Nejvíce citovaný článek - PubMed ID 21076562
BACKGROUND: Despite the proven efficacy of antipsychotics in relapse prevention in schizophrenia and schizoaffective disorder, every third patient experiences a relapse within less than one year. Relapses can worsen psychosocial and treatment related outcomes and lead to substantial economic costs, primarily due to frequent and prolonged hospitalizations. The aim of this project is to evaluate a smartphone- and web-based digital solution for detecting early warning signs of schizophrenia and schizoaffective disorder to reduce relapses and subsequent hospitalizations. METHODS: This randomized controlled trial compares the add-on use of a smartphone-based app for monitoring relapse warning signs in patients with schizophrenia and schizoaffective disorders (ICD-10 F20/F25) used within the routine psychiatric outpatient treatment against treatment as usual (TAU) without any further study-related intervention. Patients in the intervention group use the app for one year, fill in the weekly ten-item Early Warning Signs Questionnaire (EWSQ-10P) and obtain in-app feedback. Clinicians can access the symptom trajectory via a browser-accessible dashboard. If a threshold is exceeded in the inbuilt automatic algorithm, an alert is sent to both, the clinician and patient, enabling timely contact and, as part of a shared decision-making process, an optional adjustment of treatment decision. A total of 110 outpatients are recruited across eight study sites. DISCUSSION: Continuous monitoring of early warning signs is expected to lead to behavioral changes and to decrease the necessity and duration of psychiatric hospital stays, thereby lowering healthcare costs. Additionally, the intervention could reduce symptom severity, alleviate medication adherence, shared decision-making, patient activation or quality of life. Qualitative data is collected to better understand patient needs and preferences regarding app usage and relapses. Insights gained from this study can be integrated into routine psychiatric care, improving the long-term treatment of patients with schizophrenia or schizoaffective disorder. TRIAL REGISTRATION: German Clinical Trials Register (ID: DRKS00034991; registration date: 30.08.2024).
- Klíčová slova
- App, Digital monitoring, Outpatient treatment, Relapse, Schizophrenia, Shared-decision making,
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The aim of this study was to determine whether adding virtual reality therapy to conventional rehabilitation improves the quality of life, cognitive functions, and social participation of patients after an ischemic stroke. DESIGN: Randomized controlled study conducted in a rehabilitation center. PARTICIPANTS: The experimental group with therapy in virtual reality included 25 patients (age 59.4 ± 8.9 years), and the control group with conventional therapy consisted of 25 patients (age 63.0 ± 8.8 years). Inclusion criteria for the study were: age 40-79 years, stable condition, Mini-Mental State Examination >25 points, intact vision, preserved grip function of the thumb and index finger of the affected limb, functional mobility according to the functional ambulatory category (FAC) 3-5, and no other neurological disease. METHODS: The Mini Mental State Examination, the Barthel Index, the Extended Barthel Index, and the WHO Disability Assessment Schedule 2.0 were used to assess cognitive function, quality of life, and self-sufficiency. Based on the results of normality test were used: t-test for two samples (age, time since stroke), the chi-square test (gender), nonparametric paired Wilcoxon test and Mann-Whitney U test. Friedman analysis was used to analyze repeated measures and a post hoc test Scheffe test was used to compare differences. Statistical tests were evaluated at the 5% significance level. RESULTS: No significant differences were found between the experimental and control groups in any of the tests applied after treatment. Significant differences emerged after treatment in all WHODAS domains studied for each group compared to the measurement before therapy. In the experimental group, the positive effects of therapy persisted 1 year after the end of therapy compared to the measurement before therapy. CONCLUSIONS: Virtual reality has proven to be a suitable adjunct to conventional therapy for post stroke patients and offers an advantage over traditional rehabilitation methods in that it allows training in activities of daily living that are not commonly available in a hospital setting.
