“These investments highlight what the new markets tax credit investment sets out to do in communities all across the country,” said Greg Clements, Novogradac partner and conference chair. “They represent a wide swath of investments that help in rural and urban low-income communities.”

Thirteen community development entities (CDEs) that made qualified low-income community investments (QLICIs) in five businesses have been named winners of the Novogradac Journal of Tax Credits QLICIs of the Year awards for 2023.

The awards go to new markets tax credit (NMTC) stakeholders who strive for excellence in community development. This year’s winning CDEs earned the awards for the following investments:

  • DC Central Kitchen’s Klein Center for Jobs and Justice in Washington, D.C., as Metro QLICI of the Year.
  • Lauderdale Community Hospital in Ripley, Tennessee, as Nonmetro QLICI of the Year.
  • The Freelon at Sugar Hill in Detroit as Real Estate QLICI of the Year.
  • Detroit Food Commons in Detroit as Small Business QLICI of the Year.
  • Santa Cruz Community Health Centers–Live Oak Health Clinic in Santa Cruz, California, as Operating Business QLICI of the Year.

The winners will be honored at the Novogradac 2023 Spring New Markets Tax Credit Conference June 8-9 at The Fairmont in Washington, D.C.

“These investments highlight what the new markets tax credit investment sets out to do in communities all across the country,” said Greg Clements, Novogradac partner and conference chair. “They represent a wide swath of investments that help in rural and urban low-income communities.”

DC Central Kitchen’s Klein Center for Jobs and Justice in Washington, D.C., is a new, 36,000-square-foot facility that serves as a 15-hour-a-day alternative to the traditional soup kitchen and includes a culinary training kitchen and production kitchen capable of producing 25,000 meals per day. CDEs CAHEC New Markets, Reinvestment Fund and Chase New Markets Corporation allocated a combined $18.5 million in QLICIs.

Lauderdale Community Hospital replaces an aging hospital in rural Ripley, Tennessee, giving a multimillion-dollar upgrade to improve and expand its services for patients and staff due to NMTCs allocated by three CDEs. Upgrades include emergency cardiac and pulmonary rehabilitation, surgery services, radiology, laboratory, physical rehabilitation, acute care and respiratory care. DV Community Investment, Hope Enterprise Corporation and CCG Community Partners combined on $22 million in QLICIs.

The Freelon at Sugar Hill, a mixed-use development in Midtown Detroit’s Sugar Hill Arts District, will provide high-quality modern housing options, including units set aside for veterans, as well as commercial space for properties that are either woman- or immigrant-led. Building America CDE, Michigan Community Capital, Cinnaire New Markets and PNC Community Partners combined for $29.5 million in QLICIs for the endeavor.

The Detroit Food Commons a 31,000-square-foot, two-story building in Detroit’s North End neighborhood, will house the Detroit People’s Food Co-op–a community-owned, full-service grocery store including a deli and a café–on the first floor. On the second floor, there will be four teaching and shared-use commercial kitchens, a banquet hall/community meeting space and office spaces for the Detroit Black Community Food Security Network. New Markets Support Company, Michigan Community Capital and U.S. Bancorp Impact Finance combined to allocate nearly $20 million in QLICIs.

Santa Cruz Community Health Centers–Live Oak Health Clinic in Santa Cruz, California, will help an additional 3,000 patients and accommodate 20,000 visits annually at the new health clinic. SCCHC is a federally qualified health center and a Health Resources & Services Administration-designed Healthcare for the Homeless provider. Primary Care Development Corporation and HEDC New Markets combined for $14.4 million in QLICIs for the development.

Additional details about the award winners and information on how to nominate a development for the 2024 round of awards can be found at www.novoco.com/events/awards.

About Novogradac

Novogradac began operations in 1989 and has grown to more than 700 employees and partners with offices in more than 25 cities. Tax, audit and consulting specialty practice areas for Novogradac include affordable housing, community development, historic rehabilitation and renewable energy.


Share article on social media or email:

Source link

In their quest to relieve stress, many people turn to various tools and techniques. One such popular tool is the stress ball—a small, squeezable toy that promises to alleviate tension and promote relaxation.

You’ve probably seen some of those semi-soft foam balls adorning virtually every corporate office, enticing people to release tension by squeezing them between their fingers. But do these ridiculous balls actually help people decompress? Should you regularly use them or is it a better idea to blow off some steam by throwing stress balls out the window?

From work to school to romantic relationships, there’s no shortage of challenges in our lives. Often, this creates an internal conflict that manifests itself as stress. When left unchecked, stress will not only take its toll on our emotional and mental health but also on our physical well-being.

Enter stress balls — a low-key and effective solution to managing temporary stress.

How Do Stress Balls Work?

It may sound implausible, but the answer to the question, “Do stress balls work?” is yes – at least from a physiological standpoint.

Have you ever noticed how a comforting touch can instantly soothe your frayed nerves? Researchers believe that the power of tactile engagement lies at the heart of stress balls’ effectiveness. When you squeeze a stress ball, the muscles in your hand and forearm contract, triggering a series of physiological responses in your body. As you release the grip, these muscles relax, promoting a sense of relief and relaxation. 

Stress ball
Credit: Pixabay.

In 2006, researchers found that stress balls can improve the focus and attention spans of sixth graders. Another study found that fidgeting with objects — squeezing a stress ball or twirling a pen, for instance — can help boost productivity by giving the mind a break, making it easier to pay attention to the task upon returning to it.

According to MIT researchers, fidgeting objects designed to soothe or calm have to be smooth or squeezable, whereas fidgets meant to make people alert are generally clickable, sharp, or pokey. Yet another study found that stress balls helped relieve patients’ anxiety during surgery.

However, the only study that specifically researched the effectiveness of stress balls in reducing the physiological symptoms of stress found that they don’t do much. The researchers at the University of Wisconsin-Madison found that stress balls are not effective in reducing heart rate, blood pressure, or skin conductance following an episode of induced acute stress in college-aged individuals. The sample size was rather small, though, and involved only 30 students.

Do stress balls also work for anxiety? Studies suggest they do. Stress balls work to reduce stress because the act of squeezing improves the nervous system as well as decreases hormones, which can minimize stress levels. 

Stress balls can squeeze out stress, but they’re no cure for chronic stress

In light of its productivity-enhancing and anxiety-relieving properties, stress balls may be worth your time.

Bear in mind that if you’re chronically stressed, no amount of squishy foam balls or teddy bears will help you in the long run. To release the physical and emotional tension in the body from ongoing stress, doctors recommend exercising, dancing, venting with friends, and — why not — letting it all out by crying or shouting.

While stress balls offer a range of benefits, it is essential to acknowledge their limitations. While they may provide immediate relief, their effects are often temporary and may not address the underlying causes of stress.

Additionally, stress balls may not be suitable for everyone. Individuals with certain hand conditions, such as arthritis or carpal tunnel syndrome, should consult with their healthcare provider before incorporating stress balls into their routine.

What Are The Benefits of Using Stress Balls?

A stress ball
Credit: Pixabay.

America’s favorite squeezable knick-knack has come a long way since it was invented in the 1980s by Alex Carswell, a 29-year-old TV writer who came up with the idea after an angry phone call with his boss compelled him to throw a magic marker at a framed photo of his mother.

“It made me feel very good at the moment,” Carswell said later that year, “but I also had a broken picture of my mother and her dog I had to get reframed, and a mess to clean up.”

Today, hundreds of millions of foam balls are being manufactured all over the world. But do they actually do anything?

It might be tempting to laugh off the potential benefits of these handheld wonders, but in truth, we stand to gain a lot from them.  Stress balls have the capacity to enhance creativity, improve focus, reduce blood pressure, and even help you get a better night’s sleep. 

And while they’re not exactly meant for bodybuilding, a stress ball can certainly strengthen your grip muscles as well as help alleviate arthritis pain.  So, if you’re wondering how stress balls work – they work on various different levels. Ultimately, a stress ball can be used as a distraction device, or a different focal point, essentially allowing you to manage stress levels in a healthy way.

Speaking to the Huffington Post, David Posen, a stress expert and author of Is Work Killing You?: A Doctor’s Prescription for Treating Workplace Stress,” says that at least some of that stress energy can be channeled towards a physical object. Stress balls can work really well, Posen says, because they prompt you to squeeze and release, leaving you less tense.

What Are The Different Types of Stress Balls?

stress balls
Credit: Pixabay.

You might be surprised to learn there are over a dozen different types of stress balls.  In fact, there is a ball for pretty much every type of personality wanting to squeeze their way into a stress-free lifestyle. 

In the US, the most popular choice is a bean bag type of stress reliever, but there are a variety of types all around the world.  Construction of these anxiety-reducing balls can range from gel-filled, water-filled, solid foam, rubber, or a filling mixed with gel and baking soda

Since their inception, stress balls have evolved into all sorts of varieties such as porcupine balls, squeezy balls, kooshy balls, splat balls, puffer balls, and the list goes on. 

The common denominator for all of these different types of stress balls is that, on some level, they are intended to release tension, therefore, reduce stress.    

How Long Do Stress Balls Last?

The answer to this question depends upon the type of ball you have and how much you’re using it.  In general, most stress balls last a few months.  If you have a high-quality ball made with durable materials, it could last up to a year or more.  Cheaper balls made with flimsy materials will begin to deteriorate quickly. 

Of course, if your dog gets hold of your stress ball, it’s not going to last very long at all. In all seriousness, your ball should last a good, long time if it is made of sturdy materials, well-cared for, and used in moderation. 

Are Stress Balls Good For Your Hands?

Stress balls can be good for your hands because they build strength.  They can also be beneficial for building strength in your forearms and wrists. Using stress balls can increase flexibility and stimulate blood circulation, which leads to decreased stiffness and swelling. 

When used in moderation, yes, stress balls can be therapeutic for your hands, fingers, wrists, and forearms. While stress balls are used for certain types of physical therapy, they are not always the best for your hands.  Overuse of stress balls can cause strains in tendons in the wrists or might cause pain.

What Are the Symptoms of Stress?

The curious thing about stress is that it manifests differently in each person. For instance, some people may exhibit stress by sweating profusely or hyperventilating.  Other people might show symptoms of stress emotionally by becoming irascible or aggressive, while others might express stress by withdrawing, becoming sullen, or succumbing to depression.  

Moreover, stress can manifest itself in ways we normally wouldn’t, such as acting out, exhibiting nervous ticks such as nail-biting or using substances. While these are manifestations of stress, they are also behaviors that are symptoms of stress as many of us attempt to compensate or escape the unfavorable experience of stress. All in all, there are innumerable ways symptoms of stress might manifest in different people under various conditions.   

Chronic stress can lead to headaches, an upset stomach, sleep problems, and fatigue. If left unchecked, stress can contribute to far more serious health problems, such as high blood pressure, diabetes, and obesity.

One of the symptoms of stress is muscle tension. We literally clench our body’s muscles when feeling psychologically stressed, prompted by a flood of hormones like adrenaline, noradrenaline, and cortisol. Essentially, these chemicals prime the body for “fight or flight”.

However, it’s not always an option to fight your boss or run away from work — this is where the ubiquitous stress ball might come in handy.

Can Stress Be Measured? 

Yes, stress can be measured. Observation of heart rate, pulse, breathing, and emotional responses and recording this data is the most common way to measure stress.  But how can stress be measured? 

In many instances, we can measure our own stress levels by paying attention to our responses and reactions to stressful situations.  Through self-observation and recording our responses, we are better able to understand our stress levels and adjust accordingly.  

Are there objective tests for stress? Yes. You can do a stress level test which can provide you with valuable information about your condition and guide you to solutions to reduce stress. You may also opt to get a medical stress test from your doctor or mental health care provider. The types of stress tests you choose will depend upon your desired outcome.  

For instance, if your stress manifests on a physical level, you might consider getting a cardiac stress test to assess how stress is affecting your heart.  If you respond to stress more emotionally, then a mental health stress test administered by a mental professional will reveal insights that can help you manage your emotions more effectively while encountering stress.

While stress balls may not hold the key to complete stress eradication, their simple yet effective design offers a tangible means of managing stress and promoting relaxation.

The act of squeezing a stress ball engages both the body and the mind, providing a momentary respite from the pressures of everyday life.

Scientific research supports their effectiveness, revealing their potential to reduce stress, enhance cognitive performance, alleviate anxiety, and aid in physical rehabilitation.

Thanks for your feedback!

Source link

May 26, 2023 16:34 IST

Gurugram (Haryana) [India], May 26: HCAH, India's leading out-of-hospital care provider, announces its collaboration with fourteen major insurance players, becoming the first transition care provider in India to make insurance available for its patients. This is a significant milestone for HCAH as it becomes the first rehab provider to offer cashless insurance coverage for out-of-hospital care. This collaboration enables patients to receive high-quality rehabilitation services without worrying about financial burdens, while also enhancing HCAH's position as a leader in the healthcare industry.
HCAH's TCCs focus on helping patients recover in a home-like environment outside of the hospital setting. HCAH aims to drive 100% recovery of a patient through high-end equipment, a multidisciplinary team, a milestone-based approach and protocolized delivery. HCAH supports patients across multiple areas, such as stroke recovery, head injury, spine injury, critical care, pulmonary rehab, cardiac rehab, dementia, Parkinson, Onco rehab and medical management.
Placing emphasis on significant cost savings for its patients, HCAH is revolutionizing healthcare in India with its unwavering commitment to cost-effective care. By partnering with top insurance companies including Medi Assist Insurance, Manipal Cigna Health Insurance Company Ltd, SBI General Insurance Co. Ltd., Navi General Insurance Ltd to name a few from the list, HCAH is offering patients the dual benefits of financial security and quality care from trained professionals.
HCAH's TCCs' affordable prices, which are only 50 per cent of hospital costs and one-third of critical care costs, make it a practical and feasible option for healthcare consumers in India. HCAH's tailored insurance policies are available at HCAH Suvitas in Domlur, Bangalore, and HCAH Suvitas in Banjara Hills, Hyderabad. These policies are designed for patients transitioning from hospital to home. They not only save costs but also provide the necessary support for patients to return to their professional lives quickly.
Vivek Srivastava, CEO and Co-Founder, HCAH said that, "We are thrilled and equally excited to become the first company in the out-of-hospital care landscape, to introduce insurance partnerships with the key players in the insurance arena, enabling us to provide a comprehensive and holistic approach to transition care for our patients. Globally, this is a common step but in India this is a first in the realm of TCCs and rehab-care. These partnerships with top insurance providers in India will give our patients the peace of mind and financial protection they need during this critical time in their recovery process. HCAH has implemented this to ensure that its transition care centres remain affordable and accessible to all patients."

Dr Gaurav Thukral, COO, HCAH also said, "Hospitals are there to save lives! We at HCAH, make people recover back to their normal life. The alliance with key insurance players in the market can help people utilize the same sum insured to recover in the comfort of HCAH's TCCs and would lead to early discharge from the hospital, having fastest recovery to normalcy. We are committed to providing the best possible care to our patients, and we take pride in working with some of the top insurance providers in India. We are excited about the possibilities they present for the future of transition care in India. This move also strengthens HCAH's position as a credible provider."
The insurance benefits are available to all patients from the company's transition care program. The financial protection provided by these top insurers and HCAH's expertise in rehab care, enhances the quality, accessibility, and affordability of transition care in India. This is a significant step forward in the evolution of transition care in India.
HCAH is a Delhi NCR-based health-tech company present in 70+ cities across the country. It has raised investments from the Burman Family (Promoters of Dabur), Founders of Healthcare at Home UK, Quadria Capital, a Singapore-based healthcare fund and ABC Impact. HCAH provides the best possible healthcare outcomes and quality of life outside of hospitals by building the most affordable and accessible healthcare ecosystem. HCAH has 3 segments in which it delivers its services: (i) Physical rehabilitation and recovery through its service range of Inpatient Rehab, Long Term Acute Care in transition care centres, digital and home rehab; Home ICU and palliative care services; and supply of rehab equipment (ii) Elderly care services including e-commerce and caregiver services (iii) Chronic Disease Management services including screening, diagnostics, infusions, dialysis, oncology treatments, patient support programs, pharmacy, PAPs and adherence programs in association with leading pharma companies. All these services are delivered through HCAH's proprietary technology platform in homes, centres and digitally.
HCAH is the first company to be accredited under the QAI (India's homecare standards). HCAH has published/presented 40 papers in national and international journals on its outcomes. HCAH is the only out-of-hospital care provider to be certified Great Places to Work. Over the course of its existence, HCAH has maintained a NPS of 65 per cent +.
With the recent acquisition of Nightingales, HCAH becomes India's largest out-of-hospital care platform. Moreover, with the acquisition of Seniority back in 2022, HCAH has emerged as India's largest senior care platform. The company is developing an end-to-end senior care vertical for the holistic well-being of the growing elderly population.
For more information, visit www.hcah.in and www.seniority.in
(Disclaimer: The above press release has been provided by PNN. ANI will not be responsible in any way for the content of the same)

Source link

Insufficient physical rehabilitation programs for patients with COVID-19 and their hesitancy to come to medical facilities during the COVID-19 pandemic were reasons why this study was conducted, said Franco Laghi, MD, a professor and pulmonologist affiliated with Loyola University Medical Center and Edward Hines, Jr. Veterans Affairs Hospital in Maywood, Illinois.

The following questions are regarding an abstract titled “A Home-based, Remotely Monitored Program to Improve Physical Activity in Patients With Long COVID” presented at the American Thorasic Society's 2023 annual meeting.


Why did you study home-based physical activity in patients with long COVID-19?

Patients with COVID-19, particularly patients with COVID-19 that have required medical attention, tend to develop long COVID-19. And the symptoms that more commonly occur with patients with long COVID-19 are fatigue, decreased exhale capacity, and shortness of breath.

So, from there [was] the idea of implementing an exercise rehabilitation program for these patients. The problem is that the availability of hospital-based supervised programs, physical rehab programs, is very limited, [and] from here [was] the idea of developing a home-based program. Now, what is attractive about that is that this type of program probably can be implemented when a future pandemic may happen.

The other thing that pressed us to develop this program was that we noticed the reluctance of patients during the COVID-19 pandemic to come to the hospital and to clinics, and from here [came] the idea of developing something that could be delivered in the home environment.

Source link

The U of A houses one of the first clinics in Alberta dedicated to helping people manage long COVID.

More than two years after he succumbed to the SARS-CoV-2 coronavirus, Doug Norman’s long COVID symptoms are so severe he still can’t return to work as a letter carrier with Canada Post.

In addition to dizziness and brain fog, he can’t muster the concentration to drive. There is also his farm to run, which he does in fits and starts, taking breaks when overcome with exhaustion.

“It feels like there's a big clamp squeezing my head,” said Norman. A few weeks ago, the 62-year-old was put on a steroid inhaler to ease his difficulty with breathing.

“I do whatever I can, go as hard as I can until I have no energy left. Then I go back into the house. That’s how I live my life now. It’s not the best, but you do whatever you have to do to survive.”

Most puzzling is that Norman’s original infection wasn’t severe. More like a head cold, he says, adding, "I just kept getting more symptoms as time went on."

Norman is one of thousands in Alberta suffering from a range of post-COVID symptoms long after contracting the virus. According to Statistics Canada, almost 15 per cent of Canadian adults who have had, or thought they had, COVID-19 still struggle with symptoms at least three months after their initial infection.

To meet the needs of that population, a post-COVID-19 clinic at the University of Alberta, the first and largest in the province, opened in June 2021. Since then, the Long COVID Clinic has seen about 800 patients — and had about 1,500 referred — who suffer from symptoms that persist at least 12 weeks beyond the original COVID-19 diagnosis. 

A one-stop, multidisciplinary facility with a variety of physicians and therapists, the clinic began operating one half-day every two weeks when launched, but is now up to five half-days per week. Patients are referred to the clinic by their family physicians.

“We’re seeing a lot of fatigue, shortness of breath and neurocognitive disturbances,” said clinic co-director Grace Lam.

Patients with long COVID complain of myriad neurologic symptoms, adds clinic co-director Maeve Smith. They include persistent loss of sense of smell and taste, nerve pain and weakness, insomnia and problems with short-term memory, concentration and focus.

“Patients are often unable to return to work because their physical and cognitive function isn’t where it needs to be," said Smith. “Or they have to find a daycare because they can’t run around after their toddler.”

The median age of patients at the clinic is 49, “very much a working population,” she said, adding there also seems to be a “female predominance” among the cohort.

“These are individuals at the height of their careers who tell us, ‘I can’t read a document. I finish one paragraph and can’t remember what I just read,’” said Lam. “If you think about who makes up the workforce, and the age range this affects — that’s a huge hit on society as a whole.”

Perhaps most puzzling, say Lam and Smith, is that long COVID can affect anyone, regardless of the severity of the initial infection or even whether or not it was symptomatic. That means the latest variants of the virus could cause symptoms long after a mild illness.

Included on the clinic’s team are a neurologist and experts in immunology, hematology and cardiology. There is also an expert in POTS disease — or postural orthostatic tachycardia syndrome — a condition affecting blood flow that can cause light-headedness, fainting and an uncomfortable rapid increase in heartbeat.

So far, treatment for long COVID is limited, said Lam, because the root causes of symptoms are still poorly understood.

Even conventional physical rehabilitation has its limits, according to Doug Gross, director of the U of A’s Rehabilitation Research Centre

“The old-fashioned techniques of physical retraining and building muscles have been tried, and quite often they fail. We are learning that pacing and strategies for conserving energy may be more effective for some," he said.

Alberta Health Services recommends people manage mild long-COVID symptoms at home with the support of online resources and their primary care team.

As for Norman, every day continues to be a struggle as he searches for treatment solutions with specialists at the clinic. Because of his ongoing fatigue, he sees a rheumatologist who monitors him for signs of chronic fatigue syndrome.

“The challenge is to find a happy medium — how much you can do every day,” he said. “Some days I talk to myself and say, ‘Doug, you gotta suck it up, you gotta battle a little harder. One day, everything's rolling along. And the next you're a totally different person.”

But he says finding the post-COVID clinic has meant everything to his state of mind.

“I told Dr. Lam on the phone, ‘Lucky thing you’re not here in person because I’d give you a big hug.’”

Article courtesy of University of Alberta folio

Source link

The experienced staff from Eden Private Hospital.

Eden Private Hospital is the Sunshine Coast’s longest operating private rehabilitation facility, with 48 dedicated medical, rehabilitation and mental health beds.

Eden Private Hospital delivers comprehensive rehabilitation programs to both Inpatients and Outpatients, that are tailored to the patient’s specific needs and goals, and managed by a multidisciplinary team of allied health professionals under the care of a Rehabilitation Consultant.

Our experienced staff work together to help patients regain strength and cardio fitness, balance and mobility as well as redevelop skills and ultimately function with the highest possible level of independence and confidence.

Each program includes an individual consultation followed by physical rehabilitation and education sessions that are structured around the health diagnosis and patient goals. The programs are typically run twice a week, over a six week period and the duration of the programs can vary.

The programs we offer which patients can be referred into include: Orthopaedic Program; Neurological Program; Reconditioning Program; Pain Program; Cardiac Rehabilitation; Cancer Rehabilitation; Falls Prevention Program; Pulmonary Rehabilitation Program; and Robotic Assistive Therapy.

How to Be Referred:

We accept referrals from General Practitioners, Specialists and Surgeons and Public and Private Hospitals. You would simply need to see your GP or Specialist and ask for a referral to be sent to Eden Private Hospital and our Admissions and Assessment team will be in contact with you once received.


Eden Private Hospital has agreements with most private health funds as well as Tier One Provider Status with the Department of Veteran’s Affairs. The Outpatient Allied Health team also conduct sessions under Medicare’s Enhanced Primary Care program for Physiotherapy, Exercise Physiology and Occupational Therapy.

For further support in navigating your care or to utilise this service as either an inpatient or outpatient, or to learn more about Eden Private Hospital, please contact our Admissions and Assessment team on 1800 333 674 or visit edenprivate.com.au.

Source link

Individuals with chronic obstructive pulmonary disease (COPD) experience pain at levels similar to or greater than levels reported in the general population, report authors of a new study.

However, findings from this UK research groups’ systematic literature review suggest that nonpharmacologic and noninvasive interventions that have been investigated to date “do not currently improve chronic pain for people with COPD to a level that is clinically meaningful.”

Further, studies into the impact of these interventions are fundamentally flawed, according to lead author Leah Avery, PhD, professor of applied health psychology in the School of Health and Life Sciences, Teesside University, Middlesbrough, UK, and colleagues.

Current national and international COPD guidelines do not address chronic pain, write Avery et al in the journal Respiratory Medicine, nor are specific pain measures commonly used in persons with COPD. Pharmacologic treatment, while often the prescribed approach, is commonly ineffective, they add.

Current national and international COPD guidelines do not address chronic pain, nor are specific pain measures commonly used in persons with COPD. Pharmacologic treatment, while often the prescribed approach, is commonly ineffective.

With evidence accumulating that indicates the high prevalence of pain in this already vulnerable group, the investigators set out specifically to evaluate the efficacy of existing nonpharmacologic and noninvasive interventions for addressing chronic pain in those with COPD.

The team conducted a search of 14 databases from May to June 2020, with an updated search for May to August 2022. Eligible studies were any nonpharmacologic, noninvasive intervention-based studies, with both randomized and nonrandomized controlled designs, that included patients with a confirmed diagnosis of stable COPD (ie, Global Initiative for Chronic Obstructive Lung Disease stages 1-4). Outcomes of interest were pain measures or pain subscale scores. Chronic pain was defined as pain occurring for at least 3 months with no underlying tissue damage in its etiology.

From an original yield of 95 302 potentially relevant studies, Avery et al assessed 223 for eligibility, with 29 studies (n=3228) included in the final review. Of the studies, 25 were randomized controlled trials (RCT) and 4 had non-RCT designs, 1 with a mixed methods approach.


A wide range of interventions were reported including physical rehabilitation (PR), education, various forms of exercise, breathing management techniques, self-management, and psychotherapeutic interventions; most of the interventions were not targeted specifically at pain.

A clinically meaningful change in pain outcomes (minimal clinically important difference of ≥1) from pre-intervention to postintervention was reported in 7 studies, although results were statistically significant (P<.001) in only 2 studies, according to results. A third study did not find a clinically meaningful improvement but did show statistical significance (P =.0273).

Light on specifics

When Avery and team looked to identify specific behavior change techniques (BCT) associated with an effective intervention, they found very few studies reported descriptions of the interventions. In studies where descriptions were included, the BCT was reported to include “instructions on how to perform the behaviour,” “pulmonary rehabilitation,” or “goal setting” behaviour.

The researchers emphasized that study interventions did not specifically focus on pain in COPD, but rather on a range of primary outcomes. Specific BCTs, therefore, were often targeting increased physical activity or improved emotional state.

