BACKGROUND AND OBJECTIVES

Telerehabilitation is the remote delivery of rehabilitation services using telecommunication technologies. Its local adoption was catalyzed by the COVID-19 pandemic, prompting the need to assess user acceptance. This study aimed to determine the acceptance of stroke telerehabilitation among patients, carers, and rehabilitation providers in the Department of Physical Medicine and Rehabilitation at St. Luke’s Medical Center – Global City and Quezon City.

METHODS

This descriptive cross-sectional study used purposive sampling to recruit 73 rehabilitation providers and 10 consumers. Data were collected using a self-administered survey based on the Technology Acceptance Model, covering perceived ease of use, usefulness, and behavioral intent. Descriptive and inferential statistics were used for analysis.

RESULTS

Most providers (94.4%) were familiar with telerehabilitation, while only half of the consumers were aware of it. Acceptance was moderate among providers (mean score: 35.75 ± 8.67) and high among consumers (mean score: 31.6 ± 7.52). Female providers were less likely to accept telerehabilitation (p=0.049). Consumers identified financial constraints and lack of a companion as key barriers, while providers cited internet issues and technology use. Both groups viewed telerehabilitation positively for teleconsultation, teletherapy, and telemonitoring. Smartphones were the preferred device; Viber and Facebook Messenger were the most commonly chosen platforms.

CONCLUSION

Stroke telerehabilitation was moderately to highly accepted by rehabilitation stakeholders in two tertiary private hospitals in Manila. Findings may guide institutional planning for telerehabilitation services. Training, infrastructure support, and awareness campaigns can help address implementation barriers.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Remote Consultation ; Physical And Rehabilitation Medicine ; Tertiary Care Centers ; Telecommunications ; Telerehabilitation ; Cross-sectional Studies ; Technology ; Stroke ; Covid-19

Effective discharge planning is crucial for ensuring safe transitions and sustained occupational participation as clients transition from professional care to their desired community settings. Despite its importance, current discharge practices in occupational therapy remain inconsistent, often relying on informal communication, variable team coordination, and unstructured decision-making. These gaps contribute to client–caregiver unpreparedness, fragmented services, and increased readmissions. This manuscript presents the Building Rehabilitation Into Discharge Goals and Engagement (BRIDGE) Framework, a client-centered, occupation-focused conceptual model designed to structure and support the discharge planning process in occupational therapy.

The BRIDGE framework was developed through an iterative process of literature review, theoretical grounding, and integration of clinical experience. It synthesizes principles from the Canadian Practice Process Framework, Person–Environment–Occupation frameworks, the Kawa Model, and Bioecological Systems Theory. The framework outlines six discharge planning steps, ranging from goal and timeline setting to follow-up and monitoring, supported by four foundational pillars: patient and family factors, occupational therapy factors, interdisciplinary team factors, and environmental or system influences. Together, these components provide a comprehensive guide for clinical reasoning, collaborative planning, caregiver preparation, and transitional support.

The framework clarifies the role of occupational therapy, enhances interprofessional coordination, and promotes consistent transition planning. Future work should include empirical testing, case-based application, and population-specific adaptations.

Human ; Patient Discharge ; Residence Characteristics ; Rehabilitation ; Communication ; Clinical Reasoning

Abstract Background: This study aims to determine the effectiveness of programmed exercise with telerehabilitation at home in patients with obesity and knee osteoarthritis on visual analogue scale scores, body mass index, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Methods: This research is a pre–post study in patients with obesity and knee osteoarthritis. Research subjects performed a series of exercise programs at home for 28 days. Before the program, there was an initial assessment from a psychologist and a nutritionist. During the program, there was tele-education, telemonitoring, and teleconsultation from doctors. Twenty-six female subjects participated. Results: Visual analogue scale scores decreased statistically significantly every week, until the end of the fourth week, compared with before the intervention (p<0.001). Body mass index and WOMAC scores decreased statistically significantly at the end of the fourth week compared with before the intervention (both p<0.001). Further analysis of all WOMAC components in the intervention group, including pain, stiffness, and physical function, also showed a statistically significant decrease (p<0.001). Conclusion: Programmed exercise as part of telerehabilitation at home has been statistically proven to reduce visual analogue scale scores, body mass index, and WOMAC in patients with obesity and knee osteoarthritis.
Telerehabilitation ; Knee Osteoarthritis ; Obesity ; Body Mass Index ; Visual Analogue Scale ; WOMAC

BACKGROUND

Patients with severe nontraumatic brain injuries often present with disorders of unconsciousness. Immediate neurologic care, neuroprotection, and early neurorehabilitation are core principles for better outcomes. Neurorehabilitation, through both pharmacological and non-pharmacological strategies, aims to enhance neuroplasticity for faster recovery. Amantadine, primarily known as an antiviral and used in Parkinson’s treatment, has shown a potential role for accelerating neuronal recovery and neurorehabilitation.

