2ARTs – Decision Support System for Exercise and Diet Prescriptions in Cardiac Recovery Patients

The global health care system is faced with a variety of complicated challenges, ranging from limited access and increasing expenses to an aging population causing increased pressure on healthcare systems. Healthcare professionals are seeking alternative approaches to provide fair access and sustain high-quality care for everyone as a result of these challenges. Patients have historically been restricted from accessing essential healthcare services due to traditional barriers like geographic distance, financial and resource limitations. Innovative solutions to these problems are starting to take shape, thanks to the growth of eHealth platforms that use technology to improve patient care. Through a comprehensive study of existing solutions in the healthcare domain, particularly in cardiology, we identified the need for a Decision Support System (DSS) that would empower physicians with valuable insights and facilitate informed physical and diet prescribing practices into Cardiac Rehabilitation Programmes (CRPs). The major goal of 2ARTs’ project is to create and implement a cardiac rehabilitation platform into a hospital's infrastructure. A key aspect of this platform is the integration of a decision support system designed to provide physicians with valuable information when prescribing individualized treatment prescriptions for each patient, minimizing the potential of human error. The DSS uses algorithms and predictive models to classify patients into distinct groups based on their features and medical history. This classification provides critical insights and additional knowledge to doctors, allowing them to make informed judgments regarding the most effective treatment options for each patient's cardiac rehabilitation journey. By using the power of data-driven analytics and machine learning, the DSS enables doctors to better understand each patient's needs and personalize treatment actions accordingly. In order to achieve the best possible results aligned with the goals of the project, a variety of approaches based on comprehensive studies were explored, specifically feature selection and feature reduction methods, where their performance metrics were evaluated, seeking the most effective solution. It was through this thorough analysis that Principal Component Analysis (PCA) emerged as the standout choice. PCA not only demonstrated superior outcomes in evaluation metrics, but also showcased excellent compatibility with the selected clustering algorithm along with the best results after an expert analysis. Moreover, with the analysis of the data types and features the dataset had, the K-Means algorithm produced the best results and was more adaptable to our dataset. We were able to identify useful insights and patterns within the data by employing both PCA and K-Means, opening the way for more accurate and informed decision-making in the 2ARTs project

Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: From the American Physical Therapy Association Neurology Section

Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, \ Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?\ Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. Disclaimer: These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation

Exploring Techniques Used to Make Doctor-Recommended Changes in Diet and Exercise for Patients with Cardiac Disease

Motivation plays an important role in treatment adherence, as patients should make necessary health behavior changes based on their physician’s recommendations. Self-efficacy and resilience can help/hinder the patient from implementing and maintaining these changes. Previous studies concluded that individuals cannot rely on medication alone and must implement healthy lifestyle changes. However, these changes may be difficult, as the individuals may face physical or emotional barriers. Therefore, it is important to analyze the factors that motivate an individual to overcome these challenges and follow the recommended treatment plan. This qualitative study examined four participants age x-y through in-depth interviews. Three participants, had high blood pressure and one had a history of a heart attack, as well as coronary heart disease. The results indicated that most participants were not successful in implementing dietary and exercise changes as they prioritized work and family over their health. The one participant who was most successful in following dietary and exercise changes was the one who had a more severe health threat: having a heart attack. Participants mentioned the following strategies helped them to make healthy choices: modifying their diet and exercise plans to accommodate their work and family responsibilities, receiving emotional support from friends and family, receiving practical support (work-out buddy, family members making changes with them), experiencing a health behavior change-related reduction in cardiac symptoms, and being mindful of the fear of the disease getting worse. Future work is needed to help identify factors that can assist heart patients to increase both motivation and self-efficacy beliefs to make dietary and exercise changes

Influence of Mobile Application Based Brain Training Program on Cognitive Function and Quality of Life in Patients Post Stroke

Background: Stroke often leads to cognitive impairment, which can significantly reduce one's independence as well as quality of life. Cognitive rehabilitation is a treatment strategy for restoring cognitive abilities following brain injuries. Cognitive functioning can be improved through the use of multimedia as well as informatics in computerized cognitive rehabilitation (CCR). Purpose: to investigate the influence of a mobile application-based brain training program on cognitive functions as well as quality of life in post stroke patients. Methodology: forty referred medically and radiologically diagnosed stroke patients from both genders experienced post stroke cognitive impairment (PSCI), aged from 45 to 60 years old, were randomized into two groups of the same number: a study group and a control group. The Study group received mobile application-based brain training program (Lumosity training application) as well as aerobic training on a bicycle ergometer, and the control group received only the aerobic training on a bicycle ergometer for 18 sessions every other day for 6 weeks, 3 sessions/week, each session for 60 minutes. All patients were evaluated with Computer-based cognitive device RehaCom, Addenbrooke’s Cognitive Examination Revised (ACE-R) test, Montreal Cognitive Assessment (MoCA) in addition to Stroke specific quality of life scale (SS-QoL) pre and post treatment. Results: a significant difference has been detected among the two groups as the (p-value = 0.001) indicating that the study group reported enhancement in the cognitive functions as well as the quality of life more than the control group and there was a correlation between RehaCom, MoCA, ACE-R and SS-QoL. Conclusion: This study showed that six weeks of mobile application-based brain training program (Lumosity training application) as well as aerobic training on a bicycle ergometer was a beneficial approach and is a successful treatment for patients suffering from (PSCI)

A Proposal for Multidisciplinary Tele-rehabilitation in the Assessment and Rehabilitation of COVID-19 survivors

A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge

Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation

Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations