Mithilfe eines frühzeitigen und umfassenden Entlassungsmanagements sollen Schnittstellen im Behandlungsprozess überwunden und der Übergang des Patienten in die poststationäre Versorgung nach einem Krankenhausaufenthalt optimal vorbereitet werden. Trotz der allgemein anerkannten Bedeutung des Entlassungsmanagements aus der stationären medizinischen Versorgung erfolgt die Umsetzung bei den Rehabilitationskliniken sehr unterschiedlich. Im Rahmen dieser Arbeit wird ein kurzes Fragebogeninstrument für Patienten systematisch entwickelt und erprobt, welches im Rahmen einer postalischen Nachbefragung ehemaliger Rehabilitanden eingesetzt werden soll. Es soll die Qualität des Entlassungsmanagements der medizinischen Rehabilitation systematisch erfassen und Impulse für das Qualitätsmanagement der Kliniken bieten. Die Ergebnisse der Erprobung in acht Kliniken mit über 900 auswertbaren Fragebögen weisen darauf hin, dass beides möglich ist. Sie werden mit dem Ziel der Weiterentwicklung des Instruments diskutiert und es werden Vorschläge zur weiteren Nutzung im Alltag der Rehabilitation erarbeitet. / A comprehensive and early discharge management can have positive effects on treatment following acute hospital care. Although the relevance of discharge management in healthcare is widely accepted, its implementation in medical rehabilitation clinics is inconsistent. In this study, a brief questionnaire addressing medical rehabilitation patients after discharge was developed and evaluated. The instrument aims at measuring the quality of discharge management and providing data to be used for quality management in rehabilitation centers. Study results from eight clinics including 900 patients suggest that both goals can be reached. The results are discussed with regard to the further development of the questionnaire. Suggestions for the use of the instrument in daily rehabilitation practice are highlighted.

No description available.

Cardiovascular disease is the leading cause of death in America today. The potential onset of cardiovascular disease in the fourth decade for men and fifth decade for women, underscores the scope of the health problem, as the population grows older. Twenty-three percent of men and thirty percent of women who survive a myocardial infarction will have a recurrence within six months. Patients with coronary artery bypass grafts are more susceptible to progressive stenosis from atherosclerosis than native vessels. Secondary prevention through physical activity is recommended by the AHA to reduce the occurrence of these events, requiring expensive re-intervention. However, less than one half of those eligible for cardiac rehabilitation enroll. The purpose of this study is to examine whether cardiac rehabilitation or home-walking with or without nurse telephone support will affect cardiac recovery. A convenience sample of sixty-three cardiac patients self-selected a cardiac rehabilitation (comparison) program in this quasi-experimental research design. One hundred twenty-six surgical cardiac patients were randomized to a home-walking or control group. MANCOVA tests on health status, self-efficacy, and diastolic blood pressure revealed significant differences for the main effect of group on health status, self-efficacy, and diastolic blood pressure (F = 3.980, 16,647, 6.562, p = .020, .000, .011), while controlling for pre-self-efficacy, medical diagnosis, and age. Post hoc tests showed no significant difference between the cardiac rehabilitation and home-walking groups on health status (p = .485) and self-efficacy scales (p = .285). No significant difference was found between the home-walking and control groups on health status ( p = .241). A significant difference was found between the cardiac rehabilitation and control groups on all three dependent variables, respectively (p = .016, .000, .000). The home-walking group revealed a significant difference on self-efficacy from the control group (p = .000). Additional findings include significant differences between home-walking and control groups on physical function (F = 7.3354, p = .0009) and mental health (F = 4.3659, p = .0140). The findings indicate that a home-walking program could be a comparable alternative to a cardiac rehabilitation group by improving self-efficacy and health status and lowering blood pressure.

The purpose of this series of investigations was to determine how custom foot orthotic intervention influences the lower extremity dynamics and intra-limb coordination in healthy and injured female runners. For the first investigation, dynamic data were collected from 12 healthy female runners (Control group) and 12 female runners with a recent history of overuse knee running injury (Treatment group). Results revealed that the influence of CFO intervention on lower extremity appears to occur with short-term intervention. The intervention produced a similar response in both groups. The knee kinematics were not influenced by the intervention however there were changes observed in knee kinetics. For the second investigation, dynamic data were collected during overground running trials in Treatment group from Study One who had completed 6 weeks of orthotic therapy. Data were collected with the subjects running with (CFO condition) and without (Shod condition) foot orthoses in three running shoes with varying midsole composition. Results revealed that the only kinematic variable influenced by running shoe midsole durometer was maximum rearfoot eversion velocity. However, CFO intervention in the footwear led to significant decreases in rearfoot kinematic variables, tibial internal rotation and internal ankle inversion moments. In addition, it was revealed that when a CFO intervention is added to a shoe of lesser density, the dynamics exhibited by the runner are similar to when wearing a shoe of greater density. For the third investigation, kinematic data were collected from 9 healthy female runners (Control group) and 9 female runners with a recent history of overuse knee running injury (Treatment group). Both groups performed a 30-minute treadmill run and relative motion plots were created for the intra-limb couplings. Results revealed that CFO intervention helped to maintain variability during the early stance phase throughout the course of the run in the injured runners. In the Treatment group, the TibTP/CalFP and KnTP/RFFP coordination variability during the early stance phase significantly decreased throughout the course of the 30-minute run for the Shod condition. While wearing the CFO condition the variability went unchanged and better resembled patterns exhibited by the Control group.

