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1.
Psychiatr Rehabil J ; 41(3): 243-245, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29975083

RESUMO

OBJECTIVE: This study examined the feasibility and acceptability of developing a recovery-oriented book club in an acute inpatient psychiatric setting, and the impact of participation on measures of hope and recovery orientation. METHOD: Participants were recruited from an inpatient psychiatric hospital and assigned to control (N = 13) or experimental (N = 13) conditions. Participants completed the Herth Hope Index (HHI) and the Mental Health Confidence Scale (MHCS) at baseline and follow-up. Book club participants completed a satisfaction survey. ANOVA was performed to examine changes on HHI and MHCS. RESULTS: No significant differences were found between conditions on HHI or MHCS. On the satisfaction survey, most book club participants agreed "somewhat" or "strongly" that the intervention increased self-understanding (92.3%) and hope (61.6%). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Book club groups may help individuals in inpatient psychiatric settings feel more hopeful. Future research may examine the adaptability of this intervention for outpatient settings. (PsycINFO Database Record


Assuntos
Biblioterapia/métodos , Esperança , Hospitais Psiquiátricos , Transtornos Mentais/reabilitação , Satisfação do Paciente , Doença Aguda/reabilitação , Adulto , Estudos de Viabilidade , Seguimentos , Humanos , Pacientes Internados , Aceitação pelo Paciente de Cuidados de Saúde
3.
Arch Phys Med Rehabil ; 99(11): 2299-2312, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29634915

RESUMO

OBJECTIVE: To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, and are safe and cost-effective for patients with acute or subacute conditions. DATA SOURCES: Electronic database (AMED, CINAHL, EMBASE, MEDLINE, Physiotherapy Evidence Database [PEDro], PubMed) searches were updated from 2010 through June 2017. STUDY SELECTION: Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay, or cost-effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review. DATA EXTRACTION: Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale, and the Grading of Recommendation Assessment, Development, and Evaluation approach was applied to each meta-analysis. DATA SYNTHESIS: Postintervention data were pooled with an inverse variance, random-effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate-quality evidence that additional physical therapy services reduced length of stay by 3 days in subacute settings (mean difference [MD]=-2.8; 95% CI, -4.6 to -0.9; I2=0%), and low-quality evidence that it reduced length of stay by 0.6 days in acute settings (MD=-0.6; 95% CI, -1.1 to 0.0; I2=65%). Additional physical therapy led to small improvements in self-care (SMD=.11; 95% CI, .03-.19; I2=0%), activities of daily living (SMD=.13; 95% CI, .02-.25; I2=15%), and health-related quality of life (SMD=.12; 95% CI, .03-.21; I2=0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in subacute rehabilitation. CONCLUSIONS: Additional physical therapy services improve patient activity and participation outcomes while reducing hospital length of stay for adults. These benefits are likely safe, and there is preliminary evidence to suggest they may be cost-effective.


Assuntos
Doença Aguda/reabilitação , Tempo de Internação/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Fatores de Tempo , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
BMJ Open ; 8(2): e019210, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29391380

RESUMO

INTRODUCTION: Age-related loss of muscle mass and strength, sarcopaenia, burdens many older adults. The process is accelerated with bed rest, protein intakes below requirements and the catabolic effect of certain illnesses. Thus, acutely ill, hospitalised older adults are particularly vulnerable. Protein supplementation can preserve muscle mass and/or strength and, combining this with resistance exercise training (RT), may have additional benefits. Therefore, this study investigates the effect of protein supplementation as an addition to offering RT among older adults while admitted to the geriatric ward and after discharge. This has not previously been investigated. METHODS AND ANALYSIS: In a block-randomised, double-blind, multicentre intervention study, 165 older adults above 70 years, fulfilling the eligibility criteria, will be included consecutively from three medical departments (blocks of n=20, stratified by recruitment site). After inclusion, participants will be randomly allocated (1:1) to receive either ready-to-drink, protein-enriched, milk-based supplements (a total of 27.5 g whey protein/day) or isoenergetic placebo products (<1.5 g protein/day), twice daily as a supplement to their habitual diet. Both groups will be offered a standardised RT programme for lower extremity muscle strength (daily while hospitalised and 4×/week after discharge). The study period starts during their hospital stay and continues 12 weeks after discharge. The primary endpoint is lower extremity muscle strength and function (30 s chair-stand-test). Secondary endpoints include muscle mass, measures of physical function and measures related to cost-effectiveness. ETHICS AND DISSEMINATION: Approval is given by the Research Ethic Committee of the Capital Region of Denmark (reference no. H-16018240) and the Danish Data Protection Agency (reference no. HGH-2016-050). There are no expected risks associated with participation, and each participant is expected to benefit from the RT. Results will be published in peer-reviewed international journals and presented at national and international congresses and symposiums. TRIAL REGISTRATION NUMBER: NCT02717819 (9 March 2016).


