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

(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.

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

(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.

Is chronic low back pain and radicular neuropathic pain associated with smoking and a higher nicotine dependence? A cross-sectional study using the DN4 and the Fagerström Test for Nicotine Dependence.

Objective - To evaluate if a current smoking status and a higher nicotine dependence were associated with chronic low back pain and/or radicular neuropathic pain. Materials and methods- A cross-sectional study was conducted on the first eligible consecutive 120 patients. Demographic data, pain intensity, worst pain location, most distal pain radiation, the DN4 questionnaire, STarT back tool, and the Fagerström Test were collected during the initial examination. An age- and gender-matched control group (n=50), free from chronic low back pain was recruited. Results- In the chronic pain group, there was a significant difference between smokers and lifetime non-smokers in the average pain intensity (p=0.037), total DN4 score (p=0.002), STarT Back tool (p=0.006), worst pain location (p=0.023) and the most distal pain radiation (p=0.049). The mean total DN4 score increased with a corresponding increase in the number of cigarettes smoked daily (p=0.002). Current smokers had an OR of 3.071 (p=0.013) (95% CI 1.268-7.438) for developing chronic low back pain and lumbar related leg pain and an OR of 6.484 (p<0.001) (95% CI 2.323-18.099) for developing chronic radicular neuropathic leg pain. For every one-unit increase in the Fagerström test score, the likelihood for chronic low back pain and lumbar related leg pain increased by 40.71% (p=0.008) (95% CI 1.095-1.809) and for chronic radicular neuropathic leg pain increased by 71.3% (p<0.001) (95% CI 1.292-2.272). Conclusion- A current smoking status and a higher nicotine dependence were both independently associated with an increased risk for chronic low back pain and/or chronic radicular neuropathic pain.

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain: is there an association?

BACKGROUND: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain. METHODS: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were completed. A control group (n = 50) was recruited. RESULTS: There was a significant difference between current smokers and nonsmokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP "definite/probable" neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of "definite/probable" increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score. CONCLUSIONS: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.

Pulmonary Rehabilitation in patients with Interstitial Lung Disease: The effects of a 12-week programme.

BACKGROUND: The inclusion of Pulmonary Rehabilitation as part of the management of Interstitial Lung Disease, although being highly recommended in most recent guidelines, still has limited studies exploring the outcomes from such an intervention. The present study aims to contribute to the available literature by investigating the effects of a high intensity, 12 week PR programme on functional and quality of life measures in patients with a diagnosis of Interstitial Lung Disease. METHOD: ology: This paper reports outcomes of an observational, prospective, quasi experimental type of study. A total of 120 participants were recruited: 60 patients formed part of the active group, and another 60 patients were enrolled in an inactive group. Each participant was classified according to the modified Medical Research Council dyspnoea scale and placed in one of 5 categories (0-4) according to self-perceived breathlessness during daily activities. The following outcomes were measured: Lung function tests including plethysmography and diffusion capacity of carbon monoxide (DLCO), functional tests (6-min walking distance test, Dyspnoea Borg Scale) and health status measures (St George's Respiratory Questionnaire and Hospital Anxiety and Depression Score). RESULTS: A 12-week PR programme for patients with Interstitial Lung Disease, led to significant improvements in the active group of patients in the 6 min walking distance test, the modified Borg Scale, mMRC scores and in the health status measures. Lung function measures did not show any significant improvement following this intervention. CONCLUSION: This 12week Pulmonary Rehabilitation programme resulted in improvements in functional aspects for patients with Interstitial Lung Disease. Further studies are recommended as Pulmonary Rehabilitation for Interstitial Lung Disease may have an impact at both an individual level and at global organisational/financial levels.

Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ.

The St. George's Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1-2) and severe to very severe (mMRC 3-4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3-4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3-4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3-4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

Strengthening and rationalizing pharmacovigilance in the EU: where is Europe heading to? A review of the new EU legislation on pharmacovigilance.

Amendments to the European pharmacovigilance legislative framework are expected to come into force in 2011, following the adoption of the proposed amendments to Directive 2001/83/EC on the community code relating to medicinal products for human use (hereinafter referred to as the Directive) and to Regulation (EC) No. 726/2004 laying down community procedures for the authorization and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency (EMA) [hereinafter referred to as the Regulation]. The Regulation shall apply 18 months after publication in the Official Journal of the European Union. The amendments to the Directive and the Regulation will induce changes in the EU in terms of evaluation of risk associated with medicinal products as well as the framework on how the EU takes harmonized regulatory action on drug safety. In this review, the text agreed between the European Parliament and Council is examined and compared with the pharmacovigilance legislative framework currently in force. We argue that the new legislation has improved numerous uncertainties in current legislative framework and provides for the following: (i) clear roles, responsibilities and obligations for the key responsible parties; (ii) rationalization of EU decision making on drug safety issues in order to deliver measures that are equally and fully implemented for all relevant products across the community with a view to preventing unnecessary patient exposure to risks; (iii) strengthening medicine safety transparency and communication so that the understanding and trust of patients and health professionals in the safety of medicines will improve, as well as the penetration of key warnings; (iv) strengthening companies' pharmacovigilance systems, allowing companies to improve their systems constantly while reducing administrative burden; (v) ensuring the proactive and proportionate collection of high-quality data relevant to the safety of medicines through risk management and structured data collection in the form of Post-Authorization Safety Studies (PASS), together with rationalized single-case and periodic reporting of suspected adverse drug reactions (ADRs); (vi) involvement of stakeholders in pharmacovigilance through direct patient reporting of suspected ADRs and inclusion of patients and healthcare professionals in decision making; and (vii) simplification of the current community pharmacovigilance procedures with consequent efficiency gains for both the pharmaceutical industry and medicines regulators. For the first time, companies can be made legally liable to carry out PASS and Post-Authorization Efficacy Studies. The amendments to the Regulation and to the Directive will strengthen the European network on pharmacovigilance. A Pharmacovigilance Risk Assessment Committee (PRAC) based at the EMA will be set up, which will be responsible for all matters related to pharmacovigilance at an EU level. Three European databases will be strengthened (EudraVigilance, EudraPharm and the European Pharmacovigilance issues Tracking Tool) as well as the setting up of an EU safety portal to better inform the public on all safety issues being discussed at an EU level. Public hearings at the PRAC will improve transparency in the decision-making process, whilst details and results of all PASS agreed to by the PRAC will also be made publically available.