Cardiovascular disease is the leading cause of death for U.S. adults. It adds greater than $100 billion to U.S. health care costs annually. Rates of morbidity, mortality, and economic burden of the disease could be dramatically reduced with improvements in sedentary behaviors among adults with coronary artery disease (CAD). A regular commitment to moderate physical activity can reduce ischemic heart events up to 50%. Although the benefits of physical activity are well-known for individuals with coronary artery disease, an estimated 70% of this population remains relatively sedentary. Hospital-based cardiac rehabilitation programs are the single secondary prevention option offered to improve physical activity habits in persons with CAD. Although effective, cardiac rehabilitation is inaccessible for the majority of CAD sufferers and is offered only after an acute cardiac event. Different from rehabilitation, prehabilitation (prehab) programs use physical activity as a means to deter a worsening condition or prevent injury before an acute event occurs. These programs have proved successful in other areas of medicine but there are currently no such secondary prevention programs available for stable persons with CAD in the U.S. A home-based prehab program could help adults with CAD establish improved physical activity habits and circumvent many of the barriers associated with admission and attendance of a hospital-based cardiac rehabilitation program. Researchers have indicated that self-efficacy is key to initiation and sustentation of a regular physical activity habit, regardless of the physical activity program that one attends. These habits are more likely to last when participants receive self-efficacy based support for an average of 66 days. The purpose of this study was to determine if a nurse-practitioner-led, home-based, prehab program could assist adults with CAD to improve and maintain increased physical activity habits and levels of self-efficacy for physical activity. The five primary facilitators of self-efficacy were used to devise a 10-week prehab program. A convenience sample of 54 adults with diagnosed CAD was recruited from cardiology practices in St. Johns County, Florida. The research population was 68.5% (n=37) male, 88.9% (n=48) Caucasian, and 74% (n=40) married with a mean age of 68.57 years. Participants attended a 90-minute prehab class which offered health education and group discussion of barriers and goals for regular physical activity. Following the class, participants were contacted weekly for 10-weeks to discuss goal progress, assist in circumventing barriers, and revise physical activity goals as needed. After the 10-week call period, participants were contacted 30-days later to assess for physical activity habit maintenance and any sustained benefit in self-efficacy for physical activity. Self-efficacy for exercise was measured before the prehab class, after the prehab class, and after the 10-week intervention period using the Short Self-Efficacy Expectations scale (SSEE), Multidimensional Outcomes Expectations for Exercise Scale (MOEES), and the Barriers Self-Efficacy Scale (BARSE). All baseline measures of self-efficacy (MOEES, BARSE, SSEE) improved significantly immediately following the prehab class. Baseline physical outcome expectations of the MOEES (m=21.87, sd=4.67), self-evaluative outcome expectations of the MOEES (m=16.70, sd=4.15) and SSEE (m=12.75, sd=4.02) remained significantly improved after the 10-week intervention period (p<.05). At the 10-week assessment, mean significant self-efficacy scores were 24.39 (sd=1.26, p < .01) for physical outcome expectations, 18.39 (sd=2.27, p < .02) for self-evaluative outcome expectations, and 15.06, (sd=3.25, p < .001) for SSEE. The SSEE was reassessed 30-days after the study and remained significantly improved compared to baseline (m=15.65, sd=3.42, p < .01). Qualitative data collection coincided with the quantitative self-efficacy findings. Participants reported satisfaction with physical activity goal attainment and increased confidence to continue with a regular physical activity plan. The Godin Leisure-Time Exercise Questionnaire (GLTEQ) was used to assess activity levels at baseline, during each weekly phone call, at the end of 10-weeks, and 30-days after the study. Repeated-measures ANOVA (F (2,90) = 21.86, p < .001) revealed that participant's baseline physical activity volume measured by GLTEQ (m=18.39, sd= 16.93) improved significantly after 10 weeks in the prehab study (m=41.10, sd=24.11, p < .001) and remained significantly improved when re-measured 30-days after the study (m=39.02, sd=21.87, p < .001). Qualitative data concurred with quantitative data with participants reporting physical activity habit formation and maintenance of self-regulatory skills. Qualitative data also demonstrated that participants in prehab experienced very similar facilitators and barriers compared to other adults with CAD attempting an exercise program. In summary, the prehab study findings coincided with other research findings in this area. Self-efficacy based support can assist individuals with CAD to improve and maintain physical activity habits. The ease of the intervention likely contributed to lower cost and attrition rates (7%) compared to hospital-based cardiac rehabilitation programs. Although more research is needed, study findings suggest that a nurse-practitioner-led, home-based program could be a viable secondary prevention strategy for stable adults with CAD. This should be considered for the future given that even modest improvements in physical activity can substantially reduce all-cause mortality in this population.

