Community service rehabilitation therapists' understanding of social accountability.

BACKGROUND:  Social accountability is the obligation of health care providers to address the priority health concerns of the community they serve and of universities to ensure that graduates understand these social responsibilities. Although social accountability can combat systemic health inefficiencies, it is not well-understood or practised. AIM:  The study aimed to explore community service rehabilitation therapists' understanding of social accountability. SETTING:  The study was conducted in KwaZulu-Natal, South Africa. METHODS:  This study used an interpretive exploratory design and purposively recruited 27 community service rehabilitation therapists namely, audiologists, speech-language therapists, occupational therapists, and physiotherapists working in public sector health facilities in rural and peri-urban areas. Four focus group discussions and four free attitude interviews were conducted, the results being thematically analysed. RESULTS:  Despite most of the participants not being instructed in social accountability as part of their formal training or institutional induction, three themes emerged based on their experiences. These themes include describing social accountability, values of social accountability, and values of community-based rehabilitation applicable to social accountability. CONCLUSION:  Inclusion of instruction on social accountability as part of their formal training and health facility induction would contribute to rehabilitation therapists' understanding of social accountability.Contribution: The study contributes to data on rehabilitation education and community service training regarding social accountability within a South African context and has captured how experiences gained during community service contribute to the rehabilitation therapists' understanding of social accountability.

Are healthy ageing trajectories suitable to identify rehabilitation needs of the ageing population? An exploratory study using ATHLOS cohort data.

BACKGROUND: The ageing process is highly heterogeneous leading to diverse ageing trajectories. Such trajectories have been modelled to study trends and determinants of ageing and could potentially be used to inform the planning of rehabilitation services at population level. The objective of this paper was to explore whether healthy ageing trajectories are suitable to identify targets for rehabilitation interventions for the ageing population. METHODS: Data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) harmonized cohort and the English Longitudinal Study of Ageing (ELSA), which is included in ATHLOS, were used. Growth mixture models were implemented to replicate healthy ageing trajectories modelled elsewhere as 'high stable', 'low stable', and 'rapid decline'. Regularized partial correlation networks were used to estimate expected-influence and bridge expected-influence centrality measures. RESULTS: Healthy ageing trajectories modelled with ATHLOS (N = 131116) and ELSA (N = 14904) were consistent with previous work. At the first individual wave, prevalence of problems of respondents in the 'high stable' and 'rapid decline' trajectories were comparable; at the last individual wave, prevalence remained similar for the 'high stable' but increased substantially in all domains for the 'rapid decline' trajectory. Expected-influence centrality measures provided different results than prevalence estimates. For instance, in the first individual wave mobility and carrying, moving, and handling objects had highest impact on overall functioning for the 'rapid decline' and 'high stable' trajectories, while the most prevalent functioning problems concerned cognition, pain, as well as energy and drive functions. CONCLUSIONS: Our study stressed the relevance of healthy ageing trajectories for identifying functioning domains and categories that need to be targeted by rehabilitation services in a heterogeneous ageing population. The use of such trajectories at country level has the potential to make a meaningful contribution to the planning and delivery of rehabilitation interventions through health systems and to informed policy making.

[Contribution of physical and rehabilitation medicine to primary care medicine]. / Apport de la médecine physique et de réadaptation à la médecine de premier recours.

Physical and rehabilitation medicine (PRM) is an independent medical specialty, little known in Switzerland. This specialty, strongly linked to the holistic approach of the International Classification of Functioning, will be increasingly solicited by the epidemiology of disability and the imperatives of "ageing better". Its skills in prescribing human and material resources for rehabilitation provide added value in terms of loss of autonomy. Based on a biopsychosocial model, PRM has a high role to play in prevention and primary healthcare, as well as in the management and prevention of the consequences of functionally limiting diseases. There are, however, financial (pricing) and demographic (lack of representation) obstacles to effective action on behalf of the population and the healthcare system.

