From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke

Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group’s Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community

Development and Validation of the Tele-Pulmonary Rehabilitation Acceptance Scale

BACKGROUND: Using telehealth in pulmonary rehabilitation (telerehabilitation) is a new field of health-care practice. To successfully implement a telerehabilitation program, measures of acceptance of this new type of program need to be assessed among potential users. The purpose of this study was to develop a scale to measure acceptance of using telerehabilitation by health-care practitioners and patients. METHODS: Three objectives were met (a) constructing a modified scale of the technology acceptance model, (b) judging the items for content validity, and (c) judging the scale for face validity. Nine experts agreed to participate and evaluate item relevance to theoretical definitions of domains. To establish face validity, 7 health-care practitioners and 5 patients were interviewed to provide feedback about the scale's clarity and ease of reading. RESULTS: The final items were divided into 2 scales that reflected the health-care practitioner and patient responses. Each scale included 3 subscales: perceived usefulness, perceived ease of use, and behavioral intention. CONCLUSIONS: The 2 scales, each with 3 subscales, exhibited evidence of content validity and face validity. The 17-item telerehabilitation acceptance scale for health-care practitioners and the 13-item telerehabilitation acceptance scale among patients warrant further psychometric testing as valuable measures for pulmonary rehabilitation programs

Health Care Practitioners’ Determinants of Telerehabilitation Acceptance

Background: Pulmonary rehabilitation is a multidisciplinary patient-tailored intervention that aims to improve the physical and psychological condition of people with chronic respiratory diseases. Providing pulmonary rehabilitation (PR) services to the growing population of patients is challenging due to shortages in health care practitioners and pulmonary rehabilitation programs. Telerehabilitation has the potential to address this shortage in practitioners and PR programs as well as improve patients’ participation and adherence. This study’s purpose was to identify and evaluate the influences of intention of health care practitioners to use telerehabilitation. Methods: Data were collected through a self-administered Internet-based survey. Results: Surveys were completed by 222 health care practitioners working in pulmonary rehabilitation with 79% having a positive intention to use telerehabilitation. Specifically, perceived usefulness was a significant individual predictor of positive intentions to use telerehabilitation. Conclusion: Perceived usefulness may be an important factor associated with health care providers’ intent to use telerehabilitation for pulmonary rehabilitation

Changes in Walking Spatiotemporal Parameters After Therapeutic Yoga in People with Chronic Stroke

Walking limitations after stroke can contribute to long-term functional impairments. Walking characteristics such as spatiotemporal step parameters may be associated with these persistent walking limitations. The purpose of this study was to investigate changes in specific spatiotemporal walking parameters such as: walking speed; step length; swing time; step parameter symmetry; and double support time in adults with stroke who were participating in a therapeutic yoga intervention. The therapeutic yoga intervention was offered as a post-rehabilitation wellness activity 2 times per week for 8 weeks and was led by a yoga therapist. Spatiotemporal walking data were collected using the GAITRite Walkway System on a sub sample (n=24) of participants in a randomized controlled trial testing the efficacy of therapeutic yoga for improving balance in adults with chronic stroke. These data demonstrated that therapeutic yoga may have a positive impact on some spatiotemporal walking characteristics such as comfortable walking speed, step length, and double support time, while other spatiotemporal walking characteristics did not change (step parameter symmetry) or change at a significant level (sustained walking speed). The clinical relevance of this study is that participation in therapeutic yoga as a post-rehabilitation wellness activity may have a positive impact on walking characteristics in adults with chronic stroke

Post-Rehabilitation Adapted-Yoga at the YMCA for Adults with Acquired Brain Injury: A Feasibility and Pilot Study

Background & purpose: Adults with acquired brain injury (ABI) (stroke and traumatic brain injury) experience long-term physical performance deficits for which participation in post-rehabilitation exercise is recommended. Community-based adapted-yoga has potential as an exercise modality to promote post-rehabilitation exercise and physical function improvements. The purpose of this study was to examine the feasibility and benefit of adapted-yoga at the local YMCA for post-rehabilitation adults with ABI. Methods: Participants were recruited by referral from clinical therapists in outpatient rehabilitation centers to participate in adapted-yoga 2x/week for 8 weeks at the YMCA. Referral tracking, yoga attendance, safety, and intervention fidelity were assessed for feasibility. Participants completed pre and post-yoga assessments of balance (trunk impairment scale [TIS], berg balance scale [BBS], dynamic gait index [DGI]) and walking (10-meter walk test [10MWT] and six-minute walk test [6MWT]) and 8 weeks of adapted-yoga class. Results: Thirty-two people were referred to the YMCA adapted-yoga program by clinical therapists with 17 (53%) of referred persons enrolling in the program. Intervention fidelity was 87% with the standardized adapted-yoga protocol, and the average number of classes attended was 12.82+3.7. Balance (TIS, p<0.001; BBS, p<0.001; DGI, p<0.001), and walking distance (6MWT, p= 0.028) all significantly improved after 8-weeks of yoga. Balance confidence did not improve significantly and walking speed did not change. Discussion & Conclusion: Clinician referral to community-based programs may be a feasible mechanism to engage persons in post-rehabilitation community-based exercise. Adapted-yoga may beneficially impact balance and walking performance in post-rehabilitation adults with ABI

Evidence that breast cancer risk at the 2q35 locus is mediated through IGFBP5 regulation.

GWAS have identified a breast cancer susceptibility locus on 2q35. Here we report the fine mapping of this locus using data from 101,943 subjects from 50 case-control studies. We genotype 276 SNPs using the 'iCOGS' genotyping array and impute genotypes for a further 1,284 using 1000 Genomes Project data. All but two, strongly correlated SNPs (rs4442975 G/T and rs6721996 G/A) are excluded as candidate causal variants at odds against &gt;100:1. The best functional candidate, rs4442975, is associated with oestrogen receptor positive (ER+) disease with an odds ratio (OR) in Europeans of 0.85 (95% confidence interval=0.84-0.87; P=1.7 × 10(-43)) per t-allele. This SNP flanks a transcriptional enhancer that physically interacts with the promoter of IGFBP5 (encoding insulin-like growth factor-binding protein 5) and displays allele-specific gene expression, FOXA1 binding and chromatin looping. Evidence suggests that the g-allele confers increased breast cancer susceptibility through relative downregulation of IGFBP5, a gene with known roles in breast cell biology