Mean pain scores ranged from 8.15 to 77.50 with an overall weighted mean of 54.53. The weighted mean SF-36 Physical Component and Mental Component scores were 33.34 and 42.43, respectively.

Regarding the quality of evidence, 5 RCTs had a low risk of bias, 8 had a moderate risk of bias, 12 indicated a high risk of bias, and the 4 non-RCTs had a moderate risk of bias.

Avery et al cite several limitations to the research, a significant one involving BCTs. BCT protocols require that interventions be coded only when the BCT is explicitly reported in the intervention description, and this process was limited by the detail of intervention methodology reported within each study.

They add that “Intervention heterogeneity and methodological quality limit current knowledge about effectiveness of previously trialed non-pharmacological and non-invasive interventions on pain symptoms in people with COPD,” thus they could not use the data to recommend a specific intervention. “Future research should describe interventions in detail and more frequently assess pain in this population to inform the development of an intervention targeting pain management for people with COPD,” they concluded.

Reference: Morris JR, Harrison SL, Robinson J, Martin D, Avery L. Non-pharmacological and non-invasive interventions for chronic pain in people with chronic obstructive pulmonary disease: a systematic review without meta-analysis. Respir Med. Published online March 6, 2023. doi:10.1016/j.rmed.2023.107191

Source link

Katy, TX - Apex Physical Rehabilitation & Wellness specializes in trusted physical therapy treatments, providing effective solutions for pain relief and improved mobility. Through a range of techniques, including hands-on therapy, exercises, and heat and cold therapy, the clinic aims to identify and address the underlying causes of discomfort to enhance the overall quality of life for patients.

In addition to addressing existing issues, the clinic also emphasizes preventive healthcare to reduce the risk of future injuries. With expertise in treating postoperative pain, as well as knee, back, elbow, and neck pain, the clinic offers tailored treatment plans to meet the unique needs of each patient.

For postoperative care, the physical therapy clinic offers targeted therapies that help patients recover motion and reduce inflammation following surgeries. These therapies can alleviate swelling, pain, limited joint mobility, cramping, and stiffness, with the ultimate goal of restoring patients' pre-surgery movement patterns. Customized treatment plans are designed to increase endurance and help patients return to their daily activities with restored strength.

Apex Physical Rehabilitation & Wellness treats orthopedic-related dysfunctions. These focus on the musculoskeletal system and injuries to the tendons, ligaments, joints, muscles, and bones. The clinic provides therapeutic care and determines the right movement diagnosis to manage the current injury and prevent further damage. Their orthopedic-related treatments treat conditions like plantar fasciitis, swollen muscles and joints, bursitis, arthritis, scoliosis, torn rotator cuff, and more.

The physical therapist in Katy also provides sports medicine treatments. They help athletes manage injury symptoms by manipulating the body structure through a hands-on approach. They restore the normal body structure, thereby relieving pain and inflammation. The clinic identifies any misalignments and blocked nerve pathways and provides physical therapy Katy to restore normal communication between the brain and body. The staff illustrates home exercises that enhance the athlete's healing process at home. The staff follows up to ensure therapies work as anticipated.

A quote from the clinic's website stated this about their services,

"The role of our physical therapy program is to help the patient regain the use of the painful body part. Through evaluation and the individualized treatment programs, we treat existing problems and provide excellent preventive health care to meet a variety of needs."

In addition to physical therapy, the clinic provides aquatic therapy, spinal decompression, and work health services. They have a temperature-regulated pool for their aquatic therapy treatments, which aim at total body reconditioning and progressive rehabilitation. Their work health services provide solutions for injured workers, including prevention of injuries, management, post-injury treatments, and case closure. They have specialty services like vestibular rehabilitation therapy, fall risk assessment and prevention, balance and proprioception testing and training.

To schedule a consultation, contact the physical therapy clinic at (832) 240-7773. Visit the clinic for more information on their physical therapy services, Apex Physical Rehabilitation & Wellness is located at 777 S Fry Rd #104, Katy, TX, 77450, US.

Media Contact

Company Name
Apex Physical Rehabilitation & Wellness
Contact Name
Amir Kazemi
(832) 240-7773
777 S Fry Rd #104
Postal Code
United States

Source link

A 71-year patient, weighing only 32 kg and diagnosed with type 2 respiratory failure, successfully underwent a complicated open heart surgery at a Mumbai hospital recently. The surgery was a rare one and involved calculated risk as the patient, Sugandha Jadhav, was grossly underweight and had a history of bronchial asthma and tuberculosis (TB).

Speaking to ABP Live, Dr Gulshan Rohra, cardiothoracic surgeon at Wockhardt Hospital who conducted the surgery, said the risk to the patient's life was 20 per cent and there was a 67 per cent probability of her going into prolonged ventilation.

"The biggest challenge was to plan open heart surgery meticulously with pulmonary rehabilitation and making sure the family understands the risks associated with the procedure," Dr Rohra said.

Jadhav was admitted to the hospital in a very delicate condition. Her echocardiogram suggested severe aortic stenosis and severe left ventricular dysfunction.

In simple terms, severe aortic stenosis prevents our aortic valve leaflets from opening and closing properly. This makes our heart work harder to pump blood to the rest of your body. It can lead to difficulty in breathing, dizziness, and sudden cardiac death.

For this condition, according to doctors, there are only two available treatment options for patients — open heart surgery or Transcatheter Aortic Valve Implantation (TAVI). Considering her age and other comorbidities, Jadhav was advised TAVI, which is an advanced procedure in which a narrowed valve is replaced without the need for surgery.

However, the patient opted for open heart surgery.

Biggest Challenge Was To Replace The Diseased Valve: Doctor

Dr Rohra said he and his team did meticulous planning for two weeks before taking her for open heart surgery.

"I was calm and confident in the preparation we did for the surgery. As soon as the procedure was over, I was happy but concerned as well knowing the next hurdle would be to get the patient off ventilation, which we were able to do in the next 48 hours," he told ABP Live.

The doctor said during surgery, the biggest challenge was to replace the diseased valve with a new one considering her low weight and difficult valve anatomy.

"Over the next few days, we helped her with pulmonary and physical rehabilitation. She is in follow-up and doing well," Dr Rohra further said.

The 71-year-old said she was now normal and leading a wonderful life with her children. "I was admitted to the hospital in a very delicate condition. I was put on immediate medication and we were given time to think over the procedure involved. My faith in the doctors and my zest to live longer for my children made me overcome fear," Jadhav said after the surgery.

Check out below Health Tools-
Calculate Your Body Mass Index ( BMI )

Calculate The Age Through Age Calculator

Source link

The following is a summary of the “A review of current rehabilitation practices and their benefits in patients with multiple sclerosis,” published in the January 2023 issue of Multiple Sclerosis and Related Disorders by Lodice, et al.

Demyelination of the central nervous system nerves is a hallmark of multiple sclerosis (MS). This chronic, disabling disease causes patients to lose the capacity to carry out routine tasks gradually. Because of the incurability of the disease, patients must rely on rehabilitation therapy to help them regain or maintain function and enhance their physical, mental, and social health. Due to the wide variety of MS symptoms, there is no uniform model of care in place at present. Physical rehabilitation techniques, such as balance and gait treatment, speech and respiratory rehabilitation, and occupational therapy, are also accessible. Exercise-based therapies have been shown to have multiple benefits for people with MS, contrary to common belief. These benefits include a reduction in the risk of cardiovascular disease and an increase in cognitive function, and a reduction in the severity of MS-related physical symptoms. 

The benefits of cognitive rehabilitation therapy can be broken down into two categories: compensatory rehabilitation, which aids in cognitive functioning, and restorative rehabilitation, which aids in memory. In addition, non-invasive procedures like cranial stimulation and other forms of stimulation rehabilitation, such as focused muscle vibration therapy, may help patients regain mobility through excitation therapies. Robot-assisted gait therapy and telerehabilitation are more innovative rehabilitation technologies that will become increasingly important in the next years. Both in- and out-patient care settings have been proven useful, with certain patients being more suited to a particular setting, and the composition of the care team has been found to affect patient outcomes. Patients are encouraged to establish a relationship with a single point of care, but it is recommended that they work with a multidisciplinary care team and undergo regular reassessments to manage their symptoms better as they evolve. 

Several aspects of rehabilitation have been identified, and it is clear that they play a crucial role in producing positive results. Patient involvement in treatment, goal setting with a multidisciplinary care team, and a guiding-light purpose for the patient that centers on realizing their individual potential and making progress through a specialized strategy are all essential parts of an integrated, patient-centered care model. In addition, the importance of a measurable increase in activity and involvement and a decrease in impairment is emphasized by the results measurement, which is the last but most important aspect of rehabilitation. Generally, it is difficult to make comparisons due to the need for more standardization in outcome metrics. This is especially crucial when contrasting established medical practices with experimental forms of therapy. However, within the larger field of rehabilitation therapy, it is evident that MS patients can benefit from rehabilitation techniques; physically, intellectually, and socially.

Source: sciencedirect.com/science/article/abs/pii/S2211034822009646

Source link

Plain Language Summary

Nowadays, people are getting older, but also face more chronic diseases as a result. Chronic obstructive pulmonary disease, COPD, is one of the most common chronic diseases. Unfortunately, COPD cannot be cured, so people with COPD need a lot of care. In addition to medical treatment, supervised exercise is an effective treatment to manage COPD. But with the increase in the number of people with COPD, and other chronic diseases, care is becoming increasingly expensive and there is a shortage of healthcare providers to support patients. Both people with COPD and healthcare providers would benefit if patients could take more control of their own health. This self-management does require that patients keep the agreements they made with their healthcare provider. But this is not always easy for everyone.

With this study, we examined whether certain people might need more support from a healthcare provider than other people. People who participated in our study, and who suffered more from the following symptoms or problems, need more support from a healthcare provider:

  • Depressive symptoms
  • Severe shortness of breath
  • Poor motivation to exercise
  • A poorer relationship with the healthcare provider.

People who do not have these symptoms or problems, or very few, have less difficulty with following the agreements. These people might exercise more independently with regular follow-up. By discussing this together, more personalized care might be given.


Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide with an economic and social burden that is both substantial and increasing.1 The prevalence of COPD increased by almost 40% between 1990 and 2017, and by 2017 COPD had become the third leading cause of death globally.2 In the European Union, the total costs of respiratory disease are estimated to be about 6% of the total annual healthcare budget, with COPD accounting for 56% (38.6 billion euros).3 In the United States, the costs attributable to COPD are expected to increase over the next 20 years, with projected costs of 800.90 billion dollars.4 COPD prevalence, morbidity and mortality vary across countries.5

Based on demographic trends, the absolute number of patients with COPD is expected to increase by 31% between 2015 and 2040 in the Netherlands.6 COPD is associated with an increase in disability-adjusted life years and years of life lost across the life course, and with substantial social and economic consequences for both individual patients and health systems.2 Total healthcare costs for patients with COPD were 400 million euros in 2007 in the Netherlands and will rise to nearly 1.4 billion euros in 2032, being more than three times what it was in 2007 (including a growth in healthcare spending of 2.3% per year).7

Pulmonary rehabilitation (PR) aims to reduce the levels of morbidity, to improve functioning, and is currently an integral component of managing COPD.8 PR is a cost-effective method of improving health-related quality of life in patients with COPD and is recommended in national guidelines.9 Despite PR being cost-effective, increasing demand by an aging population and increasing costs of supply demands for sustainable and affordable care.10 In the medium term, the cost of care is rising and a shortage of personnel is looming.11 Due to the high number of consultations per patient per year (24.7), the cost of PR in primary care is relatively high: nearly 40 million euros in 2007.7 To keep healthcare affordable and to make PR less labor-intensive, there is a need for more focus on self-management, without compromising on the effectiveness of PR.12 Self-management programs in primary care may improve health behaviors, health outcomes, and quality of life and, in some cases, have demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic diseases.13 One of the biggest challenges here is long-term adherence.14

Adherence is a multidimensional construct that is defined as the extent to which a person’s behavior in therapeutical interventions corresponds with agreed recommendations from a healthcare provider.15 Adherence includes behaviors such as attendance at clinic appointments, the extent to which patients follow the prescribed treatment, and the communication with their healthcare provider about their recovery.16 In supporting patients staying adherent, available resources could be used in ways that are both effective (desired outcomes) and efficient (that do so with the least amount of effort and cost).17

Understanding who are adherent and who are non-adherent could be helpful to differentiate between patients who need more or less support during PR (effective and efficient). Therefore, accurate estimates of adherence in patients with COPD might be important to be able to support healthcare providers in their choices of support for the benefit of the individual patient. To predict patient’s probability of adherence to PR, a prediction model could be beneficial. Information from such a model can be used to manage the patient instead of managing the disease, as the traditional medical model does.13 The model would aim to reduce unnecessary intervention and thus reduce pressure on the health system (patients who are adherent might need less support). By reducing the average number of consultations from 24.7, healthcare costs are directly saved and the pressure on healthcare providers will also be reduced. This person-centered care requires a patient-provider partnership involving collaborative care and education in chronic disease self-management to ensure the best possible health outcomes for the patient13 and less pressure on the health system.10 So far, no prediction models for adherence are available.

Therefore, the aim of this study was to develop and validate a model to predict adherence to pulmonary rehabilitation in a cohort of patients with COPD in the Netherlands and Belgium.


The study is consistent with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) reporting guidelines (Additional file 1).

