[ReTurn To work of coronary patient : RTT French multicentre study]. / ReTour au Travail du patient coronarien : étude multicentrique française RTT.

INTRODUCTION: Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data. METHODS: Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work. RESULTS: 364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation. CONCLUSION: The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect.

[Get up, stand up! What sit-to-stand tests tell us about respiratory failure]. / Get up, stand up ! Ce que les tests de lever de chaise nous disent de l'insuffisance respiratoire.

Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular strength and endurance, as well as exercise tolerance, is therefore an important component of the evaluation of individuals with chronic respiratory failure. This evaluation can be made easier by using simple tools such as sit-to-stand tests. This review presents the main sit-to-stand tests that have been described and that can be used in everyday practice. The aim is to provide information to the clinician on the contribution of each test, and to identify the extent to which and the purpose for which these tests can be incorporated into a routine pulmonology and/or respiratory rehabilitation evaluation. Because of their inherently functional nature, these tests could help to identify the indications and/or the effects of respiratory rehabilitation.

Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder where individuals consistently feel self-motion, often triggered by motion like being on a boat (MT-MdDS). Due to the unknown pathophysiological mechanism, available treatment options for managing symptoms are limited. Our objective was to develop a virtual reality application (VRA) to simulate the full field optokinetic stimulation (OKS) booth and evaluate its efficacy compared to the standard treatment. In our randomized, open, non-inferiority clinical trial with 30 â€‹MT-MdDS patients, 15 received the OKS booth and 15 the new VRA over four consecutive days. Two 4-min treatment blocks were scheduled in the morning and afternoon, with a total of four blocks. Treatment effectiveness was evaluated through questionnaires and posturography. Our findings suggest that the choice of modality does not significantly differ in achieving an overall improvement in symptoms. We advocate that the VRA can be used as an accessible alternative to the booth method worldwide, effectively mitigating MdDS symptoms and enhancing the QoL of numerous MdDS patients.

[Effects of gender on pulmonary rehabilitation outcomes in patients with COPD]. / Impact du genre sur les effets de la réadaptation respiratoire chez les patients atteints de BPCO.

INTRODUCTION: COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP). METHODS: Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles). RESULTS: More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups. CONCLUSIONS: During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.

[French survey of patients on current and future pulmonary rehabilitation programs]. / Enquête nationale auprès des malades sur la réadaptation respiratoire actuelle et future.

INTRODUCTION: Over recent years, a growing number of studies have demonstrated the effectiveness of alternative models to centre-based pulmonary rehabilitation (PR) such as tele-PR or home-based unsupervised PR, offering perspectives for improved accessibility and adherence. Other studies have demonstrated the relevance and long-term benefits of maintenance PR programs. However, they remain poorly implemented in real-life settings. In order to encourage patient adherence to new PR models and to guide future orientations, we conducted a survey assessing patients' views on PR models and maintenance programs. METHOD: The survey (37 questions) was circulated to COPD patients of the French national respiratory patient F.F.A.A.I.R network and in five specialised PR centres. RESULTS: Among the 298 respondents, 75% had previously taken part in a PR program, mainly in hospital settings (91%), with a high degree of satisfaction. The main barriers to PR were being physically separated from their loved ones (21%) and fears of having to share a double room (47%). Regarding maintenance PR programs, patients expressed diversified opinions, in terms of ideal duration and frequency of follow-up, format of follow-up (home-based, telephone, videoconference) and type of professional involved. CONCLUSIONS: Diversified PR settings offer perspectives to increase access and improve the effectiveness of current programs. Furthermore, comprehensive personalization (professionals involved, content, setting, duration) seems to be the key to success in concrete implementation and achievement of patient satisfaction.

[Follow-up of cerebral palsy patients in neurological rehabilitation departments]. / Le suivi des patients cérébrolésés en service de rééducation neurologique.

Patients suffering from head trauma or hemorrhagic cardiovascular accident can be cared for in special facilities. Located near Grenoble, the Fondation santé des étudiants de France Grenoble La Tronche (ex-clinique du Grésivaudan) (38) provides post-resuscitation care for brain-damaged patients. This article presents the department, its specific features and their daily routine, as shared with us by Mélanie, Leslie and her fellow nurses in the neurological rehabilitation department.

[The supportive environment in SRH: characteristics that promote self-determination]. / L'environnement soutenant en SSR : les caractéristiques qui favorisent l'autodétermination.

Hospitalization is an important stage in the life of the elderly. All too often, this experience is accompanied by both physical and psychological decline. Based on self-determination theory, the aim was to qualitatively characterize support for self-determination in follow-up care and rehabilitation services (behaviours and attitudes of healthcare professionals, and patients' perception of them).

Guideline for standardized approach in the treatment of the Mal de Debarquement syndrome.

Introduction: Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder. Patients experience almost continuously a perception of self-motion. This syndrome can be motion-triggered (MT-MdDS), such as on a boat, or occur spontaneously or have other triggers (SO-MdDS) in the absence of such motion. Because the pathophysiological mechanism is unknown, treatment options and symptom management strategies are limited. One available treatment protocol involves a readaptation of the vestibular ocular reflex (VOR). This study assesses the effectiveness of vestibulo-ocular reflex (VOR) readaptation in 131 consecutive patients with a fixed protocol. Methods: We administered 131 treatments involving optokinetic stimulation (OKS) paired with a fixed head roll at 0.167 Hz over two to five consecutive days. Each day, four-minute treatment blocks were scheduled twice in the morning and afternoon. Treatment effectiveness was evaluated through questionnaires and posturography. Results: We observed significant improvements in the visual analog scale (VAS), MdDS symptom questionnaire, and posturography measures from pre- to post-treatment. No significant differences were found in outcome variables between MT- and SO-MdDS onsets. Conclusion: Symptoms improved subjectively and objectively in patients' post-treatment. The overall success rate was 64.1%, with no significant difference between MT (64.2%) and SO (63.3%). This study supports the conclusion that VOR readaptation treatment provides relief for two-thirds of MdDS patients, irrespective of the onset type. Based on consistency in the findings, we propose a standardized method for treatment of MdDS based on the OKS with head roll paradigm.

[The role of occupational therapy in Parkinson's disease]. / La place de l'ergothérapie dans la maladie de Parkinson.

Occupational therapy works with Parkinson's sufferers and their caregivers to help them maintain or resume their activities of daily living and their independence, by recommending environmental adaptations, technical aids, compensation strategies and functional training.

[The adapted physical activity teacher, a professional helping people to live better with Parkinson's disease]. / L'enseignant en activité physique adaptée, un professionnel aidant à mieux vivre avec la maladie de Parkinson.

Recognized by numerous scientific studies as an effective non-drug therapy for the treatment of most chronic illnesses, physical activity is booming. Many players are currently sharing the market. Among these professionals is the adapted physical activity teacher. They have a university degree in adapted physical activity and health. They propose motorized teaching situations using adapted physical activities, whether sporting or artistic, under technical, material, regulatory and motivational conditions that are appropriate to the situation and to the safety of the participant. The aim is rehabilitation, education, prevention and/or social integration.

Virtual care during COVID-19: The perspectives of older adults and their healthcare providers in a cardiac rehabilitation setting.

The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.

Barriers and Facilitators of a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program for Older Adults: Perspectives of a Multidisciplinary Care Team.

The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.

Exploring Therapeutic Relationships in Pediatric Occupational Therapy: A Meta-Ethnography.

