ABSTRACT
Objective: The purpose of this study was to clarify the characteristics of physical quality of life (QOL) and activities of daily living (ADL) in patients with advanced cancer undergoing home-visit rehabilitation. Method: In this prospective study, we included 35 patients with advanced cancer undergoing home-visit rehabilitation. Physical QOL was assessed using the Physical Functioning (PF) score on the QLQ-C15, and ADL was assessed using the Barthel Index (BI) and Functional Independence Measure (Motor FIM) scores. Changes in physical QOL and each ADL scores from the start of rehabilitation to 4 weeks later were investigated. Also, patients were divided into two groups according to the PF score and characteristics of physical QOL and ADL between the two groups were explored. Result: PF score was significantly improved after 4 weeks compared to baseline. In the PF score maintenance/improvement group, motor FIM score was significantly improved after 4 weeks compared to baseline. Conclusion: The physical QOL of patients with advanced cancer undergoing home-visit rehabilitation was maintained and improved 4 weeks after the start of rehabilitation. It was suggested that maintaining ADL may lead to maintenance and improvement of physical QOL.
ABSTRACT
Objectives: Virtual reality (VR) has been shown to facilitate rehabilitation at hospitals by distracting patients’ attention from pain and by providing a virtual environment favorable for motivating the patients to continue rehabilitation. However, the application of VR in a home-visit rehabilitation remains to be validated. Here, we report a case in which home-visit rehabilitation using immersive VR was effective for post-stroke hemiplegic shoulder pain.Case presentation: After treatment, at a general hospital, for the hypertensive hemorrhage in the right brain capsule that resulted in the residual attention deficit disorder and left hemiplegia, a 63-year-old woman was cared for with a home-visit rehabilitation in a rural area. The patient had persistent pain in her left shoulder, which increased during activities of daily living and during rehabilitation, and the pain precluded rehabilitation. A VR relaxation program was delivered to the patient to alleviate pain during rehabilitation. Her shoulder pain was successfully alleviated using VR during training for muscle stretching and passive joint mobilization.Conclusion: The application of VR to home rehabilitation in rural areas may augment the effectiveness of home rehabilitation by alleviating pain during the procedure and sustaining the motivation for home rehabilitation.
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Objective : This study aimed to investigate the changes in the functioning of users of visiting rehabilitation services and related factors. Methods: Among 107 users in 22 visiting rehabilitation centers, we analyzed the data of 80 who completed the 6-month study. Their Functional Independence Measure (FIM), Life-Space Assessment (LSA), and level of caregiver burden (J-ZBI_8) were compared at the commencement of this study, and at 3 and 6 months afterwards. A multiple linear regression analysis was performed to examine the factors related to the variables, which changed over 6 months. Results : Over a period of 6 months from the commencement of the study, we found that FIM and LSA scores significantly improved from 82.4 to 87.3 (<i>p</i>=0.016) and from 9.9 to 12.3 (<i>p</i>=0.05), respectively, in the group who were still within 1 year from the time since onset/injury. A multiple regression analysis revealed that the period of time since onset/injury, independence degree of daily living for the demented elderly, and presence of goal setting for activities of daily living/domestic work significantly influenced changes in total FIM scores (<i>p</i>=0.001, <i>R</i><sup>2</sup>=0.32). Furthermore, the change in LSA scores was significantly influenced by gender, presence of cerebrovascular diseases, period of time since onset/injury, number of occupations involved in visiting rehabilitation services, and J-ZBI_8 scores (<i>p</i>=0.0001, <i>R</i><sup>2</sup>=0.36). Conclusion : Effective visiting rehabilitation requires having appropriate goals set for daily living activities and the establishment of interprofessional collaboration within visiting rehabilitation centers.
ABSTRACT
Hoehn and Yahr (H-Y) staging and the Unified Parkinson's Disease Rating Scale (UPDRS) are commonly used for clinical evaluation of Parkinson's disease (PD). Iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and single photon emission computed tomography (SPECT) are useful for the differential diagnosis of PD from other Parkinsonism. Additionally, gravicorders or gait analysis systems and upper limb voluntary movement analyzing systems may be helpful for the quantitative evaluation of parkinsonian symptoms. From the early stage of H-Y, PD patents should be informed and coached about rehabilitation programs by expert therapists. Educational and health promotional gymnastics are the main programs used in stage I and II. Muscle stretching exercises, postural exercises, balance training and activity/instrumental-activity training are needed in stage III and IV. Finally, preventing changes due to disuse and lightening the caregiver load are the main purpose of rehabilitation in stage V. It is very important to understand not only the patients' clinical stages but also their personal situations such as their life-stage and life-style and their family situation. Home visit rehabilitation is useful to discover the actual daily living problems faced by patients and their families. Then, evaluation according to the International Classification of Functioning, Disability and Health (ICF) is available to clarify and solve the problems. With the progression of the clinical stage, patients need many social resources. Therefore, medical social workers (MSW) should be a part of the rehabilitation team to support the home care of patients from their incipient stage.