ORCID Profile
0000-0003-2232-6493
Current Organisations
Australasian Faculty of Rehabilitation Medicine
,
Peter MacCallum Cancer Centre
,
Royal Melbourne Hospital
,
University of Melbourne
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Publications
Translational Research for Improving the Care of Familial Hypercholesterolemia: The “Ten Countries Study” and Beyond
Publisher: Japan Atherosclerosis Society
Date: 2016
DOI: 10.5551/JAT.35949
Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To assess the effectiveness of a multidisciplinary ambulatory rehabilitation programme for women following definitive breast cancer treatment in an Australian community cohort. Eighty-five women in the community randomized to a treatment group (n = 43) for in idualized high-intensity programme, or a control group (n = 42) comprising usual activity. The primary outcome Depression Anxiety Stress Scale (DASS) scale measured restriction in participation. Secondary measures included Perceived Impact Problem Profile (PIPP) and Cancer Rehabilitation Evaluation System Short-Form (CARES-SF) and Functional Independence Measure (FIM) motor subscale for activity limitation. Assessments were at baseline and 4 months. Intention-to-treat analysis of data showed a significant difference between both groups in DASS Depression scores (p = 0.006) (moderate effect size, r > 0.3), PIPP Mobility (p = 0.05) and Participation (p = 0.04) scales, and CARES-SF Global score (p = 0.02) (small effect size, r < 0.3). The treatment group, compared with control group, showed significant improvement in the DASS Depression scores: 22/42 (52.4%) vs 12/37 (32.4%) (p = 0.02). No difference between groups was noted in the FIM scale. Rehabilitation can benefit participation in breast cancer survivors. Evidence for specific rehabilitation interventions is needed. Integrated cancer programmes allow opportunities to evaluate patients in various settings, but require outcome research to develop service models for survivorship issues.
Patient/carer perceptions of disability in motor neurone disease and carer coping
Publisher: Mark Allen Group
Date: 10-2011
DOI: 10.12968/IJTR.2011.18.10.568
Abstract: Aims: To compare patient- and carer-reported disability in motor neurone disease (MND) using the International Classification of Functioning, Disability and Health (ICF) and to describe carer burden, psychological coping, and quality of life. Methods: A prospective cross-sectional survey of MND patients (n=44) and carers (n=37). Their MND-related problems were linked with ICF categories (second level) using open-ended questionnaires and ‘linkage rules’. Standardized assessments measured carer psychological coping (depression/anxiety/ stress), strain/burden, quality of life (QoL), and coping strategies. Findings: MND patients were older than their carers (mean age 61, carers 57) there were more male patients than carers (66%, carers 27%). Most carers were spouses artners (89%). MND patients identified 70 ICF categories whereas carers identified 8: body function 15 (carers 0) body structure 5 (carers 0) activities and participation 40 (carers 6) environmental factors 10 (carers 2). Main ICF categories in activities and participation linked by patients and carers were general tasks and demands, mobility, self-care, community, social and civic life. Environmental factors included support and relationships, services, systems and policies. Carer psychological coping and burden were significant, but self-reported QoL for carers was good, possibly related to use of problem-focused coping strategies. Conclusions: ICF adequately incorporates perspectives of MND patients and carers, which may enable development of a ‘core set’ (ICF categories selected by experts that list issues in impairment, disability, participation, and environmental factors that need to be addressed in multidisciplinary care settings) to optimize care. Reduction in carer burden will optimize outcomes for MND carers and patients.
Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/09638280600756141
Abstract: To identify the preliminary comprehensive and brief core sets for multiple sclerosis (MS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF). Focus groups and a consensus process were used to identify ICF core sets for MS. This included: preliminary ICF studies empirical patient data collection for 101 MS participants review of the evidence base and treatment in MS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia. One hundred and forty-four (40%) second level ICF categories were selected by 23 participants in three rounds. The comprehensive MS ICF core set includes 34 (24%) categories from the component 'body function', six (4%) categories from 'body structures', 68 (47%) from 'activities and participation' and 36 (25%) from the component 'environmental' factors. Ten categories in 'personal factors' in MS were also suggested by the participants after intensive discussions. The brief set comprises 30 categories, 21% of categories in the comprehensive core set. Consensus expert opinion can use ICF categories to identify the core set for MS which reflects disease complexity and care burden for persons' with MS. Further research is needed to identify ICF categories of relevant personal factors to improve our understanding of the large social and cultural variance associated with them.
Quaternion-based sparse tight frame for multicomponent signal recovery
Publisher: Society of Exploration Geophysicists
Date: 03-2020
Abstract: Multicomponent noise attenuation often presents more severe processing challenges than scalar data owing to the uncorrelated random noise in each component. Meanwhile, weak signals merged in the noise are easier to degrade using the scalar processing workflows while ignoring their possible supplement from other components. For seismic data preprocessing, transform-based approaches have achieved improved performance on mitigating noise while preserving the signal of interest, especially when using an adaptive basis trained by dictionary-learning methods. We have developed a quaternion-based sparse tight frame (QSTF) with the help of quaternion matrix and tight frame analyses, which can be used to process the vector-valued multicomponent data by following a vectorial processing workflow. The QSTF is conveniently trained through iterative sparsity-based regularization and quaternion singular-value decomposition. In the quaternion-based sparse domain, multicomponent signals are orthogonally represented, which preserve the nonlinear relationships among multicomponent data to a greater extent as compared with the scalar approaches. We test the performance of our method on synthetic and field multicomponent data, in which component-wise, concatenated, and long-vector models of multicomponent data are used as comparisons. Our results indicate that more features, specifically the weak signals merged in the noise, are better recovered using our method than others.
Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease
Publisher: Wiley
Date: 10-01-2017
Use of the international classification of functioning, disability and health to describe patient-reported disability: A comparison of motor neurone disease, Guillain-Barré syndrome and multiple sclerosis in an Australian cohort
Publisher: Informa UK Limited
Date: 12-10-2012
DOI: 10.3109/09638288.2011.606345
Abstract: To compare patient-reported disability across three long-term neurological conditions [motor neurone disease (MND), Guillain-Barré syndrome (GBS) and multiple sclerosis (MS)] using the International Classification of Functioning, Disability and Health (ICF). A prospective cross-sectional survey of Australian community-based persons with MND (n = 44). Their MND-related problems were linked with ICF categories (second level) using open-ended questionnaires and 'linkage rules' and compared to similar data collected for GBS (n = 77) and MS (n = 101) participants. MND participants were older (mean age 61 years, GBS 55, MS 49) with more males (66%, GBS 59%, MS 29%). Seventy ICF categories in MND were identified (GBS 41, MS 63): "body function" 15 (GBS 7 MS 18) "body structure" 5 (GBS 3, MS 5) "activities and participation" 40 (GBS 25, MS 30) "environmental factors" 10 (GBS 6, MS 10). The main areas linked in "activities and participation" were mobility, self care, general tasks and demands, domestic life, interpersonal interactions and relationships, major life areas and community, social and civic life environmental factors included products and technology, natural environment, support and relationships, services, systems and policies. Comparison of three long-term neurological conditions will assist with development of a core set of categories to optimise consensus of care and communication amongst treating clinicians.
Evaluation of a technology-assisted enriched environmental activities programme for upper limb function: A randomized controlled trial
Publisher: Medical Journals Sweden AB
Date: 2020
Abstract: To evaluate the effectiveness and feasibility of an intensive technology-assisted inpatient enriched environmental programme for upper limb function. Patients consecutively admitted to the rehabilitation unit randomly allocated to an intervention (enriched environmental programme, n = 46)) or a control group (usual ward activity, n = 46). Assessments were performed at baseline (T0), discharge (T1) and 3 months (T2) using validated measures. At T1, the enriched environmental group showed significant improvement in upper limb func-tion, compared with the control group: Action Research Arm Test (ARAT) "Total" (p = 0.002), and "Grip", "Pinch" and "Gross" subscales (p 5.7 points on the ARAT "Total" compared with the control group (83% vs 44%, p 5.7 points) on ARAT "Total" compared with the control group (91% vs 61%, p = 0.001). Both groups improved in other measures at both T1 and T2. An enriched environmental programme was feasible and effective in improving upper limb function and increasing the activity of patients during their inpatient subacute care.
Telerehabilitation for persons with multiple sclerosis
Publisher: John Wiley & Sons, Ltd
Date: 31-05-2013
Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis
Publisher: Wiley
Date: 21-01-2009
Clinical practice guidelines for the management of brain tumours: A rehabilitation perspective
Publisher: Medical Journals Sweden AB
Date: 2019
Abstract: To critically appraise published clinical practice guidelines (CPGs) for brain tumours, and to synthesize evidence-based recommendations from a rehabilitation perspective. A comprehensive literature search included: health science databases, CPG clearinghouse/developer websites, and grey literature up to March 2018. All brain tumour CPGs that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Three authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) Instrument. Recommendations from included CPGs were categorized from a rehabilitation perspective. Of the 11 CPGs identified, only 2, developed by the National Institute for Health and Clinical Excellence (NICE) and the Australian Cancer Network (ACN), included rehabilitation components for the management of brain tumours. Both CPGs were of moderate quality. The recommendations reported were generic, and only the ACN guidelines provided detailed recommendations for rehabilitation interventions. Both guidelines recommend a comprehensive multi-disciplinary care approach. Detailed comparison, however, was not possible due to inconsistent recommendations, making it difficult to summarize rehabilitative care. Despite rehabilitation being an integral component of the management of brain tumours, only a limited number of CPGs have incorporated recommendations for specific rehabilitation interventions. In order to improve clinical outcomes in this population future CPGs should incorporate rehabilitation interventions.
Use of the international Classification of Functioning, Disability and Health (ICF) to describe patient -reported disability in primary brain tumour in an Australian comunity cohort
Publisher: Medical Journals Sweden AB
Date: 2013
Abstract: To describe patient-reported disability in primary brain tumours using the International Classification of Functioning, Disability and Health (ICF) and comparison with categories within the core sets for stroke and traumatic brain injury. A prospective community cross-sectional survey (n = 106) following definitive treatment for primary brain tumours. Problems reported by participants were linked with ICF categories using 'linkage' rules. Participants rated 'activities and participation' and 'environmental factor' components of ICF checklist (using qualifiers) and responses compared with categories within core sets for stroke and traumatic brain injury. Participant mean age 51 years, median time since diagnosis 2 years over a third had high grade tumours. Participants considered 44 categories in 'activities and participation' and 16 categories (barriers) in 'environmental factors' as relevant (≥ 10% response) using checklist. Reported problems included: Mobility, Domestic life, General tasks/ demands and Human made changes to environment. Although the linked categories for brain tumour survivors were similar to those in the core sets for stroke and traumatic brain injury, there was more commonality with the traumatic brain injury core set. The existing comprehensive stroke and traumatic brain injury core sets incorporate issues relevant to brain tumour survivors in post-acute settings. Findings from this report will assist in defining a future core set for brain tumour the possibility however, of using a single core set relevant to most long-term neurological conditions needs to be explored.
Rehabilitation for cerebral palsy: Analysis of the Australian rehabilitation outcome dataset
Publisher: Scientific Scholar
Date: 2011
Abstract: Objective: To examine the outcome of inpatient rehabilitation for cerebral palsy (CP), using the Australian Rehabilitation Outcomes Center (AROC) database. Materials and Methods: De-identified data from the AROC database was analyzed for all rehabilitation admissions during 2003 – 2008, using four classes for the functional level. The outcomes included: Functional Independence Measure (FIM) scores, FIM efficiency, hospital length of stay (LOS), and discharge destination. Results: Of 141 case episodes 56.7% were female, mean age 48.5 years, 87.2% were discharged to the community and 64.5% (n = 91) were in the lowest functional classes (217, 218, and 219). The majority of CP patients were treated in the public hospital system (66.7% versus 33.3%), and had a slightly longer LOS compared with those treated in private facilities (22.6 versus 17.9 days, mean difference - 4.7 days, 95% CI - 9.2 to - 0.2, P = 0.041). The FIM for all classes (216 – 218) showed significant functional improvement during the admission (P = 0.001). As expected those in the most functionally impaired classes showed most change (FIM change: 16.6 in class 217, 15.3 in class 218). FIM efficiency was the highest in classes 217 compared to the other classes. The year-to-year trend demonstrated a mixed pattern for hospital LOS and was not significant (P = 0.492). Conclusion: The AROC dataset is a valuable research tool for describing rehabilitation outcomes. However, more specific information needs to be collected alongside the core AROC data, to allow a more meaningful evaluation of outcomes for CP rehabilitation..
Real-time foot clearance biofeedback to assist gait rehabilitation following stroke: A randomized controlled trial protocol
Publisher: Springer Science and Business Media LLC
Date: 31-05-2019
Refugee health and rehabilitation: Challenges and response
Publisher: Medical Journals Sweden AB
Date: 2017
Abstract: The current global refugee crisis poses major challenges in providing effective healthcare to refugees, particularly for non-communicable diseases management and disability. This article provides an overview of refugee health and potential challenges from the rehabilitation perspective. A literature search (both academic and grey literature) was conducted using medical and health science electronic databases and internet search engines (2001-2016). Both authors independently selected studies. Due to heterogeneity amongst identified articles, a narrative analysis was performed for best-evidence synthesis to outline the current health and rehabilitation status of refugees and existing gaps in care. Data suggest that infectious diseases requiring treatment in refugees are a minority whilst non-communicable diseases, musculoskeletal conditions are prevalent. Many refugees arrive with complex health needs. One in 6 refugees have a physical health problem severely affecting their lives and two-thirds experience mental health problems, signifying the important role of rehabilitation. Refugees face continued disadvantage, poverty and dependence due to lack of cohesive support in their new country, which are determinants of both poor physical and mental health. This is compounded by language barriers, impoverishment, and lack of familiarity with the local environment and healthcare system. In Australia, there are concerns about sexual and gender-based violence in off-shore detention c s. Targeted physical and cognitive rehabilitative strategies have much to offer these vulnerable people to allow for improved activity and participation. Strong leadership and effective action from national and international bodies is urgently needed to develop comprehensive rehabilitation-inclusive medical care for refugees.
Effectiveness of cognitive behavioural therapy in a community-based pulmonary rehabilitation programme: A controlled clinical trial
Publisher: Medical Journals Sweden AB
Date: 2017
Abstract: To investigate whether the use of cognitive behavioural therapy in pulmonary rehabilitation addresses the depression and anxiety burden and thereby improves rehabilitation outcomes. Prospective controlled clinical trial. A total of 70 patients with chronic obstructive pulmonary disease who were referred to a community centre for pulmonary rehabilitation. Patients were allocated to either the control group, consisting of pulmonary rehabilitation alone, or to the treatment group, receiving pulmonary rehabilitation and an additional 6 sessions of group-based cognitive behavioural therapy. Assessments consisting of questionnaires and walk tests were conducted pre- and post-pulmonary rehabilitation. A total of 28 patients were enrolled. The cognitive behavioural therapy group had significant improvements in exercise capacity following pulmonary rehabilitation (mean change 32.9 m, p = 0.043), which was maintained at 3 months post-pulmonary rehabilitation (mean change 23.4 m, p = 0.045). Patients in the cognitive behavioural therapy group showed significant short-term improvements in fatigue, stress and depression (mean change 2.4, p = 0.016, 3.9, p = 0.024 and 4.3, p = 0.047, respectively) and a 3-month post-pulmonary rehabilitation improvement in anxiety score (mean change 3.1, p = 0.01). No significant changes were seen in the control group. The addition of cognitive behavioural therapy improved patients' physical, psychological and quality of life results. Cognitive behavioural therapy should be considered for inclusion in a pulmonary rehabilitation programme to enhance outcomes.