La médecine physique et de réadaptation (MPR), discipline indépendante, est peu connue en Suisse. Cette spécialité, liée à l'approche holistique de la classification internationale du fonctionnement, sera de plus en plus sollicitée par l'épidémiologie du handicap et les impératifs du « vieillir mieux ¼. Ses compétences de prescription des moyens humains et matériels en réadaptation apportent une plus-value sur la perte d'autonomie. Basée sur un modèle biopsychosocial, la MPR trouve sa place dans la prévention et les soins de santé primaires ainsi que dans la prise en charge et la prévention des conséquences des maladies induisant une limitation fonctionnelle. Il existe toutefois des obstacles financiers (tarification) et démographiques (insuffisance de représentation) pour une action efficace au service de la population et du système de santé.

Evidence of community health workers' delivery of physical rehabilitation services in sub-Saharan Africa: a scoping review.

OBJECTIVES: To map the evidence and scope of physical rehabilitation services delivered by community health workers (CHWs) in sub-Saharan Africa (SSA). DESIGN: Scoping review DATA SOURCES: PubMed, Scopus, Cochrane Central and databases within the EBSCOhost platform. We also searched other literature sources including reference lists, conference presentations and organisational websites such as WHO, Ministries of Health and non-governmental organisations in SSA. ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES: Articles presenting evidence on CHWs' delivery of physical rehabilitation services in SSA from September 1978 to June 2023. DATA EXTRACTION AND SYNTHESIS: Screening was conducted by two reviewers and was guided by the inclusion criteria. Thematic content analysis of data was employed. The results are presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews. RESULTS: A total of 6996 articles were identified through various databases, with only 20 studies qualifying for data extraction. Evidence was presented by Eritrea, Ethiopia, Malawi, Mauritius, Namibia, South Africa and Uganda. Assessments, case management, health education, community liaison with support, health systems linkage and administration were the CHWs' scope of practice identified. The review identified home-based, community-based, community and facility-based, home and community-based and facility-based as modes of delivery. The barriers experienced are resources, societal and community attitudes, governance, geographical barriers and delivery capacity, while proximity to the community, positive job attitude and support with collaboration facilitated service delivery. CONCLUSION: Training and integrating CHWs in national health care systems, with careful selection of existing CHWs, would minimise the barriers faced.

Effectiveness of Intelligent Control Strategies in Robot-Assisted Rehabilitation-A Systematic Review.

This review aims to provide a systematic analysis of the literature focused on the use of intelligent control systems in robotics for physical rehabilitation, identifying trends in recent research and comparing the effectiveness of intelligence used in control, with the aim of determining important factors in robot-assisted rehabilitation and how intelligent controller design can improve them. Seven electronic research databases were searched for articles published in the years 2015 - 2022 with articles selected based on relevance to the subject area of intelligent control systems in rehabilitation robotics. It was found that the most common use of intelligent algorithms for control is improving traditional control strategies with optimization and learning techniques. Intelligent algorithms are also commonly used in sensor output mapping, model construction, and for various data learning purposes. Experimental results show that intelligent controllers consistently outperform non-intelligent controllers in terms of transparency, tracking accuracy, and adaptability. Active participation of the patients and lowered interaction forces are consistently mentioned as important factors in improving the rehabilitation outcome as well as the patient experience. However, there are limited examples of studies presenting experimental results with impaired participants suffering limited range of motion, so the effectiveness of therapy provided by these systems is often difficult to quantify. A lack of universal evaluation criteria also makes it difficult to compare control systems outside of articles which use their own comparison criteria.

An Expert-Knowledge-Based Graph Convolutional Network for Skeleton- Based Physical Rehabilitation Exercises Assessment.

