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Federico S, Zitti M, Regazzetti M, Dal Pozzo E, Cieślik B, Pomella A, Stival F, Pirini M, Pregnolato G, Kiper P. Integration of Smart Home and Building Automation Systems in Virtual Reality and Robotics-Based Technological Environment for Neurorehabilitation: A Pilot Study Protocol. J Pers Med 2024; 14:522. [PMID: 38793104 PMCID: PMC11122358 DOI: 10.3390/jpm14050522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Technological innovation has revolutionized healthcare, particularly in neurological rehabilitation, where it has been used to address chronic conditions. Smart home and building automation (SH&BA) technologies offer promising solutions for managing chronic disabilities associated with such conditions. This single group, pre-post longitudinal pilot study, part of the H2020 HosmartAI project, aims to explore the integration of smart home technologies into neurorehabilitation. Eighty subjects will be enrolled from IRCCS San Camillo Hospital (Venice, Italy) and will receive rehabilitation treatment through virtual reality (VR) and robotics devices for 15 h per day, 5 days a week for 3 weeks in the HosmartAI Room (HR), equipped with SH&BA devices measuring the environment. The study seeks to optimize patient outcomes and refine rehabilitation practices. Findings will be disseminated through peer-reviewed publications and scientific meetings, contributing to advancements in neurological rehabilitation and guiding future research.
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Affiliation(s)
- Sara Federico
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | - Mirko Zitti
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | - Martina Regazzetti
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | - Enrico Dal Pozzo
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | - Błażej Cieślik
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | | | | | | | - Giorgia Pregnolato
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
| | - Pawel Kiper
- Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, 30126 Venice, Italy; (S.F.); (M.Z.); (M.R.); (E.D.P.); (G.P.)
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García-Rudolph A, Wright MA, Yepes C, Murillo N, Conesa L, Soriano I, Bautista R, Opisso E, Tormos JM, Medina J. Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study. PM R 2023. [PMID: 38155582 DOI: 10.1002/pmrj.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. OBJECTIVES To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. DESIGN Matched case-control study. SETTING TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). PARTICIPANTS Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). INTERVENTIONS The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. MAIN OUTCOME MEASURE(S) The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. RESULTS The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. CONCLUSIONS TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mark Andrew Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Carlos Yepes
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Narda Murillo
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Lucas Conesa
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ignasi Soriano
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Raquel Bautista
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Medina
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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García-Rudolph A, Wright MA, Murillo N, Opisso E, Medina J. Tele-rehabilitation on independence in activities of daily living after stroke: A Matched Case-Control Study. J Stroke Cerebrovasc Dis 2023; 32:107267. [PMID: 37579640 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES To compare independence in activities of daily living (ADLs) in post-acute patients with stroke following tele-rehabilitation and matched in-person controls. MATERIALS AND METHODS Matched case-control study. A total of 35 consecutive patients with stroke who followed tele-rehabilitation were compared to 35 historical in-person patients (controls) matched for age, functional independence at admission and time since injury to rehabilitation admission (<60 days). The tele-rehabilitation group was also compared to the complete cohort of historical controls (n=990). Independence in ADLs was assessed using the Functional Independence Measure (FIM) and the Barthel Index (BI). We formally compared FIM and BI gains calculated as discharge score - admission scores, efficiency measured as gains / length of stay and effectiveness defined as (discharge score-admission score)/ (maximum score-admission score). We analyzed the minimal clinically important difference (MCID) for FIM and BI. RESULTS The groups showed no significant differences in type of stroke (ischemic or hemorrhagic), location, severity, age at injury, length of stay, body mass index, diabetes, dyslipidemia, hypertension, aphasia, neglect, affected side of the body, dominance or educational level. The groups showed no significant differences in gains, efficiency nor effectiveness either using FIM or Barthel Index. We identified significant differences in two specific BI items (feeding and transfer) in favor of the in-person group. No differences were observed in the proportion of patients who achieved MCID. CONCLUSIONS No significant differences were seen between total ADL scores for tele-rehabilitation and in-person rehabilitation. Future research studies should analyze a combined rehabilitation approach that utilizes both models.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Mark Andrew Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Narda Murillo
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Josep Medina
