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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (10 May 2023) | Viewed by 16315

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Special Issue Editors

Dr. Guillaume Chapelet

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Guest Editor

Clinical Geriatric Department, Nantes University Hospital, Nantes, France - Inserm, U1235 ‘The Enteric Nervous System in Gut and Brain Disorders (TENS), Nantes University, Nantes, France
Interests: neurocognitive disorders; aging and microbiota; executive function and gait

Prof. Dr. Jos M.G.A. Schols

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Guest Editor

Department of Health Services Research and Department of Family Medicine, Caphri - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
Interests: frailty; resilience; sarcopenia; old age medicine; geriatric rehabilitation; epidemiology of and interventions for relevant care problems in (frail) old people

Prof. Dr. Wilco P Achterberg

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Guest Editor

Department of Public Health and Primary Care (PHEG), Leiden University, Medical Center, Leiden, The Netherlands
Interests: old age medicine; geriatric rehabilitation; pain in dementia

Special Issue Information

Dear Colleagues,

Rehabilitation programmes, in general, include multifactorial interventions to reduce risks, promote healthy behaviours and an active lifestyle, reduce disability, and improve health, wellbeing, daily living activities and social participation. However, in older patients, resilience and frailty can hamper the rehabilitation process. Therefore, the outcomes cannot be easily predicted, even though some factors have previously been associated with rehabilitation effectiveness.

A focus on the resilience of older persons may provide additional sources to induce recovery in an effective way, in turn allowing elderly patients to resume their lives. With an ageing global population, there is a crucial need to optimize the practice and effectiveness of geriatric rehabilitation and make it more sustainable. Additionally, rehabilitation programmes should better address older patient’s goals and wishes.

Telerehabilitation could be an innovative and cost-effective way to achieve this goal. Another aspect of rehabilitation for older persons that needs our attention is the possibility of prehabilitation, which can promote better resilience and rehabilitation effectiveness after elective surgery.

Dr. Guillaume Chapelet
Prof. Dr. Jos M.G.A. Schols
Prof. Dr. Wilco P Achterberg
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

geriatric rehabilitation
frailty
resilience
innovation
telerehabilitation
outcomes

Published Papers (10 papers)

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Research

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12 pages, 723 KiB

Open AccessArticle

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

by Sergi Rodríguez-Rodríguez, Esther Jovell-Fernández, Leonor Cuadra-Llopart, Jacobo Rodríguez-Sanz, Noé Labata-Lezaun, Carlos López-de-Celis, Joan Bosch and Albert Pérez-Bellmunt

J. Clin. Med. 2023, 12(17), 5560; https://doi.org/10.3390/jcm12175560 - 26 Aug 2023

Cited by 1 | Viewed by 819

Abstract

Background: With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test). Material and methods: A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow. Results: Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= −0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001). Conclusions: There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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11 pages, 253 KiB

Open AccessArticle

An Exploratory Study Investigating Factors Influencing the Outpatient Delivery of Geriatric Rehabilitation

by Lidy A. P. Prins, Chris J. Gamble, Eléonore F. van Dam van Isselt, Romy A. I. Stammen, Ahlam Ettaibi, Ilse A. M. Creemers and Jolanda C. M. van Haastregt

J. Clin. Med. 2023, 12(15), 5045; https://doi.org/10.3390/jcm12155045 - 31 Jul 2023

Viewed by 1007

Abstract

Background: Outpatient delivery of geriatric rehabilitation (GR) might contribute to preserving the accessibility and quality of GR, whilst dealing with an increasing demand for healthcare in an aging population. However, the application of outpatient GR differs between GR facilities. This study aimed to gain insight into factors influencing outpatient GR utilization. Methods: In this case study, 24 semi-structured interviews were conducted with physicians, physiotherapists, nurse practitioners, occupational therapists, and managers in GR. Interviews were transcribed and analyzed using summative content analysis. Results: Various patient-related barriers for using outpatient GR were mentioned including lacking social support and limited capacities and self-management skills. Additionally, professional-related barriers included a lack of awareness and consensus among care professionals regarding the possibilities and potential advantages of outpatient GR. Yet, most perceived barriers were related to efficiency and organization of outpatient GR (e.g., reimbursement system, lacking practical guidance). Still, most participants were in favor of increasing outpatient GR because of expected advantages for patients, GR organizations, and society. Conclusions: Despite experienced barriers, there seems to be agreement on the need to increase outpatient GR application. It is recommended to use the present findings to develop and evaluate new ways of organizing and reimbursing outpatient GR. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