Background. Developing strong therapeutic relationships with families is a crucial aspect of pediatric occupational therapy. However, building such relationships is complex as they involve multiple directions of interaction. Purpose. To provide a thorough interpretation of children's, caregivers', and occupational therapists' experience of the therapeutic relationship. Method. A meta-ethnography was realized to synthesize qualitative studies. A systematic search was carried out using five databases from 2005 to 2022. The CAPS checklist was used to appraise included studies' quality. The analysis was completed using a constant comparison of findings. Findings. Three themes emerged from the 14 studies synthesized. The first theme illustrates that the therapeutic relationship can have different meanings depending on the perspective of children, caregivers, or occupational therapists. The second theme explores the components impacting the experience of the relationship. These include the power dynamics, the communication, and respect for diversity. Finally, the third theme illustrates how the relationship can empower positive change. Implications. Children, caregivers, and occupational therapists each have a perspective that ought to be heard. Occupational therapists should actively ask for children's and caregivers' perspectives to encourage power sharing and effective communication. By doing so, occupational therapists can strengthen the therapeutic relationship, which, in turn, promotes positive change.

Influence of Single-Digit Exclusions on Grip Strength in Healthy Male Adults.

Grip strength (GS) of the human hand is vital to deal with objects of various sizes and shapes in daily life. The strength deteriorates if one or more digits of the hand are amputated. The main aim of this study was to determine the influence of single-digit exclusions on the GS. Healthy adults (n = 102, male) with an age range of 20 to 70 years (mean ± SD, 31.92 ± 13.14 years) participated in the study. The movements of unused digits were restrained using splints to avoid digit enslaving effects. T (Thumb), (I) Index, M (Middle), R (Ring), L (Little) digits were chosen for exclusion based on the digit configurations. The digit configurations were IMRL, MRLT, IMRT IRLT and, IMLT with exclusions T, I, L, M, and, R respectively. The results of two-way ANOVA with repeated measures showed no significant interaction (p = 0.923) between hand dominance and digit configurations. But statistical significance (p = 0.000) was observed in digit configurations and hand dominance individually. The results of posthoc analysis using Bonferroni corrected pairwise comparisons showed no statistical significance (p = 0.004) between IRLT and IMLT of both hands since the corrected p-value was 0.003. The outcomes of the F-test showed no statistical significance (p > 0.05) between the digit configurations IMRLT, IMRL; IMRL, MRLT; MRLT, IMRT; IRLT, IMLT individually within dominant (D) and non-dominant (ND) hands. When the F-test was performed using the same digit configurations between both hands, statistical significance was not observed in all the configurations except IMLT (p < 0.05). The results of the Pearson correlation of GS were observed to be very strong between the same digit configurations of D and ND hands.

La force de préhension (FP) de la main humaine est essentielle pour manipuler des objets de diverses dimensions et de diverses formes au quotidien. La force se détériore si au moins l'un des doigts de la main est amputé. Le principal objectif de la présente étude consistait à déterminer l'influence de l'exclusion d'un doigt sur la FP. Des hommes adultes en bonne santé (n=102) de 20 à 70 ans (moyenne ± ÉT, 31,92 ± 13,14 ans) ont participé à l'étude. Les mouvements de leurs doigts non utilisés ont été restreints à l'aide d'une attelle afin d'éviter les effets d'asservissement. L'exclusion du T (pouce), de l'I (index), du M (majeur), du R (annulaire) et du L (auriculaire) a été privilégiée en fonction des configurations des doigts, qui s'établissaient comme suit : IMRL, MRLT, IMRT IRLT et IMLT, et qui excluaient le T, l'I, le L, le M et le R, respectivement. Les résultats de l'analyse de variance bidirectionnelle avec reprise des mesures n'ont révélé aucune interaction significative (p=0,923) entre la dominance de la main et les configurations des doigts. Toutefois, les chercheurs ont constaté une signification statistique (p=0,000) de ces configurations avec la dominance individuelle des mains. Les résultats de l'analyse post hoc au moyen des comparaisons par paires corrigées n'ont révélé aucune signification statistique (p=0,004) entre les IRLT et les IMLT des deux mains, puisque la valeur p corrigée était de 0,003. Les résultats du test de Fischer n'ont établi aucune signification statistique (p>0,05) entre chaque configuration des doigts IMRLT, IMRL; IMRL, MRLT; MRLT, IMRT; IRLT, IMLT de la main dominante et non dominante. Lorsque les chercheurs avaient recours au test de Fischer avec les mêmes configurations des doigts sur les deux mains, ils n'ont pas observé de signification statistique, sauf la configuration IMLT (p<0,05). Les chercheurs ont remarqué des résultats très solides de la corrélation de Pearson au test de FP entre les mêmes configurations de doigts de la main dominante et non dominante.

