Systematic review of physical activity intervention studies after cardiac rehabilitation

Coronary heart disease significantly impacts the morbidity, mortality, and health care economy of our population. Enrollment into cardiac rehabilitation (CR) after cardiac events improves patient outcomes; however, physical activity (PA) behavior decreases significantly in the years following completion of CR. This article reviews the literature regarding interventions to maintain or increase PA after CR. Fourteen interventions studies from North America, Europe, Asia, and Australia used variations of cognitive and/or behavioral strategies. Women and older adults were underrepresented in the reviewed studies. Measurement of PA varied between studies and included self-report, objective pedometer or accelerometer data, or questionnaire format. Common cognitive interventions included self-efficacy enhancement measures, barrier management, and problem solving. Behavioral interventions included self-monitoring, prompting, goal setting, and feedback. Cognitive intervention studies reported inconsistent results, whereas behavioral studies and studies that used combinations of interventions reported more consistent, positive findings. More intervention studies, using rigorous designs and reliable measures of PA on larger, more diverse populations, are needed to improve the understanding of PA-related behavior change after completion of CR.     

Conceptual framework for rehabilitation in the Czech Republic: a proposal

PURPOSE: To propose a conceptual basis for a rehabilitation system in the Czech Republic (CR) founded on the WHO International Classification on Functioning (ICF). METHODS: Surveying the present state of rehabilitation in the CR using data from The Institute for Health Information and Statistics of the CR, studying the available literature of medical rehabilitation as well as the WHO ICF. RESULTS: At present the rehabilitation system in the CR is not adequate, mainly from the qualitative point of view, and requires a legal framework that would determine the availability of appropriate rehabilitation services. CONCLUSION: The WHO ICF can serve as a conceptual basis for the framework.     

Conceptual framework for rehabilitation in the Czech Republic: a proposal

Purpose : To propose a conceptual basis for a rehabilitation system in the Czech Republic (CR) founded on the WHO International Classification on Functioning (ICF). Methods : Surveying the present state of rehabilitation in the CR using data from The Institute for Health Information and Statistics of the CR, studying the available literature of medical rehabilitation as well as the WHO ICF. Results : At present the rehabilitation system in the CR is not adequate, mainly from the qualitative point of view, and requires a legal framework that would determine the availability of appropriate rehabilitation services. Conclusion : The WHO ICF can serve as a conceptual basis for the framework.     

Prehabilitation. An Interdisciplinary Patient-Centric Conceptual Framework

ObjectivesTo review the recent literature around patient-centric prehabilitation in oncology patients and propose a conceptual framework to inform development of interdisciplinary prehabilitation services leading to focused, individualized prehabilitation interventions.Data SourcesA review of recent peer-reviewed literature, national guidance, and government strategy on prehabilitation in oncology patients.ConclusionPatient- centric prehabilitation is key to improving patient's experiences of cancer throughout the cancer journey while improving population health and reducing financial costs. Successful personalized prehabilitation interventions are comprised of an interplay between individual interdisciplinary roles, as illustrated in the conceptual framework. The role of the nurse underpins this whole process in patient screening, assessment, implementation of the intervention, and patient reassessment, ensuring care is dynamic and tailored to patient need.Implications for Nursing PracticeThe review has discussed the key role that nurses play in the process but warrants more research in the area. The conceptual framework provides a basis to develop interdisciplinary prehabilitation services underpinned by the nurse's role. The review advocates the use of educational interventions to equip all health professionals with prehabilitation knowledge to enable interdisciplinary prehabilitation services to be developed.     

DGRW-update: patient education

Patient education programmes, i.?e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge.     

Understanding and enhancing patient compliance with diabetic regimens

Behavioral research on patient compliance with regimens to manage diabetes has suffered from lack of conceptual rigor, although a handful of recent studies and reviews are more theoretically oriented. The present review proposes a comprehensive conceptual framework in the context of learning theory to explain patient compliance and to derive approaches for enhancing compliance. The conceptual framework is the health belief model (HBM) expanded to include the concept of perceived self-efficacy. This expanded model may both serve as an agenda for future research as well as a set of guidelines for the education of patients with diabetes. A variety of educational interventions is recommended for use in patient education provided they succeed in reinforcing relevant health beliefs, behavioral skills, and the sense of self-efficacy. The problem of long-term maintenance, of particular significance in chronic disease management, is addressed by the relapse prevention model derived from social learning theory and emphasizing self-efficacy and the learning of coping skills.     