Study Design and Population

Participants of this prospective cohort study were Dutch/Flemish-speaking patients aged ≥18 years from primary physiotherapy practices, and from the COPD patient-organizations from the Netherlands and Belgium. Recruitment commenced in January 2021, and 12-month follow-up assessments were completed in August 2022. Patients (≥18 years) with COPD, with airflow limitation stage GOLD II–IV and having rehabilitation sessions for at least once a month, were potentially eligible for inclusion. The exclusion criteria were home-based rehabilitation and insufficient mastery of the Dutch/Flemish language to complete the questionnaires.

Physiotherapy practices were approached by e-mail and social media for participation, and patients were recruited by their attending physiotherapist. Physiotherapy practices could receive a financial compensation of €20 per participating patient, at the time of study completion as a token of appreciation. Patients who were willing to participate were contacted by the researcher per email for further information on their participation, and to obtain informed consent. For patients without an e-mail address, this was done by their physiotherapist during their visit to the physiotherapy practice. Patients were also recruited via the COPD patient-organization in the Netherlands and Belgium who, in turn, invited their physiotherapist for participation (no financial compensation was offered to the physiotherapists).


After signing informed consent and inclusion, patients completed an online (Qualtrics) or paper form on their demographic characteristics: age (years), gender (male/female), country (the Netherlands/Belgium), education (low/middle/higher), smoking status (never smoked/quit smoking/still smoking) and medication adherence (yes/no). About simultaneously, the physiotherapist provided information on the characteristics of the disease of the patient: classification of severity of airflow limitation (GOLD classification) (GOLD II/III/IV), degree of baseline functional disability due to dyspnea (MRC-score) (0/1/2/3/4/5), duration of COPD since diagnosis (years), and duration of physiotherapy (years).

Both patients and physiotherapists provided information at baseline and 12 months after inclusion. Patients provided additional information three months after inclusion. Characteristics of the participating physiotherapists are summarized in Additional file 2.

Data Collection

All questionnaires for both patients and physiotherapists were prepared in Qualtrics (online survey software).18 The questionnaires were sent by the researcher from Qualtrics to the participants at the different measurement moments. Answers to the questionnaires were automatically collected in Qualtrics. If a questionnaire was not completed after two weeks, an automatic reminder was sent. The researcher entered the responses of patients who completed a paper questionnaire into Qualtrics to obtain a complete data file of all participants. Prior to data analysis, the raw data file was checked by the researcher for any input errors. If input errors were found, the researcher contacted the respective participant (patient and/or physiotherapist), if possible. In this way, the raw data file was made technically correct and consistent. Data were anonymized by deleting the e-mail addresses and adding a PID number. Based on the PID number measurements of all measurement moments could be merged.

Candidate Predictors

To construct a prespecified model (to limit selection bias and overfitting), candidate predictors were identified through: pre-existing knowledge, fundamental mechanisms, and specified criteria for selection.

Pre-Existing Knowledge

A previous performed systematic review and meta-analysis of prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases19 formed the basis. According to this systematic review and meta-analysis higher exercise adherence was predicted by self-efficacy, exercise history, motivation, education, physical health, comorbidities, depression, fatigue, and support from a healthcare provider.19

Further, in paramedical professions, it is widely accepted that the treatment regimen alone cannot fully account for patient outcome.20 The relationship between patient and therapist (therapeutic alliance) has been viewed as an important determinant of treatment outcome and is considered central to the therapeutic process.21

Fundamental Mechanism

To model the fundamental psychological determination of behavior, the theory of planned behavior (TPB) was used. TPB supposes that a person’s intention to perform a behavior is the major determinant of that behavior.22 Furthermore, a person’s intention is determined by three theoretically independent variables: a person’s attitude, subjective norm, and perceived behavioral control (PBC).22

Other Criteria for Selection

The process of prespecifying predictors takes into account the prevalence (between 20% and 80%) of the candidate predictors in the dataset. Further, it has been taken into account that prediction models tend to include predictors that are quite readily available, not too costly to obtain, and can be measured with reasonable precision.23 To achieve parsimony and reliability of predictions that are provided by the prediction model, eight candidate predictors could be chosen. The minimum events per variable for obtaining good predictions may be ten.23 The smallest event category must be assumed (limiting sample size); this was the event “adherent” and included 84 cases. With an EPV rate of at least ten, up to eight predictors can be simultaneously included in the full model for reliable results. For the feasibility of the prediction model, we chose to categorize candidate predictors into five domains: demographic data, disease characteristic data, planned behavior constructs, psychological constructs, and exercise and fitness variables.

Based on the results of the systematic review (high and moderate quality evidence), TPB, and the other criteria for selection, the following candidate predictors were included: planned behavior constructs: PBC, attitude, subjective norm, intention; exercise and fitness variables: exercise history; disease characteristics: depression, Medical Research Council dyspnea scale (MRC)-score; and psychological constructs; therapeutic alliance (patient–provider relationship) (Additional file 3).


Exercise adherence (the outcome) was assessed by the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL). The RAdMAT-NL has good psychometric properties with an internal consistency reliability of α = 0.91.24 The RAdMAT-NL is a 16-item questionnaire that uses a 4-point rating scale (never = 1, occasionally = 2, often = 3, always = 4) to evaluate clinic-based adherence.24 The RAdMAT-NL consists of 3 subscales: Attendance/participation (items 1–5, range 5–20 points), Communication (items 6–8, range 3–12 points), and Attitude/effort (items 9–16, range 8–32 points). The total scale range is 16–64, a higher score indicates a higher degree of adherence. According to the American College of Sports Medicine guidelines, a score of at least 85% must be achieved to be adherent to the rehabilitation program.25 This means that a minimum total score of 54 or higher must be achieved on the RAdMAT-NL to be adherent. The RAdMAT-NL was completed at 12 months by the physiotherapist, independent of the patient and not in their presence.

TPB constructs were assessed at baseline. The constructs were measured according to the questions from Ajzen.22 The four intention items focused on goals and plans for exercise and uses a 5-point rating scale (totally disagree = 1, disagree = 2, do not disagree/do not agree = 3, agree = 4, totally agree = 5). The total scale range is 4–20, a higher score indicates a higher degree of intention. Attitude was measured using seven bipolar adjective scales (5-point rating scales) that asked about both instrumental (eg, useful–useless, bad–good) and affective (eg, enjoyable–unenjoyable, boring– interesting) attitude. The total scale range is 7–35, a higher score indicates a more positive attitude. PBC was measured by three questions that asked about aspects of controllability and ease/difficulty and uses a 5-point rating scale. The total scale range is 3–15, a higher score indicates better PBC. Subjective norm was measured by three items that asked about approval and support for exercise and uses a 5-point rating scale (totally disagree = 1, disagree = 2, do not disagree/do not agree = 3, agree = 4, totally agree = 5). The total scale range is 3–15, a higher score indicates more social pressure.

Alliance was assessed after three months by the Working Alliance Inventory (WAI).21 The patient-provider relationship was measured with 12 questions rated on a 5-point scale (range 12–60) and a higher score indicated a higher level of alliance.

Depression was assessed at baseline by four depression questions of the Four-Dimensional Symptom Questionnaire (4DSQ).26 The 4DSQ is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. All items were rated on a 4-point scale (range 4–16) and a higher score indicated a higher level of depression.

Exercise and fitness variables were collected by self-reports. At baseline, patients were asked about exercise history (yes/no).

Sample Size

Data were collected for regression modelling, so therefore sample size calculation has been determined for this purpose with the graph of Miles and Shevlin.27 The graph illustrates the sample size needed to achieve different levels of power, for different effect sizes, as the number of predictors vary. For ten predictors and a medium effect size, a number of 150 participants are needed.

Statistical Analysis

All statistical analyses were performed in R version 4.0.3 using “mice” for multiple imputation, “rms” for logistic regression modelling, “epi” for calculating the AUC, “cutpointr” for calculation of the “optimal” cut-off value, and “rmda” for decision curve analysis. For all analyses, p < 0.05 was considered statistically significant.

Missing Data

Following the in-depth considerations of the patterns of missing data, the data were assumed to be missing at random. First, the amount of missingness for each variable was calculated; the difference between the sample size and the number of useable observations. Second, Fisher exact tests were used to analyze differences in baseline characteristics between patients with missing and complete data. Finally, multiple imputation was used to create and analyze five multiple imputed datasets. Incomplete variables were imputed under fully conditional specification. Analyses were done in each imputed dataset and pooled using Rubin’s rules in the primary analysis.

Baseline Characteristics

Baseline characteristics are presented with appropriate measures of central tendency and dispersion for the overall cohort and for patients who are adherent and are non-adherent.

Model Development

First, the outcome variable was dichotomized: RAdMAT-NL scores ≤ 54 = 0 (non-adherent), > 54 = 1 (adherent). Second, logistic regression modelling was used with all candidate predictors. Continuous variables were handled as they had a linear relationship. The categorical variable MRC score was dichotomized (no limitations: 0–2 = 0; and limitations: 3–5 = 1) because patients with MRC 3–5 have limitations of activity due to dyspnea during daily life and are eligible for PR (MRC 0–2 are not).28

To create a parsimonious model that can more efficiently be used in clinical practice, variable selection using backward selection was performed with a p-value of >0.05 for elimination. Bootstrap samples (n = 500) were used in which the backward elimination procedure was repeated to increase the likelihood of selecting variables that are genuinely related to the outcome. Variables that remained in the model in more than half of the bootstrap samples were included in the final prediction model.

Model Evaluation

Model performance was assessed through discrimination (how well predictions differentiated participants who experienced the outcome from those who did not), quantified as the area under the receiver operating characteristic curve (AUROC), calibration (agreement between predicted and observed risk, assessed using calibration slopes, calibration-in-the-large, and calibration plots), and clinical utility (assessed using decision curve analysis and quantified as net benefit).29 An ideal calibration slope is 1, while calibration-in-the-large should be 0 if the number of observed outcome events matches the number predicted.29 Decision curve analysis was used to calculate the clinical “net benefit” for the prediction model in comparison to default strategies of “treating” all or no patients.30 In this study, the benefit of the model is that it correctly identifies which patients are adherent and who are non-adherent. Preference refers to how healthcare providers value different outcomes for a given patient, a decision that is often influenced by a discussion between the healthcare provider and that patient.30

Validity was assessed via bootstrapping (n = 500) to quantify any optimism in model performance. Adjustment for overoptimism of the overall performance enabled to better approximate the expected model performance in novel samples. Bootstrapping also estimated a uniform shrinkage factor to enable adjustment of the estimated regression coefficients for over-fitting.31 When poorly calibrated predictions at validation were found, algorithm updating was considered to provide more accurate predictions for new patients.32 An intercept adjustment was protocoled if the calibration intercept was not close to 0. Finally, the “optimal” cut-off value for the prediction model was calculated.

The study was approved by the Ethical Committee Psychology of the University of Groningen (PSY-1920-S-0504).



From January 2021 until August 2022, patients from 53 different physiotherapy practices participated in the study. Out of 199 patients who gave informed consent, data from 196 patients were analyzed. The percentage of missing values across all 83 variables throughout the main study varied between 13.7% and 22.9%. In total 151–169 out of 196 patients had a complete data set. There was no association between participants with missing data and the pattern of baseline characteristics. Reasons for missing data were leaving the study; three patients died, three patients stopped physiotherapy because they were diagnosed with cancer or other medical reason, six patients stopped physiotherapy for an unknown reason, and the remaining missing data concerned patients who indicated that they did not have to perform homework exercises.

Table 1 summarizes the demographic and disease characteristics of the patients. Table 2 presents the baseline TPB, exercise and fitness, and psychological variables. Both tables also present the p-values for differences between adherent and non-adherent patients. P-values <0.05 are considered statistically significant.

Table 1 Patient Demographic and Disease Characteristics

Table 2 Descriptive Statistics for the Theory of Planned Behavior, Psychological and Exercise and Fitness Constructs (n = 196)

Model Development

In the backward elimination procedure (including bootstrapping), variables that remained in the model in more than half of the bootstrap samples (p < 0.05) were included in the final prediction model. Four predictors were remained and entered the model: intention, MRC-score, depression and alliance. Excluded were attitude, subjective norm, PBC, and exercise history, because they did not have a significant (p > 0.05) relation with adherence.

The logistic regression analysis results of the four included variables are listed in Table 3.

Table 3 Logistic Regression Analysis of Predictors for Adherence in Patients with COPD

Model Evaluation

The AUC in the primary model was 0.79 (95% CI, 0.72–0.85); p = 0.00 (Figure 1A). After bootstrap internal validation, the optimism-corrected AUC was the same; 0.79 (95% CI, 0.72–0.85); p = 0.00, suggesting good discrimination (Figure 1B).

Figure 1 Area under the receiver operating curve. (A) ROC curve in the primary model. (B) ROC curve after internal validation.

The prevalence of adherence was 42.9% (84/196). The average estimated probability of adherence given by the prediction model was 41.9%, which indicates good estimations. The calibration slope and calibration-in-the-large were respectively 1.026 and −0.007 in the primary model (Figure 2A). After internal validation the probability of adherence given by the shrunken model was 24.4%, which indicates that there is a tendency to give underestimated scores for adherence. The new calibration slope was 1.198 and calibration-in-the-large was 1.015 (Figure 2B). So, after internal validation poorly calibrated predictions were found, with a calibration intercept far from 0. Intercept adjustment was performed by adding the calibration intercept (1.015) to the model intercept (−5.123). After this intercept update, the calibration curve of the intercept-adjusted model was close to the diagonal reference line of perfect moderate calibration (Figure 2C). The average estimated probability of adherence given by this updated model was 47.0% (slightly overestimated score).

