In-Home Telerehabilitation for Post-Knee Arthroplasty: A Pilot Study

The purpose of this study was to investigate the efficacy of in-home telerehabilitation as an alternative to conventional rehabilitation services following knee arthroplasty. Five community-living elders who had knee arthroplasty were recruited prior to discharge from an acute care hospital. A pre/post-test design without a control group was used for this pilot study. Telerehabilitation sessions (16) were conducted by two trained physiotherapists from a service center to the patient’s home using H264 videoconference CODECs (Tandberg 550 MXP) connected at 512 Kb\s. Disability (range of motion, balance and lower body strength) and function (locomotor performance in walking and functional autonomy) were measured in face-to-face evaluations prior to and at the end of the treatments by a neutral evaluator. The satisfaction of the health care professional and patient was measured by questionnaire. Results are as follows. One participant was lost during follow-up. Clinical outcomes improved for all subjects and improvements were sustained two months post-discharge from in-home telerehabilitation. The satisfaction of the participants with in-home telerehabilitation services was very high. The satisfaction of the health care professionals with the technology and the communication experience during the therapy sessions was similar or slightly lower. In conclusion, telerehabilitation for post-knee arthroplasty is a realistic alternative for dispensing rehabilitation services for patients discharged from an acute care hospital.Keywords: Telerehabilitation, Physical Therapy, Total Knee Arthroplasty, Videoconferencin

Feasibility of Lifestyle Redesign® for community-dwelling older adults with and without disabilities : results from an exploratory descriptive qualitative clinical research design

Abstract : Introduction. Although Lifestyle Redesign® has been shown to be effective in improving older adults’ health and well-being, little is known about the feasibility of implementing this program to develop meaningful and health-promoting routines of community-dwelling older adults in Canada. This study thus aimed to explore the feasibility of implementing a culturally-adapted 6-month version of Lifestyle Redesign® with community-dwelling older French-Canadians with and without disabilities. Methods. An exploratory descriptive qualitative clinical research design was used with 17 older adults living at home or in a seniors’ residence, divided into two groups participating in Lifestyle Redesign®. Semi-structured interviews were conducted with participants and the occupational therapist who delivered the program and recorded clinical notes. Findings. Participants were aged between 65 and 90; they were mainly women (n=11; 64.7%) and 7 (41.2%) had disabilities. The intervention was tailored to the participants’ needs, interests and capacities in each group (e.g., modules selected, number of individual sessions, assistance of volunteer). Over the 6-month period, older adults participated in an average of about 25 group sessions with the occupational therapist and in four or five outings with their group (e.g., restaurant, market, museum) and attended between five and eleven individual sessions with the occupational therapist. The most common reasons for missing group sessions were being ill, working, or having another appointment. Personal facilitators and barriers to participation in the intervention were mainly related to abilities, needs, spiritual life, and health. Environmental facilitators were mostly the regularity of the sessions, group and external support, including human resources to deliver the intervention, while barriers were the residence’s time restrictions and staff’s attitudes, cost of some activities targeted in the program, and transportation problems. Conclusion. Lifestyle Redesign® is a feasible preventive occupational therapy intervention for community-dwelling older French-Canadians. These findings will guide future studies including large-scale clinical trials

Effect of pulsed electromagnetic field therapy on experimental pain : a double-blind, randomized study in healthy young adults

Abstract : Past studies have suggested that pulsed electromagnetic field (PEMF) therapy can decrease pain. To date, however, it remains difficult to determine if the analgesic effect observed in patients are attributable to a direct effect of PEMF on pain or to an indirect effect of PEMF on inflammation and healing. In the present study, we used an experimental pain paradigm to evaluate the direct effect of PEMF on pain intensity, pain unpleasantness and temporal summation of pain. Twenty-four healthy subjects (mean age 22 ± 2 years; 9 males) participated in the experiment. Both real and sham PEMF were administered to every participant using a randomized, double-blind, cross-over design. For each visit, PEMF was applied for 10 minutes on the right forearm using a portable device. Experimental pain was evoked before (baseline) and after PEMF with a 9 cm2 Pelletier type thermode, applied on the right forearm (120 sec stimulation; temperature individually adjusted to produce moderate baseline pain). Pain intensity and unpleasantness were evaluated using a 0-100 numerical pain rating scale. Temporal summation was evaluated by comparing pain intensity ratings obtained at the end of tonic nociceptive stimulation (120 sec) with pain intensity ratings obtained after 60 sec of stimulation. When compared to baseline, there was no change in pain intensity and unpleasantness following the application of real or sham PEMF. PEMF did not affect temporal summation. The present observations suggest that PEMF does not directly influence heat pain perception in healthy individuals

High- and low-frequency transcutaneous electrical nerve stimulation does not reduce experimental pain in elderly individuals

