Psychometric validation of the short version of the Information Needs in Cardiac Rehabilitation scale through a first global assessment.

AIMS: Tailored education is recommended for cardiac patients, yet little is known about information needs in areas of the world where it is most needed. This study aims to assess (i) the measurement properties of the Information Needs in Cardiac Rehabilitation short version (INCR-S) scale and (ii) patient's information needs globally. METHODS AND RESULTS: In this cross-sectional study, English, simplified Chinese, Portuguese, or Korean versions of the INCR-S were administered to in- or out-patients via Qualtrics (January 2022-November 2023). Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated recruitment. Importance and knowledge sufficiency of 36 items were rated. Links to evidence-based lay education were provided where warranted. A total of 1601 patients from 19 middle- and high-income countries across the world participated. Structural validity was supported upon factor analysis, with five subscales extracted: symptom response/medication, heart diseases/diagnostic tests/treatments, exercise and return-to-life roles/programmes to support, risk factors, and healthy eating/psychosocial management. Cronbach's alpha was 0.97. Construct validity was supported through significantly higher knowledge sufficiency ratings for all items and information importance ratings for all subscales in cardiac rehabilitation (CR) enrolees vs. non-enrolees (all P < 0.001). All items were rated as very important-particularly regarding cardiac events, nutrition, exercise benefits, medications, symptom response, risk factor control, and CR-but more so in high-income countries in the Americas and Western Pacific. Knowledge sufficiency ranged from 30.0 to 67.4%, varying by region and income class. Ratings were highest for medications and lowest for support groups, resistance training, and alternative medicine. CONCLUSION: Identification of information needs using the valid and reliable INCR-S can inform educational approaches to optimize patients' health outcomes across the globe.

Patients need information to manage their heart diseases, such as what to do if they have chest pain, what a heart attack is, and how to take their medicine to lower the chances they will have another one, so a study of the information needs of over 1600 heart patients from around the globe was undertaken for the first time. Using the Information Needs in Cardiac Rehabilitation short version (INCR-S) scale­which was shown to be a good measurement tool through the study and hence may improve patient education­patients reported they most wanted information about heart events, heart-healthy eating, exercise benefits, their pills, symptom response, risk factor control, and cardiac rehabilitation­but more so in high-income countries in the Americas and Western Pacific. Knowledge sufficiency ratings for each item ranged from 30.0 to 67.4%, also varying by region and income class; perceived knowledge sufficiency ratings were highest for medications and lowest for support groups, resistance training, and alternative medicine.

Women's Cardiac Rehabilitation Barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation's First Global Assessment.

BACKGROUND: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS: In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS: Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS: CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.

A survey of the perceptions of barriers to and facilitators of cardiac rehabilitation in healthcare providers and policy stakeholders.

BACKGROUND: Cardiac rehabilitation (CR) is a prognostic management strategy to help patients with CVD achieve a good quality of life and lower the rates of recurrence, readmission, and premature death from disease. Globally, cardiac rehabilitation is poorly established in hospitals and communities. Hence, this study aimed to investigate the discrepancies in the perceptions of the need for CR programs and relevant health policies between directors of hospitals and health policy personnel in South Korea to shed light on the status and to establish practically superior and effective strategies to promote CR in South Korea. METHODS: We sent a questionnaire to 592 public health policy managers and directors of selected hospitals, 132 of whom returned a completed questionnaire (response rate: 22.3%). The participants were categorized into five types of organizations depending on their practice of PCI (Percutaneous Coronary Intervention), establishment of cardiac rehabilitation, director of hospital, and government's policy makers. Differences in the opinions between directors of hospitals that perform/do not perform PCI, directors of hospitals with/without cardiac rehabilitation, and between hospital directors and health policy makers were analyzed. RESULTS: Responses about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, hospitals' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive among hospitals that perform PCI than those that do not. Responses to questions about the effectiveness of cardiac rehabilitation and hospitals' roles in cardiac rehabilitation tended to be more positive in hospitals with cardiac rehabilitation than in those without. Hospital directors responded more positively to questions about targeting diseases for cardiac rehabilitation and governmental health policies' roles in cardiac rehabilitation than policy makers, and both hospitals and public organizations provided negative responses to the question about patients' roles in cardiac rehabilitation. Responses to questions about targeting diseases for cardiac rehabilitation, patients' roles in cardiac rehabilitation, and governmental health policies' roles in cardiac rehabilitation were more positive in hospitals that perform PCI than those that do not and public organizations. CONCLUSIONS: Hospitals must ensure timely referral, provide education, and promote the need for cardiac rehabilitation. In addition, governmental socioeconomic support is needed in a varity of aspects.

Types and Characteristics of Fatal Accidents Caused by Multiple Processes in a Workplace: Based on Actual Cases in South Korea.

