outpatient CR. A sample of 56 patients with coronary artery disease (CAD) with a mean age of 56.7 ± 7.1 entering comprehensive secondary prevention phase II was randomized into telehealth CR (n = 28) and control outpatient CR (n = 28) groups. The primary outcome was a comparison of training intensity adherence in both CR models and heart rate (HR) response from individual CR sessions, expressed by the HR reserve percentage. As a result, the parameter HR reserve percentage as the total average of the training intensity during the telehealth intervention and the outpatient CR did not differ statistically (p = 0.63). There was no death case, and all severe adverse cases required medical admission throughout an exercise training session in study subjects in both groups. This research evidence demonstrated that the telehealth CR model is similar in training intensities to the conventional outpatient CR in CAD patients with low to moderate cardiovascular risk.

Introduction: Since the emergence of COVID-19 in the UK, it is evident many within this patient group require rehabilitation. The format and effectiveness of exercise for patients that have had COVID-19 remains unclear. As an MDT, we developed a model whereby patients were screened, assessed, and where appropriate, enrolled on a twice weekly programme based on the principles of pulmonary rehabilitation. The one minute sit to stand test (1MSTS) was used as an outcome measure and has been shown to be sensitive to change in PR (Vaidja, 2016). We aimed to determine the effect of this programme on physical fitness using the 1MSTS. Methodology:All patients attending the post COVID-19 rehabilitation service perform a 1MSTS pre and post rehabilitation. We present our data on the differences. Results: Between July 2020 and February 2021 74 Patients completed post COVID-19 rehabilitation (27 male, mean age (SD) = 56 (12). Table 1 shows the difference in 1MSTS scores pre and post rehab programme. Conclusion: When providing a programme based on the principles of pulmonary rehab for patients post COVID-19, there is a highly significant improvement in physical fitness as assessed by the 1MSTS. Reference: Vaidja T et al Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimally clinically important difference in COPD International Journal of Chronic Obstructive Pulmonary Disease 2016; 11: 2609-2616

Aim. To evaluate the program of rehabilitation services for patients with ACS over the last six years in the Krasnoyarsk Region. Methods. Data from the National report on the key performance indicators of the Regional Vascular Centers and Primary Vascular Departments of the Krasnoyarsk Region from 2012 to 2017; National reports on the population health of the Krasnoyarsk Region from 2012 to 2017; reports of the healthcare institutions providing outpatient rehabilitation for patients with ACS in the Krasnoyarsk Region were included in the analysis. Results. Over the past six years the number of patients with ACS decreased in the Krasnoyarsk Region. There were 15,923 patients suffered from ACS in 2012, in 2013 - 13,119, in 2014 - 11,192, in 2015 - 11,019, in 2016 - 10,985, and in 2017 - 9,903. The number of patients with ACS decreased due to the exclusion of patients with unstable angina (UA), while the number of patients with acute myocardial infarction (AMI) remained constant and varied from 5,000 to 5,500 patients. The majority of ACS patients were treated in the Regional Vascular Centers and Primary Vascular Departments where they successfully underwent Phase 1 of the rehabilitation program. At di, all patients were referred to Phase 2 of the rehabilitation program (in-patient) performed in the sanatorium “Yenissei” and “Krasnoyarsk Zagoije”. Phase 3 of the rehabilitation program was provided in the Center of modern cardiology and Professorial Clinic of Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky. The number of ACS patients who underwent rehabilitation after hospital discharge increased over the last years: 5.9% - in 2012, 8.8% - in 2013, 11.9% - in 2014, 13.1% - in 2015, 14.4% - in 2016, 17.1% in 2017. Conclusion. The majority of patients with acute coronary syndrome (76.4-81.2%) underwent Phase 1 (early in-patient) rehabilitation in the Regional Vascular Centers and Primary Vascular Departments. The number of ACS patients who underwent Phase 2 rehabilitation had been increasing annually. Over the past 6 years the percentage of patients had increased from 5.9% to 17.1%. However, only one-sixth of patients with ACS underwent Phase 3 rehabilitation after hospital discharge. Therefore, the improvements in the management of Phase 2 (in-patient) and Phase 3 the (outpatient) through the integration with the regional hospitals of the Krasnoyarsk Region, increase in the numbers of government contracts in Krasnoyarsk, and formation of the reliable continuity between Phase 2 and Phase rehabilitation are required.