Physical therapists play a crucial role in guiding patients through effective and safe rehabilitation processes according to medical guidelines. However, due to the therapist-patient imbalance, it is neither economical nor feasible for therapists to provide guidance to every patient during recovery sessions. Automated assessment of physical rehabilitation can help with this problem, but accurately quantifying patients' training movements and providing meaningful feedback poses a challenge. In this paper, an Expert-knowledge-based Graph Convolutional approach is proposed to automate the assessment of the quality of physical rehabilitation exercises. This approach utilizes experts' knowledge to improve the spatial feature extraction ability of the Graph Convolutional module and a Gated pooling module for feature aggregation. Additionally, a Transformer module is employed to capture long-range temporal dependencies in the movements. The attention scores and weight matrix obtained through this approach can serve as interpretability tools to help therapists understand the assessment model and assist patients in improving their exercises. The effectiveness of the proposed method is verified on the KIMORE dataset, achieving state-of-the-art performance compared to existing models. Experimental results also illustrate the interpretability of the method in both spatial and temporal dimensions.

Impact of the health policy for interdisciplinary collaborative rehabilitation practices in intensive care units: A difference-in-differences analysis in Japan.

BACKGROUND: Early rehabilitation in intensive care units (ICUs) may be beneficial but is not routinely performed for adults with critical illness. In April 2018, the Japanese government introduced a health policy to provide financial incentives to hospitals that met the requirements of interdisciplinary collaboration and had teams specialized in ICU rehabilitation practices. OBJECTIVES: The present study aimed to investigate whether the health policy is associated with improved clinical practices of ICU rehabilitation. METHODS: Using a nationwide administrative inpatient database and hospital statistics data from Japan, we identified hospitals that admitted adult patients to the ICU within two days of hospital admission from April 2016 to March 2019. Using hospital-level propensity score matching, we created matched cohorts of 101,203 patients from 108 intervention hospitals that introduced the health policy, and 106,703 patients from 108 control hospitals that did not. We then conducted patient-level difference-in-differences analyses to examine changes in the percentage of patients from the intervention and control hospitals, who underwent early ICU rehabilitation within two days of ICU admission before and after the implementation of the health policy. RESULTS: In the intervention group, patients undergoing early ICU rehabilitation increased from 10% and 36% after the policy implementation. In the control group, it increased from 11% to 13%. The difference-in-difference in the percentage of patients who underwent early ICU rehabilitation between the two groups was 24% (95% confidence interval, 19%-29%). CONCLUSIONS: Early ICU rehabilitation can be facilitated by financial incentives for hospitals that engage in interdisciplinary collaboration with specialist teams. IMPLICATIONS FOR CLINICAL PRACTICE: Our Findings are relevant for hospital administrators, professional organizations, and policymakers in other nations considering strategies to support the additional deployment burdens of early ICU rehabilitation. Future studies need to explore the long-term effects and sustainability of the observed improvements in ICU rehabilitation practices.

Unlocking the Black Box? A Comprehensive Exploration of Large Language Models in Rehabilitation.

ABSTRACT: Rehabilitation is a vital component of health care, aiming to restore function and improve the well-being of individuals with disabilities or injuries. Nevertheless, the rehabilitation process is often likened to a " black box ," with complexities that pose challenges for comprehensive analysis and optimization. The emergence of large language models offers promising solutions to better understand this " black box ." Large language models excel at comprehending and generating human-like text, making them valuable in the healthcare sector. In rehabilitation, healthcare professionals must integrate a wide range of data to create effective treatment plans, akin to selecting the best ingredients for the " black box. " Large language models enhance data integration, communication, assessment, and prediction.This article delves into the ground-breaking use of large language models as a tool to further understand the rehabilitation process. Large language models address current rehabilitation issues, including data bias, contextual comprehension, and ethical concerns. Collaboration with healthcare experts and rigorous validation is crucial when deploying large language models. Integrating large language models into rehabilitation yields insights into this intricate process, enhancing data-driven decision making, refining clinical practices, and predicting rehabilitation outcomes. Although challenges persist, large language models represent a significant stride in rehabilitation, underscoring the importance of ethical use and collaboration.

Best practice rehabilitation pathway for the management of single and double-level lumbar fusion surgery: a modified Delphi Study.