OBJECTIVE

Available literature on the use of amantadine for nontraumatic brain injury patients is limited. This scoping review aims to identify the potential benefits and limitations of amantadine in neurorehabilitation.

METHODOLOGY

In the literature review, the keywords "Amantadine" AND "Neurorehabilitation" were used to search PubMed, EBSCO, and the Cochrane Library for articles published between January 1, 2003, and August 2024. Inclusion criteria required that articles have clear research objectives, strict subject eligibility criteria, a detailed methodology, and the administration of amantadine for nontraumatic brain injuries. Out of 57 identified articles, only 7 were included in the study.

RESULTS AND DISCUSSION

Its benefits include improving the level of consciousness, accelerating recovery, decreasing mortality, managing delayed post-hypoxic encephalopathy, and improving verbal fluency in nonfluent speech. Its adverse effects and the paucity of available literature recommending amantadine for neurorehabilitation are the possible limitations.

CONCLUSION

Amantadine accelerates the neurologic recovery of patients with disorders of unconsciousness secondary to nontraumatic brain injuries.

RECOMMENDATION

Future studies may conduct meta-analyses, systematic reviews, and randomized controlled trials of amantadine in patients with nontraumatic brain injury to further strengthen its promising role in neurorehabilitation.

Human ; Amantadine ; Neurological Rehabilitation ; Neurorehabilitation

Repetitive transcranial magnetic stimulation （rTMS） is an emerging technique for noninvasive brain stimulation and plays an increasingly important role in the rehabilitation treatment of post-stroke aphasia due to its advantages of noninvasiveness，safety，and targeting ability. With reference to related articles in China and globally in recent years，this article elaborates on the role，mechanism，and target of rTMS in post-stroke aphasia，in order to provide a reference for the rehabilitation treatment of patients with post-stroke aphasia.
Rehabilitation

OBJECTIVE: To observe the efficacy of the Tongnao Huoluo Liyan (unblocking brain, activating collaterals and relaxing throat) acupuncture combined with rehabilitation training for post-stroke dysphagia (PSD). METHODS: A total of 92 PSD patients were randomly assigned to an observation group (46 cases, 1 case was discontinued) and a control group (46 cases, 1 case was discontinued, 1 case dropped out). The patients in the control group received rehabilitation training, including low-frequency neuromuscular electrical stimulation for swallowing, lip and tongue movement training, and oral sensory function training, once daily, five times per week, for four weeks. The patients in the observation group received the Tongnao Huoluo Liyan acupuncture method in addition to the same rehabilitation training. Acupoints included Lianquan (CV23), bilateral Jia Lianquan, Jinjin (EX-HN12), Yuye (EX-HN13), Baihui (GV20), Shuigou (GV26), and bilateral Neiguan (PC6), once daily, five times per week, for four weeks. Before and after treatment, Kubota water stvallowing test grading, standardized swallowing assessment (SSA) scores, Fujishima Ichiro swallowing efficacy scores, and swallowing quality of life questionnaire (SWAL-QOL) scores were assessed in both groups. Surface electromyography (sEMG) was used to evaluate the average amplitude (AEMG) and mean swallowing time of the suprahyoid and infrahyoid muscle groups. RESULTS: After treatment, the proportion of patients classified as Grade Ⅰ or Ⅱ in the Kubota water stvallowing test was increased in both groups (P<0.05), with better results in the observation group compared to the control group (P<0.05). Compare before treatment, SSA scores were decreased in both groups after treatment (P<0.05), with lower scores in the observation group than in the control group (P<0.05). Compare before treatment, Fujishima Ichiro swallowing efficacy scores and SWAL-QOL scores were improved in both groups after treatment (P<0.05), with significantly higher scores in the observation group than those in the control group (P<0.05). Compare before treatment, AEMG values of the Submental musckes and infrahyoid muscles groups were increased (P<0.05), and mean swallowing time was decreased (P<0.05) in both groups after treatment. The observation group showed greater increases in AEMG values and shorter mean swallowing times compared to the control group (P<0.05). The total effective rate was 97.8% (44/45) in the observation group, higher than 84.1% (37/44) in the control group (P<0.05). CONCLUSION The Tongnao Huoluo Liyan acupuncture combined with rehabilitation training could enhance the contraction function in swallowing-related muscle groups, facilitate hyoid and laryngeal elevation, restore swallowing function, and improve patients' quality of life. This combined treatment approach is superior to rehabilitation training alone.
Humans ; Female ; Acupuncture Therapy ; Male ; Middle Aged ; Deglutition Disorders/physiopathology* ; Aged ; Stroke/complications* ; Acupuncture Points ; Adult ; Treatment Outcome ; Stroke Rehabilitation ; Combined Modality Therapy

