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Lifestyle and rehabilitation during the COVID-19 pandemic: guidance for health professionals and support for exercise and rehabilitation programs.
Goulart, CDL, Silva, RN, Oliveira, MR, Guizilini, S, Rocco, IS, Mendez, VMF, Bonjorno, JC, Caruso, FR, Arena, R, Borghi-Silva, A
Expert review of anti-infective therapy. 2021;(11):1385-1396
Abstract
Introduction: The coronavirus disease-2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and healthcare professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.Areas covered: In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.Expert opinion: We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.
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Enhanced Recovery After Thoracic Surgery.
Haywood, N, Nickel, I, Zhang, A, Byler, M, Scott, E, Julliard, W, Blank, RS, Martin, LW
Thoracic surgery clinics. 2020;(3):259-267
Abstract
Enhanced recovery pathways (ERPs), used across multiple surgical subspecialties, is a multidisciplinary delivery of perioperative care designed to lessen the psychological stress of patients undergoing surgery. Thoracic ERP has been implemented but is not widespread, and variations exist between programs. Evidence of the benefit of thoracic ERP is emerging. This article presents common components of a thoracic surgery ERP and reviews contemporary outcomes.
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Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases.
Spruit, MA, Wouters, EFM
Respirology (Carlton, Vic.). 2019;(9):838-843
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Abstract
Adult patients with chronic respiratory diseases may suffer from multiple physical (pulmonary and extra-pulmonary), emotional and social features which necessitate a comprehensive, interdisciplinary rehabilitation programme. To date, pulmonary rehabilitation programmes show a lot of variation in setting, content, frequency and duration. Future projects should strive for a standard set of assessment measures to identify patients eligible for pulmonary rehabilitation, taking disease complexity into consideration, which should result in referral to an appropriate rehabilitation setting. Local circumstances may complicate this crucial endeavour.
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Rehabilitation, the Great Absentee of Virtual Coaching in Medical Care: Scoping Review.
Tropea, P, Schlieter, H, Sterpi, I, Judica, E, Gand, K, Caprino, M, Gabilondo, I, Gomez-Esteban, JC, Busnatu, S, Sinescu, C, et al
Journal of medical Internet research. 2019;(10):e12805
Abstract
BACKGROUND In the last few years, several studies have focused on describing and understanding how virtual coaches (ie, coaching program or smart device aiming to provide coaching support through a variety of application contexts) could be key drivers for health promotion in home care settings. As there has been enormous technological progress in the field of artificial intelligence and data processing in the past decade, the use of virtual coaches gains an augmented attention in the considerations of medical innovations. OBJECTIVE This scoping review aimed at providing an overview of the applications of a virtual coach in the clinical field. In particular, the review focused on the papers that provide tangible information for coaching activities with an active implication for engaging and guiding patients who have an ongoing plan of care. METHODS We aimed to investigate the use of the term virtual coach in the clinical field performing a methodical review of the relevant literature indexed on PubMed, Scopus, and Embase databases to find virtual coach papers focused on specific activities dealing with clinical or medical contexts, excluding those aimed at surgical settings or electronic learning purposes. RESULTS After a careful revision of the inclusion and exclusion criteria, 46 records were selected for the full-text review. Most of the identified articles directly or indirectly addressed the topic of physical activity. Some papers were focused on the use of virtual coaching (VC) to manage overweight or nutritional issues. Other papers dealt with technological interfaces to facilitate interactions with patients suffering from different chronic clinical conditions such as heart failure, chronic obstructive pulmonary disease, depression, and chronic pain. CONCLUSIONS Although physical activity is a healthy practice that is most encouraged by a virtual coach system, in the current scenario, rehabilitation is the great absentee. This paper gives an overview of the tangible applications of this tool in the medical field and may inspire new ideas for future research on VC.
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[Physical Activity Recommendations for Adults with a Chronic Disease: Methods, Database and Rationale].
Pfeifer, K, Geidl, W
Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)). 2017;(S 01):S29-S35
Abstract
This paper describes the development of generic physical activity recommendations for adults (18-65 years) with a chronic disease. The physical activity recommendations were developed based on existing recommendations using a 3-phased process. Phase 1: Systematic literature searches for current physical activity recommendations for 7 chronic diseases. Phase 2: Evaluation of physical activity recommendations on the basis of 28 quality criteria; identification and content analysis of high-quality recommendations. Phase 3: Summary of content analysis and deduction of physical activity recommendations for 7 chronic diseases. Synthesis of the 7 recommendations to generate generic German physical activity recommendations for adults with chronic diseases. The quality rating identified 37 high-class physical activity recommendations (n = number); 18 reviews of physical activity recommendations and meta-analysis regarding health effects of physical activity were additionally included (number in brackets): osteoarthrosis of the hip and the knee n=9 (+6), chronic obstructive pulmonary disease (COPD) n=4 (+1), stable ischemic heart disease n=2 (+2), stroke n=8 (+5), major clinical depression n=6 (+0), chronic unspecific low back pain n=5 (+4). Synthesis of content analysis (available recommendations, health effects, dosage and dose-response-effects, risk assessment) led to the development of generic physical activity recommendations for adults with a chronic disease. Physical activity enhances the health of adults with chronic diseases. The benefits of regular physical activity include improved physical functioning, maintenance of independence, enhanced psychosocial well-being and quality of life, improved symptoms and reduced comorbidities. But, people with chronic diseases who have enhanced physical activity levels may also be at increased risk. Nevertheless, adapted, individualized physical activity is safe and with little risk. The generic physical activity recommendations for adults with chronic conditions provide an evidence-based and quality-controlled basis for physical activity promotion of the target group.
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Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: a systematic review and meta-analysis of randomised controlled studies.
