Subjective impact of osteoarthritis flare-ups on patients' quality of life

BACKGROUND: Clinical trials on osteoarthritis (OA) flare-ups treatment usually focus only on objective measures of health status, albeit recent literature suggestions on the importance of patients' subjectivity. Aim of the study was to evaluate the effects of OA and of its different types of medical treatment(s) on Health Related Quality of Life (HRQoL) in terms of both subjective satisfaction and functional status. METHODS: An observational study on prospective data collected from the Evaluation of Quality of life in OA (EQuO) clinical trial (April 1999-November 2000) was conducted; outpatients from 70 participating centers (Orthopedy or Rheumatology Departments in Italy) with a diagnosis of OA of the hip or knee were consecutively enrolled. Patients were observed at OA flare-ups (baseline) and at follow up 4 weeks after treatment. Patients' objective and subjective HRQoL were assessed by means of the SF-36 and the Satisfaction Profile (SAT-P, which focuses on subjective satisfaction); Present Pain at baseline and Pain Relief at follow up were also evaluated. RESULTS: Among the 1323 patients, 1138 (86%) were prescribed one drug/treatment of osteoarthritis, 169 (13%) 2 drugs/treatments, and 16 (1%) 3 drugs/treatments; most of treatments involved the prescription of NSAIDs; non-coxib, COX2 selective NSAIDs were prescribed in about 50% of patients. Follow-up visits were performed after 29.0 days on average (± 7.69 SD). For all SF-36 domains, all SAT-P items and factors, the differences between baseline and follow up scores resulted statistically significant (p < 0.001), enlighting an improvement both in health status and in subjective HRQoL. CONCLUSION: Besides the classic health status measures, the assessment of patients' subjective satisfaction provides important clues on treatments efficacy of OA within the patient-centered medicine model. In clinical practice this could lead to a better doctor-patient communication and to higher levels of treatment adherence

Adherence to Medication in Older Adults as a Way to Improve Health Outcomes and Reduce Healthcare System Spending

Medications are used as the primary approach to prevent and effectively manage the chronic conditions. Non-adherence to medication is recognized as a worldwide public health problem with important implications for the management of chronic diseases, which affects every level of the population, particularly older adults due to the high number of coexisting diseases and consequent polypharmacy. Estimated rates of adherence to long-term medication regimen are of about 50%, and there is no evidence for significant changes in the past 50 years. The consequences of non-adherence include poor clinical outcomes, increased morbidity and mortality and unnecessary healthcare costs. Factors contributing to non-adherence are multifaceted and embrace those that are related to patients, to physicians and to healthcare systems. Cognitive, sensorial and functional decline, poor social support, anxiety, depression symptomatology and reduced health literacy have been linked to medication non-adherence in the elderly patients. Many interventions to improve medication adherence have been described in the study for different clinical conditions; however, most interventions seem to fail in their aims. In this chapter, a revision of the implications of poor adherence as well as its predictors and available tools to improve adherence is performed

Erratum to: ICF, quality of life, and depression in breast cancer: perceived disability in disease-free women 6 months after mastectomy

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Rescheduling rehabilitation sessions with answer set programming

The rehabilitation scheduling process consists of planning rehabilitation physiotherapy sessions for patients, by assigning proper operators to them in a certain time slot of a given day, taking into account several requirements and optimizations, e.g. patient’s preferences and operator’s work balancing. Being able to efficiently solve such problem is of upmost importance, in particular as a consequence of the COVID-19 pandemic that significantly increased rehabilitation’s needs. The problem has been recently successfully solved via a two-phase solution based on answer set programming (ASP). In this paper, we focus on the problem of rescheduling the rehabilitation sessions, which comes into play when the original schedule cannot be implemented, for reasons that involve the unavailability of operators and/or the absence of patients. We provide rescheduling solutions based on ASP for both phases, considering different scenarios. Results of experiments performed on real benchmarks, provided by ICS Maugeri, show that also the rescheduling problem can be solved in a satisfactory way. Finally, we present a web application that supports the usage of our solution

A journey through roses and thorns: becoming a physician by learning from patients with life-threatening illnesses. A qualitative study with international medical students