As the social cost of disasters increases and safety is being emphasized, policy regulations at the national level have been implemented. However, various fatal accidents are continually occurring as continued economic development and enhanced technologies have increased demand and complicated the industrial structure. Workers in different industries, performing similar jobs, often experience different workplace hazards, which can result in similar types of accidents. Therefore, new policy regulations have been established to separate multiple processes and work in workplaces and are being implemented in several countries to minimize damage caused by new types of industrial accidents. Supervision and management appropriate for contractors or safety and health officials with legal obligations are required to play a regulatory role when these types of industrial accidents are likely to occur. This study classified accidental types and their characteristics based on actual cases, in which potential risks exist at multiple processes in a workplace. First, raw data of work-related fatalities that occurred in South Korea were reviewed and classified as fatal accidents caused by multiple processes in workplaces using the proposed method. Next, the classified actual cases were prepared as statistical data and analyzed based on the various categories. Finally, the accident type based on multiple processes, including risks and characteristics, in workplaces was proposed. As a result, this study improved the safety awareness and understanding of regulatory subjects regarding industrial accidents caused by multiple processes in workplaces and is expected to improve the effectiveness of the existing policy to prevent workplace accidents.

Unmet Needs for Rehabilitative Management in Common Health-Related Problems Negatively Impact the Quality of Life of Community-Dwelling Stroke Survivors.

Purpose: Community-dwelling stroke survivors have various unmet needs for rehabilitative management, but there is a lack of in-depth investigations on common health problems after stroke. Moreover, the association between unmet needs and health-related quality of life (HRQoL) has not been thoroughly investigated. This study aimed to investigate the unmet needs for rehabilitative management in common problems after stroke and their associations with HRQoL among community-dwelling stroke survivors. Methods: A face-to-face cross-sectional survey was conducted among community-dwelling stroke survivors visiting outpatient clinics of rehabilitation departments between June and October 2020 in three university-affiliated hospitals. Unmet needs for common problems after stroke were assessed across eight domains based on the post-stroke checklist: spasticity, dysphagia, communication, cognition, ambulation, pain/discomfort, anxiety/depression, and self-care. HRQoL was measured using the EuroQoL-5D three level (EQ-5D). The prevalence of unmet needs for rehabilitative management and their associations with the EQ-5D index were analyzed. Results: Among the 239 participants who responded to the survey, 63% (n = 150) were men. The mean age was 63 ± 13 years, and the mean duration of stroke onset was 55.6 months. Overall, 49% reported at least one unmet need, and the most frequently reported unmet needs were anxiety/depression (20.9%), self-care (20.9%), and pain/discomfort (18.0%). The highest proportion of unmet needs was in the anxiety/depression, communication, and cognition domains. Patients with unmet needs for cognition and pain/discomfort showed a significantly lower EQ-5D index, even after adjusting for age, sex, and modified Rankin scale scores. The total number of unmet needs was significantly correlated with a lower EQ-5D index (Pearson's r = -0.329, p < 0.001) in the multivariate linear regression model. Conclusions: Unmet rehabilitative needs are prevalent among community-dwelling stroke survivors, and the proportion of unmet needs was high among non-physical domains such as anxiety/depression. The number of unmet needs is an independent negative predictor of HRQoL. Systematic approaches to identify unmet needs and provide appropriate rehabilitative management are required in long-term stroke survivors.

Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study.

Purpose: Upper limb hemiparesis is the most common impairment in stroke survivors, and adequate assessment is crucial for setting the rehabilitation strategy and monitoring the effect of treatment. However, adequate timely assessments are difficult due to the limited accessibility to clinics for stroke survivors. We designed this study to investigate whether teleassessments for motor impairments of the spastic elbow (i.e., passive range of motion (PROM), muscle strength, and spasticity) are feasible in stroke survivors. Methods: To implement a telerobotic system for remote assessment with physical interaction, we constructed a system with a master robot interacting with a doctor (assessor) and a slave robot interacting with the elbow of a subject with stroke. The master robot is operated by the doctor, where the torque and the speed are transferred to the slave robot via the Internet, and the reaction of the patient's elbow to the slave robot's movement is measured with a torque sensor, then finally transferred back to the master robot. An intercontinental remote assessment, which is considered one of the worst possible scenarios, was used as a clinical test to strictly check the feasibility. For the clinical tests, the examiner for the teleassessment was located at a lab in the National Institutes of Health (NIH, Bethesda, MD, USA) while the stroke patients were located at Seoul National University Bundang Hospital (Bundang, Kyeonggido, South Korea). Results: In total, 12 stroke patients' elbows (age range, 28-74; M:F = 6:6) were tested. For the PROM, the absolute difference between two assessments (in-person vs. remote) was 5.98 ± 3.51° on average (range, 0-11.2). The agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial (k = 0.643) and fair (k = 0.308), respectively. No adverse events were observed during or immediately after the telerobotic assessment. Conclusions: Internet-based telerobotic remote assessment for motor impairment of spastic elbow in stroke using our system is feasible even in the worst setting, with too long of a distance and a delayed communication network.

Corrigendum: Remote Assessment of Post-Stroke Elbow Function Using Internet-Based Telerobotics: A Proof-of-Concept Study.

[This corrects the article DOI: 10.3389/fneur.2020.583101.].

