BACKGROUND

A substantial number of COVID-19 recoverees are working-aged individuals, which makes return-towork (RTW) an essential part of rehabilitation. Many COVID-19 recoverees must deal with physical and mental symptoms of post-COVID conditions such as fatigue, dyspnea, difficulty concentrating, memory lapses, and anxiety. These symptoms coupled with often insufficient support from employers and the government can make the RTW process complicated. Although research related to RTW after COVID-19 has begun to emerge over the years, few primary studies have come out from developing countries.

This exploratory study aims to describe perceived work ability and health-related quality of life, lived experiences of the RTW process, and role of rehabilitation in a limited sample of Filipino COVID-19 recoverees. 

Using purposive sampling and a convergent parallel mixed-method design, the study draws on an online survey and group interviews to understand expectations, experiences, and self-rated work ability of working-age adults with post-COVID condition. We report the findings of the questionnaire data using descriptive statistics. From the questionnaire respondents, eight participants were interviewed to explore the RTW experiences from multiple perspectives. The group interview was conducted online, and narrative analysis was used to explore the data. This analytic process involved an iterative and inductive process between data gathering and data analysis.

Findings from our narrative analysis are reported under four themes: 1) The period of liminality; 2) A ‘positive’ problem; 3) Health as a psychosocial and justice issue; and 4) The reimagination of paid work. The narratives gathered document an overview of how selected Filipinos overcame the COVID-19 infection and their recovery and RTW process.

Results call for a re-examination of the concept of health and paid work for individuals undergoing rehabilitation and recovery.

INTRODUCTION

Strength is a key modifiable risk factor for hamstring strains with significant differences between injured and non-injured sides in the lengthened position. Ensuring the test-retest reliability of measurement protocols ensures consistent injury prevention, rehabilitation and return-to-sport planning.

To evaluate the test-retest reliability of hamstring strength protocols in both standardized and lengthened positions among healthy adults.

Test-retest reliability study.

Human Performance Laboratory, Fr. Roque Ruano building, University of Santo Tomas, Espana Manila.

Ten healthy adults (six males and four females; mean age: 26.5 ± 4.03 years).

Absolute and relative peak torque for concentric and eccentric hamstring and quadriceps were measured at 60°/sec, 180°/sec and 240°/sec in the standardized position (hip and knee flexed at 90°). In the lengthened position (hip flexed at 85° and knee at 30°), isometric knee flexion and peak torque for concentric and eccentric hamstring and quadriceps were assessed at 60°/sec and 180°/sec. Strength ratios were calculated for both positions.

Intraclass Correlation Coefficient (ICC) values demonstrated good to excellent reliability for peak torque measurements, with higher reliability in the standardized position (ICC 0.83-0.94) than in the lengthened position (ICC 0.79-0.96). Conventional and functional ratios varied, with lower ICCs for the right leg in the standardized position (ICC 0.32-0.92) and moderate to good reliability in the lengthened position (ICC 0.63-0.87).

Standardized and lengthened positions provide reliable assessments of absolute and relative peak torque for hamstring and quadriceps muscles during concentric and eccentric contractions across all speeds, including conventional and functional strength ratios.

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

Background and Objective: Pre-pandemic, various healthcare settings were not used to seeing patients virtually. The unprecedented need to adopt virtual care during the COVID-19 pandemic may have caught physical therapists (PTs) unready for it. This study aimed to determine the telerehabilitation knowledge, attitude, and practice of PTs in the Philippines during the COVID-19 pandemic and determine the association between demographic and study outcome variables. Methods: This is an analytical cross-sectional study among members of the Philippine Physical Therapy Association, Inc. (PPTA) practicing in the Philippines. Purposive sampling (total enumeration) was employed. All PPTA members were invited to the study through e-mail and official social media group chats. A self-administered questionnaire was used to obtain data on telerehabilitation knowledge (through test questions on various theoretical aspects), attitude, and practice. Results: The questionnaire items had a content validity index of >0.80. The study yielded a 40% response rate. Most respondents were practicing clinicians in urban-based, private rehabilitation centers. Approximately half had average telerehabilitation knowledge, while the majority had agreeable telerehabilitation attitudes across different constructs. Among the respondents, 15.9% used telerehabilitation pre-pandemic, while 64.8% used it during the pandemic. Hybrid (synchronous and asynchronous) telerehabilitation sessions usually lasted one hour per patient, mostly using Facebook Messenger. Conclusion Telerehabilitation was not widely practiced locally pre-pandemic, which may explain their average telerehabilitation knowledge. The positive telerehabilitation attitudes may represent a small group of PTs favoring telerehabilitation, while information from the larger population remains unknown. Early adopters of telerehabilitation may help introduce virtual care to colleagues and guide them in developing relevant knowledge and skills amid and beyond the enduring COVID-19 crisis.
COVID-19 ; Developing Countries ; Physical Therapy Modalities ; Telerehabilitation ; Telemedicine

Background: Hamstring strain injury remains persistently high in sports, highlighting the need for additional investigation of its predisposing variables. Despite hamstring injury being well investigated, there’s a lack of studies on changes in echo intensity and shear wave elastography of hamstrings among athletes with a history of injury, which could be considered modifiable risk variables. Objectives: To examine echo intensity and shear wave elastography characteristics of previously injured hamstrings among athletes, assessing the differences between the injured leg and controls. Methods: This systematic review will focus on studies reporting echo intensity and shear wave elastography characteristics of athletes with a history of hamstring strain injury compared to a control group. The search strategy will locate studies written in English from 1990 to 2023 using four electronic databases: PubMed, EBSCO (CINAHL and Medline), Science Direct, and Web of Science. Studies reporting measures using imaging other than ultrasound and where no diagnosis of hamstring strain has been made will be excluded. Two independent reviewers will screen and critically appraise the studies using the McMasters Critical Review Form. Two reviewers will independently extract relevant data and present a descriptive synthesis. A meta-analysis will be conducted when two or more studies provide data for the same outcome measure. Expected Results This review can better understand hamstring maladaptation to injury. Utilizing echo-intensity and shear wave elastography as objective outcome measures can inform clinical practice toward developing an effective rehabilitation program for injury prevention.
Wounds and Injuries ; Sports ; Rehabilitation

BACKGROUND

Telemedicine offers a solution to healthcare access issues, especially during the COVID-19 pandemic when physical distancing limited in-person visits. It can also be used by the Doctors-to-the-Barrios (DTTBs), who are often newly licensed physicians who have not undergone residency training yet, to remotely consult specialists and assist them in providing better healthcare recommendations to their patients. Understanding the acceptance of telemedicine particularly among DTTBs is crucial to optimizing its implementation, as local studies on this topic are lacking.

The purpose of this study is to determine the factors affecting acceptance of telemedicine by the DTTBs.

This study employed a descriptive and analytical cross-sectional research design from 2021 to 2022. Ethical approval was obtained prior to study implementation. Informed consent form was sent to all enrolled master’s students in the DTTB program. The study adapted the questionnaire utilized by Zailani et al. using a five-point Likert scale to identify the determinants of acceptance of telemedicine based on the following constructs: government policy, external supplier’s capacity, project team’s capacity, top management support, perceived usefulness, attitude, self-efficacy, acceptance of telemedicine, and organizational culture. Linear regression was performed to identify significant constructs that determine acceptance of telemedicine. All data were reported at 95% confidence interval.

Total of 116/180 DTTBs participated in the study. Attitude (β = 0.5849, p < 0.01) and self-efficiency (β = 0.5327, p < 0.01) together with organizational culture had a significant positive impact on the acceptance of telemedicine.

This study shows the current state of acceptance of telemedicine by our DTTBs. It highlights their positive attitude and self-efficiency towards telemedicine and the lack of support they receive from the government in funding and implementing telemedicine efforts despite its potential to address healthcare access issues.

BACKGROUND

During the COVID-19 pandemic, social isolation and quarantine measures set to control the spread of the infection paved for the increased utilization of virtual methods of consultation and follow-up. Telerehabilitation allows access to rehabilitation services despite distance and makes possible the continuation of rehabilitation services despite the lack of face-to-face interaction. This is difficult for pediatric patients who are dependent on their caregivers for understanding and making decisions regarding their health. Loss of continuity of rehabilitation services led to poorer outcomes in children with disabilities. Although advantageous for them, pediatric patients may not benefit from telerehabilitation if caregivers have negative perceptions of the process and are unwilling to utilize the service.

This study determined caregivers’ perceptions and willingness to participate in telerehabilitation as a method of outpatient follow-up for pediatric patients admitted to a COVID-referral center in a developing country.

