Long-term effects of cardiac rehabilitation in elderly individuals with stable coronary artery disease

Purpose: To compare exercise capacity and cardiovascular response to exercise in elderly individuals with coronary artery disease (CAD) who attend ongoing community-based maintenance cardiac rehabilitation (CR) versus age- and gender-matched healthy “very active” (HVA;?≥?2000?kcal/week) and healthy “less active” (HLA; <2000?kcal/week) individuals. Method: Sixty-three participants (age: 72.3?±?5.1 years; 62% men; n?=?21 per group) completed the following assessments: (1) symptom-limited graded exercise test with expired gas analysis and bioimpedance assessment of cardiovascular function during exercise; (2) walking tests; (3) physical function; (4) anthropometry and (5) 12-month physical activity recall. Results: The CR group achieved 98% (range: 73–154%) of age- and gender-predicted peak oxygen consumption for healthy individuals. Peak oxygen consumption was lower in CR compared to HVA but not HLA group (VO_2peak: CR: 19.0?±?4.5, HVA: 23.7?±?2.9, HLA: 20.7?±?4.7?ml ·kg^?1?min^?1, p?=?0.001 versus HVA; p?=?0.390 versus HLA). Peak heart rate was lower in CR compared to both HVA and HLA. Walking test results and cardiovascular and physical function were not different between the groups. Conclusions: Elderly individuals with CAD participating in maintenance CR have similar exercise capacity and cardiorespiratory response to exercise compared to their age- and gender-matched less active healthy peers. The findings support referral of elderly patients to community-based CR.

• Implications for Rehabilitation

• Fitness benefits of long-term maintenance cardiac rehabilitation (CR) programs remain unknown.

• Elderly individuals with coronary artery disease participating in maintenance CR have exercise capacity and cardiorespiratory response to exercise similar to their less active healthy peers.

• Maintenance CR may play an important role prolonging independent living in elderly individuals.

     

家庭成员辅助干预对急性脑梗死患者运动功能障碍康复的影响

目的探讨家庭成员辅助干预对急性脑梗死所致偏瘫患者运动功能障碍康复的影响。方法选择 60例急性脑梗死偏瘫患者 ,随机分成观察组和对照组 (每组 3 0例 ) ,在常规药物和康复治疗的同时 ,观察组实施家庭成员辅助干预康复训练 ,通过治疗前后Fugl Meyer运动评分 (FMA)、修订的Barthel指数 (MBI)评分的变化对两组患者功能康复进行评价。 结果 8周后两组患者的FMA、MBI评分均较前有明显提高 (P <0 0 0 1) ,观察组更优于对照组 (P <0 0 5 )。结论在急性脑梗死患者康复治疗中家庭成员积极合理辅助干预对偏瘫运动功能康复、尤其是日常生活活动能力的提高起到促进作用。     

行为强化训练对慢性精神分裂症病人的康复作用

[目的]探索行为强化训练对慢性精神分裂症病人的康复作用。[方法]在原治疗不变的基础上对慢性精神分裂症病人实施行为强化训练，并进行训练前后PANSS量表评分比较。[结果]行为强化训练后PANSS量表中阳性症状、一般症状的评分及总分均较训练前明显降低。[结论]行为强化训练对慢性精神分裂症病人有积极作用。     

颅脑损伤后持续植物状态的促醒康复治疗

目的探讨颅脑损伤后持续性植物状态患者的促醒康复方法。方法27例持续性植物状态患者分为不同年龄段,均采用药物、声光电刺激及运动训练等综合康复治疗2~5个月。按持续性植物状态评分标准进行疗效评定。结果患者的病程与年龄段与康复疗效有关,10~30岁年龄段及发病3个月内的治疗效果最显著。结论系统地综合康复治疗可明显提高持续性植物状态患者的促醒率,且年龄愈小发病时间越短,康复效果愈好,大部分植物状态患者有康复的可能性。     