The medical students' well-being may be threatened by various stressors associated with providing care to different kinds of patients. This study aims to explore students' clinical experiences with patients who suffer from life-threatening illnesses, focusing on potential risk and protective factors. Audio-recorded and face-to-face interviews were conducted and transcribed verbatim. The "Interpretive Description" approach was used to analyse data. Overall, ten medical students with a mean age of 28 years old were interviewed. Well-being promoting factors were the following: therapeutic relationships, work-life balance, social support and communication, perception of improvement in knowledge and availability of advanced directives. Whilst factors that may reduce well-being included death exposure, managing emotions, communication difficulties, internal conflicts and disagreements, lack of knowledge and subjective concerns. These findings shed light on facets that are inherent parts of clinical experience with patients suffering from a life-threatening illness and that may turn in risk or protective factors for the medical students. Understanding the students' subjective experiences may aid in the improvement of the current educational programs, as well as in the development of tailored supportive and preventative interventions to promote well-being and professional competencies among this kind of students

the new frontiers of rehabilitation medicine in people with chronic disabling illnesses

Abstract Because of the demographic shift and the increased proportion of patients surviving acute critical illnesses, the number of people living with severely disabling chronic diseases and, consequently, the demand for rehabilitation are expected to increase sharply over time. As underscored by the World Health Organization, there is substantial evidence that the provision of inpatient rehabilitation in specialized rehabilitation units to people with complex needs is effective in fostering functional recovery, improving health-related quality of life, increasing independence, reducing institutionalization rate, and improving prognosis. Recent studies in the real world setting reinforce the evidence that patients with ischemic heart disease or stroke benefit from rehabilitation in terms of improved prognosis. In addition, there is evidence of the effectiveness of rehabilitation for the prevention of functional deterioration in patients with complex and/or severe chronic diseases. Given this evidence of effectiveness, rehabilitation should be regarded as an essential part of the continuum of care. Nonetheless, rehabilitation still is underdeveloped and underused. Efforts should be devoted to foster healthcare professional awareness of the benefits of rehabilitation and to increase referral and participation

Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson’s Disease: A Proof of Concept

Training subjects to step-in-place eyes open on a rotating platform while maintaining a fixed body orientation in space [podokinetic stimulation (PKS)] produces a posteffect consisting in inadvertent turning around while stepping-in-place eyes closed [podokinetic after-rotation (PKAR)]. Since the rationale for rehabilitation of curved walking in Parkinson's disease is not fully known, we tested the hypothesis that repeated PKS favors the production of curved walking in these patients, who are uneasy with turning, even when straight walking is little affected. Fifteen patients participated in 10 training sessions distributed in 3 weeks. Both counterclockwise and clockwise PKS were randomly administered in each session. PKS velocity and duration were gradually increased over sessions. The velocity and duration of the following PKAR were assessed. All patients showed PKAR, which increased progressively in peak velocity and duration. In addition, before and at the end of the treatment, all patients walked overground along linear and circular trajectories. Post-training, the velocity of walking bouts increased, more so for the circular than the linear trajectory. Cadence was not affected. This study has shown that parkinsonian patients learn to produce turning while stepping when faced with appropriate training and that this capacity translates into improved overground curved walking

Solving rehabilitation scheduling problems via a two-phase ASP approach

A core part of the rehabilitation scheduling process consists of planning rehabilitation physiotherapy sessions for patients, by assigning proper operators to them in a certain time slot of a given day, taking into account several legal, medical and ethical requirements and optimizations, e.g., patient’s preferences and operator’s work balancing. Being able to efficiently solve such problem is of upmost importance, in particular after the COVID-19 pandemic that significantly increased rehabilitation’s needs. In this paper, we present a two-phase solution to rehabilitation scheduling based on Answer Set Programming, which proved to be an effective tool for solving practical scheduling problems. We first present a general encoding, and then add domain specific optimizations. Results of experiments performed on both synthetic and real benchmarks, the latter provided by ICS Maugeri, show the effectiveness of our solution as well as the impact of our domain specific optimization