Assuntos
Doença Aguda/reabilitação , Proteínas do Leite/uso terapêutico , Treinamento de Resistência , Sarcopenia/dietoterapia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Dinamarca , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Masculino , Limitação da Mobilidade , Força Muscular , Sarcopenia/reabilitação , Sarcopenia/terapia , Resultado do Tratamento
5.
Spinal Cord ; 56(2): 158-167, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29057989

RESUMO

STUDY DESIGN: Prospective observational multicenter study. OBJECTIVES: Investigation of content, duration and adjustment of physical therapy for the rehabilitation of ambulation in acute spinal cord injury (SCI). SETTING: European Multicenter Study of SCI (EMSCI). METHODS: Physical therapy interventions during acute in-patient rehabilitation of eighty incomplete SCI patients (AIS B, C, D all lesion levels) were recorded using the SCI - Intervention Classification System. Mobility was documented using the Spinal Cord Independence Measurement (SCIM III), demographics and clinical data were retrieved from the EMSCI database. RESULTS: Overall recovery of locomotor function was categorized into three outcome groups (G1-G3). Of 76 initial wheelchair-using patients, 53.9% remained wheelchair user (G1), 25% regained moderate (G2) and 21.1% good walking (G3) capability. Strength training was the most frequently applied intervention of body function/-structure across all outcome groups (about 30% of all interventions), while interventions focusing on muscle tone and respiration were predominantly applied in wheelchair-dependent patients. Activity-focused interventions of transfer, transition, sitting were trained most intensively in outcome group G1, while walking and swimming were increasingly trained in patients with moderate and good walking outcomes. Physical therapy interventions of assistive and active trainings as well as corresponding training environments changed with the recovery of locomotor function. CONCLUSIONS: Physical therapy of locomotor function is targeted to individual patients' conditions and becomes adjusted to the progress of ambulation. Although the involved clinical sites were not following explicitly standardized rehabilitation programs, common patterns can be discerned which may form the basis of prospective standardized programs.


Assuntos
Terapia por Exercício/métodos , Locomoção/fisiologia , Modalidades de Fisioterapia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Doença Aguda/reabilitação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Caminhada/fisiologia , Adulto Jovem
6.
Mem. Inst. Oswaldo Cruz ; 113(9): e180171, 2018. graf
Artigo em Inglês | LILACS | ID: biblio-955120