Figure 2 Calibration plots. (A) Calibration plot primary model. (B) Calibration plot shrunk model. (C) Calibration plot intercept-adjusted model.

Decision curve analysis was performed for the model. In Figure 3, the net benefit of offering an intervention (less support for patients) for all or none of the patients, which are two extreme situations, is represented by the grey line and the horizontal black line, respectively. In a wide range of risk thresholds, the model outperformed the two extreme strategies with a much higher net benefit. For example, if a risk threshold of 0.5 is used to determine whether a patient needs less supervision/support according to the model, after weighing the benefit and cost, there is a net benefit for 30 out of every 100 patients.

Figure 3 Decision curve analysis of risk prediction model for adherence. The black solid line represents the assumption that none of the patients get an intervention, and the grey solid line represents the assumption that all of the patients get an intervention. The red line represents the result of the prediction model.

To make the prediction model easy to use in practice, a calculator is available (derzis.nu/Calculator/) (screenshot in Additional file 4). Users can enter the individual patient variables in the calculator to obtain the probability of adherence. The optimal cut-off point for the calculator is based on maximizing the sum of sensitivity and specificity.33 Based on the cohort of this study, a threshold of 53.5% is suggested as the optimal cut-off value to define adherent patients (Figures 4 and 5).

Figure 4 Optimal cut-off value and distribution by class; 0 = non-adherent, 1 = adherent.

Figure 5 Values per cut-off point.

Additional file 5 provides an explanation of how to use the calculator and examples of what interventions might be considered for use to improve exercise adherence.


We developed and validated a model to predict exercise adherence in patients with COPD following PR in a primary physiotherapy practice in the Netherlands and Belgium. The final model integrates four easily available predictors (intention, depression, MRC-score, alliance) and is intended for use in the population of COPD patients following PR for at least one month. Internal validation showed good discrimination, calibration, and net benefit. The calculator provides a probability output that indicates the chance that the patient under evaluation is adherent. These predictions will enable healthcare providers to objectively determine which patients are adherent and might be able to exercise more by themselves. Patients who are non-adherent might need more support than patients who are adherent. As a result, healthcare capacity might be better distributed, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.

One of the predictors in the final prediction model is not yet available at the time a patient first comes for PR: alliance. Therefore, this prediction model can only be used for patients following PR for at least one month. It is important for healthcare providers to realize, however, that alliance is an important predictor of adherence. So, when a patient follows PR for the first time, there should immediately be invested in alliance (the larger the alliance, the better the adherence). Literature shows that it is widely accepted that the treatment regimen alone cannot fully account for patient outcome.20 The relationship between patient and therapist has been viewed as an important determinant of treatment outcome and is considered central to the therapeutic process.21 The construct of alliance in therapeutic situations refers to the sense of collaboration, warmth, and support between the client and therapist.21 The study of Peiris et al showed that the patient–therapist interaction was more important to the patient than the amount or content of their physiotherapy.34 In relation with the TPB model, it is shown that patients who experience a positive alliance are more likely to have a stronger self-efficacy and outcome expectations. And self-efficacy and outcome expectations are highly correlated with patient adherence to treatment.35

Strengths and Limitations

The strengths of this study are inclusion of patients from different physiotherapy practices and from patient-organizations in the Netherlands and Belgium. In this way, a representative sample of COPD patients attending PR participated in this study, which enhances the generalizability of the study results regarding other COPD patients already attending PR. The final variables are easy to obtain and can be entered into the adherence calculator to obtain prognostic estimates. A manual for using the calculator is available, including advice for the healthcare provider how to deal with the probability score (Additional file 5). Another strength is the use of a prespecified model to limit selection bias and overfitting. A recent performed systematic review indicated variables associated with adherence.19 Further, TPB as the state-of-the-art model to predict adherence behaviors in patients with a chronic disease, was used.36

This study also has some limitations. Because we wanted a simple model, and because the sample size was not large enough, we accepted uncertainty about the assumptions; we chose to consider the continuous data as linear (cubic splines would cost too many degrees of freedom, making the model overfit). In terms of handling continuous predictors, researchers strongly advise against converting continuous variables into categorical variables, due to information loss and reduced predictive accuracy.31 That is why we choose to accept the uncertainty about the assumptions. Therefore, future validation studies in other cohorts should be performed.

In a previous study,37 we demonstrated that in this cohort of COPD patients adherence was constant over 12 months. Therefore, this prediction model can only be considered valid over this time period. Thereby, the purpose of this prediction model was to better support the current population of COPD patients. Follow-up research should examine whether this prediction model (without alliance) is applicable to patients starting PR, and if this model is valid over a longer period than 12 months. Furthermore, future research might examine whether a reduction in depressive symptoms, an improvement in alliance, intention, and MRC-score actually lead to better exercise adherence in both patients who have had PR for some time and those who are at the beginning of their PR.

Physiotherapy practices were offered a financial compensation if they participated in the full study. The compensation was offered at the end of the study as a token of gratitude and appreciation.38 This had no impact on the study recruitment as it was given at the end of the study. The financial compensation was too low to influence physiotherapist retention and therefore did not serve as an incentive to prevent a physiotherapist from dropping out of the study.

Clinical Implications

Adherence is important in many aspects of healthcare as it is related to clinical outcomes and to the (economic) burden for healthcare providers.39 To keep healthcare affordable and improving patient outcomes, attention must be paid to adherence.40 Information from this prediction model can be used by healthcare providers to facilitate discussions regarding clinical care and target services to better manage COPD and make more efficient use of health care by patients receiving prolonged (70% of patients in this cohort followed PR for ≥1 year) pulmonary rehabilitation in a primary physiotherapy practice. Counselling can possibly focus on patients who need it the most, the ones who are non-adherent. Patients who are adherent require less counselling; their self-management ensures stable health outcomes.37 Both healthcare providers and patients gain substantial benefits; less time and costs spent and placing the patients central to address their needs leading to improved health behaviors, health outcomes, and quality of life.


In this prospective cohort study, we developed and validated an adherence prediction model with good discrimination and calibration that can be used to estimate the probability of adherence in patients with COPD following PR for at least one month. The final predictors (intention, depression, MRC-score, and alliance) are easily to obtain in clinical practice and can be entered into a calculator to obtain prognostic estimates. These estimates can be used by healthcare providers to manage the patient instead of managing the disease, and thereby to determine the treatment frequency for each individual patient. As a result, healthcare capacity might be better distributed, potentially reducing pressure on healthcare without compromising the effectiveness of PR for the individual patient.


4DSQ, Four-Dimensional Symptom Questionnaire; AUC, Area Under the Curve; CI, Confidence Interval; COPD, Chronic Obstructive Pulmonary Disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; IQR, Inter Quartile Range; MRC-score, Medical Research Council dyspnea scale; PBC, Perceived Behavioral Control; PR, Pulmonary Rehabilitation; RAdMAT-NL, Dutch version of the Rehabilitation Adherence Measure for Athletic Training; TPB, Theory of Planned Behavior; WAI, Working Alliance Inventory.

Data Sharing Statement

Data are available on reasonable request. Data are available on reasonable request through the corresponding author Ellen Ricke, [email protected].

Ethics Approval and Informed Consent

This study complies with the Declaration of Helsinki and is registered with the number METc 2020/392. The METc UMCG has concluded that the study is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO). Also, the study was approved by the Ethical Committee Psychology of the University of Groningen (PSY-1920-S-0504).


The authors wish to acknowledge the contributions of the patients and physiotherapists involved in this study. Working Alliance Inventory used and reprinted by permission of the Society for Psychotherapy Research © 2016.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.


The authors declare that they have no competing interests.


1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095–2128. doi:10.1016/s0140-6736(12)61728-0

2. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a lancet commission. Lancet. 2022;400(10356):921–972. doi:10.1016/S0140-6736(22)01273-9

3. FIRS. The global impact of respiratory disease; 2021. Available from: www.firsnet.org/images/publications/FIRS_Master_09202021.pdf. Accessed March 17, 2023.

4. Zafari Z, Li S, Eakin MN, Bellanger M, Reed RM. Projecting long-term health and economic burden of COPD in the United States. Chest. 2021;159(4):1400–1410. doi:10.1016/j.chest.2020.09.255

5. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease; 2023. Available from: goldcopd.org/2023-gold-report-2/. Accessed March 17, 2023.

6. Vzinfo.nl. COPD; 2022.

7. RIVM. Maatschappelijke kosten voor astma, COPD en respiratoire allergie [Social costs for asthma, COPD and respiratory allergy]; 2012. Available from: www.rivm.nl/bibliotheek/rapporten/260544001.pdf. Accessed March 17, 2023.

8. Spruit MA, Singh SJ, Garvey C, et al. An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13–e64. doi:10.1164/rccm.201309-1634ST

9. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56:779–784. doi:10.1136/thorax.56.10.779

10. Winkelmann J, Williams GA, Rijken M, Polin K, Maier CB. Chronic conditions and multimorbidity: skill-mix innovations for enhanced quality and coordination of care. In: Maier CB, Kroezen M, Wismar M, Busse R, editors. Skill-Mix Innovation, Effectiveness and Implementation: Improving Primary and Chronic Care. Cambridge University Press; European Observatory on Health Systems and Policies.; 2022:152–220.

11. Zeilstra A, den Ouden A, Vermeulen W. Middellangetermijn- verkenning zorg 2022–2025 [Mid-term care exploration 2022-2025]; 2019. Available from: www.cpb.nl/sites/default/files/omnidownload/CPB-Middellangetermijnverkenning-zorg-2022-2025-nov2019.pdf. Accessed September 10, 2022.

12. Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. 2004;119(3):239–243. doi:10.1016/j.phr.2004.04.002

13. Allegrante JP, Wells MT, Peterson JC. Interventions to support behavioral self-management of chronic diseases. Annu Rev Public Health. 2019;40:127–146. doi:10.1146/annurev-publhealth-040218-044008

14. Sabaté E. Adherence to Long-Term Therapies. Evidence for Action. World Health Organization; 2003.

15. Meichenbaum D, Turk D. Facilitating Treatment Adherence. Plenum; 1987.

16. Clark H, Bassett S, Siegert R. Validation of a comprehensive measure of clinic-based adherence for physiotherapy patients. Physiotherapy. 2018;104(1):136–141. doi:10.1016/j.physio.2017.07.003

17. RIVM. Duurzame zorg en preventie [Sustainable care and prevention]; 2022. Available from: www.rivm.nl/over-het-rivm/strategisch-programma-rivm/duurzame-zorg-en-preventie. Accessed March 17, 2023.

18. Qualtrics. Qualtrics XM; 2023. Available from: www.qualtrics.com/nl/?rid=langMatch&prevsite=en&newsite=nl&geo=NL&geomatch=. Accessed February 10, 2023.

19. Ricke E, Dijkstra A, Bakker E. Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: a systematic review and meta-analysis. Front Sports Act Living. 2022. doi:10.21203/rs.3.rs-2582829/v1

20. Ambady N, Koo J, Rosenthal R, Winograd CH. Physical therapistis’ nonverbal communication predicts geriatric patients’ health outcomes. Psychol Aging. 2002;17:443–452. doi:10.1037/0882-7974.17.3.443

21. Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther. 2010;90(8):1099–1110. doi:10.2522/ptj.20090245

22. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. doi:10.1016/0749-5978(91)90020-T

23. Steyerberg EW. Clinical Prediction Models. Springer; 2009.

24. Ricke E, Lindeboom R, Dijkstra A, Bakker E. Measuring adherence to pulmonary rehabilitation: a prospective validation study of the Dutch version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL); 2022.

25. Medicine A. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilki; 2021.

26. Terluin B, van Marwijk HW, Adèr HJ, et al. The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006;6(1):34. doi:10.1186/1471-244x-6-34

27. Field A. Discovering Statistics Using R. SAGE Publications Ltd; 2012.

28. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–586. doi:10.1136/thx.54.7.581

29. Steyerberg EW, Vergouwe Y. Towards better clinical prediction models: seven steps for development and an ABC for validation. Eur Heart J. 2014;35(29):1925–1931. doi:10.1093/eurheartj/ehu207

30. Vickers AJ, van Calster B, Steyerberg EW. A simple, step-by-step guide to interpreting decision curve analysis. Diagn Progn Res. 2019;3(1):18. doi:10.1186/s41512-019-0064-7

31. Cowley LE, Farewell DM, Maguire S, Kemp AM. Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature. Diagn Progn Res. 2019;3(16). doi:10.1186/s41512-019-0060-y

32. Van Calster B, McLernon DJ, Van Smeden M, Wynants L, Steyerberg EW. Calibration: the achilles heel of predictive analytics. BMC Med. 2019;17(230). doi:10.1186/s12916-1466-7

33. Thiele C. An introduction to cutpointr; 2022. Available form: cran.r-project.org/web/packages/cutpointr/vignettes/cutpointr.html. Accessed December 3, 2022.

34. Peiris CL, Taylor NF, Shields N. Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother. 2012;58(4):261–268. doi:10.1016/S1836-9553(12)70128-5

35. Lee Y, Lin JL. The effects of trust in physician on self-efficacy, adherence and diabetes outcomes. Soc Sci Med. 2009;68:1060–1068. doi:10.1016/j.socscimed.2008.12.033

36. Rich A, Brandes K, Mullan B, Hagger MS. Theory of planned behaviour and adherence in chronic illness: a meta-analysis. J Behav Med. 2015;38:673–688. doi:10.1007/s10865-015-9644-3

37. Ricke E, Dijkstra A, Bakker E. Adherence to pulmonary rehabilitation during a 12-month period in Dutch and Flemish patients with prolonged COPD treatment; a prospective cohort study. J Nurs Healthc. 2023;8(1):49–56.