BACKGROUND: There is limited evidence to guide the rehabilitation of patients following single or double-level lumbar fusion surgery (LFS). This is reflected in extensive variability in current rehabilitation regimes and subsequent low clinical success rates, which urges a call for a consensus rehabilitation pathway. AIM: To establish consensus on the optimal pre-, peri- and postoperative rehabilitation of LFS. DESIGN: A modified Delphi Study. SETTING: Belgium and the Netherlands. POPULATION: A multidisciplinary panel of 31 experts in the field of LFS and rehabilitation participated. Nine patients validated the consensus pathway. METHODS: A three-round online Delphi questionnaire was followed by an in-person consensus meeting. In each round, experts could suggest new statements, and received group summary statistics and feedback for reconsidered statements. Consensus threshold was set at ≥75% agreement. The resulting rehabilitation pathway was validated by patients through an online questionnaire and subsequent in-person focus group. RESULTS: A total of 31 experts participated in the first online round, with 27 (87%) completing all online rounds, and 17 (55%) attending the in-person consensus meeting. Consensus was reached on 122 statements relating to pre-, peri- and postoperative rehabilitation of LFS, and validated by patients. Key components of the rehabilitation pathway included prehabilitation, education, physiotherapy in every phase, early postoperative mobilization, and little movement restrictions. Patients emphasized the need for support during the return-to-work process. CONCLUSIONS: This process resulted in 122 expert-consensus statements on best practice rehabilitation for managing LFS, validated by patients. CLINICAL REHABILITATION IMPACT: The proposed rehabilitation pathway can serve as guidance to support clinicians, reduce practice variability, and subsequently improve clinical outcomes after LFS.

The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial.

BACKGROUND: Total hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery. OBJECTIVE: This study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty. DESIGN: Randomised controlled trial. SETTING: A teaching hospital in Shanghai, China. PARTICIPANTS: Eighty-six patients who received a unilateral primary total hip or knee arthroplasty. METHODS: The participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations. RESULTS: At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = -0.51, 95% CI -0.91 to -0.10, P = .015), and depression (adjusted mean difference = -0.37, 95% CI -0.66 to -0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant. CONCLUSION: Mobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression. TRIAL REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

Body activity grading strategy for cervical rehabilitation training.

A body activity grading strategy is proposed for computer-assisted cervical rehabilitation training, which employs hidden Markov model to partition an exercise into independently assessable phases and a scoring reference to rate respective kinematic features. Samples of 34 cervical rehabilitation exercises are evaluated by both manual and the proposed approaches, where the average phase segmentation difference is 93 ms, the phase scoring difference is 0.045, and the grading difference for overall samples is 5.5% between the approaches. It indicates that the proposed method has similar accuracy as physical therapists and is thus capable of performing online supervision for cervical rehabilitation training.

Vagal Nerve Stimulation: A Bibliometric Analysis of Current Research Trends.

BACKGROUND: Vagal nerve stimulation (VNS) has become established as an effective tool for the management of various neurologic disorders. Consequently, a growing number of VNS studies have been published over the past four decades. This study presents a bibliometric analysis investigating the current trends in VNS literature. MATERIALS AND METHODS: Using the Web of Science collection data base, a search was performed to identify literature that discussed applications of VNS from 2000 to 2021. Analysis and visualization of the included literature were completed with VOSviewer. RESULTS: A total of 2895 publications were identified. The number of articles published in this area has increased over the past two decades, with the most citations (7098) occurring in 2021 and the most publications (270) in 2020. The h-index, i-10, and i-100 were 97, 994, and 91, respectively, with 17.0 citations per publication on average. The highest-producing country and institution of VNS literature were the United States and the University of Texas, respectively. The most productive journal was Epilepsia. Epilepsy was the predominant focus of VNS research, with the keyword "epilepsy" having the greatest total link strength (749) in the keyword analysis. The keyword analysis also revealed two major avenues of VNS research: 1) the mechanisms by which VNS modulates neural circuitry, and 2) therapeutic applications of VNS in a variety of diseases beyond neurology. It also showed a significant prevalence of noninvasive VNS research. Although epilepsy research appears more linked to implanted VNS, headache and depression specialists were more closely associated with noninvasive VNS. CONCLUSION: VNS may serve as a promising intervention for rehabilitation beyond neurologic applications, with an expanding base of literature over the past two decades. Although epilepsy researchers have produced most current literature, other fields have begun to explore VNS as a potential treatment, likely owing to the rise of noninvasive forms of VNS.