RESUMO

BACKGROUND The anti-inflammatory and cardioprotective properties of curcumin (Cur), a natural polyphenolic flavonoid isolated from the rhizomes of Curcuma longa, are increasingly considered to have beneficial effects on the progression of Chagas heart disease, caused by the protozoan parasite Trypanosoma cruzi. OBJECTIVE To evaluate the effects of oral therapy with Cur on T. cruzi-mediated cardiovasculopathy in acutely infected mice and analyse the in vitro response of parasite-infected human microvascular endothelial cells treated with this phytochemical. METHODS Inflammation of heart vessels from Cur-treated and untreated infected mice were analysed by histology, with benznidazole (Bz) as the reference compound. Parasitaemia was monitored by the direct method. Capillary permeability was visualised by Evans-blue assay. Myocardial ET-1, IL-6, and TNF-α mRNA expressions were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Microvascular endothelial HMEC-1 cells were infected in vitro with or without addition of Cur or Bz. Induction of the Ca2+/NFAT pathway was assessed by fluorometry, immunoblotting, and reporter assay. FINDINGS Oral Cur therapy of recently infected mice reduced inflammatory cell infiltration of myocardial arteries without lowering parasite levels. Compared to that of the phosphate-buffered saline-receiving group, hearts from Cur-treated mice showed significantly decreased vessel inflammation scores (p < 0.001), vascular permeabilities (p < 0.001), and levels of IL-6/TNF-α (p < 0.01) and ET-1 (p < 0.05) mRNA. Moreover, Cur significantly (p < 0.05 for transcript; p < 0.01 for peptide) downregulated ET-1 secretion from infected HMEC-1 cells. Remarkably, Cur addition significantly (p < 0.05 at 27.0 μM) interfered with T. cruzi-dependent activation of the Ca2+/NFATc1 signalling pathway that promotes generation of inflammatory agents in HMEC-1 cells. CONCLUSIONS Oral treatment with Cur dampens cardiovasculopathy in acute Chagas mice. Cur impairs the Ca2+/NFATc1-regulated release of ET-1 from T. cruzi-infected vascular endothelium. These findings identify new perspectives for exploring the potential of Cur-based interventions to ameliorate Chagas heart disease.


Assuntos
Humanos , Cardiomiopatia Chagásica/parasitologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Transcrição NFATC/análise , Western Blotting , Doença Aguda/reabilitação , Anti-Inflamatórios/farmacologia
7.
Nutr. hosp ; 34(6): 1305-1310, nov.-dic. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-168968

RESUMO

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)


Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/dietoterapia , Lesão por Pressão/epidemiologia , Doença Aguda/epidemiologia , Lesão por Pressão/prevenção & controle , Lesão por Pressão/reabilitação , Estudos Retrospectivos , Estudos de Coortes , Doença Aguda/reabilitação , Análise Multivariada , Tempo de Internação , Análise de Dados/métodos
8.
Fisioterapia (Madr., Ed. impr.) ; 39(5): 223-226, sept.-oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-166350

RESUMO

Objetivo: Evaluar el tratamiento combinado del comprehensive directed breathing con el programa de entrenamiento Square Wave Endurance Exercise Test en cicloergómetro con oxigenoterapia en el ejercicio en un paciente con EPOC grave, insuficiencia respiratoria crónica y agudización cardiorrespiratoria. Metodología: Se evalúa clínica y funcionalmente tras el alta médica a un paciente de 61 años con EPOC grave. Inicia entrenamiento tipo Square Wave Endurance Exercise Test combinado con ventilación dirigida contrastada (Comprehensive Directed Breathing) y oxigenoterapia en el ejercicio. Tras 40 sesiones de 90min se analizan parámetros físicos (frecuencia cardiaca, respiratoria y SaO2) en reposo y tras el ejercicio, funcionales (disnea de reposo y esfuerzo) y espirométricos. Resultados: Tras 8 semanas de entrenamiento se objetivan mejoras en la frecuencia cardiorrespiratoria, la SaO2, la disnea de reposo y esfuerzo, la gasometría y la espirometría (PEF 4,8L/s [+98%] y PIF 3,9L/s [+48%]), manteniéndose a los 6 meses, uno y 3 años. Conclusión: El tratamiento combinado comprehensive directed breathing -Square Wave Endurance Exercise Test con oxigenoterapia durante el ejercicio supervisado mejora la frecuencia cardiorrespiratoria, la SaO2, la disnea, la gasometría y la espirometría, manteniéndose a los 6 meses, uno y 3 años


Objective: To evaluate the effect of combined treatment with comprehensive directed breathing and Square Wave Endurance Exercise Test in cycle ergometer associated with oxygen therapy on exercise in a patient with severe COPD, chronic respiratory failure and cardiopulmonary exacerbation. Methods: Treatment with Square Wave Endurance Exercise Test, comprehensive directed breathing, and oxygen therapy during exercise was implemented in a 61-year-old patient with severe COPD. After 40 sessions of 90min, an analysis was performed on the physical parameters, including heart and respiratory rate, oxygen saturation, gasometry, and spirometry. Results: After 8 weeks of training, improvement were obtained in heart and respiratory rates, oxygen saturation, dyspnoea, gasometry, and spirometry (PEF 4.8L/s [+98%] and PIF 3.9L/s [+48%]) at 6 month and one and 3 years. Conclusion: Comprehensive directed breathing -Square Wave Endurance Exercise Test and oxygen therapy during exercise improved clinical and functional parameters at 6 months, and one and 3 years