The main and generally accepted method of surgical treatment of arthrosis of hip joint is considered to be total arthroplasty. As a result, patient gets rid of pain, motor activity increases, more mobility and sociability are added. The surgical approaches (types of implants, operative approaches) and rehabilitation approaches (centers of specialized rehabilitation, outpatient rehabilitation clinics) are being improved. However, despite positive dynamics of improving quality of life, there is a group of patients of able-bodied age who have no satisfaction with surgery results.

This study aims to investigate the association of patient-reported improvement and rehabilitation characteristics with mortality among older adults who received rehabilitation. To do so, a national sample of Medicare beneficiaries from the National Health and Aging Trends Study was examined. Among those who reported receiving rehabilitation services in the 2015 interview (N = 1,188), 4.2% were deceased at the 2016 follow-up interview. Mortality was more common among those who had received rehabilitation in nursing home or inpatient and in-home settings compared to outpatient rehabilitation settings. In multivariable analyses accounting for demographics and health status, patient-reported worsening of functioning during rehabilitation (OR=15.69; 95% CI: 1.84–133.45) and cardiovascular disease (OR=4.15; 95% CI: 1.41–12.17) were associated with mortality. Among older adults who received rehabilitation, 1 in 25 were deceased at follow-up. That patient-reported functioning is associated with mortality suggests that more systematically including patient-reported outcomes in rehabilitation care may be clinically pertinent.

Background and purpose Prolonged sedentary time and limited physical activity can result in deleterious effects on health and mobility, especially for older adults with fall-related hip fracture. Therefore, the purpose of this study was to examine the effect of a multidisciplinary clinic on sedentary behavior and physical activity (prespecified secondary outcomes) and provide descriptions of activity patterns over 1 year for men and women. Methods We conducted a parallel-group, single-blinded randomized controlled trial comparing a multidisciplinary clinic and usual care (intervention) with usual care (control). We recruited 53 community-dwelling older adults aged 65+ years who were 3 to 12 months postfracture and collected data at baseline, 6, and 12 months; study staff were blinded to group allocation. The clinic included a geriatric assessment by the geriatrician, physiotherapist, and occupational therapist. Referrals were made to other professionals, when indicated. We collected the accelerometer-measured sedentary behavior and physical activity at 3 time points. We used linear mixed-effects models to compare groups at 6 and 12 months and mixed models to compare outcomes between men and women. Results Participants were sedentary for more than 10 hours of a 13-hour day, and there were no significant differences between the study groups at 6 months (2.4 [95% confidence interval: -22.4 to 27.2] minutes) or 12 months (-3.7 [95% confidence interval: -33.6 to 26.1] minutes). Compared with women, men spent 47.2 min/d more in sedentary time (P = .052) and 43.8 min/d less in light physical activity (P = .047). Discussion Older adults after hip fracture spend prolonged periods of waking hours sedentary with very little activity.

Objective: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. Design: Observational study. Setting: A metropolitan rehabilitation hospital. Subjects: Adults ( n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. Interventions: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. Main measures: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). Results: The Fitbit significantly ( P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly ( P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). Conclusions: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers.

