Underutilisation of Physical Rehabilitation Therapy by Cancer Patients in Korea: a Population-based Study of 958,928 Korean Cancer Patients

BackgroundAdvanced cancers are associated with more severe symptoms and greater impairment. Although most patients with metastatic cancer would benefit from rehabilitation, few patients receive appropriate rehabilitation therapy. We explored the use of rehabilitation therapy by cancer patients. Our data represented the entire population of Korea. The analyses were performed according to cancer type and stage.MethodsWe extracted rehabilitation utilization data of patients newly diagnosed with cancer in the period of 2011–2015 from the Korea Central Cancer Registry, which is linked to the claims database of the National Health Insurance Service (n = 958,928).ResultsThe utilisation rate increased during the study period, from 6.0% (11,504) of 192,835 newly diagnosed patients in 2011 to 6.8% (12,455) of 183,084 newly diagnosed patients in 2015. Patients with central nervous system (28.4%) and bone (27.8%) cancer were most likely to undergo physical rehabilitation. The rehabilitation rate was higher in patients with metastatic than localised or regional cancer (8.7% vs. 5.3% vs. 5.5%).ConclusionThis claims-based study revealed that rehabilitation therapy for cancer patients is underutilised in Korea. Although patients with metastasis underwent more intensive rehabilitation than patients with early stage cancer, those without brain and bone tumours (the treatment of which is covered by insurance) were less likely to use rehabilitation services. Further efforts to improve the use of rehabilitation would improve the outcomes of cancer patients.     

Cancer rehabilitation: experience, symptoms, and needs

The aim of this study was to examine the experience of cancer patients undergoing rehabilitation, to identify symptoms associated with rehabilitation from cancer, and to assess the need for rehabilitation services for cancer patients. Cancer patients (n = 402) at the Asan Medical Center (Seoul, Korea) were enrolled from June to September 2008. A chart review was used to collect demographic and clinical data, including type of cancer, current treatment, time from initial diagnosis to screening, and cancer stage. Each participant provided informed consent and was then given a questionnaire that asked about experience with rehabilitation, symptoms associated with rehabilitation, and the need for different types of rehabilitation services. Clinicians recommended rehabilitation for 8.5% of patients, and 6.7% underwent rehabilitation. Among study patients, 83.8% had one or more symptoms associated with rehabilitation, and 71.6% of patients with symptoms wanted rehabilitation management. The need for rehabilitation was associated with the presence of metastasis, advanced cancer stage, time to diagnosis, and type of current treatment. Our results provide specific information about particular functional symptoms and the rehabilitative needs of subgroups of cancer patients. It is suggested to develop and implement rehabilitation programs for cancer patients.     

Altered aiming movements in Parkinson's disease patients and elderly adults as a function of delays in movement onset

This study investigated the effect of lengthening the time the hand remains immobilized on an aiming movement performed by Parkinson's disease (PD) patients and elderly adults, and whether visual information could compensate for the effects of delay. In Experiment One, PD patients and elderly adults kept the limb in a static position for 1, 6, or 10 s prior to movement initiation, both with and without vision of the initial limb position and the movement trajectory. Compared to elderly adults, PD patients had increased movement times and jerk scores, and exhibited shorter primary submovements that erred in initial movement direction. Lengthening the time delay increased movement time, decreased mean acceleration, and decreased the distance covered in the primary submovement for both groups. Parkinsonian patients, however, exhibited reduced length of the primary submovement across delay compared to elderly adults. Occluding vision caused the movements of PD patients to deteriorate on all measures. Although the performance of both groups was enhanced when vision was available, vision was not able to fully counteract the effects of delay in either group. In Experiment Two, participants moved to a previously viewed target to examine movement accuracy. Systematic undershooting of the target as a function of delay was found for both groups. Parkinsonian patients exhibited greater undershooting of the target after the primary submovement both with and without vision. Visual feedback reduced the effects of delay for both the elderly and PD patients. It can be inferred from the results that the decay in position sense as a function of time produces impairments in incorporating the initial limb position in motor planning process.     

An evaluation of the implementation of integrated community home-based care services in vhembe district, South Africa

Aim:

The aim of the study is to evaluate the implementation of integrated community home-based care (CHBC) services in Vhembe District, Limpopo Province, South Africa.

Materials and Methods:

In all, 393 caregivers responded to a questionnaire on various aspects of home-based care and service provider characteristics.