14 pages, 4460 KiB

Open AccessArticle

Detecting Comparative Features of Comprehensive Geriatric Assessment through the International Classification of Functioning, Disability, and Health Linkage: A Web-Based Survey

by Naoki Tomita, Yuki Ohashi, Aiko Ishiki, Akiko Ozaki, Mitsuyuki Nakao, Satoru Ebihara and Yasuyuki Taki

J. Clin. Med. 2023, 12(15), 4917; https://doi.org/10.3390/jcm12154917 - 26 Jul 2023

Viewed by 967

Abstract

Multidimensional assessments are important in evaluating the overall health of older adults. The comprehensive geriatric assessment (CGA) is a representative framework; however, the burden associated with the CGA has led to the development of simplified multidimensional tools. Comparing these tools to the CGA can help utilize them effectively. However, a direct comparison is challenging owing to the conceptual nature of the CGA. In this study, we conducted a web-based survey to identify essential CGA components by linking International Classification of Functioning, Disability, and Health (ICF) category level 2 items and “not defined/not covered” (nd/nc) items. Healthcare professionals and individuals aged >65 years participated in a two-stage Delphi study. In total, 182 respondents (7 geriatricians, 22 nurses, 20 therapists, and 4 case managers) completed the survey. Sixty-one essential components for CGA were identified, including 55 ICF categories. Additionally, personal factors (i.e., proactiveness) and nd/nc items (i.e., subjective perceptions) were aggregated. The results suggest that the CGA includes objective conditions of intrinsic capacity, functional ability, and environment as well as subjective perceptions and proactiveness toward those conditions. Thus, CGA is not merely expected to assess geriatric syndrome but also to estimate broader concepts, such as interoception, resilience, and quality of life. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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14 pages, 1411 KiB

Open AccessArticle

eHealth in Geriatric Rehabilitation: An International Survey of the Experiences and Needs of Healthcare Professionals

by Jules J. M. Kraaijkamp, Anke Persoon, Sorina Aurelian, Stefan Bachmann, Ian D. Cameron, Mohamed-Amine Choukou, Frances Dockery, Kseniia Eruslanova, Adam L. Gordon, Stefan Grund, Hyub Kim, Andrea B. Maier, Laura M. Pérez Bazan, José E. Pompeu, Eva Topinkova, Mark A. Vassallo, Niels H. Chavannes, Wilco P. Achterberg and Eléonore F. Van Dam van Isselt

J. Clin. Med. 2023, 12(13), 4504; https://doi.org/10.3390/jcm12134504 - 05 Jul 2023

Cited by 1 | Viewed by 1815

Abstract

While eHealth can help improve outcomes for older patients receiving geriatric rehabilitation, the implementation and integration of eHealth is often complex and time-consuming. To use eHealth effectively in geriatric rehabilitation, it is essential to understand the experiences and needs of healthcare professionals. In this international multicentre cross-sectional study, we used a web-based survey to explore the use, benefits, feasibility and usability of eHealth in geriatric rehabilitation settings, together with the needs of working healthcare professionals. Descriptive statistics were used to summarize quantitative findings. The survey was completed by 513 healthcare professionals from 16 countries. Over half had experience with eHealth, although very few (52 of 263 = 20%) integrated eHealth into daily practice. Important barriers to the use or implementation of eHealth included insufficient resources, lack of an organization-wide implementation strategy and lack of knowledge. Professionals felt that eHealth is more complex for patients than for themselves, and also expressed a need for reliable information concerning available eHealth interventions and their applications. While eHealth has clear benefits, important barriers hinder successful implementation and integration into healthcare. Tailored implementation strategies and reliable information on effective eHealth applications are needed to overcome these barriers. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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11 pages, 290 KiB

