ecreased mobility is one of the major concerns for patients who suffer a stroke.1 Demand for stroke rehabilitation exceeds supply, and because length of hospital stay is decreasing, new approaches to deliver rehabilitation are needed to improve health outcomes and promote independent living. Early Supported Discharge and Home Rehabilitation services for patients who have suffered a stroke offer an approach to managing rising demand for hospital beds and seem to achieve comparable clinical outcomes to inpatient rehabilitation.2,3 Shorter lengths of stay, however, can mean less access to therapists, potentially less recovery, and more burden to the caregiver and family; therefore, novel, more efficient approaches to augment practice with less costs are needed. 4 One way of increasing the intensity of exercise therapy is to actively involve family members in the rehabilitation process. 5,6 Training caregivers as co-therapists enables them to assist with exercise delivery and increase practice intensity without increasing staff time. However, studies examining caregiver-mediated rehabilitative exercise are scarce, and the effects on patient and caregiver outcomes are under investigation. 6Background and Purpose-This proof-of-concept trial investigated the effects of an 8-week program of caregiver-mediated exercises commenced in hospital combined with tele-rehabilitation services on patient self-reported mobility and caregiver burden. Methods-Sixty-three hospitalized stroke patients (mean age 68.7, 64% female) were randomly allocated to an 8-week caregiver-mediated exercises program with e-health support or usual care. Primary outcome was the Stroke Impact Scale mobility domain. Secondary outcomes included length of stay, other Stroke Impact Scale domains, readmissions, motor impairment, strength, walking ability, balance, mobility, (extended) activities of daily living, psychosocial functioning, self-efficacy, quality of life, and fatigue. Additionally, caregiver's self-reported fatigue, symptoms of anxiety, self-efficacy, and strain were assessed. Assessments were completed at baseline and at 8 and 12 weeks. Results-Intention-to-treat analysis showed no between-group difference in Stroke Impact Scale mobility (P=0.6); however, carers reported less fatigue (4.6, confidence interval [CI] 95% 0.3-8.8; P=0.04) and higher self-efficacy (−3.3, CI 95% −5.7 to −0.9; P=0.01) at week 12. Per-protocol analysis, examining those who were discharged home with tele-rehabilitation demonstrated a trend toward improved mobility (−9.8, CI 95% −20.1 to 0.4; P=0.06), significantly improved extended activities of daily living scores at week 8 (−3.6, CI 95% −6.3 to −0.8; P=0.01) and week 12 (3.0, CI 95% −5.8 to −0.3; P=0.03), a 9-day shorter length of stay (P=0.046), and fewer readmissions over 12 months (P<0.05). Conclusions-Caregiver-mediated exercises supported by tele-rehabilitation show promise to augment intensity of practice, resulting in improved patient-extended activities of daily living, reduced length of stay with fewer readm...

We investigated the feasibility of providing telerehabilitation in the home as an alternative to conventional ambulatory rehabilitation. Two groups of patients were accepted for telerehabilitation. The first group were community patients who needed rehabilitation, e.g. following a stroke, a fracture or prolonged hospital admission. The second group was from two rural nursing homes where residents were identified with a recent injury, fall or hospitalisation. Telerehabilitation employed a coaching model, with fewer therapist home visits, more feedback and "homework" for the patient. Patients had a tablet computer loaded with a videoconferencing app to connect with therapists and relevant therapeutic apps. Multidisciplinary care was provided for up to 8 weeks. The majority (86%) of eligible patients consented to receive telerehabilitation in their own home (n = 61) or in the country nursing home where they lived (n = 17). Most services were delivered using the 3G and 4G wireless networks with few technical problems. On average participants felt that they had achieved 75% of the goals set at the beginning of the programme. High levels of satisfaction were recorded. There was a 50% reduction in home visits by staff, or 10 visits per patient. Speech therapists were able to double occasions of service and direct patient contact time, whilst halving their travel time. Previous experience with technology and age were not barriers to this method of delivery but did affect recruitment. Telerehabilitation using off-the-shelf technology is feasible for post-acute treatment.

No abstract

BackgroundDigitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation.

Group mobility training and staff education to promote continence is feasible and acceptable for use with care home residents, including those with cognitive impairment.

ACTRN12613000610730.

Introduction: Home assessments conducted by occupational therapists can identify hazards and prevent falls. However, they may not be conducted because of limited time or long distances between the therapist's workplace and the person's home. Developments in technologies may overcome such barriers and could improve the quality of the home assessment process. Method: This scoping review synthesises the findings of studies evaluating information and communication technology use within occupational therapy home assessments. Results: Fourteen studies were included and revealed the two main approaches to technology use: the development of new applications and the use of existing and readily available technologies. Facilitators and barriers to use were also identified. Facilitators included usefulness, ease of use and the potential for cost-effectiveness. Barriers to use included poor usability, unsuitability for some populations and perceived threat to the role of occupational therapy. The synthesis revealed that traditional in-home assessments conducted by therapists are more sensitive in identifying hazards. Conclusion: The availability of new technologies offers potential to improve service delivery; however these technologies are underutilised in clinical practice. Technologies may offer advantages in the conduct of home assessments, especially regarding efficiency, but have not yet been shown to be superior in terms of patient outcome.

Long-term incidence studies are required to identify high-risk groups, establish trends, and forecast needs, and thus contribute to health care planning in spinal cord injury (SCI). This study aimed to determine the incidence of traumatic SCI over a 36-year period in Aragón, Spain, and compare rates with other published European estimates. Hospital records from the Servet Hospital, the only specialized SCI unit in the region, of a retrospective cohort with traumatic SCI between January 1972 and December 2008 were reviewed. Specification of SCI patient demographics, injury causes, and related factors was achieved by utilizing medical records available for inpatients, hospital archives, and central databases. A total of 540 cases were reported over the 36-year study period (79% were male). The age- and sex-adjusted incidence rate was 15.5 per million population (18.8 for males and 4.9 for females). Two incidence peaks were suggested, in the 20- to 29-year and 60- to 69-year age groups. Traffic accidents and falls were the main causes of injury. The highest peak occurs in young adults, mainly caused by traffic accidents. The majority of the lesions were at cervical or thoracic level, and ASIA grade A was most frequently observed. The proportion of SCI cases in persons older than 60 years, mostly due to falls, is increasing. The age-adjusted incidence rates found for the region of Aragón in Spain fall within the range of other published European estimates. Comparative epidemiological features for 2001-2008 suggest that there is room for prevention.