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Little J, Geraghty AWA, Nicholls C, Little P. Findings from the development and implementation of a novel course consisting of both group and individual Alexander Technique lessons for low back pain. BMJ Open 2022; 12:e039399. [PMID: 35058254 PMCID: PMC8783812 DOI: 10.1136/bmjopen-2020-039399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) To develop a mixed course of individual and group lessons in the Alexander Technique (AT) for low back pain, and (2) to explore its: (a) effectiveness and (b) acceptability to both participant AT teachers and patients. DESIGN Single-centre study, mixed methods. SETTING Members of the public in the Brighton area (community recruitment), and patients from six Hampshire General Practices (GP) (National Health Service (NHS) recruitment). PARTICIPANTS People with chronic or recurrent low back pain; AT teachers. INTERVENTIONS Iterative development and implementation of a 10-lesson (6 group, 4 individual) AT course. OUTCOME MEASURES Perceptions from semistructured interviews analysed using inductive thematic analysis. Descriptive analysis of RMDQ (Roland-Morris Disability Questionnaire) over 12 weeks. RESULTS Thirty-nine participants with low back pain were included and 32 AT teachers were interviewed, 7 of whom taught on the course. Some participants had reservations, preferring only individual lessons, but the majority found the sharing of experience and learning in groups helpful. There was also concern regarding group teaching among some AT teachers, but most also found it acceptable. By 12 weeks, RMDQ score among participants fell from 10.38 to 4.39, a change of -5.99. 29 of 39 (74%) participants had a clinically important reduction in RMDQ score of 2.5 or more. CONCLUSION Some patients and practitioners had reservations about group AT lessons, but most found groups helpful. Further development is needed, but the course of individual and group lessons has the potential to cost-effectively deliver clinically important benefits to patients with back pain, who are known to improve little and slowly.
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Affiliation(s)
- Joseph Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Adam W A Geraghty
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, University of Southampton Faculty of Medicine, Southampton, UK
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Barrett E, Conroy C, Corcoran M, Sullivan KO, Purtill H, Lewis J, McCreesh K. An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series. J Hand Ther 2019; 31:301-307. [PMID: 29217293 DOI: 10.1016/j.jht.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A case series was carried out. INTRODUCTION There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.
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Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Carmela Conroy
- Physiotherapy Department, St. John's Hospital, Limerick, Ireland
| | - Marie Corcoran
- Physiotherapy Department, Midland Regional Hospital, Portlaoise, Ireland
| | - Kieran O' Sullivan
- Sports Spine Centre, Aspetar Sports and Orthopaedic Hospital, Doha, Qatar
| | - Helen Purtill
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Jeremy Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland; Department of Allied Health Professions and Midwifery, University of Hertfordshire, Hertfordshire, UK; Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK
| | - Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
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Vallati C, Virdis A, Gesi M, Carbonaro N, Tognetti A. ePhysio: A Wearables-Enabled Platform for the Remote Management of Musculoskeletal Diseases. SENSORS 2018; 19:s19010002. [PMID: 30577467 PMCID: PMC6339172 DOI: 10.3390/s19010002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Abstract
Technology advancements in wireless communication and embedded computing are fostering their evolution from standalone elements to smart objects seamlessly integrated in the broader context of the Internet of Things. In this context, wearable sensors represent the building block for new cyber-physical social systems, which aim at improving the well-being of people by monitoring and measuring their activities and provide an immediate feedback to the users. In this paper, we introduce ePhysio, a large-scale and flexible platform for sensor-assisted physiotherapy and remote management of musculoskeletal diseases. The system leverages networking and computing tools to provide real-time and ubiquitous monitoring of patients. We propose three use cases which differ in scale and context and are characterized by different human interactions: single-user therapy, indoor group therapy, and on-field therapy. For each use case, we identify the social interactions, e.g., between the patient and the physician and between different users and the performance requirements in terms of monitoring frequency, communication, and computation. We then propose three related deployments, highlighting the technologies that can be applied in a real system. Finally, we describe a proof-of-concept implementation, which demonstrates the feasibility of the proposed solution.
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Affiliation(s)
- Carlo Vallati
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
| | - Antonio Virdis
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
| | - Marco Gesi
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia e Centro Dipartimentale di Medicina Riabilitativa "Sport and Anatomy", 56123 Pisa, Italy.
| | - Nicola Carbonaro
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
- Centro di Ricerca "E.Piaggio", 56123 Pisa, Italy.
| | - Alessandro Tognetti
- Dipartimento di Ingegneria dell'Informazione, University of Pisa, 56123 Pisa, Italy.
- Centro di Ricerca "E.Piaggio", 56123 Pisa, Italy.
