Systematization of rehabilitation interventions for neuro-oncological patients using international classification of health interventions: a scoping review.

BACKGROUND: To ensure equitable and effective rehabilitation for neuro-oncological patients the development of an effective treatment strategy is necessary. OBJECTIVE: To identify evidence for interventions used in acute rehabilitation for patients with neuro-oncological conditions and to systematize them according to the International Classification of Health Interventions (ICHI) classification Methods: A scoping review was conducted, comprising 3 parts: identification of interventions in publications; linking the interventions to ICHI classification; and identifying problems targeted by these interventions and linking them to International Classification of Functioning, Disability and Health (ICF) categories. RESULTS: The search strategy selected a total of 6,128 articles. Of these, 58 publications were included in the review. A total of 150 interventions were identified, 47 of which were unique interventions. Forty-three of the interventions were linked to the ICHI classification; 4 of these interventions were evidence level I, 18 evidence level II, 23 evidence level III, and 2 evidence level IV. Five interventions were linked to the ICF One-Level Classification, and the remaining 42 interventions were linked to the ICF Two-Level Classification. All interventions regarding the Body Systems and Functions were linked to the ICF Two-Level Classification. Only 5 interventions in the Activities and Participation domain, 3 interventions in the Health-related Behaviors domain, and 1 intervention in the Environment domain were linked to the ICF Two-Level Classification. Two identified problems (inpatient nursing and comprehensive inpatient rehabilitation) were not classified according to the ICF. DISCUSSION: A total of 47 unique interventions were identified, revealing a significant focus on addressing issues related to bodily functions and structures. The study also highlighted the challenge of linking specific interventions to ICHI codes, particularly when the source documentation lacked adequate detail. While this review offers valuable insights into rehabilitation for neuro-oncological patients and lays the groundwork for standardized coding and data exchange, it also emphasizes the need for further refinement and validation of the ICHI classification to better align with the multifaceted interventions used in rehabilitation. CONCLUSION:  There is evidence in the literature of 47 interventions used by various rehabilitation professionals in the acute rehabilitation of neuro-oncological patients. However, most of these interventions are evidence level II and III. Four interventions (virtual reality, mirror therapy, robotic upper extremity training to improve function, and cognitive group therapy) are not included in the ICHI. The problems analysed in the literature that are targeted by interventions often do not coincide with the purpose of the specific intervention or are too broadly defined and not specific. These findings emphasize the need for greater precision in describing and documenting interventions, as well as the importance of aligning interventions more closely with ICF categories, particularly in the domains of Activities and Participation. This work highlights the heterogeneity in the reporting of rehabilitation interventions, and the challenges in mapping them to standardized classifications, emphasizing the ongoing need for refining and updating these classification systems.

Use of the Digital Assistant Vigo in the Home Environment for Stroke Recovery: Focus Group Discussion With Specialists Working in Neurorehabilitation.

BACKGROUND: There is a lack of resources for the provision of adequate rehabilitation after a stroke, thus creating a challenge to provide the necessary high-quality, patient-centered, and cost-efficient rehabilitation services at a time when they are needed the most. Tablet-based therapeutic programs present an alternative way to access rehabilitation services and show a new paradigm for providing therapeutic interventions following a stroke anytime and anywhere. The digital assistant Vigo is an artificial intelligence-based app that provides an opportunity for a new, more integrative way of carrying out a home-based rehabilitation program. Considering the complexity of the stroke recovery process, factors such as a suitable population, appropriate timing, setting, and the necessary patient-specialist support structure need to be thoroughly researched. There is a lack of qualitative research exploring the perspectives of professionals working in neurorehabilitation of the content and usability of the digital tool for the recovery of patients after a stroke. OBJECTIVE: The aim of this study is to identify the requirements for a tablet-based home rehabilitation program for stroke recovery from the perspective of a specialist working in stroke rehabilitation. METHODS: The focus group study method was chosen to explore specialists' attitudes, experience, and expectations related to the use of the digital assistant Vigo as a home-based rehabilitation program for stroke recovery in domains of the app's functionality, compliance, usability, and content. RESULTS: In total, 3 focus groups were conducted with a participant count of 5-6 per group and the duration of the discussion ranging from 70 to 80 minutes. In total, 17 health care professionals participated in the focus group discussions. The participants represented physiotherapists (n=7, 41.2%), occupational therapists (n=7, 41.2%), speech and language therapists (n=2, 11.8%), and physical medicine and rehabilitation physicians (n=1, 5.9%). Audio and video recordings of each discussion were created for further transcription and analysis. In total, 4 themes were identified: (1) the clinician's views on using Vigo as a home-based rehabilitation system, (2) patient-related circumstances facilitating and limiting the use of Vigo; (3) Vigo's functionality and use process (program creation, individual use, remote support); and (4) complementary and alternative Vigo use perspectives. The last 3 themes were divided further into 10 subthemes, and 2 subthemes had 2 sub-subthemes each. CONCLUSIONS: Health care professionals expressed a positive attitude toward the usability of the Vigo app. It is important that the content and use of the app be coherent with the aim to avoid (1) misunderstanding its practical use and the need for integration in practice and (2) misusing the app. In all focus groups, the importance of close involvement of rehabilitation specialists in the process of app development and research was highlighted.

