Factors associated with willingness to use eRehabilitation after stroke: A cross-sectional study among patients, informal caregivers and healthcare professionals.

OBJECTIVE: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. DESIGN: Cross-sectional survey. SUBJECTS: Stroke patients, informal caregivers, health-care professionals. METHODS: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. RESULTS: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34-5.33), informal caregivers (OR 8.98; 95% CI 1.70-47.33) and healthcare professionals (OR 6.25; 95% CI 1.17-10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17-0.74). Limitations of the study include low response rates and possible response bias. CONCLUSION: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation.

Out-of-hospital cardiac arrest survivors need both cardiological and neurological rehabilitation!

PURPOSE OF REVIEW: Most survivors of out-of-hospital cardiac arrest (OHCA) suffer from cardiologic symptoms and approximately half of them experience cognitive problems because of hypoxic brain damage. Symptoms of anxiety and depression are also common. This review aims to give an overview of recent literature on rehabilitation treatment aiming at improvement of quality of life after OHCA. RECENT FINDINGS: Existing cognitive screening tools are now validated for OHCA survivors. OHCA patients with cognitive deficits may have lower exercise capacity. Cardiac rehabilitation seems to be well tolerated for OHCA survivors, with outcomes comparable to myocardial infarction patients. Many caregivers suffer from posttraumatic stress disorder and emotional stress. Interventions for them are available. Implementation of integrated programs covering both cognitive and cardiac rehabilitation is hampered by lack of knowledge and organizational barriers. SUMMARY: OHCA survivors should be routinely screened for cognitive and emotional problems. When patients with mild cognitive deficits participate in cardiac rehabilitation, their program should be adjusted to their cognitive abilities. For patients with severe cognitive or emotional problems, individualized rehabilitation seems favorable. Integrated rehabilitation treatment between cardiac and cognitive rehabilitation departments is recommended. Attention should be paid to the burden of caregivers.

Out-of-hospital cardiac arrest survivors with cognitive impairments have lower exercise capacity.

BACKGROUND: Hypoxic brain injury is described in up to 40% of survivors after out-of-hospital cardiac arrest (OHCA). Besides cognitive impairments, lack of circulation may also affect exercise capacity. It is not known if exercise capacity of patients with cognitive impairments differs from other OHCA survivors. METHODS: This retrospective cohort study included patients ≥18 years with myocardial infarction (MI) as cause of OHCA admitted for cardiac rehabilitation between February 2011 and April 2014. Data in socio-demographic, OHCA and medical interventions were retrieved. Cognitive functioning was determined with the Mini-Mental State Examination, Cognitive Failures Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly. Exercise capacity (VO2peak), workload (Watts) and blood pressure (mmHg) were measured at maximum cardiopulmonary exercise. Heart rate (bpm) was measured at rest and maximum exercise and Metabolic Equivalents of Tasks (MET) were calculated. RESULTS: 65 patients after OHCA caused by MI were included (85% male, median age 60years). Of 53 patients Cardio Pulmonary Exercise Test data was available of which nine patients showed cognitive impairments. Significant differences (p<0.05) in exercise capacity were found between patients with and without cognitive impairments: VO2peak (median 14.5 vs 19.7ml/kg/min), workload (median 130.0 vs 143.5W) and MET's (median 4.1 vs 5.6). CONCLUSION: Based on this small study, there seems to be a correlation between cognitive impairments and lower exercise capacity in patients referred for rehabilitation after OHCA caused by MI. It seems sensible for rehabilitation programs to take the lower exercise capacity of patients with cognitive impairments into account.

Rehabilitation after Cardiac Arrest: Integration of Neurologic and Cardiac Rehabilitation.

Cognitive impairments are common after resuscitation. Severe cognitive impairments are easily recognized. Mild cognitive impairments are much more difficult to spot. Given the influence of cognitive problems in daily functioning, it is important to identify cognitive impairments at an early stage. Also, emotional problems, mainly depression and fear, are common in this group of patients. To optimize the care for patients after an out-of-hospital cardiac arrest, rehabilitation should focus on the physical approach through cardiac rehabilitation and on brain injury and associated cognitive impairments. The goal of rehabilitation after a cardiac arrest is to provide excellent patient-centered cardiac and cognitive rehabilitation to all patients and their spouses to achieve optimal participation in society, with minimal burden for spouses and society. To achieve this, cardiac and cognitive rehabilitation need to be coordinated in an integrated care path.