This study was a sub-analysis of 20 consecutive elderly participants who underwent outpatient rehabilitation at a geriatric health services facility from January 2020 to the end of May 2020, based on our previous report. This study aimed to evaluate the longitudinal changes in their physical and psychological states with respect to gender in rehabilitation outpatients between the pre-nationwide (T1) and post-nationwide state of emergency (T2) caused by the Coronavirus disease 2019 (COVID-19). Gait speed (GS), timed up and go (TUG), handgrip strength (HG), and maximum phonation time (MPT) were measured as indices of physical status. The Japanese version of the Apathy Scale and five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) were used to assess the psychological state. Both states were measured in the male and female groups at T1 and T2 and then were compared. The final analysis was comprised of 13 outpatients. In males, the physical (GS, p = 0.463; TUG, p = 0.600; HG, p = 0.753; and MPT, p = 0.249) and psychological (Apathy Scale, p = 0.891 and EQ-5D-5L, p = 0.249) states did not change significantly between T1 and T2. In the females, the physical (GS, p = 0.600; TUG, p = 0.735; HG, p = 1.000; and MPT, p = 0.310) and psychological (Apathy Scale, p = 0.588 and EQ-5D-5L, p = 0.176) states also did not show significant change between T1 and T2. In both sexes, the continuance of outpatient rehabilitation might be recommended as one activity that can maintain physical and psychological states during a COVID-19-related state of emergency.

Purpose To understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA), and to describe potential barriers and opportunities for shared decision making (SDM) in this setting. Methods A qualitative study examined the beliefs, thoughts, and experiences of patients and physical therapists regarding decision making in outpatient rehabilitation after TKA. Semi-structured interviews were conducted and analysed using directed content analysis. Results Thirty-five participants were interviewed (20 patients, 15 physical therapists). Three main themes emerged from the data: (1) there is variability among physical therapists in how patients are involved in care decisions, (2) several features of the outpatient care paradigm are not supportive of SDM, and (3) preoperative patient-clinician interactions may facilitate SDM in postoperative rehabilitation, but these interactions are not typically utilized. Conclusion Physical therapists described using decision-making strategies with varying levels of patient involvement. Both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. Several actionable strategies for overcoming these barriers were identified for providers and organizations seeking to consistently use SDM in outpatient TKA rehabilitation.

Development of IT enhanced services in health care delivery is one of recent trends with proven benefits for increased quality of care and patient support. However, person-centred care (PCC) concept is focused on meeting personal requirements of individuals and establishing joint cooperation with doctors, family members and friends, all aimed on increasing efficiency of the treatment plan. This paper presents novel IT enhanced services for stroke outpatient rehabilitation process; developed by following proven concepts of model-driven development and integration of quantifiable non-functional requirements, thus enabling predictability and optimal treatment planning.

BACKGROUND: Intensive, multi-disciplinary, rehabilitation programs for patients with Parkinson’s disease (PWPs) have shown to be effective. However, most programs are based on in-patient service, which is expensive. OBJECTIVE: To demonstrate the feasibility of a multidisciplinary, intensive, outpatient rehabilitation program (MIOR) for moderate to advanced Parkinson’s Disease (H&Y≥2). METHOD: The MIOR program takes place at a community rehabilitation center (‘Ezra Le’Marpe’), 3 times a week, 5 hours, 8 weeks, and includes 20 PWPs in each cycle. The multi-disciplinary team includes physical, occupational, speech and hydro therapists. Additional activities include, social work groups, boxing, dancing and bridge. RESULTS: Data was collected retroactively for the first two years. Data analysis includes 158 patient files who completed the program (mean disease duration 10.1±6 and mean H&Y stage 2.8±0.67). Assessments were performed at the beginning and end of the intervention. Positive results were collected: improvement in number of falls (p