Behavioral facilitation of medical treatment for headache--part II: Theoretical models and behavioral strategies for improving adherence

This is the second of 2 articles addressing the problem of noncompliance in medical practice and, more specifically, compliance with headache treatment. The companion paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance in headache care (Behavioral Facilitation of Medical Treatment for Headache--Part I: Review of Headache Treatment Compliance). The present paper first summarizes relevant health behavior theory to help account for the myriad biopsychosocial determinants of adherence, as well as patient's shifting responsiveness or "readiness for change" over time. Appreciation of health behavior models may assist in optimally tailoring interventions to patient needs through instructional, motivational, and behavioral treatment strategies. A wide range of specific cognitive and behavioral compliance-enhancing interventions are described, which may facilitate treatment adherence among headache patients. Strategies address patient education, patient/provider interaction, dosing regimens, psychiatric comorbidities, self-efficacy enhancement, and other behavioral interventions.     

Effectiveness of follow-up booster sessions in improving physical status after cardiac rehabilitation: health, behavioral, and clinical outcomes.

There is limited research on booster interventions designed to maintain/improve health outcomes following cardiac rehabilitation (CR). The purpose of this study was to examine the effects of a booster intervention on health, behavioral, and clinical physical status outcomes among CR graduates randomly assigned to one of three groups: structured educational/counseling sessions by telephone ( n = 24), clinic ( n = 20), or usual care ( n = 20). The sessions were provided at 3 and 9 weeks following Phase II CR. A repeated measures experimental design was used to examine outcomes at baseline (completion of CR) and at 3 and 6 months. Although the effects of the booster interventions were not significant, there was evidence to suggest that a booster intervention, compared with usual care, had a positive effect on patients' physical functioning, adherence to the exercise program, frequency of exercise, heart rate, and blood pressure.     

冠心病PCI术后患者心脏康复认知现状及影响因素分析*

目的: 探讨冠心病PCI术后的患者心脏康复认知水平,分析影响心脏康复认知水平的相关因素。方法: 采用一般资料调查表、冠心病健康信念量表、自制心脏康复认知度量表对首次行PCI术的115例冠心病患者进行现况调查。结果: 冠心病PCI术后患者的心脏康复认知水平得分为(14.54±3.69)分,处于中下水平;年龄、文化程度、是否接受过相关知识宣教、知觉到益处及知觉到严重度影响冠心病患者的心脏康复认知水平（P<0.05）。结论: 冠心病PCI术后患者的心脏康复认知水平处于中下水平,有较大提升空间。医护人员可针对年龄较大、文化程度较低的冠心病患者开展个性化的心脏康复知识宣教,以促进患者更好地了解心脏康复的益处、改善患者的心脏康复认知现状,从而提高患者心脏康复的依从性及参与水平。     

脑卒中患者早期康复治疗的成本-效果分析

目的对脑卒中患者三级康复治疗期间的第一阶段康复治疗作成本-效果的经济学分析评价。方法52例脑卒中患者在脑梗死和脑出血二个层次上按区组随机化纳入到治疗组和对照组。治疗组给予规范的一级早期康复治疗；对照组不给予规范的一级早期康复治疗，但是一般的常规内科治疗同治疗组。分别采集2组患者自发病到发病后1个月的直接医疗费用、直接非医疗费用和间接费用以及各费用的详细构成。对每例样本在入选时(V0)和发病后第1个月(V1)分别采用功能综合评定量表进行评价。结果治疗组患者的功能改善明显较对照组为佳，2组患者总费用之间无明显差别；不管是运动功能、认知功能．还是综合功能评分每改善1分，治疗组所耗费的相关成本费用明显较对照组为低，对照组相关费用约是治疗组的3～5倍。结论三级康复中的第一阶段康复治疗，即一级早期康复是经济的、有效的康复治疗方案。     

Treatment of post‐traumatic stress disorder in patients with severe mental illness: A review

Although the prevalence of post‐traumatic stress disorder (PTSD) is high among those with severe mental illness, little is known about the use of interventions to lessen the burden of PTSD in this population. Currently, there are limited data about safe and effective interventions to treat these individuals. This systematic published work review presents the scientific published work reporting studies of psychological treatment approaches for individuals with comorbid PTSD and severe mental illness. A secondary aim of this study was to identify the specific models implemented and tested, and their impact upon patient outcomes. A review of the published work from January 2001 through January 2012 of English‐language publications retrieved from the Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and the American Psychological Association generated abstracts (PsycINFO) databases was conducted. Six studies met the inclusion criteria for the review. The treatment programs described were cognitive–behavioural therapy, psychoeducation, exposure‐based cognitive–behavioural therapy, and eye movement desensitization and reprocessing. Evidence of the effectiveness of these programs is examined. Data to support the use of these interventions are limited, indicating the need for further research and efficacy trials. Future areas of research and implications for nursing are discussed.     