A Mapping Review of Real-Time Movement Sonification Systems for Movement Rehabilitation.

Movement sonification is emerging as a useful tool for rehabilitation, with increasing evidence in support of its use. To create such a system requires component considerations outside of typical sonification design choices, such as the dimension of movement to sonify, section of anatomy to track, and methodology of motion capture. This review takes this emerging and highly diverse area of literature and keyword-code existing real-time movement sonification systems, to analyze and highlight current trends in these design choices, as such providing an overview of existing systems. A combination of snowballing through relevant existing reviews and a systematic search of multiple databases were utilized to obtain a list of projects for data extraction. The review categorizes systems into three sections: identifying the link between physical dimension to auditory dimension used in sonification, identifying the target anatomy tracked, identifying the movement tracking system used to monitor the target anatomy. The review proceeds to analyze the systematic mapping of the literature and provide results of the data analysis highlighting common and innovative design choices used, irrespective of application, before discussing the findings in the context of movement rehabilitation. A database containing the mapped keywords assigned to each project are submitted with this review.

Intelligent Classification Technique of Hand Motor Imagery Using EEG Beta Rebound Follow-Up Pattern.

To apply EEG-based brain-machine interfaces during rehabilitation, separating various tasks during motor imagery (MI) and assimilating MI into motor execution (ME) are needed. Previous studies were focusing on classifying different MI tasks based on complex algorithms. In this paper, we implement intelligent, straightforward, comprehensible, time-efficient, and channel-reduced methods to classify ME versus MI and left- versus right-hand MI. EEG of 30 healthy participants undertaking motional tasks is recorded to investigate two classification tasks. For the first task, we first propose a "follow-up" pattern based on the beta rebound. This method achieves an average classification accuracy of 59.77% ± 11.95% and can be up to 89.47% for finger-crossing. Aside from time-domain information, we map EEG signals to feature space using extraction methods including statistics, wavelet coefficients, average power, sample entropy, and common spatial patterns. To evaluate their practicability, we adopt a support vector machine as an intelligent classifier model and sparse logistic regression as a feature selection technique and achieve 79.51% accuracy. Similar approaches are taken for the second classification reaching 75.22% accuracy. The classifiers we propose show high accuracy and intelligence. The achieved results make our approach highly suitable to be applied to the rehabilitation of paralyzed limbs.

Development of the WHO STARS: A Tool for the Systematic Assessment of Rehabilitation Situation.

OBJECTIVE: To present the development process of the World Health Organization (WHO) Systematic Assessment of Rehabilitation Situation (STARS). DESIGN: A conceptualization phase to establish its objective and identify the content for comprehensively describing rehabilitation in countries, a second phase to draft, and a third phase to refine the tool. Reviews of existing health system assessment (HSA) tools used in other areas of health as well as expert consultations occurred. SETTING: The WHO initiated the development of STARS because there is currently no comprehensive HSA tool for rehabilitation that supports stakeholders describing their country situation and identifying priority actions. PARTICIPANTS: The WHO rehabilitation team, experts representing rehabilitation professions and from all WHO regions, and government and rehabilitation consumer groups. INTERVENTIONS: Conceptualizing, drafting, consulting, and reviewing of the WHO STARS. MAIN OUTCOMES MEASURES: Development of a tool that is comprehensive and able to support countries to describe rehabilitation and identify priorities. RESULTS: STARS was developed in a participatory process, uses a logic model to structure the 50 components of rehabilitation selected for assessment, and assesses both capacity and performance. CONCLUSIONS: STARS is the first HSA shaped to rehabilitation, has been developed by the WHO in a participatory process based on several expert consultations, and has the potential to meaningfully support governments to better understand the status of rehabilitation in their countries, define priorities for action to strengthen rehabilitation, and facilitate the monitoring of system level changes. Moreover, STARS information can be used in research to support evidence-informed policy and programs.

