Impact of the COVID-19 pandemic on rehabilitation setting. Part 1: professionals' views on the changes in routine care provided by a rehabilitation centre for patients with muscle diseases.

The outbreak of COVID-19 has forced the health care system to undergo profound rearrangements in services and facilities, especially during the periods of lockdown. In this context, inpatient and outpatient services had to rethink and reorganize their activities to meet the needs of severely disabled patients, as those affected by Muscular Dystrophies (MDs). We present the preliminary results of a survey aiming to explore the staff views on the changes in the care provided by the Gaetano Torre Rehabilitation Centre, and, the impact of these changes on professionals, patients and their families. The survey was carried out using an open-ended questionnaire including six-items, on the practical and psychological aspects emerged during the pandemic in relation to the healthcare services provided by the Centre and to the patients/caregivers conditions. The participants, most of them physiotherapists, highlighted 169 aspects emerging in the pandemic, 48.5% referring to the resources used to cope with critical issues and 51.5% concerning the difficulties encountered. Emotional aspects prevailed on practical aspects both in resources (52.4 vs 47.6%) and in difficulties (57.5 vs 42.5%) categories. In particular, with regard to patients' resources, psychological benefits, despite the burden, were greater than practical ones (87 vs 13%), in the form of improved intra-family relationships, feeling more cared for, and satisfaction for the received care. As for the patients' relatives, the staff indicated more resources than difficulties (72.8 vs 17.2%). Among the former, 75% concerned the emotional sphere, such as the perception of having a point of reference even in such a difficult time.

A comparative evaluation of inpatient rehabilitation for older adults with debility, hip fracture, and myopathy.

OBJECTIVE: To compare the functional outcomes and discharge location of older adults admitted to inpatient rehabilitation for debility, hip fracture, and myopathy. DESIGN: Retrospective cohort study from 2002 to 2003 with information from the Uniform Data System for Medical Rehabilitation (UDSMR). SETTING: United States inpatient rehabilitation facilities subscribing to the UDSMR. PARTICIPANTS: Patients 65 years or older (N=84.701) with primary diagnoses of debility (n=14,835), hip fracture (n=68,915), and myopathy (n=951). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in functional status, including efficiency (change in functional status divided by length of stay in days) and discharge setting. RESULTS: The efficiency of the patients with debility (1.7+/-2.1) was significantly lower than that of the patients with hip fracture (1.9+/-1.6; P<.001), but not different from the patients with myopathy (1.6+/-1.4; P=.3). Significantly more patients with debility (68%) were discharged home than the hip fracture and myopathy groups (66% and 65%, respectively; P<.001). CONCLUSIONS: Although statistical differences exist, the functional recovery and rate of discharge home of older adult patients admitted to inpatient rehabilitation with a primary debility diagnosis are essentially the same clinically as those of patients with a diagnosis of either hip fracture or myopathy. Given these findings, and given that hip fracture and myopathy are approved medical conditions according to the Centers for Medicare and Medicaid Services 75% rule, the medical condition debility warrants consideration for inclusion as a qualifying medical diagnosis under this rule. However, further research is needed to develop relatively objective criteria for the debility diagnosis, and to identify those patients with debility who are most likely to benefit from inpatient rehabilitation.

Work resumption or not after rehabilitation? A descriptive study from six social insurance offices.

The objective of this study was to describe measures and outcomes of vocational rehabilitation at six local national insurance offices in the same county in Sweden. Data were collected from mainframe registers and other records at each office. There were great differences in sickness allowance, incapacity rate, selected rehabilitation measures and resuming work. The percentage of sick-listed people who received any rehabilitation measure differed from 1.2 to 8.7%. The gender distribution for the study population was 36% men and 64% women and the predominant diagnosis was musculoskeletal pain conditions, which was followed by psychiatric disorders. Outcomes varied from office B, which reported 58% fully fit after completed planned rehabilitation, to office C, which reported only 24% fully fit. The clear differences in outcome between the offices indicate that various rehabilitation measures differ in effectiveness. The rehabilitation measure 'investigation of working ability' was not linked to any great proportion of people resuming work, but showed a greater correspondence to full disability pension. There were also large differences in social and demographic factors in the different municipalities. The effect of these on the rehabilitation process requires further investigation.

