Abstract Objective To determine the relative incidence, prevalence, costs, and impact on disability of 8 common conditions treated by rehabilitation professionals. Data Sources Comprehensive ...bibliographic searches using MEDLINE, Google Scholar, and UpToDate , (June, 2013). Data Extraction Two review authors independently screened the search results and performed data extraction. Eighty-two articles were identified that had relevant data on the following conditions: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain. Data Synthesis Back pain and arthritis (osteoarthritis, rheumatoid arthritis) are the most common and costly conditions we analyzed, affecting more than 100 million individuals and costing greater than $200 billion per year. Traumatic brain injury, while less common than arthritis and back pain, carries enormous per capita direct and indirect costs, mostly because of the young age of those involved and the severe disability that it may cause. Finally, stroke, which is often listed as the most common cause of disability, is likely second to both arthritis and back pain in its impact on functional limitations. Conclusions Of the common rehabilitation diagnoses we studied, musculoskeletal conditions such as back pain and arthritis likely have the most impact on the health care system because of their high prevalence and impact on disability.
Background
International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, data show ...that only a small proportion of these patients utilise rehabilitation.
Objectives
First, to assess interventions provided to increase patient enrolment in, adherence to, and completion of cardiac rehabilitation. Second, to assess intervention costs and associated harms, as well as interventions intended to promote equitable CR utilisation in vulnerable patient subpopulations.
Search methods
Review authors performed a search on 10 July 2018, to identify studies published since publication of the previous systematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL); the National Health Service (NHS) Centre for Reviews and Dissemination (CRD) databases (Health Technology Assessment (HTA) and Database of s of Reviews of Effects (DARE)), in the Cochrane Library (Wiley); MEDLINE (Ovid); Embase (Elsevier); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); and Conference Proceedings Citation Index ‐ Science (CPCI‐S) on Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and also searched two clinical trial registers. We applied no language restrictions.
Selection criteria
We included randomised controlled trials (RCTs) in adults with myocardial infarction, with angina, undergoing coronary artery bypass graft surgery or percutaneous coronary intervention, or with heart failure who were eligible for cardiac rehabilitation. Interventions had to aim to increase utilisation of comprehensive phase II cardiac rehabilitation. We included only studies that measured one or more of our primary outcomes. Secondary outcomes were harms and costs, and we focused on equity.
Data collection and analysis
Two review authors independently screened the titles and s of all identified references for eligibility, and we obtained full papers of potentially relevant trials. Two review authors independently considered these trials for inclusion, assessed included studies for risk of bias, and extracted trial data independently. We resolved disagreements through consultation with a third review author. We performed random‐effects meta‐regression for each outcome and explored prespecified study characteristics.
Main results
Overall, we included 26 studies with 5299 participants (29 comparisons). Participants were primarily male (64.2%). Ten (38.5%) studies included patients with heart failure. We assessed most studies as having low or unclear risk of bias. Sixteen studies (3164 participants) reported interventions to improve enrolment in cardiac rehabilitation, 11 studies (2319 participants) reported interventions to improve adherence to cardiac rehabilitation, and seven studies (1567 participants) reported interventions to increase programme completion. Researchers tested a variety of interventions to increase utilisation of cardiac rehabilitation. In many studies, this consisted of contacts made by a healthcare provider during or shortly after an acute care hospitalisation.
Low‐quality evidence shows an effect of interventions on increasing programme enrolment (19 comparisons; risk ratio (RR) 1.27, 95% confidence interval (CI) 1.13 to 1.42). Meta‐regression revealed that the intervention deliverer (nurse or allied healthcare provider; P = 0.02) and the delivery format (face‐to‐face; P = 0.01) were influential in increasing enrolment. Low‐quality evidence shows interventions to increase adherence were effective (nine comparisons; standardised mean difference (SMD) 0.38, 95% CI 0.20 to 0.55), particularly when they were delivered remotely, such as in home‐based programs (SMD 0.56, 95% CI 0.37 to 0.76). Moderate‐quality evidence shows interventions to increase programme completion were also effective (eight comparisons; RR 1.13, 95% CI 1.02 to 1.25), but those applied in multi‐centre studies were less effective than those given in single‐centre studies, leading to questions regarding generalisability. A moderate level of statistical heterogeneity across intervention studies reflects heterogeneity in intervention approaches. There was no evidence of small‐study bias for enrolment (insufficient studies to test for this in the other outcomes).
