Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation.
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BACKGROUND AND PURPOSE: Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay. METHODS: An ICP for stroke rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (n=76) or conventional multidisciplinary care (n=76). RESULTS: The age, sex, premorbid functional ability, and stroke characteristics of the 2 groups were comparable. There were no differences in mortality rates (10 [13%] versus 6 [8%]), institutionalization (10 [13%] versus 16 [21%]), or length of hospital stay (50+/-19 versus 45+/-23 days) between patients receiving ICP or multidisciplinary care. Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks (median change in Barthel Activities of Daily Living Index 6 versus 2; P<0.01) and had higher Quality of Life scores at 12 weeks (65 versus 59; P=0.07) and 6 months (72 versus 63; P<0.005). There were no significant differences in the mean duration of physiotherapy (42.8+/-41.2 versus 39.4+/-36.4 hours) or occupational therapy (8.5+/-7.5 versus 8.0+/-7.5 hours) received between the 2 groups. CONCLUSIONS: ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit. Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care. (+info)
The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis.
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OBJECTIVE: To describe current treatment of patients with rheumatoid arthritis (RA) in German rheumatology. METHODS: Data from the German rheumatological database of 1998, comprising clinical and patient questionnaire data of 12 992 outpatients with RA seen at 24 collaborative arthritis centres in Germany, were analysed. RESULTS: At the time of documentation, 88% of the patients with RA were undergoing disease modifying antirheumatic drug (DMARD) treatment. Methotrexate (MTX) was prescribed to 56% of the patients (61% with seropositive and 45% with seronegative RA). Combination treatment was used in 15%. MTX was the drug of first choice even in patients with up to one year's disease duration (49%), followed by antimalarial drugs (21%). Patients treated by non-rheumatologists within the previous year had received DMARD treatment in only 33% of the cases. In steroid treatment, low doses (< or = 7.5 mg/day) were used by rheumatologists much more often (44%) than higher doses (12%). 16% of the patients had been inpatients during the previous year, with a median length of stay accumulated over the year of 21 days. Together with stays in inpatient rehabilitation, 22% of all patients had had some form of inpatient treatment. Comprehensive measures such as occupational therapy and patient education were prescribed to fewer than 12% of the patients, mostly during their hospital stay. CONCLUSION: German rheumatologists do follow recent recommendations about early and effective treatment. However, there are still deficits in outpatient care with non-medicinal measures like occupational therapy and patient education, which may partly explain the high hospital admission rates. (+info)
Relationship between duration of therapy services in a comprehensive rehabilitation program and mobility at discharge in patients with orthopedic problems.
(11/332)
BACKGROUND AND PURPOSE: The purpose of this study was to examine the relationship between duration of physical therapy and occupational therapy and mobility at the time of discharge from a comprehensive rehabilitation program in a group of patients with orthopedic diagnoses. SUBJECTS: Subjects were 116 consecutive patients with orthopedic diagnoses (mean age=72.6 years, SD=12.0, range=21-99) who were admitted to a comprehensive inpatient rehabilitation program. METHODS: This retrospective cohort study utilized the Uniform Data Set, social service records, and quality assurance records to provide demographic and medical information. The Functional Independence Measure (FIM) provided information regarding mobility at admission and discharge. The duration of physical therapy and occupational therapy was measured in hours. RESULTS: Subjects received an average of 40.8 hours of therapy and showed an average change in FIM mobility subscale scores of 24.5. Multiple linear regression was used to demonstrate that duration of therapy was a predictor of FIM score at the time of discharge (partial correlation=.069) after controlling for length of stay, number of diagnoses, FIM cognitive subscale score at admission, and FIM mobility subscale score at admission. Duration of therapy accounted for 6.9% of the variance in the model. CONCLUSION AND DISCUSSION: This study indicates that the amount of physical therapy and occupational therapy that patients with orthopedic diagnoses receive during enrollment in an inpatient comprehensive rehabilitation program is related to the FIM mobility subscale score at the time of discharge. The authors suggest that increasing the hours of therapeutic intervention that a patient receives in inpatient rehabilitation could improve functional outcomes at discharge. (+info)
Vertigo and vestibular rehabilitation.