The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial.

BACKGROUND: Previous studies of the effect of rotator cuff surgery have concentrated on limb-specific or surgeon-based outcome criteria. We conducted a prospective trial to determine the effect of surgery for rotator cuff disease on general health status. METHODS: Seventy-one patients (fifty of whom were men and twenty-one of whom were women) with a mean age of 56.1 years were enrolled in the study. In addition to routine clinical and radiographic evaluation, all patients completed the Short Form-36 (SF-36) health-status questionnaire and five limb-specific questionnaires preoperatively and at six, twelve, eighteen, and twenty-four months postoperatively. All patients had a standard open acromioplasty and resection of the subacromial bursa. Thirty-one patients had repair of an associated rotator cuff tear. Sixty-seven patients (94 percent) completed the study; the remaining four patients were lost to follow-up. RESULTS: The preoperative SF-36 scores for physical function (60.6, p = 0.02), role function-physical (20.8, p = 0.001), pain (38.6, p = 0.003), physical component summary (37.0, p = 0.001), and mental component summary (45.6, p = 0.02) were significantly decreased compared with normative data. The preoperative limb-specific scores also were low. At the time of the most recent follow-up evaluation, there was improvement that approached or reached significance both in the limb-specific scores (p < or = 0.0026) and in the general-health-status scores for pain (p = 0.0001), role function-physical (p = 0.06), vitality (p = 0.01), and physical component summary (p = 0.01). The presence of a rotator cuff tear had a significant negative effect on limb-specific scores both preoperatively (p = 0.04) and postoperatively (p = 0.05). Although operative treatment of rotator cuff disease led to improved scores, patients who had filed a Workers' Compensation claim had lower limb-specific and SF-36 scores both preoperatively (p = 0.02 and p = 0.01, respectively) and postoperatively (p = 0.01 and p = 0.005, respectively). CONCLUSIONS: Surgery for chronic rotator cuff disease reliably and significantly improves general health status.

Nutritional status in chronically alcoholic men from the middle socioeconomic class and its relation to ethanol intake.

To determine the relationship between nutritional status and ethanol consumption, 250 chronically alcoholic men (mean age 41 +/- 11 years) entering an alcoholism treatment program were studied. A control group of 100 male volunteers (mean age 40 +/- 10 years) was also evaluated. Detailed clinical history, laboratory analysis and nutritional status assessment were carried out in each case and control. In addition, ethanol-related diseases such as liver disease, chronic pancreatitis, cardiomyopathy, myopathy and peripheral neuropathy were ruled out in all patients. The mean daily ethanol consumption of the alcoholics was 235 +/- 62 g over an average of 19 years. All of them belong to a very stable, middle-class working group of men. Only 25 (10%) alcoholics showed evidence of energy malnutrition, 15 (6%), of protein malnutrition, and 6 (2%) of both. In the multivariate analysis, the only independent factors for the development of malnutrition were the total lifetime dose of ethanol and calorie intake (ethanol excluded) (P < 0.01; both), as well as cirrhosis (P < 0.01) when protein malnutrition was considered. Alcoholic cirrhosis was diagnosed in 20 cases, skeletal myopathy in 117, dilated cardiomyopathy in 20 and peripheral neuropathy in 41. When patients with ethanol-related diseases were excluded, no significant differences in nutritional parameters were observed between chronic alcoholics and controls. We conclude that malnutrition is not as frequent as previously thought in middle socioeconomic class male alcoholics and its existence may be considered as another consequence of ethanol intake or secondary to the alcohol-related diseases.

Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities.

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

Applying psychometric criteria to functional assessment in medical rehabilitation: I. Exploring unidimensionality.

While rehabilitation providers are facing increasing pressure to document treatment outcomes, critics have warned against the inappropriate use of ordinal functional assessment data in arithmetic operations. Two salient criticisms concern the combination of items representing multidimensional abilities into a single total score, and the indeterminate distances between hierarchical functional assessment scale categories. In this initial study, the factor structure of the Patient Evaluation and Conference System (PECS) was studied to assess the potential for unidimensional measurement. Factor analysis of a multidiagnostic dataset (n = 3,564) yielded eight factors accounting for 60% of the variance among 68 PECS items. The factors indicate that several unidimensional measures may underlie the PECS. These factors are delineated, and further studies of unidimensionality and additivity are recommended.