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Insuficiência Respiratória/reabilitação , Exercícios Respiratórios/métodos , Doença Aguda/reabilitação , Resultado do Tratamento , Oxigenoterapia , Modalidades de Fisioterapia
9.
Rehabilitación (Madr., Ed. impr.) ; 51(3): 182-190, jul.-sept. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-163684

RESUMO

Objetivo. La reeducación de la marcha es un objetivo fundamental para mejorar el estado funcional, así como para prevenir complicaciones en el paciente con lesión medular incompleta. El objetivo del presente trabajo fue realizar una revisión sistemática sobre el empleo del sistema robótico Lokomat en la rehabilitación de la marcha de pacientes con lesión medular incompleta. Estrategia de búsqueda. Se realizó una búsqueda sistemática de artículos científicos publicados, tanto en inglés como en castellano, en las bases de datos PubMed, Web of Science, ProQuest Research Library, Scopus, Medline, y en la Journal of Physical Therapy, desde noviembre del 2011 hasta mayo de 2016. Se evaluó la calidad metodológica mediante la escala de Jadad. Selección de los estudios. Un total de 12 artículos fueron finalmente seleccionados. Síntesis de resultados. Se exponen los resultados en función de las características de los estudios realizados, severidad y fase aguda o crónica de la lesión, escalas de valoración empleadas y crono-programación de las sesiones con el dispositivo Lokomat. La calidad metodológica fue baja, siendo aceptable en solo 2 de los estudios analizados. Conclusiones. Existen evidencias a favor del uso del Lokomat sobre ciertos parámetros de la marcha en pacientes afectados por lesión medular incompleta, pero no son superiores a ninguna otra técnica empleada para este tipo de pacientes. Se aconseja su uso como una herramienta coadyuvante en la rehabilitación de la marcha en la lesión medular incompleta (AU)


Objective. Gait training is crucial to improve functional status as well as to prevent complications in patients with incomplete spinal cord injury. The aim of this study was to conduct a systematic review of the use of the Lokomat robotic device on gait rehabilitation in patients with incomplete spinal cord injury. Search strategy. We performed a systematic search of scientific articles published in the databases PubMed, Web of Science, ProQuest Research Library, Scopus, Medline and Journal of Physical Therapy in both English and Spanish from November 2011 until May 2016. The methodological quality of the articles included was assessed using the Jadad scale. Article selection. A total of 12 articles were included. Summary of the results. The results are presented in terms of the characteristics of the studies, severity and whether status was acute or chronic, the scales employed and programming sessions with the Lokomat device. The methodological quality was low, and was acceptable in only two of the studies analysed. Conclusions. There is evidence in favour of using the Lokomat device on certain gait parameters in patients with incomplete spinal cord injury, but it is not superior to any other technique used for these patients. This robotic device should be used as an adjunctive tool in gait rehabilitation (AU)


Assuntos
Humanos , Traumatismos da Medula Espinal/reabilitação , Marcha Atáxica/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Robótica/métodos , Força Muscular/fisiologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapia , Doença Aguda/reabilitação
10.
Rehabilitation (Stuttg) ; 56(4): 272-285, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28838026

RESUMO

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established.