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Pikkarainen A, Vähäsantanen K, Paloniemi S, Eteläpelto A. Rehabilitation agency of older adults in group-based intervention. Scand J Occup Ther 2018; 26:411-422. [PMID: 29313394 DOI: 10.1080/11038128.2018.1424237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS This study investigated the individual rehabilitation agency of older adults in a one-year group-based gerontological rehabilitation context. Here, rehabilitation agency is understood as being manifested when older adults make choices and decisions regarding their everyday lives, including notions of themselves. METHODS The data were obtained via non-participant observation of the final individual goal evaluation sessions of 38 older adults with their personal counselor. In these sessions, older adults discussed their rehabilitation outcomes, actions, choices and decisions during the rehabilitation year, along with their future in home settings. The data were analyzed using qualitative content analysis and an agency-centred approach. FINDINGS The findings revealed that older adults made choices and decisions differently concerning their life in and beyond the rehabilitation context. Four forms of rehabilitation agency of older adults were identified: (i) renewable, (ii) widened, (iii) selective and (iv) fractured. These forms of agency were differently connected to older adults' life courses and to their peer relations in the rehabilitation context. CONCLUSIONS An agency-centred approach could produce new theoretical ideas and practical implications for developing older adults' rehabilitation to better meet their needs as well as the goals of group-based rehabilitation interventions.
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Affiliation(s)
- Aila Pikkarainen
- a School of Health and Social Studies , Jyväskylä University of Applied Sciences , Jyväskylä , Finland
| | - Katja Vähäsantanen
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
| | - Susanna Paloniemi
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
| | - Anneli Eteläpelto
- b Adult Education, Faculty of Education and Psychology , University of Jyväskylä , Jyväskylä , Finland
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Barrett E, Hayes A, Kelleher M, Conroy C, Robinson K, O’Sullivan K, McCreesh K. Exploring patient experiences of participating in a group exercise class for the management of nonspecific shoulder pain. Physiother Theory Pract 2018; 34:464-471. [DOI: 10.1080/09593985.2017.1422208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eva Barrett
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Amy Hayes
- Physiotherapy Department, University Hospital Limerick, Limerick, Ireland
| | - Mags Kelleher
- Physiotherapy Department, Midlands Regional Hospital, Portlaoise, Ireland
| | - Carmela Conroy
- Physiotherapy Department, St. Johns Hospital, Limerick, Ireland
| | - Katie Robinson
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Kieran O’Sullivan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
- Sports Spine Centre, Aspetar Sports and Orthopaedic Hospital, Doha, Qatar
| | - Karen McCreesh
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Sandal LF, Thorlund JB, Moore AJ, Ulrich RS, Dieppe PA, Roos EM. Room for improvement: a randomised controlled trial with nested qualitative interviews on space, place and treatment delivery. Br J Sports Med 2017; 53:359-367. [PMID: 28768617 DOI: 10.1136/bjsports-2016-097448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Healthcare-oriented design in hospitals can promote better clinical outcomes. Creating optimal facilities may increase treatment effects. We investigated the influence of the treatment room on effects of exercise therapy. METHODS In a mixed-method randomised controlled double-blind trial, middle-aged individuals reporting knee or hip pain performed 8 weeks of exercise therapy in (1) a newly built physically enhanced environment, (2) a standard environment or (3) were waitlisted, receiving no intervention. Participants and therapists were blind to study aim. Primary outcome was participants' Global Perceived Effect (GPE; seven-point Likert scale). Six nested focus group interviews with participants (n=25) and individual interviews with therapists (n=2) explored experiences of the environments. RESULTS 42 people exercised in the physically enhanced environment, 40 in the standard environment, 21 were waitlisted. Contrary to our hypothesis, the treatment response seemed greater in the standard environment for GPE (0.98, 95% CI0.5 to 1.4) than for the physically enhanced environment (0.37, 95% CI -0.2 to 0.9), between-group difference (0.61, 95% CI -0.1 to 1.3) did not reach statistical significance (p=0.07). Waitlist group reported no improvement (-0.05 95% CI -0.5 to 0.4). In interviews, participants from the standard environment expressed greater social cohesion and feeling at home. Qualitative themes identified; reflection, sense of fellowship and transition. Secondary patient-reported outcomes and qualitative findings supported the primary finding, while improvements in muscle strength and aerobic capacity did not differ between exercise groups. CONCLUSION Results suggest that the physical environment contributes to treatment response. Matching patients' preferences to treatment rooms may improve patient-reported outcomes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT02043613.
