Purpose: Maintenance cardiac rehabilitation (M-CR) programs aim to preserve the health benefits achieved during phase II cardiac rehabilitation (CR). The aim of this study was to establish the effects of M-CR on functional capacity, quality of life, risk factors, costs, mortality, and morbidity, among other outcomes. Methods: Scopus, ISI Web of Science, PubMed, Embase & Embase classic OVID, and Lilacs were searched. Randomized controlled trials, published between 2000 and 2016, on the effects of M-CR in patients with cardiovascular disease, who had graduated from CR, having a control or comparison arm were included. Citations were processed by two authors, independently. Methodological quality was assessed using PEDro, and level of evidence graded with the Scottish scale. Outcomes were qualitatively synthesized. Results: The searches retrieved 1901 studies with 26 articles meeting inclusion criteria (3752 participants). Some trials tested M-CR in nonclinical settings, and others used resistance or high-intensity interval training. The methodological quality of 11 articles was good, with a level of evidence (1+) and a grade B recommendation. Results showed M-CR resulted in increased or maintained functional capacity, quality of life, and physical activity levels, when compared with the control. No adverse events were reported. Few studies assessed rehospitalizations and mortality. Conclusion: Quality of included trials was low because it is not possible to double-blind in M-CR trials and also due to the heterogeneity of M-CR interventions. Understanding, availability, and use of M-CR programs should be increased.

BackgroundStudies exploring long COVID condition (LCC) in low- and middle-income countries are scarce. Further characterization of LCC patients experiencing activity limitations and their associated healthcare use is needed. This study aimed to describe LCC patients’ characteristics, its impact on activities, and associated healthcare use in Latin America (LATAM).ParticipantsIndividuals who (cared for someone or) had COVID-19 and could read, write, and comprehend Spanish and lived in a LATAM country were invited to complete a virtual survey. Sociodemographic characteristics, COVID-19 and LCC symptoms, activity limitations, and healthcare use.ResultsData from 2,466 people from 16 countries in LATAM were analyzed (females = 65.9%; mean age of 39.5 ± 53.3 years). 1,178 (48%) of the respondents had LCC symptoms (≥3 months). These were more likely to have COVID-19 earlier in the pandemic, were older, had no COVID vaccines, had more comorbidities, needed supplementary oxygen, and reported significantly more COVID-19 symptoms during the infectious period. 33% of the respondents visited a primary care provider, 13% went to the emergency department, 5% were hospitalized, 21% visited a specialist, and 32% consulted ≥1 therapist for LCC symptoms mainly extreme fatigue, sleep difficulties, headaches, muscle or joint pain, and shortness of breath with activity. The most consulted therapists were respiratory therapists (15%) and psychologists (14%), followed by physical therapists (13%), occupational therapists (3%), and speech pathologists (1%). One-third of LCC respondents decreased their regular activities (e.g., work, school) and 8% needed help with activities of daily living (ADLs). LCC respondents who reduced their activities reported more difficulty sleeping, chest pain with activity, depression, and problems with concentration, thinking, and memory, while those who needed help with ADLs were more likely to have difficulty walking, and shortness of breath at rest. Approximately 60% of respondents who experienced activity limitations sought a specialist and 50% consulted therapists.Conclusions and relevanceResults supported previous findings in terms of the LCC demographics, and provided insight into LCC impact on patients’ activities and healthcare services used in LATAM. This information is valuable to inform service planning and resource allocation in alignment with the needs of this population.

Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

Introduction: Numerous definitions of acute low back pain (aLBP) exist. The use of different definitions results in variability in reported prevalence or incidence, conflicting data regarding factors associated with the transition to chronic LBP (cLBP), and hampers comparability among studies.Objective: Here, we compare the impact of 3 aLBP definitions on the number of aLBP cases and participants' characteristics and explore the distribution of participants across definitions. Methods: A sample of 1264 participants from the Quebec Low Back Pain Study was included. Three definitions of aLBP were used:(1) not meeting the National Institutes of Health (NIH) cLBP definition ("nonchronic"), (2) pain beginning ,3 months ago ("acute"), and (3) pain beginning ,3 months with a preceding LBP-free period ("new episode"). Results: There were 847, 842, and 489 aLBP cases meeting the criteria for the 3 definitions, respectively. Participants included in the "nonchronic" had lower pain interference, greater physical function scores, and fewer participants reporting .5 years of pain than in the other definitions. Half the participants meeting the "acute" definition and one-third of participants meeting the "new episode" definition were also classified as cLBP based on the NIH definition. Conclusions: Our results highlight the importance of the definition used for aLBP. Different definitions influence the sample size and clinical profiles (group's characteristics). We recommended that cohort studies examining the transition from aLBP to cLBP ensure that the definitions selected are mutually exclusive (ie, participants included [aLBP] differ from the expected outcome [cLBP]).