Patient experience using digital therapy "Vigo" for stroke patient recovery: a qualitative descriptive study.

BACKGROUND: The digital assistant "Vigo" is a computer-generated artificial intelligence-based application that serves as a digital assistant to a stroke patient and his family. With its conversational chatbot and gamification elements it counsels, educates, and trains the stroke patient and patient's family on stroke, rehabilitation, care, and other related issues. AIM: This study describes insights about The digital assitant "Vigo" usability from a patients' perspective. METHODS: Twelve patients tested the application at their home environment. Three semi-structured interviews were conducted with each participant to obtain information on the usability of the application. Deductive thematic analyses were used to analyze trancripts. RESULTS: Participants expressed their opinions on music, pictures, video and audio files, chat options, layout, text, name of application and stand that is used for placement of devices on which "Vigo" is installed on. All participants generally evaluated application as transparent, understandable, and handy. The overall design of the application was rated as good. Participants were mostly unsatisfied with difficulty level and diversity of exercises. CONCLUSIONS: Participants had a positive attitude towards using tablet tehchnologies in their home environment. Users of digital assistant "Vigo" acknowledged its ability to support, give educational information and increase participation in therapeutic activities.Implications for rehabilitationTablet application can support, give educational information, and increase participation in therapeutic activities for persons after stroke.As home-based rehabilitation tool, the content of the application must be simple, flexible, and diverse, to face the challenges of meeting each individual's goals, functional needs and abilities.

Comparison of Content and Psychometric Properties of Malnutrition Outcome Measures: A Systematic Review.

OBJECTIVE: To determine the most-often used outcome measures for malnutrition risk and malnutrition, analyse outcome measure content, and assess psychometric properties. METHODS: MEDLINE, SAGE Journals, Web of Science, SCOPUS, ProQuest and Science Direct databases were searched to identify outcome measures. Outcome measure content was compared using the International Classification of Functioning Disability and Health (ICF). Psychometric properties were also systematically searched and compared. This review was prepared according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 1,311 studies met the inclusion criteria. The most-often used outcome measures for detecting malnutrition or its risk overall were: body mass index (590), albumin (469), Mini Nutritional Assessment (312), haemoglobin (251), and Subjective Global Assessment (139). The most psychometrically sound outcome measure was Mini Nutritional Assessment, but the most comprehensive measure, covering the most ICF categories, was Patient-Generated Subjective Global Assessment, with a total of 58 meaningful concepts. CONCLUSION: The results provide an insight into the content and psychometric quality of malnutrition risk and malnutrition outcome measures. There was some variation between the way reviewers linked meaningful concepts to ICF, and literature gaps were identified regarding psychometric properties. These results can be used to help select the most appropriate malnutrition outcome measure.

Comparison of content and psychometric properties for assessment tools used for brain tumor patients: a scoping review.

AIMS: To determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties. METHODS: A scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed. RESULTS: Nine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments. CONCLUSION: Nine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.

Patients' physical activity in stroke units in Latvia and Sweden.

OBJECTIVE: A prospective, observational study to describe levels of physical activity in patients with stroke in a comprehensive stroke unit in Sweden and Latvia, comparing data between countries. METHODS: The study was performed at stroke units in one hospital in Sweden (data were acquired over a 2-month period in 2017) and two hospitals in Latvia (data were acquired over a 3-month period between 2016 and 2017). Patients with stroke were observed for 1 min every 10 min. The level of physical activity, location, and the people present were noted at each time-point. RESULTS: A total of 27 patients were observed in Latvia and 25 patients in Sweden. Patients from both countries were in bed half of the time and spent the majority of the day in their bedroom and alone. Patients in Sweden had higher physical activity levels, spent more time outside their bedroom and spent more time with rehabilitation specialists and visitors. CONCLUSION: Patients are inactive and alone for a majority of the time during hospitalization at a comprehensive stroke unit in both countries. There are differences in environment in the stroke unit between countries.