Person-Centered Goal Setting: A Systematic Review of Intervention Components and Level of Active Engagement in Rehabilitation Goal-Setting Interventions.

OBJECTIVE: This systematic review aims to examine (1) what components are used in current person-centered goal-setting interventions for adults with health conditions in rehabilitation and (2) the extent to which the engagement of people in their rehabilitation goal setting is encouraged. DATA SOURCES: PubMed/MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science from inception to November 2020. STUDY SELECTION: Primary inclusion criteria were peer-reviewed articles that evaluated person-centered goal-setting interventions for adults with health conditions in rehabilitation. Two independent reviewers screened 28,294 records, and 22 articles met inclusion criteria. DATA EXTRACTION: Two reviewers independently completed data extraction and quality assessment using the Physiotherapy Evidence Database (PEDRo) scale based on the original authors' descriptions, reports, and protocol publications. Any discrepancies were resolved by consensus or in consultation with another senior reviewer. DATA SYNTHESIS: Using narrative synthesis, we found that current person-centered goal setting has variability in their inclusion of intervention components. A considerable number of components are underimplemented in current practice, with formulation of coping plan and follow-up being most commonly left out. The active engagement of people does appear to be promoted within the components that are included in the interventions. Nine studies were high-quality defined as a total PEDro scale score of 6 or above. CONCLUSIONS: Although current person-centered goal setting encourages the active engagement of people, many of these interventions lack components considered important for supporting goal achievement and optimal outcomes. Future practice may be improved by incorporating a comprehensive set of goal-setting components and encouraging the active engagement of people throughout the entire goal-setting process. Together, these practices may facilitate the achievement of meaningful rehabilitation goals and improve rehabilitation outcomes for adults with health conditions.

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature.

OBJECTIVE: To develop a cross-professional model framing the concept and practice of person-centered rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature. DATA SOURCES: Key databases (PubMed, Scopus, Cumulative Index to Nursing and Allied Health), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual articles published from January 2007-February 2020. STUDY SELECTION: Two independent reviewers selected adult-based articles addressing at least 1 of the 6 categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual articles. DATA EXTRACTION: Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews. DATA SYNTHESIS: A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by 5 external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across 3 levels: (1) the person-professional dyad; (2) the microsystem level (typically an interprofessional team, involving significant others); and (3) a macrosystem level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR. CONCLUSIONS: The PCR Model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.

Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle.

BACKGROUND: Although the combination of rehabilitation and nutrition may be important for the prevention of intensive care unit (ICU)-acquired weakness, a protocolized intervention of this combination has not yet been reported. We herein developed an original combined protocol and evaluated its efficacy. METHODS: In this single-center historical control study, we enrolled adult patients admitted to the ICU. Patients in the control group received standard care, while those in the intervention group received the protocol-based intervention. The ICU mobility scale was used to set goals for early mobilization and a neuromuscular electrical stimulation was employed when patients were unable to stand. The nutritional status was assessed for nutritional therapy, and target calorie delivery was set at 20 or 30 kcal/kg/day and target protein delivery at 1.8 g/kg/day in the intervention group. The primary endpoint was a decrease in femoral muscle volume in 10 days assessed by computed tomography. RESULTS: Forty-five patients in the control group and 56 in the intervention group were included in the analysis. Femoral muscle volume loss was significantly lower in the intervention group (11.6 vs 14.5%, p = 0.03). The absolute risk difference was 2.9% (95% CI 0.1-5.6%). Early mobilization to a sitting position by day 10 was achieved earlier (p = 0.03), and mean calorie delivery (20.1 vs. 16.8 kcal/kg/day, p = 0.01) and mean protein delivery (1.4 vs. 0.8 g/kg/day, p < 0.01) were higher in the intervention group. CONCLUSION: The protocolized intervention, combining early mobilization and high-protein nutrition, contributed to the achievement of treatment goals and prevention of femoral muscle volume loss. TRIAL REGISTRATION NUMBER: The present study is registered at the University Hospital Medical Information Network-clinical trials registry (UMIN000040290, Registration date: May 7, 2020).