A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized, double-blind, sham-controlled pilot trial.

BACKGROUND: We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke. METHODS: A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke (<3 months) were allocated to sham (n = 11) and real VR group (n = 12). Both groups participated in a daily 30-minute occupational therapy for upper limb recovery for 10 consecutive weekdays. Subjects received an additional daily 30-minute Kinect-based or sham VR. Assessment was performed before the VR, immediately and 1 month after the last session of VR. Fugl-Meyer Assessment (FMA) (primary outcome) and other secondary functional outcomes were measured. Accelerometers were used to measure hemiparetic upper limb movements during the therapy. RESULTS: FMA immediately after last VR session was not different between the sham (46.8 ±â€Š16.0) and the real VR group (49.4 ±â€Š14.2) (P = .937 in intention to treat analysis). Significant differences of total activity counts (TAC) were found in hemiparetic upper limb during the therapy between groups (F2,26 = 4.43; P = .22). Real VR group (107,926 ±â€Š68,874) showed significantly more TACs compared with the sham VR group (46,686 ±â€Š25,814) but there was no statistical significance between real VR and control (64,575 ±â€Š27,533). CONCLUSION: Low-cost Kinect-based upper limb rehabilitation system was not more efficacious compared with sham VR. However, the compliance in VR was good and VR system induced more arm motion than control and similar activity compared with the conventional therapy, which suggests its utility as an adjuvant additional therapy during inpatient stroke rehabilitation.

Upper Extremity Functional Evaluation by Fugl-Meyer Assessment Scoring Using Depth-Sensing Camera in Hemiplegic Stroke Patients.

Virtual home-based rehabilitation is an emerging area in stroke rehabilitation. Functional assessment tools are essential to monitor recovery and provide current function-based rehabilitation. We developed the Fugl-Meyer Assessment (FMA) tool using Kinect (Microsoft, USA) and validated it for hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were enrolled. Thirteen of 33 items were selected for upper extremity motor FMA. One occupational therapist assessed the motor FMA while recording upper extremity motion with Kinect. FMA score was calculated using principal component analysis and artificial neural network learning from the saved motion data. The degree of jerky motion was also transformed to jerky scores. Prediction accuracy for each of the 13 items and correlations between real FMA scores and scores using Kinect were analyzed. Prediction accuracies ranged from 65% to 87% in each item and exceeded 70% for 9 items. Correlations were high for the summed score for the 13 items between real FMA scores and scores obtained using Kinect (Pearson's correlation coefficient = 0.873, P<0.0001) and those between total upper extremity scores (66 in full score) and scores using Kinect (26 in full score) (Pearson's correlation coefficient = 0.799, P<0.0001). Log transformed jerky scores were significantly higher in the hemiplegic side (1.81 ± 0.76) compared to non-hemiplegic side (1.21 ± 0.43) and showed significant negative correlations with Brunnstrom stage (3 to 6; Spearman correlation coefficient = -0.387, P = 0.046). FMA using Kinect is a valid way to assess upper extremity function and can provide additional results for movement quality in stroke patients. This may be useful in the setting of unsupervised home-based rehabilitation.

Upper-Limb Function Assessment Using VBBTs for Stroke Patients.

Evaluating and quantifying the upper-limb functions are essential to planning effective patient rehabilitation. The box and block test (BBT) is a conventional, simple, and easy-to-apply assessment tool that is used in hospitals, and previous studies have demonstrated its usefulness in stroke rehabilitation. Using a conventional depth-sensing camera, the authors developed a virtual box and block test (VBBT) system for hand, finger, and grasping assessments based on the BBT used for the grasping ability test in hospitals. Such a virtual upper-limb-function assessment tool that can be implemented in a home setting could be a key component in a home-based virtual rehabilitation system. Comparison results between the real and virtual BBTs show the possibilities for virtualizing conventional and unsupervised assessments.

Identifying factors associated with self-rated health according to age at onset of disability.

PURPOSE: Although later-onset disability has been associated with poor self-rated health (SRH), factors mediating differences in SRH related to age at onset of disability remain unclear. The present study was designed to identify the variables explaining poor SRH in later-onset disability. We examined chronic disease and functional status as alternatives to psychosocial adaptation as explanatory variables. METHOD: Our data were taken from the seventh National Survey for People with Disabilities among Korean individuals ≥18 years of age (n =5311). RESULTS: Those with later-onset disability (onset ages 20-40, 41-64 and ≥65 years) showed higher age-adjusted odds ratios (ORs) for poor SRH compared with those with earlier-onset disability (onset ages 0-19 years). The ORs for poor SRH in individuals with later-onset disability were not substantially changed after adjusting for confounding variables including alternatives to psychosocial adaptation (chronic diseases and functional status) as explanatory variables. CONCLUSIONS: Failure to explain poor SRH in later-onset disability with explanatory variables other than psychosocial adaptation indirectly supports the role of psychosocial adaptation in differences in SRH related to age at onset. Because we could not include appropriate measures of psychosocial adaptation, the use of additional instruments should be considered in future studies.