With regard to secondary outcomes, no studies reported on harms associated with the interventions. Only two studies reported costs. In terms of equity, trialists tested interventions designed to improve utilisation among women and older patients. Evidence is insufficient for quantitative assessment of whether women‐tailored programmes were associated with increased utilisation, and studies that assess motivating women are needed. For older participants, again while quantitative assessment could not be undertaken, peer navigation may improve enrolment.
Authors' conclusions
Interventions may increase cardiac rehabilitation enrolment, adherence and completion; however the quality of evidence was low to moderate due to heterogeneity of the interventions used, among other factors. Effects on enrolment were larger in studies targeting healthcare providers, training nurses, or allied healthcare providers to intervene face‐to‐face; effects on adherence were larger in studies that tested remote interventions. More research is needed, particularly to discover the best ways to increase programme completion.
Background
Cardiovascular disease is the most common cause of death globally. Traditionally, centre‐based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid ...recovery and prevent further cardiac illness. Home‐based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015.
Objectives
To compare the effect of home‐based and supervised centre‐based cardiac rehabilitation on mortality and morbidity, exercise‐capacity, health‐related quality of life, and modifiable cardiac risk factors in patients with heart disease.
Search methods
We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied.
Selection criteria
We included randomised controlled trials, including parallel group, cross‐over or quasi‐randomised designs) that compared centre‐based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home‐based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation.
Data collection and analysis
Two review authors independently screened all identified references for inclusion based on pre‐defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created.
Main results
We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.
No evidence of a difference was seen between home‐ and centre‐based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = ‐0.13, 95% CI ‐0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health‐related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI ‐0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home‐based participants.
Authors' conclusions
This update supports previous conclusions that home‐ and centre‐based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health‐related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence‐based, home‐based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre‐based programme or a home‐based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home‐ and centre‐based cardiac rehabilitation reported in the included short‐term trials can be confirmed in the longer term and need to consider adequately powered non‐inferiority or equivalence study designs.
Abstract
Introduction
Recovery from a facial burn injury can be challenging. Excessive reconstructive interventions and the emotional devastation can be taxing. Microblading, semi-permanent eyebrow ...tattooing, is a potential non-invasive alternative treatment. Little research exists on microblading’s longevity and durability over burn scar or its impact on self-esteem. A single case study showed positive impact on patient perceived body image and maintenance of shape and color. Two years post microblading new data supports its efficacy as a potential treatment for patients with a facial burn.
Methods
Single case study two years post microblading of a 22-year-old female who sustained a 30% total body surface area burn injury to bilateral upper extremities, hands and face at age one. Based on referral from her plastic surgeon, she underwent first microblading treatment March 2019 with a standard touch up session May 2019. Patient has not undergone any additional sessions since. Photos obtained two years post treatment were compared to before/after photos immediately following microblading to assess longevity and durability on scar tissue. Self-reported patient outcomes obtained two years after microblading assessed impact on self-esteem and body image.
Results
Photos were taken pre/post microblading, at nine months, and 2.5 years post. Comparison of photos over time showed some expected fading but maintenance of overall shape. Patient self-reports using an eyebrow pencil to darken when she desires brows that are more vibrant and trims hair as needed to maintain shape. Patient reports positive impact to her self-esteem post-microblading. “I most definitely did notice some changes in my self-esteem.” She notes feeling happier and more confident, especially in social situations with peers. Comparison of responses immediately post-microblading with 2.5 years later show focus on improved self-esteem versus satisfaction with appearance of the eyebrow.
Conclusions
Comparison of follow up photos obtained 2.5 years after initial microblading shows maintenance of eyebrow shape with some fading of color. Further research is needed to determine if color fading is as expected or more pronounced in patients with scarred skin. Also important is the impact of characteristic dryness of scars on fading rate. To maintain adequate color, additional treatments would be recommended. Better understanding of factors affecting fading would help determine frequency and timing of maintenance sessions. Patient report indicates increasingly improved self-esteem over time as evidenced by focus on confidence versus appearance. Despite some fading, data supports microblading as an effective non-surgical treatment in establishing eyebrow appearance and function over burn scar.
Abstract
Introduction
Virtual reality (VR) gaming offers an immersive experience that can enrich physical therapy for the burn patient by introducing variability, enjoyment, and reward during ...functional motions of the upper extremities. In this study, we aim to support a proof-of-concept for VR gaming in upper extremity burn rehabilitation by characterizing shoulder and elbow kinematics during VR gaming in a healthy volunteer.