OBJECTIVE: To construct a prediction model for the clinical effect of eye acupuncture combined with rehabilitation therapy on ischemic stroke based on interpretable machine learning. METHODS: From January 1st, 2020 to October 1st, 2024, the clinical data of 470 patients with ischemic stroke were collected in the the Second Department of Encephalopathy Rehabilitation of the Affiliated Hospital of Liaoning University of TCM. The modified Barthel index (MBI) score before and after treatment was used to divide the patients into an effect group (291 cases) and a non-effect group (179 cases). Random forest and recursive feature elimination with cross-validation were combined to screen the predictors of the therapeutic effect of patients. Seven representative machine learning models with different principles were established according to the screening results. The predictive effect of the best model was evaluated by receiver operating characteristics (ROC), calibration, and clinical decision-making (DCA) curves. Finally, the Shapley additive explanation (SHAP) framework was used to interpret the prediction results of the best model. RESULT: ①All the machine learning models presented the area under curve (AUC) to be above 85%. Of these models, the random forest model showed the best prediction ability, with AUC of 0.96 and the precision of 0.87. ②The prediction probability of calibration curve and the actual probability showed a good prediction consistency. ③The net benefit rate of DCA curve in the range of 0.1 to 1.0 was higher than the risk threshold, indicating a good effect of model. ④SHAP explained the characteristic values of variables that affected the prediction effect of the model, meaning, more days of treatment, lower MBI score before treatment, lower level of fibrinogen, shorter days of onset and younger age. These values demonstrated the better effect of eye acupuncture rehabilitation therapy. CONCLUSION The rehabilitation effect prediction model constructed in this study presents a good performance, which is conductive to assisting doctors in formulating targeted personalized rehabilitation programs, and identifying the benefit groups of eye acupuncture combined with rehabilitation therapy and finding the advantageous groups with clinical effect. It provides more ideas for the treatment of ischemic stroke with eye acupuncture combined with rehabilitation therapy.
Humans ; Acupuncture Therapy ; Machine Learning ; Male ; Female ; Middle Aged ; Ischemic Stroke/rehabilitation* ; Aged ; Stroke Rehabilitation ; Adult ; Eye

OBJECTIVE: To compare the clinical efficacy of jingjin needling combined with rehabilitation training and conventional acupuncture combined with rehabilitation training for post-stroke spastic paralysis. METHODS: A total of 60 patients with post-stroke spastic paralysis were randomly divided into an observation group and a control group, 30 cases in each one. Both groups received conventional rehabilitation training. In the observation group, jingjin needling was applied at tendon blockage points of the shoulder, elbow, wrist, hip, knee, and ankle. In the control group, conventional acupuncture was applied at Jianyu (LI15), Quchi (LI11), Hegu (LI4), Biguan (ST31), Fengshi (GB31), Taichong (LR3), etc. on the affected side. Treatment was given once daily, 5 days a week for 4 weeks in both groups. The scores of clinical spasticity index (CSI), modified Ashworth scale, modified Barthel index (MBI), and Fugl-Meyer assessment scale (FMA) were evaluated before and after treatment, and the onset time was compared between the two groups. RESULTS: After treatment, the scores of CSI and modified Ashworth scale were decreased compared with those before treatment (P<0.001), while the scores of MBI and FMA were increased compared with those before treatment (P<0.001) in the two groups. After treatment, the scores of CSI and modified Ashworth scale in the observation group were lower than those in the control group (P<0.05), the MBI score in the observation group was higher than that in the control group (P<0.05). There was no statistically significant difference in FMA scores between the two groups (P>0.05). The onset time of the observation group was earlier than that in the control group (P<0.05). CONCLUSION Both jingjin needling combined with rehabilitation training and conventional acupuncture combined with rehabilitation training can effectively treat post-stroke spastic paralysis, jingjin needling combined with rehabilitation training exhibits better therapeutic effect and rapider onset.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Aged ; Stroke/complications* ; Adult ; Acupuncture Points ; Muscle Spasticity/etiology* ; Treatment Outcome ; Stroke Rehabilitation ; Paralysis/therapy* ; Combined Modality Therapy

