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The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran
Farkhondeh Sharif, Alireza Shoul, Mansour Janati, Javad Kojouri, Najaf Zare
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-40
Abstract: The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran.For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck’s Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2?months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care.There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P?=?0.0014). However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P?=?0.079).Cardiac rehabilitation was effective in reducing depression 2?months after surgery in patients undergoing coronary artery bypass grafting.IRCTN201203262812N8
The Effectiveness of Cognitive Rehabilitation on Improving the Selective Attention in Patients with Mild Cognitive Impairment  [PDF]
Arezoo Shomali Oskoei, Vahid Nejati, Bita Ajilchi
Journal of Behavioral and Brain Science (JBBS) , 2013, DOI: 10.4236/jbbs.2013.36049
Abstract: Purpose: The aim of the present study is to evaluate the effectiveness of cognitive rehabilitation on improving selective attention in patients with mild cognitive impairment. Methods: It was a quasi-experimental study with pre-test and post-test. The population in this study was all individuals referred to a neurology clinic in Tehran in 2012. The group was comprised of 40 patients with mild cognitive impairment who were evaluated with early detection and assessment by a medical psychologist (MMSE score lower than 25 and Wechsler memory test) and were selected by available sampling. They were also older than 55 years and had a minimum education at degree level, together with a lack of neurological and psychiatric comorbidities and impaired sensory and motor retardation, according to their nursing history and medical records. They were randomly divided into experimental and control groups (20 patients in each group). The experimental group was given 12 sessions (two hours each section) of cognitive rehabilitation with Neurocognitive Joyful Attentive Training Intervention (NEJATI). The control group, as expected with this group, did not receive any trial period. The selective attention of both groups was evaluated, before and after receiving intervention, by a Strop computer programme. Data were analysed using the covariance statistical test, MANCOVA. Results: The results show an increase in selective attention scores in the experimental group compared with the control group. Therefore, we can conclude that cognitive rehabilitation leads to improvement in the performance of selective attention (F = 4/97; sig < 0/05). Conclusion: Cognitive rehabilitation can impact on improving selective focus in people with mild cognitive impairment.
Neurological impairment in proximal humeral fractures-dislocations undergoing shoulder replacement
R. Padua,L. Padua,R. Bondì,A. Insola,E. Ceccarelli,A. Campi
Journal of Orthopaedics and Traumatology , 2004, DOI: 10.1007/PL00021721
Abstract: The outcome of shoulder replacement for trauma has been studied in large series but not always all factors have been examined for their effects on the final results. One important element not sufficiently considered regards neurological impairment. This complication is reported in 1%–67% of shoulder dislocations and humeral neck fractures. Electromyography has an important role in revealing nerve injuries undetected by clinical examination alone. Three patients with typical neurological impairment complicating proximal humeral fractures are reported. The cases were studied through clinical, radiographical and electromyographical examinations, before and after undergoing shoulder hemiarthroplasty. Only a few reports have described nerve lesions in hemiarthroplasty for proximal humeral fractures, we discuss these typical cases and review the recent literature on the topic.
A pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery: trial protocol
Brian H Cuthbertson, Marion K Campbell, Stephen A Stott, Luke Vale, John Norrie, John Kinsella, Jonathan Cook, Julie Brittenden, Adrian Grant, FOCCUS Study Group
Trials , 2010, DOI: 10.1186/1745-6215-11-41
Abstract: A multi-centre randomised controlled trial with a 2 * 2 factorial design. The first randomisation is to pre-operative fluid therapy or standard regimen and the second randomisation is to routine intensive care versus high dependency care during the early post-operative period. We intend to recruit 204 patients undergoing major elective and urgent abdominal and thoraco-abdominal surgery who fulfil high-risk surgical criteria. The primary outcome for the comparison of level of care is cost-effectiveness at six months and for the comparison of fluid optimisation is the number of hospital days after surgery.We believe that the results of this study will be invaluable in determining the future care and clinical resource utilisation for this group of patients and thus will have a major impact on clinical practice.Trial registration number - ISRCTN32188676Patients undergoing major elective or urgent surgery are at high risk of death or significant morbidity. Death around the time of surgery accounts for nearly one in 20 of all deaths in the UK and the rates are not significantly declining. Amongst the patients who survive, many suffer major complications with subsequent impairment of health and quality of life.The National Confidential Enquiry into Peri-operative Deaths shows that such deaths are commonly associated with cardiac complications [1,2]. Putative contributory factors include a lack of High Dependency Unit (HDU) and Intensive Care Unit (ICU) beds, and suboptimal pre- and post-operative ward care. The Department of Health's report "Comprehensive Critical Care" [3] proposed that an HDU facility should care for frail patients who require monitoring or specialised analgesia after surgery without the immediate availability of medical staff, whereas an ICU-based HDU facility should care for patients requiring more detailed observation or intervention, including immediate availability of experienced medical staff. This simple system offers much to be commended as an at
Blast exposure and dual sensory impairment: An evidence review and integrated rehabilitation approach  [PDF]
Gabrielle H. Saunders, PhD,Katharina V. Echt, PhD
Journal of Rehabilitation Research and Development , 2012, DOI: 10.1682/jrrd.2010.08.0157
Abstract: Combat exposures to blast can result in both peripheral damage to the ears and eyes and central damage to the auditory and visual processing areas in the brain. The functional effects of the latter include visual, auditory, and cognitive processing difficulties that manifest as deficits in attention, memory, and problem solving--symptoms similar to those seen in individuals with visual and auditory processing disorders. Coexisting damage to the auditory and visual system is referred to as dual sensory impairment (DSI). The number of Operation Iraqi Freedom/Operation Enduring Freedom Veterans with DSI is vast; yet currently no established models or guidelines exist for assessment, rehabilitation, or service-delivery practice. In this article, we review the current state of knowledge regarding blast exposure and DSI and outline the many unknowns in this area. Further, we propose a model for clinical assessment and rehabilitation of blast-related DSI that includes development of a coordinated team-based approach to target activity limitations and participation restrictions in order to enhance reintegration, recovery, and quality of life.
Microalbuminuria indicates long-term vascular risk in patients after acute stroke undergoing in-patient rehabilitation
Sander Dirk,Weimar Christian,Bramlage Peter,Brandt Tobias
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-102
Abstract: Background Patients in neurologic in-patient rehabilitation are at risk of cardio- and cerebrovascular events. Microalbuminuria (MAU) is frequent and an important risk predictor but has not been validated in in-patient rehabilitation. We therefore aimed to examine MAU as an indicator of risk and predictor of vascular events in a prospective study. Methods The INSIGHT (INvestigation of patients with ischemic Stroke In neuroloGic reHabiliTation) registry is the first to provide large scale data on 1,167 patients with acute stroke (< 3 months) that survived the initial phase of high risk and were undergoing neurologic in-patient rehabilitation. MAU was determined by dipstick-testing and correlated to baseline clinical variables (stroke-origin, functional impairment, co-morbidity, ankle-brachial-index, intima-media-thickeness) as well as vascular events after one year of follow-up. Comparisons were made with the χ2 or Mann–Whitney-U Test. Relative risks (RR) with 95% confidence intervals (CI) were estimated using log-binominal models. To evaluate the association between MAU and new vascular events as well as mortality, we calculated hazard ratios (HR) using Cox proportional hazard regression. Results A substantial proportion of patients was MAU positive at baseline (33.1%). Upon univariate analysis these patients were about 4 years older (69 vs. 65 years; p < 0.0001), had a slightly higher body mass index (27.8 vs. 27.1 kg/m2; p = 0.03) and increased waist circumference (79.5 vs. 50.4% for women [p < 0.0001] and 46.8 vs. 43.2% for men [p = 0.04]) and twice as often had diabetes mellitus (41.8 vs. 20.1%; p < 0.0001). Patients with MAU had a similar NIH stroke scale score (median 3 vs. 3; p = 0.379) but had lower values on the Barthel Index (median 75 vs. 90; p < 0.001). They had higher rates of atrial fibrillation (RR 1.38; 95% CI 1.09-1.75), coronary artery disease (RR 1.54; 95% CI 1.18-2.00), heart failure (RR 1.70; 95% CI 1.10-2.60) symptomatic peripheral artery disease (RR 2.30; 95% CI 1.40-3.80) and atherosclerotic stroke etiology (53.7 vs. 35.4%; p < 0.0001). MAU was associated with an increased intima-media-thickness, decreased ankle-brachial-index and polyvascular disease (RR 1.56; 95%CI 1.31-1.99). The event rate after a median follow-up of 13 months was 6.7% for fatal or nonfatal stroke, 4.7% for death, and 10.9% for combined vascular events (stroke, MI, vascular death). The presence of MAU was predictive for vascular events during the following year (HR for total mortality 2.2; 95% CI 1.3-3.7; HR for cardiovascular events 2.3; 95% 1.2 - 4
Impact of Fibromyalgia on Functioning in Obese Patients Undergoing Comprehensive Rehabilitation  [PDF]
Marco Arreghini, Gian Mauro Manzoni, Gianluca Castelnuovo, Cristina Santovito, Paolo Capodaglio
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0091392