Influence of mobility restrictions on post-stroke pain.

OBJECTIVES: The objective of this study was to investigate the role of mobility limitations and vitality, as well as additional factors such as comorbidities, to predict post-stroke pain. MATERIALS & METHODS: This study included cross-sectional data from 214 participants living in varied settings in different parts of Sweden. Participants were asked to complete the Stroke Impact Scale, Medical Outcomes Study Short Form 36, and Self-administered Comorbidity Questionnaire to evaluate mobility, vitality, comorbidities, and pain. Descriptive statistics were used for demographic and clinical characteristics. Binary logistic regression analysis was performed to predict the pain domain score on Medical Outcomes Study Short Form 36. RESULTS: The mean age of all participants in the sample was 66 years (SD 14); 43.4% of the study population were women. After analyses, "standing without losing balance and vitality'' were found to be significant predictors in the model which explained the pain score on Medical Outcomes Study Short Form 36. CONCLUSIONS: In conclusion, the results suggest that restrictions in mobility and low vitality have an important role on the occurrence of post-stroke pain. Having post-stroke pain could be due to not able to stand without losing balance and low vitality. Thus, rehabilitation professionals may consider the importance of these factors, especially mobility restrictions, in preventing post-stroke pain.

Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale.

PURPOSE: To examine if the International Classification of Functioning (ICF) core set for stoke contains problems that are relevant for the persons living with stroke as expressed in the Stroke Impact Scale (SIS). METHODS: Cross-sectional study of 242 persons with previous stroke. The agreement between the perceived problems in the SIS items and problems in the categories of Comprehensive ICF Core Set for stroke were analyzed using percent of agreement and Kappa statistic. RESULTS: The analyses between 57 items of the SIS and 31 second-level categories of the ICF were conducted. The problems in domains of "Mobility", "Activities of daily living", "Hand function", "Strength" in the SIS had moderate agreement when compared to ICF categories. The SIS domains of "Emotion" and "Communication", as well as some aspects of the "Memory" had slight or fair agreement with corresponding ICF categories. The results of the study suggest that there is acceptable agreement between persons after stroke and health professionals in the physical aspects, but rather poor agreement in the cognitive and emotional aspects of functioning. CONCLUSIONS: Health professionals do not fully capture the magnitude of emotional or social problems experienced by persons after stroke when using the ICF Core Set as a framework for evaluation. Implications for Rehabilitation The ICF Core Set for Stroke provides comprehensive list of possible health and health related outcomes for persons after stroke. Problems reported in condition-specific patient-reported outcome scales can be important in decision making in rehabilitation. Patients and health professionals tend to agree more on physical than cognitive problems. Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale.

Factors associated with long-term mortality for stroke unit patients in Latvia.

AIM: The aim of this study was to evaluate how pre-stroke risk factors, neurological symptoms, and the level of disability shortly after stroke are associated with poststroke mortality during a 7-year period after stroke, for persons treated in a stroke unit. METHODS: The data of 231 patients were included in the study. Patients who were treated in the stroke unit at the Riga East University Hospital between February 1, 2009, and July 20, 2009, were included in this study. Three stepwise Cox proportional hazard analyses were performed to analyze mortality in the 7 years following stroke. Pre-stroke risk factors (type of stroke, arterial hypertension, diabetes mellitus, atrial fibrillation, smoking, alcohol abuse, obesity, recurrent stroke, age, gender), neurological symptoms (motor deficit, sensory disturbance, aphasia, poststroke urinary incontinence (PSUI), mental status), and limitations of activity (feeding, bathing, grooming, dressing, toilet use, transfers, mobility, stairs) were evaluated as factors associated with mortality after stroke. RESULTS: A total of 145 (62.8%) patients died during the study period. The final model for each group of factors included only one of the factors used for the analysis. Patients who had alcohol abuse were 40% more likely to die earlier. The hazard for those with PSUI is 1.72 times higher than those without PSUI. The independence in grooming showed a 39% lower likelihood of dying earlier. CONCLUSION: Alcohol abuse as a pre-stroke risk factor, poststroke urinary incontinence as a neurological symptom, and dependence in grooming as a factor of disability were associated with earlier mortality in the first seven years after stroke.