Abstract : Despite its widespread clinical use, the efficacy of transcutaneous electrical nerve stimulation (TENS) remains poorly documented in elderly individuals. In this randomized, double-blind crossover study, we compared the efficacy of high-frequency (HF), lowfrequency (LF), and placebo (P) TENS in a group of 15 elderly adults (mean age: 67 6 5 years). The effect of HF-, LF-, and P-TENS was also evaluated in a group of 15 young individuals (26 6 5 years; same study design) to validate the effectiveness of the TENS protocols that were used in the elderly group. Each participant came to the laboratory on 3 separate occasions to receive, in random order, HF-, LF-, and P-TENS. Pain intensity and pain perception thresholds were assessed before, during, and after TENS, using an experimental heat pain paradigm. For the young group, there was a significant decrease in pain intensity during and after HF- and LF-TENS when compared with baseline, with both HF- and LF-TENS being superior to P-TENS. In the older group, HF- and LF-TENS did not reduce pain when compared with baseline and no difference was observed between the 2 active TENS sessions and P-TENS. High-frequency, LF-, and P-TENS all increased pain thresholds in young individuals, whereas in older individuals, only LF-TENS increased pain thresholds. Taken together, these results suggest that TENS is effective in young, but not in older, individuals. Future studies should be conducted to confirm these results in pain populations and to identify strategies that could enhance the effect of TENS in the elderly

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Introducción: el temor a caer es una preocupación mayor tanto de los ancianos y sus familias como del  personal de la salud. Todas sus consecuencias son importantes para la salud, el bienestar y la calidad de vida  de los ancianos. La gran mayoría de los estudios se han desarrollado desde una perspectiva epidemiológica y solo raras excepciones desde una perspectiva cualitativa. Materiales y métodos: se utilizó el método  cualitativo de la teoría fundamentada. Se hizo un muestreo teórico por etapas (abierto, discriminado y  selectivo) hasta lograr la saturación de los conceptos emergentes. Las entrevistas se llevaron a cabo con 37  ancianos mayores de 60 años, en tres ciudades de la región cafetera colombiana. El análisis respeta los  principios de la teoría fundamentada: codificación abierta, axial y selectiva para la construcción del modelo  teórico. Resultados y discusión: el temor a caer es un concepto difícil de definir, impreciso y ambiguo. Los  participantes evocan un temor difuso, sin objeto preciso y sin causa evidente, cuya amenaza es oscura, vaga,  con una duración ilimitada y se acompaña de sentimientos de impotencia. El temor a caer en los ancianos  genera mucha angustia, y para controlarlo los ancianos deben transformarlo en temores secundarios. El  manejo del miedo a caer es un proceso que exige una reorganización de la vida cotidiana y tiene un carácter  eminentemente biográfico: para enfrentar este temor, los ancianos hacen ajustes que les permiten integrar  en sus vidas tanto el temor a caer como los cambios que este trae consigo. Estos cambios se armonizan a  través de interacciones. Conclusión: el miedo a caer es un sentimiento que modifica profundamente la  relación del anciano consigo mismo y con su entorno. Así, el temor a caer en los ancianos es más que una  emoción y su manejo implica cambios: ajustes biográficos y reorganización de la vida cotidiana. Cambios que se construyen a través de interacciones que se desarrollan en diferentes esferas de la vida social. Esta nueva  manera de concebir el temor a caer impone nuevos desafíos para su manejo y para evitar las consecuencias  negativas.Introduction: The fear of falling is a great worry for both, the elderly and their families and the health professionals. All its consequences are important for the health, welfare and quality of life of the elderly. Most of the studies have been developed from an epidemiologic perspective and only some rare exceptions from the qualitative perspective. Materials and methods: A qualitative method of the grounded theory was used. A theoretical sampling in different stages (open, discriminated and selective) was carried out in order to achieve saturation of the emergent concepts. The interviews were performed to 37 older than 60 people in three cities in the Colombian Coffee Region. The analysis respects the principles of the grounded theory: open, axial and selective coding for the construction of the theoretical model. Results and discussion: The  fear of falling is a difficult to define, vague and ambiguous concept. The participants recall a vague, without a  precise objective or evident cause fear whose threat is dark, hazy, with limited duration and accompanied by helplessness feelings. The fear of falling in the elderly generates a lot of anguish and in order to control it they have to transform it in secondary fears. The management of the fear of falling is a process that demands a reorganization of daily life and has an imminently biographic character: to face this fear the elderly make adjustments that allow them to incorporate in their lives both, the fear of falling and the changes it brings along. These changes harmonize through interactions. Conclusion: The fear of falling is a feeling that deeply modifies the relationship of an elderly with himself and with his environment. This way, the fear of falling in the elderly is more than an emotion and its management implies changes: biographic adjustments and daily life reorganization. These changes are built through interactions that develop in different spheres of the social life. This new way to conceive the fear of falling imposes new challenges for its  management and to avoid the negative consequences

Use of a Telerehabilitation Platform in a Stroke Continuum: A Qualitative Study of Patient and Therapist Acceptability