Objective To measure progress towards introducing a 3-phase rehabilitation programme, based on the multidisciplinary approach, for patients with cardiovascular diseases. Methods Seventeen hospital and outpatient medical centres from 13 regions of the Russian Federation participated in a pilot rehabilitation project. Baseline questionnaires assessed the involvement of multidisciplinary teams, staffing, and the equipment in healthcare facilities. These questionnaires covered 3 rehabilitation phases: inpatient rehabilitation in the intensive care units and departments of myocardial infarction/cardiac surgery; early in-hospital rehabilitation; and outpatient rehabilitation. Results The pilot project was initiated in 2013. At the 5-year follow-up, phase I was established across all 17 sites, phase II at 13 sites, and phase III at 9 sites. By 2017, multidisciplinary teams were deployed to manage patients at all sites. Early rehabilitation in regional vascular centres, reduced patients' stay from 13.7 (2.1) days in 2013 to 7.6 (1.1) days in 2017. Conclusion Despite successful implementation of the 3-phase rehabilitation programme based on the multidisciplinary approach, further improvement is required, with the main focus shifted to patients routing between healthcare facilities. Particular attention should be paid to the standards for providing phase III cardiac rehabilitation, in order to ensure continuity of cardiac rehabilitation. The next step should include assessment of the effectiveness of the implemented cardiac rehabilitation programme and its translation to other regions of the country.

Introduction: While rehabilitation has been demonstrated to be effective in improving outcomes of stroke, uptake of outpatient rehabilitation services (ORS) in Singapore remains relatively low. This study aims to determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense). Hypothesis: It was hypothesized that the uptake rate of ORS over 3 months, number of sessions attended, and time to discontinuation would be greater for participants in the intervention arms of which barriers of transportation and out-of-pocket costs are addressed, as compared to participants in the control arm. Methods: A total of 266 participants were recruited from the stroke and acute rehabilitation units of two tertiary hospitals in Singapore, and randomized to one of three study arms: the control arm, denoted Education ( E ), inclusive of a stroke rehabilitation educational program; the first intervention arm, denoted Transportation Incentives ( T ), inclusive of free transportation services for the first 3 months post-discharge; or the second intervention arm, denoted, Transportation & Sessions Incentives ( T&S ), inclusive of up to 3 months of both free transportation and no out-of-pocket costs for participants’ stroke ORS. Results: The uptake rate of ORS was 73.0% for E (CI, 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). The differences of T and T&S versus the control arm ( E ) were not statistically significant (p = 0.22 and p = 0.10, respectively). However, the average number of rehabilitation sessions attended were significantly higher in both the intervention arms: 5.50 (SD, 7.65) for T and 7.51 (SD, 9.52) for T&S versus 3.26 (SD, 4.22) for the control arm ( E ) (p-value for T vs E = 0.017; p-value for T&S vs E = 0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029). Conclusions: This study has demonstrated that incentives can improve utilization of ORS. Such incentives should be considered in finance policy, such as care bundling, for stroke or similar common conditions.

Improving participation is an important aim in outpatient rehabilitation treatment. Knowledge regarding participation restrictions in children and young adults with acquired brain injury (ABI) is scarce and little is known regarding the differences in perspectives between patients and parents in the outpatient rehabilitation setting. The aims are to describe participation restrictions among children/young adults (5–24 years) with ABI and investigating differences between patients’ and parents’ perspectives. At admission in 10 rehabilitation centers, patients and parents were asked to complete the Child and Adolescent Scale of Participation (CASP, score 0–100, lower score = more restrictions) and injury/patient/family-related questions. CASP scores were categorized (full/somewhat-limited/limited/very-limited participation). Patient/parent-reported outcomes were compared using the Wilcoxon signed-rank test. 223 patients and 245 parents participated (209 paired-samples). Median patients’ age was 14 years (IQR, 11–16), 135 were female (52%), 195 had traumatic brain injury (75%). The median CASP score reported by patients was 82.5 (IQR: 67.5–90) and by parents 91.3 (IQR: 80.0–97.5) (difference = p &lt, 0.05). The score of 58 patients (26%) and 25 parents (10%) was classified as ‘very-limited’. Twenty-six percent of children and young adults referred for rehabilitation after ABI had ”very-limited” participation. Overall, parents rated their child’s participation better than patients themselves. Quantifying participation restrictions after ABI and considering both perspectives is important for outpatient rehabilitation treatment.