Results:

Results indicate that in most areas of the Community Homes-based Care (CHBC) services, caregivers had confidence including wound dressing, health education, bet bathing, giving prescribed medication, and management of diabetes client, and they had sufficient knowledge received through training. Lower knowledge and confidence was noted for the management of hypertensive and asthmatic clients, and lower knowledge (82%) was indicated for counseling. The most common caregiving services included health education (100%), giving medication (98%), management of hypertension (22%), and counseling (15%). Most caregivers rated the implementation of CHBC in their district as excellent or good (70%). The most common problems and barriers in caregiving included (1) structural problems: none or sometimes not available home-based care kits (54%), lack of resources (32%), lack of transport money (30%), and very low stipend (22%); (2) problems with the supervisor such as “lack of management skills” (40%) and “selfishness” (38%); and (3) problems with clients and community such as “patients not taking prescribed medicines regularly” (45%) and “not welcomed by patients and family members” (35%).

Conclusion:

Community home-based caregivers are largely able to implement home-based care services but would need more support (training, financial, career structure, and health system) to improve on their services.     

Medial unicompartmental replacement for tricompartmental disease in the elderly

Between 1993 and 1998, we performed 18 unicompartmental arthroplasties of the knee, all on the medial side, in a selected group consisting of 18 elderly patients aged 74–81 (mean 77.2), with severe arthrosis mainly in the medial compartment and mild arthrosis in the lateral compartment and the patellar articular surface mostly covered with articular cartilage. The patients were mainly housebound due to relatively advanced age and severe pain. Unicompartmental arthroplasty was chosen for this group because of a quicker and easier rehabilitation. Two patients had had a high tibial osteotomy 7 and 10 years ago. The average follow up was 5.5 years ranging in age from 5 to 8 years. The average initial American Knee Society Knee Score was 52, ranging from 28 to 70 which improved at follow up to 83 (range 60–92). All prostheses used were Allegretto (Sulzer). The operation was done through short medial arthrotomy. The purpose of this study is to report our results in these low demand patients and although the follow-up was only 5–8 years, the results are promising.     

The difference in clinical presentations between healthcare-associated and community-acquired pneumonia in university-affiliated hospital in Korea

Purpose

Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, epidemiological studies for HCAP in South Korea are limited. This study aimed to reveal the differences between HCAP and community-acquired pneumonia (CAP), especially in elderly patients, in university-affiliated hospital in South Korea.

Materials and Methods

We conducted a retrospective observational study of patients with HCAP and CAP (older than 60 years old) who were hospitalized between January 2007 and December 2008. We compared the baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics, and clinical outcomes.

Results

A total of 210 patients were evaluated, including 35 patients with HCAP (17%) and 175 with CAP (83%). The most common causative organism was Streptococcus pneumoniae in CAP (33.3%), whereas, Staphylococcus aureus was most common pathogen in HCAP (40.0%). Initial inappropriate antibiotics (6.3% vs. 22.9%; p < 0.005) and initial treatment failure (15.4% vs. 31.4%; p = 0.018) were more frequent in HCAP than CAP. However, mortality (11.4% vs. 5.7%; p = 0.369) was not different between the two groups.

Conclusion

The present study provides additional evidence that HCAP should be distinguished from CAP, even in elderly patients, in South Korea. Physicians should consider S. aureus and MDR pathogens in selecting initial empirical antibiotics of HCAP in South Korea.     

"Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly

Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.     

Assessment of elderly people in general practice. 2. Functional abilities and medical problems.

A random sample of 239 patients aged 75 years and over registered with general practitioners in north and north west London was selected for home assessment to determine the functional abilities and medical problems of this group of patients. Nearly one in five of the patients were incontinent of urine (18.4%), although this was on a daily basis for only 4.1%. Around one in 20 patients were incontinent of faeces (5.9%), yet only one patient had laundry service support. Unassisted mobility outdoors was reported as possible by 81.2% of the patients. Fourteen different types of aids were present in the participants' homes, the commonest being walking sticks, bath aids and stair rails. Only a small proportion of aids seemed to be currently unused. The major functional problems were bathing, housework, shopping, washing and ironing, and cooking main meals, but the level of demand for extra help was low. One in five patients had a hearing aid (19.8%) but for only 30% of these patients was it in continuous use. Polypharmacy was common, with 29.7% of patients taking three or more prescribed medicines. The workload implications of this approach to anticipatory care of elderly people are considerable. In an average practice of 2000 patients with 130 patients aged 75 years and over the primary care team would need over 150 hours of face-to-face contact per year with these patients to fulfil the new contractual obligation and the yield of new information leading to effective medical or social intervention is limited.(ABSTRACT TRUNCATED AT 250 WORDS)     