Open AccessArticle

Comparison of Grip Strength Measurements by Widely Used Three Dynamometers in Outpatients Aged 60 Years and Over

by Sumru Savas, Asli Kilavuz, Fatma Özge Kayhan Koçak and Sibel Cavdar

J. Clin. Med. 2023, 12(13), 4260; https://doi.org/10.3390/jcm12134260 - 25 Jun 2023

Cited by 3 | Viewed by 1908

Abstract

Grip strength (GS) is widely used in various fields such as sports, rehabilitation, and geriatrics to assess muscle strength, and to diagnose sarcopenia and frailty in older adults. There is a potential for measurement differences among different dynamometers available, and studies comparing GS measurements by variable tools have conflicting results. The two most frequently used dynamometers are the Jamar hydraulic (Jamar) and spring-type hand grip dynamometers, and Jamar has not been compared to Jamar PLUS+ Digital (Jamar+) dynamometer in older adults. So, we aimed to assess GS measurements with the Jamar as the reference standard against Jamar+, and spring-type Takei T.KK. 5401 (Takei) digital dynamometers. One hundred and ten outpatients aged >60 years were included. Inter-instrumental reliability was determined. The differences between dynamometers were evaluated by Bland–Altman plots and measurement error. The measurements with Jamar+, and Takei dynamometers were reliable and valid regarding the Jamar dynamometer. Takei and Jamar+ dynamometers overestimated GS over the Jamar dynamometer. Though the differences in the measured values might be disregarded in clinical practice, individuals defined to have low GS varied by the use of different dynamometers. Grip strength better be measured by the same dynamometer in serial measurements of older individuals. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

12 pages, 834 KiB

Open AccessArticle

Immediate and Long-Term Effectiveness of Proprioceptive Neuromuscular Facilitation and Static Stretching on Joint Range of Motion, Flexibility, and Electromyographic Activity of Knee Muscles in Older Adults

by Sahar Zaidi, Asfak Ahamad, Anam Fatima, Irshad Ahmad, Deepak Malhotra, Wafa Hashem Al Muslem, Sahar Abdulaziz and Shibili Nuhmani

J. Clin. Med. 2023, 12(7), 2610; https://doi.org/10.3390/jcm12072610 - 30 Mar 2023

Cited by 4 | Viewed by 2981

Abstract

Introduction and Objective: Previously, various stretching techniques were compared to study their effects on the different physiological parameters of hamstring muscles in the elderly population. There is no research that compares the immediate and long-term effects of proprioceptive neuromuscular facilitation-contract–relax (PNF-CR) and static stretching (SS) techniques on knee range of motion (ROM), hamstring flexibility, and knee flexor muscle EMG activity in the elderly. This study intends to compare the same. Methods: A total of 30 males aged 55–75 years were randomly assigned into the PNF-CR group (n = 10), SS group (n = 10), and control group (n = 10). The PNF-CR group received four trials of the contract–relax technique, the SS group received passive stretching of an 80 s duration by the therapist, and the control group received no intervention. A total of 12 sessions were given during the four-week period. Knee range of motion, electromyographic activity of the biceps femoris, and the sit-and-reach test were taken for the dominant side thrice: pre-intervention, immediately after stretching, and after the training period. Results: A statistically significant difference was observed in the maximum voluntary isometric contraction (MVIC) of biceps femoris between the PNF and the control groups (p = 0.01) after four weeks of intervention. The knee ROM and hamstring flexibility for the PNF group showed significant improvement immediately post-test (p = 0.01) and after four weeks of training (p = 0.07 and p = 0.001). SS showed significant results for both ROM and flexibility after four weeks of intervention (p = 0.001), and significant immediate post-test improvements were seen for ROM only (p = 0.007). Conclusions: PNF stretching has an immediate, as well as long-term, effect on knee ROM and hamstring flexibility, whereas it has only a long-term effect on muscle electromyographic activity. SS has an immediate, as well as long-term, effect on knee ROM and only a long-term effect on hamstring flexibility, without any immediate or long-term effects on muscle electromyographic activity. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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13 pages, 617 KiB