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Affiliation(s)
- Louise F Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Andrew J Moore
- School of Clinical Science, University of Bristol, Bristol, UK
| | - Roger S Ulrich
- Department of Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Raymond MJM, Jeffs KJ, Winter A, Soh SE, Hunter P, Holland AE. The effects of a high-intensity functional exercise group on clinical outcomes in hospitalised older adults: an assessor-blinded, randomised-controlled trial. Age Ageing 2017; 46:208-213. [PMID: 27932360 DOI: 10.1093/ageing/afw215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Indexed: 01/31/2023] Open
Abstract
Objective to investigate a high-intensity functional exercise (HIFE) group in hospitalised older adults. Design assessor-blinded, randomised-controlled trial. Setting sub-acute wards at a metropolitan rehabilitation hospital. Participants older adults ≥65 years (n = 468) able to stand with minimum assistance or less from a chair and follow instructions. Intervention 'group' participants were offered a standing HIFE group three times a week and individual physiotherapy sessions twice a week. Control participants were offered daily individual physiotherapy sessions. Main outcome measures the primary outcome measure was the Elderly Mobility Scale (EMS). Secondary measures included the Berg Balance Scale, gait speed, Timed Up and Go Test, falls, length of stay and discharge destination. Results participants' mean age was 84.3 (7.1) years and 61% were female. There was no difference between groups for the improvement in EMS from admission to discharge (effect size -0.07, 95% confidence interval: -0.26 to 0.11, P = 0.446) and no difference in discharge destination, P = 0.904. Therapists saved 31-205 min/week treating group participants compared with control participants. Conclusion the results suggest that a HIFE group programme combined with individual physiotherapy may improve mobility to a similar extent to individual physiotherapy alone in hospitalised older adults. Providing physiotherapy in a group setting resulted in increased therapist efficiency. A high-intensity exercise group with individual physiotherapy may be an effective and efficient method to provide care to older inpatients.
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Affiliation(s)
- Melissa J. M. Raymond
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | | | - Adele Winter
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Physiotherapy Department, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Hunter
- Department of Aged Care, Alfred Health, Caulfield Hospital, Melbourne, Victoria, Australia
| | - Anne E. Holland
- Alfred Health Clinical School, Alfred Health, La Trobe University, Victoria, Australia
- Physiotherapy Department, Alfred Health, The Alfred, Melbourne, Victoria, Australia
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Deslauriers S, Raymond MH, Laliberté M, Lavoie A, Desmeules F, Feldman DE, Perreault K. Access to publicly funded outpatient physiotherapy services in Quebec: waiting lists and management strategies. Disabil Rehabil 2016; 39:2648-2656. [PMID: 27758150 DOI: 10.1080/09638288.2016.1238967] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Problems with access to outpatient physiotherapy services have been reported in publicly funded healthcare systems worldwide. A few studies have reported management strategies aimed at reducing extensive waiting lists, but their association with waiting times is not fully understood. The purpose of this study was to document access to public outpatient physiotherapy services for persons with musculoskeletal disorders in hospitals and explore organizational factors associated with waiting time. METHODS We surveyed outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada). RESULTS A total of 97 sites responded (99%) to the survey. The median waiting time was more than six months for 41% of outpatient physiotherapy services. The waiting time management strategies most frequently used were attendance and cancelation policies (99.0%) and referral prioritization (95.9%). Based on multivariate analyses, the use of a prioritization process with an initial evaluation and intervention was associated with shorter waiting times (p = 0.008). CONCLUSIONS Our findings provide evidence that a large number of persons wait a long time for publicly funded physiotherapy services in Quebec. Based on our results, implementation of a prioritization process with an initial evaluation and intervention could help improve timely access to outpatient physiotherapy services. Implications for Rehabilitation Access to publicly funded outpatient physiotherapy services is limited by long waiting times in a great proportion of Quebec's hospitals. The use of a specific prioritization process that combines an evaluation and an intervention could possibly help improve timely access to services. Policy-makers, managers, and other stakeholders should work together to address the issue of limited access to publicly funded outpatient physiotherapy services.
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Affiliation(s)
- Simon Deslauriers
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - Marie-Hélène Raymond
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Maude Laliberté
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada
| | - Amélie Lavoie
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
| | - François Desmeules
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,e Maisonneuve-Rosemont Hospital Research Centre , Montreal , Quebec , Canada
| | - Debbie E Feldman
- c School of Rehabilitation, Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada.,d Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Quebec , Canada.,f Direction of Public Health of the Centre intégré universitaire de santé et de services sociaux du Centre-Est-de-l'ḽle-de-Montréal , Montreal , Quebec , Canada
| | - Kadija Perreault
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec City , Quebec , Canada.,b Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Quebec , Canada
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