Pain in people with multiple sclerosis: Associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life
Publisher: Frontiers Media SA
Date: 05-09-2017
Validation of the international classification of functioning, disability and health core sets for traumatic brain injury from Australian community patient perspectives
Publisher: Medical Journals Sweden AB
Date: 2021
A comparison of participation outcome measures and the International Classification of Functioning, Disability and Health Core Sets for traumatic brain injury
Publisher: Medical Journals Sweden AB
Date: 2014
Abstract: To compare the contents of participation outcome measures in traumatic brain injury with the International Classification of Functioning, Disability and Health (ICF) Core Sets for traumatic brain injury. A systematic search with an independent review process selected relevant articles to identify outcome measures in participation in traumatic brain injury. Instruments used in two or more studies were linked to the ICF categories, which identified categories in participation for comparison with the ICF Core Sets for traumatic brain injury. Selected articles (n = 101) identified participation instruments used in two or more studies (n = 9): Community Integration Questionnaire, Craig Handicap Assessment and Reporting Technique, Mayo-Portland Adaptability Inventory-4 Participation Index, Sydney Psychosocial Reintegration Scale Version-2, Participation Assessment with Recombined Tool-Objective, Community Integration Measure, Participation Objective Participation Subjective, Community Integration Questionnaire-2, and Quality of Community Integration Questionnaire. Each instrument was linked to 4-35 unique second-level ICF categories, of which 39-100% related to participation. Instruments addressed 86-100% and 50-100% of the participation categories in the Comprehensive and Brief ICF Core Sets for traumatic brain injury, respectively. Participation measures in traumatic brain injury were compared with the ICF Core Sets for traumatic brain injury. The ICF Core Sets for traumatic brain injury could contribute to the development and selection of participation measures.
Nocturnal voiding frequency does not describe nocturia‐related bother
Publisher: Wiley
Date: 04-06-2019
DOI: 10.1002/NAU.24029
Abstract: Nocturia frequency has been used as a measure of treatment efficacy for nocturia even though fluctuation of the symptom over time has been well described in the literature. Additionally, given the multifactorial causal pathway and clinically relevant comorbidities, frequency alone may be an insufficient marker of treatment direction. The aim of this study was to investigate factors associated with nocturia-related bother to identify additional variables that may capture the impact of nocturia, direct clinical care and have potential to quantify treatment outcome. Prospective data from tertiary hospital Urology and Continence cohorts were matched for identical variables to generate a s le of 204 datasets. Descriptive statistics were obtained to describe the two cohorts. Characteristics of patients were evaluated across levels of nocturia frequency and nocturia-related bother using nonparametric methods statistically significant differences between groups in each cohort were established. Nocturia frequency alone does not comprehensively reflect attributable bother. Five sleep variables (poor quality sleep, short time to first awakening to void, less than 7 hours of total sleep, primary sleep latency, and daytime sleepiness) and daily urinary urgency were significantly associated with high nocturia-related bother. Attributable bother, despite high-frequency nocturia, was minimized by male gender, lack of daily urinary urgency and good sleep quality. Poor health status, urinary urgency and sleep latency were associated with nocturia frequency. Items of importance to in iduals with nocturia have been identified from patient data. These variables have the potential to sit alongside change in nocturia frequency as potential markers of treatment response.
Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.BREAST.2012.01.013
Abstract: The objective of this study was to examine factors impacting long-term functional outcomes and psychological sequelae in survivors of breast cancer (BC). A clinical assessment and structured interview assessed the impact of BC on participants' (n=85) current activity and restriction in participation, using validated questionnaires: Functional Independence Measure (FIM), Perceived Impact Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS). Participants showed good functional recovery (median motor FIM score=78). Three-quarters (74%) reported pain, 32% reported upper limb weakness, 31% pain limiting shoulder movement and 29% lymphoedema. One third (32%) reported greatest impact on psychological wellbeing. A substantial number of participants reported high levels of depression (22%), anxiety and stress (19% each). Factors associated with poorer current level of functioning and wellbeing included: younger participants, recent diagnoses, aggressive tumour types, receiving chemotherapy, shoulder limitation due to pain, and lymphoedema. BC survivors require long-term management of psychological sequelae impacting activity and participation.
Update in Disaster Rehabilitation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2021
Interdisciplinary management for chronic pain in central neurological disorders: A retrospective study
Publisher: Mark Allen Group
Date: 02-01-2020
Abstract: Chronic pain in central neurological disorders is common and the current management of chronic pain is through an interdisciplinary approach. The aim of this study was to compare outpatient interdisciplinary-based treatment for chronic pain in patients with central neurological disorders to those without central neurological disorders. This was a retrospective study and pain-related outcome measures were collected from a clinical outcomes registry (electronic Persistent Pain Outcomes Collaboration). This registry contained data on people who attended a pain management service who, for the purpose of this study, were categorised into those with a central neurological disorder and those without a central neurological disorder. The two s le t-test was used to determine the significance of the difference between the groups and statistical significance was defined as P .05. Outcome measures compared included the Brief Pain Inventory, Depression, Anxiety and Stress Scale 21, Patient Self-efficacy Questionnaire and Patient Catastrophisation Scale. There was a total of 1924 participants with a central neurological disorder. The electronic Persistent Pain Outcomes Collaboration registry shows that after engagement with an interdisciplinary pain management service, there was a reduction in pain severity scores, interference, mean depression, anxiety and stress in both groups at end of an episode of care compared to referral. There was a significant difference in mean changes for pain catastrophising between those with a central neurological disorder (−10.3) and those without (−7.8). This study shows that people with central neurological disorders can also benefit from interdisciplinary management and have similar results to those without these conditions.
Multidisciplinary rehabilitation for adults with multiple sclerosis
Publisher: Oxford University Press (OUP)
Date: 07-2008
An enriched environmental programme during inpatient neuro-rehabilitation: A randomized controlled trial
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To assess the effectiveness of an enriched environmental activities programme in an inpatient tertiary neuro-rehabilitation unit. A total of 103 participants were randomized to an intervention group (n = 52) undertaking an enriched environmental activities programme or a control group (n = 51) receiving usual ward activity. Depression, Anxiety Stress Scale (DASS). Other measures included: Neurological Impairment Scale Multidimensional Health Locus of Control, Rosenberg Self-Esteem Scale, Montreal Cognitive Assessment (MoCA) Functional Independence Measure (FIM), and Euro-Quality of Life-5D. Questionnaire assessments were performed at admission, discharge and 3-months post-discharge. Mean age of subjects was 62.5 years (standard deviation 18.5), 63% were male 53 had stroke and the remainder had other neurological conditions. Compared with controls, the intervention group showed significant improvement at discharge in: DASS: "total", "depression", and "stress" subscales (p < 0.05 for all, with small effect sizes (η2) = 0.04-0.05) MoCA (p = 0.048, η2 = 0.04) and FIM motor (total and "self-care", "mobility" subscales (p < 0.05 for all, with moderate effect sizes, η2 = 0.0-0.08). At 3-month follow-up, significant differences were maintained in most secondary outcomes in the intervention group. Cognitive function and activities improved most in participants with stroke. An enriched environmental programme can produce significant improvements in functional and cognitive ability in inpatient neurological cohorts compared with routine ward activity programmes.
Identifying unanswered questions and setting the agenda for future systematic research in Multiple Sclerosis. A worldwide, multi-stakeholder Priority Setting project
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.MSARD.2022.103688
Abstract: Eliciting the research priorities of people affected by a condition, carers and health care professionals can increase research value and reduce research waste. The Cochrane Multiple Sclerosis and Rare Disease of CNS Group, in collaboration with the Cochrane Neurological Sciences Field, launched a priority setting exercise with the aim of prioritizing pressing questions to ensure that future systematic reviews are as useful as possible to the people who need them, in all countries, regardless of their economic status. Sixteen high priority questions on different aspects of MS were developed by members of a multi-stakeholder priority setting Steering Group (SG). In an anonymous online survey translated into 12 languages researchers, clinicians, people with MS (PwMS) and carers were asked to identify and rank, 5 out of 16 questions as high priority and to provide an explanation for their choice. An additional free-text priority research topic suggestion was allowed. The survey was accessible through MS advocacy associations' social media and Cochrane web pages from October 20, 2020 to February 6, 2021. 1.190 responses (86.73% of all web contacts) were evaluable and included in the analysis. Responses came from 55 countries worldwide, 7 of which provided >75% of respondents and 95% of which were high and upper-middle income countries. 58.8% of respondents live in the EU, 23% in the Americas, 8.9% in the Western Pacific, 2.8% in the Eastern Mediterranean and 0.3% in South Eastern Asia. About 75% of the respondents were PwMS. The five research questions to be answered with the highest priority were: Question (Q)1 "Does MRI help predict disability worsening of PwMS?" (19.9%), Q5 "What are the benefits and harms of treating PwMS with one disease-modifying drug compared to another?" (19.3%), Q3 "Does multidisciplinary care by teams of different social and health professionals improve health outcomes and experiences for PwMS?" (11.9%), Q16 "Does psychological health affect disease progression in PwMS?" (9.2%) and Q10 "What are the benefits and harms of exercise for PwMS?" (7.2%). The multivariable logistic regression analysis indicated a significant influence of geographic area and income level on the ranking of Q1 and a marginal for Q16 as top a priority after accounting for the effect of all other predictors. Approximately 50% of the respondents indicated that they had an important additional suggestion to be considered. This international collaborative initiative in the field of MS offers a worldwide perspective on the research questions perceived as pivotal by a geographically representative s le of multiple stakeholders in the field of MS. The results of the survey could guide the prioritization of research on pharmacological and non-pharmacological interventions which could be meaningful and useful for PwMS and carers, avoiding the duplication of efforts and research waste. High quality systematic reviews elicited by priority setting exercises may offer the best available evidence and inform decisions by healthcare providers and policy-makers which can be adapted to the different realities around the world.
COPD: Health Care Utilisation Patterns with Different Disease Management Interventions
Publisher: Springer Science and Business Media LLC
Date: 04-05-2017
DOI: 10.1007/S00408-017-0010-9
Abstract: The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation however, the addition of PR did not reduce healthcare usage further.
More than a black box of rehabilitation: Characterizing therapy programmes following botulinum toxin injections for spasticity in adults with stroke
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To describe ambulatory rehabilitation programmes (physical and occupational therapy activities and interventions) following botulinum toxin injections for post-stroke spasticity using a stroke rehabilitation taxonomy. To explore the relationship between therapy provided and injected limb/s and treatment goals. Prospective, observational cohort study. Stroke survivors (n = 47) participating in ambulatory rehabilitation programmes following botulinum toxin injections for upper limb, lower limb or upper and lower limb spasticity. Standardized therapy documentation forms were completed prospectively for each occupational and physical therapy session. Main outcomes were the proportion of total therapy time spent in various therapeutic activities total sessions during which each intervention was used to facilitate the activities most time was spent in and goals related to each activity category. Sub-analysis was carried out for participants, based on limb/s injected. Most time was spent in "upper extremity control" activities as the upper limb was more often injected. A large proportion of therapy time was spent in activities remediating "performance skills or body structure and function impairments". In the upper and lower limb, and upper limb groups 38.7% and 46.2% of goals, respectively, related to this activity category, but less than 10% in the lower limb group. Little time was spent in community participation and leisure activities, whilst over one-third of lower limb group goals related to this category. Ambulatory rehabilitation programmes following botulinum toxin injections for post-stroke spasticity varied depending on limb/s injected and reflected treatment goals to some extent.
Factors associated with long-term functional and psychological outcomes in persons with moderate to severe traumatic brain injury
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To examine factors impacting long-term functional and psychological outcomes in persons with moderate-severe traumatic brain injury. A prospective cross-sectional study (n = 103) assessed the long-term (up to 5 years) impact of traumatic brain injury on participants' current activity and restriction in participation using validated questionnaires. Participants' median age was 49.5 years (interquartile range (IQR) 20.4-23.8), the majority were male (77%), and 49% had some form of previous rehabilitation. The common causes of traumatic brain injury were falls (42%) and motor vehicle accidents (27%). Traumatic brain injury-related symptoms were: pain/headache (47%), dizziness (36%), bladder/bowel impairment (34%), and sensory-perceptual deficits (34%). Participants reported minimal change in their physical function and cognition (Functional Assessment Measure: motor (median 102, IQR 93-111) and cognition (median 89, IQR 78-95)). Participants were well-adjusted to community-living however, they reported high levels of depression. Factors significantly associated with poorer current level of functioning/well-being included: older age (≥ 60 years), presence of traumatic brain injury-related symptoms, a lack of previous rehabilitation and those classified in "severe disability categories" at admission. Caregivers reported high levels of strain and burden (55%). Cognitive and psychosocial problems are more commonly reported than physical disability in the longer-term. A greater focus on participation and ageing with disability in these persons is needed.
Implementation of a technology-assisted programme to intensify upper limb rehabilitation in neurologically impaired participants: A prospective study
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To evaluate the implementation of a technology-assisted programme to intensify upper limb rehabilitation after stroke and other neurological conditions in an Australian community cohort. A "Hand Hub" was established in a tertiary hospital. Intervention was delivered via in idual or group sessions for a period of up to 6 weeks, in addition to the patients' regular therapy. Patients were assessed before and after the programme using validated measures. A total of 92 participants completed both assessments (mean age 57 years (standard deviation 17 years), 58% male and 88% with stroke). Post-intervention, participants showed significant improvement in arm function and strength (p < 0.001, effect sizes (r) = 0.5-0.7), streamlined Wolf Motor Function Test score (p < 0.05, r = 0.2-0.4), improved muscle tone on the Modified Ashworth Scale (p < 0.001, r = 0.4), Functional Independence Measure (locomotion, mobility and psychosocial subscales (p < 0.05, r = 0.2-0.3). Quality of life (EQ-5D) and overall health also improved significantly (p < 0.01 for all, r = 0.3-0.6). The "Hand Hub" programme is feasible and showed promising results for upper limb function in persons with neurological disorders. The findings need to be further confirmed in a larger study s le, with a longer follow-up.
Motor neurone disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2011
The development of ICF Core Sets for multiple sclerosis: results of the International Consensus Conference
Publisher: Springer Science and Business Media LLC
Date: 04-03-2011
DOI: 10.1007/S00415-011-5963-7
Abstract: To systematically and comprehensively describe functioning and disability in Multiple sclerosis (MS), practical tools based on the International Classification of Functioning, Disability and Health (ICF), such as ICF Core Sets, are needed. To report on the results of an evidence-based International Consensus Conference to develop the Comprehensive and Brief ICF Core Set for MS. A formal and iterative decision-making and consensus process was undertaken, involving the integration of evidence from preparatory studies (expert survey, systematic literature review, qualitative study, empirical cross-sectional study) and expert opinion. The decision-making and consensus process included discussions and voting in working groups and plenary sessions involving selected international experts from different health professions. Twenty-one experts from 16 countries selected 138 ICF categories for the Comprehensive ICF Core for MS (40 Body functions, 7 Body structures, 53 Activities and Participation categories and 38 Environmental factors) and 19 categories for the Brief ICF Core Set for MS (8 Body functions, 2 Body structures, 5 Activities and Participation categories, 4 Environmental factors). An evidence-based and formal decision-making consensus process led to the approval of ICF Core Sets for MS which should be further validated.