OBJECTIVE: To observe the effect of acupuncture at Jiaji (EX-B2) points on upper limb motor dysfunction in patients after stroke. METHODS: A total of 62 patients with upper limb motor dysfunction after stroke were randomly assigned to an observation group (n=31, 3 cases dropped out) and a control group (n=31, 2 cases dropped out). Both groups received routine medical treatment and rehabilitation training. The control group was treated with conventional acupuncture at the affected side's Jianyu (LI15), Quchi (LI11), Shousanli (LI10), Huantiao (GB30), Yanglingquan (GB34), and Zusanli (ST36) etc. On this basis, the observation group received additional acupuncture at the affected side's Jiaji points from C₄ to T₅. Treatment was administered once daily, five times a week, for four weeks. Motor evoked potential (MEP) latency and amplitude of the abductor pollicis brevis and abductor digiti minimi, Fugl-Meyer assessment for upper extremity (FMA-UE), and Wolf motor function test (WMFT) scores were compared before and after treatment in the two groups. RESULTS: After treatment, both groups showed increased MEP amplitudes and decreased latencies of the abductor pollicis brevis and abductor digiti minimi (P<0.05), as well as increased FMA-UE and WMFT scores (P<0.05); the observation group had greater MEP amplitudes, shorter latencies, and higher FMA-UE and WMFT scores compared to the control group (P<0.05). CONCLUSION Acupuncture at Jiaji (EX-B2) points could enhance the excitability of upper limb motor neural pathways in upper limb motor dysfunction after stroke patients, thereby promoting motor function recovery of the upper limb.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Acupuncture Points ; Stroke/complications* ; Upper Extremity/physiopathology* ; Aged ; Adult ; Stroke Rehabilitation ; Treatment Outcome

INTRODUCTION: Conservative kidney management (CKM) is a recognised treatment option for selected patients with chronic kidney disease stage 5 (CKD G5), but prognostic indicators for mortality and optimal timing for palliative care transition remain uncertain. METHOD: This is a single-centre, prospective cohort study of CKD G5 patients who opted for CKM, conducted between April 2021 and September 2024, with longitudinal monitoring of Edmonton Symptom Assessment System Revised: Renal; Palliative Perfor-mance Scale (PPS); Resources Utilisation Group.Activities of Daily Living (RUG-ADL) scale; Clinical Frailty Score; Karnofsky Performance Score; and clinical and laboratory data. Primary outcomes included identifying baseline mortality predictors and validating the PPS for survival estimation. Cox proportional hazards models were used to identify independent predictors of mortality. RESULTS: Among 109 patients (mean age 79.8±7.3 years, 64.2% female), 62 (56.9%) died during follow-up. Multivariate analysis identified baseline estimated glomerular filtration rate (eGFR) (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08.1.68, P<0.01) and serum albumin (HR 1.24, 95% CI 1.08.1.43, P<0.01) as predictors of 1-year mortality. Median survival varied by eGFR: 3.0 months (95% CI 0.6.2) for eGFR .5 mL/min/1.73 m², 13.0 months (95% CI 9.1.16.9) for eGFR 6.10 mL/ min/1.73 m², and 20.0 months (95% CI 16.5.23.5) for eGFR >10 mL/min/1.73 m² (P<0.01). Subsequent PPS correlated strongly with survival, with median survival of 1.8 months for PPS <50, 5.3 months for PPS 50.60, and 7.9 months for PPS 70.80 (P=0.03). CONCLUSION Baseline eGFR and serum albumin predict 1-year mortality in CKM patients. PPS offers a practical tool for identifying patients requiring palliative care transition, supporting personalised care pathways and timely integration of palliative care.
Humans ; Female ; Male ; Aged ; Prospective Studies ; Glomerular Filtration Rate ; Palliative Care/methods* ; Conservative Treatment/methods* ; Aged, 80 and over ; Prognosis ; Serum Albumin/analysis* ; Proportional Hazards Models ; Activities of Daily Living ; Singapore/epidemiology*