Overlapping medication associated with healthcare switching among Korean elderly diabetic patients

This study was performed to describe the patterns of healthcare switching with overlapping use of anti-diabetic medication in the elderly using the Korea Health Insurance Review and Assessment Service's claims data. The study subjects were ambulatory elderly diabetic patients (ICD-10, E10-14) receiving at least one oral anti-diabetic drug or insulin, and visiting healthcare facilities more than two times between January and December 2005. A total of 457,975 elderly diabetic ambulatory care patients were identified. The mean of visiting frequencies was 9.0 ( ± 3.6) and switching frequencies was 1.5 ( ± 0.8) during 2005. Switching group consisted of 33% of total study subject. Healthcare switching was common in female patients who were older, and had treated polytherapy more in rural areas. The movement among primary care medical services was very common among the patients in the switching group (52.6%). A statistically significant correlation was observed between the healthcare switching and concomitant drug use (rho = 0.96), and overlapping days (rho = 0.57). The use of overlapping anti-diabetic medication increased with the extent of healthcare switching. Further, frequent switching of healthcare between primary clinics was observed. Efforts should be made to establish continuity for the elderly diabetic patients with the identification of frequent switching with overlapping medication.     

Prevalence of hearing problems, and use of hearing aids among a sample of elderly patients.

BACKGROUND. Deterioration of hearing with advancing age is well documented. However, the proportion of elderly people with hearing problems who wear hearing aids is low. AIM. The aim of this study was to assess the prevalence of hearing disability in a group of elderly patients in hospital and to determine their attitudes to hearing difficulties and the wearing of hearing aids. METHOD. A random sample of patients who were convalescing were interviewed. A detailed questionnaire was administered to patients regarding their hearing difficulties. RESULTS. A total of 79 patients were recruited. Twenty two patients were excluded because of low mental test scores, hence 57 patients (72%) were eligible for inclusion into the study. Thirty eight patients were women (mean age 81 years) and 19 were men (mean age 79 years). Thirty patients (53%) reported difficulties with their hearing, of whom 12 had hearing aids. Seventeen patients had consulted their general practitioner about their difficulties, 15 of whom had been referred for audiological examination. Thirteen patients chose not to consult about their hearing problems, to 'suffer in silence'. Of the 12 patients with hearing aids three reported discomfort or pain and five reported problems such as an ill-fitting hearing aid and excessive amplification. Six patients said they wore their hearing aid for less than four hours a day. CONCLUSION. Almost all patients consulting their general practitioner with hearing problems were referred for audiological examination but subsequent follow up, especially of problems with hearing aids, was poor. Better health education and case finding is indicated and patients with hearing aids must be questioned specifically about problems when they consult health professionals. Proper assessment, screening and follow up has implications for resources and training, especially of practice nurses.     

Characteristics of Inpatient Care and Rehabilitation for Acute First-Ever Stroke Patients

Purpose

The purpose of this study was to analyze the status of inpatient care for acute first-ever stroke at three general hospitals in Korea to provide basic data and useful information on the development of comprehensive and systematic rehabilitation care for stroke patients.

Materials and Methods

This study conducted a retrospective complete enumeration survey of all acute first-ever stroke patients admitted to three distinct general hospitals for 2 years by reviewing medical records. Both ischemic and hemorrhagic strokes were included. Survey items included demographic data, risk factors, stroke type, state of rehabilitation treatment, discharge destination, and functional status at discharge.

Results

A total of 2159 patients were reviewed. The mean age was 61.5±14.4 years and the ratio of males to females was 1.23:1. Proportion of ischemic stroke comprised 54.9% and hemorrhagic stroke 45.1%. Early hospital mortality rate was 8.1%. Among these patients, 27.9% received rehabilitation consultation and 22.9% underwent inpatient rehabilitation treatment. The mean period from admission to rehabilitation consultation was 14.5 days. Only 12.9% of patients were transferred to a rehabilitation department and the mean period from onset to transfer was 23.4 days. Improvements in functional status were observed in the patients who had received inpatient rehabilitation treatment after acute stroke management.