Assuntos
Doença Aguda/reabilitação , Intervenção Médica Precoce/organização & administração , Assistência Integral à Saúde/organização & administração , Cuidados Críticos/organização & administração , Alemanha , Fidelidade a Diretrizes , Necessidades e Demandas de Serviços de Saúde/organização & administração , Número de Leitos em Hospital , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Objetivos Organizacionais , Enfermagem em Reabilitação/organização & administração
11.
Pediatr Blood Cancer ; 64(11)2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28423225

RESUMO

Physical inactivity has been shown to exacerbate negative side effects experienced by pediatric patients undergoing cancer therapy. Exercise interventions are being created in response. This review summarizes current exercise intervention data in the inpatient pediatric oncology setting. Two independent reviewers collected literature from three databases, and analyzed data following the PRISMA statement for systematic reviews and meta-analyses. Ten studies were included, representing 204 patients. Good adherence, positive trends in health status, and no adverse events were noted. Common strategies included individual, supervised, combination training with adaptability to meet fluctuating patient abilities. We recommend that general physical activity programming be offered to pediatric oncology inpatients.


Assuntos
Doença Aguda/reabilitação , Terapia por Exercício , Serviços de Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Neoplasias/terapia , Qualidade de Vida , Criança , Humanos
12.
J Am Geriatr Soc ; 64(10): 2019-2026, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27603152

RESUMO

OBJECTIVES: To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. DESIGN: Randomized controlled trial. SETTING: Acute and medical wards. PARTICIPANTS: Individuals aged 70 and older (N = 400). MEASUREMENTS: Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). RESULTS: Occupational therapist recommendations differed significantly between groups (P < .001) (HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADLs (Nottingham Extended Activities of Daily Living scale (NEADL): ß = -0.17, 95% confidence interval (CI) = -0.99-0.66) or participation (LLDI-Frequency: ß = -0.23, 95% CI = -2.05-1.59; LLDI-Limitation: ß = -0.14, 95% CI = -2.86-2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions (HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male (P = .03) or having lower perceived participation because of physical problems (P = .04) resulted in higher risk of unplanned readmissions. CONCLUSION: HOME discharge planning, which had a strong emphasis on task modification, well-being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation.


Assuntos
Atividades Cotidianas , Doença Aguda/reabilitação , Terapia Ocupacional/métodos , Alta do Paciente , Idoso , Feminino , Avaliação Geriátrica/métodos , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Visita Domiciliar/estatística & dados numéricos , Humanos , Masculino , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos
13.
BMC Geriatr ; 16: 140, 2016 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-27431505

RESUMO

BACKGROUND: The Hospital Elder Life Program (HELP) has been shown to effectively prevent delirium and functional decline in older patients in acute care, but has not been examined in a rehabilitation setting. This pilot study examined potential successes and implementation factors of the HELP in a post-acute rehabilitation hospital setting. METHODS: A mixed methods (quantitative and qualitative) evaluation, incorporating a repeated measures design, was used. A total of 100 patients were enrolled; 58 on the pilot intervention unit and 42 on a usual care unit. Group comparisons were made using change scores (pre-post intervention) on outcome measures between pilot unit patients and usual care patients (separate analyses compared usual care patients with pilot unit patients who did or did not receive the HELP). Qualitative data were collected using focus group and individual interviews, and analyzed using emergent coding procedures. RESULTS: Delirium prevalence reduced from 10.9 % (n = 6) to 2.5 % (n = 1) in the intervention group, while remaining the same in the usual care group (2.5 % at both measurement points). Those who received the HELP showed greater improvement on cognitive and functional outcomes, particularly short-term memory and recall, and a shorter average length of stay than patients who did not. Participant groups discussed perceived barriers, benefits, and recommendations for further implementation of the HELP in a rehabilitation setting. CONCLUSIONS: This study adds to the limited research on delirium and the effectiveness of the HELP in post-acute rehabilitation settings. The HELP was found to be feasible and have potential benefits for reduced delirium and improved outcomes among rehabilitation patients.