Longitudinal 7-year follow-up of chronic pain in persons with multiple sclerosis in the community
Publisher: Springer Science and Business Media LLC
Date: 25-04-2013
DOI: 10.1007/S00415-013-6925-Z
Abstract: The aim of this work is to examine the course and impact of chronic pain and pain-related disability in persons with multiple sclerosis (pwMS) over a 7-year period in the Australian community employing a longitudinal, cross-sectional study using structured interviews and validated measures. The intensity of chronic pain was assessed with the visual analogue scale (VAS) the chronic pain grade (CPG) classified pain severity using scores for both pain intensity and pain-related disability, and the assessment of quality of life (AQoL) questionnaire assessed impact on participatory domains. Of the 74 pwMS assessed at 7-year follow-up (T2), 53 (71.6 %) were female, with average age of 55.6 years, and median time since diagnosis of 16.5 years. At T2, 13 (13.8 %) more participants reported chronic pain compared with baseline assessment (T1), (61 vs. 74). Although there were no significant differences on average pain intensity rating between T1 and T2 (p = 0.65), more participants at T2 reported higher rates of pain (13.1 vs. 28.4 %). At T2, participants reported greater disability limiting their daily activities due to pain (16.2 vs. 0 %), and more deterioration and dependency suggested by the AQoL domains of "Independent living" (p < 0.001) and "Physical senses" (p = 0.013). At T2, pwMS used less pharmacological medication but accessed more "other" therapy to cope with their chronic pain. This study provides longitudinal insight into the complex multidimensional chronic pain-related disability in pwMS over a longer period. Improved clinician understanding of the course of chronic pain, early intervention, and patient self-management may decrease pain-related disability and contribute to their overall well-being.
Optimizing post-acute care in breast cancer survivors: A rehabilitation perspective
Publisher: Informa UK Limited
Date: 08-2017
DOI: 10.2147/JMDH.S117362
International classification of functioning, disability and health and motor neurone disease rehabilitation
Publisher: Emerald
Date: 15-02-2013
DOI: 10.1108/20420911311302290
Abstract: The purpose of this paper is to determine if issues relevant to multidisciplinary rehabilitation care from the perspective of the patient and caregiver can be addressed utilising the International Classification of Functioning, Disability and Health (ICF) framework also to identify gaps in evidence and service provision to optimise clinical care. Participants with motor neurone disease (MND) ( n =44) and their caregivers ( n =37) were recruited from a tertiary MND clinic. Cross‐sectional predominantly qualitative methodology was used to explore the perspectives of MND patients and their caregivers on disability and service gaps. Their disability experience and relevant environmental factors were then mapped onto the ICF framework. Personal factors were described. The impact of MND on caregivers was also described. There were significant gaps in MND care. In particular, the need for coordinated care by neurology, rehabilitation and palliative care services (“neuropalliative rehabilitation” model) was highlighted. The ICF framework adequately incorporated patient‐and caregiver‐ reported disability in MND. This is the first review that the authors can identify, that lays the foundation for development of an ICF “Core set” (expert‐selected ICF categories that should be addressed in multidisciplinary care settings) for MND, which could improve consensus of care and communication amongst treating clinicians.
Joint Traditional and Reflection Envelope Inversion
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2022
Load response of an osseointegrated implant used in the treatment of unilateral transfemoral amputation: An early implant loosening case study
Publisher: Elsevier BV
Date: 03-2020
Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease
Publisher: Wiley
Date: 07-10-2009
Repetitive transcranial magnetic stimulation for management of post-stroke impairments: An overview of systematic reviews
Publisher: Medical Journals Sweden AB
Date: 2020
Abstract: To evaluate evidence from published systematic reviews of clinical trials to determine the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in stroke population. The Cochrane Library, MEDLINE, CINAHL, EMBASE, and PubMed were searched for systematic reviews up to 15 January 2019. Three authors independently screened the reviews and assessed the methodological quality, using Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool. Quality of evidence for outcomes evaluated within the reviews was appraised with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Twelve reviews (n = 9,117 participants) evaluated the effectiveness of rTMS on motor and non-motor (aphasia, depression, dysphagia and cognition) functions. The rTMS protocols applied and outcomes measured were erse amongst the selected reviews. The findings suggest beneficial effect of rTMS with: "moderate quality" evidence for dysphagia and hemineglect, "low to moderate quality" evidence for motor function (upper limb function, daily activities), and "low quality" evidence for aphasia and post-stroke depression. Despite widespread use of rTMS, high-quality evidence for its routine use for the treatment of stroke survivors is lacking. Further studies are required to establish differential roles of various protocols and long-term effects of rTMS in the stroke population.
Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study
Publisher: Elsevier BV
Date: 11-2017
Clinical practice improvement approach in multiple sclerosis rehabilitation: a pilot study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial
Publisher: SAGE Publications
Date: 09-12-2022
DOI: 10.1177/02692155211064949
Abstract: To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Feasibility randomised controlled trial. Outpatient rehabilitation facility. Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Of 74 in iduals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.
Sexual dysfunction in multiple sclerosis
Publisher: Springer Science and Business Media LLC
Date: 23-01-2011
Beyond speed: Gait changes after botulinum toxin injections in chronic stroke survivors (a systematic review)
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.GAITPOST.2019.03.035
Abstract: The mechanisms by which spasticity reductions after botulinum toxin A (BoNT) affect gait in stroke are not well understood. We systematically reviewed the effects of BoNT on spatiotemporal, kinematic, kinetic and electromyographic (EMG) measures during gait. What are the effects of botulinum toxin on gait mechanics in stroke patients? Systematic search using PubMed and Web of Science. We considered all studies that reported laboratory-based and instrumented gait measures as primary or secondary outcomes to determine the effects of BoNT on walking performance in stroke populations only. Selected studies were classified and analysed based on the injection sites. A total of 240 articles were identified of which 22 were selected for analysis. Overall, 91% of the studies reported spatiotemporal, 64% kinematics, 23% kinetics, 32% EMG and 23% other gait measures. All but one study found significant effects of BoNT on gait measures using instrumented assessments even when clinical measures (i.e. speed) did not significantly improve. However, the majority of the studies had a high risk of bias. Overall, BoNT improved: a) dorsiflexion during stance, propulsive forces and timing and activity of more proximal musculature with injections in the plantarflexors b) hip, knee and ankle angles and velocities, coordination and energetic cost with injections in the rectus femoris c) segmental coordination and energetic cost when several lower limb muscles were injected and, d) elbow and trunk angles when upper limb muscles were injected. Instrumented and laboratory measures of gait improve after BoNT injections in different muscle groups even in the absence of clinical changes.
Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials.
Publisher: Springer Science and Business Media LLC
Date: 17-09-2014
A novel neuromodulation technique for the rehabilitation of balance and gait: A case study
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.JOCN.2018.04.077
Abstract: Cranial-nerve non-invasive neuromodulation (CN-NINM) through the tongue has been proposed as an adjuvant intervention to improve efficacy of rehabilitation. However, CN-NINM effects have only been explored in multiple sclerosis and stroke populations. In this report we used CN-NINM during a 2-week (2 × 1.5 h sessions daily) physiotherapy program for the rehabilitation of a 57 y/o woman presenting with balance and gait impairments after a surgical resection of a fourth ventricular ependymoma. Clinical and instrumented balance and gait assessments showed improved performance in all tests and without adverse effects This study shows the beneficial effects and feasibility of combined physiotherapy and CN-NINM in this patient.
Advance care planning in rehabilitation: An implementation study
Publisher: Medical Journals Sweden AB
Date: 2018
Abstract: To identify implementation and process issues that influence the implementation of an advance care planning (ACP) programme in rehabilitation settings. An ACP programme was established in an inpatient tertiary rehabilitation setting in Victoria, Australia. Rehabilitation patients with chronic illnesses were recruited and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework used. Pre-implementation measures included: patient medical record audit of ACP discussions and barriers and facilitators analyses. Implementation interventions were staff group educational sessions and clinical process changes. Further medical record audit was carried out to review the number of ACP conversations performed and re-evaluate ACP barriers. A total of 180 consecutive inpatients were recruited for pre- (n = 90) and post- (n = 90) implementation groups. The majority of the pre-implementation cohort were female (51%), mean age 64.2 years (standard deviation 16.4 years) and had low rates of ACP discussions (n = 9, 10%). Major ACP barriers included: lack of staff education programme, and insufficient knowledge to conduct ACP. There was a significant increase in ACP conversations performed (n = 21, 23.3%) between both groups however, staff reported limited time and skills to perform discussions. This ACP programme is feasible, but needs robust process evaluation and longer term follow-up to assess the impact of outcomes in public hospital settings on care quality.
Relevance and completeness of the international classification of functioning, disability and health (ICF) comprehensive breast canc er core set: The patient perspective in an australian community cohort
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To examine the relevance and completeness of the International Classification of Functioning, Disability and Health (ICF) comprehensive core set for breast cancer using patient reported disability in an Australian cohort. Cross-sectional community survey of 85 women following definitive treatment for primary breast cancer. Everyday living problems reported by participants (using open ended questionnaires) were linked with ICF categories using 'linkage' rules. Participants rated 'Activities and Participation' and 'Environmental factors' components of ICF checklist using World Health Organisation qualifiers (0-4). The impact of breast cancer on health areas corresponding to 90 ICF categories in these two components was assessed and compared with ICF categories within the comprehensive breast cancer core set. Participants identified 16 of 22 categories from 'Activities and Participation' and 11 of 23 categories (barriers) from 'Environmental factors' included in the comprehensive Core Set for BC, as relevant (≥ 10% of the participants). Median number of problems reported was 4 (IQR 1-9) and 1 (IQR 1-4) for 'Activities and Participation' and 'Environmental factors' categories', respectively. Thirteen additional relevant categories relating to mobility, major life areas, community civic life and societal attitudes currently not included in the breast cancer core set, were identified. The comprehensive breast cancer core set needs to incorporate issues important to survivors with breast cancer in post-acute settings, prior to its validation from a global perspective.
Non-pharmacological interventions for chronic pain in multiple sclerosis
Publisher: Wiley
Date: 30-03-2017
Use of Goal Attainment Scaling in Inpatient Rehabilitation for Persons With Multiple Sclerosis
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.APMR.2007.09.049
Abstract: To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation. Prospective, observational cohort study. Tertiary inpatient rehabilitation unit in Victoria, Australia. Consecutive s le of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age +/- standard deviation was 52.0+/-8.3 years (range, 37-62y). Over half (n=14 [58.3%]) had secondary progressive MS. Not applicable. GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures-the FIM instrument and Barthel Index-rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression. Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 in idualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (rho=-.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=-3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index. This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.
Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease
Publisher: John Wiley & Sons, Ltd
Date: 29-06-2015
RESPONSIVENESS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) CLINICAL FUNCTIONING INFORMATION TOOL (ClinFIT) IN ROUTINE CLINICAL PRACTICE IN AN AUSTRALIAN INPATIENT REHABILITATION SETTING
Publisher: Medical Journals Sweden AB
Date: 20-04-2022
DOI: 10.2340/JRM.V54.159
Abstract: Objective: To examine the responsiveness of the International Classification of Functioning, Disability and Health (ICF) Clinical Functioning Information Tool (ClinFIT) in routine clinical practice in an Australian context.Methods: A prospective observational study with consecutive recruitment of inpatients at a tertiary rehabilitation facility. The assessments were at admission (T0), discharge (T1) and 3-month postdischarge (T2), using the following questionnaires: ClinFIT, Functional Independence Measure (FIM) and European Quality of Life (EQ-5D-5L). Extension Indices (EI) were calculated for the ClinFIT set, and responsiveness measured as a change in scores over time. The association between FIM and ClinFIT scores was explored.Results: Participants (n = 91, mean age 66.8±13.0 years, 52% male, 48% following stroke) reported ≥ 1 issue related to ClinFIT categories. ClinFIT total raw scores improved significantly across all health conditions compared with T0 (median (interquartile range):196 (110, 228)) at both T1: 69 (37, 110) p 0.001 and T2: 46.5 (20.8, 77) p 0.001, with a medium effect size (r = 0.61 for both). There were significant changes in EI in the entire ClinFIT set from T0 to T1, and from T0 to T2 (p 0.001 for both), with small to mediumeffect sizes. Analyses confirmed significant correlation in improvements between ClinFIT and FIM scores.Conclusion: ClinFIT is useful in evaluating patient functioning and can detect changes in functioning over time and across different health conditions. LAY ABSTRACTRegular patient evaluation and clinical assessment is needed to maximize positive outcomes from rehabilitation intervention. This prospective study assessed the responsiveness of the International Classification of Functioning, Disability and Health (ICF) – Clinical Functioning Information Tool (ClinFIT) for the assessment of functioning in an inpatient rehabilitation facility in Australia. Overall,91 patients with different health conditions (majority with stroke) were assessed at admission, discharge, and at 3 months after discharge, using the ClinFIT set, and compared with another routinely used instruments, the Functional Independence Measure (FIM). The findings showed that the ClinFIT set is useful in evaluating patients’ functioning over time across different health conditions.
Factors associated with long-term functional outcomes and psychological sequelae in Guillain-Barre syndrome
Publisher: Springer Science and Business Media LLC
Date: 13-07-2010
DOI: 10.1007/S00415-010-5653-X
Abstract: To examine factors impacting long-term health-related outcomes in survivors of Guillain-Barre syndrome (GBS). Seventy-six consecutive patients with definite GBS admitted to the Royal Melbourne Hospital (1996-2009) were reviewed in the neurorehabilitation clinics. They underwent a structured interview designed to assess the impact of GBS on their current activity and restriction in participation using validated questionnaires: Functional Independence Measure (FIM), Perceived Impact of Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS). Their sociodemographic and disease severity data were obtained from the medical record. The 76 patients [60% male, mean age 56 years, median time since GBS 6 years (range 1-14 years)] showed good functional recovery (median motor FIM score 90). However, 16% reported moderate to extreme impact on their ability to participate in work, family, and social activities and 22% substantial impact on mood, confidence and ability to live independently. More reported moderate to extreme depression (18%), anxiety (22%) and stress (17%) compared with the normative Australian population (13%). Factors associated with poorer current level of functioning and wellbeing included: females, older patients (57+ years), acute hospital stay (>11 days), those treated in intensive care and those discharged to rehabilitation. No associations were found between the Medical Research Council (MRC) Motor Scale Rating scores at admission, nor time since GBS diagnosis (≤6 vs. >6 years) on outcomes used. GBS is complex and requires long-term management of psychological sequelae impacting activity and participation.
Multiple sclerosis: disability profile and quality of life in an Australian community cohort
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2006
Do patient-reported outcome measures in hip and knee arthroplasty rehabilitation have robust measurement attributes? A systematic review
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: The aim of this study was to systematically review and compare the measurement attributes of multidimensional, patient-reported outcome measures used in hip and knee arthroplasty rehabilitation. A search of PubMed, CINAHL, Cochrane Central Registry, SCOPUS and PEDro databases up to December 2009 identified the validation studies. The quality of the measurement properties were assessed based on the Terwee and Bot criteria, and Scientific Advisory Committee of the Medical Outcomes Trust guidelines. A total of 68 studies examining 28 instruments were identified. Three instruments had positive ratings for content validity. None of the instruments satisfied both factor analysis and Cronbach's α criteria for internal consistency. Four measures were positively-rated for agreement. Nine tools had positive ratings for construct validity. Twenty-four of the instruments had indeterminate ratings for responsiveness to clinical change. Only certain subscales of 2 instruments were positively-rated for responsiveness to clinical change. A wide variety of multidimensional patient-reported instruments has been used to assess rehabilitation outcomes after hip and knee arthroplasty, but information about their measurement attributes in these populations is inadequate. More data are needed to clarify their reproducibility and responsiveness to clinical change. :
Applicability of traumatic brain injury rehabilitation interventions in natural disaster settings
Publisher: Informa UK Limited
Date: 17-07-2019
Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal
Publisher: Informa UK Limited
Date: 17-07-2019
DOI: 10.1080/02699052.2019.1641747
Abstract: This review aim to provide an overview of recommendations and quality of existing clinical practice guidelines (CPGs) for the management of traumatic brain injury (TBI) from the rehabilitation perspective. Comprehensive literature search, including health databases, CPG clearinghouse/developer websites, and grey literature using Internet search engines up to September 2017. All TBI CPGs published in the last decade were selected if their scope included management of TBI, systematic methods for evidence search, clear defined recommendations, and supporting evidence for rehabilitation interventions. Three authors independently critically appraised the quality of included CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument. Four of 13 potential CPGs met the inclusion criteria. Despite variation in scope, target population, size, and guideline development processes, all four CPGs assessed were good quality (AGREE score of 5-7/7). Key rehabilitation recommendations included education, physical rehabilitation, integrated computer-based management, repetitive task-specific practice in daily living activities, safe equipment usage, cognitive/behavioral feedback, compensatory memory/visual strategies, swallowing/communication, and psychological input for TBI survivors. In conclusion, although rehabilitation is an integral component in TBI management, many published CPGs do not include rehabilitation. These CPGs, however, recommend comprehensive, flexible coordinated multidisciplinary care and appropriate follow-up, education, and support for patients with TBI (and carers).