Thesis (Ed.D.)--Boston University

<p>This thesis summarizes the findings of two studies, one qualitative and one quantitative, that examined the participation of adults with class III obesity in occupations of everyday living which included work, self-care, recreation and rest. The results of this research form the basis of the three manuscripts included in this thesis.</p> <p>The purpose of the first study was to describe the experience of living with obesity in the context of participation in daily activities and to identify factors that constrain or facilitate participation. Using a descriptive, phenomenological approach, in-depth, semi-structured interviews were conducted with 10 adults who were enrolled in an obesity treatment program. This analysis revealed themes that underscored the tensions, barriers and coping strategies across and within occupations of everyday living. The quality and diversity of occupation was influenced by several barriers within their environment such as inaccessible physical spaces and negative attitudes towards persons with obesity. Participants described their lives as being "on-hold" until weight was lost. Findings from this study were used to develop a larger, cross sectional survey.</p> <p>The purpose of the cross sectional survey (study number 2) was to describe how adults with class III obesity spend their daily time and to identify factors that predict participation in the occupations of everyday living. An analysis of data collected (n= 128) using the Occupational Questionnaire revealed that the distribution of time spent across activities classified as work, daily living, recreation and rest was similar to the time use of adults with chronic health conditions. A multiple regression analysis (n=140) resulted in a model in which factors including social support and disability status explained 35% of the variance in satisfaction with participation.</p> <p>Results of these studies contributed to a better understanding of the daily experience of participation in the occupations of everyday living for adults with class III obesity and the factors that best predict satisfaction with participation.</p> / Thesis / Doctor of Philosophy (PhD)

Stroke is the leading cause of adult neurological disability. Novel markers of vascular disease progression, such as arterial stiffness and endothelial function, may provide early and sensitive stroke risk detection. However, measurement properties of these novel vascular risk markers have not yet been established in the post-stroke population, nor has the association between these risk markers and measures of physical function. Moreover, given that subclinical vascular disease may initially manifest as a decline in cognitive function, understanding vascular disease progression in older adults with and without cognitive impairment may provide information regarding early stroke risk. This study aimed to investigate 1) test-retest reliability and between-side differences in novel vascular risk markers in individuals with stroke, 2) differences in arterial stiffness and endothelial function between older adults without cognitive impairment, with cognitive impairment, and with stroke, and 3) relationships between novel vascular risk markers and physical function in individuals with and without stroke. Participants were 50-80 years of age, able to ambulate ≥10 meters, and for those with stroke, ≥1 year post-stroke. Carotid-femoral, carotid-radial, and femoral-foot pulse wave velocity (cfPWV, crPWV, and ffPWV, respectively) were used to quantify systemic arterial stiffness, and compliance and distensibility were used to quantify local carotid arterial stiffness. Flow-mediated dilation (FMD) was used to quantify endothelial function. Findings revealed almost perfect test-retest reliability of cfPWV (ICC>0.91, P<0.0001) and substantial test-retest reliability of FMD in individuals with stroke (ICC>0.70, P<0.01). There were no between-side differences in novel vascular measures, no differences in these measures across subgroups of increasing vascular risk, and a positive correlation between cfPWV and walking speed. Findings suggest that in the post-stroke population, cfPWV and FMD may be the most appropriate measures of vascular risk progression, that it may be more clinically feasibly to assess these measures on the unaffected side. / Thesis / Master of Science (MSc) / Novel measures of arterial health, such as arterial stiffness and endothelial function, may provide early stroke risk detection. This study aimed to assess the day-to-day reliability and between-side differences of these new arterial measures in people with stroke, and to also investigate relationships between these measures and cognitive function in older adults with and without stroke. Arterial stiffness was assessed using pressure sensors that measure the speed of the pulse waves, and endothelial function was assessed using ultrasound to measure the capacity of the arteries to expand following an increase in blood flow. Results found that the most well-established measures of arterial health were reliable and there were no between-side differences in any measures. No relationships were observed between arterial measures and cognitive function. Overall, this study increases knowledge surrounding novel measures of arterial health in older adults with and without stroke.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

No description available.