Methods
A healthy volunteer without burn injuries played two games, a virtual rhythmic baton and virtual boxing game, on a commercially available VR gaming platform. Kinematics during play were assessed using two external cameras placed orthogonally, to the player’s front and left, so that 3-dimensional motion of the player’s left arm could be captured. Video of each gaming session was processed using an open-source perceptual computing software that dynamically tracks the user’s upper extremity during play. Kinematics at the left shoulder and elbow were characterized with respect to range of motion (ROM) and time spent in composite positions.
Results
During the rhythmic baton game, the player achieved 157 degrees of elbow flexion ROM and 90 degrees shoulder elevation ROM. During the boxing game, the player achieved 156 degrees of elbow flexion ROM and 123 degrees shoulder elevation ROM. The baton game was associated with more time spent in the “rest” position (elbow extended with shoulder adducted, 60% of the game) while boxing was associated with more time in the “Guard” position (elbow flexed with shoulder elevated, 79% of the game) (Figure 1). Both games demonstrated simultaneous movement at both the shoulder and elbow during play.
Conclusions
The two VR games investigated in this kinematic assessment challenged players to achieve a wide range of motion at the upper extremity with functional, multi-joint movements. These findings support a potential role for commercial VR gaming in burn rehabilitation and future research in burn patients is required to demonstrate its therapeutic value.
Abstract
Introduction
Numerous health professions face challenges and opportunities resulting in increasing contexts for service delivery. One element of this changing landscape for occupational ...therapy is the ongoing development and delivery of services in new or underdeveloped practice settings, often identified as emerging practice (Holmes & Scaffa, 2009). Often, occupational therapy practitioners work on interprofessional teams. Articulating occupational therapy's distinct value is necessary to communicate with clarity to those outside of the profession. According to the American Occupational Therapy Association (AOTA) Vision 2025, As an inclusive profession, occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living. One of the pillars identified in the AOTA 2025 vision is Collaboration: Occupational therapy excels in working with clients and systems to produce effective outcomes (AOTA, 2017).
Methods
Through the initiative of one of the surgeons, she collaboratively integrated Occupational Therapy in the OR during the debridement and skin grafting process. While the patient is on sedation, the surgeon allowed OT to facilitate a range of motion, allowing optimal range of motion (ROM). The focus of the management in the acute phase of burn rehabilitation is the preservation of function through the prevention of deformities. Using a case study, the therapist's clinical and professional reasoning concerning a client's occupational performance (AOTA, 2020 p.20).
Results
Occupational therapy specialists use theoretical principles and models, knowledge about the outcomes of disorders on participation, and existing evidence on the efficacy of interventions to guide their reasoning. Understanding this distinct role as an occupational therapist should start from the beginning of burn care management among patients with burns inside the operating room. Having said all this, our Rehabilitation Department Burn Therapy Team was allowed to learn the introductory course in scrubbing, gowning, and gloving for healthcare professionals.
Conclusions
The idea of health care teams working together is not new. However, applying a culture of transformation, where concepts such as patient safety, mutual respect, shared decision making, and patient centered care are the norm, remains a novel and often fleeting idea in most burn care facilities (Sexton & Baessler, 2016).
Abstract
Introduction
Fifty seven year old male who sustained an electrical burn injury that resulted in bilateral below elbow amputation began inpatient rehabilitation program. Patient was motivated ...to increase independence to return home prior to prosthetic fitting and training being completed. Quality options for adaptive equipment required to increase independence were not sufficient to meet patients needs, thus innovative specialty fabrication of adaptive equipment were required to meet patient’s goals of independence.
Methods
Occupational therapist to use thermoplastic material to fabricate various adaptive equipment in order to address patient's goals to increase independence with self care tasks. Occupational therapist and patient to have one time consult with hospital maintenance employee to create pant hook to use for ease of donning/doffing over hips. Patient participated in daily Occupational therapy sessions focused on trialing adaptive equipment and to provide feedback for any desired changes of equipment to maximize patient progress and success with reaching independence with self cares and return to life roles.
Results
Patient met all goals to become independent with self care tasks including: toileting, dressing and showering as a result of using fabricated adaptive equipment and techniques addressed during therapy sessions. Patient able to return home independently following discharge from inpatient rehabilitation stay.
Conclusions
Use of easily accessible ezeform thermoplastic material can result in fabrication of adaptive equipment to increase patient's independence. It is important to maintain a creative outlook as a clinician and to continue to collaborate with our patient's to identify barriers to success and explore options to increase patient's desired independence.
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