38. Sansom LJ, Minh TPN, Hill IE, et al. Towards a fair and transparent research participant compensation and reimbursement framework in Vietnam. Int Health. 2020;12(6):533–540. doi:10.1093/inthealth/ihaa066

39. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331–342. doi:10.1046/j.1365-2710.2001.00363.x

40. Mold J. Goal-directed health care: redefining health and health care in the era of value-based care. Cureus. 2017;9(2). doi:10.7759/cureus.1043

Source link

About 15.7% of Idahoans have experienced long COVID, according to a recent CDC survey, slightly higher than the national estimate of 14.7%.

Long COVID, also known as post-acute sequelae of COVID-19, is a syndrome in which people continue to experience symptoms of COVID-19 months after the initial infection. It has been found to impact about 1 in 3 of those who had COVID, and can affect even those who had cases with very mild symptoms.

These are five key facts about the state of long COVID in Idaho.

Long COVID map.png
About 15.7% of Idahoans have experienced long COVID, according to a recent CDC survey, slightly higher than the national estimate of 14.7%. Centers for Disease Control and Prevention

long COVID state percentages.png
About 15.7% of Idahoans have experienced long COVID, according to a recent CDC survey, slightly higher than the national estimate of 14.7%. Centers for Disease Control and Prevention

1. Over a quarter of Idahoans who had COVID also experienced long COVID

An estimated 29.9% of Idahoans who have had the virus have reported experiencing long COVID. That means they’ve had symptoms lasting three months or longer that they did not have before having COVID-19.

Also, 71.9% of Idaho residents with long COVID say that these long-term symptoms reduce their ability to carry out day-to-day activities. Worse, about 22.8% say there are “significant activity limitations.” Some of the more common long-term symptoms include fatigue or brain fog, which is characterized as difficulty thinking or concentrating.

2. Multiple long COVID studies are being conducted

The Idaho Department of Health and Welfare does not track long COVID data. However, the department is following a pair of studies assessing long COVID symptoms.

One study published in the National Library of Medicine looks at the neurological effects and cognitive dysfunction in those with COVID symptoms for more than six weeks. The study found that among 100 non-hospitalized COVID-19 patients across 21 states, 85% reported at least four neurological symptoms, such as brain fog, headache, and taste or smell disorders.

The study also found many patients suffered from non-neurological symptoms, such as fatigue (85%), shortness of breath (46%), chest pain (37%), and gastrointestinal symptoms (29%).

In addition, a second study published in the National Library of Medicine looked at long COVID patients roughly 8.5 weeks after infection. Of the 143 patients studied, 18 were completely free of COVID-related symptoms, 46 had at least one or two symptoms, and 79 had three or more.

3. People with long COVID experience a wide variety of symptoms

Long COVID was added as a recognized condition that could result in disability under the Americans with Disabilities Act in July 2021. The CDC acknowledges that people with post-COVID or long COVID conditions may experience many symptoms and lists them online:

General symptoms

Respiratory or heart symptoms

Neurological symptoms

Digestive symptoms

Other symptoms

Long COVID symptoms can take weeks, months, or longer to go away completely. Initial studies show that most people are improving slowly over time.

People who continue to experience symptoms of COVID-19 months after the initial infection should speak with their primary care provider about being referred to a multidisciplinary care team with expertise in long COVID.

4. Treatment options for long COVID

Boise State University recommends that individuals with long COVID be referred to healthcare specialists in cardiology, pulmonology, neurology, or other relevant fields. The university also outlines potential treatment options for those with the most common long COVID symptoms:

Fatigue: Patients with fatigue may consider learning the “4 Ps” strategies — pacing, planning, prioritizing and positioning. Undertaking physical activities that involve stretching, strengthening and aerobic exercises can also battle fatigue, but if symptoms worsen, physical activity should be reduced or stopped.

Respiratory symptoms: A primary treatment option is pulmonary rehabilitation, a guided program that teaches individuals to learn breathing techniques and perform breathing exercises.

Cardiac symptom: Those with cardiac symptoms may be referred to a cardiovascular specialist. At-home treatment options will likely involve cardiac rehabilitation, which involves physical activity, education about healthy living, and counseling on removing stress from life.

Neurological symptoms: For patients with brain fog and memory loss, Boise State says doctors recommend exercise and remaining physically active. Those with memory problems can also be taught memory exercises and get in the habit of using memory aids such as calendars and planners.

Psychological symptoms: Individuals who suffer from depression, anxiety, and other psychological symptoms are typically referred for counseling, support groups and medications to manage the symptoms.

Smell and taste symptoms: Boise State experts note that doctors may prescribe topical corticosteroids to reduce inflammation in the nose, which often leads to smell loss. Patients may be referred to an ear, nose and throat specialist if symptoms don’t resolve.

5. Preventing COVID reinfection is key

Treatment plans look different for each person based on their specific symptoms. Potential treatment options for long COVID may include a combination of physical rehabilitation, breathing and mental exercises, and medications.

While long COVID is not as contagious as the initial infection, according to the CDC, it is recommended that you receive a COVID-19 vaccination and take the appropriate health precautions to prevent re-infection. The best way to protect yourself and those you love is by getting vaccinated, wearing masks and practicing social distancing.

Related stories from Idaho Statesman

Source link

Katy, Texas - Apex Physical Rehabilitation & Wellness provides personalized outpatient physical therapy and rehabilitation. Their main area of focus is resolving chronic and acute injuries. The clinic's services include; physical therapy, spinal decompression, aquatic therapy, specialty services, and work health.

In physical therapy, they assist their patients in regaining function in injured body parts with the help of their individualized treatment programs. Their team takes care of the existing issues and then creates effective preventative health care that meets a wide range of patient needs. They offer post-operative rehabilitation and relieve hip, knee, foot, and ankle pain. The clinic also treats neck, shoulder, elbow, and ankle pain and patients with orthopedic-related dysfunctions.

The Katy physiotherapist offers physiotherapy for post-operative rehabilitation. This type of rehab helps patients to re-establish joint motion and build the strength of the muscles around the affected joint. Eventually, the therapy will restore the normal function of the injured joint. The staff gradually adds the stimuli and workloads on the repaired joint throughout the recovery process to strengthen it. They train patients on the correct exercises to enhance healing while at home.

Apex Physical Rehabilitation & wellness offers orthopedic physiotherapy for clients with orthopedic-related dysfunction. They have physiotherapists who help reduce the pain by mobilizing stiff joints or releasing the tight muscles and fascia so the nerve pathways can open. The staff simultaneously engages patients in manual therapy, education, and movement for the best possible results.

The clinic addresses pain caused by sprains and strains, arthritis, and plantar fasciitis, among other issues. Their physical therapy Katy involves working with the patients to get to the root cause of the problem and offer effective treatment. The therapies promote tissue healing, reduce pain, reduce swelling, improve strength, and encourage ligament healing.

Besides that, the facility has a devoted team of workers' compensation professionals offering solutions for injured workers through prevention, management, treatment, and case closure. Under work health, they offer endurance training, functional capacity evaluation, injury prevention, and work conditioning.

Apex Physical Rehabilitation & Wellness uses evidence-based treatments with reliable research backing. The clinic provides care to its patients in a friendly and exceptional way. The clinic has treated thousands of patients with neurological and orthopedic conditions since its founding by Amir Kazemi in 1999. A quote from the company website says this about their services.

"Our genuine pledge is to take pride in passionately serving and caring for every patient. Our team desires to connect with each patient, on every visit, through sound and persistent performance of every detail of your physical therapy visit; so that we may have the honor of becoming your clinic of choice."

To consult or book an appointment, contact Apex Physical Rehabilitation & Wellness at (832) 240-7773. For more information about their physical therapy services, visit the clinic website. Apex Physical Rehabilitation & Wellness is located at 777 S Fry Rd #104, Katy, Texas, 77450, US.

Media Contact

Company Name
Apex Physical Rehabilitation & Wellness
Contact Name
Amir Kazemi
(832) 240-7773
777 S Fry Rd #104
Postal Code
United States

Source link

Pilates is a form of low-impact exercise with moves that help strengthen your muscles while improving posture, mobility, and flexibility. This exercise program, which was developed in the early 1900s by Joseph Pilates, is designed to coordinate your breathing with your body movements resulting in more body control.

Originally known as "controlology," Pilates offers a number of health benefits including improving your mobility, helping to manage pain, and building muscle endurance. Typically, workouts last about 45 minutes or longer in a class setting, but there are some Pilates workouts you can do in 20 to 30 minutes at home.

Keep reading to find out how Pilates can impact your health as well as how to implement a program at home.

Pilates is a low-impact exercise program that's good for any age. Whether you are bored with your current fitness routine or you are just looking to exercise more and improve your flexibility, Pilates may be exactly what you are looking for. Here is an overview of some of the potential health benefits of Pilates.

Improves Balance and Mobility

If you are looking to improve your functional movement—the type of movement that helps you complete everyday tasks like walking, sitting, standing, and carrying things—then you may want to consider Pilates. Not only can it help your movements become more fluid, but it also can help you develop more balance and stability.

In fact, a study found that people who practiced Pilates for 1 hour, three times a week for eight weeks showed increased balance, stability, and mobility. What's more, the study participants showed more improvement—or scored higher on their functional movement screenings—than the group performing yoga.

Increases Muscle Strength and Endurance

Pilates also is great for anyone looking to build muscle strength and endurance. This is largely due to the concentrated effort and control it requires to perform the moves.

For instance, one older study found that people who did 1 hour of Pilates twice a week for 12 weeks experienced significant increases in both abdominal endurance and upper-body muscular endurance.

Meanwhile, another study found that people who completed two Pilates sessions a week over three months showed improvements in lower body strength and postural balance. And, a study of postmenopausal women found that Pilates helped strengthen their upper body, lower body, and abdominal muscles.

Helps Manage Pain

There is emerging research suggesting that Pilates may be useful for coping with different forms of pain. In fact, in one preliminary study on those with fibromyalgia found that people who consistently participate in Pilates may experience less anxiety and more pain relief.

There also is some evidence that Pilates may be useful in reducing pain caused by osteoarthritis. A randomized controlled study found that people with knee pain benefitted more from doing Pilates than conventional therapeutic exercise.

Pilates may even be useful during pregnancy and lead to better labor and delivery outcomes. For instance, a randomized clinical trial of pregnant women found that those who participated in Pilates twice a week during pregnancy had improved labors with fewer C-sections, episiotomies, and obstructed labor. They also had lower blood pressure and more flexibility.

Boosts Mental Health

Like many exercise programs, Pilates can boost your mood and help manage symptoms of anxiety and depression. Some of this boost in energy and mood may be related to the mind-body connection that occurs when practicing Pilates, as well as the fact that working out can boost your endorphins—or those feel-good hormones.

What's more, there are plenty of studies illustrating the positive impact Pilates can have on your mood. For instance, a meta-analysis of eight Pilates studies found that those who practiced Pilates reported fewer symptoms of anxiety and depression. They also had more energy and were less fatigued.

Improves Quality of Life

Researchers note that Pilates may be particularly useful for those who live sedentary lifestyles. Not only is it a low-impact way to stay active, but it can be particularly instrumental in improving quality of life.

In fact, one small study of sedentary women ages 61 to 67 showed that those who did 30-minute Pilates mat and equipment-based sessions twice a week for six months experienced significant improvements in their quality of life.

While Pilates and yoga are both low-impact, bodyweight workouts that emphasize the mind-body connection, they were created with different roles in mind. For instance, Pilates has a greater focus on building strength and stability in your core and your spine and was initially introduced by Joseph Pilates to dancers and other athletes recovering from injuries.

Meanwhile, yoga—which began in India thousands of years ago—has more of a meditative focus. It blends the use of different poses (or asanas) with breathing techniques. And although both Pilates and yoga build core strength, yoga is more focused on stretching and expanding your consciousness through movement.

You can benefit from either discipline, especially because both build flexibility and strength, but Pilates is often more useful for physical rehabilitation. It also can help build your core strength. Meanwhile, yoga may be better for cardiovascular health, especially vinyasa yoga, which tends to be faster paced.

If you are interested in giving Pilates a try to see if it is right for you, you may want to try a few exercises at home first. Doing so, can help you get familiar with the movements and help you decide if you like it before joining a class or finding a studio.

What's more, there are plenty of online resources that allow you to practice the discipline in the comfort of your home. Here are some Pilates moves you can try, but keep in mind there are many more options than what is listed here.


Perhaps one of the most popular Pilates move is "the hundred," which is named after the 100 beats your arms make while holding your legs extended and your head and shoulders off the mat. Many times, this move is used at the beginning of a Pilates class. Here is how you do the hundred.

  1. Lie on your back with your arms at your side.
  2. Curl your head, neck, and shoulders up and lift your legs off the mat at a height that is comfortable for you.
  3. Make sure your abs are engaged but that your lower back is not lifting off the mat.
  4. Pump your arms up and down, breathing in for five counts and out for five counts, which totals 10 breath counts.
  5. Repeat the arm movements and breath counts 10 times.

Shoulder Hip Bridge

If your goal is to target your backside including the hamstrings, inner thighs, and obliques then the shoulder hip bridge is the move for you. Here is how to do the move.