World Health Organization Global Disability Action Plan: The Mongolian Perspective
Publisher: Medical Journals Sweden AB
Date: 2018
Abstract: To provide an update on disability and rehabilitation in Mongolia, and to identify potential barriers and facilitators for implementation of the World Health Organization (WHO) Global Disability Action Plan (GDAP). A 4-member rehabilitation team from the Royal Melbourne Hospital conducted an intensive 6-day workshop at the Mongolian National University of Medical Sciences, for local healthcare professionals (n = 77) from medical rehabilitation facilities (urban/rural, public rivate) and non-governmental organizations. A modified Delphi method (interactive sessions, consensus agreement) identified challenges for rehabilitation service provision and disability education and attitudes, using GDAP objectives. The GDAP summary actions were considered useful for clinicians, policy-makers, government and persons with disabilities. The main challenges identified were: limited knowledge of disability services and rehabilitation within healthcare sectors lack of coordination between sectors geo-topographical issues limited skilled workforces lack of disability data, guidelines and accreditation standards poor legislation and political commitment. The facilitators were: strong leadership advocacy of disability-inclusive development investment in local infrastructure/human resources opportunities for coordination and partnerships between the healthcare sector and other stakeholders research opportunities and dissemination of information. Disability and rehabilitation is an emerging priority in Mongolia to address the rights and needs of persons with disabilities. The GDAP provides guidance to facilitate access and strengthen rehabilitation services.
Guillain-Barré syndrome: Prevalence and long-term factors impacting bladder function in an Australian community cohort
Publisher: Korean Neurological Association
Date: 2013
Predicting compliance with treatment following stroke: A new model of adherence following rehabilitation
Publisher: Cambridge University Press (CUP)
Date: 09-2008
DOI: 10.1375/BRIM.9.2.122
Abstract: Background and purpose: Adherence to medication is fundamental to optimal health recovery yet compliance to medication rates are lower than 50% in most studies. This study aimed to investigate the correlates of adherence in stroke patients. Method: Twenty-six stroke patients and 29 utee patients who had completed a rehabilitation program at Melbourne Rehabilitation Centre were investigated. Medical adherence was determined from computed adherence metrics based on pill counts and subjective reports of patient knowledge of medication use. Model components that were believed to contribute to poor adherence, included emotional and cognitive dysfunction, beliefs about medication, and social support. These factors were assessed by patient and partner self-rating questionnaires. Results: Stroke patients showed a lower level of adherence compared to utee patients. Cognitive and emotional dysfunction, beliefs about medication, and the level of care were significantly associated with low adherence to medicine regimes in stroke patients. Level of cognitive impairment and emotional impairment were significantly associated with low adherence to medicines in utee patients. Emotional dysfunction was the best predictor of poor adherence in both patient groups. Conclusion: The findings are in keeping with past adherence studies with other patient groups and support the position that emotional, cognitive, and social factors are important factors in adherence. The specific nonadherence profile for this brain-damaged group is modeled and the application for outpatients following rehabilitation is discussed.
Rehabilitation outcomes in persons with Spina Bifida: A randomized controlled trial
Publisher: Medical Journals Sweden AB
Date: 2015
Abstract: To assess the effectiveness of an interdisciplinary ambulatory rehabilitation programme for persons with spina bifida in an Australian community cohort. Fifty-four participants randomized to a treatment group (n = 27) for a high-intensity rehabilitation programme (with cognitive behavioural therapy) or a control group (n = 27) comprising usual care. Outcome measures include: Disability: Urogenital Distress Inventory (UDI6), Incontinence Impact Questionnaire-7 (IIQ7), American Urological Association Symptom Index (AUA), Wexner-Faecal Incontinence Score (WFIS), Neurological Disability Scale (NDS) Depression, Anxiety Stress Scale (DASS), McGill Quality of Life (MQOL), Brief COPE Scale, Genera-lized Self-efficacy Scale (GSE). Assessments were made at baseline and 3-months post-intervention. Adjusted for baseline disease and demographic covariates, the intervention group improved significantly at 3-month follow-up for primary and secondary outcomes, with moderate to large effect sizes (r): urinary/bowel dysfunction (AUA, UDI6, IIQ7, WFIS) (p < 0.001 for all, r = 0.4-0.7) and cognitive function: NDS "cognitive" and "mood" (p < 0.01, r = 0.6 for both) DASS "depression", "anxiety" and "stress" (p < 0.001 for all, r = 0.5-0.7) MQOL total (p = 0.013, r = 0.5), "psychological symptoms" (p < 0.001, r = 0.8) "active coping" (p = 0.035) and "self-efficacy" scores (GSE p < 0.001). No difference between groups was noted in other subscales. Targeted rehabilitation can improve clinical outcomes in persons with spina bifida. Further research is needed for longer-term outcomes related to "ageing" and participation restriction.
Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity
Publisher: Wiley
Date: 05-06-2013
Outcomes of high- and low-intensity rehabilitation programme for persons in chronic phase after Guillain-Barré syndrome: a randomized controlled trial.
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: To assess the effectiveness of a high- vs low--intensity multidisciplinary ambulatory rehabilitation programme over 12 months for persons in the chronic phase after Guillain-Barré syndrome (pwGBS) in an Australian community cohort. A total of 79 pwGBS, recruited from a tertiary hospital, were randomized to a treatment group (n = 40) for an in idualized high-intensity programme, or a control group (n = 39) for a lower intensity programme. The primary outcome the Functional Independence Measure (FIM) motor subscale assessed "activity limitation" while secondary measures for "participation" included: World Health Organization Quality of Life Depression, Anxiety Stress Scale and Perceived Impact Problem Profile (PIPP) scales. All outcome measures were assessed at baseline and at 12 months. Intention to treat analysis of data from 69 participants (treatment n = 35, control n = 34) showed reduced disability in the treatment group in post-treatment FIM domains (mobility, transfers, sphincter control and locomotion all p < 0.005) and PIPP scores (relationships p = 0.011), with moderate-to-small effect sizes (r = 0.36-0.23). The treatment group compared with control group showed significant improvement in function (FIM scores): 68% vs 32%. Higher intensity rehabilitation compared with less intense intervention reduces disability in pwGBS in later stages of recovery. Further information on rehabilitation modalities and impact on quality of life is needed.
Multidisciplinary care for adults with amyotrophic lateral sclerosis or motor neuron disease
Publisher: John Wiley & Sons, Ltd
Date: 08-10-2008
Multidisciplinary rehabilitation after primary brain tumour treatment
Publisher: Wiley
Date: 23-08-2015
Advance care planning in patients with primary malignant brain tumors: A systematic review
Publisher: Frontiers Media SA
Date: 24-10-2016
Multidisciplinary rehabilitation after primary brain tumour treatment
Publisher: John Wiley & Sons, Ltd
Date: 31-01-2013
Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: Study protocol for a cluster randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 11-07-2014
Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis
Publisher: Hindawi Limited
Date: 2011
DOI: 10.1155/2011/740505
Abstract: Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a “neuropalliative” approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes.
A new decoupling and elastic propagator for efficient elastic reverse time migration
Publisher: Society of Exploration Geophysicists
Date: 09-2020
Abstract: Methods to decompose the elastic wavefield into compressional wave (P-wave) and shear wave (S-wave) components in heterogeneous media without wavefield distortions or energy leakage are the key issues in elastic imaging and inversion. We have introduced a decoupled P- and S-wave propagator to form an efficient elastic reverse time migration (RTM) framework, without assuming homogeneous Lamé parameters. Also, no wave-mode conversions occur using the proposed propagator in the presence of strong heterogeneities, which avoids the potential imaging artifacts caused by wave-mode conversions in the receiver-side backward extrapolation. In the proposed elastic RTM framework, the source-side forward wavefield is simulated with a P-wave propagator. The receiver-side wavefield is back extrapolated with the proposed propagator, using the recorded multicomponent seismic data as input. Compared to the conventional elastic RTM, the proposed framework reduces the computational complexity while preserving the imaging accuracy. We have determined its accuracy and efficiency using two synthetic ex les.
Rehabilitation in Madagascar: Challenges in implementing the world health organization disability action plan
Publisher: Medical Journals Sweden AB
Date: 2015
Abstract: To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach, new partnerships, strategic collaboration, provision of technical assistance, future policy directions, and research and development. Other challenges for many basic policies included: access to rehabilitation services, geographical coverage, shortage of skilled work-force, limited info-technology systems lack of care-models and facility/staff accreditation standards limited health services infrastructure and "disconnect" between acute and community-based rehabilitation. The DAP summary actions were useful planning tools to improve access, strengthen rehabilitation services and community-based rehabilitation, and collate data for outcome research.
Rehabilitation for people with multiple sclerosis: an overview of Cochrane systematic reviews
Publisher: Wiley
Date: 25-07-2017
Chronic Pain in Multiple Sclerosis: Prevalence, Characteristics, and Impact on Quality of Life in an Australian Community Cohort
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.JPAIN.2007.03.005
Abstract: This cross-sectional study describes chronic pain in 94 persons with multiple sclerosis residing in the community. The characteristics of chronic pain, pain-related disability, pain treatments, barriers to health care, and impact on quality of life were examined. Sixty-four percent of participants reported chronic pain of these, 60% had dysesthetic pain and 70% had episodic increases in pain. The mean numerical pain intensity rating score was moderate (5). Chronic Pain Grade was used to classify severity of pain, using scores for items for pain intensity and pain-related disability. Those in the higher pain grades had more disability and recorded more health care visits (P = .06) (not significant because of small s le size). Effective pain management techniques included analgesic medication and physical measures as reported by 54% and 44% participants, respectively. Participants' perceived barriers to health care included environmental and personal factors. Those with multiple sclerosis and pain, compared with those with no pain, showed a significant difference in the domain of psychological well-being scores (P = .01) on the Assessment of Quality of Life scale. Additionally, the domains of independent living (P = .009) and total scores (P = .04) showed better quality of life in participants with lower pain grades. Improved understanding of chronic pain in this population may facilitate early identification for timely intervention and minimize pain-related disability. This article describes chronic pain in persons with multiple sclerosis living in the community. The information regarding pain prevalence, pain-related disability, and impact on quality of life provides insight into the complex multidimensional pain experience. Improved understanding of pain and early intervention may contribute to the overall well-being and decrease pain-related disability in this population.
Disaster Rehabilitation Response Plan
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-08-2019
Multidisciplinary rehabilitation for follow-up of women treated for breast cancer
Publisher: Wiley
Date: 12-12-2012
Comparison of rehabilitation outcomes for long term neurological conditions: A cohort analysis of the Australian rehabilitation outcomes centre dataset for adults of working age
Publisher: Public Library of Science (PLoS)
Date: 13-07-2015
Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.ATHEROSCLEROSIS.2018.08.018
Abstract: This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual). This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP. A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ± 13.92 vs. 35.2, SD ± 14.13), t(370) = 8.66, p < 0.001. Regarding awareness, 39% were aware of the NICE FH guideline and only 27.2% were aware of FH diagnostic criteria. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 11.54), p = 0.013. Regarding practice, only 19.1% stratified FH patients as high risk irrespective of other risk factors. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (52.4, SD ± 12.92 vs. 42.7, SD ± 16.63), t(370) = 9.65, p < 0.001. Substantial gaps in FH-KAP among Malaysian PCP were identified, with PCP-PG-Qual having better knowledge, awareness and practice than PCP-noPG-Qual, emphasising the importance of professional training and certification.
A randomised controlled trial: Outcomes of bladder rehabilitation in persons with multiple sclerosis
Publisher: BMJ
Date: 11-06-2010
Abstract: A stratified, randomised, waitlist controlled study over 12 months assessed the effectiveness of a 6 week bladder rehabilitation programme in persons with multiple sclerosis (pwMS) in an Australian community cohort. Patients with definite MS and bladder issues (n=74) recruited from a tertiary hospital database were randomised to a treatment group (n=40) for an in idualised bladder rehabilitation programme or to a control waitlist group (n=34). The Urogenital Distress Inventory (UDI6), Neurological Disability Scale (NDS) and the American Urological Association Symptom Index (AUA) assessed bladder impairment and 'activity limitation' a single Quality of life (QoL) item in the AUA and the Incontinence Impact Questionnaire (IIQ7) measured restriction in 'participation'. Primary outcome measures were assessed at baseline and at 12 months. Analysis of per protocol data from 58 patients (treatment n=24, control n=34) showed reduced disability in the treatment group, with significant differences (p 0.5) in post-treatment UDI6, NDS, AUA total, AUA QoL and IIQ7 scores for the two groups. The treatment group compared with the control group showed improvement: 78% versus 27% for UDI6 and 59% versus 17% improved for IIQ7. More patients in the control group deteriorated over the study period on the UDI6 (30% vs 0% p<0.001) and IIQ7 (39 vs 0% p=0.001). A multifaceted, in idualised bladder rehabilitation programme reduces disability and improves QoL in pwMS compared with no intervention after 12 months of follow-up. Information on specific interventions in different bladder types in MS and the impact on QoL need further evaluation. Australian Clinical trials Registry ACTRNO12605000676617.
Rehabilitation interventions in multiple sclerosis: an overview
Publisher: Springer Science and Business Media LLC
Date: 08-07-2012
DOI: 10.1007/S00415-012-6577-4
Abstract: Multiple sclerosis is a complex, heterogeneous disease associated with long-term disability. Despite the availability of advanced disease-modifying and symptomatic therapies that may decrease activity and progression of disease and alleviate complaints to a certain extent, there is still a need for comprehensive rehabilitation interventions in order to reduce sequels and symptoms of the disease on personal activities and social participation to achieve the highest possible independence and the best quality of life. Timing and setting of rehabilitation interventions should be selected in idually depending on disease phase, functional deficits, personal requirements, as well as specific goals. In addition, limitations and disease-specific characteristics that may influence rehabilitation outcome should be noted. Rehabilitation interventions should be considered early for maintaining functional capacity and reducing risk for losing important abilities or independence. Due to gradual failure of adaptive compensatory mechanisms along the course of disease, benefits of rehabilitation interventions are generally higher in earlier phases of MS. Inpatient and outpatient multidisciplinary rehabilitation has been shown to be beneficial in improving disability, participation and quality of life despite progression of the disease. Good evidence exists for different specific interventions improving physical and cognitive performance. Other important issues responsible for beneficial effects of comprehensive rehabilitation in MS include education, instruction, and information of patients and caregivers. Comprehensive assessment of health domains in MS patients using standardized framework and common language for describing the impact of disease at different levels, using International Classification of Functioning, Disability and Health (ICF) core sets may increase the knowledge of needs of these patients for more efficient and adapted rehabilitation interventions meeting these in idual requirements, and promote perception and acceptance of rehabilitation as a valuable treatment option in MS. ICF core sets may increase the knowledge of more efficient and adapted rehabilitation measures meeting more properly in idual requirements, and promote perception and acceptance of rehabilitation as a valuable treatment option in MS.