The study utilized a descriptive cross-sectional design. Respondents were adults (≥19 years old) caring for pediatric patients admitted at non-COVID wards of the Philippine General Hospital and who were referred for rehabilitation services. A survey tool adapted from a previous study on willingness to utilize telemedicine among caregivers of pediatric patients was translated into the Filipino language and used in the study. A dataset from Excel was imported in STATA 16 (StataCorp, Texas, USA) and was exhaustively checked for completeness, accuracy, and consistency before analysis. The association between patient characteristics and willingness to utilize telerehabilitation for any app was determined using Pearson’s chi-squared test or Fisher’s exact test, as appropriate. The latter was used when more than 20% of the cells had an expected value of less than or equal to five. A P value of less than 0.05 was considered significant for all tests.

Of 123 respondents, 92 (75%) reported willingness to utilize telerehabilitation for outpatient consultation and therapy using video calls or a customized telerehabilitation app when available. Among 31 (25%) respondents who were not willing or unsure of participation, the main reasons identified were preference for face-to-face, lack of financial resources/load, poor connectivity, and doubt about the effectiveness of telerehabilitation.Patients with younger age (Fisher’s exact test, P=0.023), low usage of video call service (Fisher’s exact test, P=0.020), and lack of available devices (Fisher’s exact test, P=0.015) significantly reduced willingness to utilize telerehabilitation. Caregiver age, sex, educational attainment, estimated monthly income, number of devices used, speed of internet connectivity, and technological behaviors did not show statistical significance in association with willingness to participate in telerehabilitation.Most caregivers recognized the usefulness of a service allowing transmission of health data to and from the hospital, consultation with a doctor in case of an emergency, sending of reminders for medical visits and therapy, and provision of a list of home exercises and nutritional recommendations. Telerehabilitation was perceived advantageous, but concerns regarding privacy, trust, lack of human contact, and technological difficulty were also present.

With high levels of willingness among caregivers, telerehabilitation is a viable method of providing rehabilitation services for the continuation of management after inpatient admission among pediatric patients. Limitations in its utilization include technological issues including the lack of devices, low level of service use, and slow internet connectivity. Although well perceived as advantageous, there are concerns regarding loss of human contact, difficulty in using technological devices, and trust and privacy issues that may affect utilization.

BACKGROUND

The Philippine General Hospital (PGH) is a tertiary government hospital that serves as the national referral center for Filipinos from across the country. In partnership with Latter-Day Saint Charities (LDSC), PGH has been serving patients in need of mobility devices, such as wheelchairs, through in-person services from screening to assessment, measurement, assembly, fitting, and mobility training. Given the patients’ barriers to in-person follow-up consultations, regular healthcare provision has been challenging. The use of telerehabilitation, a form of telemedicine, has emerged as a practical and innovative solution, but it needs further evaluation.

The study aimed to determine the wheelchair recipients’ perceived barriers to in-person and virtual follow-up consultations.

This cross-sectional study involved a purposive sample of 413 patients who received a wheelchair from the LDSC through PGH. An original survey was prepared to determine patients’ perceived barriers to actual in-person and potential virtual follow-up consultations. Consent was obtained prior to data collection. After the pretest and pilot testing were conducted, the final version of the survey was administered either electronically or through individual phone interviews. Descriptive statistics was used to analyze and present the data.

A total of 113 wheelchair recipients participated, with an average of 42.9 years of age. The majority resided outside Metro Manila (53.1%), and 86.7% were within the income bracket of less than PhP 9,520 per month. The majority received a standard type of wheelchair (85.8%). The top 3 reasons hindering compliance to in-person consultation follow-ups were accessibility issues (82.3%), costs of travel (79.6%), and distance to hospital/wheelchair assessor (71.7%). With respect to potential virtual follow-ups, 72% expressed willingness to experience telemedicine/telerehabilitation in the future, despite having neither prior awareness (50.4%) nor experience (74.3%) of it. The majority had access to mobile phones (98.2%), and 67% had stable internet access.

The main barriers to in-person follow-ups were related to accessibility, costs, and travel. Telehealth or telerehabilitation in particular, despite patients’ interest and willingness to try it, still has yet to be optimized in our country. Internet connectivity can still be improved, as well as our stakeholders’ level of telehealth awareness. Future efforts to improve and sustain the uptake of telehealth solutions are recommended, as well as studies comparing the cost-effectiveness of in-person versus virtual consultations especially among persons with lived experiences of disability.