早期康复对急性脑卒中患者认知功能的影响

目的：探讨早期康复治疗对急性脑卒中患者认知功能的影响。方法：90例急性脑卒中患者分为康复组47例和对照组43例，均予以神经内科常规治疗与护理；康复组同时由经过专业训练的治疗师给予系统的康复训练。治疗前后采用简易精神状态量表（MMSE）、长谷川智力量表（HDS）、韦氏记忆量表（WMS）、临床痴呆量表（CDR）、老年临床评定量表（SCAG）、日常生活能力量表（ADL）定期对2组患者进行认知功能评价。结果：治疗第4周时康复组MMSE、WMS、SCAG、HDS和ADL评分与治疗前比较均明显改善，对照组仅WMS和HDS评分有明显改善（均P〈0.05或0.01）；治疗8周后,康复组CDR评分下降（P〈0.05），对照组MMSE、ADL、SCAG评分出现明显改善（P〈0.05或0.01），CDR则无改变。治疗后各时间段各项指标评分比较,康复组均优于对照组（P〈0.05）。结论：早期康复治疗对急性脑卒中安全有效,可明显改善脑卒中患者的认知功能。     

Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures

The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.     

A framework for the role of Registered Nurses in the specialty practice of rehabilitation nursing in Australia

AIM OF THE STUDY: This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia. BACKGROUND: Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area. METHODS: This study used a qualitative approach by engaging 13 nurses in one-to-one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data. FINDINGS: Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the 'how' and 'what' of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues. CONCLUSION: The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.     

恢复期SARS患者康复治疗疗效分析

目的:观察SARS患者恢复期康复治疗效果。方法:9例恢复期肺弥散功能异常的SARS确诊患者,平均年龄为(31.44±11.53)岁,在平均病程为(73±4.97)天时接受为期3周的康复治疗,主要包括呼吸操、有氧运动及肺部物理因子治疗。在治疗前后进行肺功能、呼吸困难程度及静息心率等方面评定,将结果进行统计学分析。结果:恢复期SARS患者经康复治疗后,7例肺弥散功能正常,1例明显改善但仍低于正常标准,1例未复查。平均肺弥散率较治疗前有极显著性提高(P<0.01),呼吸困难程度和静息心率也有显著性改善(P<0.01和P<0.05)。与同期未绎康复治疗的对照组相比,康复治疗组患者的呼吸困难程度明显低于对照组,差异具有极显著性意义(P<0.01),但两组静息心率差异无显著性意义,均属正常范围。结论:以深呼吸运动、有氧运动和物理因子治疗为主的康复治疗有助于恢复期SARS患者肺弥散功能的改善,减轻呼吸困难症状,提高活动耐力。     

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

Objective: Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.

Design: Community-level, cross-sectional analysis with multidimensional clinical work ability assessments.

Setting: Paltamo, Finland.

Participants: Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n?=?230, 81%).

Main outcome measures: Based on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.

Results: Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.

Conclusions: Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed.

• KEY POINTS

• Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.

• Work disabilities are common among the unemployed.

• Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.

• Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability.

     

康复护理干预对精神分裂症患者社会功能缺陷的影响

目的:探讨康复护理干预对精神分裂症患者社会功能缺陷的影响。方法:将211例精神分裂症患者随机分为研究组105例和对照组106例,研究组实施住院康复及综合护理干预;对照组实施住院康复和常规护理。应用社会功能缺陷评定量表(SDSS)在康复前和干预3个月后各评定1次,比较两组患者社会功能恢复情况。结果:研究组SDSS总分康复前为6.34±1.67,康复后降为4.22±1.06,前后比较差异有显著性(P<0.01),且均显著优于对照组(P<0.01)。其中,以职业功能、社会活动、家庭活动、生活能力等功能的改善较明显(P<0.05,P<0.01)。结论:精神分裂症患者存在不同程度的社会功能缺陷,住院康复及综合护理干预对精神分裂症患者社会功能缺陷有显著改善作用。