Effectiveness of a structured sexual rehabilitation programme following stroke: A randomized controlled trial
Publisher: Medical Journals Sweden AB
Date: 2017
Abstract: Sexual activity is an integral part of life it is important to address sexual health after stroke, but this is often poorly done. To assess the effectiveness of a structured sexual rehabilitation programme compared with written information alone regarding sexual and psychological functioning (anxiety, depression, stress), functional independence and quality of life in an Australian stroke cohort. A total of 68 participants were randomized to a structured sexual rehabilitation programme (treatment group n = 35) or to written information alone (control group n = 33). Outcome measures included: Sexual Functioning Questionnaire Short Form Depression, Anxiety Stress Scale Functional Independence Measure, and Stroke and Aphasia Quality of Life Scale-39 Generic. Assessments were performed at baseline, 6 weeks and 6 months after the intervention. Participant's preferences regarding how they would like to receive information, who from, and how frequently, were collected at baseline. There was no difference between groups for any outcome measures. Half of the participants (51%) wished to receive information and were ided equally into preferring written information vs face-to-face counselling, with the majority (54%) preferring information after discharge from an inpatient setting. Provision of written information alone appears to be as effective as a 30-min in idualized sexual rehabilitation programme in an inpatient setting. Further research is needed regarding longer term outcomes and outpatient settings.
Nocturia as a marker of poor health: Causal associations to inform care
Publisher: Wiley
Date: 06-04-2017
DOI: 10.1002/NAU.23000
Abstract: Nocturia is a common symptom of many conditions and is encountered in patients presenting to services across different medical specialities and health disciplines. The causal pathway of nocturia is multi-factorial and differs between patients. There is currently no symptom-specific clinical algorithm for all-cause diagnosis of nocturia. The aim of this study was to investigate the interrelationships between causes of nocturia in order to inform the development of a comprehensive multidisciplinary assessment metric. A PubMed search that identified studies reporting relationships between nocturia and a priori aetiological factors was conducted by cross referencing the term "nocturia" with "polyuria, postural hypotension, hypertension, cardiac function, heart failure, depression, anxiety, polypharmacy, sleep disturbance, sleep disorder, apnoea, and lower urinary tract symptoms." Directed acyclic graphs (DAGS) were constructed to visually represent causal assumptions and to identify underlying relationships. This study confirmed that causality of nocturia can be expressed in a directed acyclic graph, with the key variables being cardiovascular dysfunction, polyuria, sleep disturbance, mental health, metabolic and inflammatory changes, health status and lower urinary tract symptoms. None of the variables were independently a sufficient or necessary direct cause of nocturia and multiple backdoor pathways exist to nocturnal voiding. Polypharmacy, increasing age and BMI all have confounding effects. There are significant interactions between voiding at night and metabolic, cardiovascular, hormonal, mental health, sleep and inflammatory changes that flag nocturia as a likely marker of co-morbid poor health. Patients should be comprehensively evaluated for all-causes of nocturia since multiple aetiologies commonly co-exist. Neurourol. Urodynam. 36:697-705, 2017. © 2016 Wiley Periodicals, Inc.
Neurorehabilitation: applied neuroplasticity
Publisher: Springer Science and Business Media LLC
Date: 24-10-2016
DOI: 10.1007/S00415-016-8307-9
Abstract: The prevalence of disability due to neurological conditions is escalating worldwide. Neurological disorders have significant disability-burden with long-term functional and psychosocial issues, requiring specialized rehabilitation services for comprehensive management, especially treatments tapping into brain recovery 'neuroplastic' processes. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring coordinated effort of erse sectors, professions, patients and community to manage complex condition-related disability. This review provides evidence for a range of neurorehabilitation interventions for four common neurological conditions: multiple sclerosis (MS), stroke, traumatic brain injury and Parkinson's disease using the Grade of Recommendation, Assessment, Development and Evaluation tool for quality of evidence. Although, existing best-evidence for many interventions is still sparse, the overall findings suggest 'strong' evidence for physical therapy and psychological intervention for improved patient outcomes and. 'moderate' evidence for multidisciplinary rehabilitation for longer term gains at the levels of activity (disability) and participation in MS and stroke population. The effect of other rehabilitation interventions is inconclusive, due to a paucity of methodologically robust studies. More research is needed to improve evidence-base for many promising rehabilitation interventions.
Evaluating Rehabilitation Progress Using Motion Features Identified by Machine Learning
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 04-2021
Mild traumatic brain injury presenting with delayed intracranial hemorrhage in warfarin therapy: a case report
Publisher: Springer Science and Business Media LLC
Date: 18-08-2015
Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.REHAB.2017.10.001
Abstract: Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes. Data sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017. two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is "moderate" evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. "Low" quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions extracorporeal shock-wave therapy in brain injury transcranial direct current stimulation in stroke transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive. Despite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions.
Disaster Response and Management: The Integral Role of Rehabilitation
Publisher: Korean Academy of Rehabilitation Medicine
Date: 31-08-2023
DOI: 10.5535/ARM.23071
Abstract: With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation challenges and key future perspectives in this area.
Effectiveness of telerehabilitation interventions in persons with multiple sclerosis: A systematic review
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.MSARD.2015.06.011
Abstract: Telerehabilitation, a service delivery model using telecommunications technology to provide therapy at a distance, is used in persons with multiple sclerosis (pwMS), but evidence for their effectiveness is yet to be determined. To investigate the effectiveness and safety of telerehabilitation intervention pwMS. A comprehensive literature search was conducted using medical and health science electronic databases. Three reviewers selected potential studies and independently assessed the methodological quality. A meta-analysis was not possible due to heterogeneity amongst included trials, and a qualitative analysis was performed for best evidence synthesis. Ten RCTs and 2 observational studies (n=564 participants) investigated a wide variety of telerehabilitation intervention in pwMS, which included: physical activity educational, behavioural and symptom management programmes. All studies scored "low to moderate" on the methodological quality assessment implying high risk of bias. Overall, the review found low level evidence for the effectiveness of telerehabilitation on reducing short-term disability and reducing and/or improving symptoms, such as fatigue. There was low level evidence suggesting some benefit of telerehabilitation in improving functional activities improving symptoms in the longer-term and psychological outcomes and quality of life. There is limited data on safety, process evaluation and no data on cost-effectiveness of telerehabilitation. A wide range of telerehabilitation is used in pwMS, however, the quality of evidence on these interventions was low. More robust trials are needed to build evidence about these interventions.
Quantitative Assessment of ADL: A Pilot Study of Upper Extremity Reaching Tasks
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/236474
Abstract: Effective telerehabilitation technologies enable patients with certain physiological disabilities to engage in rehabilitative exercises for performing Activities of Daily Living (ADLs). Therefore, training and assessment scenarios for the performance of ADLs are vital for the promotion for telerehabilitation. In this paper we investigate quantitatively and automatically assessing patient’s kinematic ability to perform functional upper extremity reaching tasks. The shape of the movement trajectory and the instantaneous acceleration of kinematically crucial body parts, such as wrists, are used to compute the approximate entropy of the motions to represent stability (smoothness) in addition to the duration of the activity. Computer simulations were conducted to illustrate the consistency, sensitivity and robustness of the proposed method. A preliminary experiment with kinematic data captured from healthy subjects mimicking a reaching task with dyskinesia showed a high degree of correlation (Cohen’s kappa 0.85 with p 0.05 ) between a human observer and the proposed automatic classification tool in terms of assigning the datasets to various levels to represent the subjects’ kinematic abilities to perform reaching tasks. This study supported the use of Microsoft Kinect to quantitatively evaluate the ability of in iduals with involuntary movements to perform an upper extremity reaching task.
Factors associated with long-term functional outcomes, psychological sequelae and quality of life in persons after primary brain tumour
Publisher: Springer Science and Business Media LLC
Date: 05-01-2013
DOI: 10.1007/S11060-012-1024-Z
Abstract: To examine factors impacting long-term functional outcomes and psychological sequelae in persons with primary brain tumours (BT) in an Australian community cohort. Participants (n = 106) following definitive treatment for BT in the community were reviewed in rehabilitation clinics to assess impact on participants' current activity and restriction in participation, using validated questionnaires: Functional Independence Measure (FIM), Perceived Impact Problem Profile (PIPP), Depression Anxiety Stress Scale, Cancer Rehabilitation Evaluation System-Short Form and Cancer Survivor Unmet Needs Measure. Mean age of the participants was 51 years (range 21-77 years), majority were female (56 %) with median time since BT diagnosis 2.1 years and a third (39 %) had high grade tumours. Majority showed good functional recovery (median motor FIM score 75). Over half reported pain (56 %), of which 42 % had headaches. Other impairments included: ataxia (44 %), seizures (43 %) paresis (37 %), cognitive dysfunction (36 %) and visual impairment (35 %). About 20 % reported high levels of depression, compared with only 13 % in an Australian normative s le. Two-third (60 %) participants reported highest impact on the PIPP subscales for psychological wellbeing (scores of >3 on 6-point scale) and participation (45 %). Factors significantly associated with poorer current level of functioning and wellbeing included: younger participants (≤40 years), recent diagnoses, aggressive tumour types and presence of pain. No significant differences in scale scores were found across various treatments (surgery, chemotherapy or radiotherapy) on outcomes used. Rehabilitation for BT survivors is challenging and requires long-term management of psychological sequelae impacting activity and participation. More research into participatory limitation is needed to guide treating clinicians.
Multidisciplinary rehabilitation for adults with multiple sclerosis
Publisher: Wiley
Date: 18-04-2007
Effectiveness of rehabilitation intervention in persons with multiple sclerosis: A randomised controlled trial
Publisher: BMJ
Date: 05-06-2008
Cognitive-behavioral classifications of chronic pain in patients with multiple sclerosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Efficient Acoustic Reverse Time Migration With an Attenuated and Reversible Random Boundary
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2020
Environmental enrichment for stroke and other non-progressive brain injury
Publisher: Wiley
Date: 22-09-2015
Information provision for people with multiple sclerosis
Publisher: Wiley
Date: 21-04-2014
Information provision for people with multiple sclerosis
Publisher: Wiley
Date: 14-10-2018
Late mortality after severe traumatic brain injury
Publisher: AMPCo
Date: 2012
DOI: 10.5694/MJA11.11126
Abstract: The first Australian report is welcome and should help inform policy.
Stable and High-Efficiency Attenuation Compensation in Reverse-Time Migration Using Wavefield Decomposition Algorithm
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 10-2019
Chronic pain in multiple sclerosis: A 10-year longitudinal study
Publisher: Walter de Gruyter GmbH
Date: 07-2017
DOI: 10.1016/J.SJPAIN.2017.04.070
Abstract: Pain is a common symptom associated with multiple sclerosis (MS), and has lasting effects on an in idual’s functional capacity and quality of life. A wide range of prevalence rates of pain (between 23% and 90%)have been reported in MS and this is mainly due to the methodological differences amongst the studies such as variability in patient sources, method of s ling and the definition of pain used. Chronic pain in MS, defined as pain lasting for greater than 3–6 months, can have a significant impact on their biopsychosocial health, including negative impact on activities of daily living, relationships and social participation. The long-term course of MS-related pain and its impact in an Australian cohort over a 7-year period has been investigated earlier. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. This was a prospective longitudinal study conducted at the Rehabilitation Department of Royal Melbourne Hospital (RMH), a tertiary referral hospital in Victoria and Australia. The source of participants was from the RMH MS database and contains detailed MS patient information including demographic data, diagnosis details (using McDonald’s criteria), pain characteristics. Structured face-face interviews and validated measures were used, which include the visual analogue scale (VAS) chronic pain grade (CPG) the assessment of quality of life (AQoL) and the carer strain index (CSI). The mean age of the participants ( n = 70) was 55.3 years and majority (70%) were female. The mean age of the participants ( n = 70) was 55.3 years and majority (70%) were female. The findings show that over time (10 years), participants report having greater bilateral bodily pain and greater description of pain as ‘worse as it could be’. Pain types were similar to 7-years follow-up but remained higher than baseline. There was a significant deterioration in quality of life in those with more severe CPG over time. Almost half of the participants 31 (44%) required care either from a private carer, institution or from a family member. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment over time and an increase in the use of healthcare services, mainly neurologists and general practitioners. The pain measures reported by the participants were similar to those at the 7-year follow-up except there was a greater representation of bilateral pain locations (limb, trunk and facial pain) compared to baseline and 7-year follow-up. At 10-year follow-up, more participants used medications compared tc 7-year follow-up and there was an increase in the use of health professionals at the 10-year follow-up At the 10-year follow up QoL of the participants deteriorated significantly and more participants had progressed to higher CPGIII and CPGIV. This study demonstrates that chronic pain is a significant issue over time in MS, with clinical and health implications, impact on quality of life, disability and healthcare utilization. Greater awareness of chronic pain in pwMS, cognitive classifications and an interdisciplinary approach is required to improve long-term patient outcomes and well-being. Crown Copyright © 2017 Published by Elsevier B.V. on behalf of Scandinavian Association for the Study of Pain. All rights reserved.
Wave-Equation-Based Q Tomography With Local Peak Frequency Shift Measurements
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2022
Intracortical Circuits in the Contralesional Primary Motor Cortex in Patients With Chronic Stroke After Botulinum Toxin Type A Injection: Case Studies.
Publisher: Frontiers Media SA
Date: 24-08-2020
Identification of Personal Factors in Motor Neurone Disease: A Pilot Study
Publisher: Hindawi Limited
Date: 2011
DOI: 10.1155/2011/871237
Abstract: Motor neurone disease (MND) is a devastating condition. This preliminary study aims to identify relevant personal factors affecting the experience of living with MND from the perspective of persons with MND (pwMND) in an Australian cohort. A prospective cross-sectional survey of pwMND () using an open-ended questionnaire identified personal factors that were categorised thematically. Standardised questionnaires assessed disease severity: depression, anxiety, and stress and coping strategies. Personal factors identified included demographic factors (socioeconomic status), emotional states (depression, anxiety, and fear), coping strategies (problem-based coping and denial), personality, beliefs (religious and personal values), attitudes (of the patient), and others (such as perceived support). An understanding of personal factors by treating clinicians is essential in the provision of optimal care in MND. This study may assist in the development of personal factors within the International Classification of Functioning, Disability, and Health for improved consensus of care and communication amongst treating clinicians.
Cranial nerve non-invasive neuromodulation improves gait and balance in stroke survivors: A pilot randomised controlled trial
Publisher: Elsevier BV
Date: 11-2017
Do patient-reported outcome measures used in assessing outcomes in rehabilitati on after hip and knee art hroplasty capture issues relevant to patients ? Results of a systematicre view and ICF linking process
Publisher: Medical Journals Sweden AB
Date: 2011
Abstract: To compare the contents of patient-reported instruments used in hip and knee arthroplasty rehabilitation with the International Classification of Functioning, Disability and Health (ICF). A search of PubMed, CINAHL, Cochrane Central Registry, SCOPUS and PEDro identified patient-reported outcome instruments. The meaningful concepts extracted from the instruments were linked to the ICF based on established linking rules and compared with the osteoarthritis core set. The number of concepts per item, the breadth, and the depth of coverage of instruments in relation to the ICF were determined through calculation of content density, bandwidth per ICF component, and content ersity, respectively. Eight instruments were reviewed and 375 meaningful concepts were linked to the ICF. Activity and participation had the most representation (61%). The Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteo-arthritis Outcome Score had the widest coverage (bandwidth) for body functions (1.62%, 1.22%, respectively). The Arthritis Impact Measurement Scales had the broadest bandwidth (8.4%) for activity and participation. All tools addressed general mobility but lacked coverage in "driving", "assisting others", "interpersonal relationships" and "community life". The majority of tools did not address environmental factors. Patient-reported outcome measures in arthroplasty rehabilitation do not fully address relevant areas of activity, participation and environment, suggesting limited clinical applicability.
Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia
Publisher: SAGE Publications
Date: 22-05-2009
Abstract: Objective To examine the outcomes of inpatient rehabilitation for persons with multiple sclerosis (pwMS), using the Australian Rehabilitation Outcomes Centre (AROC) database. Method Deidentified data from the AROC database were analyzed for all rehabilitation admissions during 2003–2007, using four classes for functional level. The outcomes included Functional Independence Measure (FIM) scores and efficiency, hospital length of stay (LOS), and discharge destination. Results Of 1010 case episodes, 70% were women, admitted from home ( n = 851) and discharged into the community ( n = 890), and 97% ( n = 986) were in the higher three classes for functional level (classes 216, 217, and 218). Majority of the more disabled pwMS were treated in the public hospital system, with a longer LOS compared with private facilities ( P 0.001). The FIM for classes 216–218 showed significant functional improvement during the admission ( P 0.001), and those in higher classes showed less change (likely due to higher FIM admission scores). FIM efficiency was significantly higher in class 217 than other classes ( P 0.001). The year-on-year trend was toward reducing hospital LOS and FIM efficiency, but these did not reach significance ( P = 0.107, P = 0.634). Conclusion The AROC data set is useful for describing rehabilitation outcomes for pwMS. However, additional information needs to be collected to evaluate nature of services provided and service implications.
Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy
Publisher: Wiley
Date: 23-04-2008
Use of international classification of functioning, disability and health (ICF) to describe patient-reported disability in multiple sclerosis and identification of relevant environmental factors
Publisher: Medical Journals Sweden AB
Date: 2007
Abstract: To use the International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identify relevant environmental factors. Cross-sectional survey of 101 participants in the community. Their multiple sclerosis-related problems were linked with ICF categories (second level) using a checklist, consensus between health professionals and the "linking rules". The impact of multiple sclerosis on health areas corresponding to 48 ICF categories was also assessed. A total of 170 ICF categories were identified (mean age 49 years, 72 were female). Average number of problems reported was 18. The categories include 48 (42%) for body function, 16 (34%) body structure, 68 (58%) activities and participation and 38 (51%) for environmental factors. Extreme impact in health areas corresponding to ICF categories for activities and participation were reported for mobility, work, everyday home activities, community and social activities. While those for the environmental factors (barriers) included products for mobility, attitudes of extended family, restriction accessing social security and health resources. This study is a first step in the use of the ICF in persons with multiple sclerosis and towards development of the ICF Core set for multiple sclerosis from a broader international perspective.
World Health Organisation Global Disability Action Plan 2014–2021: Challenges and perspectives for physical medicine and rehabilitation in Pakistan
Publisher: Medical Journals Sweden AB
Date: 2017
Abstract: To provide an update on disability and outline potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Pakistan. A 6-day workshop at the Armed Forces Institute of Rehabilitation Medicine, Islamabad facilitated by rehabilitation staff from Royal Melbourne Hospital, Australia. Local healthcare professionals (n = 33) from medical rehabilitation facilities identified challenges in service provision, education and attitudes/approaches to people with disabilities, using consensus agreement for objectives listed in the GDAP. Respondents agreed on the following challenges in implementing the GDAP: shortage of skilled work-force, fragmented healthcare system, poor coordination between acute and subacute healthcare sectors, limited health services infrastructure and funding, lack of disability data, poor legislation, lack of guidelines and accreditation standards, limited awareness/knowledge of disability, socio-cultural perceptions and geo-topographical issues. The main facilitators included: need for governing/leadership bodies, engagement of healthcare professionals and institutions using a multi-sectoral approach, new partnerships and strategic collaboration, provision of financial and technical assistance, future policy direction, research and development. The barriers to implementing the GDAP identified here highlight the emerging priorities and challenges in the development of rehabilitation medicine and GDAP implementation in a developing country. The GDAP summary actions were useful planning tools to improve access and strengthen rehabilitation services.
Denosumab for the treatment and prevention of postmenopausal osteoporosis
Publisher: Wiley
Date: 17-05-2021
Neuropsychological sequelae in motor neurone disease: outcomes of a peer support programme
Publisher: Mark Allen Group
Date: 08-2011
DOI: 10.12968/IJTR.2011.18.8.429
Abstract: Aims: Motor neurone disease (MND) is an incurable, progressive and fatal neurodegenerative disease. The focus of management is on achieving the best quality of life for patients and their families. Peer support has been proposed as an effective means of coping with a stressful life experience although data on efficacy are mixed. Methods: The first (preliminary) study on the effectiveness of six-week face-to-face peer support program (n = 7) in MND was studied through a pre-post design. Findings: Results showed that despite high participant satisfaction and a trend towards reduced psychological distress (depression, anxiety and stress) six-weeks post programme, psychological distress had worsened again at 12 months, while quality of life, coping strategies and caregiver burden remained unchanged. Conclusions: Although participant numbers were too small to be conclusive, it is suggested that group face-to-face peer support is a feasible form of support in MND and should be considered even in patients who are severely disabled and/or have severe verbal communication (dysarthria).
Accommodation lags are higher in myopia than in emmetropia: Measurement methods and metrics matter
Publisher: Wiley
Date: 07-2022
DOI: 10.1111/OPO.13021
Abstract: To determine whether accommodative errors in emmetropes and myopes are systematically different, and the effect of using different instruments and metrics. Seventy‐six adults aged 18–27 years comprising 24 emmetropes (spherical equivalent refraction of the dominant eye +0.04 ± 0.03 D) and 52 myopes (−2.73 ± 0.22 D) were included. Accommodation responses were measured with a Grand Seiko WAM‐5500 and a Hartmann–Shack Complete Ophthalmic Analysis System aberrometer, using pupil plane (Zernike and Seidel refraction) and retinal image plane (neural sharpness—NS and visual Strehl ratio for modulation transfer function—VSMTF) metrics at 40, 33 and 25 cm. Accommodation stimuli were presented to the corrected dominant eye, and responses, referenced to the corneal plane, were determined in the fellow eye. Linear mixed‐effects models were used to determine influence of the refractive group, the measurement method, accommodation stimulus, age, race, parental myopia, gender and binocular measures of heterophoria, accommodative convergence/accommodation and convergence accommodation/convergence ratios. Lags of accommodation were affected significantly by the measurement method ( p 0.001), the refractive group ( p = 0.003), near heterophoria ( p = 0.002) and accommodative stimulus ( p 0.05), with significant interactions between some of these variables. Overall, emmetropes had smaller lags of accommodation than myopes with respective means ± standard errors of 0.31 ± 0.08 D and 0.61 ± 0.06 D ( p = 0.003). Lags were largest for the Grand Seiko and Zernike defocus, intermediate for NS and VSMTF, and least for Seidel defocus. The mean lag of accommodation in emmetropes is approximately equal to the previously reported depth of focus. Myopes had larger (double) lags than emmetropes. Differences between methods and instruments could be as great as 0.50 D, and this must be considered when comparing studies and outcomes. Accommodative lag increased with the accommodation stimulus, but only for methods using a fixed small pupil diameter.
Technologies for Advanced Gait and Balance Assessments in People with Multiple Sclerosis
Publisher: Frontiers Media SA
Date: 02-02-2018
Interventions for sexual dysfunction following stroke
Publisher: Wiley
Date: 05-07-2014
Let's talk about sex: A pilot randomised controlled trial of a structured sexual rehabilitation programme in an Australian stroke cohort
Publisher: Mark Allen Group
Date: 02-01-2015
DOI: 10.12968/IJTR.2015.22.1.21
Abstract: Sexual dysfunction is a common problem after stroke. Sexual rehabilitation is recommended but little is known about the types or effectiveness of this intervention. To assess the effectiveness of a structured sexual rehabilitation programme alongside the use of written material in comparison with the use of written material alone, and to evaluate the impact of both interventions on sexual and psychological function in an Australian stroke cohort. Twelve participants (patients n=10 partners n=2) were randomly assigned to an intervention (n=4) or control (n=6) group. Standardised measurements were used to assess: sexual functioning (Changes in Sexual Function Questionnaire Short-Form) (CSFQ-14) (primary outcome) psychological functioning (Depression, Anxiety and Stress Scale) (DASS) physical functioning (Functional Independence Measure) and quality of life (Stroke and Aphasia Quality of Life scale–39-item generic version) (SAQOL-39g). All measures were assessed at baseline (T1) and six weeks after the programme (T2). There was no significant difference between the intervention and control groups at T2 in sexual functioning (CSFQ-14), psychological functioning (DASS) and quality of life (SAQOL-39g) however, there was a trend in both groups toward improvement in all outcome measures at T2 compared with T1. This preliminary study demonstrates the feasibility and importance of providing sexual rehabilitation following stroke, and that sexual rehabilitation may improve sexual and psychological functioning and quality of life. Further studies are needed to confirm these findings for stroke survivors and their partners to address sexual issues that may arise and perceived rehabilitation needs.
Environmental enrichment for adults with neurological conditions: a systematic review
Publisher: Mark Allen Group
Date: 02-09-2016
DOI: 10.12968/IJTR.2016.23.9.423
Abstract: Environmental enrichment is proposed to improve neurological recovery through neuroplasticity. The objective of this systematic review is to determine whether environmental enrichment improves neurological outcomes. An extensive search in PubMed (1966 to March 2015), EMBASE (1988 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), Cochrane Controlled Trials Register (March 2015) and PsycINFO(1806 to March 2015) was performed. Studies that compared environmental enrichment to control conditions in a controlled design or pre ost-test and/or time series with a minimum of five participants were included. A best evidence synthesis based on methodological quality was performed using GRADE. Studies were grouped by single or multimodal environmental enrichment. Three studies (two randomised controlled trials and one controlled clinical trial) were identified. Based on these two ‘moderate’ quality and one ‘low’ quality studies, there is ‘low level’ evidence for music for improvement in cognitive function and mood but not quality of life and for light for improvement of fatigue, and ‘very low level’ evidence for multimodal environmental enrichment for the improvement of activity levels. Current evidence tentatively suggests that environmental enrichment improves cognitive function, mood and activity levels however further high-quality studies are needed for conclusive findings. Specifically, further studies are needed to determine the relative effectiveness of various environmental enrichment interventions, as well as the optimal ‘dose’ of environmental enrichment.
Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews
Publisher: Wiley
Date: 14-01-2019
A PROCESS EVALUATION OF PATIENT CARE NEEDS USING THE POST-STROKE CHECKLIST: A PROSPECTIVE STUDY
Publisher: Medical Journals Sweden AB
Date: 14-02-2022
DOI: 10.2340/JRM.V53.349
Abstract: Objective: To assess the utility of the modified Post-Stroke Checklist (mPSC) to identify impairments and care needs of patients with stroke (PwS) in an inpatient rehabilitation setting.Methods: Prospective observational design with consecutive admission of PwS (n = 44) at a tertiary rehabilitation facility. The post-stroke checklist was administered at hospital discharge (T1) and 3 months post-discharge (T2). Furthermore, validated questionnaires assessed function and participation, including the Clinical Functioning Information Tool (ClinFIT) on admission (T0), T1 and T2. Results: Participants’ mean age was 67.7 years (standard deviation SD) 14.6), 58% of participants were female, and the mean length of inpatient stay was 32.7 days (SD 22.4). At T1, 80% and at T2 only 60% of participants reported ≥1 stroke-related problem (mean 5.3 (SD 3.3) and 3.6 (SD 2.8), respectively). Half of participants were referred to physiotherapy/occupational therapy, and 36% to specialist clinics following discharge. The most prevalent problems included: life after stroke (62.2%), fatigue (55.6%), activities of daily living, and mobility (51.1% each). Compared with T1, at T2 there was an observed reduction in all mPSC items, except pain and incontinence. Participants showed improved function at T1 and T2 (Extension Index, ClinFIT set), from T0 to T1 and T0 to T2 (p .001, with large effect sizes). Conclusion: The mPSC is feasible to implement in an inpatient rehabilitation setting and community. It can identify relevant stroke-related problems, and hence facilitate targeted intervention. Lay AbstractPatients with stroke can develop significant long-term functional, communication and psychosocial disability, which can limit their daily activities and quality of life. Hence, regular follow-up is important to identify the patients’ clinical needs after discharge from the hospital to the community. This study used a universal tool, the modified Post-Stroke Checklist (mPSC) to identify common persisting stroke-related issues of patients admitted to a rehabilitation unit to facilitate appropriate referrals during discharge. The mPSC is feasible to implement in an inpatient rehabilitation setting and community for treating clinicians to identify relevant stroke-related problems and provide appropriate intervention.
Supportive Care Needs following Cancer Treatment: A Comparison of Breast and Brain Cancer in an Australian Cohort
Publisher: Hindawi Limited
Date: 20-01-2014
DOI: 10.1155/2014/945472
Abstract: Objective . To assess and identify patient-reported supportive care needs following definitive treatment in persons with breast cancer (BC) and primary brain tumours (gliomas) (BT) in an Australian community cohort and to assess the commonalities and/or discrepancies of the reported needs in these oncological populations. Methods . A prospective cross-sectional survey of persons with BC ( n = 85 ) and BT ( n = 106 ) using questionnaires for supportive care needs, psychological morbidity, and quality of life. Results . BT participants were younger than BC patients (mean ages 51 and 57 years). The median time since diagnosis for both groups was over 2 years. The level of psychological morbidity, mainly depression, was high in both groups: BC (22%) and BT (20%). Participants in both groups reported at least one need (“met” or “unmet”). The BC patients reported higher numbers of “needs” and “unmet” needs compared with BT patients (mean 13.7 versus 11.6 needs “unmet” needs mean 6.0 versus 4.1). The common “met” and “unmet” needs highlighted by both groups were comparable the domain for most “met” needs included comprehensive cancer care, while “unmet” needs related to existential survivorship issues. Conclusion . Despite successful treatment many cancer survivors experience unmet supportive care needs in longer term. Understanding the impact of these beyond the acute phase is important as care shifts to community settings. More research in existential survivorship issues is needed.
Challenges and barriers for implementation of the World Health Organization Global Disability Action Plan in low- and middle- income countries
Publisher: Medical Journals Sweden AB
Date: 2018
Abstract: To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries. A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conducted intensive workshops at medical/academic institutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabilitation facilities. A modified Delphi method identified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia. Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (governmental olicymakers) and micro levels (community/social/in idual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabilitation workforce, guidelines and accreditation standards coordination amongst healthcare sectors social issues data and research legislation and political commitment. Common potential facilitators included: need for strong leadership advocacy of disability-inclusive development investment in infrastructure/human resources coordination artnerships in healthcare sector and research. Disability care is an emerging priority in low- and middle-income countries to address the needs of people with disability. The challenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services.
Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis.