Conclusion

Our analysis revealed that a relatively small portion of patients who suffered from an acute first-ever stroke received rehabilitation consultation and inpatient rehabilitation treatment. Thus, applying standardized clinical practice guidelines for post-acute rehabilitation care is needed to provide more effective and efficient rehabilitation services to patients with stroke.     

Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty

Background: Failure of knee arthroplasty can lead to significant pain and functional disability. In a small number of patients with fracture, sepsis or massive bone loss they are considered for arthrodesis or above knee amputation. The purpose of this study was to investigate the results and complications of using customised hinged knee replacements in their place. Methods: Since 1993, 30 of the 280 (10.7%) revision knee replacements in the Avon Orthopaedic Centre, Bristol have used Endo customised hinged knee prostheses (21 rotating, nine fixed) for salvage of limb threatening situations in elderly patients. Surgical indications were 22 low periprosthetic fractures (with or without aseptic loosening), five massive aseptic osteolyses, and three deep infections. Results: The mean length of post-operative hospital stay was just 14.6 days and all patients were discharged walking with aids. At follow up (mean 3.0 years, range 0.5–9.3 years) nine patients had died with their prostheses in situ and functioning. Six patients developed deep sepsis, two of which underwent above knee amputation, and two had received further surgery for septic problems. Two patients required further surgery for prosthetic disarticulation and one patient had successful on table vascular repair. Twenty-five patients had mid- or long- term follow up. Their mean American Knee scores (AKS) were 69.8 for knee and 35.6 for function (maximum 100), with mean total knee flexion 83°. Mean Oxford knee scores (OKS) and WOMAC scores (both scored between 12 and 60 with low score indicating less difficulties) were 34.0 and 30.5, respectively. Conclusions: Customised hinge revision knee replacements gave rapid rehabilitation and hospital discharge. Complications were high but at mid- and long-term review, no prostheses had failed from an aseptic cause and most of the knees of this challenging group were providing both stability and flexion.     

老年髋部骨折患者术后功能恢复的长期强化家庭康复训练

文题释义： 家庭康复训练：主要由主管医师、康复医师、康复治疗师及护理人员指导康复训练,主管医师与康复医师共同评估病情并制定康复训练计划,康复治疗师指导训练内容,护理人员协助加强患者管理。出院时向患者及家属发放康复手册,通过文字及视频内容指导患者院外进行长期强化家庭康复训练。每周通过移动电话、网络工具对患者及家属进行线上随访,要求家属定期录制患者康复的视频,并根据实际状态及时调整康复训练处方。建立网络线上交流群,将患者纳入该群,及时向患者解答康复过程中的疑问,防止康复训练不足及康复过度等情况。 日常生活能力量表(Activity of DailyLiving Scale,ADL)：由美国的Lawton和Brody制定于1969年。由躯体生活自理量表(PSMS)和工具性日常生活能力量表组成。共有14项：一是躯体生活自理量表,共6项,包括上厕所、进食、穿衣、梳洗、行走和洗澡;二是工具性日常生活能力量表,共8项,包括打电话、购物、备餐、做家务、洗衣、使用交通工具、服药和自理经济。主要用于评定被试者的日常生活能力。 背景：老年髋部骨折患者术后存在极高的功能致残率,传统康复更多地关注患者住院期间的康复,而忽视院外家庭康复训练。6个月的强化家庭康复训练已被证实为一种确实有效的方法,但更长时间的家庭训练仍有待进一步研究。 目的：探究进行长期强化家庭康复训练法对老年髋部骨折患者术后功能恢复情况的影响。 方法：前瞻性纳入接受手术治疗的老年髋部骨折患者89例,采用随机数字表法分为试验组42例和对照组47例。对照组采用传统康复训练方法,试验组采用长期强化家庭康复训练法,指导功能锻炼并进行规律随访,利用网络工具及时调整康复计划。2组患者均规律随访12个月,分别在术后3,6,12个月进行日常生活能力评分、6分钟步行试验、髋关节Harris评分、功能独立性测量量表评分、SF-36评分,评估患者术后功能改善情况。研究方案的实施符合成都市第六人民医院的相关伦理要求,参与试验的患病个体对试验过程完全知情同意。 结果与结论：①2组患者术后功能逐渐恢复,试验组患者术后3,6,12个月的日常生活能力评分、功能独立性测量量表评分、6分钟步行试验、Harris评分及SF-36评分均优于对照组(P < 0.05);②结果说明,老年髋部骨折患者术后长期强化家庭康复训练法可提高患者日常生活能力,改善患者生活质量,但该康复计划及其疗效仍需要进一步研究。 ORCID: 0000-0002-0570-9065(王可心) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Patterns of care for the elderly in general practice