(12/332)
The role of rehabilitation in the management of vertigo is limited to a very specific group of conditions. An Occupational therapist who is a part of the multidisciplinary team treating the vertiginous patient, with the knowledge of physiology and therapeutic benefit of vestibular rehabilitation can widen the rehabilitation spectrum for various diseases producing vertigo and dysequilibrium, to resolve or minimise these symptoms. The present article reviews the need for vestibular rehabilitation and the different conditions needing the same along with its characteristics, physiology and various exercises prescribed. (+info)
Care of spinal cord in the armed forces of India.
(13/332)
Development of Spinal Cord Injuries Centre in the Armed Forces of India has been discussed. Starting from a 30-bedded unit in 1965 we have now a 100-bedded spinal cord injury centre, a major rehabilitation centre managed by trained medical staff for these patients. A 25-bedded paraplegic home for ex-servicemen has been recently built with modern facilities and amenities. Medical rehabilitation and vocational services are now available to paraplegics in a radius of one kilometre at this centre. (+info)
Occupational therapy and Colles' fractures.
(14/332)
In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary. (+info)
Treatment of functional impairment in severe somatoform pain disorder: a case example.
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OBJECTIVE: To describe the assessment and treatment of severe functional impairment in a young female adolescent with somatoform pain disorder. METHODS: Treatment included an inpatient hospital admission using a rehabilitation approach and behavior modification program. Standardized assessment of functional impairment and health-related quality of life was performed at baseline and follow-up. Diagnostic evaluation and treatment costs were computed using insurance and hospital billing data. RESULTS: Pre-/postintervention measures of functional disability indicated significant improvement in physical and psychosocial functioning in everyday activities. Although costly, the inpatient admission decreased frequent health care use over the short term. CONCLUSIONS: Delay in diagnosis of somatoform disorders may seriously extend children's disability and require more intensive treatment. Functional disability is a critical measure of treatment outcome in children with severe somatoform disorder. Future research concerning interventions for children with a broad range of recurrent and chronic pain symptoms can be strengthened through a focus on reducing functional disability. (+info)
One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis.
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OBJECTIVE: Joint protection aims to reduce pain and local inflammation, preserve the integrity of joint structures and improve function. There is evidence that it can improve pain and function in the short term, but the long-term effects are uncertain. This study evaluated the effects of joint protection in early rheumatoid arthritis (RA). METHODS: A randomized, controlled, assessor-blinded trial of duration 1 yr was conducted. Two interventions (both 8 h) were compared: standard arthritis education, including 2.5 h of joint protection education based on typical UK practice; and a joint protection arthritis education programme, using educational-behavioural teaching methods. Assessments were made at entry and 6 and 12 months. RESULTS: Sixty-five people with RA attended the joint protection programme and 62 the standard programme. The groups were matched for age (51 and 49 yr), disease duration (21 and 17.5 months) and use of non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs. In comparison with the standard group, the joint protection group significantly improved with respect to adherence to the joint protection programme (P=0.001), hand pain (P=0.02), general pain (P=0.05), early morning stiffness (P=0.01), self-reported number of disease flare-ups (P=0.004), visits to the doctor for arthritis (P<0.01), and the AIMS2 (Arthritis Impact Measurement Scales) activities of daily living scale (P=0.04). A trend to improved swollen joint counts was identified (P=0.07). Within-group analyses also showed improvements in arthritis self-efficacy and perceived control. Hand deformity scores continued to increase in both groups. CONCLUSION: We found significant improvements in adherence, pain, disease status and functional ability amongst those attending the joint protection programme. Benefits became more apparent with time, suggesting that joint protection can help slow the progression of the effects of RA over and above the effects of drug therapy. (+info)