Living in Latvia after stroke: the association between functional, social and personal factors and the level of self-perceived disability-a cross-sectional study.

OBJECTIVE: To investigate how functional, social and personal factors are associated with self-perceived level of disability in the chronic phase of stroke in a Latvian stroke population. The consequences of stroke can vary greatly and often leads to long-term disability that, according to the WHO definitions, depends on the interaction between the person and his/her context. DESIGN: Cross-sectional study with retrospective data gathering. SETTING: Community-dwelling persons who received specialised in-patient rehabilitation after stroke in Latvia. PARTICIPANTS: Of 600 persons after stroke who were identified through hospital register and selected for the study, 255 were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: The medical information and discharge data of the Functional Independence Measure (FIM) was extracted from medical records. Participants filled out a questionnaire on sociodemographic information and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), either in Latvian or Russian, depending on their wish when contacted for their oral agreement to participate. Stepwise multiple regression analysis was conducted to find a model that best explains the variance in WHODAS 2.0 scores. RESULTS: The models explained 23-43.5% of variance in outcomes. The best explained WHODAS 2.0 domains were 'mobility' and 'self-care'. The significant factors were level of independence in 'self-care', 'locomotion' and 'communication' according to FIM, as well as working status, time since rehabilitation, age, gender, living alone or in family and preferred language. CONCLUSIONS: Functional, social and personal factors are of similar importance when explaining self-perceived disability in the chronic phase of stroke. Some, but not all, of the factors are modifiable by the healthcare system. Therefore, a complex approach and involvement of medical, social and political systems is needed.

Analyzing the modified rankin scale using concepts of the international classification of functioning, disability and health.

BACKGROUND: The World Health Organization (WHO) suggests using the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for disability outcomes and the modified Rankin Scale (mRS) as an outcome measure in stroke. AIM: The aim of this study was to analyze the content of the mRS and the mRS-Systematic Interview (mRS-SI) by linking the scales to the ICF and to explore the association between the mRS and the ICF Core Set for stroke. DESIGN: Analysis of mRS and mRS-SI using ICF linking rules, as well as quantitative analysis using cross-sectional data. SETTING: In- and outpatient settings, community dwelling individuals after stroke. METHODS: Both scales were independently linked to the ICF and correlations between the mRS scores and the sum of problems in functioning, deriving from 266 stroke patients, were assessed under the components of the ICF Core Set for Stroke, the domains of 'Activities and Participation' and 15 second level categories linked to the mRS. RESULTS: Twelve meaningful concepts in the mRS and 40 meaningful concepts in the mRS-SI were identified and linked to different ICF categories, covering 9% and 32% of the ICF Core Set for stroke respectively. The strongest association of the mRS scores was with the number of problems in 'Activities and Participation', especially with the 'Self-care', 'Mobility' and 'Domestic life' domains, as well as with single categories of 'Moving around using equipment', 'Changing basic body position', 'Walking' and 'Carrying out daily routine'. CONCLUSIONS: The content of the mRS and the mRS-SI can be linked to the ICF framework. But the content may not be related to a specific outcome that would be in accordance with the disability terminology suggested by the World Health Organization. CLINICAL REHABILITATION IMPACT: In order to follow the ICF model, interpretation of mRS rating requires caution.

Exploration of some personal factors with the International Classification of Functioning, Disability and Health core sets for stroke.

OBJECTIVE: The aim of this study was to explore the influence of personal factors (i.e. age, gender, place of residence and time since onset of stroke) on self-perceived functioning and environmental factors, using the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke (extended version) as a framework. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 243 community-dwelling persons (53% men) with prior stroke (6 months to 13 years) with a mean age of 68 years (age range 24-95 years). METHODS: Regression analysis of 4 personal factors (age, gender, place of residence, and time since onset of stroke) was used to explore their influence on different components, domains and categories of functioning and environmental factors, evaluated with the extended version of the Comprehensive ICF Core Set for Stroke. RESULTS: The personal factors had statistically significant predictive values for almost all the categories, domains and components of functioning and environmental factors examined in this study. These factors influence self-perceived functional outcome and environmental factors in terms of being barriers or facilitators in various ways. CONCLUSION: Personal factors, such as age, gender, place of residence and time since onset of stroke, influence self-perceived functioning and environmental factors.