ABSTRACT
To investigate the impact of the COVID-19 pandemic on the health and life quality of individuals living with traumatic brain injury (TBI) in the United States. Cross-Sectional. General community. 1,440 adults with mild (49%), moderate (22%), and severe (29%) TBI. 3,857 adults from general population. N/A. Self-report measures of extent to which pandemic/stay-at-home orders have impacted mental health, isolation, financial stress, and access to medical care;brief assessment of vaccine hesitancy. Self-report psychometric measures of depression (PHQ-9), anxiety (GAD-7), comorbid disease burden, substance use, and domestic violence victimization. In this diverse nationwide sample, 55% of individuals with TBI lost wages due to the COVID-19 pandemic;only 16% felt they were able to pay for basic needs (food, shelter, heat). Those with TBI reported substantially elevated worry and isolation;29% reported their cognitive function and 36% felt their mood (36%) had changed due to social-distancing and/or shelter-in-place orders. The majority met criteria for clinically significant depression (78%) and/or anxiety (76%). Only 11% reported increased alcohol use, and 24% reduced use;however, 24% reported high-risk prescription pain medication use. Recent physical and verbal violence was common: only 30% indicating that others "never" physically hurt them, and only 42% said they were "never" verbally abused. Control comparison data suggest disproportionate burden among those with TBI. Individuals with TBI are at unique risk for financial loss, unmet care needs, medication misuse, and domestic violence during the ongoing pandemic. The extent to which observed disparities among those with TBI are limited to the early stages of the pandemic (i.e., 2020-2021) warrants further investigation;regardless, immediate remediation is required. None.
ABSTRACT
To examine patient-focused facilitators and barriers to accessing chronic pain care for individuals with TBI from a national sample of providers. A descriptive, qualitative study guided by a conceptual framework of access to health care services. Medical facilities representing Veteran Affairs, Department of Defense, and civilian health care systems. 63 providers representing VA, DoD, and Civilian sites across the United States. N/A. Facilitators and barriers to chronic pain treatment. Several facilitators were identified by providers, including providing education to ensure comprehension of diagnosis and treatment;patient motivation and buy-in;patients having functional and realistic goals;insurance covering the costs of care and referrals;and patients seeing positive changes in themselves. Providers identified many barriers to care, including patient lack of participation such as no-showing to appointments or not participating in treatments;patients being unsure of telehealth;patient work schedules;lack of transportation;and no caregivers or visitors permitted due to Covid restrictions. Barriers and facilitators to chronic pain treatment exist across multiple dimensions of a healthcare access framework. Given importance of patient motivation and buy-in and engagement in treatment, provider training and experience in motivational enhancement and addressing health beliefs may help facilitate access to chronic pain care when adapted for persons with TBI. Targeted patient education that ensures rationale for treatment and patient acceptance of the treatment was the most discussed facilitator to care. Findings support multiple points of intervention to promote equitable access to chronic pain care for persons with TBI. None.
ABSTRACT
To describe experiences of disability among adults living with Long COVID. We conducted a community-engaged qualitative descriptive study involving online semi-structured interviews. We recruited participants via collaborator community networks in Canada, United Kingdom, United States and Ireland. Adults who self-identified as living with Long COVID, defined as signs and symptoms that develop during or following an infection consistent with COVID-19, which continue for 12-weeks or more and not explained by an alternative diagnosis. We purposively recruited for diversity in country, gender, age, sexual orientation, and duration since initial COVID-19 infection. Not applicable. We used a semi-structured interview guide to explore experiences of disability living with Long COVID, specifically health-related challenges and how they were experienced over time. We asked participants to draw their health trajectory. We conducted a group-based content analysis. Among the 40 participants (10 per country), the median age was 39 years;majority were women (63%), white (73%), heterosexual (75%), and living with Long COVID for ≥1 year (83%). Participants described their disability experiences as episodic in nature, characterized by fluctuations in presence and severity of health-related challenges (disability) that may occur within the day to over the long-term living with Long COVID. They described living with 'ups and downs', 'flare-ups', and 'peaks' followed by 'crashes', 'troughs', and 'valleys', likened to a 'yo-yo' 'rolling hills', and 'rollercoaster ride' with 'relapsing/remitting', 'waxing/waning', 'fluctuations' in health. Illustrations demonstrated trajectories of health dimensions, some more episodic than others. Uncertainty intersected with the episodic nature of disability, characterized as unpredictability of episodes, their length, severity and triggers, and process of long-term recovery, which had implications on broader health. Experiences of disability were described as episodic in nature, characterized by fluctuating health challenges, which may be unpredictable among this sample of adults living with Long COVID. Results will help to better understand experiences of disability among adults living with Long COVID and inform approaches for rehabilitation. None.