"What Services?": Stakeholders' Perceived Unmet Support Needs for Parents With Neurological Disorders.

Background. Knowledge about the needs of parents with neurological disorders who take care of young children is limited. Purpose. The overall aim of this qualitative study was to explore the perceived unmet parent needs, current supports, and potential solutions to optimize supports of parents with neurological disorders in early childhood in a Canadian setting. Method. Focus groups and individual interviews with parents (n = 8), spouses (n = 5), rehabilitation clinicians (n = 8), community partners (n = 7), and researchers (n = 7) were conducted with a total of 35 participants recruited using convenience sampling. Inductive iterative thematic analysis was performed. Findings. The participants identified the need for society to officially recognize parenting with disabilities, adjust public policies, increase the scope of public programs, consider child development and family well-being, and have barrier-free communities. Conclusion. Providing customized solutions that will adequately fill perceived service gaps is of utmost importance to address these families' needs.

[The role of the physiotherapist in the assessment and management of dyspnea]. / Le rôle du kinésithérapeute dans l'évaluation et la gestion de la dyspnée.

The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.

"Metacognitive Reflection and Insight Therapy" (MERIT) for the Occupational Therapy Practitioner.

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

Re-braiding the Strands of Life through Community Rehabilitation, Home Care, and Informal Support: A Longitudinal Collective Case Study.

Limited research exists on the experiences of older adults participating in community rehabilitation. Our longitudinal, collective case study explored older adults' experiences while they engaged in community rehabilitation and home care services, as well as family caregivers' concurrent experiences. Drawing on interpretive description, we inductively analysed interview data gathered at three points over 3-6 months from six family dyads. Questions focused on activities of daily living, instrumental activities of daily living and other meaningful activities affected by changes in the older adult's health. From our thematic analysis, three themes emerged: (a) Centring community rehabilitation and home care services around the older adult and family; (b) Understanding the intricate interface of formal and informal supports; and (c) Supporting the meaningful aspects of life. Our findings suggest a metaphor of re-braiding, a reconfiguration of activities that requires increased integration of formal and informal supports within home care and community rehabilitation.

[The multi-professional care team to guide the rehabilitation of Covid long patients]. / L'équipe soignante pluriprofessionnelle pour guider la réhabilitation des patients Covid long.

La Porte verte hospital in Versailles is one of the reference establishments in the Yvelines department (78) for the reception and care of patients with long term cancer. The follow-up care and rehabilitation department and the day hospital organize care dedicated to very complex patients. The teams offer a personalized rehabilitation care program over a defined period of time, with multidisciplinary management and the ability to conduct explorations, assessments and evaluations on site.

[Posttraumatic Disorders and Their Impact on the Capacity to Work]. / Traumafolgestörungen und ihre Auswirkungen auf die Arbeitsfähigkeit und Wiedereingliederung.

Posttraumatic Disorders and Their Impact on the Capacity to Work Abstract. Posttraumatic disorders include a range of mental illnesses and can have relevant effects on the capacity to work. Work usually is an important resource in treatment. The severity or type of trauma is not decisive for assessing the capacity to work, but the functional limitations caused by the disorder must be carefully assessed and compared with the requirements of the job. The rating by Mini-ICF-APP is a helpful tool for this. A reintegration-oriented attitude can strongly support the treatment.