Background The New York State (NYS) Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) was launched in 2015 to determine the most appropriate level of care for individuals seeking addiction treatment. However, research has not studied its predictive validity. We examined the predictive validity of the LOCADTR recommendation for outpatient treatment by determining whether those who entered a level of care (LOC) concordant with the LOCADTR recommendation differed in continuous engagement in treatment compared to those who entered a discordant LOC. Methods The study combined data from two NYS administrative sources, the LOCADTR database and a treatment registry. The study examined characteristics of the clients who entered concordant and discordant LOCs as well as tested for differences in continuous engagement of clients who entered discordant care compared to a propensity score-matched comparison group of clients who entered the concordant LOC. Results Among clients for whom the LOCADTR recommended the outpatient LOC, concordant clients who entered the outpatient LOC were more likely to be retained in care than discordant clients who entered the inpatient LOC (aOR = 0.53; 95% CI = 0.36, 0.77). We did not observe statistical differences in continuous engagement among clients who were recommended for outpatient and entered that LOC versus those who entered the outpatient rehabilitation LOC instead (aOR = 1.08; 95% CI = 0.90, 1.30). Conclusion This study provides support for predictive validity of recommendations stemming from the LOCADTR. Clients, treatment providers, and payers benefited from a tool that provides clear guidance and predictively valid recommendations for treatment placement. The study found that clients were more likely to be retained in treatment for 6 months or longer if admitted to outpatient care, as recommended by the LOCADTR algorithm, rather than to inpatient treatment. One factor accounting for the longer engagement in outpatient care is the low level of continuity of care among patients being discharged from inpatient treatment.

Background One of the main aims of rehabilitation is to improve participation. Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks ‘Ability to Participate in Social roles and Activities, (PROMIS-APS) and ‘Satisfaction with Social Roles and Activities’ (PROMIS-SPS) are promising options to measure participation, but the literature on PROMIS measures of (satisfaction with) participation across diagnoses in rehabilitation is limited. Therefore, the objective of this study was to describe levels of and changes in participation, as assessed with the PROMIS-APS and the PROMIS-SPS short forms, of patients in outpatient rehabilitation. Methods This study had quantitative, observational design with assessments at admission and discharge. Consecutive patients treated between April and August 2018 receiving outpatient multidisciplinary rehabilitation were the population of this study. The following diagnosis categories were included: brain injury (e.g. stroke), spinal cord and nerve injury, neuromuscular disorder (e.g. lateral sclerosis), amputation, musculoskeletal condition (e.g. osteoarthritis) or heart or lung disease (e.g. myocardial infarction, chronic obstructive pulmonary disease). The main patient-reported outcomes (PRO) of this study were the short form of the PROMIS-APS (8 items, Dutch general population reference score 50.6 [SD 9.5]), and PROMIS-SPS (8 items, Dutch general population reference score 47.5 [SD 8.3]. Results Of the 1279 patients invited, 777 (61%) completed the online forms at admission. Of those, 329 patients were invited at discharge, with 209 (64%) completing the forms. The mean (SD) T-scores of the PROMIS-APS and PROMIS-SPS were lower at admission (42.7 [SD 7.4]; (41.4 [SD 7.7]) and discharge (43.6 [SD 7.2]; (43.7 [SD 7.8]) than the Dutch general population. The change scores of the PROMIS-APS and PROMIS-SPS were 1.2 (95% CI 0.4–1.9; p = 0.004; effect size 0.16), and 2.4 (95% CI 1.6–3.2; p 30 paired measurements statistically significant improvements of PROMIS-APS, PROMIS-SPS or both were seen. Conclusions Patients undergoing outpatient rehabilitation had, both at admission and discharge, considerably lower PROMIS-APS and PROMIS-SPS T-scores short forms than the general Dutch population, and showed small T-score improvements at discharge.