Open AccessArticle

Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review

by Francesca Muscat, Liberato Camilleri, Conrad Attard and Stephen Lungaro Mifsud

J. Clin. Med. 2023, 12(3), 919; https://doi.org/10.3390/jcm12030919 - 24 Jan 2023

Cited by 1 | Viewed by 1792

Abstract

(1) Objective: To identify the assessment tools and outcome measures used to assess older adults for inpatient rehabilitation. (2) Design: Scoping review. (3) Data sources: ProQuest, PEDro, PubMed, CINAHL Plus with full text (EBSCO), Cochrane Library and reference lists from included studies. (4) Review method: The inclusion of studies covering patients aged >60, focusing on rehabilitation assessments delivered in hospitals in community settings. Studies reporting on rehabilitation specifically designed for older adults—testing for at least one domain that affects rehabilitation or assessments for admission to inpatient rehabilitation—were also included. Results were described both quantitatively and narratively. (5) Results: 1404 articles were identified through selected databases and registers, and these articles underwent a filtering process intended to identify and remove any duplicates. This process reduced the number to 1186 articles. These, in turn, were screened for inclusion criteria, as a result of which 37 articles were included in the final review. The majority of assessments for geriatric rehabilitation were carried out by a multidisciplinary team. Multiple studies considered more than one domain during assessment, with a high percentage evaluating a specific outcome measure used in geriatric rehabilitation. The most common domains assessed were function, cognition and medical status—with communication, vision and pain being the least common. A total of 172 outcome measures were identified in this review, with MMSE, BI, FIM and CCI being the most frequent. (6) Conclusions: This review highlights the lack of standardised approaches in existing assessment processes. Generally, older-adult-rehabilitation assessments struggle to capture rehabilitation potential in a holistic manner. Hence, a predictive model of rehabilitation for assessing patients at the initial stages would be useful in planning a patient-specific programme aimed at maximising functional independence and, thus, quality of life. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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14 pages, 391 KiB

Open AccessArticle

Inpatient Geriatric Rehabilitation: Definitions and Appropriate Admission Criteria, as Established by Maltese National Experts

by Francesca Muscat, Liberato Camilleri, Conrad Attard and Stephen Lungaro Mifsud

J. Clin. Med. 2022, 11(23), 7230; https://doi.org/10.3390/jcm11237230 - 05 Dec 2022

Cited by 1 | Viewed by 1368

Abstract

(1) Background: The importance of having an appropriate admissions system for geriatric rehabilitation is on the increase. However, the process of admitting patients to inpatient rehabilitation is a complex process. This is yet to be standardised across the European Union, as the approach to geriatric rehabilitation tends to vary from one Member State to another. (2) Objective: To discuss evidence-based practice with clinical experts, in order to define geriatric rehabilitation and admission criteria based on the Maltese population. (3) Method: The study entailed conducting four panel sessions using a purposive sample of thirteen local clinicians with extensive knowledge in clinical rehabilitation and healthcare management. A total of 48 items, based on the literature and clinical experience, were presented to the panel. Data analysis was done quantitatively and qualitatively, using IBM SPSS Statistics Version 24 and thematic analysis. (4) Results: The panel formulated a definition of rehabilitation, which shared common elements with the definition provided by the World Health Organization (WHO) and other sources/literature. The panel agreed on a list of eight criteria for appropriate inpatient geriatric rehabilitation admission in Malta. Consensus was also reached on: the need for a consultant-led multidisciplinary approach to assessment; the adoption of a standardised assessment processes for an equitable chance for all older adults assessed; the benefit of digital health in assessments; and the consideration that most patients would have some form of rehabilitation potential, depending on availability of resources. (5) Conclusion: Inpatient geriatric rehabilitation hospitals should have a unified strategy for rehabilitation services. The conclusions reached by the panel, could be useful in supporting the clinical evidence and establishing future rehabilitation guidelines and standards for inpatient rehabilitation. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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Other