Assuntos
Doença Aguda/reabilitação , Cognição , Delírio/prevenção & controle , Administração dos Cuidados ao Paciente/métodos , Recuperação de Função Fisiológica , Idoso , Canadá , Cuidados Críticos , Delírio/etiologia , Estudos de Viabilidade , Feminino , Geriatria , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Resultado do Tratamento
14.
Contemp Clin Trials ; 49: 6-14, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27178766

RESUMO

Hospitalization induces functional decline in older adults. Many geriatric patients fail to fully recover physical function after hospitalization, which increases the risk of frailty, disability, dependence, re-hospitalization, and mortality. There is a lack of evidence-based therapies that can be implemented following hospitalization to accelerate functional improvements. The aims of this Phase I clinical trial are to determine 1) the effect size and variability of targeted interventions in accelerating functional recovery from hospitalization and 2) the feasibility of implementing such interventions in community-dwelling older adults. Older patients (≥65years, n=100) will be recruited from a single site during hospitalization for an acute medical condition. Subjects will be randomized to one of five interventions initiated immediately upon discharge: 1. protein supplementation, 2. in-home rehabilitation plus placebo supplementation, 3. in-home rehabilitation plus protein supplementation, 4. single testosterone injection, or 5. isocaloric placebo supplementation. Testing will occur during hospitalization (baseline) and at 1 and 4weeks post-discharge. Each testing session will include measures of muscle strength, physical function/performance, body composition, and psychological function. Physical activity levels will be continuously monitored throughout study participation. Feasibility will be determined through collection of the number of eligible, contacted, and enrolled patients; intervention adherence and compliance; and reasons for declining enrollment and study withdrawal. This research will determine the feasibility of post-hospitalization strategies to improve physical function in older adults. These results will also provide a foundation for performing larger, multi-site clinical trials to improve physical function and reduce readmissions in geriatric patents.


Assuntos
Doença Aguda/reabilitação , Androgênios/uso terapêutico , Proteínas na Dieta/uso terapêutico , Suplementos Nutricionais , Terapia por Exercício/métodos , Serviços de Assistência Domiciliar , Hospitalização , Recuperação de Função Fisiológica , Testosterona/uso terapêutico , Atividades Cotidianas , Doença Aguda/psicologia , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Depressão/psicologia , Depressão/reabilitação , Exercício , Fadiga/psicologia , Fadiga/reabilitação , Estudos de Viabilidade , Feminino , Humanos , Injeções Intramusculares , Masculino , Força Muscular , Projetos Piloto , Equilíbrio Postural , Fatores de Tempo , Resultado do Tratamento
15.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 51(1): 11-17, ene.-feb. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-148659

RESUMO

Objetivo. Analizar la asociación entre el diagnóstico principal que motiva el ingreso hospitalario en una unidad geriátrica de agudos (UGA) y el riesgo de mortalidad intrahospitalaria y al año del alta. Material y métodos. Estudio longitudinal de los pacientes que ingresaron en la UGA del Hospital Central de la Cruz Roja de Madrid durante 2009. El diagnóstico de ingreso se agrupó por grupos relacionados por el diagnóstico (GRD). La fecha de fallecimiento fue recogida del informe médico y del Índice Nacional de Defunciones del Ministerio de Sanidad. Como variable resultado se analizó la asociación entre diagnósticos al ingreso y deterioro funcional al alta (medido como una pérdida de 10 o más puntos entre el Índice de Barthel al alta respecto al previo al ingreso), mortalidad durante el ingreso, a los 3 meses y al año del alta. El análisis se ajustó por edad, sexo, comorbilidad, situación funcional y cognitiva, y niveles de albúmina sérica. Resultados. Se estudiaron 1.147 pacientes, con una edad media de 86,7 años (DE: ± 6,7), 66% eran mujeres. Fallecieron durante el ingreso un 10,1% y presentaron deterioro funcional al alta el 36,6%. La mortalidad postalta fue del 25,5% a los 3 meses y el 42,2% al año. La frecuencia de los principales diagnósticos al ingreso (entre paréntesis su mortalidad intrahospitalaria y al año) fueron insuficiencia cardiaca 21,4% (8,1 y 37,4%), neumonía no aspirativa 13,3% (12,3 y 46,4%) y neumonía aspirativa 4,7% (27,5 y 71%), bronconeumopatías 13,3% (6,6 y 38,2%), infección urinaria 10,2% (5,1 y 42,7%) e ictus (excluyendo AIT) 9,9% (13,3 y 46,9%). En el análisis multivariante solo el ingreso por neumonía aspirativa se asociaba de forma independiente con mayor riesgo de mortalidad intrahospitalaria (odds ratio-2,23; IC95% = 1,13-44,42) y el ingreso por ictus a la presencia de deterioro funcional al alta (odds ratio-6,01; IC95% = 3,42-10,57). Ningún diagnóstico se asoció de manera independiente con aumento del riesgo de muerte a los 3 meses y al año. Conclusiones. El ingreso por neumonía aspirativa conlleva un mayor riesgo de muerte en ancianos hospitalizados por patología médica aguda. Tras el alta, el riesgo aumentado de muerte debe ser atribuido a otros factores diferentes al diagnóstico (AU)