Little is known about the care provided for the elderly by general practitioners. This study is based on data from 89 030 consultations with patients of all ages of which 17 771 were with patients over 65 years of age. It was found that general practitioners carry out more follow-up work with their elderly patients than with their younger patients and they make more home visits and referrals to nursing and social services. However, they do less investigative work with elderly patients and the level of referral to consultants is the same for patients of all ages. Considerable variation was found between doctors in the pattern of care provided for older patients. The proportion of elderly patients on the list of a general practitioner had little effect on his overall workload. The implications of these findings for health service research and planning are discussed.     

Glaucoma patient-provider communication about vision quality-of-life

ObjectiveThe purpose of this study was to: (a) describe the extent to which ophthalmologists and glaucoma patients discuss vision quality-of-life during office visits, and (b) examine the association between patient and ophthalmologist characteristics and provider-patient communication about vision quality-of-life.MethodsPatients with glaucoma who were newly prescribed or on glaucoma medications were recruited at six ophthalmology clinics. Patients’ visits were video-tape recorded and quality-of-life communication variables were coded. Generalized estimating equations were used to analyze the data.ResultsTwo hundred and seventy-nine patients participated. Specific glaucoma quality-of-life domains were discussed during only 13% of visits. Older patients were significantly more likely to discuss one or more vision quality-of-life domains than younger patients. African American patients were significantly less likely to make statements about their vision quality-of-life and providers were less likely to ask them one or more vision quality-of-life questions than non-African American patients.ConclusionEye care providers and patients infrequently discussed the patient’s vision quality-of-life during glaucoma visits. African American patients were less likely to communicate about vision quality-of-life than non-African American patients.Practice implicationsEye care providers should make sure to discuss vision quality-of-life with glaucoma patients.     

Cognitive appraisals,distress and disability among persons in low vision rehabilitation

Objective Examined cognitive appraisals of interference and tolerance in the prediction of distress and self‐reported disability among persons presenting for low vision rehabilitation. Design Cross‐sectional; correlational and path analyses. Methods One‐hundred and thirteen patients (mean age, 71 years; 52 men and 61 women) presenting for low vision rehabilitation at a university‐based centre for low vision rehabilitation participated in an initial clinical vision examination and completed several questionnaires to evaluate cognitive appraisals, emotional distress and self‐reported disability. Results Path analyses indicated that greater tolerance was associated with less interference imposed by vision loss. Greater tolerance was also associated with less emotional distress and symptom severity (visual acuity) was associated with self‐reported disability. Cognitive appraisals (tolerance and interference) indirectly influenced self‐reported disability through emotional distress. Conclusions The data indicate that appraisals of personal ability to tolerate vision loss and the perceived interference of vision loss on goal‐directed behaviour and expected activities have greater influence on distress and are subsequently predictive of disability in comparison with objective symptoms (visual acuity). Implications for clinical interventions and further research are discussed.     

Motor recover during the acute period of craniocerebral trauma using kinetotherapy

The aim of the present work was to assess the influences of age, gender, and the severity of brain trauma on recovery of motor function using kinetotherapy. The study included 131 patients (99 men and 32 women) investigated during the acute phase of trauma in the Department of Brain Trauma, Clinical Hospital, Kaunas Medical University. After stabilization, 80 patients were transferred to the neurorehabilitation clinic and 51 were transferred to other rehabilitation centers. Motor function in the patients was assessed using the Clinical Outcomes Variable Scale (COVS) at the beginning and end of the acute trauma period and during early rehabilitation, i.e., at the beginning, 25 days later, and on completion. During the acute trauma period, patients had impairments to the abilities to turn over, sit, maintain balance while sitting, to move horizontally and vertically, walk, and use mobility aids, along with reductions in walking duration and speed, and difficulty in wheelchair mobility and hand functions. Kinetotherapy yielded high or intermediate levels of efficacy in 90% of the patients. The efficacy of kinetotherapy was significantly greater in young patients than in elderly and old patients (p < 0.05). Gender and trauma severity had no statistically significant effects on the efficacy of kinetotherapy (p > 0.05).