Rehabilitation clinicians need information about patient activities in the home/community to inform care. Despite active efforts to develop technologies that can meet this need, clinicians' perspectives regarding how information is collected and used in outpatient rehabilitation have not been comprehensively described. Therefore, we aimed to describe: (1) what data pertaining to a patient's health, function and activity in their home/community are currently collected in outpatient rehabilitation, (2) how these data can impact clinical decisions, and (3) what challenges clinicians encounter when they manage the care of outpatients based on this information.Eight clinicians working in outpatient rehabilitation programs completed qualitative interviews that were analyzed using an inductive thematic analysis.Four themes were identified: "Nature of data about a patient's health, function and activity in the home/community and how it is collected by clinicians," "Value of data from the home/community," "Perceived drawbacks of current data collection methods," and "Improving data collection to understand patient trajectory."Clinicians described the importance of understanding patient activities in the home/community, but perspectives varied regarding the suitability of current methods. These perceptions may inform the design of solutions to bridge the gap between the clinic and the community in outpatient rehabilitation.Implications for rehabilitationClinical decision-making in outpatient rehabilitation is guided by verbal and written reports about a patient's health and function in the community and adherence to treatment plans.Differing perceptions on the suitability of current data collection methods indicate that the development of new solutions, such as rehabilitation technologies, needs to carefully consider clinician workflows and what data are perceived as meaningful.Potentially impactful directions for new solutions include providing well validated data on adherence, movement quality, or longitudinal progression, presented in formats that match clinical decision criteria.

Objectives: To estimate the prevalence of dual motor disability and to identify social, demographic, clinical and rehabilitation-related characteristics. Methods: Retrospective descriptive study in an outpatient rehabilitation center with individuals with dual motor disability from major lower limb amputation associated to post-stroke hemiparesis. Social demographic, clinical and rehabilitation characteristics data were collected from medical record. Results: The prevalence of dual motor disability was 5.4%. Seventy-six subjects were evaluated, 69.7% were male, with a mean age of 65.6 ± 9.3 years. Hypertension was present in 96.1% of subjects, and 25% were smokers. Over 73% of patients had had the stroke prior to amputation. Time elapsed between lesions had a median of 23 months, and sequelae were ipsilateral in 51.3% of patients. Of these, 54 patients (71%) were referred to physical therapy. The time interval between dual disability and the beginning of therapy was 28 months, with total rehabilitation time of 14.3 months. At rehabilitation completion, 36% achieved their goals but 30% were discharges consequent to lack of compliance. Conclusion: The prevalence of dual motor disability due to hemiparesis secondary to stroke and lower limb amputation in a rehabilitation center was 5.4%. Our population showed singular characteristics related to the rehabilitation process, such as a long time between the occurrence of dual disability and the beginning of rehabilitation, and long rehabilitation period.

Transcranial direct current stimulation (tDCS) has strong potential for outpatient clinical use, but feasibility and safety of tDCS has only been evaluated in laboratory and inpatient clinical settings. The objective of this study was to assess feasibility and safety of tDCS for stroke in an outpatient clinical setting. Individuals with stroke in outpatient therapy received tDCS during physical therapy sessions. Feasibility was assessed with screening, enrollment, withdrawal, and adherence numbers, tDCS impressions, and perceived benefits and detriments of tDCS. Acute changes in fatigue and self-reported function and pre-post changes in fatigue were also assessed. Safety was assessed as adverse events and side effects. In total, 85 individuals were screened, and 10 were enrolled. Most exclusions were unrelated to clinical feasibility. In total, 3 participants withdrew, so 7 participants completed 2 sessions/week for 5&ndash, 6 weeks with 100% adherence. In total, 71% reported positive impressions of tDCS. tDCS setup decreased to 5&ndash, 7 min at end of study. There was one adverse event unrelated to tDCS. Mild to moderate side effects (tingling, itching, pinching, and fatigue) were experienced. In total, 86% of participants recounted benefits of tDCS. There were acute improvements in function and energy. Results support the feasibility and safety of tDCS in an outpatient clinical setting.