Objective. To analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after discharge. Material and methods. A longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin. Results. The study included1147 patients, with a mean age of 86.7 years (SD ± 6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI = 1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI = 3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at year. Conclusions. Admission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis (AU)


Assuntos
Idoso , Idoso de 80 Anos ou mais , Humanos , Doença Aguda/epidemiologia , Doença Aguda/mortalidade , Doença Aguda/terapia , Mortalidade Hospitalar/tendências , Fatores de Risco , Pneumonia/complicações , Pneumonia/diagnóstico , Pneumonia/mortalidade , Doença Aguda/classificação , Doença Aguda/reabilitação , Alta do Paciente/normas , Estudos Longitudinais , Repertório de Barthel , Razão de Chances , Análise de Variância , Indicadores Básicos de Saúde
17.
PLoS One ; 10(12): e0143590, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26630131

RESUMO

BACKGROUND: Evaluations of the impact of interventions for resource allocation purposes commonly focus on health status. There is, however, also concern about broader impacts on wellbeing and, increasingly, on a person's capability. This study aims to compare the impact on health status and capability of seven major health conditions, and highlight differences in treatment priorities when outcomes are measured by capability as opposed to health status. METHODS: The study was a cross-sectional four country survey (n = 6650) of eight population groups: seven disease groups with: arthritis, asthma, cancer, depression, diabetes, hearing loss, and heart disease and one health population 'comparator' group. Two simple self-complete questionnaires were used to measure health status (EQ-5D-5L) and capability (ICECAP-A). Individuals were classified by illness severity using condition-specific questionnaires. Effect sizes were used to estimate: (i) the difference in health status and capability for those with conditions, relative to a healthy population; and (ii) the impact of the severity of the condition on health status and capability within each disease group. FINDINGS: 5248 individuals were included in the analysis. Individuals with depression have the greatest mean reduction in both health (effect size, 1.26) and capability (1.22) compared to the healthy population. The effect sizes for capability for depression are much greater than for all other conditions, which is not the case for health. For example, the arthritis group effect size for health (1.24) is also high and similar to that of depression, whereas for the same arthritis group, the effect size for capability is much lower than that for depression (0.55). In terms of severity within disease groups, individuals categorised as 'mild' have similar capability levels to the healthy population (effect sizes <0.2, excluding depression) but lower health status than the healthy population (≥0.4). CONCLUSION: Significant differences exist in the relative effect sizes across diseases when measured by health status and capability. In terms of treating morbidity, a shift in focus from health gain to capability gain would increase funding priorities for patients with depression specifically and severe illnesses more generally.


Assuntos
Doença Aguda/reabilitação , Indicadores Básicos de Saúde , Qualidade de Vida , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários , Adulto Jovem
18.
Aust Occup Ther J ; 62(1): 41-9, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25649034

RESUMO

BACKGROUND/AIM: Older adults admitted to an acute hospital setting with an illness often experience deconditioning. Although occupational therapists frequently work with deconditioned older adults in inpatient rehabilitation programmes, limited information exists regarding the type of interventions used and how these interventions are provided. This study aimed to determine the level of consensus among Australian occupational therapists about occupational therapy service delivery and interventions commonly used during inpatient rehabilitation with older adults who have become deconditioned during acute hospital admission for a medical illness. METHODS: The Delphi technique was used to reach consensus among expert occupational therapists regarding service delivery and interventions commonly used in an ideal clinical setting. Data were analysed from three rounds of surveys and the percentage of agreement between clinicians were calculated. RESULTS: Twenty-six participants completed round one survey, with 24 completing subsequent surveys (92% response rate). Fifteen commonly used interventions were identified, including showering/dressing, light meal preparation and home assessment. Consensus was reached on commonly used aspects of service delivery, including intervention provision, programme length, team members and follow up after discharge. CONCLUSION: Results generated may assist in guiding occupational therapists in the attributes of service delivery and the type of interventions currently considered best practice when working with deconditioned older adults in a rehabilitation setting. The information provides preliminary data for effectiveness studies.