Inefficient management of personal health in oral anticoagulation. Home nursing care in primary health care

This case report describes an 83 year-old immobilised patient with multiple diseases and on polypharmacy. Nursing care is developed at home. The patient is included in patient care programs for the anticoagulated and polymedicated patient. Nursing assessments were made using the Marjory Gordon functional health patterns, by which we identified, among others, problems related to non-compliance with the pharmacological treatment. The Nurse's Diagnosis was: Ineffective Management of own health. With the support of NANDA, NOC and NIC taxonomy we determined the nursing objectives and interventions. The expected results of the Care Plan were achieved. Polypharmacy in the elderly can lead to treatment problems, increasing hospital admissions, morbidity and mortality and health expenditure Nursing care at home is a continuous development process and is increasing due to aging of the population, the prevalence of chronic diseases, as well as the increased life expectancy. It is estimated that in 2030, 24% of the Spanish population will be over 64 years. The physical, sensory, cognitive and chronic disabilities of aging make this type of care necessary. It is a major element in the comprehensive care of these patients, by checking the correct use of medication, symptom control, helping them to be autonomous in managing their disease and establishing a fluid relationship between the patients and their family.     

Development of guidelines for rehabilitation of patients with stroke: analysis of therapeutic procedures

The Federal Insurance Institute for Salaried Employees (BfA, Bundesversicherungsanstalt für Angestellte) in Berlin took the initiative to develop evidence-based guidelines for rehabilitation including stroke rehabilitation. In the present study we performed a systematic survey of the scientific literature on stroke rehabilitation and deduced 8 evidence-based therapeutic modules. They were supplemented by 5 practice-based modules to cover the full range of interventions currently applied in stroke rehabilitation. Modules are clusters of various interventions which were aggregated according to the rehabilitative goal they have in common. Data were analysed from 8,876 BfA patients, the total population of "neuro"-patients in 2001 and 2002 with 142,951 interventions and 1,071,885 appointments. Stroke diagnoses covered ICD-10 codes I60, I61, I62, I63, I64 or were coded by G45, G81 and one of these I-codes. Stroke rehabilitation as provided in daily practice was found to be a complex multimodal treatment programme in all hospitals which were studied. On average, patients receive treatments from 7.3 therapeutic modules. A dominating role is played by "motor modules". Obviously, they play a major role in acute stroke rehabilitation in all hospitals compared to cognitive retraining, language therapy and especially improvement of psychic functions, which were significantly less applied. A dramatic variation could be shown to exist between the rehabilitation hospitals (1) with respect to the number of patients who were treated with a given module (e. g., some modules showed variations between 18 % and 100 %), and (2) with respect to treatment intensity and treatment duration per week. Several factors can be taken into account for interpretation of this high variance. Intrinsically, the high variation in symptomatology after stroke can play a major role, as both the deficit profile and the level of severity of a given deficit and the combined severity level can vary from patient to patient. On the other hand, extrinsic factors such as lack of staff may also account for some of the differences. In any case, the results show the necessity to optimize stroke rehabilitation by development and implementation of guidelines. Yet, they also point to a need for further research into rehabilitation interventions and procedures to yield evidence for the approximately 30 % of "only" practice-based interventions.     

冠心病患者心脏康复相关知识认知及影响因素研究

目的 调查冠心病患者对心脏康复相关知识认知的现状并分析其影响因素.方法 选取重庆市某三级甲等医院及心脏康复中心2019年8月-2020年5月收治的220例冠心病患者,采用一般资料问卷和中文版冠状动脉教育问卷-简版对其进行调查.结果 冠心病患者对心脏康复相关知识认知总分为(13.35±4.62)分,不同居住地、合并症、文...     

Positive outcomes in traumatic brain injury-vegetative state: patients treated with bromocriptine

OBJECTIVE: To assess the effects of multidisciplinary rehabilitation interventions and use of bromocriptine on outcome in patients with traumatic brain injury-vegetative state (TBI-VS). DESIGN: Retrospective review of clinical cases. SETTING: Free-standing rehabilitation hospital; Acute and extended rehabilitation hospital. PARTICIPANTS: Five consecutive TBI-VS patients, as well as 33 TBI-VS patients and 37 traumatic brain injury-minimally conscious state (TBI-MCS) patients reported in the literature. INTERVENTIONS: Bromocriptine administration, systematic neuropsychologic testing, sensory stimulation, and traditional comprehensive rehabilitation with physical therapy, occupational therapy, and speech therapy. MAIN OUTCOME MEASURES: Disability Rating Scale (DRS) at 1, 3, 6, and 12 months postinjury and FIM instrument scores at 1 month and 12 months postinjury, Coma Recovery Scale, and Barry Rehabilitation Inpatient Screening of Cognition. RESULTS: The 5 TBI-VS patients emerged from a VS into a MCS and regained functional status. Their recovery of physical and cognitive functioning, as rated by the DRS, was greater than previously reported in the literature for patients in a VS or MCS at 3, 6, and 12 months postinjury. CONCLUSION: Bromocriptine administration, systematic neuropsychologic testing, sensory stimulation, a comprehensive rehabilitation program, or a combination of these treatments may enhance functional recovery in this TBI-VS patient group. Further systematic study to quantify the contribution of these variables and to reproduce this data in a larger patient population should be performed.