Purpose of ReviewThis systematic review aimed to determine the effects of interdisciplinary/multidisciplinary outpatient rehabilitation programmes by looking at physical, psychosocial and return to work status of adult cancer patients.Recent FindingsThere is growing evidence that emphasizes the importance of interdisciplinary/multidisciplinary rehabilitation especially in outpatient care, which addresses the complex and individual needs of cancer patients. Many studies focus on measuring the effect of individual rehabilitation interventions.SummaryRandomized controlled trials (RCTs) and before-after studies examining the effects of interdisciplinary/multidisciplinary outpatient rehabilitation programmes were included in this systematic review. The electronic literature search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and PEDro. The PICO statement was used for selection of the studies. Six randomized controlled trials and six before-after studies were included. Interdisciplinary/multidisciplinary outpatient cancer rehabilitation programmes improved physical and/or psychosocial status of cancer patients. However, non-significant changes in a variety of single physical and psychosocial measures were also common.The findings of the systematic review indicate that interdisciplinary/multidisciplinary outpatient cancer rehabilitation can improve cancer patients’ physical and psychosocial status. This review is limited by the narrative approach due to the heterogeneity of outcome measures. To evaluate effects of rehabilitation, better comparable studies are necessary. Further research is needed in regard to long-term outcomes, effects on return to work status and on the associations depending on cancer type.

Objective The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales. Methods Cross-sectional study of patients 18 years and older presenting to 1 of 8 outpatient rehabilitation clinics in southwestern Pennsylvania. Patients completed one survey with questions from the AM-PAC Daily Activity and Mobility short forms, and the PROMIS PF item bank. Using item response theory, 2 rounds of fixed-parameter calibration were performed. In the first, the AM-PAC Daily Activity and Mobility items were calibrated with 27 fixed item parameters from the PROMIS PF. Second, the AM-PAC Daily Activity items were calibrated with 11 PROMIS Upper Extremity fixed item parameters. This process uses the construct of physical function and equates AM-PAC items on the same underlying measurement scale for the PROMIS PF. Results Both scales measured a wide range of functioning and demonstrated good calibration. Data were appropriate for a fixed-parameter item response theory-based crosswalk. AM-PAC Daily Activity and Mobility raw scores were mapped onto the PROMIS PF metric. AM-PAC Daily Activity scores were also mapped onto the PROMIS PF Upper Extremity metric. Conclusion Question items from the AM-PAC Daily Activity, AM-PAC Mobility, and PROMIS PF similarly measure the construct of physical function. This consistency allows for a crosswalk of AM-PAC scores onto the PROMIS PF metric. Impact Crosswalk tables developed in this study allow for converting scores from the AM-PAC Daily Activity and Mobility scales to the PROMIS PF metric. This will facilitate monitoring of longitudinal change in function over time and across settings.

Introduction. As a result of involution processes and diseases, changes occur in the human body, as a result of which, psychophysical fitness declines with age. Comprehensive rehabilitation is the way of improving and maintaining health condition, including, among others, the appropriate level of physical activity and the quality of affective functioning. This type of program was carried out as part of the Outpatient Healthcare Home (DDOM) at the Witold Chodźko Institute of Rural Health in Lublin. Aim. The objective of the present study was to assess the impact of comprehensive ambulatory rehabilitation, including tailored endurance training preceded by an ergospirometry test, on indicators demonstrating the level of involvement in daily physical activities and the severity of depressive symptoms of patients over 60 years of age receiving health services at DDOM. Material and methods. The study involved 60 seniors participating in the rehabilitation cycle implemented as part of the services provided to patients at DDOM of the Witold Chodźko Institute of Rural Health in Lublin. The tests were carried out in the test-retest model on the first and last day of the kinesiotherapy cycle. The tests were performed with use of International Physical Activity Questionnaire IPAQ and Geriatric Depression Scale GDS. The patient rehabilitation program included adapted systemic kinesiotherapy (endurance training with a load determined according to individual exercise capacity, as determined on the basis of the ergospirometry test) and local kinesiotherapy and physical therapy adapted to the needs resulting from the condition of the musculoskeletal system. Results. After the completion of the rehabilitation cycle we compared the tests carried out before it, and the patients received higher scores in the scales of IPAQ questionnaire for measuring weekly, intensive and mode-rate physical activity and time required for walking and were less likely to spend their time sitting or lying down. There were also lower scores of the respondents in GDS scale used to assess the severity of depressive symptoms. Conclusions. As a result of the rehabilitation program applied, DDOM patients simultaneously obtained the desired changes in the level of involvement in physical activity and minimization of the intensity of depressive symptoms.