Abstract: A possible link between fibromyalgia (FM) and obesity has been recently suggested but very scanty data on the prevalence of FM in obese populations are available. The aims of the present cross-sectional study were: 1) to estimate the prevalence of FM in a population of obese patients undergoing rehabilitation and 2) to investigate the effect of FM on obese patients' functional capacities. One hundred and thirty Italian obese (Body Mass Index, BMI ≥30) patients admitted to hospital for 1-month rehabilitation treatment took part in the study. All participants were interviewed by a rheumatologist according to the 2010 American College of Rheumatology (ACR) diagnostic criteria for FM. At admission and discharge from hospital (on average, after 28 days), the following measures were compared between the group of patients with FM and the other patients: body weight, body mass index, functional independence (FIM), obesity-related disability (TSD-OC), self-reported functioning and the Timed-Up-Go (TUG) test. Thirty seven patients out of 130 fulfilled the diagnostic criteria for FM. The prevalence rate was 27.7% (95% CI: 20 to 35.4). Between-group comparisons showed that FM patients had higher disability level at the first assessment, had lower scores on the FIM at the final assessment, scored lower on self-reported functioning both at the first and the final assessments and had a lower body weight. The prevalence of FM in our study is much higher than the rates reported in the general normal-weight population (on average, 3.5%) and the 5.15% rate previously reported in a bariatric population. Functional data showed that the FM obese group yielded lower performance capacity and higher disability level as compared to the non-FM obese group. However, due to the relatively small sample size and the selected population, such results need to be confirmed in larger obese subpopulations.
Early intensive hand rehabilitation after spinal cord injury ("Hands On"): a protocol for a randomised controlled trial
Lisa A Harvey, Sarah A Dunlop, Leonid Churilov, Ya-Seng Hsueh, Mary P Galea
Trials , 2011, DOI: 10.1186/1745-6215-12-14
Abstract: A multicentre randomised controlled trial will be undertaken. Seventy-eight participants with recent tetraplegia (C2 to T1 motor complete or incomplete) undergoing inpatient rehabilitation will be recruited from seven spinal cord injury units in Australia and New Zealand and will be randomised to a control or experimental group. Control participants will receive usual care. Experimental participants will receive usual care and an 8-week program of intensive unilateral hand training using an instrumented exercise workstation and functional electrical stimulation. Participants will drive the functional electrical stimulation of their target hands via a behind-the-ear bluetooth device, which is sensitive to tooth clicks. The bluetooth device will enable the use of various manipulanda to practice functional activities embedded within computer-based games and activities. Training will be provided for one hour, 5 days per week, during the 8-week intervention period. The primary outcome is the Action Research Arm Test. Secondary outcomes include measurements of strength, sensation, function, quality of life and cost effectiveness. All outcomes will be taken at baseline, 8 weeks, 6 months and 12 months by assessors blinded to group allocation. Recruitment commenced in December 2009.The results of this trial will determine the effectiveness of an 8-week program of intensive hand training with functional electrical stimulation.NCT01086930 (12th March 2010)ACTRN12609000695202 (12th August 2009)The incidence of spinal cord injury (SCI) varies between countries but is estimated at 10 to 83 per million, per year with most injured under the age of 25 years [1]. More than one third of these individuals sustain an injury that causes damage to the spinal cord in the cervical region and results in tetraplegia [1]. Most people with tetraplegia remain wheelchair-dependent and reliant on others for physical care. Importantly, however, limited hand and upper limb function is often more di
An inpatient rehabilitation model of care targeting patients with cognitive impairment
Katherine S McGilton, Aileen Davis, Nizar Mahomed, John Flannery, Susan Jaglal, Cheryl Cott, Gary Naglie, Elizabeth Rochon
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-21
Abstract: A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6?months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date.Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures.The study is registered at http://clinicaltrials.gov webcite, Identifier NCT01566136.
Cost-Effectiveness of New Cardiac and Vascular Rehabilitation Strategies for Patients with Coronary Artery Disease  [PDF]
Sandra Spronk, Johanna L. Bosch, Constance Ryjewski, Judith Rosenblum, Guido C. Kaandorp, John V. White, M. G. Myriam Hunink
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0003883
Abstract: Objective Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation. Data Sources Best-available evidence was retrieved from literature and combined with primary data from 231 patients. Methods We developed a Markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75 000 was used. Results ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44 251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: ?0.17, 0.29) at a threshold willingness-to-pay of $75 000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30 246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:?0.24, 0.46) compared to current practice. The results were robust for other different input parameters. Conclusion ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.
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