Beck, AM, Dent, E, Baldwin, C
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2016;(6):733-745
Abstract
BACKGROUND Nutritional intervention is increasingly recognised as having an important role in functional rehabilitation for older people. Nonetheless, a greater understanding of the functional benefit of nutritional interventions is needed. METHODS A systematic review and meta-analysis examined randomised controlled trials (RCTs) published between 2007 and 2014 with the aim of determining whether nutritional intervention combined with rehabilitation benefited older people with reduced functional ability. Six electronic databases were searched. RCTs including people aged 65 years and older with reduced physical, social and/or cognitive function were included. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and gradepro computer software (http://gradepro.org) was used for the quality assessment of critical and important outcomes. Included studies considered to be clinical homogenous were combined in a meta-analysis. RESULTS Of the 788 studies screened, five were identified for inclusion. Nutritional intervention given with functional rehabilitation improved energy and protein intake, although it failed to provide any improvement in final body weight, hand-grip strength or muscle strength. There was no difference between groups in the critical outcomes; balance, cognition, activities of daily living and mortality at long-term follow-up. Nutritional intervention given with functional rehabilitation was associated with an increased likelihood of both mortality (odds ratio = 1.77; 95% confidence interval = 1.13-2.76) and hospitalisation (odds ratio = 2.29; 95% confidence interval = 1.10-4.79) during the intervention. Meta-analysis of the baseline data showed that, overall, the intervention cohort had a lower body weight and cognition. CONCLUSIONS This meta-analysis highlights concerns regarding the quality of the randomisation of participants at baseline. Future high-quality research is essential to establish whether older people with loss of functional abilities can benefit from nutritional intervention.
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A Systematic Review of Montessori-Based Activities for Persons With Dementia.
Sheppard, CL, McArthur, C, Hitzig, SL
Journal of the American Medical Directors Association. 2016;(2):117-22
Abstract
OBJECTIVES Montessori-based activities are becoming a popular approach for the care of older adults living with dementia. The aim of this study was to systematically assess the quality of the research examining the benefits of Montessori-based activities for persons with dementia. METHODS Six peer-reviewed databases were systematically searched for all relevant articles published until April 2015. Included articles were peer-reviewed studies published in English that employed Montessori-based activities with persons with dementia. Methodological quality was assessed by 2 independent raters using the Physiotherapy Evidence Database Scale or the Downs and Black evaluation tool. Levels of evidence were assigned to the study design using a modified Sackett scale. RESULTS One hundred fifty articles were identified, and 14 were selected for inclusion. Level-2 evidence examining the impact of Montessori-based activities on eating behaviors suggested that difficulties with eating could be reduced with Montessori training. There was limited level-4 evidence for the benefits of Montessori-based activities on cognition, wherein benefits appeared to be specific to lower-level cognitive abilities including memory and attention. Finally, there is level-1 (n = 1), level-2 (n = 3), and level-4 (n = 6) evidence for the benefits of Montessori-based activities on engagement and affect, whereby constructive engagement and positive affect were heightened. DISCUSSION Overall, there is a strong level of evidence for the benefits of Montessori-based activities on eating behaviors and weak evidence for the benefits on cognition. Evidence for the benefits of Montessori-based activities on engagement and affect are mixed. Future research is needed to examine the long-term benefits of Montessori-based activities.
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[Health promotion, prevention, and rehabilitation in the elderly].
Mau, W, Reuter, S
Deutsche medizinische Wochenschrift (1946). 2011;(43):2199-204
Abstract
Considering the increasing disability with higher age and the demographic changes health promotion, prevention and rehabilitation are of high relevance for the maintenance and restoration of activity and participation of the elderly. Among the most important goals of prevention are mobility including physical activity and prevention of falls, adequate nutrition, maintenance of mental health, social integration and function. Different conditions of geriatric rehabilitation in Germany focussing either on acute care hospitals with early rehabilitation (inpatient or outpatient) or on rehabilitation in specialized centres lead to regional disparities. The application for rehabilitation measures has to consider the need, ability to participate, specified goals and prognosis after the interventions. Disease specific rehabilitation has to be differentiated from general geriatric rehabilitation addressing typical multimorbidity and geriatric syndromes. Significant characteristics of geriatric rehabilitation are regular patient oriented discussions within the multi-professional and interdisciplinary team coordinated by geriatricians. This includes prioritizing the patient's problems according to their significance and availability of effective therapy, evaluation of the results and adjustment of treatment goals if necessary. Standardised geriatric assessments should be applied. Geriatric rehabilitation including the interdisciplinary team increases function and reduces the risks of nursing home admissions and mortality. Therefore, the access to and the capacities of geriatric rehabilitation should be further improved.
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Cardiac rehabilitation: a contemporary review.
Braverman, DL
American journal of physical medicine & rehabilitation. 2011;(7):599-611
Abstract
Cardiac rehabilitation is increasingly recognized as an essential part of the continuum of care for patients with cardiovascular disease. The discipline has evolved over the last 15 yrs to reflect the importance of targeted initiatives in the management of cardiovascular risk factors. Changes in program scope have broadened to shift the emphasis away from primarily focusing on exercise therapy to embracing a comprehensive secondary prevention strategy addressing the multiple medical, exercise, nutritional, and behavioral factors that place a patient at increased risk of a subsequent cardiac event. Cardiac rehabilitation is a class I recommendation in most current cardiovascular clinical practice guidelines. Despite the large body of literature verifying the sizeable morbidity and mortality benefits, cardiac rehabilitation services are vastly underused. The implementation of recent performance measures will provide the potential to boost referral to, enrollment in, and completion of cardiac rehabilitation programs. The goals, core components, benefits, risks, and outcome measures of cardiac rehabilitation will be reviewed.