ABSTRACT
To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.
ABSTRACT
The purpose is to verify whether patients with Long Covid-19 symptoms can recover Functional Capabilities and Endurance reaching the normotype subjects' level. The study is a before-after trial comparing the affected sample with baseline normotype data. The study was carried out at the private clinic "Move Different" near Aosta Italy. The clinic has an agreement with public health for a project for patients with Long Covid-19 symptoms. About 60 subjects (mean age 62+-3) healed from Covid-19 Virus with more than one day of hospitalization, older than 60 years old were included. They were divided into two clusters: Low Performance Patients (LPP) and Medium Performance Patients (MPP), decided by the Medical Equipe. The program consisted of 10 sessions of 1h, divided into 2/3 treatments per week;based on the use of Virtual Reality and Augmented Reality through a Digital Mirror. Tests were performed before and after the intervention. Increase in meters covered in the 6 Minutes Walking Test (MPP increases 56+- 65 meters, LPP increases 99+-74 meters). Wilcoxon test was performed between pre and post 6MWT for both of populations (pvalue < 0.005, pvalue < 0.005). After the treatment, results are close to normative data of Perera et al, 2006, Geriatrics. The improvement of both groups is statistically significantly difference;data support that especially the medium-functional group achieves the similar level of normotype subjects. A future randomized control trial aimed at testing whether improvement of this method over a traditional one is suggested. The authors declared no potential conflicts of interest with respect to the research authorship and/or publication of this poster.
ABSTRACT
To observe the effects of COVID-19 infection on ANS function over a follow-up period in young adults. Observational prospective case-control study. Subjects were evaluated at baseline and in a follow-up visit six weeks following the first shot of SARS-CoV-2 immunization. Private Physical Therapy ambulatory. Male and female subjects aged 20-40 years with, a diagnosis of mild or moderate clinical COVID-19 with a positive PCR test and slight clinical symptoms, and who were not admitted to intensive care unit. Participants were recruited after a minimum of 15 and a maximum of 120 days of diagnosis (PCOV). An age-matched heathy control group (CG) that was negative for COVID-19 was also recruited. Autonomic nervous system function was measured through heart rate variability (HRV). Heart rate was recorded beat-to-beat to evaluate cardiac autonomic modulation. We used a cardio-frequency meter (Polar RS800CX). Participants were equipped with a chest strap and monitor and remained at rest for 25 minutes. Sympathetic and Parasympathetic indexes through HRV. 57 subjects were evaluated at baseline. After 19 exclusions, 38 subjects with complete data were included in the baseline analysis where 18 subjects were in CT and 20 in the PCOV group. Regarding sympathetic nervous system activity, there was no difference between baseline and follow-up moments within CT or PCOV groups (p>0.05). For intergroup analysis, we observed that PCOV group presents significant higher reductions in sympathetic activity over time when compared to CT demonstrated by HR (p=0.0088) and SNS index (p=0.0068). Observations of parasympathetic nervous system activity reveals a statistical increase between baseline and follow up in Mean RR (p=0.0312) and pNN50 (p=0.0312) for PCOV group. The intergroup analysis revealed that PCOV group presented a significant higher increase in parasympathetic activity overtime demonstrated by mean RR (-44.54±32.38 vs. 60.36±55.35;p= 0.0097) and PNS index (-0.32±0.20 vs. 0.54 ± 0.35;p= 0.0091) when compared to CT. Sympathetic activity decreased in PCOV after infection and over the follow up period. Authors declare no conflicts.
ABSTRACT
To provide up to date evidence on the acoustic considerations for dementia care settings, to support healthspan and quality of life. Scoping Review. Institutionalized settings to include assisted living, nursing homes, rehabilitation centers, skilled nursing facilities, and other supported care environments. Individuals living with dementia. Per the nature of a scoping review, we are considering multiple levels of evidence and several aspects of the intervention of interest, to include the following: auditory environment, acoustic environment, or sound-based intervention or observation. Cognitive, behavioral, or other health related outcomes relative to participants with dementia. The initial search was carried out by a librarian and yielded 1671 articles for screening after duplicates were removed. Title and screening was carried out among 4 independent reviewers via Covidence review software. Of the initial 1671 articles, 101 were included for full text review. Full text review screening is ongoing. This will be followed by data extraction and the development of a thematic summary of the available evidence. We plan to complete this review prior to reporting at the conference. We anticipate our findings to provide preliminary insight into the importance of acoustic environments and interventions in supporting the day-to-day functional needs of older adults living with dementia in supported contexts. This preliminary insight will be used to guide future, high level evidence, needed to further elucidate this aspect of care. N/A.