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7 pages, 450 KiB

Open AccessBrief Report

Diminished Physical Activity in Older Hospitalised Patients with and without COVID-19

by Karolina Piotrowicz, Ian Perera, Monika Ryś, Anna Skalska, Suzy V. Hope, Barbara Gryglewska, Jean-Pierre Michel, Tomasz Grodzicki and Jerzy Gąsowski

J. Clin. Med. 2023, 12(19), 6261; https://doi.org/10.3390/jcm12196261 - 28 Sep 2023

Viewed by 670

Abstract

Acute viral respiratory infections have proven to be a major health threat, even after the Corona Virus Disease 2019 (COVID-19) pandemic. We aimed to check whether the presence or absence of an acute respiratory infection such as COVID-19 can influence the physical activity of older hospitalised patients. We cross-sectionally studied patients aged ≥60 years, hospitalized during the pandemic in the non-COVID-19 and COVID-19 ward at the University Hospital, Kraków, Poland. Using activPAL3^® technology, we assessed physical activity for 24 h upon admission and discharge. In addition, we applied the sarcopenia screening tool (SARC-F); measured the hand grip strength and calf circumference; and assessed the Modified Early Warning Score (MEWS), age-adjusted Charlson Index, SpO2%, and length of stay (LoS). Data were analysed using SAS 9.4. The mean (min, max) age of the 31 (58% women, eight with COVID-19) consecutive patients was 79.0 (62, 101, respectively) years. The daily time (activPAL3^®, median [p5, p95], in hours) spent sitting or reclining was 23.7 [17.2, 24] upon admission and 23.5 [17.8, 24] at discharge. The time spent standing was 0.23 [0.0, 5.0] upon admission and 0.4 [0.0, 4.6] at discharge. The corresponding values for walking were 0.0 [0.0, 0.4] and 0.1 [0.0, 0.5]. SARC-F, admission hand grip strength, calf circumference, and LoS were correlated with physical activity upon admission and discharge (all p < 0.04). For every unit increase in SARC-F, there was a 0.07 h shorter walking time upon discharge. None of the above results differed between patients with and without COVID-19. The level of physical activity in older patients hospitalised during the pandemic was low, and was dependent on muscular function upon admission but not on COVID-19 status. This has ramifications for scenarios other than pandemic clinical scenarios. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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7 pages, 584 KiB

Open AccessPerspective

How to Conduct International Geriatric Rehabilitation Research?

by Miriam L. Haaksma, Adam L. Gordon, Eléonore F. van Dam van Isselt, Jos M. G. A. Schols, Irma H. J. Everink, Ian D. Cameron, Clemens Becker, Stefan Grund and Wilco P. Achterberg

J. Clin. Med. 2023, 12(3), 951; https://doi.org/10.3390/jcm12030951 - 26 Jan 2023

Viewed by 1533

Abstract

With an ageing global population and an increasing focus on aging in place, the number of people in need of geriatric rehabilitation (GR) is rapidly increasing. As current GR practice is very heterogenous, cross-country comparisons could allow us to learn from each other and optimise the effectiveness of GR. However, international GR research comes with many challenges. This article summarises the facilitators and barriers relating to the recruitment of rehabilitation centres, the inclusion of patients, and data collection, as experienced by experts in the field of international GR research. The three most important methodological recommendations for conducting cross-national collaborative research in the field of GR are (1) make use of existing (inter)national networks and social media to aid recruitment of GR centres; (2) clearly define the GR treatment, setting, and patient characteristics in the inclusion criteria; and (3) use a hierarchical study structure to communicate transparently and regularly with both national and local coordinators. International GR research would greatly benefit from the implementation of a core dataset in regular GR care. Therefore, future studies should focus on developing an international consensus regarding the outcomes and corresponding cross-culturally validated measurement instruments to be used during GR. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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