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Rehabilitation Hospital (rehabilitation + hospital)
Selected AbstractsCollaboration of a dentist and speech-language pathologist in the rehabilitation of a stroke patient with dysarthria: a case studyGERODONTOLOGY, Issue 2 2005Takahiro Ono Objective:, To elucidate the effectiveness of the collaboration of a dentist and speech-language pathologist (SLP) in the rehabilitation of a stroke patient with dysarthria. Design:, A clinical case report treated in the rehabilitation hospital and dental surgery. Subject:, A 71-year-old Japanese man who was admitted to the rehabilitation hospital for speech rehabilitation 2 years and 5 months after a stroke. Methods:, Provision of prosthesis (palatal lift prosthesis + palatal augmentation prosthesis) for improving velopharyngeal incompetence (VPI) and articulation by dentist, and speech behavioural management by SLP including self-monitoring and bio-feedback training using the See-Scape. Results:, Speech behavioural management proved useful for promoting improvement in speech intelligibility to a functionally sufficient level after improving VPI by prosthesis. Conclusion:, The collaborative efforts of the dentist and SLP in the rehabilitation of post-stroke patients with velopharyngeal incompetence should be encouraged. [source] Examining item bias in the anxiety subscale of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary diseaseINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2008Wai-Kwong Tang Abstract The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for depression and anxiety in medically compromised patients. The purpose of this study was to examine the differential item functioning (DIF) of the anxiety subscale of the HADA (HADS-A). A research assistant administered the HADS-A to 166 Chinese patients with chronic obstructive pulmonary disease (COPD) who were consecutively admitted to a rehabilitation hospital. Although the HADS-A was overall uni-dimensional, there were one mute item and two items with borderline misfit. Only one item had a DIF for arterial oxygen saturation. No item had DIF for other indicators of the severity of COPD. In conclusion, this study found that for one item the HADS-A has significant item bias for the severity of disease in patients with COPD. Copyright © 2008 John Wiley & Sons, Ltd. [source] Efficacy of urinary guidelines in the management of post-stroke incontinenceINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2009Stephanie Vaughn Abstract Urinary incontinence (UI) is common occurrence among stroke survivors and impacts their recovery. This mixed method study examined the effects of implementation of evidence-based urinary guidelines by the Interdisciplinary (ID) team in the management of post-stroke UI in stroke survivors in an acute rehabilitation hospital in Southern California. Essential elements of the guidelines included assessment of the bladder pattern, the urinary WBC's, the implementation of a scheduled toileting program, pelvic floor exercises, and the administration of Vitamin C 500 mg. by mouth. Functional Independent Measure (FIM) scores and urinary white blood cells (WBC's) were used to evaluate the efficacy the guidelines. Post guideline implementation FIM scores and urinary WBC's demonstrated improvement over the pre-scores. These results indicate that positive stroke outcomes were achieved following implementation. In addition, the ID team, comprised of nurses, physical therapists, speech pathologists, and occupational therapists, was queried as to the member's knowledge and perceptions of their roles in the implementation of the guidelines. Highlighted themes from the ID focus groups were communication and structure, relating that the guidelines were useful in promoting collaborative practice among the ID team members. [source] Relationship between the length of hospital stay after hip fracture surgery and ambulatory ability or mortality after discharge in JapanJAPAN JOURNAL OF NURSING SCIENCE, Issue 1 2010Akiko KONDO Abstract Aim:, To examine whether the length of hospital stay after hip fracture surgery is related to patients' ambulatory ability or mortality after discharge. Methods:, This is a retrospective observational study of patients who had undergone hip fracture surgery at one of three hospitals in Japan. The medical records of patients who were ,65 years and who had hip fracture surgery within the past 2.5 years were reviewed regarding the demographics, treatments, and health outcomes during the hospital stay. A mail survey, asking about health outcomes after discharge, was sent to the study participants and/or their family members. The response rate of the survey was 70% (n = 149). Results:, The patients who were discharged between 30 and 39 days after surgery had significantly lower current ambulatory ability, compared to the patients who stayed for ,40 days, after adjusting for patient characteristics, treatments, and hospital. The patients who were discharged within 2 weeks after surgery and the patients who were discharged between 30 and 39 days after surgery had a significantly higher risk of mortality, compared to the patients who stayed in the hospital for ,40 days, after adjustments were made. Conclusions:, If patients are discharged to a rehabilitation hospital before they are totally recovered from surgery, the emphasis might be on their rehabilitation without adequate management of their comorbidities. Additional prospective studies are needed to determine the effects of a shorter length of hospital stay after hip fracture surgery on patient outcomes. [source] A Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic SurgeryJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009R. Sean Morrison MD OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery. DESIGN: Controlled prospective propensity score,matched clinical trial. SETTING: New York City acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty. INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care. MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge. RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8-foot-walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03). CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function. [source] The Effect of Changing Practice on Fall Prevention in a Rehabilitative Hospital: The Hospital Injury Prevention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004Michael Vassallo FRCP Objectives: To determine whether a change in practice to introduce a multidisciplinary fall-prevention program can reduce falls and injury in nonacute patients in a rehabilitation hospital. Design: A quasi-experimental study. Setting: Three geriatric wards with a similar design, equipment, staffing levels, and skill mix. Participants: Eight hundred twenty-five consecutive patients. Intervention: The patients' fall-risk status was assessed using the Downton Score. Current practice was maintained on the two control wards (n=550). On the experimental ward (n=275), a fall-prevention program was introduced. A multidisciplinary team met weekly specifically to discuss patients' fall risk and formulate a targeted plan. Patients at risk were identified using wristbands; risk factors were corrected or environmental changes made to enhance safety. Measurements: Primary outcomes were number of fallers, recurrent fallers, total falls, patients sustaining injury, and falls per occupied bed days. Secondary outcomes were place of discharge and mortality. Results: Patients were matched for age and risk status. Control wards had proportionally more fallers (20.2% vs 14.2%: P=.033), patients sustaining injury (8.2% vs 4%: P=.025), and total number of falls (170 vs 72: P=.045). These results did not remain significant after controlling for differing length of stay. There was no reduction in recurrent fallers (6.4% vs 4.7%: P=.43) and no effect on place of discharge (home discharges; 57.5% vs 60.7%: P=.41) or mortality (15.3% vs 13.8%: P=.60). Conclusion: This study shows that falls might be reduced in a multidisciplinary fall-prevention program, but the results are not definitive because of the borderline significance achieved and the variable length of stay. More research on fall prevention in hospital is required, particularly as to what interventions, if any, are effective at reducing falls in this group of patients. [source] Physical Medicine and Rehabilitation (85)PAIN PRACTICE, Issue 1 2001Erbil Dursun Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. (Kocaeli University, Kocaeli, Turkey) Arch Phys Med Rehabil 1999; 81:944,946. This is a case-controlled study of the relationship between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients set in an inpatient rehabilitation hospital. Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in this study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points. Glenohumeral subluxation was found in 74.3% of the RSD group and 40% of the non-RSD group (P = 0.004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (P = 0.019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (P = 0.152). Conclude that the findings suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients. Comment by Miles Day, MD. The purpose of this study was to examine the relationship between shoulder subluxation in hemiplegic patients and reflex sympathetic dystrophy. They also examined if subluxation is associated with shoulder pain and the grade of subluxation in patients with subluxation and no reflex sympathetic dystrophy (RSD). Patients with injuries to the rotator cuff of the brachial plexus, marked spasticity, and major trauma to joint structures were excluded as these can be precipitating factors for RSD. The study noted a significantly higher presence of shoulder subluxation within the RSD group and the presence of pain was significantly high in patients with shoulder subluxation in the non-RSD group. The take home message of this article is that any measure or treatment that can be applied to the glenohumeral joint should be performed to eliminate the possibility of the patient developing RSD and subsequently hindering further rehabilitation in these patients. [source] Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patientsACTA NEUROLOGICA SCANDINAVICA, Issue 5 2006S. K. Saxena Background,,, Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. Aim,,, The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Methodology,,, Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. Results,,, The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index , 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01,12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32,14.98). Conclusion,,, Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed. [source] | ||||||||||