ABSTRACT
The aim of the study is to evaluate the efficacy of ultrasound-guided infiltrative treatment associated with early rehabilitation program in patients with adhesive capsulitis devoleped in Post-Covid syndrome. This is an observational study. The setting for patient assessment is ambulatory. Six consecutive patients regarded to outclinic for adhesive capsulitis in the post-covid syndrome are clinically and ultrasonographically evaluated and undergo an interventional ultrasound procedure associated with early rehabilitation treatment. Patients are treated with infiltrative hydrodistension therapy under ultrasound guidance. This technique consists in injecting a saline solution combined with corticosteroids and anesthetic that relax the capsule thanks to the increase in hydrostatic pressure (called hydrodistension) increasing the volume capacity of the shoulder. The rehabilitation treatment is undertaken immediately after the infiltrative treatment in order to improve the joint ROM. Attive shoulder range of motion (ROM), Visual Analogic Scale for Pain (VAS), Shoulder Pain and Disability Index (SPADI) and Disability of the Arm, Shoulder and Hand (DASH) are used for clinical assessment. In patients with adhesive capsulitis, before the treatment, a fairly reduced shoulder range of motion is seen with mean elevation values allowed for 55°;abduction 40 °, internal rotation allowed for 30 ° with arm abducted to 90 °, external rotation allowed for 40 ° with arm abducted to 90 °. After 2 months from the treatment we obtain an almost complete recovery of the range of motion (elevation 150 °;abduction 130 °, internal rotation allowed in for 70 ° with arm abducted to 90 °, external rotation allowed for 80 ° with arm abducted at 90 °). The VAS mean score before the treatment is 6,9, after 2 months of treatment the VAS score is 1. In patients with adhesive capsulitis developed in post-Covid Syndrome, infiltrative hydrodistension therapy associated with early rehabilitation treatment provides more successful results in terms of active ROM of the joint and reduction of pain. The author declares no conflict of interest.
ABSTRACT
To understand the impact of the COVID-19 pandemic on participation for persons with traumatic brain injury (pwTBI). Inductive qualitative analysis was performed to identify themes from semi-structured interviews or focus groups of pwTBI or their family members. Community. Study included 32 structured interviews and 4 focus groups with 41 participants (n=34 pwTBI and n=7 family members). Participants with TBI were eligible if they were >=18 at the time of initial TBI, presented with mild BI, able to speak and understand English, able to access the video conferencing platform, and were community-dwelling. Family members were eligible if they were >=18, related to an individual who was >=18 at the time of initial TBI, currently living in a community setting, speak and understand English, and able to access the video conferencing platform. N/A. Experience of participation during the COVID-19 pandemic. Several themes emerged relating to participation during the COVID-19 pandemic for pwTBI including: 1) transitioning remote, 2) normalization of 'stay at home' lifestyle, 3) mental health implications, and 4) impact of pandemic mandates on participation. Within these themes, many respondents identified challenges such as isolation, depression, and fear of infection;however, respondents also identified positive experiences such as feeling that participation challenges were no longer restricted to those with TBI or other disabilities, new opportunities for socializing, and more remote job opportunities that eliminate the need for transportation and ability to perform in a distracting environment. The experiences of participation for pwTBI during the COVID-19 pandemic had many similarities to the experiences of the general population;however, these findings suggest that pwTBI also have distinct positive experiences. There may be an element of resiliency in social engagement that individuals develop post TBI that warrants further investigation as society continues to transition to pre-pandemic patterns. None.
ABSTRACT
To explore facilitators and barriers to chronic pain care in individuals with traumatic brain injury (TBI) from a national sample of health care providers. Qualitative interviews guided by a conceptual framework of access to health care services. Healthcare settings (hospitals or clinics) in the US. Healthcare providers from VA and Civilian settings recruited via email. Not applicable. Facilitators and barriers to healthcare services. A total of 63 providers completed interviews: 28 rehabilitation therapists, 15 psychologists, 17 medical doctors and nurses, and 3 resource facilitators with 60% of them working in Civilian settings and 40% from VA settings. Several facilitators were identified by most providers including treatment adaptions, use of multidisciplinary teams, integration of specialty providers, having sufficient resources (high quality easy to use telehealth platforms, space) and provision of education about treatments prior to initiation. Providers identified many barriers to care, including several factors related to patient dimensions, including TBI disability as well as mental health comorbidity. COVID-19 Pandemic restrictions, long wait times, and policies limit care provided across specialists were also identified frequently as barriers to care. This is the first study to examine facilitators and barriers to treatments for chronic pain in persons with TBI. Using an access to care framework, multiple dimensions from the supply side of healthcare were associated with treatment access. Findings have implications for management approaches and the nature of resources needed to successfully promote chronic pain healthcare access to minimize inequalities for individuals with TBI. None.