Rehab Centers: Service Quality and Clinical Outcomes: An Example From Mental Health Rehabilitation Services in England.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

Filed under: Rehab Centers

Br J Psychiatry. 2012 Oct 11;
Killaspy H, Marston L, Omar RZ, Green N, Harrison I, Lean M, Holloway F, Craig T, Leavey G, King M

BACKGROUND: Current health policy assumes better quality services lead to better outcomes. AIMS: To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. METHOD: Standardised tools were used to assess the quality of mental health rehabilitation units and service users’ autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. RESULTS: A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users’ autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. CONCLUSIONS: Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.
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EMG-based visual-haptic biofeedback: a tool to improve motor control in children with primary dystonia.

Filed under: Rehab Centers

IEEE Trans Neural Syst Rehabil Eng. 2012 Oct 5;
Casellato C, Pedrocchi A, Zorzi G, Vernisse L, Ferrigno G, Nardocci N

New insights suggest that dystonic motor impairments could also involve a deficit of sensory processing. In this framework, biofeedback, making covert physiological processes more overt, could be useful. The present work proposes an innovative integrated set-up which provides the user with an EMG-based visual-haptic biofeedback during upper limb movements (spiral tracking tasks), to test if augmented sensory feedbacks can induce motor control improvement in patients with primary dystonia. The ad-hoc developed real-time control algorithm synchronizes the haptic loop with the EMG reading; the brachioradialis EMG values were used to modify visual and haptic features of the interface: the higher was the EMG level, the higher was the virtual table friction and the background color proportionally moved from green to red. From recordings on dystonic and healthy subjects, statistical results showed that biofeedback has a significant impact, correlated with the local impairment, on the dystonic muscular control. These tests pointed out the effectiveness of biofeedback paradigms in gaining a better specific-muscle voluntary motor control. The here-developed flexible tool show promising prospects of clinical applications and sensorimotor rehabilitation.
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The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study.

Filed under: Rehab Centers

Arch Osteoporos. 2012 Sep 22;
Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Johansson H, McCloskey E, Kanis JA,

INTRODUCTION: With the development of country-specific FRAX® tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended. OBJECTIVES: The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact. PATIENTS AND METHODS: Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50 years or more. RESULTS: Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0 % at the age of 50 years to 31 % at the age of 90 years. Approximately 8.6 % of the female Turkish population aged 50 years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6 % without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50 years or more eligible for treatment was 3.1 % CONCLUSIONS: FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.
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Comparison of muscle strength, sprint power and aerobic capacity in adults with and without cerebral palsy.

Filed under: Rehab Centers

J Rehabil Med. 2012 Oct 11;
Groot SD, Dallmeijer AJ, Bessems PJ, Lamberts ML, Woude LH, Janssen TW

Objective: To compare: (i) muscle strength, sprint power and maximal aerobic capacity; and (ii) the correlations between these variables in adults with and without cerebral palsy. Design: Cross-sectional study. Subjects: Twenty adults with and 24 without cerebral palsy. Methods: Isometric and isokinetic knee extension strength, sprint power (mean power over the 30s (P30)), peak aerobic power output (POpeak) and oxygen uptake (VO2peak) were determined. Regression analysis was used to investigate correlations between parameters. Results: Adults with cerebral palsy had significantly lower strength (53-69%) and P30 (67%) than adults without cerebral palsy, but similar POpeak and VO2peak. In adults without cerebral palsy the only significant correlations, albeit weak, were between P30 and isometric (R2;?=?0.34) or isokinetic strength (R2;?=?0.20), as well as the correlation between P30 and VOpeak (R2;?=?0.26) or POpeak (R2;?=?0.36). Stronger correlations were found in the group with cerebral palsy between P30 and isometric (R2;?=?0.52) and isokinetic strength (R2;?=?0.71) and between P30 and VOpeak (R2;?=?0.75) or POpeak (R2;?=?0.94). Conclusion: In contrast to aerobic capacity, strength and P30 are reduced in (active) people with cerebral palsy. Stronger correlations were found between strength, P30 and POpeak in adults with cerebral palsy. Therefore, muscle strength may be the limiting factor in adults with cerebral palsy for activities involving the lower extremities, such as cycling.
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Physical rehabilitation interventions in nonambulatory people with multiple sclerosis: a systematic review.

Filed under: Rehab Centers

Int J Rehabil Res. 2012 Oct 10;
Toomey E, Coote SB

There is an expanding body of research on exercise intervention for multidisciplinary rehabilitation of people with multiple sclerosis (PwMS). Most of this research focuses on people with mild/moderate MS who are ambulatory. As the costs of care increases with increasing disability, it is important to evaluate the evidence for interventions in nonambulatory PwMS. The aim of this study was to evaluate the evidence regarding physical rehabilitation interventions in nonambulatory PwMS. The databases AMED, CINAHL, MEDLINE, EMBASE and PSYCHARTICLES were searched up to 31 May 2011. Reference lists, Google Scholar and PEDro were also searched. Trials of physical rehabilitation interventions in nonambulatory PwMS that analysed nonambulatory results separately were included. Pharmacological, surgical, medical and assistive device interventions were excluded. Risk of bias was assessed and the GRADE approach was used to classify the quality of evidence. Sixteen low-grade studies, only three of which were randomized controlled trials (RCTs), were found. There are trends of improvement following some interventions such as cooling suits, respiratory training and multidisciplinary rehabilitation, but there is no high-grade evidence in terms of the benefits of interventions in this population. The effectiveness of physical rehabilitation interventions in nonambulatory PwMS remains unclear. Although trends in the results suggest positive benefits, conclusions cannot be drawn about the effectiveness of interventions in this population because of the small number and poor quality of studies. As approximately 25% of PwMS are nonambulatory and considerable costs are associated with their care, it is imperative that efforts be to increase the quality of evidence for nonambulatory PwMS.
HubMed – rehab

 

 

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