- Klíčová slova
- activities of daily living, cognitive functions, ischemic stroke, physiotherapy, self-sufficiency, standardized questionnaires,
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Stroke often impairs upper extremity motor function, with recovery in the sub-acute phase being crucial for regaining independence. This study examines changes in isometric muscle strength, dexterity, and self-care independence during this period, and evaluates the effects of a comprehensive intensive rehabilitation (COMIRESTROKE). METHODS: Individuals in sub-acute stroke recovery and age- and sex-matched controls were assessed for pre- and post-rehabilitation differences in primary outcomes (grip/pinch strength, Nine Hole Peg Test [NHPT], Action Research Arm Test [ARAT]). COMIRESTROKE's effects on primary and secondary outcomes (National Institute of Health Stroke Scale [NIHSS], Modified Rankin Scale [MRS], Functional Independence Measure [FIM]) were evaluated. Outcomes were analyzed for dominant and non-dominant limbs, both regardless of impairment and with a focus on impaired limbs. RESULTS: Fifty-two individuals with stroke (NIHSS 7.51 ± 5.71, age 70.25 ± 12.66 years, 21.36 ± 12.06 days post-stroke) and forty-six controls participated. At baseline, individuals with stroke showed significantly lower strength (dominant grip, key pinch, tip-tip pinch, p adj < 0.05), higher NHPT scores (p adj < 0.05), and lower ARAT scores (p adj < 0.001). COMIRESTROKE led to improvements in dominant key pinch, non-dominant tip-tip pinch, NHPT, and both dominant and non-dominant ARAT (p adj < 0.05). Notably, non-dominant key pinch improved significantly when considering only impaired hands. Pre- and post-test differences between groups were significant only for ARAT (both limbs), even after adjustment (p adj < 0.05). All secondary outcomes (NIHSS, MRS, FIM) showed significant improvement post-COMIRESTROKE (p adj < 0.001). CONCLUSION: Individuals with stroke exhibit reduced muscle strength and dexterity, impairing independence. However, comprehensive intensive rehabilitation significantly improves these functions. Data are available from the corresponding author upon request and are part of a sub-study of NCT05323916.
- Klíčová slova
- dexterity, ischemic stroke, isometric grip strength, maximum strength during key, tripod, and tip-tip pinch, physiotherapy, rehabilitation,
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: While the role of physiotherapy as part of a comprehensive inpatient rehabilitation is indisputable, clear evidence concerning the effectiveness of different rehabilitation managements [interdisciplinary implementing the International Classification of Functioning, disability and health (ICF) vs. multidisciplinary model] and physiotherapy categories (neuroproprioceptive "facilitation, inhibition" vs. motor/skill acquisitions using technologies) are still lacking. In this study, four kinds of comprehensive inpatient rehabilitation with different management and content of physical therapy will be compared. Moreover, focus will be placed on the identification of novel biological molecules reflective of effective rehabilitation. Long non-coding RNAs (lncRNAs) are transcripts (>200 bps) of limited coding potential, which have recently been recognized as key factors in neuronal signaling pathways in ischemic stroke and as such, may provide a valuable readout of patient recovery and neuroprotection during therapeutic progression. METHODS AND ANALYSIS: Adults after the first ischemic stroke in an early sub-acute phase with motor disability will be randomly assigned to one of four groups and undergo a 3 weeks comprehensive inpatient rehabilitation of different types: interdisciplinary team work using ICF model as a guide; multidisciplinary teamwork implementing neuroproprioceptive "facilitation and inhibition" physiotherapy; multidisciplinary teamwork implementing technology-based physiotherapy; and standard multidisciplinary teamwork. Primary (the Goal Attainment Scale, the Patient-Reported Outcomes Measurement Information System, and the World Health Organization Disability Assessment Schedule) and secondary (motor, cognitive, psychological, speech and swallowing functions, functional independence) outcomes will be measured. A blood sample will be obtained upon consent (20 mls; representing pre-rehabilitation molecular) before and after the inpatient program. Primary outcomes will be followed up again 3 and 12 months after the end of the program. The overarching aim of this study is to determine the effectiveness of various rehabilitation managements and physiotherapeutic categories implemented by patients post ischemic stroke via analysis of primary, secondary and long non-coding RNA readouts. This clinical trial will offer an innovative approach not previously tested and will provide new complex analysis along with public assessable molecular biological evidence of various rehabilitation methodology for the alleviation of the effects of ischemic stroke. CLINICAL TRIAL REGISTRATION: NCT05323916, https://clinicaltrials.gov/ct2/show/NCT05323916.
The International Classification of Functioning Disability and Health (ICF) was approved in 2001 and, since then, several studies reported the increased interest about its use in different sectors. A recent overview that summarizes its applications is lacking. This study aims to provide an updated overview about 20 years of ICF application through an international online questionnaire, developed by the byline authors, and sent to each World Health Organization Collaborating Centers of the Family of International Classifications (WHO-FIC CCs). Data was collected during October 2020 and December 2021 and descriptive content analyses were used to report main results. Results show how, in most of the respondent countries represented by WHO-FIC CCs, ICF was mainly used in clinical practice, policy development and social policy, and in education areas. Despite its applications in different sectors, ICF use is not mandatory in most countries but, where used, it provides a biopsychosocial framework for policy development in health, functioning and disability. The study provides information about the needs related to ICF applications, that can be useful to organize targeted intervention plans. Furthermore, this survey methodology can be re-proposed periodically to monitor the use of the ICF in the future.
- Klíčová slova
- ICF, biopsychosocial, disability, functioning, health, international classification, public health,
- MeSH
- lidé MeSH
- mezinárodní klasifikace funkčních schopností, disability a zdraví * MeSH
- postižení * MeSH
- posuzování pracovní neschopnosti MeSH
- průzkumy a dotazníky MeSH
- Světová zdravotnická organizace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