Assuntos
Doença Aguda/reabilitação , Técnica Delfos , Idoso Fragilizado , Terapia Ocupacional/organização & administração , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Competência Profissional , Populações Vulneráveis
19.
J Telemed Telecare ; 20(7): 370-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25399997

RESUMO

We investigated the feasibility of providing telerehabilitation in the home as an alternative to conventional ambulatory rehabilitation. Two groups of patients were accepted for telerehabilitation. The first group were community patients who needed rehabilitation, e.g. following a stroke, a fracture or prolonged hospital admission. The second group was from two rural nursing homes where residents were identified with a recent injury, fall or hospitalisation. Telerehabilitation employed a coaching model, with fewer therapist home visits, more feedback and "homework" for the patient. Patients had a tablet computer loaded with a videoconferencing app to connect with therapists and relevant therapeutic apps. Multidisciplinary care was provided for up to 8 weeks. The majority (86%) of eligible patients consented to receive telerehabilitation in their own home (n = 61) or in the country nursing home where they lived (n = 17). Most services were delivered using the 3G and 4G wireless networks with few technical problems. On average participants felt that they had achieved 75% of the goals set at the beginning of the programme. High levels of satisfaction were recorded. There was a 50% reduction in home visits by staff, or 10 visits per patient. Speech therapists were able to double occasions of service and direct patient contact time, whilst halving their travel time. Previous experience with technology and age were not barriers to this method of delivery but did affect recruitment. Telerehabilitation using off-the-shelf technology is feasible for post-acute treatment.


Assuntos
Doença Aguda/reabilitação , Serviços de Assistência Domiciliar/organização & administração , Telemedicina/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Serviços de Saúde Rural/organização & administração , População Rural , Austrália do Sul , Reabilitação do Acidente Vascular Cerebral , Ferimentos e Lesões/reabilitação
20.
PM R ; 6(11): 988-91, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24990448

RESUMO

OBJECTIVES: To explore the impact of contact isolation on the change in functional independence measure (FIM) score, FIM efficiency score, and length of stay. DESIGN: Retrospective matched case control study. SETTING: Tertiary care hospital (academic medical center). PARTICIPANTS: Persons admitted to an acute inpatient rehabilitation facility at a tertiary care hospital from July 2009 through December 2010. METHODS: Retrospective chart review by obtaining patient data regarding contact isolation status, patient demographics, and rehabilitation diagnosis. Two hundred charts were reviewed, which resulted in identification of 20 patients in contact isolation. These patients subsequently were matched to patients not in contact isolation based on age, rehabilitation diagnosis, and type of insurance. Admission and discharge FIM scores were obtained for these 40 study subjects (20 cases and 20 matched controls). MAIN OUTCOME MEASUREMENTS: The primary study outcome measurements were change in FIM score (discharge FIM score minus admission FIM score), FIM efficiency score (change in FIM score divided by length of stay), and length of stay. RESULTS: Compared with patients not in contact isolation, patients in contact isolation showed no statistically significant difference in FIM score change, a lower FIM efficiency score (P = .010), and a 39% longer length of stay (P = .017) when adjusting for confounders. CONCLUSIONS: This study identifies contact isolation as a likely variable that is associated with increased length of stay and decreased FIM efficiency score in patients in an acute inpatient rehabilitation facility. Further study is needed to identify the role or mechanisms by which contact isolation is involved in these adverse effects so that interventions may be developed to counteract them.


Assuntos
Atividades Cotidianas/psicologia , Doença Aguda/reabilitação , Pacientes Internados , Tempo de Internação/tendências , Isolamento de Pacientes/psicologia , Centros de Reabilitação/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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