  1. Lie on your back with your knees bent.
  2. Place your hands on the floor along your sides.
  3. Lift your hips, tilting your rib cage upward. Then, lift one leg to the ceiling.
  4. Assume the bridge position on your shoulders and hold briefly.
  5. Move your raised leg to the side keeping it straight (crossing over your other leg). Then, return back to the center.
  6. Keep your pelvis stable during the movement without tilting when your leg moves.
  7. Complete 15 to 20 repetitions while keeping the hips lifted.
  8. Repeat on the other side.

Supported Roll Back

People who are looking to really challenge their abdominal muscles, often want to try the roll up. That said, if you are new to Pilates, the best place to start is with the supported roll back and then transition to roll up once you have built up some strength. Here's how to do the supported roll back.

  1. Start sitting up with your knees bent in front of you.
  2. Place your hands around your thighs just below the knees
  3. Drop your shoulders and relax your neck.
  4. Pull in your abs to initiate the move and start moving backward.
  5. Go back until your lower back touches the mat and your arms are straight. (Your feet should not lift off of the floor.)
  6. Pull with your abs to return to upright keeping your back in a C-curve as long as possible.

Roll Up

Once you have mastered the supported roll back, you may want to give the roll up a try. However, if you have low back pain or a low back injury, this exercise may not be right for you. At least talk with a healthcare provider before giving it a try.

Based on how difficult it is to master the roll up, it is not surprising that proponents of Pilates claim that this move can be more effective than traditional sit-ups or crunches. Here is how to do the roll up.

  1. Lie down on your back with your legs straight.
  2. Extend your arms so that your hands are reaching toward the wall behind you.
  3. Roll your torso up slowly breathing out as you come up.
  4. Try to engage your abdominal muscles and not rely on momentum to come up.
  5. Reach for your toes keeping the head tucked and the back rounded. (If you need to modify this move slightly, you can allow your legs to bend).
  6. Return to your starting position by rolling down slowly, one vertebrae at a time.
  7. Repeat six times.

Source link

Individuals with idiopathic pulmonary fibrosis (IPF) who experience unintended weight loss are at significantly higher risks of being admitted to the hospital or dying within one year, a Danish study reported.

Specifically, IPF patients with unintended weight loss were found to have a nearly 30 times higher risk of death, and were almost 16 times more likely to be hospitalized.

These findings highlight that “higher attention regarding research and practice should be given to nutritional and functional status in pulmonary fibrosis,” according to researchers.

The study, “A one-year follow-up study in patients with idiopathic pulmonary fibrosis regarding adverse outcomes to unintended weight loss,” was published in the journal Nutrition.

Recommended Reading

Weight loss risk

Investigating unintended weight loss among patients

People with IPF often experience weight loss, likely due to a decrease in calorie intake accompanied by heightened inflammation. Many patients with the disorder are found to have poor nutrition.

Malnutrition associated with pulmonary fibrosis (PF) results in body changes, as well as impaired physical and mental function, which are associated with higher hospitalization and mortality rates.

Although unintended weight loss has been found to be associated with survival rates in idiopathic PF patients, the burdens associated with IPF-related nutrition problems have not been thoroughly investigated.

Now, researchers in Denmark explored the link between body weight, weight loss, and signs of sarcopenia — loss of muscle mass and strength — and hospital admissions and mortality in a group of IPF patients. The team, from the Aalborg University Hospital, also assessed the rate of pulmonary rehabilitation among these patients, as well as the prevalence and associations of signs of sarcopenia, as measured by the SARC-F questionnaire.

Individuals with IPF being followed at an outpatient clinic were recruited for the study while waiting for a clinical consultation. At the study’s start, or baseline, participants filled out a questionnaire, and their height and body weight were measured.

One year later, the participants were interviewed by phone to collect follow-up data regarding their current body weight, sarcopenia, and pulmonary rehabilitation participation. Their medical records also were analyzed.

In total, 98 patients were included at baseline, and data were available for 91 of them after one year of follow-up. Two patients died during the study period and five were lost to follow-up.

The median body-mass index (BMI) – a ratio of height to weight that’s used to estimate body fat – at baseline was 27.8 kilograms per square-meter (kg/m2), and 27.4 kg/m2 at the one-year follow-up.

The proportion of patients with unintended weight loss was higher at follow-up than it was at baseline (13.2% vs. 10.2%.) Mean weight loss increased from 9.1 kg (around 20 pounds) at baseline to 11.8 kg (around 26 pounds) at the one-year follow-up.

At the study’s start, the patients’ hospitalization rate for the prior three months was 26.5%. Nearly one-third of the patients (30.8%) were admitted to the hospital due to IPF, and 69.2% for other reasons. At follow-up, 39.6% of the patients had been admitted to the hospital. There was a median of two hospitalizations per year for the participants.

Patients who already lost weight at [the study’s start] were subject to higher risk of mortality and hospital admissions within the year.

From the 91 patients with one-year data, 11 (12.1%) were offered pulmonary rehabilitation and four (36.4%) went ahead and participated in the rehabilitation program.

A total of 19 patients (20.9%) were at risk of developing sarcopenia, as shown by a SARC-F score of four or higher. Scores equal to or greater than four in the SARC-F questionnaire are predictive of sarcopenia and poor outcomes.

Compared with patients with low SARC-F scores, those with higher scores who were at an increased risk of developing sarcopenia were more frequently offered pulmonary rehabilitation (5.99 times more often).

Recommended Reading

Main graphic for column titled

Unintended weight loss linked to poor outcomes

Statistical analyses also revealed that being female, older (age 71 and older), having additional diseases or comorbidities, and experiencing unintended weight loss at baseline all were variables that were independently associated with experiencing unintended weight loss at follow-up.

Importantly, patients with unintended weight loss at baseline were at a higher risk — 29.81 times higher — of death, and were 14.68 times more likely to be hospitalized.

Obese patients — those with a BMI of 30 kg/m2 and higher — had more coexisting medical conditions and a tendency for being admitted to the hospital more frequently than those with a lower BMI. The rate of hospitalizations was 3.8 times higher for obese patients, the data showed. Age was found to be a factor impacting the association between unintended weight loss at follow-up and sarcopenia.

At follow-up, obese IPF patients were 5.10 times more likely to be offered pulmonary rehabilitation, and patients at risk of sarcopenia (SARC-F score of four or higher) were 6.51 times more likely.

“Unintended weight loss frequently occurs in pulmonary fibrosis outpatients and increases in [up to one year] of follow-up,” the researchers wrote, adding, “Patients who already lost weight at baseline were subject to higher risk of mortality and hospital admissions within the year.”

The scientists said these findings highlight the need for research into unintended weight loss in IPF patients.

“Based on this study, [unintended weight loss], high BMI, body composition, and a low degree of physical rehabilitation participation, including a systematic approach to tertiary rehabilitation, should be the focus of further investigations,” the researchers concluded.

Source link

Allyse Dowell, a registered nurse at Saint Luke’s Hospital of Kansas City, cares for a severely infected COVID-19 patient at the Cardiovascular Intensive Care Unit on Tuesday, Jan. 18, 2022. Dowell withdraws blood from the patient to measure their oxygen levels.

Allyse Dowell, a registered nurse at Saint Luke’s Hospital of Kansas City, cares for a severely infected COVID-19 patient at the Cardiovascular Intensive Care Unit on Tuesday, Jan. 18, 2022. Dowell withdraws blood from the patient to measure their oxygen levels.

[email protected]

About 14% of Texans have experienced long COVID, according to a recent CDC survey, slightly lower than the national estimate of 15%.

Long COVID, also known as post-acute sequelae of COVID-19, is a syndrome in which people continue to experience symptoms of COVID-19 months after initial infection.

These are five things you should know about the state of long COVID in Texas.

long covid tx 1.PNG
About 14% of Texans have experienced long COVID, according to a recent CDC survey, slightly lower than the national estimate of 15%.

long covid tx 2.PNG
About 14% of Texans have experienced long COVID, according to a recent CDC survey, slightly lower than the national estimate of 15%.

1. A quarter of Texans who have had COVID have experienced long COVID

An estimated 26% of Texans who have had the virus have reported experiencing long COVID. That means they’ve had symptoms lasting three months or longer that they did not have prior to having COVID-19.

And 81% of Texas residents who have long COVID say that these long-term symptoms reduce their ability to carry out day-to-day activities. Worse, about 28% say there are “significant activity limitations.”

2. Several long COVID studies are being conducted in Texas

Because it is not a reportable condition, the Texas Department of State Health Services doesn’t track data on long COVID. However, several state universities are monitoring and treating the illness in Texas.

UT’s Post-COVID-19 Program provides medical care, research and education for patients who experience new or persistent symptoms months after their initial COVID infection. According to the UT program website, these include:

  • Fatigue
  • Deconditioning
  • Muscle weakness
  • Neuropathy and myopathy
  • Pain
  • Headaches
  • Exercise intolerance
  • Shortness of breath
  • Autonomic instability
  • Difficulty with thinking and concentration
  • Neurologic symptoms
  • Depression and anxiety

The care team includes internal medicine specialists, neurologists, advanced practice providers, nurses and social workers. They utilize the latest research, diagnostic and treatment techniques, allowing them to learn more about the emerging illness and develop diagnostic and therapeutic guidance as well as referral pathways to specialty providers.

The University of Texas Health Science Center at San Antonio is conducting the PREVAIL South Texas study (Prevention, Evaluation and Incidence of Long-Term COVID in South Texas) as part of the National Institutes of Health’s COVID research initiative. The study is looking into a drug that may help improve long COVID symptoms when taken nightly at bedtime for 14 weeks.

UT Southwestern has an outpatient rehabilitation program called COVID Recover, designed to help patients restore muscle, lung and brain function, mental health and psychological well-being after being infected with COVID-19.

The Inspire (Innovative Support For Patients with SARS-CoV-2 Infections) study at UT Southwestern aims to understand the long-term effects of COVID-19 infection. Participants describe how they are feeling by completing online surveys and share their medical information through a personal health platform.

3. Long COVID is more common in people who experienced severe symptoms requiring hospitalization

Serious symptoms that require hospitalization include severe inflammation, shortness of breath, confusion, persistent pain or pressure in the chest and organ damage, according to UT Southwestern.

The UT team’s research has found that one third of patients who were hospitalized and needed oxygen, and two thirds of patients who were hospitalized and needed a ventilator, have some level of lung scarring and tissue damage, making it hard for them to breathe. For patients who had the virus but didn’t need to be hospitalized, concerns include persistent cough, shortness of breath and respiratory issues.

However, anyone can experience long COVID, including young adults, healthy individuals and people who experienced mild COVID symptoms or were asymptomatic.

Risk factors, according to UT Health Austin, include:

  • Older age
  • Number of symptoms
  • Higher BMI
  • Females
  • History of asthma

4. People with long COVID experience a wide variety of symptoms

Symptoms of long COVID vary from person to person, per the UT long COVID website.

The most common symptom is chronic fatigue, which includes exhaustion, tiring with exertion and brain fog (difficulties with memory, lack of concentration, headaches, confusion and decreased mental clarity). Long COVID can also cause more serious health conditions including heart damage, lung damage, blood clots and blood vessel problems. Living with long COVID can lead to post traumatic stress disorder, depression and anxiety.

Here are the long COVID symptoms you should look out for, according to UT:

  • Fatigue
  • Difficulty sleeping
  • Persistent cough
  • Shortness of breath or difficulty breathing
  • Chest pain
  • Headaches
  • Joint or muscle pain
  • Loss of smell or taste
  • Rash
  • Hair loss
  • Rapid or pounding heartbeat
  • Depression or anxiety
  • Fever or night sweats
  • Inability to control body temperature
  • Constipation
  • Diarrhea
  • Memory problems or difficulty concentrating
  • Dizziness
  • Confusion
  • Worsened symptoms after physical or mental activities

Long COVID symptoms can take weeks, months, or longer to go away completely. Initial studies show that most people are improving slowly over time.

If you are continuing to experience symptoms of COVID-19 months after initial infection, speak with your primary care provider about being referred to a multidisciplinary care team with expertise in long COVID.

5. Preventing COVID reinfection is key

Treatment plans look different for each person because it’s based on their specific symptoms. Potential treatment options for long COVID may include a combination of physical rehabilitation, breathing and mental exercises and medications.

According to Dr. Michael Brode, medical director of the UT long COVID program, there’s currently no recognized, FDA-approved treatment for long COVID. Instead, doctors treat the specific symptoms of fatigue, anxiety, shortness of breath etc. For instance, shortness of breath is treated with albuterol inhalers and anxiety is treated with counseling and antidepressant medications. The research team’s goal is to find targeted curative therapies for long COVID.

While long COVID is not as contagious as the initial infection, it is recommended that you receive a COVID-19 vaccination and take the appropriate health precautions to prevent re-infection. The best way to protect yourself and the ones you love is by getting vaccinated, wearing masks and practicing social distancing, Texas long COVID experts say.

This story was originally published February 27, 2023, 7:00 AM.

Related stories from Fort Worth Star-Telegram

Dalia Faheid is a reporter on the Star-Telegram’s service journalism team. She is a graduate of the Medill School of Journalism at Northwestern University.

Source link

Millions of Americans of all ages suffer from post-COVID-19 condition, or long COVID. In fact, recent data show that the condition is affecting more than 16 million working-age Americans and is keeping between two and four million of them out of work completely.

According to the World Health Organization, long COVID occurs when an individual continues to suffer from prolonged symptoms of the virus at least 3 months after initial onset. Common symptoms include difficulty thinking or concentrating, sleep trouble, dizziness, headaches, fatigue, brain fog and more. In many cases, these symptoms prove to be debilitating and result in significant health and quality of life issues.