Purpose: We compared walking in hospital and on discharge from in-patient geriatric rehabilitation. Method: Participants included 28 adults (22 women) with a mean age of 85.4 (SD 6.8) years, ambulating independently with planned discharge to the community. Steps per day, short and long walking bouts, and cadence (steps per minute) were measured using an ActiGraph GT3X+ activity monitor (5 d in hospital, 5 d at home). Results: Steps per day did not differ between hospital and home (median difference=401; 95% CI: −364, 1,215; p=0.10). Long walking bouts (≥5 min) were infrequent in both locations (1/d) but lasted longer in hospital. Short walking bouts (≥15 s) were more frequent and shorter at home. Daily peak 1-minute cadence and peak 30-minute cadence were greater in hospital. Conclusions: Older adults in geriatric rehabilitation take longer walks and walk at faster paces in hospital, and they engage in more frequent, shorter walks at home. Although further research is needed, older adults would benefit from the opportunity to walk at different paces and different distances on discharge. Outpatient rehabilitation or other community-based programmes and initiatives may provide these experiences and appropriate environments to enable individuals to maintain mobility and independent functioning in the long term.

BACKGROUND: Over recent years there has been a paradigm shift towards a patient-centred biopsychosocial care model in physical therapy. This new paradigm features a growing interest in understanding the contextual factors that influence the patient's experience of disease, pain and recovery. This includes generalized consensus regarding the importance of establishing a therapeutic relationship that is centred on the patient. OBJECTIVE: To explore physical therapists’ perceptions and experiences regarding barriers and facilitators of therapeutic patient-centred relationships in outpatient rehabilitation settings. METHODS: This is a qualitative study with four focus groups including twenty-one physical therapists. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audiotaped and videotaped, transcribed verbatim and analysed thematically using a modified grounded theory approach. RESULTS: Physical therapists perceived that the therapeutic patient-centred relationship not only depends on the personal qualities of the professional, but also on the patient's attitudes and the characteristics of the context, including the organization and team coordination. CONCLUSIONS: Although being more linked towards the patients’ contextual factors and needs than towards the practice of the profession, a therapeutic relationship is worth considering by physical therapists. Furthermore this study highlights the need for physical therapists and administrators to rethink the situation and propose strategies for improvement.

To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense).Three-arm randomized controlled trial.Stroke units of 2 Singapore tertiary hospitals.Singaporeans or permanent residents 21 years or older who were diagnosed as having stroke and were discharged home with physician's recommendation to continue outpatient rehabilitation (N=266).A Transportation Incentives arm (T), which provides free transportation services, a TransportationSessions Incentives arm (TS), offering free transportation and prescribed stroke rehabilitation sessions, and a control arm, Education (E), consisting of a stroke rehabilitation educational program.The primary study outcome was uptake of outpatient rehabilitation services (ORS) among patients poststroke and key predefined secondary outcomes being number of sessions attended and adherence to prescribed sessions.Uptake rate of ORS was 73.0% for E (confidence interval [CI], 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for TS (CI, 76.7%-91.8%). Differences of T and TS vs E were not statistically significant (P=.22 and P=.10, respectively). However, average number of rehabilitation sessions attended were significantly higher in both intervention arms: 5.50±7.65 for T and 7.51±9.52 for TS vs 3.26±4.22 for control arm (E) (T vs E: P=.017; TS vs E: P.001). Kaplan-Meier analysis indicated that persistence was higher for TS compared with E (P=.029).This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing survivors of stroke to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services.