[Computer survey of the rehabilitation data and social conditions of children with motor disabilities in Györ-Sopron and Baranya Counties]. / Mozgássérült gyermekek rehabilitációs és szociális helyzetének számítógépes felmérése Györ-Sopron és Baranya megyékben.

To investigate the occurrence of motor disability a pilot study was carried out in the total children's population of Györ-Sopron county and in 57% of the children of Baranya county by computer-based questionnaires. The data of the 492 motor handicapped children were analysed by 55 computer programs. These programs are constructed for the analysis of the somatic and mental health, schooling, rehabilitation possibilities, social background, care of these children and their further needs for specialists and institutions. This procedure is suitable for national and longitudinal data collection and for the complex registration of the status of these children.

Description and interobserver reliability of the Tufts Assessment of Motor Performance.

This paper describes the conceptual basis for the development of a new clinical evaluation instrument, the Tufts Assessment of Motor Performance (TAMP). The TAMP is a 32-item, diagnosis-independent, criterion-referenced test that samples physical performance items in the areas of mobility, activities of daily living and physical aspects of communication. The administrative and scoring criteria of the TAMP are presented, and the multiple measurement dimensions are described. The documentation of patient status and progress, as described in the functional and performance profiles, is outlined. The paper also reports initial interobserver reliability on the intraitem tasks and the summary indexes of the two profiles. Forty individuals (20 adults and 20 children) with neurologic and musculoskeletal disorders comprised the reliability sample. Kappa and intraclass correlations were used to estimate the reliability of three independent raters on individual tasks and aggregate scores, respectively. Task reliability for the assistance and approach measurement dimensions were generally higher than for the more qualitative pattern and proficiency dimensions. Yet over 90% of all the tasks had acceptable reliability, while all the summary indexes had high interobserver reliability. Determination of interobserver reliability data is the initial phase of defining the most appropriate and technically valuable items, and will serve as a basis for item revision and reduction to enhance the clinical utility of the test.

Comparison of seven- and five-day physical therapy coverage in patients with acute orthopedic disorders.

This study evaluated the efficacy of seven- versus five-day physical therapy coverage in an acute care hospital setting by monitoring percentage of consecutive treatments, mean number of treatments per patient, and lengths of hospital stay (LOS) for 482 patients with acute orthopedic disorders. The Experimental Group (n = 276) received seven-day coverage; the Comparison Group (n = 206) received five-day coverage for four months. Results were analyzed for the group as a whole and by diagnostic categories. Experimental Group subjects received a higher percentage of consecutive treatments than the Comparison Group subjects (72% vs 42%). No difference was found between the groups for mean number of physical therapy treatments received per patient. The LOS was neither significantly different between the two groups as a whole nor for 9 of the 11 diagnostic categories. The results imply that providing consecutive physical therapy treatments through seven-day coverage without increasing the number of physical therapy treatments will not reduce the LOS for patients with acute orthopedic disorders.

Evaluation of a rehabilitation component of home care for homebound elderly.

Fifty-seven elderly homebound patients with musculoskeletal disability were randomized to a stepped-up outreach rehabilitation program or to usual treatment. Sixty-four percent of patient goals were met, but overall there were no significant differences in functional scores, institutionalization, or quality of life. Twenty-three patients had maintained clinical improvement at the end of the study. The services were achieved at a modest marginal cost.

Evaluation of comprehensive rehabilitation services for elderly homebound patients with arthritis and orthopedic disability.

Fifty-seven elderly homebound patients with arthritis and orthopedic disabilities were randomized to a goal-oriented outreach rehabilitation program or to usual treatment. Although 64% of patient goals were met, there were no overall significant differences in functional scores, institutionalization, or contentment between treatment and control periods. Twenty-three patients had maintained clinical improvement at the end of the study and some patients were dramatically improved with simple measures. The program's marginal costs were modest and consisted primarily of expenses associated with therapist's visits. The total costs of assistive devices and home modifications amounted to $1,902. Twenty-five percent of the homebound population could benefit from such services but the actual number who would partake is small.