Publisher: John Wiley & Sons, Ltd
Date: 16-07-2008
Telerehabilitation for persons with multiple sclerosis
Publisher: Wiley
Date: 09-04-2015
Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries
Publisher: Medical Journals Sweden AB
Date: 2018
Abstract: Despite the prevalence of disability in low-and middle-income countries, the clinical skills of the rehabilitation workforce are not well described. We report health professionals' perspectives on clinical skills in austere settings and identify context-specific gaps in workforce capacity. A cross-sectional pilot survey (Pakistan, Morocco, Nigeria, Malaysia) of health professionals' working in rehabilitation in hospital and community settings. A situational-analysis survey captured assessment of clinical skills required in various rehabilitation settings. Responses were coded in a line-by-line process, and linked to categories in domains of the International Classification of Functioning, Disability and Health (ICF). Respondents (n = 532) from Pakistan 248, Nigeria 159, Morocco 93 and Malaysia 32 included the following: physiotherapists (52.8%), nurses (8.8%), speech (5.3%) and occupational therapists (8.5%), rehabilitation physicians (3.8%), other doctors (5.5%) and prosthetist/orthotists (1.5%). The 10 commonly used clinical skills reported were prescription of: physical activity, medications, transfer-techniques, daily-living activities, patient/carer education, diagnosis/screening, behaviour/cognitive interventions, comprehensive patient-care, referrals, assessments and collaboration. There was significant overlap in skills listed irrespective of profession. Most responses linked with ICF categories in activities articipation and personal factors. The core skills identified reflect general rehabilitation practice and a task-shifting approach, to address shortages of health workers in low-and middle-income countries.
Medical rehabilitation in pandemics: Towards a new perspective
Publisher: Medical Journals Sweden AB
Date: 2020
Evaluation of the structured bowel management program in inpatient rehabilitation: A prospective study
Publisher: Informa UK Limited
Date: 05-06-2016
DOI: 10.3109/09638288.2015.1047970
Abstract: The purpose of this study is to evaluate the impact of the structured bowel management program (SBMP) in an inpatient rehabilitation service. Prospective recruitment of consecutive patients admitted to the rehabilitation unit (n = 100). Each patient was assessed for bowel dysfunction on admission and an in idualised SBMP was instituted based on the clinical needs. The assessments were at baseline (T1), and discharge from ward (T2) using validated questionnaires. Program evaluation was at 3-month (T3) post-discharge. Participants were predominantly female (52%), mean age 68 ± 13 years. Almost one-half (43%) had neurological conditions and 41% musculoskeletal problems. At admission, 62% self-reported bowel dysfunction, mainly constipation (82%) and faecal incontinence (FI) (11%). At T2, participants showed significant improvement in bowel habit and stool consistency (Bristol stool chart, p < 0.001) severity of bowel symptoms such as FI (Wexner FI score, p < 0.05) and impact on quality of life (FI Quality of Life (QoL) subscales: "life style" and "coping/behavior", p < 0.05 for both). All functional independent measure "motor" and "cognition" subscales improved significantly (p < 0.01 for all), with moderate to large effect sizes (r = 0.5-0.7). No adverse effects were reported. Bowel management should be a priority within rehabilitative services. Evidence-based SBMP can improve bowel symptoms and enhance overall QoL in patients admitted to rehabilitation settings. Bowel dysfunction is common in inpatient rehabilitation settings. A structured bowel management program can improve bowel symptoms and enhance overall QoL in patient. Bowel management should be a priority for patients admitted to rehabilitation settings.
Medical rehabiliation in disaster relief: Towards a new perspective
Publisher: Medical Journals Sweden AB
Date: 2017
Abstract: With increasing frequency of natural disasters, there has been greater focus recently on the importance and role of rehabilitation services in disaster management. In past disasters, rehabilitative needs were often neglected, with emphasis on acute response plans focused on saving lives and treating acute injuries. There was a lack of, or inadequate, rehabilitation-inclusive disaster response plans and rehabilitation services in many disaster-prone developing countries. The World Health Organization (WHO) Emergency Medical Team (EMT) initiative recognizes rehabilitation as an integral part of medical response and patient-centred care in disaster settings. Current developments under this initiative include: the development of minimum standards for rehabilitation in emergencies to allow rapid, professional, coordinated medical response by both national and international EMTs. These guidelines ensure that EMTs deliver effective and coordinated patient care during disasters and continuum of care beyond their departure. The aim is to strengthen national capacity, foster an environment of self-empowerment of EMTs and local health services, and work in rehabilitation within defined coordination mechanisms in disaster-affected areas. A brief overview of rehabilitation in natural disasters, highlighting current developments, challenges and gaps in the implementation of WHO guidelines for Minimum Standards for Rehabilitation in Emergencies is discussed in order to improve care for victims of future disasters.
Can the ICF osteoarthritis core set represent a fütüre clinical tool in measürlng fünctioning in persons with osteoarthritis undergoing hip and knee joint replacement?
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: To determine the dimensionality, reliability, model fit, adequacy of the qualifier levels, response patterns across different factors, and targeting of the International Classification of Functioning, Disability and Health (ICF) osteoarthritis core set categories in people with osteoarthritis undergoing hip and knee arthroplasty. The osteoarthritis core set was rated in 316 persons with osteoarthritis who were either in the pre-operative or within one year post-operative stage. Rasch analyses were performed using the RUMM 2030 program. Twelve of the 13 body functions categories and 13 of the 19 activity and participation categories had good model fit. The qualifiers displayed disordered thresholds necessitating rescoring. There was uneven spread of ICF categories across the full range of the patients' scores indicating off--targeting. Subtest analysis of the reduced ICF categories of body functions and activity and participation showed that the two components could be integrated to form one measure. The results suggest that it is possible to measure functioning using a unidimensional construct based on ICF osteoarthritis core set categories of body functions and activity and participation in this population. However, omission of some categories and reduction in qualifier levels are necessary. Further studies are needed to determine whether better targeting is achieved, particularly during the pre-operative and during the sub-acute care period.
Maintaining Gains Following Pulmonary Rehabilitation
Publisher: Springer Science and Business Media LLC
Date: 27-06-2015
DOI: 10.1007/S00408-015-9751-5
Abstract: Pulmonary rehabilitation (PR) is an accepted intervention for in iduals with chronic obstructive pulmonary disease. Despite initial improvements following PR, many patients eventually return to baseline function or decline even further. The aim of this study is to look at long-term (>1 year) outcomes following PR. This was a prospective cohort study of patients who had completed PR. Participants were invited for an assessment consisting of participant interviews and clinical assessments using standardised instruments. 129 patients between 2003 and 2012 completed rehabilitation and were eligible. 88 patients were included in the analysis. The mean time of the long-term assessment was 22 months following PR. The mean age was 71 years. Mean FEV1 was 46%. There was a statistically significant (p < 0.001) increase in the incremental shuttle walk test distance of 29.0 m following PR but this gain was lost at the long-term reassessment. Chronic Respiratory Questionnaire (CRQ) scores showed a statistically significant (p < 0.001) increase in all four domains but only the domains of dyspnoea and fatigue remained statistically significant (p < 0.001, p < 0.01, respectively) at the long-term reassessment. Hospital Anxiety and Depression Scale scores reduced following rehabilitation but only the anxiety component was statistically significant (p < 0.01). These improvements persisted at the long-term reassessment but were not statically significant. This study confirms that many of the functional gains achieved in PR are lost in the longer term. Regular surveillance or monitoring of these patients post-PR is important to identify those requiring further intervention.
Non pharmacological interventions for spasticity in multiple sclerosis
Publisher: Wiley
Date: 28-02-2013
Outcomes of a Peer Support Program in Multiple Sclerosis in an Australian Community Cohort: A Prospective Study
Publisher: Hindawi Limited
Date: 05-12-2013
DOI: 10.1155/2013/429171
Abstract: Background/Objectives . This pilot study evaluated the impact of a peer support program on improving multiple sclerosis (MS) related psychological functions (depression, anxiety, and stress) and enhancing quality of life. Methodology . Participants ( n = 33 ) were recruited prospectively and received an 8-week group face-to-face peer support program. Assessments were at baseline (T1), 6 weeks after program (T2), and 12 months after program (T3), using validated questionnaires: Depression Anxiety Stress Scale (DASS), McGill Quality of Life (MQOL), and Brief COPE. Results . Participants’ mean age was 52 the majority were female (64%) and married (64%). Median time since MS diagnosis was 16 years. At T2, participants reported improved psychological functioning (DASS “depression,” “anxiety,” and “stress” subscales, z values −2.36, −2.22, and −2.54, moderate effect sizes ( r ) 0.29, 0.28, and 0.32, resp.) and quality of life (MQOL SIS z score −2.07, r = 0.26 ) and were less likely to use “self-blame” as a coping mechanism (Brief COPE z score −2.37, r = 0.29 ). At T3, the positive improvements in stress (DASS stress subscale z score −2.41, r = 0.31 ) and quality of life were maintained (MQOL SIS, z score −2.30, r = 0.29 ). There were no adverse effects reported.
Increased ankle muscle coactivation in the early stages of multiple sclerosis
Publisher: SAGE Publications
Date: 2020
Multiple sclerosis: Prevalence and factors impacting bladder and bowel function in an Australian community cohort
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/09638280802639566
Abstract: To describe the prevalence and impact of bladder and bowel dysfunction on quality of life (QoL) in persons with multiple sclerosis (pwMS) in an Australian community cohort and to explore the relationships between commonly used continence measures. Patients (N = 73) recruited from a tertiary hospital database, interviewed using standardised measures, based on the framework of International Classification of Functioning, Disability and Health. Of 73 participants (mean age 50 yrs, 73% female, 56% progressive MS), two thirds were bothered by urinary frequency whereas half reported urinary incontinence, and 14% bowel incontinence. Urinary problems impacted emotional health (31%), ability to perform household chores (22%) and physical recreation (28%), with detrimental impact on QoL. There was a significant relationship between symptoms, level of urogenital distress (rho = 0.74, p < 0.001) and impact of incontinence (rho = 0.68, p < 0.001). The single item of Urological Association Symptom Index assessing impact of bladder symptoms on QoL correlated significantly with all other bladder scales (rho = 0.60-0.74), making it a potential 'screening tool' to identify patients for further assessment. Continence issues cause significant disability in pwMS. Improved awareness of currently available treatment options and clinically robust trials are needed to assess outcomes of continence intervention.
Systematic review of multidisciplinary rehabilitation in patients with multiple trauma
Publisher: Oxford University Press (OUP)
Date: 22-12-2011
DOI: 10.1002/BJS.7776
Abstract: Multiple trauma is a cause of significant disability in adults of working age. Despite the implementation of trauma systems for improved coordination and organization of care, rehabilitation services are not yet routinely considered integral to trauma care processes. MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, Physiotherapy Evidence Database, Latin American and Caribbean Literature on Health Sciences and Cochrane Library databases were searched up to May 2011 for randomized clinical trials, as well as observational studies, reporting outcomes of injured patients following multidisciplinary rehabilitation that addressed functional restoration and societal reintegration based on the International Classification of Functioning, Disability and Health. No randomized and/or controlled clinical trials were identified. Fifteen observational studies involving 2386 participants with injuries were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach assessed methodological quality as ‘poor’ in all studies, with selection and observer bias. Although patients with low functional scores showed improvement after rehabilitation, they were unable to resume their pretrauma level of activity. Their functional ability was significantly associated with motor independence on admission and early acute rehabilitation, which contributed to a shorter hospital stay. Injury location, age, co-morbidity and education predicted long-term functional consequences. Trauma care systems were associated with reduced mortality. The gaps in evidence include: rehabilitation settings, components, intensity, duration and types of therapy, and long-term outcomes for survivors of multiple trauma. Rehabilitation is an expensive resource and the evidence to support its justification is needed urgently. The issues in study design and research methodology in rehabilitation are challenging. Opportunities to prioritize trauma rehabilitation, disability management and social reintegration of multiple injury survivors are discussed.
Evaluating rehabilitation progress using motion features identified by machine learning
Publisher: Cold Spring Harbor Laboratory
Date: 16-04-2020
DOI: 10.1101/2020.04.15.043919
Abstract: Evaluating progress throughout a patient’s rehabilitation episode is critical for determining effectiveness of the selected treatments and contributing to the evidence-based practice. The evaluation process is complex due to the inherent large human variations in motor recovery and the limitations of commonly used clinical measurement tools. Information recorded during a robot-assisted rehabilitation process can provide an effective means to continuously quantitatively assess movement performance and rehabilitation progress. However, selecting appropriate motion features for rehabilitation evaluation has always been challenging. This paper exploits unsupervised feature learning techniques to reduce the complexity of building the evaluation model of patients’ progress. A new feature learning technique is developed to select the most significant features from a large amount of kinematic features measured from robotics, providing clinically useful information to health practitioners with reduction of modeling complexity. A novel indicator that can reflect monotonicity and trendability is proposed to evaluate the suitability of kinematic features, which are derived from the collected data of a population of stroke patients participating in robot-aided rehabilitation. The selected kinematic features allow for human variations across a population of patients as well as over the sequence of rehabilitation sessions. The study is based on data records pertaining to 41 stroke patients using three different robot assisted exercises for upper limb rehabilitation. Consistent with the literature, the results indicate that features based on movement smoothness are the best measures among 17 kinematic features used to evaluate rehabilitation progress.
Non-pharmacological interventions for chronic pain in multiple sclerosis
Publisher: Wiley
Date: 19-12-2018
A Novel Wavefield-Reconstruction Algorithm for RTM in Attenuating Media
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 04-2021
4: Rehabilitation after traumatic brain injury
Publisher: AMPCo
Date: 03-2003
DOI: 10.5694/J.1326-5377.2003.TB05199.X
Abstract: Traumatic brain injury (TBI) commonly affects younger people and causes life-long impairments in physical, cognitive, behavioural and social function. The cognitive, behavioural and personality deficits are usually more disabling than the residual physical deficits. Recovery from TBI can continue for at least 5 years after injury. Rehabilitation is effective using an interdisciplinary approach, and close liaison with the patient, family and carers. The focus is on issues such as retraining in activities of daily living, pain management, cognitive and behavioural therapies, and pharmacological management. The social burden of TBI is significant, and therefore family education and counselling, and support of patient and carers, is important. General practitioners play an important role in providing ongoing support in the community, monitoring for medical complications, behavioural and personality issues, social reintegration, carer coping skills and return-to-work issues.
Medical Rehabilitation in Natural Disasters: A Review
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.APMR.2015.02.007
Abstract: To present an evidence-based overview of the effectiveness of medical rehabilitation intervention in natural disaster survivors and outcomes that are affected. A literature search was conducted using medical and health science electronic databases (PubMed, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO) up to September 2014. Two independent reviewers selected studies reporting outcomes for natural disaster survivors after medical rehabilitation that addressed functional restoration and participation. Two reviewers independently extracted data and assessed the methodologic quality of the studies using the Critical Appraisal Skills Program's appraisal tools. A meta-analysis was not possible because of heterogeneity among included trials therefore, a narrative analysis was performed for best evidence synthesis. Ten studies (2 randomized controlled trials, 8 observational studies) investigated a variety of medical rehabilitation interventions for natural disaster survivors to evaluate best evidence to date. The interventions ranged from comprehensive multidisciplinary rehabilitation to community educational programs. Studies scored low on quality assessment because of methodologic limitations. The findings suggest some evidence for the effectiveness of inpatient rehabilitation in reducing disability and improving participation and quality of life and for community-based rehabilitation for participation. There were no data available for associated costs. The findings highlight the need to incorporate medical rehabilitation into response planning and disaster management for future natural catastrophes. Access to rehabilitation and investment in sustainable infrastructure and education are crucial. More methodologically robust studies are needed to build evidence for rehabilitation programs, cost-effectiveness, and outcome measurement in such settings.
Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.APMR.2016.04.016
Abstract: To systematically evaluate existing evidence from published systematic reviews of clinical trials for the effectiveness of rehabilitation for improving function and participation in persons with multiple sclerosis (MS). A literature search was conducted using medical and health science electronic databases (MEDLINE, EMBASE, CINAHL, PubMed, Cochrane Library) up to January 31, 2016. Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the effectiveness of organized rehabilitation for persons with MS. Data were summarized for type of interventions, type of study designs included, outcome domains, method of data synthesis, and findings. Data were extracted by 2 reviewers independently for methodological quality using the Assessment of Multiple Systematic Reviews. Quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development, and Evaluation. Thirty-nine systematic reviews (one with 2 reports) evaluated best evidence to date. There is "strong" evidence for physical therapy for improved activity and participation, and for exercise-based educational programs for the reduction of patient-reported fatigue. There is "moderate" evidence for multidisciplinary rehabilitation for longer-term gains at the levels of activity (disability) and participation, for cognitive-behavior therapy for the treatment of depression, and for information-provision interventions for improved patient knowledge. There is "limited" evidence for better patient outcomes using psychological and symptom management programs (fatigue, spasticity). For other rehabilitation interventions, the evidence is inconclusive because of limited methodologically robust studies. Despite the range of rehabilitative treatments available for MS, there is a lack of high-quality evidence for many modalities. Further research is needed for effective rehabilitation approaches with appropriate study design, outcome measurement, type and intensity of modalities, and cost-effectiveness of these interventions.
Effective Q-compensated reverse time migration using new decoupled fractional Laplacian viscoacoustic wave equation
Publisher: Society of Exploration Geophysicists
Date: 03-2019
Abstract: Seismic waves are attenuated and distorted during propagation because of the conversion of acoustic energy to heat energy. We focus on intrinsic attenuation, which is caused by [Formula: see text], which is the portion of energy lost during each cycle or wavelength. Amplitude attenuation can decrease the energy of the wavefields, and dispersion effects distort the phase of seismic waves. Attenuation and dispersion effects can reduce the resolution of image, and they can especially distort the real position of interfaces. On the basis of the viscoacoustic wave equation consisting of a single standard linear solid, we have derived a new viscoacoustic wave equation with decoupled litude attenuation and phase dispersion. Subsequently, we adopt a theoretical framework of viscoacoustic reverse time migration that can compensate the litude loss and the phase dispersion. Compared with the other variable fractional Laplacian viscoacoustic wave equations with decoupled litude attenuation and phase dispersion terms, the order of the Laplacian operator in our equation is a constant. The litude attenuation term is solved by pseudospectral method, and only one fast Fourier transform is required in each time step. The phase dispersion term can be computed using a finite-difference method. Numerical ex les prove that our equation can accurately simulate the attenuation effects very well. Simulation of the new viscoacoustic equation indicates high efficiency because only one constant fractional Laplacian operator exists in this new viscoacoustic wave equation, which can reduce the number of inverse Fourier transforms to improve the computation efficiency of forward modeling and [Formula: see text]-compensated reverse time migration ([Formula: see text]-RTM). We tested the [Formula: see text]-RTM by using Marmousi and BP gas models and compared the [Formula: see text]-RTM images with those without compensation and attenuation (the reference image). [Formula: see text]-RTM results match well with the reference images. We also compared the field data migration images with and without compensation. Results demonstrate the accuracy and efficiency of the presented new viscoacoustic wave equation.
Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/01443610600964141
Abstract: To describe the level of caregiver strain and factors associated with caregiver self-efficacy and quality of life (QoL) in a community cohort with multiple sclerosis (MS). A cross-sectional survey of 62 informal caregivers and 101 participants with confirmed MS and quantified physical and cognitive disability recruited from a tertiary hospital MS database. Structured interviews conducted at home using standardized assessments to measure: (i) Caregiver strain and subjective burden of care (ii) participant with MS and caregiver QoL and self-efficacy and (iii) participant with MS level of depression, anxiety and stress. The mean caregiver age was 54 years (range 37 - 62). The mean caregiver strain score was 5.63 (SD 3.63). Twenty-six of 62 (42%) caregivers reported strain for items such as emotional adjustments, demands on time, change in personal plan and disrupted sleep. Caregiver burden was higher in those caring for the more severely affected persons with MS, especially those with higher depression, anxiety and stress levels. The caregiver strain correlated with a lower QoL in both the person with MS and their caregiver, but not with their self-efficacy scores. Caregivers of persons with MS reporting high levels of caregiver strain experienced a lower QoL and were caring for persons with MS with a lower QoL and higher levels of depression and anxiety. Interventions to reduce caregiver strain and burden in those at risk are necessary to reduce poor outcomes among both caregivers and care recipients with MS.
Guillain-Barré syndrome: An update in rehabilitation
Publisher: Mark Allen Group
Date: 08-2009
DOI: 10.12968/IJTR.2009.16.8.43483
Abstract: Guillain-Barré syndrome (GBS) is an autoimmune mediated polyradiculoneuropathy which causes acute neuromuscular paralysis and ventilatory failure. It mainly affects young adults, and most patients (80%) make a good recovery being ambulant again at 6 months post-onset. However, residual deficits can cause significant long-term disability, which impacts on activities of daily living, work, social activities, and health-related quality of life. This article provides an overview of the aetiology, pathogenesis and clinical presentation of GBS. Current evidence regarding use of outcome measures and the symptomatic and rehabilitation treatment for adult GBS survivors is outlined. Issues impacting on rehabilitation are also discussed, including complications as a result of immobility, autonomic dysfunction and deafferent pain syndromes. GBS is a complex and challenging condition that requires integrated and coordinated health-care delivery and services. Rehabilitation is aimed at improving a person's functional ability in daily living tasks and social reintegration. However, evidence for many rehabilitation treatments is currently lacking. Outcome measurement for disability in this group is also limited and not well quantified. The longer term impact of disability in GBS survivors and ‘aging’ effects are not well understood. Further research in these areas is therefore required.
Management of fatigue in persons with multiple sclerosis
Publisher: Frontiers Media SA
Date: 15-09-2014
The Authors Respond
Publisher: Elsevier BV
Date: 11-2016
Rehabilitation in Disaster Relief
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PMR.2019.06.001
Abstract: Rehabilitation plays a crucial role in natural disasters owing to the significant upsurge of survivors with complex and long-term disabling injuries. Rehabilitation professionals can minimize mortality, decrease disability, and improve clinical outcomes and participation. In disaster-prone countries, skilled rehabilitation workforce and services are either limited and/or comprehensive rehabilitation-inclusive disaster management plans are yet to be developed. The World Health Organization Emergency Medical Team initiative and guidelines provide structure and standardization to prepare, plan, and provide effective and coordinated care during disasters. Many challenges remain for implementation of these standards in disaster settings and integrating rehabilitation personnel.
Rasch analysis of the Multiple Sclerosis Impact Scale (MSIS-29)
Publisher: Springer Science and Business Media LLC
Date: 22-06-2009
The Effect of Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients with Multiple Sclerosis: Randomized Controlled Trial.
Publisher: Oxford University Press (OUP)
Date: 28-06-2020
DOI: 10.1093/PM/PNAA128
Abstract: Chronic neuropathic pain is a common symptom in multiple sclerosis (MS). This randomized controlled single-blinded study investigated whether a new protocol involving five days of transcranial direct current stimulation (tDCS) with an interval period would be effective to reduce pain using the visual analog scale (VAS). Other secondary outcomes included the Neuropathic Pain Scale (NPS), Depression Anxiety Stress Score (DASS), Short Form McGill Pain Questionnaire (SFMPQ), and Multiple Sclerosis Quality of Life 54 (MSQOL54). A total of 30 participants were recruited for the study, with 15 participants randomized to a sham group or and 15 randomized to an active group. After a five-day course of a-tDCS, VAS and NPS scores were measured daily and then weekly after treatment up to four weeks after treatment. Secondary outcomes were measured pretreatment and then weekly up to four weeks. After a five-day course of a-tDCS, VAS scores were significantly reduced compared with sham tDCS and remained significantly low up to week 2 post-treatment. There were no statistically significant mean changes in MSQOL54, SFMPQ, NPS, or DASS for the sham or treatment group before treatment or at four-week follow-up. This study shows that repeated stimulation with a-tDCS for five days can reduce pain intensity for a prolonged period in patients with MS who have chronic neuropathic pain.
Use of the International Classification of Functioning, Disability and Health to identify preliminary comprehensive and brief core sets for Guillain Barre syndrome
Publisher: Informa UK Limited
Date: 2011
DOI: 10.3109/09638288.2010.527031
Abstract: To identify the preliminary comprehensive and brief core sets for Guillain Barre syndrome (GBS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF). Focus groups and a consensus process were used to identify ICF core sets for GBS. This included: preliminary ICF studies empirical patient data collection for 77 GBS participants review of the evidence base and treatment in GBS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia. The expert consensus selected 99 second level ICF categories (in three rounds) which identify health domains relevant to GBS for multidisciplinary assessment. These domains were consistent with current practice and existing GBS literature. The comprehensive core set includes: 27 (23%) categories from the component 'body function', 7 (12%) categories from 'body structures', 43 (36%) from 'activities and participation' and 22 (29%) from the component 'environmental' factors. The brief set comprised 20 categories, 20% of categories in the comprehensive core set. The core set categories for GBS-related health need to be addressed in multidisciplinary care programs. Future clinical 'rating' of this set may facilitate scale development using the ICF in GBS. Further research is needed to confirm the generalisability of this set in clinical settings.
Overview of the current status of familial hypercholesterolaemia care in over 60 countries - The EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.ATHEROSCLEROSIS.2018.08.051
Abstract: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.
The combined effect of cranial-nerve non-invasive neuromodulation with high-intensity physiotherapy on gait and balance in a patient with cerebellar degeneration: a case report.
Publisher: Springer Science and Business Media LLC
Date: 05-03-2018
The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis
Publisher: SAGE Publications
Date: 11-07-2016
Abstract: Laboratory gait analysis or three-dimensional gait analysis (3DGA), which uses motion capture, force plates and electromyography (EMG), has allowed a better understanding of the underlying mechanisms of gait deterioration in patients with multiple sclerosis (PwMS). This review will summarize the current knowledge on multiple sclerosis (MS)-related changes in kinematics (angles), kinetics (forces) and electromyographic (muscle activation) patterns and how these measures can be used as markers of disease progression. We will also discuss the potential causes of slower walking in PwMS and the implications for 3DGA. Finally, we will describe new technologies and methods that will increase precision and clinical utilization of 3DGA in PwMS. Overall, 3DGA studies have shown that functionality of the ankle joint is the most affected during walking and that compensatory actions to maintain a functional speed may be insufficient in PwMS. However, altered gait patterns may be a strategy to increase stability as balance is also affected in PwMS.
TANGO ‐ a screening tool to identify comorbidities on the causal pathway of nocturia
Publisher: Wiley
Date: 12-02-2017
DOI: 10.1111/BJU.13774
Abstract: To develop a robust screening metric for use in identifying non-lower urinary tract comorbidities pertinent to the multidisciplinary assessment of patients with nocturia. Variables having a significant risk association with nocturia of greater than once per night were identified. Discriminating items from validated and reliable tools measuring these comorbidities were identified. A self-completed 57-item questionnaire was developed and a medical checklist and pertinent clinical measures added. Pre-determined criteria were applied to retain or remove items in the development of the Short-Form (SF) screening tool. The tool was administered to 252 in iduals with nocturia who were attending either a tertiary level Sleep, Continence, Falls or Rehabilitation service for routine care. Data collected were subjected to descriptive analysis criteria were applied to reduce the number of items. Using pre-determined domains, a nocturia screening metric, entitled TANGO, was generated. The acronym TANGO stands for Targeting the in idual's Aetiology of Nocturia to Guide Outcomes. The demographic characteristics of the s le are described, along with item endorsement levels. The statistical and structural framework to justify deleting or retaining of items from the TANGO Long-Form to the SF is presented. The resultant TANGO-SF patient-completed nocturia screening tool is reported. A novel all-cause diagnostic metric for identifying co-existing morbidities of clinical relevance to nocturia in patients who present across disciplines and medical specialties has been developed. TANGO has the potential to improve practice and smooth inequalities associated with a siloed approach to assessment and subsequent care of patients with nocturia.
Rehabilitation Response in Pandemics
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-05-2020
Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: A controlled clinic al trial
Publisher: Medical Journals Sweden AB
Date: 2014
Abstract: To evaluate effectiveness of a multidisciplinary rehabilitation program for persons following definitive primary brain tumour treatment in a community cohort. The brain tumour (glioma) survivors (n = 106) were allocated either to the treatment group (n = 53) (intensive ambulatory multidisciplinary rehabilitation), or the waitlist control group (n = 53). The primary outcome - Functional Independence Measure (FIM), measured 'Activity' limitation secondary measures included Depression, Anxiety Stress Scale, Perceived Impact Problem Profile and Cancer Rehabilitation Evaluation System. Assessments were at baseline, 3 and 6 months after program completion. Participants were predominantly women (56%), with mean age 51 years (standard deviation 13.6) and median time since diagnosis of 2.1 years. Intention-to-treat analysis showed a significant difference between groups at 3-month in favour of multidisciplinary rehabilitation program in FIM motor subscales: 'self-care', 'sphincter', 'locomotion', 'mobility'(p < 0.01 for all) and FIM 'communication' (p < 0.01) and 'psychosocial' subscales (p < 0.05), with small to moderate effect size (r = 0.2-0.4). At 6-month follow-up, significant improvement in the treatment group was maintained only for FIM 'sphincter', 'communication' and 'cognition' subscales (p < 0.01 for all). No difference between groups was noted in other subscales. brain tumour survivors can improve function with multidisciplinary rehabilitation, with some gains maintained up to 6 months. Evidence for specific interventions in the 'blackbox' of rehabilitation is needed.
Brief osteoporosis education in an inpatient rehabilitation setting improves knowledge of osteoporosis in elderly patients with low-trauma fractures
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2006
Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke.
Publisher: Medical Journals Sweden AB
Date: 2014
Abstract: To examine the benefits of high intensity ambulatory rehabilitation programmes over usual care following botulinum toxin A (BoNT-A) for post-stroke spasticity in Australian adults. Prospective single centre, controlled clinical trial. Fifty-nine adults, median 61 years old and 2.5 years following stroke. PARTICIPANTS were dichotomised into high intensity ambulatory rehabilitation programmes (≥ 3 × 1-h weekly sessions for approximately 10 weeks) or usual care programmes (≤ 2 × 1-h weekly sessions) following BoNT-A injections for spasticity. A blinded assessor completed outcomes at 0 (baseline), 6, 12 and 24 weeks. Primary endpoints: proportion of participants achieving ≥ 50% of their goals (using Goal Attainment Scaling: GAS) and GAS T-score change at 12 weeks. Modified Ashworth Scale (MAS), participant satisfaction, activity articipation measures and caregiver burden. Both groups showed significant improvement in goal attainment and participant satisfaction up to 24 weeks, with no overall between-group significant differences. There was, however, a statistical trend (p = 0.052) for participants to achieve more upper limb goals in the high intensity therapy group. GAS and satisfaction benefits persisted beyond the duration of spasticity reduction as measured by MAS. While patient-centred outcomes following BoNT-A injections for post-stroke spasticity were not influenced by intensity of ambulatory rehabilitation programmes, there was a trend for high intensity therapy to be associated with greater upper limb goal attainment. This suggests that the effects of more intensive therapy may be a modifier of the 'black box' of rehabilitation however, further research is required to evaluate this effect and determine which elements of therapy programmes optimise post-BoNT-A outcomes.
Rehabilitation in patients with lymphoma: An overview of Systematic Reviews
Publisher: Medical Journals Sweden AB
Date: 2021
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Can Real-time Biofeedback Of Foot Clearance Data Be Used To Assist With Gait Rehabilitation Following Stroke?
Start Date: 2016
End Date: 2019
Funder: National Health and Medical Research Council
View Funded Activity