BACKGROUND AND OBJECTIVE

COVID-19 is a novel disease primarily affecting the respiratory system. Of those infected, approximately 20% require management in a hospital-setting which may lead to deconditioning. Measures implemented to control spread of the virus also restricted mobility both in the hospital and community setting. The goal of this study was to describe the patient characteristics (age, sex, comorbidities), hospitalization (length of hospital stay, ICU stay, referral to Rehabilitation Medicine), and long-term functional outcome of patients who have clinically recovered from moderate to critical COVID-19 in terms of participation in activities of daily living.

This was a descriptive prospective cohort study conducted at a tertiary government hospital with participant recruitment from September 2020 to February 2021 consisting of clinically recovered adult patients managed as COVID-19 Confirmed via rRT-PCR with moderate, severe, or critical risk status. Descriptive statistics were obtained and multiple regression analysis was done to determine associations between patient demographics and their Barthel Index Scores on follow-up at discharge, one month post-discharge, and six months post-discharge.

A total of 63 patients were recruited to our study with an average age of 52.4 years. More recovered patients had fulfilled the criteria of moderate illness (46%), with the most common comorbidity being chronic lung disease (42.1%) and diabetes (42.1%). Almost all had total independence pre-morbidly with better baseline functional scores for the COVID-19 severe population. Majority of the patients (63.5%) were not referred for Rehabilitation services. Across all patients, Barthel Index Score at discharge indicated a significant decline from slight dependence to moderate dependence in performing activities of daily living with the pre-morbid status significantly predicting scores at discharge (β = 0.621, p = 0.001) on multiple regression analysis. Patient demographics, hospitalization and ICU stay and outcome, and referral to Rehabilitation Medicine were not found to be significant factors. In the course of follow up, a high dropout rate was observed across the population and by the end of the study, 57.1% of the participants were alive while among those lost to follow up, 20.6% had expired and the remaining 22.2% had an unknown status.

COVID-19 significantly affects the functional outcome of patients in terms of activities of daily living as measured by the Barthel Index. Preliminary data gathered from our study and the high dropout rate supports the need for better follow-up and selecting a tool that is better able to describe the non-demographic factors affecting functionality and participation in activities of daily living.

OBJECTIVE

To determine the effects of guitar lessons (intervention group) in comparison to conventional occupational therapy (OT) sessions (control group) on hand function of chronic stroke patients with unilateral hand impairment.

This randomized controlled trial enrolled 34 chronic stroke patients with unilateral hand impairment. Participants were grouped randomly into intervention (guitar lessons) and control (conventional occupational therapy) groups. Each group participant underwent a total of eight consecutive therapy sessions, twice weekly for an hour each session, at the designated treatment rooms in the Department of Rehabilitation Medicine of the Philippine General Hospital. Pre- and post-treatment evaluations were done to assess range of motion, grip and pinch strength, and hand functions. Satisfaction surveys were answered at the end of the 8-therapy session.

Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and posttreatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength.

Results. Improvements in hand function were assessed through measurement of range of motion (ROM), grip and pinch strength, and with the use of Beery-Buktenica Developmental Test of Visual-Motor Integration, Jebsen-Taylor Hand Function test, and Purdue Pegboard Test of Manual Dexterity. In this study, the comparison of actual change of passive range of motion (ROM) of the impaired hand from pre- to post-treatment between control and intervention groups showed no statistically significant difference. No statistically significant difference between groups were also observed for the active ROM of the impaired hand. Comparison of function of the impaired hand pre- and posttreatment between control and intervention groups showed no statistically significant difference except for an observed greater improvement with the control group in motor coordination (median [IQR] 0 [-1 to 0] vs 1 [1 to 5], p = 0.004), tip (median [IQR] 0.33 [0 to 0.75] vs 1 [0.58 to 1.5], p = 0.006), and 3-jaw (median [IQR] 0.5 [0 to 0.92] vs 1.08 [0.41 to 2], p = 0.043) pinch strength.

All participants in both groups displayed 100% compliance in attending onsite treatments. Despite not showing statistically significant difference between groups (p = 0.721), an 11.8% tendency for better compliance is found in the intervention group.

The specific guitar lesson created and performed in this study as used by 17 participants of the intervention group have brought about improvement in hand function that is comparable with those who underwent traditional occupational therapy. This may be most helpful in areas with limited access to rehabilitation facilities and occupational therapy services. This may also be used as a continuing activity of chronic stroke patients at home to help improve hand function.