The purpose of this study was to describe the acceptability of a stroke telerehabilitation platform from the perspective of both patients and therapists. Two public rehabilitation centers participated in a pilot telerehabilitation trial. A theoretical framework was used to conceptualize acceptability. Semi-structured individual interviews with patients and focus groups of therapists were conducted. Most participants and therapists were satisfied with the intervention. Participants emphasized the advantages of staying at home to get their treatments. Therapists were more skeptical at first about their self-efficacy to deliver therapy remotely. There was a consensus among therapists about the need for a combination of telerehabilitation and in-person visits to optimize treatments. While we found overall good acceptability, effectiveness of this technology could be improved via an accessible user interface, complementary rehabilitation material, and ongoing training and technical just-in-time support with therapists

Satisfaction With In-Home Speech Telerehabilitation in Post-Stroke Aphasia: an Exploratory Analysis

Patient satisfaction with healthcare has a major impact on clinical outcomes and compliance. Satisfaction with telehealth services for speech and language problems has been documented but not in post-stroke aphasia. The main objective here was to evaluate patient satisfaction with speech tele rehabilitation based on the PACE pragmatic rehabilitation approach in post-stroke aphasia. This study was embedded in a pre-/post-test feasibility and efficacy study in which 20 patients with chronic post-stroke aphasia received 3 weeks of speech therapy (9 sessions) through in-home tele-rehabilitation. A telerehabilitation platform based on a commercial videoconferencing system (Tandberg 550 MXP) with custom software was used to transmit audio, video and data through a high-speed Internet connection between the participant’s home and the clinician. Participants’ satisfaction with in-home telerehabilitation and healthcare received was assessed using French adaptations of the Telemedicine Satisfaction Questionnaire and Health Care Satisfaction Questionnaire. Satisfaction with functional communication, i.e. communication in common situations of daily life, was compared pre- and post-intervention with participants and caregivers. Participants’ satisfaction with in-home telerehabilitation was excellent (94%±4.3%). Satisfaction with healthcare received was good overall (80%±11.4%) and for three factors measured independently, i.e. relationship with healthcare professional (84%±12.5%), services delivered (73%±13.8%), and general healthcare  organization (84%±12.0%). Participants’ and caregivers’ satisfaction with communication was higher after the intervention (p=0.001 and p<0.001, respectively) and was correlated with age (r=-0.60; p=0.007). Patients with post-stroke aphasia receiving speech tele-therapy were very satisfied with this service delivery method. Also, technology use was not an issue for seniors post-stroke

Investigating the autonomic nervous system and cognitive functions as potential mediators of an association between cardiovascular disease and driving performance

Abstract: Cardiovascular disease (CVD) impacts the autonomic nervous system and cognitive functions related to activities of daily living, including driving an automobile. Although CVD has been linked to unsafe driving, mechanisms underlying this relationship remain elusive. The aim of this study was to examine the role of cognitive functions and the autonomic nervous system as potential mediators of driving performance. Nineteen individuals having recently suffered a cardiac event and sixteen individuals with no history of CVD completed a simulated drive using a STISIM simulator to assess driving performance. Heart rate was recorded throughout testing using a Polar RS800CX heart rate monitor and measures of executive, orienting and alerting functions were obtained through the Attention Network Test. We used the Baron and Kenny analysis method to assess potential mediating effects of the relationship between CVD and driving performance. Executive function was the only potential mediator investigated to be associated with driving (p < 0.01) and CVD (p < 0.05), however, it did not appear to play a mediating role (p = 0.28). These results suggest that individuals with CVD exhibit decrements in complex cognitive tasks such as driving and that further research is needed to better understand the mechanisms underlying this relationship

Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study

Introduction: Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge. Methods: This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach. Results: Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies. Conclusion: The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly

Impact of a Multifaceted Community-Based Falls Prevention Program on Balance-Related Psychologic Factors

Objective: To©assess©the©impact©of©a©multifaceted©falls prevention© program© including© exercise© and© educational© components© on© perceived© balance© and© balance© confidence© among community-dwelling© seniors. Design: Quasi-experimental© design. Setting: Community-based© organizations. Participants: Two©hundred©community-dwelling©adults aged© 60© years© and© over© recruited© by© community-based© organizations. Intervention: A© 12-week© multifaceted© falls© prevention© program© including© 3© components© (a© 1-hour© group© exercise© class held© twice© a© week,© a© 30-minute© home© exercise© module© to© be performed© at© least© once© a© week,© a© 30-minute© educational© class held© once© a© week). Main Outcome Measures: Perceived© balance© and© balance confidence. Results: Multivariate© analysis© showed© that© the© program© was successful©in©increasing©perceived©balance©in©experimental participants.© However,© balance© confidence© was© not© improved by© program© participation. Conclusions: A© multifaceted© community-based© falls© prevention© program© that© was© successful© in© improving© balance© performance© among© community-dwelling© seniors© also© had© a© positive impact© on© perceived© balance.© However,© the© program© did© not improve© participants&apos;© balance© confidence.© These© results© suggest© that© balance© confidence© has© determinants© other© than© balance© and© that© new© components© and/or© modifications© of© existing components© of© the© program© are© required© to© achieve© maximal benefits©for©seniors©in©terms©of©physical©and©psychologic outcomes