Health care professionals around the globe are working tirelessly to understand, diagnose. and treat long COVID. While there is no single treatment that has been approved to completely rid those with long COVID of their symptoms, a growing body of clinical research supports the potential of a specific hyperbaric oxygen therapy (HBOT) protocol to become part of the standard of care for the condition. A breakthrough randomized controlled trial on use of the protocol for symptom management was published in Scientific Reports in July.

The study was conducted by the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center in Israel, known for its pioneering research on novel indications of hyperbaric medicine for cognitive and physical rehabilitation. The cohort was comprised of 73 participants with reported long COVID cognitive symptoms. To study the effectiveness of the HBOT protocol in treating these individuals, patients were randomly assigned to either a treatment or placebo (sham) group. The unique treatment protocol was comprised of 40 daily HBOT sessions, 5 sessions per week.

The randomized, double-blind, placebo-controlled clinical trial demonstrated that HBOT, when used in a specific protocol was effective at improving symptoms of long COVID. Participants showed significant improvement in global cognitive function, energy, sleep, psychiatric symptoms, and pain interference. Participants in the control group did not exhibit these same improvements.

The study revealed that HBOT can induce structural and functional repair of damaged regions of the brain and improve cognitive, behavioral, and emotional function of patients with long COVID conditions.

Further analysis of the brain network activity of those patients was published in the journal Neuroimage: Clinical and shed additionallight on how COVID can disrupt the normal functionality of the brain. Moreover, the study shows that in post-COVID-19 patients, HBOT improves disruptions observed in white matter tracts (neuronal fibers) and alters the functional connectivity organization of neural pathways attributed to cognitive and emotional recovery.

While HBOT has been used for centuries, this new study indicates that utilizing a specific protocol involving oxygen fluctuation in a multiplace chamber can induce neurogenesis, neuronal stem cell proliferation, increased blood flow, and neuroplasticity. HBOT involves breathing 100% pure oxygen while in a controlled hyperbaric chamber. The air pressure inside is elevated above normal to help the lungs collect more oxygen and more effectively deliver that oxygen to damaged tissues, thus expediting the healing process. Deliberate fluctuations of oxygen levels during each HBOT session work to induce the hypoxia inducible factor, increasing vascularization and promoting angiogenesis in damaged brain tissues.

The specific HBOT protocol studied here is in use for treatment of the symptoms of long COVID at Aviv Clinics through an exclusive partnership with the Sagol Center. The partnership allows Aviv clinics in Florida and Dubai to use the protocols, evaluation methods, and treatments used in the Scientific Reports study. Patient assessment includes high resolution brain imaging to identify damage in the brain caused by the SARS-CoV-2 virus. When combined with the results of intensive cognitive, physical, and nutritional assessments, these scans allow a multidisciplinary team of clinicians to develop a customized treatment program to help each patient.

Shai Efrati, MD, is founder and director of the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center, Be'er Ya'akov, Israel, where he also serves as director of research and development and head of nephrology. Efrati’s research focuses on novel aspects of hyperbaric medicine and brain rehabilitation. He is a professor at the Sackler School of Medicine and the Sagol School of Neuroscience in Tel Aviv University. Since 2008, he has served as Chairman of the Israeli Society for Diving and Hyperbaric Medicine.

Source link

Eden Private Hospital delivers comprehensive rehabilitation programs.

Eden Private Hospital is the Sunshine Coast’s longest operating private rehabilitation facility, with 48 dedicated medical, rehabilitation and mental health beds.

Eden Private Hospital delivers comprehensive rehabilitation programs to both inpatients and outpatients, that are tailored to the patient’s specific needs and goals, and managed by a multidisciplinary team of allied health professionals under the care of a rehabilitation consultant.

Their experienced staff work together to help patients regain strength and cardio fitness, balance and mobility as well as redevelop skills and ultimately function with the highest possible level of independence and confidence.

Each program includes an individual consultation followed by physical rehabilitation and education sessions that are structured around the health diagnosis and patient goals. The programs are typically run twice a week, over a six week period and the duration of the programs can vary.

The programs offered which patients can be referred into include:

– Orthopaedic.

– Neurological.

– Reconditioning.

– Pain.

– Cardiac rehabilitation.

– Cancer rehabilitation.

– Falls prevention.

– Pulmonary rehabilitation.

– Robotic assistive therapy.

How to be referred

Eden accepts referrals from general practitioners, specialists and surgeons, and public and private hospitals. You would simply need to see your GP or specialist and ask for a referral to be sent to Eden Private Hospital and the admissions and assessment team will be in contact with you once received.


Eden Private Hospital has agreements with most private health funds as well as tier one provider status with the Department of Veteran’s Affairs. The outpatient allied jealth team also conducts sessions under Medicare’s enhanced primary care program for physiotherapy, exercise physiology and occupational therapy.

For further support in navigating your care or to utilise this service as either an inpatient or outpatient, or to learn more about Eden Private Hospital, please contact the admissions and assessment team on 1800 333 674 or visit edenprivate.com.au

Source link

  • The physical rehabilitation market in India largely comprises of geriatric care, restorative care and pain relief.
  • An estimated 35-40% of the physical rehab spend in India is concentrated in the top 10 cities.
  • Restorative care comprises 28% of the physical rehabilitation market in India.

India’s physical rehabilitation market is expected to grow by 15.5% to become a $35 billion market by FY28, according to a report by Redseer Consultants.

Currently, it’s a $17 billion market and covers – restorative care that includes recovery after critical health conditions like a complex surgery; geriatric care that includes services and products for the elderly; and pain-relief via physiotherapy for arthritis, injury and more. Both at-home and at-centre care are included here.

“Rehab is rapidly evolving and today transition care centres and out-of-hospital care providers can address a wide range of patient requirements from basic to complex or critical care,” says Vivek Srivastava, CEO of HCAH India, an out-of-hospital patient care provider.

According to Redseer’s Rehab Tech report, lack of awareness, sparse availability and limited capabilities of rehab providers are currently restricting the usage of rehab, despite its strong need.

The report says that the potential for growth comes from the fact that an estimated 35-40% of the physical rehab spend in India is concentrated in the top 10 cities – Delhi NCR, Hyderabad, Bangalore, Mumbai, Kolkata, Chennai, Pune, Kochi, Coimbatore and Indore.

Physical rehabilitation care in India:

Segment Market value in India Description
Restorative care $5 billion Recovery from critical health conditions, post-surgical care
Geriatric care $5 billion Medical care to optimise functioning in elderly people
Pain relief $3-4 billion Physiotherapy-led care in non-critical conditions such as arthritis, injuries and lifestyle related pains
Others $3 billion

Source: Redseer Rehab Tech Report

Physical rehab market an attractive business opportunity

Not only is physical rehab a large opportunity, it is also an attractive business proposition. In the case of restorative care, which comprises 28% of the total market, the gross margins are at 50-55% for the service provider, as per the report.

Moreover, this is a high-value service. A consumer recovering from a critical surgery spends anywhere around $650-700 or ₹50,000 for 12 days of care.

It’s also a scattered and an unorganised market. While hospitals dominate the critical, restorative rehab segment, local providers lead the geriatric and pain-relief segments.

“Both of them aren’t able to aptly serve the consumer needs. Despite providing a standard service, consumers find rehab at hospitals to be expensive and lacking a recovery-focused environment. While local players are more affordable, they lack the basic quality and professionalism in service and have limited ability to address complex situations,” said the report.

Redseer also believes that there is a strong case for specialised players who employ technology to solve these pain points. Consumers also have a latent need related to the ease of availing rehab – booking, customisation, care plan management, remote monitoring etc.

"Elders are consuming more technology, are using tech devices, buying online, and want more safety, more healthcare, and more engagement than ever before", says Saumyajit Roy, CEO, Emoha, an eldercare facility in India.

Kushal Bhatnagar, engagement manager at Redseer, believes that players with a stronger tech enablement are better placed to thrive in the market. “Specialised rehab providers with wide segment coverage have access to a larger total addressable market (TAM) and potential to create a stronger brand in the rehab space among both consumers and doctors,” he added.

Redseer also believes that specialised rehab players with cross-segment coverage, both at-home and at-centre capabilities, and tech focus, are likely to prosper.

SEE ALSO: A startup that could ‘either be a hero or zero in 2 years’ get no funds on Shark Tank India S2
From selling puran poli on a bicycle to being offered seat at Shark Tank: Bhaskar’s Puranpoli Ghar’s story

Source link

Patients with acute decompensated heart failure who were frail at baseline improved more with targeted, early physical rehabilitation than those who were prefrail, a new analysis of the REHAB-HF study suggests.

"The robust response to the intervention by frail patients exceeded our expectations," Gordon R. Reeves, MD, PT, of Novant Health Heart and Vascular Institute in Charlotte, North Carolina, told theheart.org | Medscape Cardiology. "The effect size from improvement in physical function among frail patients was very large, with at least four times the minimal meaningful improvement, based on the Short Physical Performance Battery (SPPB)."

Furthermore, the interaction between baseline frailty status and treatment in REHAB-HF was such that a 2.6-fold larger improvement in SPPB was seen among frail vs prefrail patients.

However, Reeves noted, "We need to further evaluate safety and efficacy as it relates to adverse clinical events. Specifically, we observed a numerically higher number of deaths with the REHAB-HF intervention, which warrants further investigation before the intervention is implemented in clinical practice."

The study was published online January 4 in JAMA Cardiology.

Interpret With Caution

Reeves and colleagues conducted a prespecified secondary analysis of the previously published Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a multicenter, randomized controlled trial that showed that a 3-month early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and quality of life (QoL) in comparison with usual care. The secondary analysis aimed to evaluate whether baseline frailty altered the benefits of the intervention or was associated with risk of adverse outcomes.

According to Reeves, REHAB-HF differs from more traditional cardiac rehab programs in several ways.

  • The intervention targets patients with acute HF, including HF with preserved ejection fraction (HFpEF). Medicare policy limits standard cardiac rehabilitation in HF to  long-term patients with HF with reduced ejection fraction (HFrEF) only who have been stabilized for 6 weeks or longer after a recent hospitalization.

  • It addresses multiple physical function domains, including balance, mobility, functional strength, and endurance. Standard cardiac rehab is primarily focused on endurance training, which can result in injuries and falls if deficits in balance, mobility, and strength are not addressed first.

  • It is delivered one to one rather than in a group setting and primarily by physical therapists who are experts in the rehabilitation of medically complex patients.

  • It is transitional, beginning in the hospital, then moving to the outpatient setting, then to home and includes a home assessment.

For the analysis, the Fried phenotype model was used to assess baseline frailty across five domains: unintentional weight loss during the past year; self-reported exhaustion; grip strength; slowness, as assessed by gait speed; and low physical activity, as assessed by the Short Form-12 Physical Composite Score.

At the baseline visit, patients were categorized as frail if they met three or more of these criteria. They were categorized as prefrail if they met one or two criteria and as nonfrail if they met none of the criteria. Because of the small number of nonfrail participants, the analysis included only frail and prefrail participants.

The analysis included 337 participants (mean age, 72; 54%, women; 50%, Black). At baseline, 57% were frail, and 43% were prefrail.

A significant interaction was seen between baseline frailty and the intervention for the primary trial endpoint of overall SPPB score, with a 2.6-fold larger improvement in SPPB among frail (2.1) vs prefrail (0.8) patients.

Trends favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QoL, and the geriatric depression score.

"However, we must interpret these findings with caution," the authors write. "The REHAB-HF trial was not adequately powered to determine the effect of the intervention on clinical events." This plus the number of deaths "underscore the need for additional research, including prospective clinical trials, investigating the effect of physical function interventions on clinical events among frail patients with HF."

To address this need, the researchers recently launched a larger clinical trial, called REHAB-HFpEF, which is powered to assess the impact of the intervention on clinical events, according to Reeves. "As the name implies," he said, "this trial is focused on older patients recently hospitalized with HFpEF, who (compared to HFrEF) also showed a more robust response to the intervention, with worse physical function and very high prevalence of frailty near the time of hospital discharge."

"Never Too Old or Sick to Benefit"

Commenting on the study for theheart.org | Medscape Cardiology, Jonathan H. Whiteson, MD, vice chair of clinical operations and medical director of cardiac and pulmonary rehabilitation at NYU Langone Health's Rusk Rehabilitation in New York City, said, "We have seen in clinical practice and in other (non–heart failure) clinical areas that frail older patients do improve proportionally more than younger and less frail patients with rehabilitation programs. Encouragingly, this very much supports the practice that patients are never too old or too sick to benefit from an individualized multidisciplinary rehabilitation program."

However, he noted, "patients had to be independent with basic activities of daily living to be included in the study," so many frail, elderly patients with heart failure who are not independent were not included in the study. It also wasn't clear whether patients who received postacute care at a rehab facility before going home were included in the trial.

Furthermore, he said, outcomes over 1 to 5 years are needed to understand the long-term impact of the intervention.

On the other hand, he added, the fact that about half of participants were Black and were women is a "tremendous strength."

"Repeating this study in population groups at high risk for frailty with different diagnoses, such as chronic lung diseases, interstitial lung diseases, chronic kidney disease, and rheumatologic disorders will further support the value of rehabilitation in improving patient health, function, quality of life, and reducing rehospitalizations and healthcare costs," Whiteson concluded.

The study was supported by grants from the National Key R&D program. The authors have disclosed no relevant financial relationships.

JAMA Cardiol. Published online January 4, 2023. Abstract

Follow Marilynn Larkin on Twitter: @MarilynnL.

For more from the heart.org | Medscape Cardiology, follow us on Twitter and Facebook.

Source link