Supplemental Digital Content is Available in the Text.We provide reference values and internal consistency for the Canadian version of the National Institutes of Health minimum dataset for chronic low back pain research.

ObjectivesDeveloping solutions to optimize care trajectories (CareTs) requires examining patient journeys through the health care system. This study aimed to describe CareTs among people living with arthritis and evaluate their association with self-reported health outcomes.MethodsAnalyses were conducted using the TorSaDE Cohort (n = 102,148), which connects the 2007 to 2016 Canadian Community Health Surveys (CCHS) with Quebec administrative databases (longitudinal claims). CareTs of participants living with arthritis according to CCHS (n = 16,631), over the two years before CCHS completion, were clustered using state sequence analysis (months as a time unit). CareT group membership was then put in association with self-reported outcomes (pain intensity and interference, self-perceived general and mental health).ResultsThe analysis revealed five CareT groups characterized predominantly by: (1) arthritis-related visits to a specialist (n = 2,756; 16.6%), (2) arthritis-related emergency department visits (n = 2,928; 17.6%), (3) very high all-cause health care utilization and arthritis-related hospitalizations (n = 1,570; 9.4%), (4) arthritis-related medical visits to general practitioners and specialists (n = 2,708; 16.3%), (5) low all-cause health care utilization (n = 6,669; 40.1%). Multivariable results revealed that CareT group membership was associated with higher levels of pain interference (CareT group #3 vs. #5: OR: 1.4, 95%CI: 1.1–1.8) and fair/poor self-perceived general health (CareT group #1 vs. #5: OR: 1.551, 95%CI: 1.319–1.824; #2 vs. #5: OR: 1.244, 95%CI: 1.062–1.457; #3 vs. #5: OR: 1.771, 95%CI: 1.451–2.162; #4 vs. #5: OR: 1.481, 95%CI: 1.265–1.735).DiscussionSate sequence analysis is an innovative method of studying CareTs and valuable for making evidence-based decisions taking into account inter- and intra-individual variability.

BackgroundRehabilitation therapies are still in the early stages of development in Honduras. At the present time there are no formal training opportunities in Honduras to support the learning needs of health professionals and healthcare workers who specialize in neurological rehabilitation. Support and development of those delivering rehabilitation services from community engaged academic collaborations outside of Honduras can enhance the learning and knowledge of healthcare workers. The purpose of this study was to evaluate reaction and learning linked to two continuing educational workshops for rehabilitation workers in northern Honduras. MethodsThe study design was a pretest-posttest design. The workshops were conducted in a rehabilitation center and a family support organization located in northern Honduras in September 2017.Faculty from Canada and Colombia, together with health professionals from Honduras, facilitated two workshops. Seventeen participants attended the ‘Acquired brain injury/spinal cord injury workshop’ (adult workshop); 15 attended the ‘Rehabilitation for children with impaired neuromotor development workshop’ (pediatric workshop). Participants completed three questionnaires: sociodemographic, knowledge, and Modified Stages of Learning Questionnaires (MSLQ), and three after: Modified Kirkpatrick, knowledge, MSLQ. ResultsWorkshop participants were physiotherapists, physicians, nurses, educational professionals and other non-physiotherapists. Most agreed that the workshops had positive effects in reaction (engagement, relevance, satisfaction), and learning (skills, attitude, confidence and commitment). Stages of Learning changed from scanning/evaluation to learning/experience (p<0.05) in three out of six topics in the pediatric workshop. Three of the knowledge questions showed important learning effects. ConclusionsWorkshops offered to the neurological rehabilitation healthcare workers in Honduras through an international collaboration resulted in enhanced learning and knowledge of participants. This has the potential to improve quality of care for people with neurological conditions in the region.